Staffing and leadership as drivers of nurse retention: A work environment analysis

TL;DR

This study finds that staffing and nurse manager leadership are key factors in retaining nurses and improving job satisfaction.

Contribution

The study identifies specific Practice Environment Scale subscales that most strongly influence nurse retention and satisfaction.

Findings

Staffing and resource adequacy most strongly predict nurse retention and job enjoyment.

Nurse manager leadership significantly affects retention and respect/recognition.

Nurse participation in hospital affairs mainly impacts respect and recognition.

Abstract

Nurse work environment (NWE) is a well-established predictor of nurse and patient outcomes. However, limited research has examined the individual contributions of NWE domains to nurse outcomes.

This study aimed to identify which subscales of the Practice Environment Scale (PES) most strongly influence nurse outcomes: retention, job enjoyment, respect and recognition, and missed nursing care.

A cross-sectional analysis was conducted using 2024 National Database of Nursing Quality Indicators® RN Survey data from 1789 inpatient units across 221 hospitals. NWE was measured using PES subscales, and nurse outcomes were assessed via standardized instruments. Structural equation modeling evaluated direct effects of PES domains on outcomes.

All PES subscales were significantly associated with nurse outcomes (P < .05). Staffing and resource adequacy had the strongest effects on retention (β = 0.44), job enjoyment (β = 0.61), and reduced missed care (β = -0.87). Nurse manager leadership and support also significantly predicted retention and respect and recognition. Nurse participation in hospital affairs primarily influenced respect and recognition, whereas nurse-physician interaction showed weaker associations.

Adequate staffing and strong nurse manager leadership are critical to nurse retention and satisfaction. Targeted improvements in these domains may enhance workforce stability and care quality.

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