NHS Employers (2019) has just published its latest infographic illustrating the results of a survey undertaken in 2018, where 563 nursing students and registered nurses were asked their views about what would both attract them to a new role and make them want to stay in it. The opportunity for flexible working was cited in both groups.
Archard (2018) reflected that many aspects of the NHS have remained largely unchanged since its inception 70 years ago, and with this comes an inability to adapt quickly to accommodate the ever-changing requirements of modern society. Archard recognised that today there are up to five generations in the NHS workforce, which means that people are at different stages of their careers and have different expectations and needs. The question is therefore: ‘How far has the NHS moved towards fully considering flexible working as a viable approach?’
In a recent conversation with an agency nurse, she told me that she desperately wanted a permanent contract with the NHS. However, she had had a bad experience of applying for flexible working and her view was that the only option was taking on a temporary role.
One of the reasons behind a reluctance to support staff recognised by Archard (2018) —and one I often find senior leaders hiding behind—is that, legally, an organisation does not have to grant flexible working if this option does not fit with its business needs; this gives rise to a fear around flexible working being detrimental to business continuity.
For managers in charge of staffing, Archard suggested that it is safer to close down the idea of flexible working completely, because, if one person is ‘allowed’ this working option, managers fear it will open the floodgates and they will be forced to ‘allow’ everyone to do it.
So, as nurse leaders, what examples of good practice are available for us to learn from in considering an approach for flexible working?
NHS Employers (2018) cites flexible working as an excellent way to both recruit and retain staff, to enable them to be supported in achieving a better work–life balance. The organisation recognises flexible working as being operationalised in a number of different ways, such as part-time working, job sharing, a range of contractual options such as annualised hours, compressed hours or term-time only contracts.
Action plan
Timewise (2018), a community interest company, worked with a number of trusts to scope how flexible working could aid retention. The resulting three-part action plan is a good starting point for senior leaders to consider the issue.
Define what flexibility means
Timewise (2019) cites a flexibility maturity curve model, which is a useful diagnostic tool that can be used at both ward/departmental level and at organisational level. It moves from a reactive request-response model to a proactive job design model, and is a good basis for discussion.
In my experience, although all the trusts that I have worked in have flexible working policies, application of these policies varies and they are open to local interpretation. They typically operate on a request-response model, which treats flexibility as a problem to be accommodated, rather than a way to meet the non-work needs of all staff. The variety of roles in the NHS and different ways of working add further complexity, with different solutions needed for shift-based working.
In case studies from both Timewise (2018) and NHS Employers (2018), the approach that strikes a chord is one that views flexible working as ‘team working’ rather than as individual requests. Among the good practice case studies is one on how the use of an e-roster system as a tool can support team working.
Design flexible roles
The next step cited by Timewise is to start creating flexible job design options. The solution is to redesign jobs and working practices, while taking into account the specific clinical and operational constraints within each profession, job role and specialty. Such an innovative approach to flexible job design could create role-specific flexible options for staff at all levels.
Develop a flexible culture
Possibly the most important element for success, I would suggest, is fostering an organisational culture that promotes and supports flexible working at team level, which is essential for any change to be successful. Leading from the top and ensuring that senior leaders understand the benefits of flexible working is fundamental. The case studies show how leadership training can encourage support for flexible working and improve fairness at work Timewise (2018)
Starting point
In summary, the evidence base cited overwhelmingly supports the notion that flexible working, if done well, could enable the NHS to deliver care in an environment that supports all staff whatever their responsibilities outside work. We are all searching for the golden ticket to retention, and flexible working is certainly an approach on which my own organisation lacks maturity. It is a topic that requires urgent professional debate.