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

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.