Title: Factors influencing sustainability of newly qualified nurses in emergency departments: A literature review on stable workforce and retention
Abstract:
Background: Nurses form the backbone of healthcare delivery, yet the profession faces escalating challenges of burnout and turnover, magnified by the Covid-19 pandemic. The World Health Organization predicts a global shortage of 4.5 million nurses by 2030. Newly Qualified Nurses (NQNs) are particularly vulnerable, with high attrition rates threatening workforce sustainability. For example, in one London Emergency Department (ED) in 2022, 11 NQNs were recruited, only four stayed beyond the first year, and only three remained for a second year. Premature departures risk undermining care quality, wasting resources, and intensifying staffing pressures. Given Benner’s theory that competence takes at least two years to develop, structured support and retention strategies are critical.
Aim: This study explores the lived experiences of NQNs in EDs, identifies factors influencing early attrition, and highlights opportunities for co-produced, evidence-based strategies to improve sustainability. Methods: A literature review was conducted using CINAHL, Medline, and the Cochrane Library. Inclusion criteria encompassed English-language studies examining NQNs across diverse healthcare contexts, while non-clinical staff were excluded. No timeframe restrictions were applied to capture consistent challenges over time. From 85 identified papers, 10 were deemed relevant, and two qualitative studies were analysed in depth. Brown et al. (2023) conducted Abstract Submission a scoping review of individual and environmental factors influencing nurse retention, while Ho et al. (2021) explored the transition experiences of 23 UK-based NQNs through thematic analysis. Evidence quality was appraised using the GRADE framework.
Findings: Brown et al. (2023) identified resilience, career aspirations, and work-life balance as key individual factors, alongside environmental influences such as organisational culture, workload, and professional development opportunities. Ho et al. (2021) provided rich qualitative insights into NQNs’ emotional and practical struggles, highlighting lack of support, overwhelming workloads, and organisational expectations as major contributors to stress and attrition. While Brown’s review offers breadth across multiple settings, it lacks ED-specific focus. Ho’s study delivers depth but is limited by small sample size. Collectively, both studies underscore the urgent need for robust mentorship, structured transition programs, and supportive workplace cultures. Conclusion: Sustainability of NQNs in high-pressure settings such as EDs hinges on addressing both individual resilience and systemic organisational support. Employers and policymakers must prioritise structured onboarding, mentorship, and professional growth opportunities to foster competence and confidence during the critical first two years. Current evidence remains moderate in quality and lacks ED-specific focus, underscoring the need for larger, mixedmethods studies. Strengthening NQN retention is vital to safeguarding patient outcomes and building a resilient global nursing workforce.
