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European Journal of Applied Sciences – Vol. 11, No. 3
Publication Date: June 25, 2023
DOI:10.14738/aivp.113.14836.
Salminen-Tuomaala, M. (2023). Factors Associated with Attractiveness and Retention in Nursing. European Journal of Applied
Sciences, Vol - 11(3). 360-374.
Services for Science and Education – United Kingdom
Factors Associated with Attractiveness and Retention in Nursing
Mari Salminen-Tuomaala
Seinäjoki University of Applied Sciences, Finland
ABSTRACT
The study describes factors associated with the attractiveness and retention of
nursing, as experienced by registered nurses (n=24) upgrading their education to a
Master’s Degree at a University of Applied Sciences in Finland. The study aims at
producing knowledge that can be used to improve nurse retention and the
attractiveness of the clinical nursing profession. The 6-3-5 Brainwriting Method of
Rohrbach was used to collect data which was analysed using inductive content
analysis. The findings support previous international literature. Promotion of
appreciation, professional development and wellbeing at work through optimal
working conditions, increased influence and compassionate, supportive leadership
were among the most significant, recurrent themes in the participant contributions.
Further work is required to increase the appreciation of nursing in order to retain
nurses and attract new applicants. The measures suggested in this research include
the development of more compassionate leadership, professional development
options and optimal conditions to ensure wellbeing at work.
Keywords: Attractiveness, retention, career, nursing, wellbeing at work
INTRODUCTION
Millions of new nurses will be required globally by the year 2030; the pre COVIC-19 pandemic
world was already short of almost six million nurses [1,2]. Finland is also struggling to attract
and retain nursing staff; the shortage of staff is likely to persist and even intensify within the
next decade [3]. In this article, attractiveness refers to any force or means that helps
organizations recruit and retain staff and to promote work engagement [4]. Retention refers to
an organization’s ability to prevent staff leaving their work [5].
Health services across the world are facing the challenge of poor retention, as well as ageing
and retirement of the workforce. A significant part of the nursing workforce will retire or leave
the profession in the next few years, while the need for services is likely to increase in countries
with ageing populations [2]. It is important, both nationally and internationally, to explore what
kind of factors could promote nurse retention and help recruit new professionals [6, 7].
International research indicates that nurse retention and the attractiveness of the profession
can be promoted by nurses’ influence over their work, professional development and career
opportunities, a positive work atmosphere and well-functioning multiprofessional
collaboration [8, 9, 10, 11, 12, 13]. Open nurse-leader dialogue and mutual appreciation can
increase retention [14, 15, 16, 17]. Support and encouraging feedback, both in words and deeds
are called for [18]. It is recommended that leaders make an effort to listen to their employees
and to be more approachable and flexible to reduce turnover intention. [19, 20]. In other words,
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Salminen-Tuomaala, M. (2023). Factors Associated with Attractiveness and Retention in Nursing. European Journal of Applied Sciences, Vol - 11(3).
360-374.
URL: http://dx.doi.org/10.14738/aivp.113.14836.
more compassionate leadership might have a positive impact on the turnover rates [18]. Nurse
engagement - nurses’ commitment to and satisfaction with their jobs, and their level of
commitment to the nursing profession itself - has also been found to be associated with nurse
retention [21, 22, 23, 24, 25].
In contrast, a perceived heavy workload and stress have been found to decrease nurse retention
and the attractiveness of the profession [18, 26, 27, 28]. The same holds true when the work
requirements have been considered unreasonable, the working conditions inadequate [10]
and/or the professional development prospects poor. [11, 29]. Lack of leader support and
appreciation, a negative work atmosphere and poor management and leadership mar nurse
engagement [18, 27, 30, 31]. Experienced bullying early during the career can cause nurses to
leave their profession [11, 32].
In Finland, the attractiveness of the nursing profession has been studied recently from the
perspectives of nursing students [33], licensed practical nurses [34], and nurses [35, 36, 37].
The results are similar to international research. According to the nursing students, the role
and appreciation of nursing should be advanced at the level of individual nurses, organizations
and society [33]. Increasing the appreciation of nursing is essential for licensed practical nurses
as well [34]. Nurses agree that the attractiveness of their profession has deteriorated. Their
wishes include adequate human resources, better professional development opportunities and
salaries to match the responsibilities [35, 36, 37].
RESEARCH PURPOSE AND RESEARCH QUESTIONS
This study describes factors associated with the attractiveness and retention of nursing, as
perceived by experienced nurses undertaking a Master Programme in Advanced Practice
Nursing. The study aims at producing knowledge that can be used to improve nurse retention
and the attractiveness of the clinical nursing profession. The research problems are:
1. What kind of factors are associated with improving the attractiveness of nursing?
2. What kind of factors are associated with improving retention in nursing?
DATA AND METHOD
Data Collection
A qualitative approach was selected to explore experienced nurses’ views of factors associated
with the attractiveness of nursing and retention of nursing professionals. The participants
(n=24, including 22 women and 2 men) were registered nurses with 5-25 years’ experience
across a diverse range of clinical specialities. They were upgrading their education to a Master’s
Degree in Advanced Practice Nursing at a University of Applied Sciences. The participants were
employed as nurses in various locations across Finland.
The 6-3-5 Brainwriting Method of Rohrbach (1968) was used to bring together participants’
individual experiences and associations yielded by the shared ideation process [38]. The
method is suitable for collecting qualitative experiential expert knowledge. The participants
worked in groups of six persons. Two groups were allocated the topic of “Factors that increase
the attractiveness of nursing”, whereas the other two groups were given the topic of ”Factors
that increase the retention of nursing professionals”. All participants were given a piece of
paper and five minutes time to write down three ideas on how to improve the attractiveness of
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European Journal of Applied Sciences (EJAS) Vol. 11, Issue 3, June-2023
nursing/ retention of nursing professionals. After the five minutes were over, all participants
were instructed to pass their paper to the next participant sitting on their right side. During the
following five minutes, each participant read the existing ideas and added three new ideas. The
process continued, using five-minute intervals, until the participants received their original
papers. Rich material involving fresh associations was produced in each of the four groups
during the 30 minutes [39, 40].
Data Analysis
The 6-3-5 Brainwriting Method yielded clauses and sentences, which were analysed using
inductive content analysis [41]. The original clauses and sentences were reduced into 198
meaningful units, which were grouped into sub-categories according to content. Last, the sub- categories were combined into more generic categories, which were collapsed into the two
main categories.
Ethics and Trustworthiness
Owing to the deteriorating staff shortage in nursing, the topic can be considered to be
significant from the perspective of the nursing profession and society. The Research and
Development Manager at the University of Applied Sciences granted permission for the
research. The Finnish National Board on Research Integrity Guidelines (2023) were followed
[42]. Participation was voluntary. All participants gave verbal consent to have the material used
as research data. Their anonymity was protected throughout the research process.
The criteria of credibility, confirmability, transferability and reflexivity were used to ensure
research trustworthiness. [43]. Credibility means that the findings reflect participants’
conceptions of the phenomenon under study. The method used, 6-3-5 Brainwriting, and the fact
that participants were nurses with a long work history either in primary health care or
specialized medical services across Finland, can be claimed to ensure an authentic picture of
the topic. Confirmability means that the findings are based on research data, not on
investigators’ ideas of the phenomenon. The description of the data collection and analysis,
together with tables, make it possible for readers to see how the research process took place.
Transferability is about the possibility that similarity could be found in other research contexts.
The findings of this study are likely to be transferable at least nationally, and they may provide
useful insights to international readers as well. Last, reflexivity means that the investigators
acknowledge the effect their pre-conceptions may have on the study. In this study, both
researchers’ long history of nursing may have influenced their interpretation of the data.
RESULTS
This section presents experienced nurses’ views of factors associated with the retention of
nursing professionals (4.1) and of factors associated with the attractiveness of nursing as a
profession (4.2). Direct participant quotes are provided to support the findings.
Professionalization and Appreciation as Factors Increasing Nurse Retention
The first research question dealt with research participants’ ideas of factors that make it more
likely for nurses to remain in their current positions. Table 1 shows the seven generic
categories (4.1.1 - 4.1.7) and the sub-categories that emerged in the analysis
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Salminen-Tuomaala, M. (2023). Factors Associated with Attractiveness and Retention in Nursing. European Journal of Applied Sciences, Vol - 11(3).
360-374.
URL: http://dx.doi.org/10.14738/aivp.113.14836.
Table 1. Professionalization and Appreciation as Factors Increasing Nurse Retention
Sub-category Generic category Main category
Interesting duties
Meaningful work that
promotes and makes use of
expertise
Professionalization and
Appreciation as Factors
Increasing Nurse Retention
Meaningful projects
Advanced practice nurses as
educators
Allocating advanced practice
nurses’ duties that match their
qualification and competence
Career advancement
Making use of nurses’ expertise
Influence over the development of
one’s job description
Training opportunities
Being appreciated in society
Appreciation and promotion
of the value of nursing
Being appreciated in the
organisation
Being appreciated by the employer
Having one’s competence
appreciated
Support and appreciation from
leaders
Appreciation of one’s own work
Making clinical expertise visible
Making the work/profession visible
Flexible working hours
Ensuring optimal working
conditions
Adequate resources
Lunch benefits
A pool of substitutes
Visible networking
Developing leadership
Adequate support staff (IT,
secretarial)
Remote work
Work rotation
Chance to attend to patients
without interruptions
Fully functioning equipment
Safe working facilities
Appropriate uniforms
Adequate salary
Ensuring optimal salaries
Match between salary and
contribution
Salary bonuses
Influence over one’s salary