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.

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.