Implications for practice and research

• Front-line nursing leaders can choose from a variety of pragmatic strategies to improve the workplace and increase nurses’ desire to stay.

• Implementation science approaches to retention allow researchers to examine evidence-based strategies in different contexts and identify the skills needed by front-line leaders for effective implementation.

Context

Nursing workforce shortages have gained global attention and concern, with surveys highlighting high rates of nurses who are burned out and want to leave their job1 and health facilities reporting difficulties in attracting and retaining staff.2 Nurse turnover, defined as leaving a job or organisation, and retention, defined as staying in a job, have been urgent matters in healthcare for years, but the lack of consistent reporting mechanisms makes it difficult to quantify turnover outside of organisations. Instead, nurses’ intentions to leave or stay are often used as outcomes and have been attributed to factors such as workplace features and leadership.3

Findings

Findings focused on four themes, termed ‘guiding lights’, shown to improve nurse retention: (1) fostering relational connectedness; (2) enabling professional practice autonomy; (3) cultivating healthful workplace culture and (4) facilitating professional growth and development. Within each theme, multiple examples of strategies were linked with different desired outcomes. For example, in the ‘enabling practice autonomy’ theme, strategies such as encouraging nurse participation in planning and achieving unit quality objectives could improve satisfaction and engagement, both of which are linked to improved retention rates or intent to stay.

Commentary

This study provides a needed perspective on nursing workforce issues, acknowledging the pervasive and complex nature of turnover and highlighting pragmatic approaches to improve retention of nurses. While previous reviews have noted the difficulty in comparing intentions to leave with actual turnover,3 the model used in this review shows job intentions as part of the turnover process which can be influenced by factors specific to an individual’s workplace. By emphasising the process and the context of turnover, the study provides multiple strategies that can be used to improve a given workplace without incurring the costs of additional resources or programming beyond supporting front-line leadership to make change. This front-line approach emphasises the locality of workplace issues and allows for direct intervention rather than a top-down or prescriptive approach adopted by administrators. With the diversity of strategies and targets, study findings apply to any and every nurse work environment, and support an implementation science approach to projects that allow for contextualisation of interventions, flexibility, and tracking of results, which can be used to further develop the context-method-outcomes models in meaningful ways.

This study and its ‘guiding lights’ provide strategies to address a complex issue that has been worsened by the stress, demands and trauma of working through the pandemic. The strategies presented here involve a person-centred approach of connecting with nursing staff to increase communication, support and involvement of nurses to strengthen positive workplace features, promote retention and improve patient outcomes. In addition to improving staff retention, the investment in targeted education and support of front-line nursing leaders helps develop their skills, improve their retention, and prepare them for promotion to larger leadership roles.5 Altogether, the study provides a hopeful and optimistic perspective on retaining a supply of engaged and satisfied nurses to meet the needs of patients and communities.