Recruiting and retaining an engaged specialist workforce in child and adolescent mental health

Key benefits and outcomes

• The number of incidents and restrictive practices in the unit, including restraints, seclusions and rapid tranquilisation, has reduced and continues to decrease.
• The unit is well recruited for both trained and untrained nursing staff.
• Austen House now has a pool of regular agency staff to alleviate the pressure on regular staff.

What the organisation faced

Austen House was faced with a number of challenges when the service opened. This included managing the complexities that young people present with, such as self-harm and emotional dysregulation, while working towards its priorities as a least restrictive unit, all during a global pandemic.

The greatest challenge was the fact that Austen House was a new purpose-built unit, the first low secure unit (LSU), in Southern Health Trust, and one of a number of LSU’s in England.  Due to the uniqueness of the service, a significant number of nursing and support staff were required to obtain additional specialist child and adolescent specific training, including attachment and trauma training. Specialist skills were imperative to enabling staff to offer consistent quality care to young people.

This difficulties faced were further compounded by the COVID-19 pandemic,  workforce retention and management of infection control, to ensure that young people and staff were able to work in a safe environment. The pandemic posed unique challenges for retention; staff left the service to relocate and live close to their families as soon as the COVID-19 restrictions were lifted, meaning further roles had to be filled.

Some universities held off from sending students during the pandemic and there were also times when the acuity of the ward meant that it was not possible to host the same number of students as usual.

What the organisation did

The leadership worked tirelessly to support their team with achieving the requirement to be 95 per cent compliant with their statutory and mandatory training. This was required due to the staff being new to the organisation and many not having any previous experience. The staff team was trained in attachment and trauma and basic DBT (dialectical behavioural therapy) skills to support young people with self-harm.  The team also engaged in the reducing restrictive practice during a quality improvement project. This was to reduce the likelihood of needing restraints and other hands-on approaches, and comprised of ongoing in-house training, teaching skills in recognising emotional dysregulation and distress, communication skills for staff, and sensory techniques. As a result, the staff team and young people adopted a unit approach to monitoring and managing some of the potential restrictions that young people could be subject to during admissions to inpatient services.

Austen House also took steps to recover the number of staff who were absent during the pandemic. This included developing a pool of regular agency and support staff to alleviate the pressure on regular staff, while retaining access to the regular staff who knew the young people well. To support these agency staff, the unit developed easy-read care plans and tailored inductions, and the team offers supervision to block-booking agency staff and invites them to team meetings, as well as adding them to the staff picture board.

The nursing management signed up for leadership coaching, participating in culture reframing activities that were provided to the nursing team and the wider MDT. These activities specifically covered engaging with staff to offer one-to one coaching and support worker forums. The team holds staff debriefs at the end of every shift and safety huddles are held each morning. Austen House held departmental away days, which included Q&A sessions with senior management, and the opportunity to discuss what the service can do to improve the care given to its young people.

Austen House has taken a personal approach to supporting the nursing team, offering a range of shifts to suit the individual needs of staff. A wellbeing room supports nursing staff to have some personal time off the ward and increase overall wellbeing, and a ‘shout-out board’ shows the unit’s gratitude towards staff in a visible way, celebrating all the work they do.

Furthermore, core team days were developed to allow staff to meet and discuss their daily working activities in a creative way to allow nursing staff to  influence care plans, supervision and training. This is used to allow staff to have the time and space to catch up on the important care planning activities and formulations.

Results and benefits

The project saw a significant reduction in the number of incidents in the unit and improved staff and young people relationships. In addition, Austen House team cohesion improved by openly discussing and addressing some of the challenges faced in working with young people in the least restrictive way possible.

To support nursing staff career progression, the unit has band 2, 3, 4 , 5, 7 and 8, allowing all bands to have an opportunity to train to develop skills.

Many nursing students have elected to have a placement at Austen House due to the great breadth and depth of experiences available on site.

The service is seeing an increase in the quality and standard of care plans and supervisions.

Since opening, the unit has successfully recruited 60 nursing staff members from a range of specialisms including paediatric, mental health and general nursing. Although navigating through the pandemic has been challenging, Austen House has successfully increased its CQC rating to ‘good’ from ‘requires improvement.’

Overcoming obstacles

There were numerous services and vacancies that were recruiting at the same time. Management had to ensure that the service appeared promising and a great place to work. Staff were apprehensive about working in a clinical environment during an active pandemic so it was critical to reassure them that they would be safe. This was done through the interviews and during recruitment days.

Takeaway tips

• Ensure staff voices are heard and they feel supported.
• Ensure the team is kept up to date with any changes in the team or service.
• Ensure that training is provided to support staff to work effectively for the service.

Further information

For more information about the work in this case study, contact Alicia Osei, dialectical behavioural therapy nurse specialist at Southern Health NHS Foundation Trust: Alicia.Osei@southernhealth.nhs.uk.