Should I stay or should I go? – Exploring relative drivers of employee early-exit from the NHS.

Shortages of suitably qualified health professionals prepared to work in the NHS are not a new phenomenon. However, there are increasingly widespread claims that the NHS faces the prospect of unprecedented shortages over the next decade. Causal vectors present as multiple, having variously been attributed to changes in training bursaries e.g. nurses; rises in job-demands; budgetary cuts; changes to contractual arrangements, e.g. junior doctors; uncertainty over Brexit implications; and more. Prim face implications relate to training, recruitment and retention. This paper is focused on issues of relevance to staff retention. As a component of our Medical Research Council funded Research ‘Extending Working Lives in the NHS: Opportunities, Challenges and Prospects’, an opportunity sample of NHS employees (N=1605) completed a paired comparisons exercise on variables identified as representing headline ‘push’ influences in employee early exit. The ratio scale produced by the method of paired comparisons affords a number of advantages over alternatives, e.g. direct ranking or rating scales. Specially, it provided a means of demonstrating the relative distance (importance/salience) between the variables being ranked. It also permitted formal testing of the degree of concordance (shared view) for the sample as a whole and, critically from the perspective of segmented intervention, the degree to which different employee demographics (by profession/role/grade) can be considered to share discrete ‘push’ profiles. Findings indicate the primacy of variables relating to extrinsic components of job demands.The implications of our findings from the perspective of intervention to increase rates of NHS staff retention are discussed.