Factors influencing nurse retention within children’s palliative care

Abstract

Retention of staff presents major challenges within children’s palliative care; this has substantial implications for children, families and the nursing workforce. To address this, a programme was undertaken that provided pathways of professional development for senior nurses working in this field. This study reports the views of nurses completing this programme, the overall project manager (PM) and the day-to-day programme lead (PL) as well as factors that influence nurse retention within children’s palliative care nursing. The study drew on an Appreciative Inquiry approach that comprised of interviews with the PM and PL as well as focus groups and questionnaires with senior nurses from the children’s palliative care sector, who participated in the training programme. Thematic analysis of data from interviews and focus groups revealed factors influencing nurse retention: speciality, positivity and making a difference, support, provision of adequate resources, tailored education/professional development and resilience. These themes were supported by the questionnaire findings. The programme was perceived as having a positive influence on nurse retention within the children’s palliative care workforce. In addition, it was felt to be very beneficial in terms of shared learning and development. Participants highlighted the need for similar opportunities in the future.

‘With every fibre of their being’: Perspectives of healthcare professionals caring for children with non‐malignant life‐limiting conditions

“…This at times generated feelings that they were providing impersonal or inadequate care. The findings from a number of studies likewise revealed demanding workloads with implications such as stress and fatigue for healthcare professionals (McCloskey & Taggart, 2010; Quinn & Bailey, 2011; Whiting et al, 2020). However, the healthcare professionals in the present study seemed to ‘find’ time, knowing perhaps the way to ‘create’ time was by being fully engaged with each family in the moments that were available.…”

“Holding back my own emotions”: Evaluation of an online education module in pediatric end-of-life care

“…Organizations must be attentive to this (Rawlings et al, 2020b), and offer staff the opportunity and time for self-care (Beaune et al, 2018) and team building (Dryden-Palmer et al, 2018). Strategies that can help to retain staff working in these areas include formalized support mechanisms, such as Employee Assistance Programs (EAPs) and clinical supervision, as well as education and professional development (Whiting et al, 2020). Some learners also reported feeling helpless in view of imminent death (Grimston et al, 2018), with challenges noted in talking to the child and their family about dying, and in prognosticating.…”

Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review

“…Unsurprisingly this included the well-reported staff shortages and high attrition in the professions [as reported above, within aim (a)], which could have knock on implications. For example, Lone working (N, 99,118,119 Poor relationships with colleagues/incivility/ bullying 9,25,30,34,75,83,89,90,96,110,123 Fear of assault/abuse from public/patients (P, 124 but also N and M in some settings e.g. emergency nurses, 23 secure forensic 25,111 ) Challenging relationships with patients, public, clients 23,80,100,105,106,111,124,125 Not feeling able to speak out 9,83,90,94,114 continued one nursing paper focused on newly qualified nurses 73 highlighted that this can mean regularly working with temporary staff (bank or agency staff) and/or being moved to other units (impacting teamwork and collegiality as well as knowledge of the systems and patients), and that such shortages can often mean being the only registered nurse on a shift, leading to feeling "vulnerable, and their units unsafe" 73 (p. 3).…”

“…Lack of support related mostly to poor support from leadership/managers and organisational-level support, with one paramedic paper stating that it was a lack of confidence in support from employers that led paramedics to self-refer to their regulator. 114 However, one nursing paper highlighted the lack of support for leaders (senior nurses): '(it is) quite lonely at the top when you have no one to speak to' 110 (p. 8), and a paramedic paper described the culture as sometimes being unsupportive if a colleague was struggling, referring to the military background of the profession and that there was consequently a very low tolerance for low standards amongst peers. 115 In one midwifery paper, midwives described feeling invisible and not being acknowledged, 83 and another referred to the harsh mentorship they had received and lack of kindness from managers/mentors, 116 with a third describing how midwives felt 'scrutinised rather than supported by management' 89 (p. e553).…”

“…Learning and education throughout career 30,83 Manager/employee training to recognise early signs/assist staff who disclose 35,98,114,120,153 Mental health awareness for family, friends and loved ones 94,114 relation to support and/or career progression, several sources across all three professions described the provision of formal mentorship/community practice schemes; 110,119 only one training course was categorised at 'organisational' level and that was 'implicit bias training' recommended in an editorial focused on tackling racism in healthcare provision and wider society. 79 At a societal level, two paramedic-focused editorials mentioned World Mental Health Day/World Suicide Prevention Day campaigns as ways of raising awareness of psychological ill-health in staff and/or encouraging action.…”