NHS must value its nursing staff, warns new report

A report published on Wednesday 17 January 2014, by The Point of Care Foundation, shows that the way healthcare staff feel about their work has a direct impact on the quality of patient care as well as on an organisation’s efficiency and financial performance.

The report, Staff Care: how to engage staff in the NHS and why it matters, argues that it is not only necessary for healthcare providers to encourage staff engagement (the process by which staff come to have a positive attitude towards the organisation and its values) but to accelerate it. 

The report, which reviewed evidence from a wide range of sources, highlights that:

• Patient satisfaction is consistently higher in trusts with better rates of staff health and wellbeing
• There is a link between higher staff satisfaction and lower rates of mortality and hospital-acquired infection
• The NHS could save £555 million a year if it reduced sickness absence by a third. 
• Stress and burnout are more frequent in the NHS than in other sectors. Approximately 30% of sickness absence in the NHS is due to stress.

It points out that NHS staff engagement fell for three consecutive years from 2009 before rising very slightly in 2012. Only 55% of staff would recommend their organisation as a place to work.

The Foundation calls on healthcare organisations to increase staff engagement at both a strategic and operational level by making support for staff central to their strategies to improve patient care, productivity and financial performance. It also sets out simple steps being used in parts of the NHS to improve staff engagement.

However, the report demonstrates there are discrepancies between what senior managers and staff think and say when it comes to how effectively their organisation supports staff and promotes high quality patient care:

• Putting patients first: While 62% of NHS staff agree the care of patients and service users is their organisation’s top priority, over a third either disagree (17%) or neither agree or disagree (21%). In contrast, 95% chief executives who responded to a survey for the Foundation reported that a focus on the quality of patient care was either fully in place or mostly in place within their organisation.
   
• Solving problems: While 74% of staff say they are able to make improvement suggestions, only one in four (26%) say senior managers act on them.  CEOs, however, report that staff engagement is one of their top three priorities. Worryingly, while 86% of CEOs surveyed by the Foundation are confident staff are able to raise concerns, the Chartered Institute of Personnel Development found that fewer than six in ten staff (58%) felt confident about doing so.
• Listening to and involving staff: only one in three NHS staff (35%) say communication between senior managers and staff is effective. Yet despite CEOs reporting that they prioritise staff engagement, nearly half (46%) of foundation trusts rely solely on the annual staff survey to formally canvas staff opinions.  

Steps that board members and managers can take to increase staff engagement are set out in the report, including:

• articulating values in plain English and showing how they translate into behaviours 
• giving staff responsibility and authority to solve the problems they think affect patient care 
• creating space for staff to reflect on the emotional challenges of caring for patients 
• training line managers in people management skills – including the large number of clinicians who lead and supervise other staff but who  don't think of themselves as managers. 

Professor Jill Maben, director of the National Nursing Research Unit at King’s College London and a trustee of the foundation, said staff engagement was all the more important in tough times.

“It is an enormously pressured time and when you’re under pressure there is this temptation to batten down the hatches and not come up for air,” she said.

“But at times like that it’s even more important staff feel valued and listened to, otherwise more people end up burnt out and stressed and then leave, leaving you with unfilled vacancies and making things worse.”

Professor Maben said it was vital nurses had the opportunity to “stop, reflect and feed back on what they are doing”. However, she noted that opportunities had fallen by the wayside in recent years with the advent of 12-hour shifts where nurses rarely left the ward and handovers were brief.

Solutions could include initiatives like Schwarz Rounds, monthly one-hour sessions where groups of nurses and others talk about and reflect upon particular cases, she suggested.

Professor Maben also called for formal supervision currently available to midwives and mental health nurses to be extended to all, and said it was vital managers really listened to staff.

“People often think they are listening but they are not really,” she said. “It’s almost worse to ask people what they think then not do anything, than not asking.”

Staff care includes eight case studies of good practice in supporting and engaging staff working in healthcare. The aim of the case studies, and the report overall, is to inspire senior managers and everyone responsible for leading healthcare staff to take action and support staff to deliver patient-centred care.