Nurses are one of the primary health workers in the health system who are still experiencing a crisis or lack in terms of number, type and quality. It is estimated, the world will experience a shortage of 7.6 million nurses by the end of 2030. This situation will worsen if the government or relevant stakeholders do not make strategic and systematic efforts to maintain nurses in their workplaces. This effort to maintain a nurse is known as nurse retention.
Nurse retention is widely recognized as an important international workforce issue, but the concept remains ambiguous. So far, there is no concept analysis of nurse retention developed to clarify the concept or meaning, despite numerous studies, reviews, and policies on the issue of human health resources. Given the variability of terms and definitions used, an analysis of the concept of nurse retention is needed to obtain clarity and a better understanding of this nurse retention phenomenon.
This study aims to examine the concept of nurse retention to identify the attributes, antecedents, and decisive consequences. A comprehensive analysis will contribute to increasing awareness of retention in health issues and the nursing profession. Improved understanding will lead to the development and adoption of evidence-based recruitment and retention initiatives in health facilities that effectively address current and future shortages of the nursing workforce.
In analyzing the concept of “nurse retention”, a systematic eight-stage analytical procedure is performed using the Walker and Avant (2004) concept analysis approach. This approach includes: (i) choosing a concept; (ii) determine the purpose of the analysis; (iii) identifying all concepts used; (iv) defining attributes; (v) identifying case models; (vi) identifying additional cases; (vii) identifying antecedents and consequences; and finally (viii) defining empirical references.
The concept analyzed is the concept of nurse retention, which is stated in various terms in the literature, including ” retention ” and ” intention to stay ” in nursing human resources. Literature searches are limited to nursing, from three databases (Web of Science, CINAHL, and PubMed), references published between 2000-2018 and written in English. Other relevant documents which complement and add value to the research article were also reviewed. An initial literature search resulted in around 230 publications. After removing the duplication, use Endnote and filtered based on titles and abstracts that match the criteria. Forty-one articles were taken that met the inclusion criteria, which were then reviewed and analyzed to identify the attributes, antecedents, and consequences of nurse retention.
Based on a review of relevant literatures, four general attributes of nurse retention were found, namely: (i) motivation, intentions, and individual decisions; (ii) strategies and interventions; (iii) geographical context; and (iv) attachment to work. Motivation and intention are essential characteristics of nurse retention that influence an individual’s decision to remain in the hospital rather than leaving their job. An effective nurse retention strategy is critical for managers to ensure that there are competent nurses to provide high-quality health care at an affordable cost. Geographical factors must be considered by an organization during planning, implementing, and evaluating initiatives to manage nurse retention, especially in developing countries.
There are four preliminary categories in the concept of nurse retention that is identified, the health system at the macro level, health facilities, health workers, and living conditions. Based on the literatures, nurse retention brings impacts on three entities: individuals/nurses who remain in their work, health service organizations, and a country’s overall health care system. Retention measures must focus not only on the number of employees who leave work but must also include the characteristics of those who have left work to be evaluated from time to time as a reflection of nurses’ intentions to remain in their profession or go and find a new job.
Nurse retention is a complex and dynamic concept that involves psychological, managerial, political, and health aspects. This concept has four defining attributes, namely: motivation-intention and individual decisions; strategy and intervention; geographical context; and attachment to work. Nurse retention is driven by external factors at the macro-level of the health system and health facilities, as well as personal/individual factors. The level of nurse retention has consequences for the nurse itself, the health care organization where the nurse works, and finally, for the national and international community. Based on an analysis of this concept, it is clear that a comprehensive strategy is needed to recruit and retain professional nurses effectively in an organization.
Author: Ferry Efendi RN, M.Si, Ph.D
https://www.scopus.com/authid/detail.uri?authorId=55301269100
Details of research available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/nhs.12629
Efendi, F. et al. 2019 ‘Concept analysis of nurse retention’, Nursing & Health Sciences, p. nhs.12629. doi: 10.1111/nhs.12629.
