By Dr Charlotte Gascoigne
We’re now nine months into our FlexAbility in Nursing project, which we’re running in conjunction with three leading hospital trusts. Supported by funding from the Burdett Trust, it’s a piece of action research into how flexible working could bring about the structural change the profession needs to attract, recruit and keep enough staff. Our hope is that this will lead to a transformation in nursing culture, which better balances the needs of the ward with those of its staff.
The first stage of the project identified that the current, variable rota system isn’t working. It makes it hard to give nurses with responsibilities outside of work the fixed working arrangements they need; and it doesn’t give ward managers enough choice about how to organise their shifts.
So the next step was to identify and pilot a new approach that works for everyone. That means giving nurses the right kind of flexibility to suit their work-life balance needs and keep them in the profession, whilst supporting managers to deliver efficient and effective resourcing. It also means allowing everyone on the team to have an input into the roster, whilst increasing their understanding of operational factors, such as safe patient ratios and the skills mix.
Before coming to a decision about our preferred approach, we considered several different options. One was to work with the existing e-rostering system, through which employees make a limited number of requests in terms of timing or frequency. Another was trialling a paper-based, self-rostering system, through which people would physically sign up for their shifts, on a first-come-first-served basis.
While there are positive aspects to both of these, our research found that neither delivered the true flexibility that our stakeholders need. We have therefore chosen to pilot a team-based approach, which we believe solves many of the problems that the profession is currently experiencing, increases the potential for flexibility, and gives everyone in the team the chance to have an input.
However, whilst team-based rostering has been shown to work successfully in a number of similar areas, such as the social care sector, we recognised that nursing requires a bespoke approach. In other professions, the whole team can meet regularly to fill out the roster; but in nursing, where a ward has to be staffed at all times, this simply isn’t possible.
We have therefore designed a structure around a lead team, made up of eight or nine people, each of whom represents four or five colleagues. The lead team members find out from their colleagues what their requirements and preferences are, and then liaise with the others on the lead team to populate a draft roster. This is then refined and agreed through conversations between the lead team members and their colleagues.
While the logistics of a team-based approach may sound complicated to anyone outside the nursing profession, the potential benefits are substantial.
Team-based rostering encourages a sense of collective responsibility and cooperation, helping nurses understand how the system works and how their working patterns impact on the ward as a whole. It also gives them the opportunity to express preferences and work together to find a solution that works for everyone, rather than having shifts imposed upon them.
So as well as improving nurses’ work-life balance, this approach should help ward managers keep the wards fully staffed without having to pull in expensive agency nurses, and ensure that less popular shifts are more equally spread among the members of the team.
As FlexAbility in Nursing is a piece of action research, trialling and refining is a central part of the process. So having decided on team-based rostering, and designed a structure that suits the profession, we are now piloting it with 120 staff across three wards at Birmingham Women & Children’s Hospital. The teams on these wards are currently building the first roster using this approach, for shifts to be worked in April.
We’ll be talking to the teams on the ground to see how well the approach is working during this pilot stage, and will continue to measure the impact using a range of data over the coming months. This will allow us to assess and refine the approach, before making final recommendations for a second round of pilots at Nottingham University Hospital and University Hospital Southampton later in the year.
The end goal, of course, is to encourage more people to become and remain nurses, by making flexible nursing achievable. And with recent headlines painting a bleak picture of the number of nurses who are leaving the profession, this work couldn’t be more critical. We’re optimistic that a team-based approach is a huge step in the right direction, but time and the research will tell; we’ll keep you updated as the project progresses.
To find out more about the innovative research opportunities we offer, contact info@timewise.co.uk or call 020 7633 4444
