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Explaining nursing attrition through the experiences of return-to-practice students: a mixed-methods study

22 April 2021
Volume 30 · Issue 8



Nurse shortage is an international issue that has adverse effects on health and the quality of care of whole populations.


The study aimed to explore attrition experienced by return-to-practice students attending higher education institutions in England.


A mixed-methods design, involving questionnaires (n=114) and in-depth interviews (n=20), was used.


Just over half (52%) of respondents left nursing after ≥10 years. Most of these (84%) stayed in alternative employment during their break from nursing. There were two distinct reasons for leaving nursing: the inability to maintain a positive work/life balance and a lack of opportunity for career advancement while retaining nursing registration. Respondents reflected positively on their nursing experience yet frequently reported significant personal or professional incidents prompting their decision to leave.


The reasons nurses leave are complex. Professional bodies and managers need to work together to address concerns many nurses have during their careers that lead to them deciding to leave the profession.

High attrition rates in nursing, which have adverse effects on staff: patient ratios, workload, patient safety and care quality, are a global problem (Aiken et al, 2002; 2014; 2018; Royal College of Nursing (RCN), 2015). In 2020, the World Health Organization (WHO) estimated a global nursing and midwifery shortage of 5.9 million, concluding this to be damaging to the health and wellbeing of entire populations (WHO, 2020).

Nurse scarcity and maintaining an adequately skilled workforce are concerns of healthcare employers internationally (Price, 2009; McLaughlin et al, 2010; Jirwe and Rudman, 2012; Perry 2012). In the UK, NHS England/Improvement (2019) suggested that greater attention needed to be paid to why nurses leave the profession, as a large-scale investigation had evidenced the harmful association between levels of nurse staffing and the calibre of nurse education, staff burnout, patient outcomes and patient mortality (Aiken et al, 2014); indeed, Aiken et al (2014) reported that one additional patient on a nursing workload increases the likelihood of another inpatient dying by 7%.

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