Creating Organisational Working Conditions Where Nurses Can Thrive: An International Action Research Study

Background: Attracting and retaining sufficient numbers of nurses is an international challenge. The group most difficult to retain are newly qualified nurses within their first five years of practice or earlier. A recent US study reported that approximately 25 percent of nurses leave within the first year of graduation. Health organisations play a crucial role in providing workplace cultures where nurses feel empowered and can thrive. Research needs to focus on improving organisational culture, yet most approaches to supporting and retaining nurses have used top-down, management-designed interventions. This article describes a collaborative international programme of research. Methods: This innovative international theory-driven multi-site action research programme adopts a longitudinal co-design approach based on principles of appreciative inquiry to develop and implement organisational support for newly qualified nurses. It integrates the Institute for Health Improvement (IHI) Framework for Improving Joy at Work and the Thriving at Work model, both focused on improving the well-being of the healthcare workforce and health service outcomes. Each year, a new group of nurses during their first-year orientation is invited to participate. Over five years, each cohort will then participate in an annual survey, focus groups, and co-design meetings with nurse leaders/managers, generating new solutions developed through open dialogue for subsequent testing driven by these key stakeholders. Expected outcomes: This research will generate a new co-design management model to improve systems of support that may assist nurse retention and thriving that can be shared with other nursing organisations. It will provide an understanding of the effectiveness of current support for nurses by their employers from the perspective of those nurses whilst providing evidence about what extra support nurses would like from their employers. Conclusions: This international research programme gives agency to nurses and organisational nurse leaders/managers to co-design interventions for building positive work environments where early-career nurses can thrive. This programme will capture what works, where, how, and with whom, ultimately benefiting both individual nurses and the overall effectiveness and sustainability of healthcare systems.