Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review

Abstract

Background: nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective: to evaluate the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. Design: this is a systematic review Data sources: Online databases including Academic Search Complete, Medline, Health Policy reference Centre, EMBASE, Psychinfo, CINAHL and the Cochran Library were searched to identify relevant publications in English published between 2001 and April 2018. Studies included evaluated an intervention to increase retention or reduce turnover and used turnover or retention figures as a measure. Review methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were quality-assessed using the Joanna Briggs Institute Critical Appraisal tools for Quasi Experimental and Randomised Controlled Trials. Retention/turnover data were used to guide the comparison between studies and appropriate measures of central tendency and dispersion were calculated and presented, based on the normality of the data. Results: A total of 11, 656 papers were identified, of which 53 were eligible studies. A wide variety of interventions and components within those interventions were identified to improve nurse retention. Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. Conclusions: Methodological issues impacted on the extent to which conclusions could be drawn, even though a large number of studies were identified. Future research should focus on standardising the reporting of interventions and outcome measures used to evaluate these interventions and carrying out further research with rigorous methodology. Clinical practice areas are recommended to assess their current interventions against the identified What this paper adds • Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. • These characteristics can be used as a foundation for developing or refining transition programmes for early career nurses so that maximum return on investment is achieved.

Development and evaluation of a prospective staffing model to improve retention

“…In a recent, systematic review of the international literature on workforce stabilization in health care systems, although 53 interventions for improving nurse retention met criteria for the review, few were focused on the needs of nurse leaders (Brook et al, ). Nurse manager needs addressed in this study, including lack of tools to assess and predict local workforce fluctuation, a dearth of practical strategies for NMs to use in building stability and lack of professional development opportunities for NMs represent important underlying threads affecting workforce volatility.…”

“…Using such a model to predict turnover may allow leaders to hire ahead of turnover, decreasing the gap between turnover of functional staff and the recruitment, hiring and training of nurses new to the organisation. Having consistent evidence‐based approaches for onboarding and orienting newly hired nurses has been previously identified as a critical element to successful staffing (Brook et al, ); however, tools to support this endeavour are difficult to identify. The strategies represented in the Prospective Staffing Model provide a standardized, consistent methodology for nurse leaders that enables transparency in projected vacancies and guides the leader to hire prior to current staff leaving their job.…”

“…In a recent, systematic review of the international literature on workforce stabilization in health care systems, although 53 interventions for improving nurse retention met criteria for the review, few were focused on the needs of nurse leaders (Brook et al, 2019).…”

“…Nurse manager needs addressed in this study, including lack of tools to assess and predict local workforce fluctuation, a dearth of prac- identified as a critical element to successful staffing (Brook et al, 2019); however, tools to support this endeavour are difficult to identify. The strategies represented in the Prospective Staffing Model provide a standardized, consistent methodology for nurse leaders that enables transparency in projected vacancies and guides the leader to hire prior to current staff leaving their job.…”

“…As a result, a disproportionate number of newly licensed nurses are hired into acute care environments. Often new hires are onboarded without a structured, clinically based learning process with frequent feedback, an approach which has demonstrated more effective transitions into practice (Jones, ), reduced turnover (Brook, Aitken, Webb, MacLaren, & Salmon, ) and improved intention to stay (Karlsson, Gunningberg, Backstrom, & Poder, ). In the United States, the overall rate of RN turnover in critical care is high at 18.2% (NSI Nursing Solutions Inc., ).…”