Nurses’ intention to stay in the work environment in acute healthcare: a systematic review

Abstract

Background With staffing shortages affecting increasing numbers of health services globally, and predictions that shortages will worsen in the future, there is broad consensus that leaders at all levels must do more to support and develop current employees. However, the wide range of attributes of a healthy work environment identified in the literature and the financial implications of creating healthy work environments make it challenging to determine which elements of the nursing work environment are the most important in terms of workforce sustainability. This is a significant gap in our knowledge, and there is no consensus in the literature regarding definition and explanation of work environment factors in a way that facilitates prioritisation. Objectives The aim of this review was to synthesise and evaluate the evidence of the factors which may have an effect on intention to stay and role of the work environment in enhancing nurses’ intention to stay in the work environment in acute healthcare. Design and methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. A comprehensive search was performed for relevant articles published between 1990 and December 2017 using the following electronic databases: Allied and Complementary Medicine Database (AMED), Excerpta Medica dataBASE (EMBASE), ProQuest Nursing & Allied Health Source, ProQuest theses and dissertations, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MEDLINE (Ovid) and PsycINFO. The reviewers independently screened the abstracts and full texts, extracted data, and assessed the methodological quality of the included papers using appropriate tools. Results A total of 4968 studies were screened by title, abstract, and full-text review, and 29 studies were included in this review. The identified determinants of nurses’ intention to stay were grouped into four main categories: individual indicators (personal and professional), organisation/profile, work environment, and patient-related. Several working environment variables identified in this review were significantly associated with the nurses’ intention to stay. Conclusion Despite the limitations of this review, the evidence indicates that attention to meso-level variables such as organisational characteristics and work environment is vital if the working environment is to improve and nurses’ intention to stay is to increase. The multifaceted nature of the concept of intention to stay makes it difficult to present definitive conclusions based on the findings of this review. However, the identified theoretical models were instrumental in differentiating intention to stay from other concepts such as intention to leave, turnover and retention, theoretically, and operationally.

A systematic review study on the factors affecting shortage of nursing workforce in the hospitals

“…overload and low-level job satisfaction are factors that cause staff turnover (Adams et al, 2021;Aeschbacher & Addor, 2018;Aiyub et al, 2013;Alameddine et al, 2017;Alshmemri et al, 2013;Chan et al, 2013;Drennan & Ross, 2019;Gray et al, 2018;Heijden et al, 2019;Hung & Lam, 2020;Ke & Stocker, 2019;Leineweber et al, 2016;Liu et al, 2018;Masenyani et al, 2018;Nantsupawat et al, 2017;Purohit & Vasava, 2017;Sirisub et al, 2019;Uthaman et al, 2016;Varasteh et al, 2021;Yahyaei et al, 2022;Yang et al, 2017). Another 10 (20.83%) articles confirmed that poor salaries or no changes to salary and poor working conditions are some of the contributing factors to nurses' turnover (Alameddine et al, 2017;Alreshidi et al, 2021;Chan et al, 2013;Hudgins, 2016;Kakemam et al, 2019;Marufu et al, 2021;Mehdaova, 2017;Park & Yu, 2019;Sirisub et al, 2019;Souza et al, 2017) and four (8.3%)…”

“…While the world has credibly acknowledged nursing profession as vital in delivering healthcare services, one of the main challenges faced today is the shortage of nursing workforce, which causes severe compromise on the quality of healthcare services, and in improving the well‐being of the global population and in achieving universal health coverage (Adams et al, 2021 ; Alameddine et al, 2017 ; Kurjenluoma et al, 2017 ; Park & Yu, 2019 ; Yahyaei et al, 2022 ). This is due to disproportions between the number of existing nurses and those that are entering the nursing profession compared with the required number of nurses to meet the patient's needs (Hudgins, 2016 ).…”

“…This is due to disproportions between the number of existing nurses and those that are entering the nursing profession compared with the required number of nurses to meet the patient's needs (Hudgins, 2016). Many studies discovered that there are discrepancies in the supply of nurses to maintain the adequate number of nursing workforce in response to ageing population, retirement along with the new recruitment of nurses as well as in retaining the existing nurses, which made it difficult to respond to the growing demand (Adams et al, 2021; Alameddine et al, 2017; Heijden et al, 2019; Matsuo et al, 2021; Otto et al, 2019; Park & Yu, 2019; Yahyaei et al, 2022). For instance, in the United States of America (USA), there is an extreme shortage of nurses as it will need approximately 3 million nurses to fulfil its nursing gap, a demand that cannot be easily achieved (Yun et al, 2010) and an estimate of 12.9 million deficit of skilled nurses and midwives by 2035 (Adams et al, 2021; Yahyaei et al, 2022).…”

“…Many studies discovered that there are discrepancies in the supply of nurses to maintain the adequate number of nursing workforce in response to ageing population, retirement along with the new recruitment of nurses as well as in retaining the existing nurses, which made it difficult to respond to the growing demand (Adams et al, 2021; Alameddine et al, 2017; Heijden et al, 2019; Matsuo et al, 2021; Otto et al, 2019; Park & Yu, 2019; Yahyaei et al, 2022). For instance, in the United States of America (USA), there is an extreme shortage of nurses as it will need approximately 3 million nurses to fulfil its nursing gap, a demand that cannot be easily achieved (Yun et al, 2010) and an estimate of 12.9 million deficit of skilled nurses and midwives by 2035 (Adams et al, 2021; Yahyaei et al, 2022). Furthermore, it is estimated that the shortage of nurses may exceed 500,000 by year 2025, while in Europe, 590,000 nursing vacancies are estimated by year 2020 (Valizadeh et al, 2016).…”

Transformational leadership and predictors of resilience among registered nurses: a cross-sectional survey in an underserved area

“…Transformational leadership is positively correlated with worker engagement, organizational commitment, and job satisfaction [29]. Furthermore, transformational leadership predicts job satisfaction [30], which in turn predicts nurses' intent to stay [31].…”