Abstract
BACKGROUND: The global nursing shortage poses a critical challenge to healthcare systems. The World Health Organization projects a shortage of 4.5 million nurses by 2030. Contributing factors include an aging workforce and an increasing rate of nurse turnover, driven by high workloads, limited development opportunities, and a lack of managerial support. Intentions to leave predict actual departure and threaten the quality of care, increase patient mortality, and impose high replacement costs. While retention strategies exist, many are not tailored to nurses because nurses' subjective experiences and perspectives are lacking, potentially limiting their effectiveness. Engaging nurses in designing these interventions may enhance their relevance and impact. OBJECTIVES: (i) Identify the key factors associated with nurses' retention in hospitals, and (ii) provide an in-depth understanding of why nurses perceive these factors as critical in shaping their retention. DESIGN: A mixed-methods approach, utilizing Q-methodology and semi-structured interviews, was employed. SETTING: Dutch hospitals. PARTICIPANTS: A diverse group of 26 practicing and three former nurses. METHODS: Participants ranked 58 statements in response to the prompt: "I am willing to continue working as a nurse within the organization if…" Consecutively, individual interviews were conducted to provide further insight into the reasoning behind nurses' choices. Quantitative data were analyzed using centroid factor analysis with varimax rotation to identify shared viewpoints. Qualitative interview data were analyzed using the rigorous and accelerated data reduction method to deepen the understanding of the factors shaping nurses' retention. RESULTS: A total of 29 Q-sorts and interviews were analyzed. This resulted in three factors: (A) 'Challenging work and inclusive positioning for high-quality care', (B) 'Room to excel in nursing roles', and (C) 'Being seen, heard, and valued'. Together, these perceptions shaped participants' intention to stay. Additionally, a common pattern across all factors was participants' perception of being structurally unheard. CONCLUSIONS: A multifaceted interplay of factors influenced nurse retention. While meaningful and challenging tasks were essential, professional recognition, support systems, and growth opportunities were equally important. A systemic approach that addresses these various dimensions may be crucial for enhancing retention rates, maintaining a high-quality of patient care, and ultimately mitigating the impact of the nursing shortage in healthcare organizations. Nurses may play a crucial role in designing and implementing retention strategies. Their input is not just valuable but most likely necessary for the relevance and effectiveness of these strategies.