Nursing Practice Environment and its impact on Retention and Turnover: Umbrella Review Protocol

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. Favorable environments are associated with higher satisfaction, better performance, and lower intention to leave, whereas unfavorable environments contribute to turnover, dissatisfaction, and burnout. 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. 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, 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.

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.