RoMHS Extension

The RoMHS team is pleased to announce that the Retention of Mental Health Staff study has been extended. We are continuing our partnership with the Health Foundation for an additional year. This extra time will allow us to interview clinical support staff in roles such as healthcare assistant and support worker in adult mental health settings

Clinical support staff provide a large proportion of hands-on patient care but are often excluded from discussions around staffing. We will be investigating the experiences of this neglected staff group and discovering what is important to them when it comes to intention to leave and how the NHS can retain this group of valuable and experienced staff.

2022 Conference News

The RoMHS team are excited to announce they will be at the 2022 HSRUK conference in Sheffield 5th – 7th July https://hsruk.org/conferences/conference-2022 

We are pleased to say we have had 4 abstracts accepted for the conference:

  • A realist review of factors affecting retention of mental health staff in UK adult services
  • Predictors of Staff Turnover in NHS Mental Health Trusts
  • Understanding factors affecting mental health workforce retention using organisational case studies
  • Virtual data collection – experiences of participants and interviewers

Visit our RoMHS website conference page to see our abstracts for an overview of what we will be talking about  https://sites.google.com/sheffield.ac.uk/romhs/conferences

Hope to see you there.

Research during a pandemic

When our research team started developing the research proposal looking at what affects retention in the mental health workforce (RoMHS), we did not imagine at the time that we would be conducting our case studies amidst a global pandemic.

Conducting research during such times can result in increased practical and ethical challenges, with constantly changing government guidelines. Original planned research methods can become obsolete when balanced with the realities of the situation.

Unique circumstances

Whilst our research was divided into three work packages, the first two looking at existing literature and the data relating to NHS staff survey results and mental health trusts workforce retention figures. These were both in the final stages of being written up and the pandemic of 2020 had little impact on the research processes, findings or results.

However our third part of our research study was just about to get underway. In this work package we planned to conduct case studies in different NHS mental health Trusts to explore any theories that came from literature around health care retention and any findings from the statistical data.

The case studies planned pre pandemic involved researchers travelling to different Trusts across England. The aim was to explore the different Trusts ways of working through a series of face to face interviews with frontline mental health staff as well as face to face interviews with senior staff. Research staff had planned to spend time visiting the different inpatient, community and trust head quarters, to both drive recruitment, conduct interviews and make small scale observations.

With government legislation restricting travel and physical contact, our case study methods required urgent transformation.

How the pandemic transformed our research methods?

Flexibility became the name of the game. Our research methods needed to be able to adapt and respond to the changing environment that we still planned to conduct our case studies in. But having researchers physically being present in NHS wards, community services and even Trust headquarters was no longer appropriate.

The move to virtual case studies data collection was much more than just moving to online interviews. The research team made a move to become paperless by embracing digital methods, such as websites and Qualtrics to give potential participants space to read information about the study and complete consent forms on-line. Recruitment became a series of emails, using snowballing techniques to encourage participation. We embraced using a range of platforms to conduct interviews virtually giving participants maximum flexibility. The move also gives participants the option for participating outside of their working hours at a time that suits them.

Flexibility

Rapid change

As with all changes in research methods, maintaining scientific integrity is key. When the conduct of the research is changed from face to face to online, this must be fully documented and approved by ethics boards. Consent forms and information sheets must be renewed to reflect these changes and all of this takes time.

Having both a research team who can be responsive and a system which also supports this, can be paramount for success in conducting research within these unusual circumstances

The flip side

With recruitment and data collection for our third part of research in full swing, we have ensured that we have had time to reflect with both current research participants and the research team on what the intended and unintended outcomes of our change of methods will be. Increased anonymity has time and time again come up as a positive outcome of being online. No-one is now witnessing a researcher in discussion with a member of staff about the research project. Or seeing a member of staff taking time out to attend and travel to a face to face interview. Participants are now in control of the location and time of the interviews, whether it comes out of work time or not. The move to virtual case studies is allowing a new level of anonymity, that is seeming to be embraced by participants so far.

The Unknown

However there is still much unknown about how this pandemic will affect our research and particularly our outcomes. We have chosen to include the impact this pandemic is having within our data collection, by trying to capture our participants perspectives on how this pandemic is and potentially will impact on mental health staff retention levels in the future.

The affect on recruitment and participation levels in a research case study that is now being conducted virtually, with a pandemic ongoing, is something we are keen to explore. Its is widely known that NHS staff have faced the brunt of the challenges of this health pandemic. Will this stop health care staff from wanting to participate in research? Will clinical staff wish to participate in online interviews? Will health care staff have the time to participate in research mid pandemic? Will staff have the energy and capacity to partake in research?

And that leads us to how will the results from our findings obtained during these unusual circumstances be generalisable?

In this we are all still learning.

Happy New Year?

The last 12 months have been unprecedented on so many scales but the challenges for health care have been intense and sustained. Whilst much of the news has focussed on emergency and critical care services, for obvious and very valid reasons, other areas of the health service have also had to adapt.

Photo by cottonbro on Pexels.com

Mental health care is no exception. Services which have always relied on face to face meetings to build relationships with service users, were suddenly not allowed. Online psychotherapy existed before the pandemic but it was fringe and often controversial, it is now the norm. A recent report has found the number of mental health appointments and prescriptions actually decreased during the first lockdown. However, instead of this being good news, it is likely that this is an indication of people avoiding health care services and not seeking support as soon as they normally would.

This could be storing up more severe problems when people do finally get to services. Likewise we know isolation, anxiety, poor physical health and financial concerns will cause or worsen mental health problems. Many people, including those who never previously needed mental health services, have been hit by multiple stressors and a lack of control over their situation. 

Photo by cottonbro on Pexels.com

Adaptations to mental health services may turn out to be exactly what was needed. Video calls, are for many, more accessible than travelling to a clinic and may be more acceptable from a stigma point of view. They may cut down on missed appointments. However, for some the need to build relationships and see people in person to reduce isolation will remain and must not be discounted.

Necessity is the mother of invention and 2020 necessitated us all learning to do things very differently. Some of this will continue to be necessary into the future. By embracing innovation and listening to the needs of both staff and service users mental health services can provide accessible services even in the most challenging of circumstances.

2021 may at least be a hopeful New Year.

Support, respect and never forget.

As we are all aware 2020 is Florence Nightingale’s bicentennial year, designated by World Health Organisation (WHO) as the first ever global Year of the Nurse and Midwife. Nurses and midwives make up the largest numbers of the NHS workforce and are highly skilled, multi-faceted professionals from a host of backgrounds that represent our diverse communities. 2020 was to be a chance to showcase and celebrate the professions but I’m sure no one could ever envisage what a year it would prove to be, not just here in the United Kingdom but worldwide.

Nursing I’m sure is not just a job but a calling, a heartfelt passion to care for those who are suffering and in need. I think that quite clearly shows in the amount of NHS staff who have answered the call and come out of retirement to join their colleagues in this crisis.

Photo by Irina Anastasiu on Pexels.com

So many have without doubt gone above and beyond what is expected of them and today, 28th April we have had a minute’s silence to show our respect for those who have already paid the highest price. Hopefully in the near future, when this is all over, we will find a permanent way to honour all these selfless people because we must not forget them.

And when this is over, what then for this courageous group of people. Will they feel so burnt out, emotionally empty and let down that some decide not to continue, I truly hope not. We know from the recent NHS staff survey that our workforce was already feeling the pressure physically and mentally and many staff felt their work was not valued. And with so many unfilled posts already we cannot afford to lose more of the workforce, we need to find ways to retain them.

One thing I do know is, we MUST give them the support, compassion, respect and time to heal that they truly deserve.

In the words of Dame Donna Kinnair – Out of this crisis, we must build a better future for nursing (https://www.rcn.org.uk/news-and-events/blogs/covid-19-out-of-this-crisis-we-must-build-a-better-future-for-nursing)

Valuing our NHS staff

The NHS staff survey is one of the largest workplace surveys in the world. It has been run every year since 2003 and this year over half a million staff completed the questionnaire.

Photo by bongkarn thanyakij on Pexels.com

Its findings are revealing about the state of the NHS and its workforce. For example, only 48% of respondents felt their work was valued by their employer. This is an increase on previous years but by implication means 52% of staff think their work is not valued.

Photo by Jonathan Borba on Pexels.com

Our workforce is feeling the pressure physically and emotionally too, 28% reported musculoskeletal problems and 40% reported stress as a result of work. 56% have gone into work when too ill to do so in the last year but less than 30% think their Trust takes positive action on health and well-being.

We repeatedly tell people they should look after themselves to ensure they can look after others, but this is clearly not happening in practice. A sick and stressed workforce is more susceptible to other illness and a bad winter of flu could see more staff off sick.

However, it is not just employers that are not helping. Nearly 30% of staff reported being harassed or verbally abused by patients and their families and 15% experience violence. Rates were far higher in ambulance services than elsewhere.

As a society, as employers and as people we need to value our healthcare staff. They need to be physically and mentally healthy to look after us when we need them. They need to be able to look after us without the fear of violence or abuse.

2020 – International Year of the Nurse and Midwife

Jan 2020

The RoMHS Principle Investigator Emily Wood discusses her nursing role models.

In this International Year of the Nurse and Midwife there will be a lot said about Florence Nightingale, and rightly so. However, I wanted to start the year by reflecting on my nursing hero, Edith Cavell.

Edith Cavell 1865 – 1915

Edith Cavell was a British nurse in Belgium during World War One. She saved the lives of soldiers from both sides and ran an underground railroad to help Allied soldiers escape from German lines. For this, she was arrested, charged with treason and shot by firing squad on 12 October 1915.

Her execution stunned the world and was widely reported and used as propaganda, but it is her courage that inspires me. She deeply and passionately believed in nursing. She ‘could not stop whilst there were lives to be saved’. Even in though she knew what she did was incredibly dangerous.

The night before her death, she told the chaplain, ‘Patriotism is not enough, I must have no hatred or bitterness towards anyone.’

Although this was said over 100 years ago, I think in the current context in the UK these words are as pertinent as ever. I aspire to have the courage and wisdom of Edith Cavell, being able to call myself ‘nurse’ makes me feel in some small way connected to her and her legacy. The Cavell Nurses’ Trust (https://www.cavellnursestrust.org/) provides support for nurses, midwives and health care assistants suffering personal or financial hardship #herefornurses.

In our study on nurse retention (RoMHS) we have considered the role of team dynamics on intention to stay. Role models can give people a sense of loyalty or pride about belonging to a profession. Local role models can model excellence but also help junior nurses feel a sense of belonging to the team (Vinales, 2015).

Who is your role model?

RoMHS seeking staff opinion – a report from a staff research champion event.

The RoMHS team from the University of Sheffield were excited to present the ‘Retention Of the Mental Health Staff’ research project at Sheffield Health and Social Care (SHSC) Foundation NHS Trust staff research champion event on Thursday 13th November 2019. 

A photo from the event (photo credit @MJHorspool )
The range of health care professionals who attended the SHSC research champion event

Over 30 NHS staff and health care students attended the event to listen to a series of presentations about new research projects where they can get involved in the development, live recruiting or disseminating stage.

This was a key opportunities to not only let our local NHS Foundation Trust know about this exciting project but to also engage interested stakeholders to become advisors to this research project. As well as to have the opportunity to hear their opinions and experiences of mental health staff retention.

The RoMHS team wanted to ask the audience some key questions to see if the theories emerging from the ongoing literature review are the same as those staff front line value or perceive.

During a live poll we asked the group to vote on which one area they believed affects mental health staff retention the most. The group highlighted ‘Workload’ and ‘Emotional demand of the job’ as the most likely to affect retention. Pay and work pattern were not popular reasons for this group of stakeholders.

The next question we posed to the group was to consider at what point in a health care workers’ career are they most likely to leave their profession. Interesting very few suggested ‘students or in first year of qualifying’ despite recent reports from nursing standards about 1 in 4 nursing students leaving before qualifying. Most left that staff loss occurred during the first 5 years of being in post.

100% of the staff who participated in the live poll felt that staff retention had an effect on service user outcomes. This is similar to what the literature we are reviewing also suggests. We asked the audience in the second part of the presentation to explore this further and to consider why this occurs and how it could be measured for research purposes.

During the second part of the presentation the larger group divided into 5 smaller table groups to collaboratively discuss areas in much more detail. These areas have been identified as key during our current literature review, but with mixed conclusion or areas where we are finding limited previous research associated directly with mental health staff and service users.

We asked them to focus on three questions. Here are the questions and a summary of the key points they raised under each question.

  1. What contributes to mental health NHS staff leaving their professions?
    • Workload burnout
    • Pay gap
    • Travel
    • Not being valued
    • Stress and emotional burnout
    • Lack of support/ workplace bullying
  2. What types of interventions might have the biggest impact on retention in mental health trust?
    • Flexibility with work pattern and hours
    • Incentives (social, financial)
    • Career development opportunities across specialities
    • Feedback and being valued
    • Preceptorship and training opportunities for new staff
    • Support/training for new managers
    • Role models
    • Restorative supervision
  3. How does poor staff retention affect service users?
    • Breakdown in staff/service user relationship and trust
    • Increase in incidents
    • Deterioration in mental health symptoms
    • Lack of experienced staff
Live screen capture of the feedback collected on Padlet during the event.

This informative stakeholder discussion will help to highlight which key theories, that are emerging from our ongoing review of all health care workforce retention interventions and research, may be the most relevant to the mental health workforce.

We would like to thank everyone who attended to getting so involved and to SHSC for inviting us to talk.

If you would like to become more involved in this research please become a stakeholder advisor – to find out more please fill out this form:

RoMHS announced

NEWS RELEASE The University of Sheffield is selected to take part in research programme exploring efficiency and sustainability in health and social care

05/07/19

The University of Sheffield has been selected by the Health Foundation, an independent charity, to be part of its programme supporting innovative research ideas into issues of efficiency and sustainability in health and social care provision in the UK.

The ‘Efficiency Research Programme’ is supporting seven research teams from across the UK with grants of up to £500,000 each. Each project will be completed over three to five years.

The Efficiency Research Programme looks to advance understanding of labour productivity in health and social care in order to bring about financial sustainability, and to better understand workforce retention in the sectors in order to improve workforce sustainability.

The research teams behind the chosen projects will work to explore how innovative research can generate a more nuanced understanding of workforce productivity, and the causality of enhanced retention on performance and patient care outcomes.

The Efficiency Research Programme was launched in 2014 and this is the third round of the programme.

The project from The University of Sheffield will investigate variation in, and determinants of, mental health care staff retention, with the aim of better understanding how organisational contexts and the experiences of health care staff in the workplace influence staff retention and patient outcomes.

Emily Wood, Principle Investigator, The University of Sheffield said, “This project is an exciting collaboration between the School of Health and Related research, School of Nursing and Midwifery and the Management School. We are looking forward to working with NHS colleagues to investigate retention of mental health staff, you can find out more about this project from the Health Foundation (https://www.health.org.uk/news-and-comment/news/six-research-projects-chosen-for-programme-on-efficiency-and-sustainability) or from our blogsite https://romhsstudy.home.blog/

Usha Boolaky, Assistant Director of Research at the Health Foundation, said: “The chosen projects for this round of the Efficiency Research Programme are all looking to generate new ways of thinking and new knowledge around labour productivity and workforce retention.

“Through our funding, we are supporting ideas that have the potential to make a transformational difference to health and social care.”