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NURS 3046 | Nursing Project | Factors That Influence The Employees

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Conduct a systemic review which will help to explore the factors that might an effect or influence the employees to stay in their given position as well as retention of the nurse managers in their present position.



Presence of a healthy work environment has evidently shown to have a positive impact on the employee turnover rate and creation of retention cultures among the employees (Blake et al., 2013). The leadership roles of the nurse managers and their behaviours tend to have an effect on the job satisfaction of the nursing staff which in turn helps in their retention. Retaining of the employees is significant to ensure high quality of health care delivery systems. Therefore considering the importance of nursing leadership and its impact on the factors of employee retention, this has been identified as a significant problem related to nursing practise (Bormann & Abrahamson, 2014). This paper aims to conduct a systemic review which will help to explore the factors that might an effect or influence the employees to stay in their given position as well as retention of the nurse managers in their present position. Using qualitative studies retrieved from several databases, the paper will discuss the leadership behaviour that might affect the workplace setting in terms of healthcare setting in addition to the maintenance of a quality health-care delivery system.

Research question

The research question that is to be addressed in the proposed study is as follows-

“What are the factors that influence employee and nurse manager retention in their current position and how does leadership behaviour of the nurse managers influence employee retention?”

Significance of study

In relation to nursing practise, one of the problems that has become evident in the recent times deals with proper nursing leadership or management and its effect on the retention of the employees in the healthcare setting. The role of the nurse managers is of quite of significance since this can have an effect on the health care delivery system (Cleary et al., 2013). The role of the nurse managers affects the employees as they play an instrumental role in the retention of the staff which in turn has an impact on the quality of health care provided to the patients. The nurse managers are involved directly in the process of implementation of the organizational strategies which are required in order to meet the future and current goals and objectives of the healthcare organization (Negussie & Demissie, 2013). It is required to understand the role of the nurse leader or the nurse manager and their leadership behaviour, in order to determine the effect of the leadership quality on the staff retention factors. Therefore the information that will be derived from the study in terms of the factors of retention and the nursing leadership improvement scores will be helpful in addressing the recognised nursing problem (Titzer & Shirey, 2013). In addition the importance of the leadership styles namely the transformational and transactional leadership styles in addressing the identified nursing problem will be recognised.

Conceptual framework

The conceptual framework indicating the factors influencing retention of healthcare professionals  

The above conceptual framework has been made to determine the factors that influence employee retention at different levels. The framework indicates a relationship between variables on the basis of the assumptions derived from existing literature.

Literature review

Literature review is referred to an evaluation or search of the existing literature that is related to the identified problem or chosen study area. The objectives of a literature review include survey of the existing of literature in relevance to the study area. In addition the literature review helps in synthesising information into the form of a summary. It also critically analyses the data or the information that is collected from the existing literature. The literature review helps the surveyed literature to be presented in an organised way. As already mentioned, the problem in terms of nursing practise is identified as the role of the nurse managers and their leadership behaviours, and its impact on the retention on the employees in the healthcare setting (Hutchinson & Hurley, 2013).

According to the study conducted by Bamford, Wong & Laschinger (2013), it is important to understand the role of the nurse managers and their leadership behaviour and the effect it has on the job satisfaction of the employees along with employee retention. It has also been stated that one of the primary roles that these nurse managers have to play is the planning and the implementation of the retention strategies. One of the studies identified that leadership acts as a factor that significantly influences the nurse satisfaction and in turn retention. The cross-sectional design of the study inhibited the capacity of the design to determine causality. Further, nurses in the study were part of the employment in acute-care settings, limiting the generalizability of results as compared to other nurses employed in other settings. Lavoie?Tremblay et al., (2016), in a study mentioned that healthy work environments have been associated positive outcomes both in nursing and patients. Challenges have been identified in creation of cultures of retention by the nursing leaders in the healthcare setting. A healthy work environment reflects an environment in which the nurses are able to carry out and produce good quality work which involves job satisfaction. The study had the limitation that information provided by respondents was self-reported. This might have reduced the accuracy of information. Several studies have shown that leadership is one of the key factors that helps in influencing the turnover rate of the nursing staff especially in the acute care hospitals (Mason, Leavitt & Chaffee, 2013).The studies also showed that there is a link between the leadership styles and the participative governance, thus influencing the nurse satisfaction in addition to the commitment of the nurses and their retention in the organisation.  According to Top, Akdere and Tarcan (2015), leadership is about the relationships between the people. The true leaders are expected to work together along with their co-workers. It is the duty of the true leaders to engage their co-workers in a shared meaning of the work. The study conducted was the first study to examine the relationships among transformational leadership, organizational commitment, organizational trust and job satisfaction in a Turkish context. It has been perceived that leadership has a profound effect on the quality and retention of staff since it is seen to have a strong and significant influence on the achievement of the group and the achievement of the goals as a unit (Titzer &Shirey, 2013). A study by Trybou et al., (2014), showed that there is a positive relationship between the practices of relational leadership and that of transformational leadership along with the nursing staff’s intention to stay back in their position. Another study concluded that the impact of true leadership has the capability to spread beyond the unit level, having an impact on the profession in addition to the health care delivery system and also the society at a large. The cross-sectional nature of the research precluded claims of causal effects. Further, the sample consisted of both nursing homes and a hospital.

Nei, Snyder & Litwiller, (2015) in a study revealed that it is recently becoming quite difficult to make the experienced nurse get attracted to the position of management positions which has been declining gradually. Therefore the existing shortage of nurses has in turn resulted in elevated concerns in terms of delivery of health care and management of care activities in most of the countries. Several limitations exist in this study. The most prominent one is that although statistical research is in support of the calculation of meta-analytic correlations between two studies, no certainty remains regarding how similarity of study characteristics affects the accuracy of meta-analytic correlations derived from two primary studies. Studies suggest that there are requirements to bring out implementation of the strategies that will help in reducing the nurse shortage in the health care organizations, thus affecting the quality of patient care especially in the acute care settings (Merrill, 2015).

Many researchers have often used the concept of social exchange theory in order to explain the attitude and behaviour of an organization. According to this, when the employees receive unfavourable treatment from the employers, they tend to change their attitudes and their behaviour towards their respective organization (Negussie & Demissie, 2013). In another study conducted by (Lartey, Cummings & Profetto?McGrath, 2014), it was argued that transformational leadership generally includes four major elements like idealised influence, motivation, stimulation in an intellectual manner and lastly individualised consideration. The study was one of the few to examine interventions that promote the retention of experienced Registered Nurses in healthcare. According to this concept, it is required that the leader should strive to inculcate trust and respect through playing a role model character and set an example for the people following them. (Kutney-Lee et al., 2013). Motivation or rather inspirational motivation takes place only when nurse managers are able to motivate their staff to achieve their mission and the goals that are set by the organization and even their own personal goals. Considering the intellectual stimulation, it tends to arise only when nurse managers are able to motivate their staff to implement new ideas. Is also includes continuity of learning either through formal training courses or from evidence-based materials (Bamford, Wong & Laschinger, 2013). In terms of individualized consideration, it refers to nursing managers who should possess the ability to encourage the staff members individually by helping and supporting them. There is also a need to achieve high functioning or positive feedback to every employee. Therefore the study suggests that transformational leadership possesses the capability to elevate the nurse’s interest in committing to the mission and vision of the organization for which they are working. Additionally they can influence the nursing staff to think and act beyond their personal interests. According to Lavoie?Tremblay et al., (2016), transformational leadership is one of the better known leadership styles and most frequently studied leadership approach especially in the clinical setting.  A study by Laschinger & Fida, (2014), concluded that the existing literature on nurse leadership supported the idea that the use of transformational leadership practices among nurse managers is positively associated with improved nursing staff outcomes. The study also states that development of transformational leadership is crucial for improvement of the health outcomes of the patients. The evidences also suggests that relationships between the leadership styles and the higher patient satisfaction.

Research design and methodology

Study design

The study will be conducted through systematic review that will be conducted by collecting secondary data and by appraising the existing literature. The research will follow a deductive approach through the implementation of qualitative data analysis (Wong, Cummings & Ducharme, 2013). The inclusion criteria that will be considered are retention, nurse managers in acute care settings. The exclusion criteria will be the primary care nurses and nurse managers. For this particular study the systematic review design has been used because since it acts one of the most reliable sources in terms of provision of evidence in order to guide a clinical practice. The systematic review provides a summary of the already existing primary research in a meticulous way. The researchers can establish the existing knowledge through the use of systematic review.

Sampling method selected

Sampling will involve selection of articles related to the nursing problem identified here. A total number of 20 papers will be selected which will be collected from various database sources. The key words or the search words that will be used for sampling will include nurse managers, nursing leadership, staff retention, factors of retention, translational leadership and social exchange theory. In order to reduce sampling bias convenience sampling and judgement sampling will be avoided in the study (Wallis & Kennedy, 2013).

Databases used

The databases that will be searched for are the following databases: ABI Inform, Academic Research, Dissertations & Thesis, CINAHL, ERIC, Health Source, Nursing & Allied Health Source, Medline, Health Star, Psych Info and Embase (Twigg & McCullough, 2014). The key terms will be used simultaneously for each database. Google scholar will also be searched by applying all the key terms.

Instruments used

For this study, a standardised abstraction form will be used so that proper consistency is achieved in the study along with reduction of bias and improvement of the validity and the reliability of the study method. The content of the abstraction will be based on the determined methodology.  This form will be useful to classify as well as describe the key characteristics of the interventions and evaluation of the retrieved data. The studies chosen for this research will be abstracted by independent reviewers and additionally will be reconciled by the chapter development team. All these factors will be helpful in increasing the viability and the reliability of the study.

Data collection

The data will be collected from the retrieved quantitative studies which will include the author, the name of the journal and the date of the publication. Additionally the research purpose of the chosen paper will be identified along with the theoretical framework used. The design of the paper, the sampling method and the measuring instruments will be identified. The reliability, validity, the factors of retention, analysis method and other significant and non-significant factors will also be considered (Sawatzky, Enns & Legare, 2015). The search strategy will involve the keywords nurse mangers AND employee retention in the initial phase. Additionally factors for retention will also be searched along with nursing leadership. First the abstracts will be reviewed and then the articles in order to identify the aim or the purpose of the study in relevance to the identified problem of nursing practise. The reference lists of the searched papers will also be reviewed in order find other potential articles. From the initial number of papers that will be retrieved selection will be carried out, reducing the number of final papers which will be used in the final study. All the articles that will be searched for will be those which have been published within the last five years, therefore this will indicate a rapid rise in the research that is being conducted in this area.

Data analysis

Data analysis or in this case quality review assessment will be carried out. Each paper that will be selected should be reviewed at least twice and will be appraised using the quality rating tool that will be adapted from some instrument which will be chosen from any previous work. The tool that will be adapted will be used to measure the quality of the overall design that will be based on the design of the research, the sampling method used along with the statistical analysis and the measurement for each chosen paper. The Critical Appraisal Skills Programme (CASP) screening tool will be used for proper screening of the quantitative studies that were chosen. The appropriateness of the chosen qualitative studies in terms of the research design, the data collection method, the sampling technique and the ethical issues along with data analysis will be determined through the use of the CASP tool (Hutchinson & Hurley, 2013).

Synthesis of results

The method of content analysis will be used to synthesize the results deduced from the qualitative studies that were selected. The concept of analysis of the content refers to a systemic means using which the content of the study can be categorised and the factors recognised can be segregated into various themes. In this study, the method of meta-analysis was not carried out as there was variability between the study designs in each of the papers which were selected (Brunetto et al., 2013). Therefore for each of the factor, examination will be conducted for number of times, in order to determine in which context and how significant are the factors to influence the nurse manager and the intention of the employees to stay in their present position.

Ethical consideration

A systematic review is to follow the fundamental conventions on research and publication. Specifically, researchers are to ensure that particular issues that arise are looked into. Accordingly, for the proposed systematic literature review, the contributors of the independent research papers are to be duly acknowledged and the potential conflicts of interest are to be declared.  The evaluation protocol will be reviewed and approved by the existing authorized Institutional Review Board. The considerations that will be followed by carrying out and publishing this systematic review will include avoiding of duplicate or redundant publication. Care will be given to avoid plagiarism. Additionally the data and the results will be transparent. The accuracy of the data needs to be ensured. In addition, the data generated from the research would be saved in a secured manner. A highly protected computer system would be used for storing all the information related to the research. This would ensure that the information is out of hands of any external agencies (Bormann & Abrahamson, 2014).


In conclusion it can be stated that role of the nurse managers is of quite of significance since this can have an effect on the health care delivery system. The nurse managers play a role that affects the employees as their role is a determining one in the retention of the staff which in turn effects the quality of health care provided to the patients. The transformational leadership is one of the better known leadership styles and most frequently studied leadership approach especially in the clinical setting. Using the transformational leadership practices, the nurse managers are able to be positively associated with the improvement in the nursing staff outcomes. This includes factors like job satisfaction, productivity, retention and increased patient satisfaction. Transformational leadership is crucial for improvement of the health outcomes of the patients. Using the articles retrieved from the various data sources, we intend to examine the leadership behaviour of the nurse managers and its effect on the retention of the nursing staff. The study also intends to find out the factors that might be associated with the employee retention. These factors will be further categorized through the study into several themes.


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