# Experience and Perceptions of Retention Strategies in District Nursing Services: A Web‐Based Mixed Methods Cross‐Sectional Survey

## TL;DR

This study explores how nurses and nursing associates in district nursing services in England experience and perceive various retention strategies.

## Contribution

The study provides insights into the effectiveness of retention strategies in district nursing services, highlighting disparities based on pay grade and location.

## Key findings

- Over 60% of respondents experienced strategies related to safe working environments and flexible schedules.
- Nurses in lower pay grades were less likely to experience professional growth and decision-making involvement.
- Nurses in affluent areas reported more retention strategies than those in deprived areas.

## Abstract

To investigate the experience and perceptions of the effectiveness of retention strategies of nurses and nursing associates in district nursing services.

Mixed methods cross‐sectional online survey.

Electronic invitations were circulated via district nursing professional networks to complete an online survey in England. The survey questions were developed from international evidence‐based guidance. Quantitative data were analysed descriptively and using multinomial regression analysis, tested the variation in experienced strategies by job and work characteristics. Content analysis informed qualitative data analysis.

Three hundred and forty‐five completed surveys were received. Over 60% of respondents reported experiencing strategies related to a safe working environment (75%), flexible work schedules (65%), well‐being (64%) and professional development opportunities (60%). The least frequently reported strategies experienced were involvement in service policymaking (26%), reducing job demands (31%); and creating cohesive nursing teams (40%). Nurses on lower pay grades were statistically less likely than those on the higher pay bands to experience strategies involving professional growth opportunities and involvement in service decision‐making. Nurses working in affluent areas were statistically more likely to report experiencing more types of retention strategies than those working in socio‐economically deprived areas. Participants' views on effective strategies were mixed but attention to financial aspects (particularly travel costs), manageable workloads, flexibility in work scheduling plus tailored induction/support for those new to district nursing were given the most testimony as effective.

Retention strategies are created and enacted by those within employing organisations, district nursing services and district nursing teams, but within the context of a wider health care and labour market system. We suggest the findings could be the starting point for review by district nursing services experiencing high vacancy rates. Our findings raise questions for subsequent investigation across health systems.

This paper adhered to the relevant Equator guideline A Consensus‐Based Checklist for Reporting of Survey Studies (CROSS), https://doi.org/10.1007/s11606‐021‐06737‐1.

This study did not include patient or public involvement in its design, conduct or reporting.