Co-production of an intervention to increase retention of early career nurses

The nursing workforce is a national and global priority, highlighting the importance of identifying reliable ways to encourage nurses to remain in their role and in the profession. The extent and impact of nurse turnover has been discussed extensively in the nursing literature as it affects many countries' ability to fight disease and improve health.

In England, more than one in 10 registered nursing posts in the NHS are vacant, and international research indicates that on average 10% of the nursing workforce seriously considers leaving either their current role or the profession. The issue of retention is particularly topical in the wake of the COVID-19 pandemic, which has shone a spotlight on the importance of a sufficient and robust nursing workforce.

As part of a larger study to design an intervention to increase retention of early career nurses, academics from City, University of London investigated how feasible and acceptable the implementation of a co-production process would be to nursing students, early career nurses and the researchers.

Co-production is a process employed to solve complex issues, recognizing the expertise of all stakeholders. However, while widely used in policy and other settings, its use in a higher education setting is still relatively novel. As such there remains limited evidence on the optimal approach to take toward co-production of interventions, and indeed the evaluation of any benefit of the process.

The study involved 12 co-production group members, two male and 10 female. Two members were early career nurses and 10 were student nurses. The groups were facilitated by two researchers, and six group co-production meetings were convened at the university. Evaluation of the acceptability and feasibility of the process consisted of a mixed method approach involving a questionnaire taken at the beginning, mid-point and end-point of the study; semi-structured interviews with members of the group and note taking by the facilitators, with data collected between April 2018 and January 2019.

Overall, group members reported personal benefit from participating; they developed and practiced transferable communication and problem-solving skills, believed they were able to make a difference, enjoyed contributing, found benefit from using the group as a reflective space and considered that co-production produced a credible intervention.

However, some challenges were faced during the process, including the academic facilitators highlighting the balance they had tried to maintain between the time and space given to group members to express their views and the other needs of the project; pointing to a specific skill set required to effectively manage the dynamics of co-production.

The university setting of the group meetings was also noted as a potential constraint on free-flowing discussion between the group members and the facilitators, with the acknowledgement that such an environment may be conducive to academic knowledge being perceived as more valued in discussion. The setting may have emphasized the perception of an academic-student hierarchy between the researcher facilitators and students and early career nurse group members, preventing the blurring of boundaries that has been espoused as key to the co-production process.

Nevertheless, the findings indicated that co-production equipped participants to function more effectively in their nursing roles, and that incorporating co-production into the development of future interventions may prove beneficial. The relative novelty of this approach, and the potential application of the findings to a diverse range of geographical and organizational settings, add to the utility of the findings.

First author of the study, Judy Brook, is Associate Dean, Partnerships and Placements, at the School of Health Sciences, City, University of London. She commented: "The co-production process helped us to develop an intervention to support early career nurses to stay in the profession. As the intervention was produced with final year students and early career nurses it was perceived as much more credible and appropriate than it would have been if we had just designed it ourselves."

The study is published in the journal Nurse Education in Practice.