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Factors influencing retention among hospital nurses: systematic review

11 March 2021
15 min read
Volume 30 · Issue 5



Recruitment and retention of nursing staff is the biggest workforce challenge faced by healthcare institutions. Across the UK, there are currently around 50 000 nursing vacancies, and the number of people leaving the Nursing and Midwifery Council register is increasing.


This review comprehensively compiled an update on factors affecting retention among hospital nursing staff.


Five online databases; EMBASE, MEDLINE, SCOPUS, CINAHL and NICE Evidence were searched for relevant primary studies published until 31 December 2018 on retention among nurses in hospitals.


Forty-seven studies met the inclusion criteria. Nine domains influencing staff turnover were found: nursing leadership and management, education and career advancement, organisational (work) environment, staffing levels, professional issues, support at work, personal influences, demographic influences, and financial remuneration.


Identified turnover factors are long-standing. To mitigate the impact of these factors, evaluation of current workforce strategies should be high priority.

Nurses are fundamental in ensuring the delivery of high-quality care in healthcare institutions. Globally, there are an estimated 29 million nurses and midwives (Wong et al, 2015), who constitute the largest group of health professionals within healthcare organisations. However, over the past decades, nursing shortages have become a global challenge. Across the UK, there are around 50 000 nursing vacancies in total: 43 615 in England, 3060 in Scotland, 1612 in Wales and 1671 in Northern Ireland (Royal College of Nursing (RCN), 2020; RCN Northern Ireland, 2020; RCN Wales, 2020).

In 2019, the total number of registrants who left the Nursing and Midwifery (NMC) register was 27 589, which included both UK-trained and non-UK trained nurses, a figure that was 23% higher than in 2013 (RCN, 2020). Such a reduction in nurse numbers inevitably puts patient safety at risk, as well as the quality of the care provided, it also decreases efficiency. In addition, reduced staff numbers affect staff morale, the health of individual nurses, and increase costs for organisations, which have to continually recruit and train new employees to replace those who have left (AbuAlRub et al, 2009; Perreira et al, 2018).

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