International Journal of Nursing Studies 47 (2010) 418–426

Flexible working and the contribution of nurses in mid-life to theworkforce: A qualitative study

Ruth Harris a,*, Janette Bennett b, Barbara Davey c, Fiona Ross a

a Faculty of Health and Social Care Sciences, Kingston University and St. George’s University of London, UKb National Nursing Research Unit, King’s College London, UKc Advisory, Conciliation and Arbitration Service (ACAS), London, UK

A R T I C L E I N F O

Article history:

Received 30 March 2009

Received in revised form 20 August 2009

Accepted 30 August 2009

Keywords:

Flexible working

Workforce policy

Work–life balance

Mid-life nurses

A B S T R A C T

Background: With the changing demographic profile of the nursing workforce,

retaining the skill and experience of nurses in mid-life is very important. Work–life

balance is a concept that is gaining increasing prominence in today’s society. However,

little is known about older nurses’ experience of family friendly policies and flexible

working.

Objectives: This study explored the organisational, professional and personal factors that

influence perceptions of commitment and participation in the workforce for nurses

working in mid-life (aged 45 and over).

Design: A qualitative study using a range of methods including biographical methods,

semi-structured face-to-face interviews, focus groups and telephone interviews. Data

were analysed using constant comparative method.

Settings: A large inner city acute teaching hospital and an inner city mental health and

social care trust providing both community and inpatient health and social care.

Participants: 34 nurses and 3 health care assistants participated in individual interviews,

10 nurses participated in two focus groups and 17 managers participated in individual

telephone interviews.

Results: Four themes emerged: the nature of nursing poses a challenge to the

implementation of flexible working, differences in perceptions of the availability of

flexible working, ward managers have a crucial role in the implementation of flexible

working policies and the implementation of flexible working may be creating an inflexible

workforce.

Conclusions: The findings suggest that there are limits to the implementation of flexible

working for nurses. In some areas there is evidence that the implementation of flexible

working may be producing an inflexible workforce as older nurses are required to

compensate for the flexible working patterns of their colleagues. Ward managers have a key

role in the implementation of family friendly policies and require support to fulfil this role.

There is a need for creative solutions to address implementation of flexible working for all

nurses to ensure that workforce policy addresses the need to retain nurses in the workforce

in a fair and equitable way.

� 2009 Elsevier Ltd. All rights reserved.

Contents lists available at ScienceDirect

International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

* Corresponding author.

E-mail address: Ruth.Harris@sgul.kingston.ac.uk (R. Harris).

0020-7489/$ – see front matter � 2009 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ijnurstu.2009.08.009

What is already known about the topic?

� T

he nursing workforce is ageing and this is likely tocontribute to difficulty maintaining adequate numbers ofnurses in the healthcare workforce.

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426 419

� T

here has been considerable change in working arrange-ments in industrialised countries with greater variationand flexibility in how, when and where people work.

What this paper adds

� T

here are limits to the implementation of flexibleworking for nurses particularly those working in 24 h,7 days a week services. � N urses working in mid-life may be compensating for the

flexible working patterns of their colleagues with child-care responsibilities.

� W ard managers have a key role in the implementation of

workforce related policy and may need support tomanage the varying needs of their teams in a fair andequitable way.

1. Introduction

Over the last two decades there has been considerablechange in working arrangements in industrialised countrieswith greater variation and flexibility in how, when andwhere people work. This has been largely driven byincreasing competitiveness, technological advance andglobalisation with successful organisations being able toprovide high quality products and service at the conve-nience of their customers (Pettinger, 2002). In addition,flexible working practices are also being sought by employ-ees to improve their work–life balance. Pettinger (2002)defines flexible working as ‘‘the ability to employ peoplewhen and where required in the interests of everybody’’ (p.6). This paper reports the findings of a study that examinedthe organisational, professional and personal factors thatinfluence perceptions of commitment and participation inthe workforce for nurses working in mid-life (aged 45 andover). It will focus on older nurses’ experience of flexibleworking and other family friendly working policies.

Work–life balance is a concept that is gaining increasingprominence and importance in today’s society. For sometime now family friendly practices have been advocated topromote workplace equality and improved ability to carefor children and dependents (Budd and Mumford, 2006).The UK central government has pledged to supportfamilies and children by encouraging more family friendlyemployment. Legislation supports this with parents ofchildren under 6 years and those who care for elderly ordisabled relatives having the right to request flexibleworking arrangements. Furthermore, it has been proposedto extend this right to parents of children aged up to 16years (Walsh, 2008). There is increasing evidence of theadvantages to employers and organisations of implement-ing family friendly policies including increased perfor-mance, increased employee commitment and increasedcost-effectiveness (Dex and Smith, 2002). These familyfriendly initiatives include part-time work, job-sharing,flexitime, compressed working week, annualised hours,term time working and working from home. Although menare opting to work in a more flexible way reflecting a trendfor greater sharing of household tasks between men andwomen, typically higher numbers of women are likely totake up these working practices (Stevens et al., 2004).

However, a number of industries, particularly those inthe public sector, e.g. emergency services, energy, trans-port and health care have long provided round the clockservices to meet the needs of those using them, oftenrequiring staff to work in an irregular, shift based systemrather than the standard or normal hours of Monday toFriday, 9 am to 5 pm. Working shifts is generally notpopular and adverse effects both in terms of physical andmental health and social and domestic life are oftenreported (Harrington, 1994; Poissonnet and Veron, 2000).Certainly, shift work and workload have been identified asimportant factors linked to nurses leaving the workforce(McVicar, 2003; Storey et al., 2009a).

Key to the NHS modernisation programme (Depart-ment of Health (DH), 1999, 2000a) is recognition that theNHS as an employer has a responsibility to develop andsupport their staff. Under the Improving Working Lives(IWL) Standard (DH, 2000b), NHS organisations have todemonstrate commitment to more flexible workingconditions to allow a better work–life balance, such asgiving staff more control over their own time, reducedhours options, flexitime and career breaks. However, therehas been evidence of variation throughout acute Trusts inimplementation of flexible working policies for nurses(Royal College of Nursing (RCN), 2002) and there is also ageneral perception that flexible working opportunitieshave been targeted at nurses with young children ratherthan nurses with different work–life balance needs ordifferent caring responsibilities, for example, for teenagers,grandchildren or parents (Coyle, 2003; Bennett et al.,2007). Changes in familial structures with parents livinglonger and young people delaying leaving home due toincreased costs of living mean that the responsibility ofsimultaneously caring for older and frail parents andchildren is becoming increasingly common. People (mainlywomen) who carry out these responsibilities are known asthe ‘sandwich generation’ (Grundy and Henretta, 2006;Hart, 2006). These new dynamics of care will becomeincreasingly prominent and will add another dimension tothe need for access to flexible working.

Thus, the accessibility of flexible and family friendlyworking is becoming more important for nurses in mid-life. However, Budd and Mumford (2006) propose that thelink between the availability of flexible working practicesand actual usage is more complex than is often thought. Intheir study, they hypothesise a three-tier conceptualframework of the usage of family friendly work wherebyemployee usage depends on perceived accessibility, whichin turn depends on actual availability (Budd and Mumford,2006). The top tier or the availability level is whereorganisations decide whether to offer family friendlypolicies and to which staff. The next tier is the perceivedaccessibility level, where individual employees working inorganisations with family friendly policies perceive thesepolicies to be available to them individually or not. Thebottom tier, the actual usage level is where employees whoperceive that the family friendly policies are accessible tothem individually choose to use them or not.

Workforce planning for nursing is, at best, an inexactscience. In the past wastage from nursing was never takentoo seriously as replacement of new recruits was relatively

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426420

straightforward. However, demographic shifts, changes incareer aspirations and the image of health care professionsas being less secure has had an impact on workforce flowsso that this ‘disposability’ of nurses is no longer sustainable(Davies, 1995). Brooks and Swailes (2002) observed thatthe growth of flexible working in the NHS coincided with alengthy period of nurse shortage. This shortage is likely toremain as the demographic profile shows that the nursingworkforce is progressively ageing. In the UK, out of anapproximate total of 366,000 nurses, more than 100,000nurses on the Nursing and Midwifery Council (NMC)register are aged 55 or older, and a further 80,000 are aged50–55 (Buchan and Seccombe, 2006). Furthermore,Buerhaus et al. (2000) project that by 2020 the registerednurse workforce will be 20% below projected require-ments. This trend applies elsewhere, for example, in theUnited States (US) (Gabriel, 2001), Canada (CanadianInstitute for Health Information, 2007) and Australia(Wickett et al., 2003). These demographic changes ledBuchan (2007) to conclude that ‘‘the future nursingworkforce is mainly today’s nursing workforce – onlyolder and (perhaps) wiser’’ (slide 15). Therefore, it isimperative that we gain a greater understanding of theexperience of nurses, aged 45 and over, of working in theNHS. This knowledge will enable organisations to developand implement policies that may encourage older nursesto remain in the workforce.

2. Purpose of the study

The research was proposed against a backdrop ofconcerns about a shortage of skilled nurses in London andever increasing numbers of older nurses taking earlyretirement. The study formed part of the working livesprogramme of the National Nursing Research Unit at King’sCollege London funded by the UK Department of Health.

Sustaining the nursing workforce is very complex andindividuals’ decisions to remain in the workforce can beinfluenced by a range of factors, personal, professional ororganisational. It has become increasingly recognised thatpeople working in ‘mid-life’ have particular preferences interms of balancing work, life, health and well-being as wellas training needs, which must be addressed to help themaccommodate workplace and professional changes(Bowers et al., 2003; Hirsch, 2000). Knowledge of theneeds, values and interests of older nurses can be useful sothat organisations can develop policies that may encou-rage older nurses to remain in the workforce and thereforeretain skills and experience. Little is known about theexpectations, aspirations and factors that influence parti-cipation in the workforce therefore the overall aim was toexamine organisational, professional and personal factorsthat influence perceptions of commitment and participa-tion in the workforce for nurses working in mid-life (aged45 and over) within the context of a modern humanresources framework. The nursing staff included in thisstudy comprise registered nurses and health care assis-tants (HCA) working in a nursing role. In the UK, registerednurses delegate some aspects of nursing care (for example,personal care and feeding) to HCAs who make a largecontribution to care provision and are valuable members of

the nursing team. Therefore it was considered important totake an inclusive approach.

The research was conducted in two separate Trusts inLondon selected to provide diverse organisational con-texts. Trust A is a large inner city acute teaching hospitaland was established as a National Health Service Trust in1991 under the National Health and Community Care Act1990. The Trust became an NHS foundation trust in 2006.Trust B is a mental health and social care trust, whichprovides both community and inpatient health and socialcare across 57 different sites. Care Trusts, introduced in2002, are part of the NHS but with delegated LocalAuthority (LA) functions and aim to provide a vehicle forthe integration and coordination of health and social careservices to increase continuity of care and simplifyadministration (DH, 2002).

Ethical approval for the study was obtained through theCentral Office for Research Ethics Committees (COREC)now the National Research Ethics Service (NRES). Pseu-donyms are used where participants are directly quoted.

3. Research methods

Data were collected over a 9-month period in 2005using a range of methods including biographical methods,semi-structured interviews and focus groups with nursesand health care assistants aged 45 and over. Documentaryanalysis of Trust records was undertaken to identify theimplementation and take up of various initiatives andpolicies. A biographical life course perspective using semi-structured interviews (Chamberlayne et al., 2000) wasadopted to take into consideration diversity of work andlife experiences, especially of women. Individual biogra-phies were collected before each interview and involvedcharting important life events such as marriage, pregnan-cies and partner’s redundancy alongside their own careerpathway. The lifeline and some of the interview questionswere drawn from a schedule developed by Crompton et al.(2003).

Seventeen nurses and one HCA participated in theindividual interviews at Trust A and seventeen nurses andtwo HCAs at Trust B. Five nurses aged 45 and overparticipated in a focus group in each Trust. The aim of thefocus groups was to assess views of Trust policies in termsof retention and retirement strategies, flexibility, trainingand career development opportunities, organisational andprofessional barriers to and facilitators of implementationof policies for older nurses. In addition to focus groupssemi-structured telephone interviews were undertakenwith managers in Trust A (n = 8) and Trust B (n = 9) toidentify main human resource concerns and assess viewsof: deployment of older members of the workforce, policiestargeted at older workers and needs of older nurses interms of flexibility, training and development.

All interviews were recorded with the participants’permission and were transcribed and analysed aided bythe qualitative software package, Atlas.ti, using theconstant comparative method, identifying themes anddata patterns (Patton, 1987). The analysis of the datainvolved within case analysis and, across case analysis(Eisenhardt, 1989). Data were segmented, coded and

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426 421

arranged into categories, which facilitated comparisonwithin the data of each case study site and across the dataof both case study sites (Strauss and Corbin, 1990). Theinitial stage of the analysis involved ‘open coding’ where thebroad features of working life were identified. The secondstage of the analysis involved ‘axial coding’ of data andduring this process relationships within and across the dataemerged. Data were compared across both sites to enhancenaturalistic generalisation (Stake, 2000). The data collectedfrom the managers were continually compared with datacollected from the nurses in order to refine the developmentof categories to assess the organisational and professionalbarriers and facilitators to policy implementation.

4. Findings

The findings of the full study are reported in Bennettet al. (2007). This paper reports findings from the studythat increase understanding about how older nursesexperience flexible working.

The findings indicate that the implementation of familyfriendly policies was subject to a number of organisational,personal, perceptual and economic factors. Four importantthemes were identified within the data. These are:

� T

he nature of nursing poses a challenge to theimplementation of flexible working. � D ifferences in perceptions of the availability of flexible

working.

� W ard managers have a crucial role in the implementa-

tion of flexible working policies.

� T he implementation of flexible working may be creating

an inflexible workforce.

4.1. The nature of nursing poses a challenge to the

implementation of flexible working

The nature of nursing work poses many challenges to theimplementation of flexible working arrangements, withsome organisational structures more facilitative and sup-portive than others. Generally access to flexible working incommunity based services or outpatient departments wasunproblematic, as demonstrated by two nurses who said:

‘‘. . .because I work on my own, on a sort of discreet part of

the service, I can come in at what time I like and go at what

time I like within reason.’’

Trevor, senior nurse, care trust.

‘‘I do, I actually do work in a different way. My hours are

slightly different because of living in Brighton. And again

that’s something that they’ve done for me. I avoid traveling

in the mad rush hour. So I finish at 4. The service closes at 5.That’s to avoid the big rush hour. I start at 8, granted. But

that’s my choice. The service opens at 9.’’

Sam, H grade community nurse, care trust.

However, it was interesting that the different workingpractices between nurses and social workers generated a

perception of unequal access to flexible working and thatthere may be a difference in professional culture thatinfluences the availability of flexible working or possiblythe perception of its availability.

‘‘One of the social workers who went away to have her

second baby. And she did sort of two days a week and one

day from home, three days a week. She did three days’working, but her third day she spent and worked from

home. I wonder whether that would happen in nursing,probably not, you know, that’s a kind of a ‘social work

thing’ - which I think was quite good for her really.’’

Kathy, G grade, care trust.

The difficulties of flexible working in a 24-h setting arewell known (Brooks and Swailes, 2002). These findings showthat the implementation of flexible working in 24-h settingswas influenced by a number of constraining factors.Working patterns for example, appear to either facilitateor hinder the implementation of flexible working. Ininpatient settings there is a need for some to be at shifthandover.

‘‘But with nursing, I do think it’s quite limited because

nurses need to go to handover. If you’re working in a

clinical setting, you need to go to the handover at the

beginning of the shift and then you need to handover at the

end of the shift.’’

Anna, trust manager, care trust.

Furthermore, a shift pattern of long days, common ininpatient areas, was seen to be a particular barrier to theimplementation and take up of flexible working for some:

‘‘[the acute trust] very much sees themselves as employers

who give flexitime to their staff. But I think within that, you

know, there are certain restrictions. [. . .] When I was

actually working as the F grade on that side and I wanted

to work flexitime, the shift patterns were different because

then they did earlies and lates, so I could, whereas now we

only do long days.’’

Pamela, clinical nurse manager, acute trust.

Although long days facilitated flexible working forothers:

‘‘I have negotiated long days so I have a Friday off, which is

great’’

Julia, G grade, acute trust.

In trust A access to flexible working was seen to berestricted in certain departments:

‘‘Not necessarily the Trust but our [directorate] is not

family friendly. If people want to go part-time they won’tguarantee them days, and they want them to be flexible

about what days they work and all that sort of thing, which

I don’t think is family friendly. [. . .] If you have to arrange

childcare you need to have it on specific days.’’

Linda, G grade, acute trust.

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426422

There was also some evidence that more senior nurseshad better access to flexible working arrangements. Thismay partly be due to a more autonomous way of workingas nurses in management positions often manage theirown schedule and hours of working or have more authorityand control in decision making:

‘‘I mean one of the issues I think is about, [flexible working]

seems to be used more by senior members of staff and less

by the ward staff. Now I can understand why that’s the

case because if you have a workforce on a ward and

everyone was [working flexibly] you wouldn’t be able to

run the ward. So there is an issue.’’

Phyllis, trust manager, acute trust.

‘‘Well mainly in my position, I’m quite fortunate that I can

work 9 to 5 most days. I don’t have to do weekends and I

don’t have to do nights. So that does help. And I’m quite

lucky. There are days when I do work long days, but again, I

tend to fit that in with where my children are and what

they need to be doing. So if they’ve got after school

activities and I can’t work a long day, which would finish at

half past eight, and I would then, if I needed to work a long

day, I would fit that in with a day when, you know, my

daughter can be at home or my husband’s at home.’’

Pamela, clinical nurse manager, acute trust.

4.2. Differences in perceptions of the availability of flexible

working

There were striking differences in perceptions of theavailability of flexible working with senior managerstaking the view that flexible working could be accessedeasily. One of the senior human resources managers in thetrust A thought that flexible working was available to allstaff irrespective of their reason for needing it or wanting itwhich reflected the all-inclusive flexible working policydeveloped by the trust.

‘‘. . .it’s a scheme that’s open to everybody so you don’thave to have a family, you don’t have to have, be a carer,you know you can want flexible working purely because

you want it. And it’s made as easy as possible so you know

the individual goes and talks to their manager and their

manager tries to accommodate it. [. . .] So yes I don’t think

it is difficult to get flexible working in any area of the

Trust.’’

Laura, trust manager, acute trust.

However, this view was not shared by other staff. Onehealth care assistant said:

‘‘The policies there and the papers there – when it comes to

the reality at ward level, some of it’s not that easily

accessed – you know, flexible working times and annual-

ised hours and all these things, you know, they’re very

much – yes the policy is good in theory, but it’s not

workable.’’

Marion, healthcare assistant, care trust.

Even though it is clear that the Trusts are dedicated tothe ethos of flexible working, there are gaps between

policy development, implementation and take up. Thefindings suggest that some managers are aware that staffcan misunderstand who can take advantage of IWLinitiatives:

‘‘We try and encourage the idea that it’s not just about

accommodating people with children, but it’s difficult to

know whether there could still be an element of staff

perceiving it to be that way. I think also, workers over 45

and upwards, perhaps when they were younger, there was

less around, and they may not be as used to the culture of

flexible working as, say, newer entrants would be, where

it’s more or less understood that, at some point, everyone

has this entitlement.’’

Harriet, trust manager, care trust.

There was evidence that older nurses did not perceivethat the flexible working policies applied to them. Therewas a tendency not to ask for it and to organise their livesaround their work schedule rather than organise theirwork around their responsibilities at home.

‘‘I know my partner had a very bad knee and often I would

help him get down the stairs and leave him there because it

was very painful, he was going for operation soon, but for a

long time he couldn’t walk very much. So I’d help him

downstairs and kind of get all the things so that he doesn’thave to move too much in the daytime. And then I would

come in to work and then go home and then help him, or he

would stay in bed for a long time and I’d go home and I’dhelp him. But I never, ever took time off work as a family

person would do.’’

Danielle, G grade community nurse, care trust.

Although both trusts claimed to involve all levels ofstaff in the development of workforce policy there was theview that some policies were idealistic and that there was aneed to widen consultation to include people on the frontline who understand how nurses work to ensure that theyare workable in practice.

‘‘But then you know what they don’t then often see is that

you know the needs of the service are priority, that any

requests like that must be discussed as a team so that other

people don’t feel disadvantaged and all that sort of thing.

So I think, I think they can, I think they can be

implemented, I think some might be slightly idealistic

and sometimes if they’re not written by people, or there

isn’t an input from people who know how nurses work on

an everyday sort of day-to-day basis then you know they

can become quite idealistic, and you sort of think well

that’s, you know we can’t do that.’’

Jean, clinical manager, H grade, acute trust.

Several managers emphasised that the implementationof flexible working must meet the needs of the service toensure that service delivery is not compromised, and meetthe needs of the whole team so that others do not feeldisadvantaged. However, many of the nurses we inter-viewed had a strong sense of duty and commitment to theorganisation and delivery of care and were prepared to put

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426 423

responsibility to others before their own preferences. Eventhough these staff nurses were getting tired and found shiftwork increasingly challenging, they accepted that theneeds of the service came first and their access to flexibleworking was not possible. However, one of these nurseswas being asked to increase the number of nights she didand was concerned that she would not cope.

‘‘I would quite like to work 9 to 5, but I recognise that

actually shift working is quite important in nursing,

because somebody has to be here 24 hours. So we accept

that.’’

Fran, staff nurse, care trust.

4.3. Ward managers have a crucial role in the

implementation of flexible working policies.

There was a strong feeling that immediate line managerswere instrumental in making flexible working available.

‘‘It depends on your manager.’’

Focus group – acute trust.

There was also some evidence that the demand forflexible working was increasing. This was seen to causeconsiderable pressure for ward managers who bore thebrunt of trying to implement family friendly policies in afair, equitable way.

‘‘I certainly get more requests for flexible working! . . .I was

getting a little bit concerned because, you know, some-

times you have to say no. I think people – you have to have

a good reason to say no. I think that’s the bottom line. And I

think, you know, because they see somebody doing these

shifts and ‘why can’t I do it?’ So they have to have a

genuine reason, you know. So it’s just trying to get to the

bottom of why people want these flexible working and for

how long. And sometimes that becomes a problem.’’

Robert, matron, care trust.

Furthermore, managers were also seen to be in aposition where they had to decide which staff would beallowed to work flexibly. UK National policy, which isaimed at parents and carers, has given a clear steer withregard to where central government priorities lie.Although local policy in trust A had taken an inclusiveapproach, there was some evidence that where choices hadto made, parents and carers were prioritised.

‘‘. . .often Managers can be flexible in a certain way for a

certain number of people, so there’s an element of choosing

between staff as well. . ..and where as I would expect a

grandmother, for example, would have equal rights for

flexible working you know say compared with a mother if

the caring responsibilities were the same. It may well be

the older person wanted, say for example, to pursue a

hobby because they’re looking to reduce their hours and

can have set days, the same weighting might not be given

to that.’’

Rick, trust manager, acute trust.

There was evidence that this gate-keeping role of linemanagers or ward managers was very difficult withconsiderable tension between meeting the needs of theorganisation and the individual.

‘‘No the manager normally discusses with HR and make a

decision on that. But often, you know, it’s very, very

difficult, very, very difficult for – managers are put in quite

impossible positions. But you know, if you say ‘‘yes’’, then

you know, the consequences with the rest of the team – if

they know, then they won’t be happy.’’

Alex, service manager, care trust.

Ward managers are required to balance the competingneeds of individuals, ensure that no-one in the team feelsdisadvantaged, develop and maintain good teamworkingand prioritise service delivery ensuring that no extra cost isincurred. In some areas managers had allowed too manystaff to work flexibly. The reasons for this are unclearalthough may possibly include misunderstanding betweenward managers and human resources departments ordifficulty experienced by ward managers in decliningrequests or choosing between staff needs. Clearly flexibleworking is popular.

‘‘I’d be saying to them only if you can run the service as

efficiently as you run it at the moment, and there should be

no extra cost involved at all. But we, but we always, well

our starting point is always you must be as open and

flexible as possible, but you’re allowed to say no. We found

actually managers. . .. were being rather over, over flexible

in some areas, and they had unsustainable rotas as a result.And so in a couple of wards I can think of we had to get

them to go back to basics actually, which was very

unfortunate because everybody was enjoying this flex-

ibility, but from an organisational point of view wasn’tworking.’’

Rick, trust manager, acute trust.

To address this difficult issue, a number of participantshighlighted the need to involve the whole team inimplementing flexible working, for example:

‘‘but really flexible working should be as much a team

based thing as possible because it’s important that a team

feel positive about flexible working, not just the individual

that it’s been granted to and they don’t feel that this person

always gets to cherry pick their hours or their shifts. So the

request would normally go through their line manager in

the first instance.’’

Harriet, trust manager, care trust.

However, there was also some evidence that wardmanagers restricted the availability of flexible workingpossibly due to perceived difficulty in organising workrotas and maintaining sufficient cover for busy clinicalareas and concerns about keeping track of what nurses aredoing.

‘‘culturally there can be resistance in the traditional 24

hour, 7 day week inpatient setting, to working flexibly,because they’re so used to having a set rota system. I think

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426424

historically the rota was probably used as a way to control

people as well. And also doing a rota is quite complicated.It’s not easy to juggle around all these different require-

ments so I suspect there’s still some inpatient areas [. . ..]

still a culture of a bit of resistance.’’

Harriet, trust manager, care trust.

But I’m not really clear about just how open other, you

know Ward Managers, Heads of Nursing are to their staff

working [flexibly]. And one of the issues, I mean I’m just

lucky really, one of the issues that I’ve had mentioned to

me in the past is where someone’s manager has said that

you know if I allow you to work flexibly I won’t get as many

hours out of you.’’

Phyllis, trust manager, acute trust.

The key role of the ward manager was acknowledgedfrequently and this highlights the need to support themand address development needs as their role expands toinclude implementation of complex workforce policies.Furthermore, the need to facilitate greater stability withinservice management was also highlighted:

‘‘. . ..a bit more stability in the management structure

would help because it’s not – the thing is, I suppose it

would help anybody, the retention of anybody really –

because the fact is that it takes a long time for any manager

to understand the intricacy and the complexity of the

workforce individually and personally. But with the

constant change it doesn’t allow that to happen. So I

think, you know, less structural changes, less moving

round the tables, less merry-go-round, so that managers

understand where nurses are coming from.’’

Alex, service manager, care trust.

4.4. The implementation of flexible working may be creating

an inflexible workforce

One of the advantages of an age diverse workforcemeans that flexible working can be more easily imple-mented within teams. In inpatient settings, the absence ofchildcare responsibilities means that older nurses aremore likely to work ‘traditional shift patterns’. Conversely,those with childcare responsibilities adhere to lesstraditional and inflexible shift patterns. Although thefindings suggest that both Trusts appear to benefit from anage diverse workforce, flexible working may inadver-tently produce an inflexible workforce. As one managersaid:

‘‘A quite a high proportion of our workforce are young

people with families who do flexible working. If they’re a

nurse they might be doing say 3 long days so they’ve got a

big chunk of you know sort of time to sort of you know

spend with the family or doing whatever they’re doing, or

they might be having an annual hours contract which is

working term time only. So I don’t necessarily see that you

know it’s the older, the older person that’s doing more of

the part-time working. And in fact I think you would

probably find that that wasn’t the case now because you

know there is so much flexible working that happens

because people want to fit it in more with their younger

families that I think perhaps that switch changed.’’

Laura, trust manager, acute trust.

‘‘very supportive to flexible working. But then the

consequences of that is that if you are not having children,you don’t have a family or the family is grown up, you will

be in the team whereby all your colleagues are working

flexibly, working condensed hours, so the burden may well

be on those people who are more mature and then having

to provide the cover. Someone has to do it. So I think that

needs to be considered by managers, you know, not that

you want – you can’t be totally flexible, you also need to

think about how your work balances out.’’

Alex, service manager, care trust.

Furthermore those older nurses with no childcareresponsibilities may feel they are disadvantaged.

. . .‘‘she’ll always fill in or they’re always doing that, you

know the older ones have this better idea of the word duty

you know. Oh she’s not married, no she’ll have plenty of

time to do this, this or this. It is, it’s sort of almost expected.You know somebody rang me up and said would you work

tonight, and I said no. But you always fill in. . .. It’s sort of

almost expected at times.

Jane, senior staff nurse, F grade, acute trust.

‘‘So somebody can say. ‘I need to be with my children, I

need to work 9 to 5, I can’t do this on-call burden that

you’re giving me, I can’t get childcare provision’ – apart

from the fact that has a knock on effect on the other staff, I

can’t say that because I don’t have young children

increasingly they’re looking at service, what service

needs.’’

Sylvia, G grade, acute trust.

Older nurses may be happy to work regular shiftpatterns. However, there needs to be awareness that theavailability of flexible working to younger nurses does notimpose a burden on older nurses, many of whom may haveincreasing health problems or want to introduce newactivities in their lives. It is known that adapting to shiftwork becomes more difficult with age and many of thenurses in this study described increasing tiredness andmusculo-skeletal problems due to shift work and inparticular increasing difficulty in adjusting to night duty.As one Trust manager said:

‘‘But I must admit I do think sometimes, you know, can you

reasonably expect somebody who is 45 plus, of age, to be

charging around an orthopaedic, 32 bedded orthopaedic

ward, answering every buzzer and giving every bed pan

out, as sprightly as I used to do when I was 24, 25?’’

Josephine, trust manager, acute trust.

5. Discussion

This is a small study based in two inner city healthcaretrusts. Recruitment was limited by ethical requirements,which restricted access to HR records. As a result we relied

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426 425

on nurses volunteering to participate in the study with theinevitable drawback of a self-selecting sample. However,both trusts were very helpful in raising awareness of thestudy, for example, senior managers emailed staff andmanagers inviting them to participate, members of theresearch team were invited to key service area meetings.The research team designed posters with details of thestudy and contact details and both Trusts ensured thesewere displayed in all areas. The research was alsopublicised by a website to provide information to potentialparticipants. Members of the research team also visited theclinical areas and handed out flyers. Nonetheless, evenwith these measures to facilitate recruitment, general-isabilty of findings is limited.

This paper has presented findings on the experiencesand expectations of flexible working for nurses working inmid-life. It has illustrated some of the operationaldifficulties in implementing a national policy at local levelthat suggest flexible working initiatives may be toouniform and prescriptive to accommodate the needs ofall workers. Certainly flexible working is not available toeveryone. The findings across both Trusts reveal a numberof barriers to the successful implementation of flexibleworking for nurses working in mid-life. The increaseddifficulty to implement flexible working in 24-h inpatientareas is not surprising, however, it is interesting that theprofessional culture within nursing appears to discourageflexible working across the board. Several nursesexpressed tensions between wanting to do their job, meettheir own needs and not to let others in the team down.This is an area where further research would be beneficial.

Government policy to address work–life balance isprimarily designed to improve the life of children andparents, and carers of disabled relatives. These ambitionsare important. In the UK it is women who typicallyshoulder the majority of the responsibility for caring forchildren and other relatives. This increasing attention,nationally and internationally, in addressing work–lifebalance is a consequence of changes in employment trendsfor women particularly mothers (Crompton and Lyonette,2006). This rising level of employment among women notonly fulfils the increasing aspirations and ambitions ofwomen themselves but also improves the economic statusof families and contributes to the wider economy and thewelfare state and thus are actively supported. In aprofession where a large majority of workers are womenand the nature of the work is not amenable to some flexibleworking models, e.g. working at home it is not surprisingthat implementation of family friendly working in nursingis difficult. New government legislation may compoundthis difficulty further as parents of children up to the age of16 will be legally supported to request flexible workinggiving added emphasis that flexible working is targeted atparents.

This study suggests that the implementation of flexibleworking has caused strain and may be producing aninflexible workforce with the result that older nurses maybe required to compensate for the flexible workingpatterns of their younger colleagues. There is evidencethat the availability of flexible working is key to retainingnurses (Gould and Fontenla, 2006; Storey et al., 2009b) and

that the desire for flexible working increases as nursesapproach retirement (Cohen, 2006). Working the gaps onthe rota generated by flexible and family friendly workingis likely to cause divisions and resentment amongst staff(Curtis et al., 2006; Wray et al., 2006) not to mentionencourage older nurses to retire early (Andrews et al.,2005). Thus, the policies to encourage nurses to remain inthe workforce may be counterproductive for nursesworking in mid-life. It is suggested that directing policiesto improve work–life balance towards staff with childcareneeds, while very important, may be disadvantaging oldernurses who are likely to be more experienced and skilled.Therefore, there is a need to carefully examine theimplementation of work–life policies in nursing not onlyto maximise the potential of flexible working to retain askilled, older workforce but also to uphold fairness inemployment practice.

The variation in perceptions of access to, and imple-mentation of, flexible working is an issue that needs furtherexploration. Local trust policy subscribes to an inclusiveapproach while the view of nurses and line managers is thatthese policies are unrealistic and unworkable. However, likeDean (2008) this research has indicated that ward managersare key to the implementation of family friendly workingpolicies. Under the present system, it is not unusual for wardmanagers to decide who can have flexible working and whocannot. These choices are made against a backdrop of risingexpectation of the availability of flexible working. Nationalpolicy is extending rights to request family friendly workingand local policy is espousing universal availability (withinthe confines of service delivery). What is the impact of thisrising expectation of the availability of flexible workingwithin a female dominated workforce in a 24 h on-siteservice? Furthermore, there is evidence of mixed messageswithin policy and the views of senior managers and linemangers suggesting that there is tension in the interfacebetween policy and practice. There is a need for greaterclarity and guidance about how to manage this tension. Akey conclusion of this paper is the urgent need to supportward managers to implement workforce policies.

This study indicates that the availability of flexibleworking for nurses is more complex than the conceptualmodel proposed by Budd and Mumford (2006). Similarly,this study found perceived accessibility to be an importantinfluencing factor in the uptake of flexible working policieswith several older nurses assuming that flexible workingwas intended for nurses with children. However, inaddition to the need for health care organisations todecide to offer family friendly policies, and for individualemployees to perceive these policies to be available tothem and then to individually choose to request to work ina flexible way, for nurses there is also the need for their linemanager to determine whether their request can beaccommodated by the rest of the team and will not beto the detriment of the service.

There is a need to explore how feasible it is toimplement these policies in an equitable way withinnursing services that require 24 h cover and for creativesolutions to address implementation of flexible workingfor nurses. Moreover, there is the need to evaluate the costsand opportunity costs of implementing flexible working

R. Harris et al. / International Journal of Nursing Studies 47 (2010) 418–426426

policies. The current assumption that it is possible toimplement an effective flexible working policy that enablesnurses to remain part of the NHS workforce withoutincurring additional costs may be unfounded. Furthermore,as Costa et al. (2004) concluded, although individualflexibility in working arrangements would appear bydefinition to be good, there is little empirical evidence tosupport the effectiveness and benefits of flexible working toindividual staff or the organisations within which theywork.

Acknowledgements

This paper is drawn from an independent reportcommissioned and funded by the UK Department of HealthPolicy Research Programme. The views expressed are thoseof the authors and not necessarily those of the Departmentof Health. We would like to thank the participants in theresearch.

Conflict of interest: None.Funding: Department of Health Policy Research Pro-

gramme.Ethical approval: Ethical approval was given by UK

Central Office for Research Ethics Committees (COREC) –reference number 04/Q0703/153.

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