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Resolving recruitment and retention

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We reported recently on the shortfall of children’s hospice nurses and how this shortage is hitting care for UK’s sickest children. This, at a time when demand on children’s hospice services is increasing. We’re heading for a crisis in children’s palliative care nursing: with Brexit potentially causing a further drop in the number of qualified nurses from the EU who will be able to fill posts, these very real recruitment challenges are only set to increase in the coming years. The UK’s governments, health workforce planners and children’s hospices all need to act urgently to make sure that there are enough skilled nurses to care for the growing number of seriously ill children across the UK.

The nurse vacancy rate among children’s hospice services is the same as for the NHS – and is growing. The average vacancy rate in 2016 was found to be over 11%, which is an increase on the 10% reported in 2015. This represents over 130 whole time equivalent (WTE) posts unfilled.

Children’s hospices have told us that it’s getting harder to fill nursing posts, with nearly two thirds (65%) of unfilled posts remaining vacant for more than three months. Over half (61%) of children’s hospices attribute this to a lack of available appropriately skilled nurses being available to fill posts. The high vacancy rate is also due in part to the more limited terms and conditions which children’s hospices are able to offer, including salary, flexible working options, shift patterns and annual leave. A negative perception of children’s hospice care can also put nurses off from applying to work at children’s hospices.

Children’s hospice services have an important role to promote themselves as attractive employers, with a compelling offer of pay, conditions and shift patterns to attract children’s nurses to work for them. It’s important to communicate any additional, unique benefits which they may offer compared to other providers – for example, free workplace parking, free food and/or free childcare. We’ve provided a snapshot here to share some of the innovative ways children’s hospice organisations are meeting recruitment challenges head on.

Ellenor offer a full children’s hospice at home service and recruiting sufficient nurses into the team at ellenor continues to be a challenge. The team identified a number of ways that issues could be addressed including: offering flexible working; a return to nursing ‘as it was’ – allowing quality time with patients; a caring environment and supportive/friendly team; education – supporting nurses in developing their careers; highlighting how nurses can transfer their NHS pensions to ellenor; and offering support nurses who want to return to practice.

Ellenor set up a focus group during 2016 to brainstorm ways of encouraging existing nurses to make the switch from their current role – perhaps in a hospital setting – to working in a hospice. Initiatives the group came up with included physical banners at adult hospices; advertorials in local press; open days; incentives to current staff recommending a nurse they knew; and highlighting what a rewarding role it is through social media by linking in with other awareness initiatives.

Haven House Children’s Hospice in Woodford Green recently launched a Hospice at Home pilot service in Waltham Forest and may expand further which means recruitment of sufficient nursing staff is critical. They have launched a ‘be the nurse you’ve always wanted to be’ campaign which aims to showcase the fulfilling nature of hospice work. The hospice published articles in their local press and staff have been busy writing blogs to share their experiences and job satisfaction.

One nurse commented: “We have time to take part in creative play, to read a sensory story, to go for a walk in our wonderful grounds and still provide high standards of clinical care.” Speaking about the campaign, director of care at Haven House, Eileen White said: “We’re trying to recruit more nurses because it’s a highly-specialised sector, it may be that people think they will lose skills but the opposite is true actually. You’re not taking a backwards step, you’re taking a side step. Hospice care offers the ultimate nursing experience.”

Children’s Hospice South West (CHSW) provide hospice care for children with life-limiting conditions and their whole family across the South West of England. Following on from our You Can Be That Nurse campaign they have shared blogs from nurses across each CHSW hospice site to share experiences of their role working for a children’s hospice. These blogs have published alongside a fundraising campaign to sponsor a nurse, raising the profile of nursing roles within the hospice and suggesting local businesses join forces to collectively sponsor a children’s nurse for one year.

A further recruitment initiative from CHSW has been to encourage nurses who may have left the profession, to return to nursing and be inspired to care again in a nursing role in the hospice. Nurses under the scheme will become a paid member of the CHSW care team. Health Education England will fund the return to nursing course fee and pay a £1,000 incentive to the candidate.

Noah’s Ark Children’s Hospice, a community based hospice service providing support for children and young people with life-limiting or life-threatening conditions and their families in Central and North London ran a follow-on campaign to You Can Be That Nurse highlighting it on their website where they included an interview with a nurse who said: “I am that Nurse and You Can Be That Nurse too.”

Noah’s Ark has also secured funding from a charitable trust which helps children with disabilities, life-limiting conditions or those extreme poverty. The trust will help Noah’s Ark by paying for a paediatric palliative care nurse to work with them for 12 months. Their website introduces the nurse who came into this post and describes how she initially volunteered for Noah’s Ark prior to taking up her staff role.

Some children’s hospices are looking at ways they can improve communications and build relationship with local universities. For example, CHAS in Scotland plan to attend universities to discuss recruitment with newly qualified staff. Our recent survey showed that a third of universities which responded were planning to increase their children’s undergraduate nursing course intake in the future.

We need to continue to work with the UK’s governments, health workforce planners, nurse education institutions and children’s palliative care providers to build a strong and sustainable workforce with the skills and knowledge to deliver care to children and young people who are expected to die young. There is no one solution to these recruitment challenges but, by identifying barriers and thinking creatively, local service providers are tackling these increasing problems of how to attract and keep qualified nurses in the sector head on.

In Autumn 2016 Together for Short Lives launched a campaign to highlight what a rewarding role children’s palliative nursing is, and to encourage people to consider a career in the sector. You can watch the #YouCanBeThatNurse film below

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