{"id":2278,"date":"2024-04-18T11:57:29","date_gmt":"2024-04-18T10:57:29","guid":{"rendered":"https:\/\/blogs.bath.ac.uk\/iprblog\/?p=2278"},"modified":"2024-04-18T11:57:29","modified_gmt":"2024-04-18T10:57:29","slug":"should-i-stay-or-should-i-go-monitoring-influences-on-nhs-staff-retention-in-the-post-covid-19-world","status":"publish","type":"post","link":"https:\/\/blogs.bath.ac.uk\/iprblog\/2024\/04\/18\/should-i-stay-or-should-i-go-monitoring-influences-on-nhs-staff-retention-in-the-post-covid-19-world\/","title":{"rendered":"Should I stay or Should I go? - Monitoring influences on NHS staff retention in the post COVID-19 world"},"content":{"rendered":"<p class=\"s3\"><em><span class=\"s4\"><a href=\"https:\/\/researchportal.bath.ac.uk\/en\/persons\/andrew-weyman\">Dr Andrew Weyman<\/a> <\/span><span class=\"s4\">joined<\/span><span class=\"s4\"> the University of Bath <\/span><span class=\"s4\">in<\/span> <span class=\"s4\">2006, <\/span><span class=\"s4\">having previously worked in central government. \u00a0H<\/span><span class=\"s4\">is specialism is the psychology of risk, in particular employee safety, health and well-being at work. A central theme of his more recent research has been the issue of staff retention. He was principal investor <\/span><span class=\"s4\">for <\/span><a href=\"https:\/\/www.bath.ac.uk\/publications\/should-i-stay-or-should-i-go-nhs-staff-retention-in-the-post-covid-19-world\/\"><span class=\"s5\">Should I <\/span><span class=\"s5\">stay<\/span><span class=\"s5\"> or Should I go? - Monitoring influences on NHS staff retention in the post COVID-19 world <\/span><\/a><span class=\"s4\">(ESRC 2020-22)<\/span><span class=\"s6\">;<\/span> <a href=\"https:\/\/researchportal.bath.ac.uk\/en\/publications\/extending-working-life-audit-of-research-relating-to-impacts-on-n\"><span class=\"s5\">Extending working life \u2013 Audit of research relating to impacts on NHS Employees <\/span><span class=\"s4\">(NHS Employers 2013)<\/span><\/a><span class=\"s5\">; <a href=\"https:\/\/www.gov.uk\/government\/publications\/extending-working-life-behaviour-change-interventions-rr809\">Extending working life \u2013 Behaviour change interventions <\/a><\/span><span class=\"s4\">(DWP 2012-2013)<\/span><span class=\"s5\"> and co-investigation for <a href=\"https:\/\/researchportal.bath.ac.uk\/en\/publications\/extending-working-life-in-the-nhs-opportunities-challenges-and-pr\">Extending Working Lives in the NHS: Opportunities, Challenges and Prospects <\/a><\/span><span class=\"s4\">(MRC 2014-2018)<\/span> <span class=\"s4\">and <\/span><a href=\"https:\/\/researchportal.bath.ac.uk\/en\/projects\/uncertain-futures-managing-late-career-transitions-and-extended-w-2\"><span class=\"s5\">Extending Working Life Uncertain futures, Late Career Transitions <\/span><\/a><span class=\"s4\">(ESRC 2014-2017).<\/span><\/em><\/p>\n<p><span class=\"s4\">The issue of staff retention in the NHS is not new but has been brought into sharp relief in the post-COVID-19 era of unpreceded staff shortage. \u00a0While steps have been taken to train new health professionals and recruit from overseas, net gains to the NHS staff complement are at risk of being significantly blunted or defeated in the absence of finding ways to stabilise and enhance the retention of established staff. \u00a0<\/span><\/p>\n<p><span class=\"s4\">At the institutional level, what has been widely characterised as a pandemic of<\/span><span class=\"s5\"> early-exit <\/span><span class=\"s4\">risks a<\/span> <span class=\"s4\">spiral of inter-related losses becoming endemic. Foreseeable impacts include loss of expertise and institutional memory, degraded capacity to deliver patient care, degraded workforce and work-team stability, loss of return on investment in health professional training, and increased human resource costs to employers (e.g. recruitment and employment of bank\/agency staff). All have implications for standards of patient care and the potential to negatively impact on the well-being of staff in-post to the extent that it risks degrading their disposition and\/or capacity to remain.<\/span><\/p>\n<p><span class=\"s4\">\u2018<\/span><span class=\"s4\">Should I <\/span><span class=\"s4\">stay<\/span><span class=\"s4\"> or should I go? NHS staff retention in the post COVID-19 world: Challenges and prospects\u2019, <\/span><span class=\"s4\">was funded by the Economic and Social Research Council, in response to the UKRI open-call for COVID-19 relevant social research in spring 2020<\/span> <span class=\"s4\">and has received <\/span><span class=\"s4\">follow-on funding from the health sector.<\/span><\/p>\n<p><span class=\"s4\">The study too<\/span><span class=\"s4\">k<\/span><span class=\"s4\"> a risk management and mitigation s<\/span><span class=\"s4\">ystems perspective<\/span><span class=\"s4\"> to explore variables with potential impact on staff well-being, in particular their disposition to stay or leave NHS employment<\/span><span class=\"s4\">.<\/span><span class=\"s4\"> This was a mixed methods study that aimed to tap the insights of NHS employees (all professions\/occupations, grades) working in secondary care (acute hospitals, mental health, community and ambulance services)<\/span><span class=\"s4\"> as well as in non-provider roles.<\/span><\/p>\n<p><span class=\"s4\">The study comprised <\/span><span class=\"s4\">of a four-wave <\/span><span class=\"s4\">staff survey covering the period <\/span><span class=\"s4\">winter<\/span><span class=\"s4\"> 2020 to <\/span><span class=\"s4\">spring<\/span><span class=\"s4\"> 2023) <\/span><span class=\"s4\">and interviews with a cross section of employees (2021<\/span><span class=\"s4\">-2022<\/span><span class=\"s4\">).<\/span><\/p>\n<p><span class=\"s4\">T<\/span><span class=\"s4\">he <\/span><span class=\"s4\">study was design <\/span><span class=\"s4\">to provide human resource strategy and policy relevant insight into:<\/span><\/p>\n<ul>\n<li class=\"s10\"><span class=\"s9\">The impact of the COVID-19 experiences and its legacy on employees\u2019 strength of attachment, commitment and capacity to remain in NHS employment;<\/span><\/li>\n<\/ul>\n<ul>\n<li class=\"s10\"><span class=\"s9\">The relative salience and strength of push and pull variables on staff stay versus leave intentions and behaviour;<\/span><\/li>\n<li class=\"s10\"><span class=\"s9\">What might need to change to motivate\/enable current employees to remain in NHS employment; and \u00a0<\/span><\/li>\n<li><span class=\"s9\">The need, nature and scope for intervention to maintain\/enhance retention rates.<\/span><\/li>\n<\/ul>\n<p><span class=\"s4\">At Wave four of our survey, the scope of data gathering broadened from its initial focus on primary impacts arising from COVID-19 in 2020\/21 to include other features of the post- pandemic work environment, including: staff shortages, workload, job-demands, working conditions, pay and other background climate factors on staff resilience, capacity and disposition to remain.<\/span><\/p>\n<p>The most prominent and salient finding from the four waves of data gathering was that, while impacts on staff well-being and disposition to remain in NHS employment directly attributable to the COVID-19 pandemic have attenuated, the core feature of insufficient institutional capacity to meet the demand for care persists. This presents as the biggest single root cause and challenge to staff resilience.<\/p>\n<p><a href=\"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/8C910585-61D8-45A1-849D-803090E41557.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-2280\" src=\"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/8C910585-61D8-45A1-849D-803090E41557.png\" alt=\"\" width=\"1024\" height=\"576\" srcset=\"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/8C910585-61D8-45A1-849D-803090E41557.png 1024w, https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/8C910585-61D8-45A1-849D-803090E41557-300x169.png 300w, https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/8C910585-61D8-45A1-849D-803090E41557-768x432.png 768w, https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/8C910585-61D8-45A1-849D-803090E41557-382x215.png 382w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/a><\/p>\n<p><span class=\"s4\">Perhaps the most striking finding was the 24 percentage point drop from 61% to 37% in the proportion of staff who \u2018<\/span><span class=\"s5\">would recommend working for the NHS to others\u2019 <\/span><span class=\"s4\">between winter 2020\/21 and spring 2023. <\/span><\/p>\n<p><span class=\"s4\">By Wave Four of <\/span><span class=\"s4\">the<\/span><span class=\"s4\"> survey there was an indication of some stabilisation in previously rising profile of rates of staff applying for jobs outside the NHS. However, the (all-staff) external (non-NHS employment) application rate remains quite high at around one in seven employees, and one in four for certain segments, notably early career staff<\/span><span class=\"s4\"> and<\/span><span class=\"s4\"> ambulance service personnel. <\/span><span class=\"s4\">There were also continued more negative moves that are precursors to external applications<\/span><span class=\"s4\">.<\/span><\/p>\n<p><span class=\"s4\">T<\/span><span class=\"s4\">he majority of <\/span><span class=\"s4\">variables<\/span><span class=\"s4\"> explored showed <\/span><span class=\"s4\">either <\/span><span class=\"s4\">no change, or rising negative trajectories, i.e. ratings of an array of fundamental issues have become more negative between 2020 and 2023, year on year. Their persistence in the context of falling demand for COVID-19 care is suggestive of deeply rooted issues, that do not present as transitory consequences of the unprecedented demands on staff at the height of the pandemic, or <\/span><span class=\"s4\">issues that <\/span><span class=\"s4\">are solely attributable to the pandemic and its legacy. \u00a0<\/span><\/p>\n<p><span class=\"s4\">This suggest<\/span><span class=\"s4\">s<\/span><span class=\"s4\"> that either the increasingly negative profile of these variables was present and incubating prior to the emergence of COVID-19, although plausibly becoming more visible because of the pandemic, or that negative changes to working conditions\/arrangements that emerged in response to the pandemic have become baked-in features of the new-normal of the post-pandemic workplace climate. It is possible, perhaps likely, that elements of both may be at play. \u00a0<\/span><\/p>\n<p><span class=\"s4\">In spring 2023, around two in three respondents rated staffing levels, workload and feeling undervalued by government as having worsened over the previous six months, a rise from<\/span><span class=\"s4\"> about<\/span><span class=\"s4\"> one in two in spring 2022. <\/span><span class=\"s4\">In 2023, o<\/span><span class=\"s4\">ne in two reported a worsening of morale or stress, confirm<\/span><span class=\"s4\">ing <\/span><span class=\"s4\">the rising linear profile indicated in previous waves. Mirroring findings at Wave Three, ratings of confidence that working conditions would improve over <\/span><span class=\"s4\">the<\/span> <span class=\"s4\">next 12 months<\/span><span class=\"s4\"> (<\/span><span class=\"s4\">i.e. <\/span><span class=\"s4\">from spring 2023) ranged from low (e.g. workload, NHS funding) to modest (e.g. delivering acceptable care) across each of the criteria explored. <\/span><\/p>\n<p><span class=\"s4\">Over half of<\/span><span class=\"s4\"> respondents reported <\/span><span class=\"s4\">tiredness <\/span><span class=\"s4\">and one in three <\/span><span class=\"s4\">low<\/span><span class=\"s4\">-<\/span><span class=\"s4\">energy (every day or on most days)<\/span><span class=\"s4\">. Approximately one in four reported <\/span><span class=\"s4\">physical exhaustion<\/span><span class=\"s4\">, <\/span><span class=\"s4\">mental exhaustion<\/span><span class=\"s4\"> and <\/span><span class=\"s4\">feeling overwhelmed in spring 2023.<\/span> <span class=\"s4\">All burnout measures assessed had worsened relative to Wave <\/span><span class=\"s4\">t<\/span><span class=\"s4\">hree.<\/span><span class=\"s4\"> \u00a0By inference, this has intuitive implications<\/span><span class=\"s4\">\u00a0for staff productivity.<\/span><\/p>\n<p><a href=\"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/7E3E41EE-297C-4ACC-9BF7-AC9A6D3C9DD6.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-2282\" src=\"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/7E3E41EE-297C-4ACC-9BF7-AC9A6D3C9DD6.png\" alt=\"\" width=\"1024\" height=\"576\" srcset=\"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/7E3E41EE-297C-4ACC-9BF7-AC9A6D3C9DD6.png 1024w, https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/7E3E41EE-297C-4ACC-9BF7-AC9A6D3C9DD6-300x169.png 300w, https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/7E3E41EE-297C-4ACC-9BF7-AC9A6D3C9DD6-768x432.png 768w, https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/7E3E41EE-297C-4ACC-9BF7-AC9A6D3C9DD6-382x215.png 382w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/a><\/p>\n<p><span class=\"s4\">The most commonly cited reasons why staff leave NHS employment in spring 2023 were, respectively, <\/span><span class=\"s4\">stress<\/span><span class=\"s4\">, workload, <\/span><span class=\"s4\">shortage of staff\/resources<\/span><span class=\"s4\"> and <\/span><span class=\"s4\">pay<\/span><span class=\"s4\">. The first three reflect close alignment with their profiles in previous waves. A notable change since 2020, however, was the ascendant profile of pay<\/span><span class=\"s4\">; <\/span><span class=\"s4\">ranked eighth of the 15 variables explored in winter 2020\/21, rising to fourth in spring 2023.<\/span><\/p>\n<p><span class=\"s4\">Contemporary perspectives on staff retention, and consideration of what might need to change to stabilise\/enhance retention invariably focus on determining why staff leave. However, a focus on <\/span><span class=\"s5\">push<\/span><span class=\"s4\">variables alone risks producing a partial perspective. It is also important to consider the role of <\/span><span class=\"s5\">pull<\/span><span class=\"s4\"> variables, i.e. those factors that underpin why staff continue in their current employment. Insight into both <\/span><span class=\"s5\">push<\/span><span class=\"s4\"> and <\/span><span class=\"s5\">pull<\/span><span class=\"s4\">variables is necessary to produce a comprehensive perspective on what might need to be preserved, emphasised, or enhanced to support staff well-being and mitigate exit rates.<\/span><\/p>\n<p><span class=\"s4\">Our findings indicate not only negative changes in the profile of <\/span><span class=\"s5\">push<\/span><span class=\"s4\"> variables, but also a trend of weakening headline <\/span><span class=\"s5\">pull<\/span><span class=\"s4\"> influences, notably with respect to job security and intrinsic elements relating to job satisfaction from caring for patients and personal commitment to the NHS. Relatedly, the negative profile of ratings of working conditions, concern over standards of patient care, and <\/span><span class=\"s4\">insufficient time<\/span><span class=\"s4\"> to do their job properly <\/span><span class=\"s4\">supports<\/span><span class=\"s4\"> the inference that the arising impacts conspire to frustrate the primary motivation of a significant proportion of NHS care providers. \u00a0<\/span><\/p>\n<p class=\"s13\"><em><span class=\"s12\">All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.<\/span><\/em><\/p>\n<p class=\"s16\"><span class=\"s14\">Read the report <a href=\"https:\/\/www.bath.ac.uk\/publications\/should-i-stay-or-should-i-go-2-influences-on-nhs-staff-retention-in-the-post-covid-19-world\/attachments\/should-i-stay-or-should-i-go-2.pdf\">\u2018Should I stay or Should I go? \u2013 2 Monitoring influences on NHS staff retention in the post COVID-19 world. Winter 2020 to Spring 2023\u2019<\/a>.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dr Andrew Weyman joined the University of Bath in 2006, having previously worked in central government. \u00a0His specialism is the psychology of risk, in particular employee safety, health and well-being at work. A central theme of his more recent research...<\/p>\n","protected":false},"author":1742,"featured_media":2279,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[108,118,124,126,131],"tags":[],"class_list":["post-2278","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-culture-and-policy","category-health","category-public-services","category-science-and-research-policy","category-welfare-and-social-security"],"acf":[],"jetpack_featured_media_url":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-content\/uploads\/sites\/115\/2024\/04\/A54B89D3-DDDA-4272-BC0B-B5427AAC499C.png","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/posts\/2278","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/users\/1742"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/comments?post=2278"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/posts\/2278\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/media\/2279"}],"wp:attachment":[{"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/media?parent=2278"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/categories?post=2278"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bath.ac.uk\/iprblog\/wp-json\/wp\/v2\/tags?post=2278"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}