Sumner Jennifer, Lim Hui Wen, Woo Brigitte, Lim Yee Wei, Lee Margaret, Yeo Hwee Chyi, Mukhopadhyay Amartya
Medical Affairs-Research, Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore.
Department of Healthcare Redesign, Alexandra Research Centre for Healthcare in a Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore.
J Nurs Manag. 2025 Jul 1;2025:5078305. doi: 10.1155/jonm/5078305. eCollection 2025.
Nurse retention is a persistent and complex problem. Using a system approach, we aimed to understand what is currently impacting nursing turnover and the interplay between the micro-, meso- and macrolevel factors. We surveyed and interviewed current and former nurses using a convenience sampling approach. The survey = 479, which targeted working nurses, included questions on job satisfaction and workload. For interviews, we recruited both practising nurses and nurse leavers = 35. The interviews explored individual experiences and perspectives on nursing and what influences nursing turnover. The data were analysed through a system lens, exploring the relationship between an individual's behaviour, interactions and relationships (microlevel), the organisational environment, including policies and regulations (mesolevel) and the social, economic, political and cultural norms within which individuals and organisations reside (macrolevel). Results showed a complex interplay of micro-, meso-, and macrofactors shaping the nursing experience. The survey data revealed poor satisfaction with work-life balance (51%), control over work (43%) and remuneration (43%). Over half (53%) of the participants were considering leaving their organisation, and 36% were contemplating exiting the profession due to exhaustion (74%), inadequate staffing (72%), feeling undervalued (66%), low pay (61%) and excessive pressure (58%). Qualitative interviews revealed negative personal interactions, generational conflicts, unmet or poor expectations of nursing (microlevel), limited autonomy, administrative burdens, poor work-life balance (mesolevel), integration challenges and prohibitive immigration policies for foreign nurses, negative public perceptions and the impact of education on nursing expectations (macrolevel). Furthermore, we found that these factors do not operate in isolation; rather, micro-, meso- and macrolevels interact. Our study underscores the importance of adopting a system approach to understand and address nursing retention issues. Examining micro-, meso- and macrofactors and the interplay between these levels is essential in developing targeted interventions to improve nurse retention.
护士留用是一个长期且复杂的问题。我们采用系统方法，旨在了解当前影响护士离职率的因素以及微观、中观和宏观层面因素之间的相互作用。我们采用便利抽样法对在职和离职护士进行了调查与访谈。针对在职护士的调查（n = 479）涵盖了工作满意度和工作量等问题。在访谈方面，我们招募了在职护士和离职护士（n = 35）。访谈探讨了个人对护理工作的经历和看法以及影响护士离职率的因素。通过系统视角对数据进行分析，探究个人行为、互动及关系（微观层面）、组织环境（包括政策法规，中观层面）以及个人和组织所处的社会、经济、政治和文化规范（宏观层面）之间的关系。结果表明，微观、中观和宏观因素之间存在复杂的相互作用，共同塑造了护理体验。调查数据显示，护士对工作与生活平衡（51%）、工作控制权（43%）和薪酬（43%）的满意度较低。超过半数（53%）的参与者考虑离开所在机构，36%的人因疲惫不堪（74%）、人员配备不足（72%）、感觉未得到重视（66%）、薪资低（61%）和压力过大（58%）而考虑退出该职业。定性访谈揭示了负面的人际互动、代际冲突、对护理工作未实现或不佳的期望（微观层面）、自主权有限、行政负担、工作与生活平衡差（中观层面）、融合挑战以及针对外国护士的严格移民政策、负面的公众认知和教育对护理期望的影响（宏观层面）。此外，我们发现这些因素并非孤立存在；相反，微观、中观和宏观层面相互作用。我们的研究强调了采用系统方法来理解和解决护士留用问题的重要性。审视微观、中观和宏观因素以及这些层面之间的相互作用对于制定有针对性的干预措施以提高护士留用率至关重要。
