Cynics Guide: Staff Retention (Part 1)

Hello. I’m going to start with more general stuff. Most of this will be aimed at more systemic things rather than just the personal problems that convinced me my last job was not where I wanted to be.

Most of this will be aimed at The Management, sorry Julie, for the porpoises of argument management will be deemed as Charge Nurse / Ward Manager / Matron / Sister and above. Whatever your title is if you are the highest authority on the ward you are probably the bottom end of management. Also when looking up from the bottom you can often appear to be one large homogeneous blob.

So here goes.

1. Banish The Blame Culture

If you work somewhere where the comment;

Mental: I can’t do that because I’ll get into trouble with …

is heard too often there is possible a culture of blame. Too much of that and staff become demotivated and willing to experiment and try new (or old) things which may benefit the lives of clients. Simply for fear of ‘getting into trouble‘. It does not matter whether the nurse actually will get into trouble, the fear is the blocking factor.

Let’s say as a young, good looking, nurse I let Doris the Client out for an hours leave. She doesn’t come back within the agreed time. Police are called and drag her back falling over drunk from the pub.

Doris: *sings* Show me the way to go home …

Right I have made a mistake here right enough. Let’s look at our superiors potential responses. Here are;

Sharon: The bad manager (boo his)

Julie: The good manager (hooray cheer!)

Sharon: Mental; you’re an idiot. Why did you do such a stupid thing, what possessed you … (five minutes of pointing out my flaws) … you are not getting put in charge of the ward again !

I know have met management (rarely) that would do that at the top of their voices, potentially in public, then walk away.

What Would Julie Do ?

She would sit me down in an office. In private. Get me to identify the errors made. Ensure that I did feel the full gravity of the error made. For example if Doris was at serious risk when out a lot of gravity. Less so if the risks were lesser.

Julie would make sure next time if a similar thing occurred I may make a better decision. Further discussion with Doris, better documentation, whatever.

Then she would say some nice things;

Julie: Mental you’re very nice !

Than put me in the same position to make the same kind of mistake to see if I had learned from the experience. After all it is all about reflective learning.

If I made exactly the same mistake then something more might have to be done …

As mentioned previously a bad management response can have far-spread results. If I am crushed I will warn others not to make similar decisions in case of the Wrath Of Sharon. The ticking off becomes Ward Legend then no one makes a decision without clearing it with Sharon.

Sharon wonders why everyone is so stupid they need to keep asking her the stupidest thing. I’m sure this kind of thing happens to dictators everywhere. Is there a technical name for it ?

Of course someone has to tell the Dictator this is happening …

2. Learn To Communicate : Top To Bottom

I read the Trust Staff Magazine recently. Let’s call it ‘Our Staff Are Idiots‘.

OSAI was full of all kind of useful information. A new management group had chosen a cute little logo. We all had to wash our hands a lot more. Some staff, who were lovely lovely people, had left. Our trust was a fabulous place to work. It had overspent it’s budget a little. We had a really good Zero Tolerance policy to violence. How well Agenda for Change was getting on somewhere. There was probably mention of cakes and a Fete somewhere as well.

All of the above with lovely pictures and written with small words and nice short sentences. All resolutely upbeat and totally useless.

The wards at this time were abuzz with rumours about hospital closures, agenda for change, ward budgets etc …

At this time the trust was £9.6 million in the red (not near the end of the financial year). Had not (still has not) moved staff over to Agenda for Change. Was planning to move sites (possibly). Was not a fabulous place to work. Had been slammed in the local press for hygiene failures.

Now I can think of all kind of technical computer based methods of improving communication involving intranets, rss feeds, blog, wiki sites etc These probably wouldn’t be much for for the non-technical staff.

But a magazine or newsletter should be used for more than fluff articles. It should have fluff articles and good solid information about what is concerning the staff at the time. Even if there is no information. For example:

The managers are aware there is a great deal of concern about moving sites. Currently there is still no final decision. A further meeting will be held on the 25th of December. Minutes will be available from the general office the day afterwards.

I also would have liked to have seen the major public management meetings better advertised. Rank and file staff encouraged to attend.

3. Allow Communication : Bottom Up (Hee Hee!)

Again I can think of many technical ways of doing this. But we will aim for the low tech methods.

Firstly I think a supervision process should be put in place for all staff involved in direct patient care. Supervision should be considered essential, regular, non threatening and supportive. There are lots of different supervisory models. All of them are better than nothing I am sure.

Use OSAI to give a list, or directions to a list, of Unison, RCN, Amicus reps or whatever. If you have a staff support network in place make sure it is well known, respected and used.

One employer had a ‘whine line’ that went to just underneath the Board of Management, up there in the stratosphere. There were lots of notices about it and how anyone could use it to makes comments about the organisation without comebacks. But everyone was still too scared to use it. It was eventually discontinued. Good attempt though. Good implementation too, just the wrong system. On the up side staff made excellent use of the supervision network. Things were often passed upwards and responded to.

4. Encourage Communication : On The Level (fnord)

For the Widows Son.

Here I mean staff meetings between staff that work together. With shift patterns and general nurse bitchiness it is often hard to form a good team spirit.

An easy way to help with this would be ward / team / staff meetings. They could be used for team forming, dissemination of info from above, discussion of current concerns etc etc.

These meetings should also be considered important and not always put off because it is not direct hands on nursing, with the patient.

Staff meetings will not solve bitching and poor team spirits but they would give a forum for some of it to be challenged and dealt with. Apparently average levels of nursing staff bitchiness are only 37% of those found working in a normal office environment.

If we use an hour for supervision and and hour for the staff meeting once a month that is about 0.01% of staff time. Not too much to spare.

Right I am losing steam for a bit … after Chrissie will do some more.

All statistics made up by my cat picking numbers from a hat.

Mental

Links

Tenth of NHS staff still waiting for pay reform

NHS staff bid to close public sector pay gap

Recruits to nursing ‘must double’

Christmas NHS crisis

Nurses ‘quitting to buy houses’

Concern over foreign nurse exodus

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