Staff Shortages and Retention in NHS:
An Examination of the Causes of Staff Nurse Shortages and an Assessment of Possible Retention Strategies
Table of Contents
Theoretical Background and Research Focus. 4
Doctors and Nurse Shortages in the NHS. 5
Strategies for Overcoming Healthcare Staff Shortage. 7
Research Aim and Objectives. 7
Justification and Contextualisation. 8
Ethical Considerations and Access. 11
Appendix: Data Collection Questionnaire. 17
Introduction
The NHS could experience a staff shortage of about a quarter-million by 2030 unless sustained efforts are undertaken to address the shortage of personnel like nurses, doctors, and general practitioners (Iacobucci, 2018). As of 2019, there were 106,000 vacancies across NHS England, including more than 44,000 vacant positions in nursing (Scammell, 2019). Staff shortages are a significant problem that undermines the provision of patient-centred care while leading to adverse effects like the susceptibility to medical errors and other similar sentinel events. The shortage contributes to nurses and health staff working longer hours that can contribute to injuries, mistakes, and job dissatisfaction. Understaffing puts the patients at risk as well as compromising the safety aspects of care (Baker et al., 2019). The other impact of the shortage is the fact that the care providers are forced into working many hours of unpaid overtime to help cope with the increased demand for the health services, resulting from the labour shortage.
The shortage in the workforce further implies that the NHS cannot implement its long-term care plans that are associated with the strengthening of primary and community care (Iacobucci, 2018). The negative implications of staff shortages in NHS are serious issues of concern in healthcare for both the health workers and the patients. Additionally, the staff shortage compromises the ability of the health system to handle cases of global pandemics such as the novel coronavirus (COVID-19) that started in China in December 2019 before spreading globally (Read et al., 2020). The purpose of this study is, therefore, to investigate the factors that contribute to the staff shortage in NHS and to outline the various strategies that can be used in the retention of the key members of the caregiver staff.
Theoretical Background and Research Focus
Theoretical Framework
The shortage of healthcare staff is a global problem against the increasing need for health services in all the countries of the world (Combes et al., 2018). Consequently, addressing the shortage is a significant consideration by the policymakers. The systems theory that entails the consideration of the inputs and outputs in the healthcare framework will be used to understand the causes of staff shortages in the NHS. According to Anderson (2016), systems theory outlines how the components of an organisation work to accomplish the common objectives while highlighting both the internal and external factors that influence the functioning of the specific parts of the organisation. On the same note, Williams (2017) outlines that systems theory is useful for the improvement of healthcare systems, and hence, the theory is vital for the exploration of some of the retention strategies that can be adopted by the organisation.
Staff motivation theories like the Maslow’s need hierarchy and Herzberg’s motivator-hygiene theory can also be used in the understanding of the healthcare professional’s retention dynamics in the NHS (Ștefan et al., 2020). The Maslow’s need hierarchy is a motivational theory that provides that human needs can be ranked into five groups, namely physiological, safety, social, esteem, and self-actualisation (Stawasz, 2019). How the employer meets each level of the need determines the willingness of the workers to remain in the organisation. On the other hand, Herzberg’s motivator-hygiene theory outlines that the retention of the staff depends on factors that contribute to satisfaction and dissatisfaction with the work (Ranjithkumar and Supraja, 2019).
Doctors and Nurse Shortages in the NHS
Nurses constitute about 50% of the global health workforce (Drennan and Ross, 2019). The shortage of nurses in a healthcare system is, therefore, a significant contributor to the health staff shortage. Great Britain faces the largest nurse shortage in the world despite the efforts to hire nurses from other countries in Central and Eastern Europe as well as from other parts of the world (Marć et al., 2019). Migrant nurses thus comprise a significant proportion of the nursing workforce in the UK, with the country being the third most popular destination for nurses in the world (Gillin and Smith, 2019). The findings are supported in the work of Marangozov et al. (2016), who describes that the UK nursing labour market has always been characterised by a cyclic pattern of the shortage of nurses.
The shortage of nurses is causing the NHS to rely on less qualified staff, such as nurse associates and healthcare assistants who are included in the service, to help address the rising demand amidst the shortage of the staff (Jones-Berry, 2017). The NHS has depended on overseas recruitment. However, the developments due to Brexit imply that UK may face recruitment problems, especially relating to the EU workers (Gray et al., 2018). The crisis in the NHS is further compounded by the global shortage of nurses that implies that the organisation faces stiff competition when attempting to recruit qualified personnel from the international job market pool. Apart from the difficulty in the recruitment of qualified nurses, the nurse shortage in the NHS also arises due to the challenge of retaining the professionals. Razak et al. (2018) report that the difficulty to retain nursing professionals in the NHS is due to factors like political unrest following Brexit, insufficient recruitment levels, and financial instability.
The acute shortage of doctors is also experienced in the UK with just 2.8 doctors per 1,000 people as compared to the average 3.5 in other Organisation for Economic Cooperation and Development (OECD) countries (Papanicolas et al., 2019). The shortage of doctors in the UK is the second lowest across the OECD after Poland. The shortage of doctors is especially experienced in the rural areas in which the shortage of the physicians can lead to disparity in the country’s healthcare in which the urban areas have more access to the specialist attention as compared to the rural regions. According to Rimmer (2019), some of the factors that contribute to the shortages of doctors in the UK include the reduction in job ads and trainees.
The impact of the recruitment problem in the shortage of general practitioners is also highlighted in the work of Rees and Bracewell (2019), who assert that the medical schools may not be able to produce enough professionals to address the identified challenges. The shortage of physicians implies that the NHS can no longer offer the required services adequately, hence lowering the quality of healthcare while risking the safety of the patients. The high cost of training doctors is also another reason that is leading to the shortages of GPs in the UK (Cutting et al., 2020). Kumar et al. (2019) estimate that it costs the local economy £610,000 over 10 years. However, after training, some of the doctors leave for other countries, like Australia and New Zealand. According to Gauld and Horsburgh (2015), one of the major reasons that motivate the young doctors to leave the NHS UK is the quality of life considerations, in which the medical graduates are attracted by the sunny climate in New Zealand.
Strategies for Overcoming Healthcare Staff Shortage
The strategies for overcoming healthcare staff shortages are based on the adoption of both human resource and organisational approaches (Theodoulou et al., 2018). Some of the human resource strategies that can be used include the promotion of the staff career development, enhancement of scheduling flexibility and adopting effective recruitment strategies to attract and retain top talents to the organisation. The career development approaches include the facilitation of the workforce to obtain the highest form of education, hence contributing to the need by the staff to continue staying in the organisation (Attenborough et al., 2019).
Apart from the management and human resources for overcoming the staff shortages, policymakers and the government should implement efforts such as the subsidisation of medical and health education to encourage more students and individuals to be trained as health professionals (Merkel et al., 2019). Such efforts may also include changing the perspectives and attitudes of students regarding the health profession. The other governmental strategies towards overcoming the healthcare staff shortage include the implementation of appropriate and lenient immigration laws to enable the health institutions to hire qualified workers from other countries (Glasper, 2019). Medical schools should also offer scholarship opportunities to international students with a commitment that such professionals will be retained in the country for some period before they can go back to their countries.
Research Aim and Objectives
The problem of health staff shortage in the NHS is well documented as observed in a large number of vacancies to the positions of the various personnel like nurses, general practitioners, and midwives, among others (Charlesworth and Lafond, 2017). The focus of the study is, therefore, based on the investigation of the causes of NHS staff shortage while outlining the potential retention strategies by examining the nurse workforce dynamics. The specific objectives pursued in the proposed study include:
- To assess the possible Staff Nurses retention strategies that can be adopted by the agency to mitigate the shortage problem.
- To explore the current measures that are being adopted by the NHS to address the shortage problem;
- To investigate the impact of the NHS staff shortage in the provision of health services during the COVID-19 pandemic;
Research Questions
The research questions that are associated with the identified objectives are:
- What are the retention strategies that are best suited to address the NHS staff shortage?
- What are some of the measures that are being implemented by the NHS to address the shortage in the workforce?
- How has the staff shortage affected the delivery of healthcare services during the COVID-19 pandemic?
Justification and Contextualisation
While staff shortage is a significant issue affecting healthcare systems globally, the proposed study is undertaken in the context of the National Health Service of the UK. The most vital asset to health and social care in the UK is the workforce that offers the required services to the patients (Gershlick et al., 2017). A study to investigate the factors affecting the workforce is, therefore, significant for the promotion and enhancement of the working environment and ensuring that the wellbeing of both the staff and the patient is maintained. Similarly, the investigation of the factors affecting the workforce is vital for the establishment of strategies that can be used by the institution to attract and recruit the most talented employees to help in the delivery of high-quality care (Dunn et al., 2016). Additionally, the assessment is necessary for the identification of the major deficiencies in the workforce, hence outlining the key measures that can be adopted to address the problems.
The study is justified to provide information that can be used as part of the policymaking process that is intended to address the major factors that contribute to the shortage of staff in the NHS. Additionally, an investigation into the specific causes of the staff shortage problem is vital in contributing to the existing literature. The findings will thus be important in addressing the gap in literature relating to the dynamics of the healthcare workforce in the NHS. The identification of the causes of the healthcare staff shortage is not only critical in the development of the knowledge in the topic but is also necessary for the formulation of the retention strategies as well as measures for mitigating the shortages based on the specific problems. The findings of this study will thus be important in the development of proactive approaches to the mitigation of the problems relating to the shortages of healthcare staff in the NHS.
One of the major adverse impact of staff shortage in NHS is the fact that the institution cannot plan effectively relating to the specific long-term goals and strategic objectives (Buchan et al., 2017). The identification of the causes of staff shortages and potential is thus important as part of the long term planning process, in which the policymakers can proactively identify the primary issues that need to be addressed as part of the delivery of the quality healthcare to the patients in the country and the region. Part of the planning process includes budgeting, in which the NHS allocates necessary funds to specific workforce issues to accomplish the organisational objectives. The identification of both causes of understaffing and possible retention strategies is vital in the understanding of the exact amount of money or investment that is required to maintain an adequate workforce in the healthcare system. According to Leary (2019), the need to invest in the healthcare workforce is essential in addressing the problem that is associated with the rising demand for health services.
Part of the retention strategies includes the identification of the factors contributing to worker satisfaction or dissatisfaction. The proposed study is, therefore, important in highlighting the major factors that impede the staff from delivering their duties. On the other staff satisfaction influences job productivity and quality of services that are delivered by the staff (Chang et al., 2017). Some of the factors that contribute to staff satisfaction include job rewards, the work environment, nature of the job itself, and hospital management practices (Meng et al., 2018). An evaluation of the factors that influence the behaviours of the employees should thus be undertaken as part of identifying and implementing the critical aspects of healthcare service delivery. The research is timely due to the prevailing health crisis in the UK due to the shortages of the care staff (Taylor, 2020). Furthermore, the need for more healthcare professionals currently and in the future is being experienced due to the increasingly ageing population that increases the burden due to the growing demand for health services.
Methodology
Research Design
The research is designed to use a quantitative approach to collect and analyse data on the key issues leading to staff shortages and to propose possible strategies that can be used in the improvement of retention in the health organisations in the UK. The quantitative enables an investigation of a phenomenon through the use of numerical and statistical evaluation of information (Bryman, 2016). Accordingly, the approach will be vital for the investigation of the main issues related to staff shortages in the NHS. The suitability of the quantitative approach in the proposed study is based on the advantages such as the ability to generalise the findings to a larger population. The quantitative approach also enables the elimination of the researcher’s bias as the data collection is undertaken based on a structured manner.
Additionally, quantitative research allows faster collection of data as methods such as questionnaires enable the respondents to easily answer the questions (Bryman, 2016). Apart from the primary data collected from the respondents, secondary analysis in which existing information from reputable publications and reports are synthesised to support the major outcomes obtained in the study is conducted. The secondary data obtained can thus be used to affirm the trends that are associated with NHS staff shortages and the retention strategies that can be adopted.
Data Collection
The target population from which the data will be collected in the study is a group of nurses working for the NHS. A convenience sample size of 10 nurses will be used to obtain the required data using a questionnaire. Convenience sampling is useful in this study due to the cost-effectiveness of the approach. A questionnaire will be utilised as the main data collection tool in which the survey will be sent to the respondents through emails. Questionnaires are suitable for data collection in this study due to the advantages such as the ease of analysis and visualisation, respondent anonymity, and scalability (Regmi et al., 2016). Additionally, questionnaires are suitable in the provision of actionable data and hence appropriate in this research as the outcomes will be used to propose actions that can be taken by the NHS to address the problem of staff shortages. The data collection tool is attached in the appendix.
Data Analysis
The data analysis process will entail the synthesis of the data to present an understanding of the key issues investigated. A descriptive statistics approach will be adopted as the main methodology for the analysis of data. Descriptive statistics provide summary statistics that quantitatively describe or summarise features from the information collected in a study (McCarthy et al., 2019). The data analysis approach will thus be used to present quantitatively describe the responses related to the issues associated with the staff shortages and possible retention strategies. The suitability of descriptive statistics in the proposed study is the ability of the approach to allow the presentation of data in a more meaningful manner and thus enabling proper interpretation.
Ethical Considerations and Access
The ethical considerations undertaken in the study include the use of personal information from the participants. Accordingly, the participants will be informed fully about the nature of the study and their involvement in the process and that their participation is voluntary. The study will also be undertaken following the approval of the ethics application and consent form while ensuring that the identity of the participants and personal data are kept confidential as part of privacy considerations. The respondents will be mainly accessed through email in which the questionnaires will be sent for appropriate responses.
Limitations of the Study
The limitations of the proposed methodology mainly arise from the disadvantages of the quantitative research approach and the use of questionnaires as a data collection instrument. While the quantitative methodology allows for collection and analysis of data objectively, the approach does not enable the collection of detailed information from the respondents. The close-ended nature of the questionnaire items does not allow the respondents to provide additional information regarding the questions that are being asked (Bryman, 2016). Similarly, the structured nature of the questionnaire does not allow the researcher to seek clarification from the respondents and hence not obtaining in-depth information about the issue being investigated. Accordingly, the approach may restrict the respondents from giving detailed information regarding the staff shortages in the NHS. The proposed convenience sampling strategy is also subject to selection bias. Despite the limitations, the suitability of the proposed research design is based on the advantages of the quantitative approach that outweigh the disadvantages.
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