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. 2025 Jun 16;42(3):Doc35.
doi: 10.3205/zma001759. eCollection 2025.

Drivers and barriers to career entry and retention of nurses with initial higher education: A scoping review

Julia Müller  1 , Florian Breitinger  2 , Patricia Bräuer  2 , Bettina Dauer  3 , Max Zilezinski  4 , Denny Paulicke  1   5 , Patrick Jahn  1
Affiliations

Drivers and barriers to career entry and retention of nurses with initial higher education: A scoping review

Julia Müller et al. GMS J Med Educ. .

Abstract
in English, German

Background: While previous systematic reviews have examined specific aspects of the career trajectories of bachelor-qualified nurses, including adjustment strategies, workplace challenges, and support programmes, no comprehensive synthesis exists addressing how these factors interact across the broader early career pathway.This article examines the drivers and barriers influencing entry, role transition, and retention of graduate nurses, providing insights that complement existing research.

Methods: A systematic literature search following the principles of a scoping review was conducted in the professional databases MEDLINE via PubMed and CINAHL via EBSCO in February and May 2022, as well as in August 2024. The characteristics of the included studies were summarised narratively in a pre-consented data extraction table. The synthesis of information was performed inductively and organised into three emergent themes: Career Entry, Role Development, and Retention.

Results: 31 publications from 13 countries were included in the synthesis and presentation of results. Among these, 18 studies examined factors inhibiting career entry, 10 studies explored role transition, and 3 studies investigated factors influencing retention. Barriers included insufficient team support, fear of making mistakes, and increased workload. Facilitators included support structures, such as mentors and peer networks, as well as designated transition periods.

Conclusion: To promote the academic professionalisation of nursing in Germany and integrate of bachelor-qualified nurses into practice, structural frameworks embedded within the nursing process and oriented across multiple levels are essential. These frameworks should address both the barriers and facilitators identified in this review.

Hintergrund: Bisherige Übersichtsarbeiten beleuchten einzelne Aspekte der frühen Berufslaufbahn Bachelor-qualifizierter Pflegefachpersonen – etwa Anpassungsstrategien, Herausforderungen im Arbeitsalltag oder Unterstützungsprogramme. Ein integrativer Überblick über das Zusammenspiel dieser Faktoren fehlt bislang.Dieser Beitrag zeigt systematisch Treiber und Barrieren auf, die den Berufseinstieg, die Rollenentwicklung sowie den langfristigen Verbleib von Pflegefachpersonen mit primärqualifizierendem Hochschulabschluss beeinflussen.

Methodik: Ein Scoping Review wurde nach den Richtlinien des Joanna Briggs Institute durchgeführt. Die systematische Literaturrecherche erfolgte in den Datenbanken MEDLINE (via PubMed) und CINAHL (via EBSCO) im Februar, Mai 2022 sowie im August 2024. Die Studienmerkmale wurden narrativ zusammengefasst. Die Analyse erfolgte induktiv und wurde thematisch in die Bereiche Berufseinstieg, Rollenentwicklung und Verbleib gegliedert.

Ergebnisse: 31 Studien aus 13 Ländern wurden eingeschlossen. Davon befassten sich 18 mit Faktoren zum Berufseinstieg, 10 mit der Rollenentwicklung und 3 mit dem Verbleib. Zentrale Barrieren waren mangelnde Teamunterstützung, Angst vor Fehlern und hohe Arbeitsbelastung. Förderlich wirkten sich die Unterstützung durch Mentor:innen, Peer-Netzwerke und strukturierte Übergangsphasen aus.

Schlussfolgerung: Für die nachhaltige Integration von Bachelor-qualifizierter Pflegefachpersonen in der Pflegepraxis sind mehrstufige strukturelle Rahmenbedingungen erforderlich, die sowohl hemmende als auch förderliche Einflussfaktoren adressieren.

Keywords: barriers; drivers; initial higher education; nursing; scoping review; staff development.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Table 1
Table 1. Inclusion and exclusion criteria
Figure 1
Figure 1. PRISMA flowchart for literature selection (Tricco et al. [50])
See this image and copyright information in PMC

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