Title: REcruiting and RetAining nurses, and carers in Care Homes: what works, for which staff, under what circumstances, and at what cost? The REACH Realist Review
Funder: Department of Health and Social Care

Abstract: Background to the research: _x000D_ People living in care homes are society’s most frail and vulnerable older people, and the nurses and carers working in care homes are essential in supporting them. Planning how care homes across the country will manage the future increasing numbers of older people is an important national priority. Key to this is ensuring care homes have the staff needed to deliver care. Currently there are big challenges in finding and keeping care staff. Low pay is often stated as the reason for these challenges. While pay is important, research shows other reasons influence staff decisions to join or stay, such as feeling valued at work, flexible hours, supportive management, good training, and team relationships. It is reasonable to expect that staff wants, needs, and expectations will vary across nurses, care workers, age groups, and levels of experience/qualifications. We need to know what is needed for different staff, why, and the costs of successfully attracting new staff, and keeping current staff. _x000D_ _x000D_ Aims of the research:_x000D_ 1. Understand what is needed and why to attract nurses and carers new to care home work._x000D_ 2. Understand what is needed and why to keep the nurses and carers currently working in care homes. _x000D_ 3. Describe the differences between different staff (e.g. younger, older) and describe what level of cost is needed to recruit and retain staff in care homes._x000D_ _x000D_ What we will do:_x000D_ We will read previous work (research articles, reports, policies, and other relevant materials) to find relevant evidence. Evidence will be brought together to build a picture called an ‘explanatory framework’. The framework will tell us what is needed for which staff, why and the cost required to successfully attract, recruit and keep nurses and carers in care homes. _x000D_ _x000D_ How will we involve the care home sector and members of the public?_x000D_ Early in the project we will interview nurses and carers to hear their experiences. Their views will contribute to building a picture of what is needed and why to attract and keep nurses and carers in care home jobs. We will meet regularly with care home residents, relatives, staff (nurses, carers, managers, owners), and people working in social care at a national level. Involving these people will help to ensure the research messages are relevant, and reflect the views of people experienced in care homes. _x000D_ _x000D_ How will we share the findings? _x000D_ The findings will be captured in artwork sketches and a plain English summary which will be shared with care homes across the country. Throughout the project we will also examine how the findings can feed into national recruitment campaigns, and workforce strategy and planning._x000D_ _x000D_ The findings will be published in research and care home journals, and presented at national and international meetings. _x000D_ _x000D_ In Leeds, we are currently working in partnership with local care homes, and will support these local homes to take the findings on board and implement into practice. _x000D_ _x000D_ We will also organise an event to take place at the University of Leeds and present the findings to care home staff, relatives, researchers, and organisations relevant to care homes (for example, people responsible for planning and purchasing healthcare services for older people). We will also use Twitter to regularly share updates throughout the project.

Lay abstract: Research question: _x000D_ what strategies are effective (and ineffective) for attracting, recruiting, and retaining registered nurses (RNs) and care workers in the long-term care sector? What works, for which staff, under what circumstances, and at what cost? _x000D_ _x000D_ Background: _x000D_ The adult social care system is under strain, and as the number of older people with complex care needs rises, urgent action is needed to plan how the sector will be sustainably staffed. Care home staff are fundamental for care homes to function, and provide the everyday care that residents need. High staff turnover, and high number of vacancy rates are long standing challenges and need addressing. There is also a need to attract and recruit new staff to avoid future workforce shortages._x000D_ _x000D_ Aim: _x000D_ To develop an explanatory framework (underpinned by programme theories) of effective strategies to recruit and retain RNs and carers working in care homes. _x000D_ _x000D_ Objectives: _x000D_ 1) Develop initial programme theories_x000D_ 2) Identify the outcomes underpinning effective (and ineffective) recruitment and retention_x000D_ 3) Identify the context and underlying mechanisms that generate outcomes_x000D_ 4) Search for evidence which tests and refines theories_x000D_ 5) Identify and explain the cost (e.g. time) and consequences (outcomes) of theories_x000D_ 6) Bring the theories together and provide an overarching explanatory framework_x000D_ 7) Develop guidance that explains how to successfully recruit and retain RNs and carers_x000D_ 8) Prioritise RNs and carers voice as experts throughout the process_x000D_ _x000D_ Methods: _x000D_ A realist review will build, test, and refine programme theories that explain what recruitment and retention strategies work, for which staff, and in what circumstances. The programme theories will be shaped iteratively over 4 steps: (1) initial programme theories will be developed through expert stakeholder consultations, interviews with RNs and carers, and scoping literature searches; (2) systematic literature searches and screening for credible and relevant evidence; (3) data extraction and analysis using realist logic to develop context-mechanism-outcome configurations; (4) synthesising evidence and drawing conclusions. _x000D_ _x000D_ Timelines for delivery: _x000D_ - 0-4 months: develop initial programme theories (step 1)_x000D_ - 5-12 complete literature searches (step 2) and start selecting evidence, and extracting and analysing data (step 3) _x000D_ - 13-15 start and complete synthesising evidence and drawing conclusions (step 4) _x000D_ - 16-18 write up and disseminate findings_x000D_ _x000D_ Anticipated impact and dissemination: _x000D_ The following outputs will reach target audiences through: _x000D_ 1. Artwork sketches and a plain English summary will provide practical evidence based guidance to care home providers, managers, and staff, and will be shared through the National Care Forum, Care Provider Alliance, and Skills for Care organisations. _x000D_ 2. Input evidence based guidance into workforce strategy through working with the Department of Health and Social Care. _x000D_ 3. Publish the findings in both academic and care provider journals. _x000D_ 4. Publish blogs on relevant websites, and share links through social media. _x000D_ 5. Present findings at national and international conference presentations, and at a dissemination event in Leeds. _x000D_ 6. Work with, and support local care homes to implement findings into practice through an existing partnership between University of Leeds, Leeds Care Association care homes, and Leeds City Council.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE