Characteristics of effective interventions to optimise retention for early career nurses: a scoping review

Abstract

Background: Nursing shortages, driven by high turnover rates among early career registered nurses (ECNs), present a critical global challenge, threatening workforce sustainability, compromising patient care quality, and imposing financial burdens on healthcare systems. While various interventions have been developed to improve retention, gaps in reporting, scalability, and long-term evaluation hinder their widespread adoption. This review applies Proctor et al.s implementation science framework to evaluate the design and operationalisation of retention strategies, addressing existing gaps and identifying actionable insights. Objective: This scoping review synthesises evidence on the characteristics of effective interventions designed to enhance retention and reduce turnover among ECNs. Inclusion criteria: This review included studies evaluating interventions aimed at improving retention or reducing turnover of ECNs within the first five years of practice. Eligible studies presented original data or systematic reviews addressing intervention characteristics and outcomes. Methods: The review adhered to the JBI methodology for scoping reviews and PRISMA-ScR guidelines. Systematic searches of Medline, EMBASE, PsycINFO, CINAHL, and the Cochrane Library were conducted in May 2024. Articles published in English were screened independently by two reviewers, with data extraction and synthesis guided by Proctor et al.s implementation science framework. Results were synthesised narratively and presented in tabular formats. Results: From 3,462 records, 21 studies met inclusion criteria. Interventions varied widely, including mentorship (n = 9), preceptorship (n = 8), in-person classes (n = 10), clinical simulations (n = 6), reflective practice, and career advancement programs. Program durations ranged from 8 weeks to 2 years, with one year being the most common. Factors associated with success included tailored content for ECNs, structured competency frameworks, mentor training, and integration into organisational leadership and culture. Challenges such as variable reporting standards and inconsistent evaluation methods were noted. Conclusions: Effective retention strategies for ECNs require structured, supportive, and competency-based interventions tailored to organisational and individual needs. Emphasising mentor preparation, career development, and specialised approaches for high-stress environments, such as critical care, can enhance program outcomes. Improved reporting standards and methodological rigour are necessary to scale and adapt these programs across healthcare systems, ultimately contributing to a more stable and resilient nursing workforce.