Perceived importance of recruitment and retention measures for bachelor-qualified nurses in German hospitals: mixed-methods study.

Abstract

Hospitals across Europe are under pressure to recruit and retain a well-qualified nursing workforce amid ongoing shortages. The study aimed to assess the perspective of bachelor-qualified (BSN) nurses compared with vocationally educated nurses on the relative importance of various recruitment and retention (R&R) measures to determine tailored, suitable R&R measures according to BSN-specific needs. A convergent mixed-methods study combining a survey and semi-structured interviews through triangulation, conducted as part of the BSN4Hospital study. BSN and 3-year vocationally educated nurses were surveyed in 22 German hospitals with R&R strategies and above-average numbers of BSN. In addition, interviews took place with BSN, chief nursing officers (CNO) and nurse scientists and those working in strategic units (NSC/other). The survey included items related to R&R (work environment, onboarding, salary, shift work, work-life-balance, leadership, roles, tasks), perceived importance and the top three R&R measures. Interviews focused on targeted R&R measures, implementation and challenges. A total of 1856 nurses participated in the survey (282 BSN and 1574 vocationally educated nurses). Semi-structured interviews were conducted with 19 individuals (6 BSN, 8 CNO and 5 NSC/other). On recruitment measures, a significantly higher proportion of BSN (82.6% vs 52.7% of vocationally educated nurses, p<0.001) rated salary according to nurses' qualifications as highly important. Good teamwork and work-life-balance were valued similarly by both groups. Additional recruitment measures emanating from the interviews were BSN-specific onboarding, mentorships, targeted job advertisements outlining BSN profiles, hospital networking and external communication strategies. On retention, in addition to salary, a higher proportion of BSN (63.8% vs 40.1%, p<0.001) highly rated individual career opportunities, advanced clinical tasks (59.9% vs 32.0%, p<0.001), independence (55.3% vs 47.8%, p=0.020) and practice development projects (47.5% vs 20.0%, p<0.001). The interviews underlined the importance of clinical career opportunities, expanded roles and protected time for additional tasks. Multiple measures were identified as relevant for both R&R. Several R&R measures specific for BSN were identified suggesting that a tailored approach is needed. An integrated management approach that recognises BSN qualifications can support workforce stability and high-quality patient care.