Wye Valley NHS Trust needs to fill 200 full time medical and nursing posts

Increasingly, the trust is looking to the EU and beyond to boost numbers, with a range of recruitment programmes now underway.

The challenges see the Trust developing action plans for so-called “worry wards” and other departments where staff turnover is high.

A ward-by-ward, department-by-department break down - based on figures available to date – for nurses alone shows where the worry may immediately lie.

Those figures show an increase of 18.25 whole time equivalent roles across the trust’s substantive workforce during October.

The highest increase in nursing staff was in the Care Closer to Home Service unit, while the biggest individual department increases were in Maternity followed by Redbrook ward and A&E.

There was an overall increase in agency workers as medical staff and a drop in those working as nurses.

Nurse bank usage was also down.

Over the month, temporary staff comprised of 6.8% of the trust’s total workforce, down by just over 7% on September.

Staff turnover that has gradually increased over the past year started dropping in August.

An exercise is underway to collate and analyse exit interview data to identify trends  and  action plans for so-called “worry wards” and other departments struggling to retain staff.

There are currently  204 full time equivalent posts going through the recruitment process. This equates to around 8% of the workforce.

Bank recruitment is in addition to these numbers and to encourage recruitment to the rust’s internal bank, staff will be transferred from zero hour contracts to annualised hours contracts from January.

A review of recruitment processes has also been undertaken to tighten the time between recruitment from advertisement to taking up post.

The Trust is still experiencing recruitment issues to a large number of middle grade posts including A&E and Medicine.

Consultants’ posts in Anaesthetics and A&E are said to be particularly hard to fill.

The Trust has commissioned recruitment agencies to support an overseas medical recruitment programme.

Amongst nursing posts, the recruitment issues are in district nursing, the virtual ward, and ITU.

A recruitment drive, supported by recruitment agencies, has just begun to secure Theatres staff.

Recruitment is progressing slowly for the Stroke unit which has a high number of bank and agency staff.

Since September 2012 the trust has  increased the number of District Nurse students.

In 2012, two took the Specialist Practitioner Course and four last year.

There are around 30 members of the District Nursing workforce who are over 50, another 25 that are within the 45-49 year bracket which will start to impact on recruitment in the next couple of years.

But the staffing challenges are most immediately apparent on the wards which struggle to retain full complements.

A number of EU nurses are already working and the trust accepts that it will have to continue to recruit from overseas.

The majority of the wards at Hereford County Hospital are seeing more newly qualified and EU nurses.

A ward-by-ward, department-by-department  break down shows where - on statistics currently available - staffing issues exist

ELECTIVE

Teme

All uplift - or numbers identified as required - had been recruited to but now there are 2.82 vacancies general nurse (or B5) vacancies.

Three EU nurses have been working on the ward since May this year.

 

Leadon

All of the uplift recruited to but now 3.43 B5 vacancies of which  one whole time nurse recruited from the EU is due to start soon.

A further three EU nurses started in March 2014 with one of those leaving shortly and one newly qualified nurse also started in March 2014.

The additional B5 nurse on a late shift has made an impact on to the ward with a decrease in relation to Clostridium Dificile and drug errors compared to April-September 2013/14.

 

Monnow

Had all of the uplift recruited to and now has a whole time B5 vacancy.

Two newly qualified and two EU nurses also started in March this year.

The additional nurse on a late is recognised as having made an impact on the ward.

 

Redbrook

Has been unable to recruit to all of the agreed uplift with 5.35 vacancies at B5.

The Clinical support worker (B2) uplift has been fully recruited to.

Indicators show there has been a small deterioration with Clostridium Dificile, slips, trips and falls and drug errors this year which does correlate to vacancies the ward is carrying.

Within this workforce there are four EU nurses of which one is leaving and six newly qualified nurses of which one has left.

An increase in drug errors compared to April-September 2013 is acknowledged. The trust says this is “predominantly due” to the EU workforce with further work underway to improve this.

If recruitment continues to be a challenge on this ward then the trust will consider assistant practitioner roles.

 

Urgent Care

Acute Admissions Unit

Had 5.54 B5 uplift in October this year as agreed by the trust board.

This uplift has not been recruited to due to the inability to fill current vacancies.

Four B5s are due to start in January to resolve the existing vacancies so work can start on recruiting the uplift.

However, a further two B5 nurses have since resigned.

The past six months show a 50/50 split of experienced nurses against newly qualified and EU nurses and, again,  assistant practitioner  roles will explored.

Arrow

Has had the most significant number of vacancies since April and got a whole time uplift of 1.69 WTE in October.

Last year there was a stable workforce on Arrow, but a number of staff retired including the Ward Sister.

Currently there are 9.07 B5 vacancies which include the uplift.

Two-thirds of the workforce now on Arrow have been there less than a year, with five EU nurses and 4 newly qualified nurses.

Two agency nurses have been block booked for six months for stability.

Indicators show that there have been small increases in drug errors, falls with harm and pressure ulcers compared to last year.

Wye

Currently B5 vacancies, uplift did come in a year ago and the ward stayed at establishment until March this year.

Again, there are two B5 agency nurses block booked.

In the last six months the ward has had two EU nurses and five newly qualified nurses.

There has been an increase in the number of direct stroke admissions from 308 last April-September to 377.

Practitioners again being explored for this area.

Indicators identify a small increase in clinical care complaints, drug errors and slips, trips and falls.

Lugg

Currently has five B5 whole time staff and, despite an uplift given in October last year has not been been able to get to full establishment.

Three EU nurses were due to start last month, which will leave two B5 vacancies.

Over the past six months the ward has had four newly qualified and three EU nurses join.

Indicators show a Clostridium Dificile increase, although the ward is classed as the Clostridium Dificile ward, and an increase in the number of slips, trips and falls.

 

Community Hospitals and Intermediate Care

Within Community Hospitals there are no EU or newly qualified nurses.

Indicators at these sites have largely remained the same.

Hillside rehabilitation centre has, however, seen an increase in slips, trips and falls, possibly due to all rooms being single rooms and the increase in more medical patients compared to the previous year.

Hillside currently only has .65 of a B5.

Ross

Currently has 2.07 B5 vacancies. Staffing was reviewed in July when, in the trust’s words, it was becoming “impossible” to recruit to the uplift on the nights.

There has been an extra health care assistant (HCA) on nights, taking the total to four 4 HCAs on a night and two qualified on a night.

Use of an assistant practitioner is being explored here.

 

Leominster Community Hospital

B5 vacancy at 0.6 B5, again due to the re-profiling of the night shift.

Assistant Practitioner roles are being explored.

 

Bromyard Community Hospital

Has a  third of posts vacant (3.47 whole time equivalent roles) at B5.

Assistant Practitioner roles are being explored.

 

Other areas

Clinical Care

Has recruited to establishment, however not all staff will be in post until January/February next year.

Theatres

 Six B5 vacant posts with a workforce review underway.

Midwifery

Actively recruiting to five posts.

Special Care Baby Unit

An uplift of 0.4 at B5 will be included in the trust’s business planning cycle for the next financial year.

Childrens Ward

A shortfall of 0.6 whole time at B5 to be covered, as proposed, by the trust’s additional winter funding monies.

Emergency Department

Currently has 7.9 whole time B5 vacancies.

 

Clinical Assessment Unit

Currently has two whole time B5 vacancies.

Coronary Care Unit

Currently has 0.51 whole time B5 vacancies.

Women’s Health

Has had vacancies but expects to be at full establishment by next month.

Indicators show a small increase in slips, trips and falls.