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Sustainable Opportunity Recognition a Systematic Literature Review on Individual Factors

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  • Journal List
  • Prim Health Care Res Dev
  • v.21; 2020
  • PMC7503170

Prim Health Intendance Res Dev. 2020; 21: e31.

Factors influencing the recruitment and retention of registered nurses in developed customs nursing services: an integrative literature review

Edwin Chamanga

1City Academy London, London, United kingdom

Judith Dyson

2City University London, London, UK

Jennifer Loke

3Academy of Hull, Hull, UK

Eamonn McKeown

4City University London, London, UK

Received 2019 Nov 8; Revised 2020 May ane; Accustomed 2020 Jul twenty.

Abstract

Groundwork:

Adult community nursing services are evolving effectually the world in response to government policies and irresolute patient demographics. Amidst these changes, recruitment and memory of community nursing staff are proving a claiming. An integrative literature review has identified multiple factors that influence nurse retentiveness in adult community nursing with sparse data on recruitment factors. Although factors impacting retention of community nurses take been identified, their generalisability around the earth is a claiming as they are context and co-dependent. Indicating the need for this expanse of report to be explored at a local level, as the same factors present with different findings globally.

Aim:

To establish factors influencing recruitment and retention of registered nurses in adult community nursing services.

Design:

Integrative literature review.

Data sources:

4 electronic databases were searched in August 2019 from January 2008 to December 2018: CINAHL Complete, Web of Science, MEDLINE and PROQUEST. Both qualitative and quantitative studies focusing on factors influencing community nursing recruitment and retention were included.

Review methods:

An integrative literature review methodology by Whittemore and Knafl (The integrative review: updated methodology. Periodical of Avant-garde Nursing 52, 546–553) was followed, supported by Cochrane guidelines on data synthesis and analysis using a narrative synthesis method. The Heart for Evidence-Based Management (CEBMa) critical appraisal tools were used for study quality assessment.

Results:

Ten papers met the study inclusion criteria. Data synthesis and analysis revealed individual and organisational factors influencing the retentiveness of customs nurses with the following three ascendant themes: (ane) work force per unit area, (2) working weather and (3) lack of appreciation by managers.

Conclusion:

The review identified context-dependent factors that influence adult community nurses' retentiveness with limited generalisability. At that place is a lack of data on factors influencing recruitment into adult customs nursing; further research is needed to explore factors affiliated to community nursing recruitment.

Primal words: community nursing, customs nurses, integrated literature review, recruitment, retention

Introduction and background

The demand for chief care, community intendance and community nursing services is on the increase due to world demographic changes (Globe Health System, 2008; Maybin, Charles and Honeyman, 2016; Kroezen et al., 2015). The needs of community nursing patients are changing, requiring a new skill mix responsive to local patient and population needs (Drennan and Ross, 2019; Drennan et al., 2018; Jackson et al., 2015). The increasing need for community nurses is further confounded by challenges with recruitment and retention of nurses with the World Health Organization reckoning it is nearing a universal challenge (World Health Organization, 2016, 2020).

Ane in three adults in developed countries take multiple long-term conditions; this is predicted to double by 2035 (Hajat and Kishore, 2018). By 2050, there will exist a global increase in nursing need due to an ageing population, in both developed and developing countries (United nations, 2015). As nursing home placements are costly, patients are increasingly opting to be nursed at home to mitigate such costs (Maurits et al., 2015a). In nigh countries, a proficient death is defined by people dying in a place of their choice whilst receiving optimal care; this has become a social and political priority (Sines et al., 2013; Gomes et al., 2010; Reed, Fitzgerald and Bish, 2018) and virtually people in both developed and developing nations are opting to die at home in the comfort of family unit and friends whilst receiving customs nursing care.

Governments are urging for the provision of care closer to abode (Edwards, 2014; NHS England, 2015; Reed, Fitzgerald and Bish, 2018; Aiken et al., 2014) based on a recognition that quality and evidence-based healthcare in the community tin can be cheaper than hospital care (Kraszewski and Norris, 2014; Dickson, Gough and Bain, 2011; Maybin, Charles and Honeyman, 2016; Naruse et al., 2012). However, in England, nursing workforce shortage is a greater challenge to community nursing healthcare provision than funding (The Health Foundation, The King'south Fund and the Nuffield Trust, 2018) making it difficult to meet such demands.

The English developed community nursing workforce is diverse and fabricated up of different roles (NHS England, 2015). For example, community matrons, specialist nurses, registered full general nurses and district nurses to name a few. District nurses take an additional specialist qualification to beingness a full general registered nurse and, in most cases, they hold a squad leader office (Queen's Nursing Institute [QNI], 2015). Betwixt 2010 and 2017, commune nurses have declined past approximately 45% with an average vacancy charge per unit of 21% (Stephenson, 2015; Nuffieldtrust, 2017; Marangozov et al., 2017). This is farther precipitated past virtually commune nurses retiring and an underfunding of the specialist qualification (QNI, 2015). In 2014, 35% of developed community nurses were above the historic period of fifty years, in comparison to 23.6% of infirmary nurses, with both groups planning on retiring within a decade (Imperial College of Nursing [RCN], 2012; Brawl et al., 2014).

Customs nurses' telescopic of practice is infirmary avoidance and an improved quality of life for those with long-term conditions, palliative care for those at the end of life who are housebound (Drennan, 2018). Community nurses are currently employed by different organisations, the government through the National Health Service (NHS), charitable organisations, private sector and community interest companies (QNI, 2014; Maybin et al., 2016). Historically, customs nursing services were a single entity provision being provided past commune nurses. However, with population changes and illness, progression models aimed at addressing the changes in demand take resulted in new models of care being designed. For instance, in February 1996, community-integrated intendance teams were introduced, and in September, the same year rapid response teams were introduced (Inspect Commission, 1999). These two services aimed at having a grouping of therapists (nurses, physiotherapists, occupational therapists, social workers and doctors) working as one team from the aforementioned function providing a hospital avoidance service. To date, other models of care such as the @home service, a highly specialised service staffed past highly skilled clinicians aimed at hospital avoidance (hospital at home), by administering therapies and requesting tests which are usually accessible in a hospital setting, has been designed (Lee et al., 2017). In addition to the to a higher place, Buurtzorg model (originated from the netherlands) has been evaluated across the country (Drennan et al., 2018). The Buurtzorg model evolves around small teams of nursing staff providing a range of personal intendance, social and clinical intendance to people in their own homes in a neighbourhood (a smaller area to the one existence currently covered by community nurses). Thus, indicating possible future changes to current community nursing service provision.

Methods

The aim of this integrative literature review was to answer: 'What are the factors that present challenges to community healthcare organisations in recruiting and retaining registered nursing staff into developed community nursing teams?'

Search strategy

A search on PROSPERO database was conducted to establish there were no similar ongoing reviews. The protocol for this review can be found on PROSPERO (registration number CRD42018086197). The databases CINAHL Complete, Web of Science, MEDLINE, and PROQUEST were used as some of the best electronic databases for supporting nursing-related literature searches which are, based on wide coverage of journals, widely used and as well roofing biomedical literature (Allen et al., 2006). Citation review and snowball arroyo were practical to identify papers that may have used unusual terms within the inclusion criteria.

Population, Exposure/Outcomes (PEO) underpinned the research question and search terms equally it sought to understand a phenomenon, which could have been answered using quantitative or qualitative approach (Bettany-Saltikov, 2012). The search terms chosen to answer the review question are presented in Table1; both search terms and search procedure were guided past a bailiwick librarian.

Table 1.

Search terms

Population
'community health nurs*' OR 'chief care nurs*' OR 'home intendance' OR 'district nurs*' OR 'public health' OR 'community healthcare' OR 'community health service' OR 'domiciliary healthcare' OR 'domicilic intendance' OR 'home visi*' OR 'main healthcare' OR 'community nurs*'
AND
Exposure/Outcome
'recruit* OR retain* OR selection OR career* OR employ* OR appoint* OR retention OR turnover OR attrition'

Inclusion and exclusion criteria

The search was restricted to 10 years to maintain a comprehensive yet contemporary review (January 2008–December 2018). Selected studies were peer-reviewed empirical research looking at customs nursing for adult patients (over 18 years of age). Studies which looked at customs nursing equally a subset of other nursing fields were also included due to a dearth solely focusing on community nursing as an contained cohort. All studies were published in English from high- to centre-income countries with a community nursing service comparable to the English language community nursing service. Equally the review procedure accessed international literature, nurses included were registered nurses of any role licensed to provide community nursing care (in peoples' homes) to developed patients with physical health needs. Opinion papers, editorials, secondary research, commentaries and studies funded by charitable organisations were excluded due to the potential risk of bias.

Study selection, information extraction and quality appraisal

Championship and abstract reviews were conducted by EC and JD. JL mediated any study disputes between EC and JD. All the authors reached consensus on all papers which were advisable for a total-text review and inclusion. Details of the papers selected are shown in the adjusted Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart (Effigyane) (Moher et al., 2009). In total, 1106 subject-related papers were identified as shown in Figure1, and these were downloaded to Refworks® from each database for record keeping and further assay. After the removal of duplicates, virtually of the papers did non meet the inclusion criteria past title (as they were either opinion papers, editorials or not inclusive of developed community nursing or, principal care in full general). The remaining papers were reviewed by abstract and 95 did non run into the inclusion criteria every bit they were non-empirical studies and or irrelevant to this review in terms of focus, which left 27 papers for total-text review against the inclusion criteria, from which only 10 papers were selected. Data extraction included writer, aims, location, design, findings and quality appraisal exceptions. The Center for Evidence-Based Management (CEBMa, 2014) critical appraisal of survey and qualitative research tools were used for quality appraisal (Table2).

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Process of newspaper pick – adapted PRISMA flow diagram.

Tabular array ii.

Study characteristics

Author Aim Country/location Design and participants Findings Quality appraisal exceptions
Ellenbecker et al. (2008) To examine the contributions of task satisfaction, nurse, agency and market characteristics and intent to stay employed. United States Random opportunistic survey (northward = 2459) (62% response rate) followed by instrument testing (due north = 1900) (83% response rate) and a further 34% phone chase up of non-respondents bring a total of the two phases to (n = 1912) with complete datasets. Job retention is influenced by: job tenure, job satisfaction, intent to stay, living arrangements, retirement plan; position of direct patient intendance, non-profit agency and area wages.
Intent to stay within an organisation is influenced by: chore satisfaction, directly patient care, educational level and agency size.		 Limited response to the mailed survey in stage 1, no pilot of the instrument and no account of ethical consideration.
Sample size not justified.
Estryn-Behar et al. (2010) To examine specific determinant factors that differentiate betwixt 'stayers' and 'leavers' within the nursing profession and identifying factors for premature leaving. Eight countries (the Netherlands, Kingdom of belgium, Finland, France, Germany, Italia, Poland and Slovakia). Cross-national European survey with 2 time points (baseline) (north = 34,587) follow-up (n = 14,882). Main reasons for leaving employment were associated with working conditions, family unit, health issues and the want for continuing education. Cocky-reported questionnaire bias.
Sample size not justified.
Hai-Xia et al. (2015) To arm-twist the weather condition and factors that crusade job burnout in customs nurses. People's republic of china Convenience survey (n = 420). Job exhaustion is intrinsically linked to leaving employment with the following factors impacting significantly on task burnout: emotional exhaustion, income, work satisfaction, educational opportunities, professional title, and years of employment, age, marital status and educational level. No account of ethical consideration.
Sample size not justified.
Halcomb and Ashley (2016) To identify the most and least satisfying elements of primary healthcare nurse work. Commonwealth of australia Online cross-sectional survey using an instrument designed by the research squad
(n = 950).		 Nigh satisfying aspects were helping people, teamwork, autonomy, work–life remainder and variety of piece of work.
The least satisfying were fourth dimension constraints, lack of space, lack of respect or recognition and poor remuneration.		 Unbalance sample representation as the study had more do nurses than community nurses.
Sample size non justified.
Maurits et al. (2015a) To examine home care nursing staffs' self-perceived autonomy and how this relates to whether they have considered leaving the healthcare sector. The Netherlands Random opportunistic cross-sectional survey (n = 262) (67% response rate). Domicile intendance nurses who perceive more autonomy and are more engaged with their work are less probable to consider leaving. Self-administered questionnaire bias.
Sample size not justified.
Maurits et al. (2015b) To identify task and organisational factors related to self-perceived power to go along working in the current line of work until the official retirement age. The Netherlands Cross-sectional correlational survey with two validated questionnaires (n = 730) completed both questionnaires. Work pressure, appreciation by senior management, autonomy, educational opportunities and communication accept a substantial impact on job satisfaction, which is related to cocky-perceived ability to continue working. Self-reported assumption bias as reported past the researcher, selection bias.
Sample size not justified.
Naruse et al. (2012) To investigate perceptions betwixt perceived time pressure and burnout among home visiting nurses. Japan Self-administered questionnaires with three validated instruments (n = 177) (85.1% response rate). Domicile nurses experienced a higher emotional burnout and depersonalisation every bit they experience overloaded from paperwork, and anxiety during abode visits, due to frequently perceived fourth dimension pressure, with bereft rest time. Self-administered questionnaire bias.
Sample size not justified.
Storey et al. (2009) To examine issues associated with the impact of age on retentiveness of nurses. England Cross-sectional survey using semi-structured postal questionnaires (n = 485) (61% response rate). Nurses are likely to get out in response to high authoritative tasks, work and family unit commitments; and lack of support.
They would also like a reduction in working hours near retirement, reduced workload and pension considerations; older nurses felt it was of import to be valued and considered when changes are existence implemented.		 Lack of representativeness in the sample.
Sample size not justified.
Tourangeau et al. (2014) To identify factors influencing home care nurses' intention to remain employed. Canada Qualitative focus group interviews (north = 50). Home intendance nurses' intention to remain employed is influenced by multiple factors: job characteristics, piece of work structures, relationships and communication, work surroundings, conditions of employment and nurse response to work. Participants cocky-selected to participate in the focus group.
No business relationship of interview question pilot study.
Tummers et al. (2013) To analyse the bear upon of six task characteristics on the intention to exit employment. Kingdom of the netherlands Survey of (north = 9982) nursing home, care home and home care nurses using comparable validated questionnaires. Nurses' intention to get out is personal and context-dependent; however, lack of development and career opportunities are the most important factors, followed past a negative working atmosphere. Sample size not justified.

Analysis

An integrative literature review arroyo was chosen as it permits the inclusion of empirical studies conducted with varied methodologies (Whittemore and Knafl, 2005). Specifically, qualitative, and quantitative using different methods, without following a rigorous systematic process on inclusion papers. Data were extracted according to the review question and a Cochrane narrative synthesis was employed as the method of information analysis as information technology is a robust and systematic method (Ryan, 2013; Snilstveit et al., 2012).

Results

From the selected 10 empirical studies, 3 were from the Netherlands and there was i study conducted in each of the following countries: Canada, U.s., Red china, Australia, Nippon and England. The tenth paper included was from Europe including viii countries (kingdom of the netherlands, Belgium, Republic of finland, France, Germany, Italy, Poland and Slovakia). All but one of the studies were surveys, the exception being focus grouping interviews.

Synthesis of results and emergent themes

In that location were no studies constitute relating to the recruitment of community nurses. Yet, at that place were 10 reviewed studies focusing on factors which influence retention of customs nurses, with emergent and recurring private and organisational themes that were so selected for synthesis. They were identified by similarities, before existence clustered together, either every bit a main theme or a subtheme as shown in Effigy2. The three key themes were (one) work pressure, (two) working weather condition and (three) lack of appreciation by managers. Each will be discussed along with the included subthemes.

An external file that holds a picture, illustration, etc. Object name is S1463423620000353_fig2.jpg

Themes and subthemes from the reviewed literature.

Individual factors

Work pressure

Eight studies identified work pressure level (caseload and workload) as a factor that influences the decision for community nurses to remain or leave employment (Maurits et al., 2015b; Estryn-Behar et al., 2010; Ellenbecker et al., 2008; Tummers et al., 2013; Storey et al., 2009; Halcomb and Ashley, 2016; Naruse et al., 2012). In i written report, 60–lxx% of nurses identified piece of work pressure as an of import factor that would influence their decision to leave employment (Estryn-Behar et al., 2010). Information technology is worth noting that this study included nurses from other fields of nursing non simply community nurses and it was not possible to disaggregate responses. However, this argument was also supported two other studies (Ellenbecker et al., 2008; Tourangeau et al., 2014), which focused only on community nurses. Both the authors argued that a reduction in stress and piece of work force per unit area supports nurse retention. Storey et al. (2009) institute caseload pressure linked to early retirement of community nurses who are nearing their retirement age. Participants in one report said they would prefer a lighter workload rather than retire (Storey et al., 2009). The same study found 36% of participants identified staff shortages and increased workload as precipitating factors towards early retirement from community nursing. However, staff retirement is a by-production of staff being overwhelmed cypher to do with recruitment and retention. Unsurprisingly, increased work force per unit area correlated with reduced occupational commitment and subsequent negative task satisfaction, impacting on patient prophylactic and quality of service being provided (Maurits et al., 2015a). Similarly, study participants in Halcomb and Ashley'southward (2016) study felt rushed and spending less time as desirable with patients. Equally rightly pointed out by Naruse et al. (2012), xxx% of community nurses feel time pressure ofttimes due to workload, which results in higher levels of emotional exhaustion.

Poor piece of work–life balance

Community nurses were establish to exist dissatisfied with their work–life rest with challenges in meeting piece of work and family demands in 4 studies (Storey et al., 2009; Tourangeau et al., 2014; Estryn-Behar et al., 2010; Naruse et al., 2012). From focus groups conducted by Tourangeau et al. (2014), community nurses reported of working from home after hours, with the process being described every bit stressful, characterised by paperwork to be completed and order of supplies. Eighty-eight per cent of participants in a study by Naruse et al. (2012) reported of insufficient rest time. Conversely, Estryn-Behar et al. (2010) notation starting a family and caring for a family fellow member are challenges associated with achieving a work–life balance, especially for those with total-fourth dimension contracts.

Emotional exhaustion

A study by Hai-Xia et al. (2015) defined community nursing associated with emotional burnout as a situation, where customs nurses cannot easily address challenges they are facing at work. These challenges were reported to be a effect of piece of work environment and workload, which will result in perceived time pressure and job exhaustion, leading to staff turnover, due to decreased job satisfaction and lack of professional person pride (Naruse et al., 2012; Hai-Xia et al., 2015). Emotional exhaustion every bit a reason for leaving employment in over 50% of participants (Estryn-behar et al., 2010) and Hai-Xia et al. (2015) observed a positive relationship between married community nurses and emotional burnout. As married community nurses presented with a higher score of emotional exhaustion in comparison to their unmarried counterparts, this highlights family unit life equally a significant gene that can influence community nurses' decision-making in relation to remaining employed.

Depersonalisation

A report by Hai-Xia et al. (2015) reported depersonalisation to exist (the adoption of negative and indifferent attitudes towards others) positively correlated with job burnout. And Naruse et al., (2012) found that customs nurses who perceive job-related time pressure are likely to feel a higher level of depersonalisation. Fourth dimension force per unit area is felt past community nurses at patients' homes and during commuting with 95% reporting of feet during dwelling house visits (Naruse et al., 2012). Emotional exhaustion, poor work–life residue and depersonalisation are positively correlated (Hai-Xia et al., 2015; Naruse et al., 2012).

Organisational factors

Working conditions

In a cantankerous European report with participants from different nursing fields, including community nurses, the main and most frequent reason for leaving an organisation was poor working conditions (Estryn-Behar et al., 2010). A poor piece of work atmosphere was the 2d highest ranked motive for people to leave employment; conducive working conditions enhance an organisation'south power to retain community nursing workforce (Tummers et al., 2013). The nature of these working atmospheric condition was not divers. Conversely, a positive work atmosphere including pleasure at work, skillful squad spirit and collegiality was found necessary for community nurses' retentivity (Tummers et al., 2013).

Lack of autonomy

Six studies identified community nurses are likely to remain employed if they felt democratic (empowered/contained) within their roles (Maurits et al., 2015b; Tummers et al., 2013; Maurits et al., 2015a; Halcomb and Ashley, 2016; Tourangeau et al., 2014; Estryn-Behar et al., 2010). Autonomy encourages task satisfaction which promotes staff retention (Maurits et al., 2015b) and dissatisfaction with a lack of autonomy is a contributing cistron towards the decision to leave an organisation (Estryn-Behar et al., 2010; Tummers et al., 2013). Whilst autonomy was valued, some community nurses found information technology isolating and stressful (Halcomb and Ashley, 2016).

Salaries and wages

There is some testify to suggest that nurses employed in Eastern European countries are probable to leave employment due to remuneration in comparison to those in other European countries (Estryn-Behar et al., 2010). Notwithstanding, some community nurses felt their low wage rate was mitigated past practiced working atmospheric condition (Halcomb and Ashley, 2016). Some nurses said their bacon or wage did not reflect the amount of work and responsibilities of their jobs (Halcomb and Ashley, 2016; Storey et al., 2009). Community nurses earning below a sure threshold are more likely to feel emotionally exhausted and burnout, with a higher intent to leave employment (Hai-Xia et al., 2015). Salaries and wages were used as some of the studies had participants on a monthly salary, whilst others had a wage paid based on the hours worked per week.

Lack of educational opportunities

Educational opportunities (career opportunities/personal evolution) were identified as of import factors in retaining community nurses in five studies (Estryn-Behar et al., 2010; Tummers, Groeneveld and Lankhaar, 2013; Maurits et al., 2015b; Halcomb and Ashley, 2016; Storey et al., 2009). In a study by Halcomb and Ashley (2016), most participants were dissatisfied with access to education and training, leading to staff turnover. Development and career opportunities are of import for retaining workforce in community nursing (Estryn-Behar et al., 2010). In dissimilarity, Maurits et al. (2015b) argue a lack of educational opportunities lonely is not straight significant for staff turnover. However, combined with other factors, it increases 1's likelihood of leaving employment. This is also evidenced by Storey et al. (2009) where community nurses nearing retirement were happy to take early retirement as they felt, there were no further educational opportunities; they had reached the 'ceiling' of their career.

Increased administration

Four studies identified community nurses' assistants (paperwork) every bit a risk factor that has a negative affect on workforce retentiveness (Halcomb and Ashley, 2016; Storey et al., 2009; Tourangeau et al., 2014; Naruse et al., 2012). Over ninety% of participants who took part in the community nurses' task burnout report (Naruse et al., 2012) felt overloaded by paperwork. Similarly, Tourangeua et al. (2014) and Storey et al. (2009) identified issues not simply with the quantity of community nurses' paperwork but also how this had to be done in their own fourth dimension with no remuneration and duplication of effort in having to paper then electronic records.

Lack of appreciation by managers

Four studies identified a lack of appreciation (recognition) by managers as a motive for community nurses to consider leaving employment (Halcomb and Ashley, 2016; Tummers, Groeneveld and Lankhaar, 2013; Storey et al., 2009; Maurits et al., 2015b). Occupational commitment, task satisfaction and staff retention are positively linked to appreciation by managers Maurits et al. (2015b), Although, Tummers et al. (2013) establish appreciation by managers had a modest but even so important bear upon on community nursing memory. Nurses feeling particularly undervalued, especially when being managed by not-clinicians as they believed they had no understanding of their work (Halcomb and Ashley, 2016. Similarly, Storey et al. (2009) establish job satisfaction diminishes when there is a lack of appreciation past managers.

Application of cognition and skill

Ii studies identified community nurses were dissatisfied when they were unable to use of their competencies and this influenced their conclusion to consider leaving employment (Estryn-Behar et al., 2010, Tourangeau et al., 2014). The awarding of knowledge and skill with a variety of patients is essential to task satisfaction and retaining customs nurses (Tourangeau et al., 2014).

Provision of pension and benefits

A good exit pension was a factor influencing the retention of community nursing staff who are nearing retirement, though few nurses understood their pension options (Storey et al., 2009). The pension was not enough to the remaining in the workplace, other factors such equally an opportunity for reduced working hours and workload were besides of import.

Discussion

Our exploration of literature identified a multitude of factors which influence the retentions of nurses as highlighted above at both individual and organisational level. Interestingly, the World Health Arrangement (2020) suggests that in some situations, nurse retentivity can exist solved by improving salaries, specifically pay equity, working conditions with developmental opportunities and lastly enabling nurses to piece of work to the full extent of their scope of do. Some of these factors take already been identified as influencing factors towards the retention of community nurses as shown above. However, drawing from the wider literature, a number of studies have considered why infirmary nurses exit employment and many of these studies cite job satisfaction (Lu et al., 2012), effectiveness of nurse managers (Halter et al., 2017), staffing levels (Hairr et al., 2014), work autonomy and collegial relationships (Duffield et al., 2014) equally influencing factors. No dubiousness, some of these factors mirror those highlighted to a higher place. Yet, contextual differences should be considered when analysing these factors. As the setting or the context may accept an influence on the level of resilience for the nurse.

Community nurses as democratic practitioners, in most cases, they are lone workers, working in isolation and this may influence their controlling. For case, 1 pregnant departure for community nursing compared with hospital nursing is the nurse–patient ratio related to safe staffing levels and its impact on chapters modelling (Keller et al., 2013; Hairr et al., 2014). A infirmary ward has a manageable flow of patients usually with the aforementioned levels of acuity, and the ward tin can control the number of admissions which means the nurse–patient ratio can be managed; this is not the case in community nursing and at that place is no provision of establishing a nurse–patient ratio (Jackson et al., 2016). Thus, putting more need on community nurses not only based on skill mix but an expectation to be able to manage all patients with varying levels of vigil. As a upshot, community nurses go task-focused to consummate a job, or in some cases, patient visits are reassigned to another day, impacting on continuity of care (Maybin et al., 2016) and such practices do influence one's determination to remain employed (RCN, 2018). It is recommended that patient acuity and skill mix are considered when addressing nursing workforce bug (Tevington, 2011; Hairr et al., 2014). This results in increased piece of work pressure on community nurses, which volition negatively bear upon on their work–life balance, resulting in poor emotional well-being and may effect in depersonalisation.

Despite some of the nurse retentiveness factors being similar betwixt hospital and community nursing, the supply and demand of nurses is a challenge for both sectors (Lee et al., 2017) with a huge affect on customs nursing. Equally community nursing is a subset of the nursing workforce later hospital nursing, competing for the same supply of nurses (Drennan et al., 2015). Furthermore, in England, there has been a steady turn down of community nurses between 2008 and 2018, equivalent to one in three and this decline is currently estimated at 37% (Rolewicz and Palmer, 2019). Therefore, the presentation of similar retentivity factors to an already depleted workforce will accept dissimilar implications between infirmary and community nursing workforce. It is worth noting economies of calibration which are enjoyed by most hospital trusts have an influence on how much extra administrative workload is washed past nurses related to caring. This is based on differences in their funding and contractual obligations. As hospitals tin can either specifically create nursing roles to address such workloads, which may be a luxury for customs nursing organisations, given the reduction in the pool of staff they can recruit from and financial commitments (Everhart et al., 2013; Beech et al., 2019).

The English nursing register indicates that nurses exit employment before the age of retirement, due to alternative career opportunities, which may attract flexibility and better working conditions (Nursing and Midwifery Council, 2017) and these factors have been identified hither too. In addition to this, nurses have been reported of using the profession every bit 'stepping stone' (McCrae et al., 2014). This peradventure is related to poor provision of alimony and benefits, and remuneration. However, it is unknown how many community nurses and how many hospital nurses have taken this arroyo or have identified opportunities elsewhere. Overall, literature shows the absence of constructive and efficient models considering organisational, professional and personal factors, impinging the development of interventions capable of improving the retention of nursing workforce (Halter et al., 2017).

Current workforce strategies

Show suggests that electric current nursing workforce retention strategies have been mainly focusing on infirmary nursing staff, with naught specific for community nursing, subsequently customs nurses are regarded as 'the invisible workforce' (QNI, 2009, 2014; RCN, 2013; ). This is not the only flaw, in that location is also evidence suggesting that these memory models are not co-created with the frontline staff, they are a pinnacle-down arroyo (The King'due south Fund, 2014), and in some cases, they are unevaluated and their bear upon is unknown (Ellenbecker et al., 2007). For example, in England, a serial of measures were put in place in the early 2000s, to date, and it is withal unclear if these measures have been a success at retaining staff or if they were fifty-fifty implemented (Halter et al., 2017). Schemes such as workplace nurseries and 'golden handshakes' accept been implemented to entice nurse to join an organisation and remain employed within the organization (Drennan et al., 2011; Kleebauer, 2016; Jeffrey, 2017). In 2017, a national nurse memory initiative was implemented in England with seven steps for organisations to aid amend their staff retention (NHS Improvement, 2017).

To address nurse retention, some organisations have developed mentorship/preceptorship schemes, mainly aimed at newly qualified nurses (Forlines, 2018; Camarena, 2018; Sherrod et al., 2020). As a outcome, nurses have been noted to take improved job satisfaction, thus leading to retention. Still, longitudinal studies are needed to evaluate the effectiveness of these schemes with staff retention (Camarena, 2018).

In some cases, there are regional disparities in terms of what is existence implemented as a fashion of staff retentiveness. For example, in London, there is the Capital Nurse project aimed at returning student nurses who were trained in London to work in London (Longhurst, 2016). Therefore, at that place is a need for the co-creation of customs nursing-specific retentivity strategies which are informed by lived experiences of community nurses to inform policy.

Limitations

There were several limitations associated with this review. First, research on customs nursing recruitment and retention, is lacking for the former, scant and various for the latter. Second, the heterogeneity of methods, instruments and surveys (and included constructs or items).

Tertiary, we cannot exist confident we have captured all studies relating to customs nurse retentivity due to the range of job descriptions and the potential for a range in or chore expectations. However, nosotros thoroughly reviewed citations and used a snowball approach to identify other terms or potential papers.

Fourth, the reviewed papers' quality of included papers was variable. Included papers were more often than not surveys offering no more a snapshot of information and providing no depth of agreement of the issues relating to retentivity of customs nurses or the potential solutions to the problems. Equally a result, these methodological bug hampered the extent to which conclusions could exist drawn.

Fifth, upstanding considerations were considered in all simply a few studies. Notwithstanding, information technology is unknown whether the absence of reference to ideals approval represents researchers' failure to detect the procedure or failure to written report the process.

Hereafter research

Further inquiry exploring both recruitment and retentivity into customs nursing will be able to inform on factors impacting on community nursing recruitment and retention challenges. And this needs to take a qualitative approach, in order to fully explore recruitment and retention factors in detail in comparing to using a predetermined questionnaire, which may non be able to provide detailed information on either individual or organisational influences.

Conclusion

At that place are multitude of factors which influence community nurses' retention with a lack of information on recruitment factors, and it is difficult to depict a conclusive statement as some of the factors which influence retention also influence recruitment. From the explored studies, factors influencing retention are context-dependent, co-dependent and vary from one clinician to some other, and one country to another.

Acknowledgements

The authors give thanks Fiona Ware, subject field librarian and skills counselor at the University of Hull, for her assistance with retrieving some of the reviewed research papers included in this review.

Author contributions

All the authors have agreed on the final version.

Conflict of interest

No conflict of involvement.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503170/

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