Experienced nurses depart the workforce in significant numbers; therefore, it is critical to understand how those departures affect patient care and safety. The focus of this systematic review included appraisal of recent research to provide an understanding of strategies used in acute care settings to retain experienced nurses. Guided by Benner's model of skill acquisition, the purpose of this systematic review was to identify factors that influence the decision of nurses with experience to leave or remain working in acute care work settings. The 19 articles selected for this review were limited to those pertaining to experienced registered nurses who have worked in the acute care setting for 2 years and longer. The review excluded articles pertaining to registered nurses with fewer than 2 years of experience, who were considered at the novice or proficient level of nursing. The results of this literature review showed that management conflicts, lack of support, work environments, work schedules, and disproportionate staffing levels were among the factors leading to morale distress and burnout in experienced nurses. These findings have the potential to contribute to positive social change by guiding administrative efforts to retain experienced nurses and improve mentoring of newer nurses and, ultimately, improve patient outcomes.

School nurses who transition from hospital or clinic-based settings to a school-based work environment often lack sufficient transitioning skills and orientation to cope with the roles and responsibilities of school-based nursing. The result is a high attrition rate among school-based nurses. School nurses may leave their positions due to experiences of marginalization, including isolation, role confusion, and barriers to practice. In this phenomenological study, the lived experiences of 12 school-based nurses who transitioned from hospital or clinical settings were explored. Bandura's self-efficacy and Spreitzer's psychological empowerment theories were used in interpreting the findings. Data were collected via face-to-face individual interviews with nurses residing in the State of Maryland. The study findings revealed the difficulties experienced by these nurses during the initial years of their transition to school nursing. Multitasking was very challenging at the initial stage of transition for nurses who were new to school-based-practice. For nurses who were learning to navigate the school system, adhering to educational standards and protocols while setting appropriate priorities to provide quality nursing care for students was difficult. The nurses' understanding of health and wellness shaped and influenced their decision to continue with school nursing to help students reach their maximum health and academic achievements. This study may lead to positive social change by helping readers to better understand the transition process for hospital-based nurses who enter the school environment. With an improved understanding of this population, it may be possible to lower attrition and burnout rates among school nurses.

Research has shown that 400,000 people die every year due to preventable medical errors. Medical error reporting and safety is a responsibility of all members of a health care organization. Creating an environment that addresses and prevents potential or actual safety problems can help reduce the incidence of medical errors made by nurses in the workplace. The purpose of this quantitative research study was to determine if nurses' perceptions of safety problems and error-preventing procedures and systems affected their comfort in reporting safety problems and intent to leave. High-reliability theory was the theoretical foundation for this study. Data were obtained from 1,171 surveys completed by newly licensed registered nurses located in 51 different metropolitan statistical areas and 9 counties. SPSS Version 25 was used to conduct a secondary data analysis including descriptive statistics, bivariate analysis, and multiple logistic regression for each variable. Themes that emerged from the data analysis included the importance of education on safety protocols and improving nurse satisfaction and nurse retention. The findings of the study might contribute to social change by creating an increased awareness for nurse leaders, managers, and newly licensed registered nurses in ensuring that there is improved comfort of reporting and appropriate error-preventing procedures and system in the health care environment. Increased awareness will allow for action and improved protocols to enhance the overall safety and quality of care for nurses and their patients.

Introduction: The shortage of nurses is a global problem of a multifactorial nature, to which demographic change in the world's population contributes greatly. In the future, a growing imbalance in the supply and demand of nursing staff can be expected, and according to WHO estimates (2015), the deficit of nurses and midwives will reach 7.6 million in 2030. The lack of nurses is largely due to their turnover, which is influenced by a number of interrelated factors and has a negative impact on the quality and safety of health care, the economy, health systems and the nurses themselves. The first step in solving this issue is to examine the causes of institutional and professional turnover of nurses and then create stabilization measures. Aim: Identify, characterize and analyse the factors that influenced the decision to change the current job position of general nurses with more than two years of experience. Methodology: Qualitative research was carried out through individual semi-structured interviews, phenomenological approach and method of purposeful selection was methodologically chosen. The research survey was attended by 14 general nurses from Prague hospitals aged 30 to 52 years. Data collection was terminated by reaching theoretical saturation. Data analysis was performed using open coding...

Professional nurses comprise the largest number of health care professionals in South Africa. High turnover rates contribute to shortages of nurses in South Africa, aggravated by the emigration of nurses, inadequate recruitment of student nurses, and the expected retirement of many baby boomer nurses by 2016. This study addressed factors influencing the retention of professional nurses in the Gauteng Province of South Africa. In phase 1, postal questionnaires were completed by 101 registered nurses while semi-structured interviews were conducted with 21 nurse managers in phase 2. Personal, organisational and managerial factors influenced the retention potential of the professional nurses. In terms of Maslow' Hierarchy of Needs Theory, most factors influencing nurses' retention operated on the lowest (physiological) level and concerned remuneration. Safety needs were compromised by the lack of equipment and supplies, the shortage of nurses and unsafe working places. Esteem needs included respect from doctors, managers and colleagues as well as recognition for outstanding performance. In terms of Vogt et al's Theory of Nurse Retention Theory, the constrictions caused by inadequate remuneration and safety aspects should be addressed. Lewin's Force-Field Analysis Theory recommends that the factors that influence nurses' retention negatively should be unfrozen, changed and refrozen, including communication. Based on these results guidelines were compiled for enhancing the retention rates of professional nurses (Annexure G). / Health Studies / D.Litt. et Phil. (Health Studies)

Professional nurses comprise the largest number of health care professionals in South Africa. High turnover rates contribute to shortages of nurses in South Africa, aggravated by the emigration of nurses, inadequate recruitment of student nurses, and the expected retirement of many baby boomer nurses by 2016. This study addressed factors influencing the retention of professional nurses in the Gauteng Province of South Africa. In phase 1, postal questionnaires were completed by 101 registered nurses while semi-structured interviews were conducted with 21 nurse managers in phase 2. Personal, organisational and managerial factors influenced the retention potential of the professional nurses. In terms of Maslow' Hierarchy of Needs Theory, most factors influencing nurses' retention operated on the lowest (physiological) level and concerned remuneration. Safety needs were compromised by the lack of equipment and supplies, the shortage of nurses and unsafe working places. Esteem needs included respect from doctors, managers and colleagues as well as recognition for outstanding performance. In terms of Vogt et al's Theory of Nurse Retention Theory, the constrictions caused by inadequate remuneration and safety aspects should be addressed. Lewin's Force-Field Analysis Theory recommends that the factors that influence nurses' retention negatively should be unfrozen, changed and refrozen, including communication. Based on these results guidelines were compiled for enhancing the retention rates of professional nurses (Annexure G). / Health Studies / D.Litt. et Phil. (Health Studies)

Till följd av NPM (New public management) och de ökade kraven på produktivitet och effektivitet har sjuksköterskors arbetssituation försämrats alltmer under de senaste decennierna. Det har resulterat i en försämrad hälsa hos sjuksköterskorna och många sjuksköterskor har valt att lämna yrket. Det har bland annat genererat brist på erfarna sjuksköterskor på akutvårdsavdelningarna som bedrivs dygnet runt i regionerna och detta anser Socialstyrelsen utgöra ett hot mot patientsäkerheten. Ett bra verksamhetsnära ledarskap, i regionerna benämns dessa som första linjens chefer, är en betydande faktor för sjuksköterskors hälsa och vilja att stanna kvar på sin arbetsplats. Det är därför av intresse att undersöka vilka ledaregenskaper som krävs för att erfarna sjuksköterskor skall arbeta kvar på vårdavdelningar som är öppna dygnet runt. Syftet med studien är att utröna vad som är viktiga hörnstenar i det hälsofrämjande ledarskapet för att bibehålla erfarna sjuksköterskor i dygnet runt verksamhet. Som metod användes semistrukturerade kvalitativa intervjuer med en induktiv ansats, åtta intervjuer utfördes totalt. Råmaterialet analyserades med hjälp av innehållsanalys och meningsbärande enheter, koder, kategorier och teman identifierades. Resultatet utmynnade i tre teman: individuellt stöd, teamarbete och kommunikation. Informanterna lyfte bland annat individanpassade scheman, kompetensutveckling och temaarbete som viktiga aspekter för att kvarstanna på arbetsplatsen. Ett salutogent förhållningssätt och specifika hälsofrämjande ledarskapsegenskaper är grunderna för att bibehålla erfarna sjuksköterskor i verksamheter som bedrivs dygnet runt. Cheferna i en dygnet runt-verksamhet bör besitta följande förmågor: rak och tydlig kommunikation, förmåga att skapa tillit, vara lyhörda, kunna entusiasmera, prestigelöshet, vara drivna och målfokuserade samt inneha ett coachande förhållningssätt. Definition av erfarna sjuksköterskor, se sida 7 under Metod. / As a result of NPM (New public management) and the increased demands on productivity and efficiency, the work situation of nurses has deteriorated more and more in recent decades. This has resulted in a deterioration in the health of the nurses and a number of staff have chosen to leave the profession. Among other things, it has generated a shortage of experienced nurses in the Swedish emergency departments with twenty-four seven operations in the regions, and the Swedish National Board of Health and Welfare considers this to be a threat to patient safety. A leadership with the adjacent connection to the ward and the staff, are referred to as first-line managers in the Swedish regions. These mangers are significant factors for nurses' health and willingness to stay in their workplace. It is therefore of interest to investigate what leadership qualities are required for experienced1 nurses to continue working in wards that are open twenty-four seven. The purpose of the study is to find out what are important cornerstones in the health promoting leadership in order to retain experienced nurses in twenty-four seven operations. As a method, semi-structured qualitative interviews with an inductive approach were used, eight interviews were performed. The raw material was analyzed using content analysis and meaningful units, codes, categories and themes were identified. The result resulted in three themes: individual support, teamwork and communication. The informants highlighted, among other things, individualized schedules, skills development and team work as important aspects for staying in the workplace. The result was that specific health promoting leadership qualities and a salutogenic approach are the foundations for retaining experienced nurses in twenty-four seven operations. The managers in a twenty-four seven operations should possess the following abilities: straight forward and clear communication, the ability to create trust, be responsive, be able to enthuse, lack prestige, be driven and goal focused and have a coaching attitude. For a definition of experienced nurses, see page 7 under Method.