The nurse retention, quality of care and patient satisfaction chain.

This paper proposes an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention, healthcare quality and patient satisfaction. The paper depicts and describes a generic conceptual framework or chain derived from a review of the literature on nurse recruitment and retention, service quality and human resource management. The chain is made up of the following components: NHS and Trust conditions and environment (internal quality)--service capability--nurse satisfaction--nurse retention--quality of patient care--patient satisfaction. The value of the chain is derived from its synthesis and display of the prime constituents or drivers of nurse satisfaction, quality of patient care and satisfaction. From this holistic picture it is possible for both national and local initiatives to be integrated in a mutually reinforcing way in order to achieve improvements in nurse recruitment, retention, quality of care and patient satisfaction.