Stabilizing and Destabilizing Factors of Nurse Retention: A Comparative Analysis of Two Healthcare Settings in...

The global nursing shortage poses a significant threat to healthcare systems. Despite the extensive corpus of research gathered over several decades, there remains a notable gap in the comprehensive understanding of the underlying factors influencing nurses' retention decisions, particularly in critical care (ICU) and long-term-care (LTC) facilities.

This study aims to identify and analyze the nuanced differences and similarities in stabilizing and destabilizing factors that impact frontline nurses' decisions to remain in or depart from critical care and LTC facilities.

To achieve this objective, semistructured interviews and focus group discussions were conducted with 52 participants, including nursing managers and frontline nurses from nine hospitals and eight nursing homes in Austria. Data were analyzed using qualitative content analysis.

The findings revealed several on-the-job stabilizing factors, including empowering leadership, a positive team culture, and work autonomy. Off-the-job stabilizing factors encompassed family time, proximity to the workplace, and professional prestige, the last of these being particularly salient for critical care nurses. On-the-job destabilizing factors included disproportionate individual responsibility, ethical challenges, and power dynamics, with slight variations between the two settings. Off-the-job destabilizing factors comprised caring responsibilities for relatives, professional advancement opportunities elsewhere, and the ease of movement within the nursing labor market.

Notable distinctions emerged between the two settings: Critical care nurses emphasized collaborative team culture and ethical dilemmas tied to pronounced hierarchical structures as central concerns, whereas LTC nurses were more affected by limited physician availability, feelings of being undervalued, and restricted opportunities for professional advancement. Overall, while several stabilizing and destabilizing forces were shared across both settings, their salience and expression differed meaningfully, underscoring the need for context-specific retention strategies tailored to the distinct challenges faced by critical care and LTC nurses.