A new study published in found that age-related and contractual factors are stronger determinants of retention of Britain’s National Health Service clinical staff in hospitals compared to organizational factors BMJ open.
Rather than adopting a one-size-fits-all approach, retention efforts need to be tailored by age and occupation, the study found. The authors suggest that much better compensation systems are needed to increase employee retention and ensure sustainability in the face of increasing demand for healthcare and an aging workforce.
To examine the range of factors that influence healthcare professionals’ desire to remain employed, researchers examined the demographic, contractual and organizational factors such as staff commitment and job satisfaction that are associated with clinical staff retention in acute care and psychiatric settings Care in NHS hospital trusts in England.
Why employees stay
The study involved a total of 70,777 senior doctors aged 30 to 70 and 448,568 nurses and midwives of all grades aged 20 to 70 working in NHS hospitals in 2009-13 and 2014-18. Researchers relied on employee survey responses and employment records to track their retention through 2019-20.
Almost a quarter (23%) of senior doctors in acute hospitals held part-time positions, while in mental health trusts the figure was almost a third (32%). The opposite was true for nurses: in both groups, 38-41% of acute care workers and 27-29% of mental health workers held part-time jobs. Around 9% of the doctors were employed on a temporary basis and 3% were employed in temporary locum positions. But only 2% of nurses and midwives had temporary positions.
Five years later, only about half of the total clinical staff in the 2009 group were still working at the same trust. This trend was particularly noticeable among nursing staff.
In mental health trusts, only 42% of nurses in the 2014 group worked in the same organization for five years, compared to 54% in the 2009 group.
Senior doctors from ethnic minority backgrounds working in acute care are less likely to stay with the same trust than white senior doctors. Senior doctors from Europe or other parts of the world were also less likely to remain in the same trust in both timeline groups.
Female nurses were more likely to stay with the same trust than male nurses. But in mental health trusts, the likelihood of female nurses and midwives remaining in the same organization fell sharply after both one and five years in the 2014 timeline group compared to the 2009 timeline group.
Nurses of Asian descent in the 2009 timeline group were almost 75% more likely to stay in the same hospital trust for five years than white nurses. But black nurses in the 2014 timeline group were less likely to remain in the same trust position after both one and five years.
International nurses from both timelines, however, were more likely to stay in the same trust, but only if they worked in acute care.
Part-time work was positively associated with nurse retention in both mental health and acute care settings, while working on a fixed-term contract reduced the likelihood of staying with the same trust for longer.
Demographic and contractual factors
The retention rate of senior doctors and nurses fell after the age of 50, both in terms of moving to other hospitals and leaving the NHS overall.
In terms of potentially influential organizational factors, a higher engagement score in the NHS survey was strongly associated with the retention of nursing staff under the age of 51 in both acute and psychiatric hospitals, as well as with the retention of senior doctors in this age group of acute care.
Trusted managers responding to staff feedback was the only other organizational factor strongly associated with retention at one year, but only for senior nurses and midwives in acute care hospitals.
Apart from the shortage of staff in psychiatric hospitals, which was strongly linked to the retirement of younger doctors, no other organizational factors were found to be significant.
Because this is an observational study, no firm conclusions can be drawn about causal factors. Additionally, the data does not capture recent, potentially influential events, including Brexit, the COVID-19 pandemic and recent industrial action, the researchers noted. Other factors, such as independent health and social care regulator Care Quality Commission (CQC) ratings and local housing costs, were not included in the mix but could also impact retention, they said.
“The study results reveal heterogeneous retention drivers across occupations and care settings,” the researchers write, adding that the results “underscore the importance of disaggregating retention challenges and solutions by both occupation and specialty, rather than using a one-size-fits-all approach.” Approach.”
Part-time work, for example, appears to work well for nurses, perhaps because it is more flexible and suitable for those with caregiving responsibilities, but not for doctors, perhaps because they find it precarious and unfulfillable, the researchers say.
Mobility and retention
“Retention is lowest among younger and older employees who are more mobile. Younger employees have lower opportunity costs when changing jobs. Retention of older staff is linked to retirement, with departures from the NHS being highest among those aged over 51,” they wrote.
“The NHS faces significant challenges in retaining valuable staff amid high turnover, an aging population and growing care demands. “With retention rates of junior doctors having fallen sharply over the last decade and more than half of consultants expecting early retirement, this analysis raises the alarm about unsustainable staffing dynamics that could threaten the future functioning of the NHS,” they noted firmly.
“Demographic and contractual factors appear to be stronger predictors of hospital staff retention than organizational characteristics. “The observed poor retention reinforces the call for healthcare organizations to develop more effective reward systems aimed at increasing employee retention,” the researchers concluded.