Being a professional nurse until retirement - a qualitative interview study in Germany

Abstract

Background: Nurses are crucial to the global healthcare system, yet there is a growing shortage, exacerbated by demographic shifts and the coronavirus disease 2019 (COVID-19) pandemic. The International Council of Nurses projects a deficit of 13 million nurses worldwide in the near future, contributing to missed nursing care and jeopardizing patient safety. Although extensive research has explored reasons why nurses leave the profession, far less is known about the factors that support their long-term commitment and retention until retirement. Hence, study aimed to identify the factors contributing to long-term retention of nurses in the profession, particularly those who stay until retirement.

Methods: This qualitative study used semi-structured expert interviews with 22 nurses in Germany who had at least 30 years of work experience, aiming to explore the personal, organizational, and societal factors that have supported their continued engagement in the profession. A purposive sampling method was used to select participants from various care settings, including acute, long-term, and outpatient care. Data were audio- and video-recorded, transcribed, and analyzed using content-structuring qualitative content analysis. Thematic categories were developed using a structured content analysis approach following Kuckartz, supported by both deductive and inductive coding via the MAXQDA software to identify key themes related to job retention.

Results: The analysis revealed three overarching thematic categories: personal resources and motivations, organizational context and working conditions, and recognition and social value. The first category includes factors such as career choice motives, personal values, and generation-specific influences, all of which are significant contributors to long-term career commitment. The category organizational context and working conditions, including job satisfaction, work-time control, role clarity, and coping strategies, plays a pivotal role in retaining nurses. The third category encompassed the perceived value of nursing work in society, appreciation from patients and peers, and the professional identity fostered by meaningful recognition.

Discussion: This study provides valuable insights into the factors that contribute to nurses' decisions to stay in the profession until retirement. While many studies emphasize the challenges and negative aspects of nursing that lead to attrition, this research highlights the positive factors that promote job retention. Addressing these factors, such as improving working conditions, ensuring adequate recognition, and supporting personal values and career motivations, could enhance nurse retention strategies. These findings underscore the importance of retention-focused strategies that enhance meaning in work, professional identity, and workplace culture-shifting the policy lens from attrition prevention to long-term engagement.

Clinical trial number: Not applicable.

Keywords: Job satisfaction; Nurse’s role; Personnel retention; Professional autonomy; Qualitative research.

Fig. 1

Category development process

Fig. 2

Results and recommendations