Investigating the retention and attrition of emergency care advanced clinical practitioners in the UK

Abstract

Background: Advanced clinical practitioners (ACPs) are an integral part of the healthcare workforce, and recognising growth in these roles is a priority for the future. ACPs within emergency care (EC) are often senior clinical decision-makers that work within the multidisciplinary team to provide high-quality care to a variety of patients, presentations and acuity. Reflection upon clinical practice over the last 7 years has revealed an issue with the retention of experienced ACPs. Losing ACPs in a service that is already stretched due to increasing attendance and subsequently longer waiting times places further burden on strained departments. While there is research that examines the retention and attrition of emergency medicine trainees and consultants, there is a dearth of literature on the retention of ACPs. Aims: The aim of this scoping review is to investigate what is already known about retention of ACPs in EC and examine why ACPs leave EC for other areas of practice. Methods: A database search was conducted using keywords, from 2–21 November 2022, across five databases (the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the British Nursing Index (BNI), MEDLINE, PsycINFO and the Cochrane Library). This search identified 892 studies that were examined using a two-stage process against inclusion and exclusion criteria, which resulted in seven articles being selected for inclusion in the review. Findings: Three themes were identified: the importance of a clear career pathway; a structured training programme and education; and concerns regarding working conditions in EC. Conclusion: The review identifies a gap in the literature on the reasons for attrition rates of ACPs in EC. Future research is required to identify the reasons why some ACPs leave EC and what aspects make others stay.