Staff Side staff survey for the ‘Review of shift patterns across Sussex inpatient units’ (2 shift system) consultation

Staff Side staff survey for the ‘Review of shift patterns across Sussex inpatient units’ (2 shift system) consultation

Final Report

Introduction

The Trust is proposing changes to shift patterns for staff working within a number of inpatient units. The current 24 hour shift pattern is based on a 3 shift, 3 handover system with the 2 day shifts 7.5 hours in duration. The proposed change is for a 2 shift, 2 handover system where a shift is 12.5 hours in duration.

The Trust’s rationale for the proposal is two fold:

  • Maximising staff resources to provide clinical care that is safe and designed to meet the required outcomes of the patient stay
  • Contributing to the savings target for the Trust and supporting the organisation in achieving challenging financial targets.

As a part of the consultation process it was agreed with management that staff side could carry out a survey to ascertain the views of staff affected by the proposal. Staff also had the opportunity to attend group meetings and email staff side and management with their opinions. UNISON Sussex Partnership Branch also carried out a basic online poll.

The survey lasted for the duration of the consultation period: eight weeks from 20th June 2012.

The Survey

Staff had the option to complete the survey anonymously. All questions were optional. Respondents were able to provide information on:

  • Designation/ Banding
  • Work base
  • Division
  • Union membership

Respondents were then asked 4 questions in the following order:

  • What do you believe are the benefits of the proposal for you/ your team/ your patients?
  • What do you believe are the disadvantages of the proposal for you/ your team/ your patients?
  • As it stands do you approve of the proposal (options were: Yes, No, Don’t know, Don’t mind either way)
  • What support, if any, would you need if this proposal was implemented?

The results of this survey were collated by Nick McMaster, Staff Side Lead for Brighton & Hove. They are as follows:

Surveys returned by Division

87 questionnaires in total were returned.The break down form the three Divisions of East Sussex, West Sussex and Brighton & Hove were as follows:

Surveys returned by Divisional work bases

The biggest return was from West Sussex (43%) with Brighton & Hove returning41% and East Sussex 14%. A number of work bases returned surveys and they are presented by Division as follows:

East Sussex (total 12):

West Sussex (total 37):

Brighton & Hove (total 36):

Surveys returned by Divisional designation/ bandings

Overall where a designation or banding was given more qualified than unqualified nursing staff responded. However, in West Sussex just under half of the surveys were returned without identifying a designation or banding. The breakdown by Division is as follows:

East Sussex (total 12):

West Sussex (total 37)

Brighton & Hove(total 36)

Union membership by Division

The majority of nursing staff are in a union. The majority of respondents were also in a union.

  • East Sussex: 9 out of 12 respondents
  • West Sussex: 27/ 37
  • Brighton & Hove: 32/ 36
  • Not identified: 2/ 2

Total 79/ 87 or 91% of respondents

Approval of the proposal

Respondents were asked “As it stands do you approve of the proposal?” There were four options from which to choose and presented in the following order: Yes, No, Don’t Know and Don’t mind either way.

Results by division are as follows.

  • East Sussex (total 12)
  • West Sussex (total 37)
  • Brighton & Hove (total 36)

Of the 2 forms where the Division was not identified the respondents circled “No”.

As a combined total the result was as follows (total 87):

SUMMARY AND ADDITIONAL SUPPORTING INFO: Taken as a whole, almost 5 times as many respondents rejected the proposal as those who accepted it. East Sussex, with a much smaller return compared to West Sussex and Brighton & Hove, marginally favoured the proposal, whereas the other two Divisions strongly rejected it.

In East Sussex 4 out of the 6 who approved the proposal were from St Anne’s. The most returns from one unit were from MillViewHospital of the Brighton & Hove Division. 82% of respondents here rejected the proposal.

Written feedback

There was a great deal of written qualitative feedback on the proposal. For the purpose of this report this feedback has been collated into themes.

Respondents were asked “What do you believe are the benefits of the proposal for you/ your team/ your patients. 15 themes emerged and they are presented here by Division and frequency (Please note NI = Division not indicated):

Theme / East / West / B&H / NI
More days off for staff (including more time with family) / 3 / 7 / 10
Therapeutic engagement with patients over whole day / 1 / 2 / 1
Less change for patients (including continuity of care) / 7 / 11 / 4
More time with patients / 1 / 3
Get shifts out of the way/ longer time off between work / 2
Little/ no benefit / 2 / 13 / 10 / 2
Saving money for the Trust / 2 / 4 / 7
Better clinical information / 1
More time to complete tasks/ improved time management / 3 / 1
Working with same staff / 1 / 1
Improved work/ life balance / 2
More energy working with patients / 1 / 1
Easier rostering / 1 / 1
Potential to increase earnings / 2
Working less shifts / 1

SUMMARY: Out of the 15 themes on the benefits of the proposal, 3 emerged consistently as scoring highest across all Divisions (except for Saving money for the Trust in East Sussex), though not necessarily in the same frequency order. They were:

  1. Less change for patients (including continuity of care) - 22 mentions in total
  2. More days off for staff (including more time with family) - 20 mentions in total
  3. Saving money for the Trust - 13 mentions in total

It is worth noting however that “Little/ no benefit” received 27 mentions.

Respondents were asked “What do you believe are the disadvantages of the proposal for you/ your team/ your patients?” 34 themes emerged and they are presented here by Division and frequency:

Theme / East / West / B&H / NI
Less staff to do range of duties/ activitieswith patients due to less handovers / 3 / 8
Staff burn out/ tiredness working longer shifts / 1 / 19 / 11
Increase in sickness absence, inc due to stress / 1 / 13 / 6
Increased risk of making mistakes/ SUIs due to tiredness / 6 / 5
Impact on child care inc financially / 1 / 11 / 3
Staff could be faced with aggression and violence over a longer period / 2 / 2 / 3
Working with same staff group/ not seeing other staff team – impact on team morale / 1 / 5 / 7
Patients feeling stuck with the same staff / 2 / 3
Negative impact on work/ life balance / 4 / 7
Longer gaps without Primary Nurse for patients/ lack of continuity of care / 1 / 3 / 10
Lack of empathy/ quality of care caused by staff fatigue / 1 / 13 / 13
Impact on relationship with children and family / 1 / 7 / 5
Lack of safety due to less staffing / 1
More difficulty covering sickness absence / 1 / 5 / 3
Impact on team meetings/ ability to carry out supervision / 2 / 1 / 8
Reduced earnings if not on nights/ working weekends / 5 / 3
Difficulty in having breaks inc rooms in which to take them / 5 / 5
12. 5 hour shift is too long / 1
Impact on having pets especially dogs / 1
Difficulty in winding down from long shift and feeling refreshed for work the next day / 1 / 2
Increased stress / 2 / 2 / 3
Staff feeling under the weather may not feel able to do 12.5 hour shift when they would work through 7.5 hour shift / 1 / 1 / 1
Impact on documentation / 1 / 2
Difficult to do on part time hours / 1
Working three long shifts in a row / 2
Impact on travel arrangements / 3 / 1 / 1
Impact on physical health / 2 / 1
Rota not being able to accommodate flexible working, training, sickness absence etc / 2
Communication issues with team / 4
Longer night shifts/ doing more nights / 4
Discriminates against older or less physically fit staff members / 3
Less time for planned restraints often done during handover / 1
Anomaly of owing the Trust hours / 2
Lack of time to do training / 1
Difficulty in getting Bank staff to cover longer shift / 2
Lack of access to sunlight/ fresh air / 1

SUMMARY: Looking at the whole picture 3 themes emerged as particularly dominant on the disadvantages of the proposal:

  1. Staff burn out/ tiredness working longer shifts – 31 mentions
  2. Lack of empathy/ quality of care caused by staff fatigue – 27 mentions
  3. Increase in sickness absence, inc due to stress – 20 mentions

Of some interest is the comparison of issues between West Sussex and Brighton & Hove, which returned an almost identical number of surveys (37 to 36). Outside of the three already mentioned above, there appeared to be some differences.

For example: “Impact on child care, inc financially” was a bigger reported concern in West Sussex (11 mentions to 3), whereas in Brighton & Hove “Longer gaps without Primary Nurse for patients/ lack of continuity of care” (10 mentions to 3),“Impact on team meetings/ ability to carry out supervision” (8 mentions to 1) and“Less staff to do range of duties/ activities with patients due to less handovers” (8 mentions to 3) appear to be more important.

The most frequently mentioned issue in East Sussex (albeit only 3 times) was “Impact on travel arrangements”.

Respondents were asked “What support, if any, would you need if this proposal was implemented?”29 themes emerged and they are presented here by Division and frequency:

Theme / East / West / B&H / NI
More staff on shift / 1 / 8
Protected breaks inc full hour / 1 / 3 / 7
Less patients / 1
Choice of days/ nights / 2 / 2 / 5
Not working nights / 1
Honouring/ having flexible working agreement especially around child care / 2 / 6 / 4 / 1
More information about breaks / 1
To have regular work pattern/ set days / 3
No support would make up for impact on family and work/ life balance / 1 / 1
Paid breaks / 1 / 2
Free meals / 1
More activities on ward / 3
Split shifts/ Option to continue with 7.5 hour shift or opt out / 2 / 4
Longer handovers / 1
Increased/ regular supervision and team meetings / 1 / 1 / 4
Only ever working 3 shifts a week / 1
I do not want to work a 12.5 hour shift/ I will try to look elsewhere for employment/ resign from post / 4 / 2
Protected pay covering reduced enhancements / 2
Option of some 9-5 hours / 1
2 qualified staff each shift to enable breaks / 2
Would like to start this shift pattern / 1
Financial support for extra child care and other caring responsibilities including pets / 4
Support of team / 1 / 1
Hot meal facility for staff/ adequate break facilities / 1 / 2
None needed / 3 / 6
No long days at Christmas / 1
Don’t believe I would get support / 2
Funding for team days / 1
Redeployment / 1

SUMMARY: Of the 29 themes that emerged on support required, the most frequently mentioned were:

  1. Honouring/ having flexible working agreement especially around child care – 13 mentions
  2. Protected breaks inc full hour – 11 mentions
  3. Choice of days/ nights – 9 mentions
  4. None needed – 9 mentions

6 respondents also reported “I do not want to work a 12.5 hour shift/ I will try to look elsewhere for employment/ resign from post”

Conclusion

According to this survey a significant majority of staff (71%) reject the proposal to bring in the 2 shift system. Although they can identify a number benefits (mentioned in total 81 times) they are outweighed by the disadvantages, at least numerically (mentioned in total 266 times).

The reasons for rejecting the proposal are not all personal. The impact on patients and quality of care scores highly, too. It is noticeable though that continuity of care is seen as both being advantaged (22 mentions) and disadvantaged (14 mentions) by the proposal.

Tiredness and stress caused by working longer shifts impacting on a number of areas is of particular concern to the respondents and in total accounts for 36% (95 mentions) of identified disadvantages.

It is often acknowledged that we have a dedicated and creative staff group and in this survey a number of support solutions are mentioned. If Trust Management is to implement this proposal through against the wishes of the staff (at least according to this survey), then tackling tiredness, stress and taking on board the requests for support mentioned here and in other forum would need to be seriously considered.

Acknowledgements

Thanks to all staff participating in this survey and to management for agreeing to Staff Side’s request to carry out this survey.

REPORT AUTHOR:

Nick McMaster,

Staff Side Lead

Brighton & Hove Division

August 16th 2012

1