What matters to those amazing nurses that work in our NHS? Pay? Somewhat, but when it comes to what motivates them, one thing is clear: it’s not all about the money. Prior to the recent announcement of an expected new pay deal for nurses, pay had been capped since 2011. Yet, we know that only around one in six nurses cite pay as a reason for leaving the NHS.
One of the main reasons nurses come to work is because they are passionate about what they do. They care deeply about their patients’ wellbeing and want to deliver high quality care. The more alignment between their values and what they do at work, the more likely they are to feel passion for that work. So, if money isn’t what makes nurses tick, how might we tap into their intrinsic personal and professional motivation in ways that sustain, or better still increase, passion for work that may ultimately lead to higher performance and reduced burnout and turnover?
For a wide variety of reasons, many nurses do not always feel they are adequately fulfilling their core values of providing high quality care. This can lead to reduced levels of job satisfaction, and an increased likelihood of burnout. The findings of a study led by Jon Jachimowicz from Columbia Business School illustrate this. After interviewing the nursing staff at the Walton Centre, a small specialised trust in Liverpool, the authors found that:
- for almost all nurses, providing patient care is one of their most important values and reasons why they entered the profession (one nurse said ‘If you do it for the money, you wouldn’t last a week.’)
- many nurses do not feel they are providing sufficient high-quality patient care
- where this mismatch exists, nurses are more likely to be frustrated, and voice doubts about prolonging their tenure at the trust and even in the profession.
Ironically, most patients report that the nurses treating them do an excellent job. Adult inpatients score their experience of how they were treated by staff and whether they were treated with dignity and respect in the top decile. However, once a patient has been discharged, nurses would more often than not only know about this feedback if they happen to read these results. And even then, the information is not provided in real time, nor is it delivered in a personalised way. If nursing staff could receive direct feedback from patients, could that narrow the mismatch between perceived and desired levels of patient care? Is there a way to close this feedback loop in a more efficient way that is easy, attractive, social and timely?
There might be. The Health Foundation is working with the South London and Maudsley NHS Foundation Trust and researchers from Columbia Business School to trial a behaviourally informed intervention that may help nurses to sustain their passion for their work. It involves changing a small aspect of the patient discharge process: a few days after patients leave the hospital, they receive a letter from the trust’s chief executive outlining how much nurses enjoy hearing from their patients, and reminding them how important it is to say thank you. Also included will be the names of the nurses that worked on their case. As part of this letter, patients will also receive a postmarked envelope addressed to the ward that treated them, and a thank you card. Any returned thank you cards received by the trust will then be displayed on the ward, allowing nurses to see their former patients’ appreciation for their work, thus providing real-time reassurances about the level of care they are providing.
Data will be collected through a survey before the trial, and will be collected again following the end of the trial. The trial will also monitor nurse wellbeing, sick days, turnover, agency spend, patient complaints and job performance to understand the impact of the intervention. So, can such a low-cost, light-touch intervention work? We will know more about its impact this time next year.
On a personal note, this trial reminded me of when my sister first entered the NHS as a community dentist. Pinned on her bedroom wall were numerous thank you cards that she received from her patients. I recently told her about this trial and she smiled and told me that those cards were the reason she went to work. And even today, years after she moved out of the family home, they are still there, and she still has the passion to go into work to care for her patients.
Darshan Patel is a Senior Research Manager at the Health Foundation