Abstract

Pensar Enfermagem / v.30 n.Sup / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30iSup.486 / e00486

Nursing Practice Environment and its impact on Retention and

Turnover: Umbrella Review Protocol

Ana Rita Figueiredo1*, Cristina Baixinho2, Pedro Lucas3

1 PhD student at the University of Lisbon, Lisbon, Portugal; Member of Nursing Research Innovation and Development Centre of Lisbon

(CIDNUR), School of Nursing, University of Lisbon, Portugal; https://orcid.org/0000-0002-5373-5284

2 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon; https://orcid.org/0000-

0001-7417-1732

3 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon; https://orcid.org/0000-

0002-2560-7306

* Corresponding author: anaritafigueiredo@esel.pt

Abstract

Introduction

The shortage of nurses constitutes a global challenge with repercussions on care quality, patient safety, and the

sustainability of health services. Among the factors influencing retention, the nursing practice environment

stands out. It is understood as the set of organizational characteristics that either facilitate or constrain

professional practice.1 Favorable environments are associated with higher satisfaction, better performance, and

lower intention to leave, whereas unfavorable environments contribute to turnover, dissatisfaction, and

burnout.2 The COVID-19 pandemic intensified workload, resource shortages, and occupational stress, with

significant impacts on professional attrition, making retention an even more pressing, yet imperative, challenge.1

Despite the extensive scientific literature, a comprehensive synthesis that integrates existing evidence remains

lacking. This protocol aims to address that gap by proposing an umbrella review that consolidates current

knowledge and supports evidence-based decision-making within organizations.

Objective

To identify systematic reviews of the literature that describe the characteristics of the nursing practice

environment which contribute to nurse retention or intention to leave in hospital settings.

Methods

Protocol based on JBI guidelines 3, including the following databases: JBI, Cochrane, CINAHL, Medline, and

Scopus. Two independent reviewers will conduct the selection and appraisal process, with a third reviewer

involved in case of disagreement. Methodological quality will be assessed using the JBI Critical Appraisal

Checklist and the ROBIS tool. Data will be synthesized narratively. Protocol registration: INPLASY doi

10.37766/inplasy2023.11.0039.2

Conclusion

This protocol outlines an umbrella review designed to consolidate and synthesize systematic review evidence

on the association between the nursing practice environment and nurse retention, turnover, and turnover

intention in hospital settings. The planned synthesis will map the available evidence, highlight potentially

modifiable practice environment domains, and inform organizational and policy actions aimed at strengthening

workforce stability and quality of care.

Keywords

Hospitals; Nursing; Personnel turnover; Work Environment.

Abstract

Pensar Enfermagem / v.30 n.Sup / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30iSup.486 / e00486

References

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2. Figueiredo AR, Gaspar F, Baixinho C, Lucas P. How the nursing practice environment influences

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October 29]; 14(4):3233-41. Available from: https://doi.org/10.3390/nursrep14040235

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Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI manual for evidence synthesis

[Internet]. Adelaide: JBI; 2024 [cited ano mes dia]. Available from: https://jbi-global-

wiki.refined.site/space/MANUAL/355829653/9.+Umbrella+reviews