Building, Recruiting and Retaining the Hospital Nursing Workforce: An International Policy-Oriented Narrative Review of Workforce Pipeline Interventions (2016-2026).
TL;DR
Transition-to-practice and nurse-residency programmes had the most consistent direct support for early-career retention, although heterogeneity limited certainty.
Abstract
Background
Acute care nursing shortages reflect constraints in education, recruitment and retention. Transparent synthesis is needed to distinguish tested interventions from plausible workforce strategies.
Aim
To synthesise 2016-2026 evidence on building, recruiting and retaining the hospital nursing workforce and interpret it for nursing and health policy.
Methods
MEDLINE/PubMed, CINAHL, Embase, Scopus and Web of Science were searched on 21 February 2026. Both authors independently screened records and assessed full texts. FMI charted characteristics, and GS verified entries against reports. The prespecified build-recruit-retain structure was combined with inductive thematic development. The 24 sources comprised 11 reviews (seven systematic, two scoping, one umbrella and one integrative), five primary studies/evaluations, seven policy/standards documents and one commentary. Direct intervention evidence was separated from contextual and policy evidence; no formal risk-of-bias assessment was undertaken.
Findings
Transition-to-practice and nurse-residency programmes had the most consistent direct support for early-career retention, although heterogeneity limited certainty. Work-environment, staffing, leadership and safety evidence was usually observational or based on proximal outcomes. Recruitment redesign, return-to-practice and digital models had limited or emerging evidence on observed workforce outcomes. Studies were concentrated in the United States and Europe.
Discussion
Well-specified transition programmes merit priority; other linked strategies require evaluation with common attrition, turnover and retention definitions and claims calibrated to evidence strength.
Conclusion
The author-developed pipeline is useful for organising evidence, but several pathways remain unvalidated and require prospective evaluation in more diverse health systems. IMPLICATIONS FOR NURSING AND HEALTH POLICY Nurse leaders can prioritise structured transition support and test whether staffing, governance, leadership and safety reforms improve observed retention. Policymakers should consider education capacity, ethical recruitment and standardised metrics while distinguishing intervention-supported actions from policy-based or framework-generated proposals.