Individual and environmental factors that influence longevity of newcomers to nursing and midwifery: a scoping review

Abstract

Objective: The objective of this review was to identify the literature and map the individual and environmental factors that influence registered nurses’ and midwives’ decision to stay or leave their professions within the first 3 years of practice. Introduction: Nursing and midwifery workforce sustainability is an international concern. One aspect is the retention of new registered nurses and midwives in their first years of practice. Several factors are thought to influence the decisions of new registered nurses and midwives to leave or stay in their professions. This review sought to identify and map those factors to enable further research for workforce sustainability development strategies. Inclusion criteria: The study cohort included registered nurses and midwives in their first 3 years of practice, which we called newcomers. Nurses who were required to work under the supervision of registered nurses and midwives (eg, enrolled nurses, licensed practical nurses, and licensed vocational nurses) were excluded. Papers were only included if they explored individual or environmental factors influencing nurses’ decision to stay in or leave the professions of nursing or midwifery. Studies could be from any country or care environment, and participants were newcomers providing direct clinical care. Newcomers employed in other health roles, such as education, research, administration, and non-nursing/midwifery roles were excluded. All research designs and peer-reviewed papers were included; policy documents were excluded. The date of inclusion was from the earliest publication on this topic, which was 1974 to the date of the search. Methods: The JBI methodology for scoping reviews was followed, and reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. The search strategy aimed to locate published and unpublished primary studies, reviews, and text and opinion papers. The initial search of relevant databases was conducted in January 2020 and updated in January 2022. Reference lists of included articles were also screened. Following data extraction, descriptive qualitative content analysis was undertaken. Results: Twelve articles from 11 studies were included in this review. They were published between 2005 and 2020 and originated from 5 countries. Two studies were observational, 3 were cross-sectional, 5 were longitudinal studies, 1 was a pre- and post-program evaluation, and 1 was a scoping review. All studies focused on registered nurses: no publications on registered midwives met the inclusion criteria. Individual factors we identified that impact newcomers’ intention to stay in or leave the profession included physical and psychological health, professional identity, professional commitment, and development. Environmental factors included workplace culture, engagement, and management. Conclusions: Professional self-image, identity, and a sense of pride in the profession are important components of newcomer retention. Strategies that positively support transition and create realistic expectations were highlighted. Managers play an important role in registered nurse retention as they can influence many of the newcomers’ experiences. It is concerning that no studies about newcomer midwives were found. Many studies explored turnover or intention to leave the job/employer rather than the profession. These are important considerations for future research.