Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings

Objectives: This paper summarises and critically reviews strategies identified in the literature which support retention of nurses by the creation and enhancement of positive practice environments in the clinical setting. Design: Literature review. Data sources: A literature search was undertaken in February 2012 of major healthcare-related databases, Cinahlplus, Medline, and Proquest. Review methods: The keywords "nurs* AND practice AND environment" were used in the first instance. Additional keywords "retention strategies" were also searched. Abstracts were reviewed and articles which potentially outlined strategies were identified. Reference lists were scanned for other potential articles. Articles in languages other than English were excluded. Lake's Practice Environment Scale of the Nursing Work Index provided a framework from which to assess the strategies. Results: Thirty-nine papers reported strategies for creating a positive practice environment. Only two articles reported on a pre-test post-test evaluation of the proposed strategy. Strategies included: empowering work environment, shared governance structure, autonomy, professional development, leadership support, adequate numbers and skill mix and collegial relationships within the healthcare team. Conclusions: Creating positive practice environments enhances nurse retention and facilitates quality patient care. Managers and administrators should assess and manage their practice environments using a validated tool to guide and evaluate interventions. (C) 2013 Elsevier Ltd. All rights reserved.