Exploring Retention Strategies for Mid-Career Nurses: A Scoping Review and Thematic Analysis

For nursing students

Study summary

Nurse turnover is expensive and disruptive, but most retention research has focused on nurses who are new to the profession. This scoping review, published in the Canadian Journal of Nursing Research by Victoria Babysheva and Elena Neiterman, turns the spotlight on a group that gets far less attention: mid-career nurses. These are the experienced nurses who mentor newer staff, hold institutional knowledge, and keep units running smoothly. When they leave, healthcare systems lose more than a body on the schedule; they lose expertise that took years to build.

The researchers used a scoping review method based on the well-known Arksey and O'Malley framework. Unlike a systematic review, which tries to answer a narrow question about whether an intervention works, a scoping review maps out what research already exists on a topic and identifies where the gaps are. The team searched PubMed and CINAHL, two major health-research databases, and also looked at grey literature (reports, theses, and other material not published in academic journals) for studies published between January 2014 and February 2025.

After screening the literature, 22 studies from 10 different countries met the criteria for inclusion. Of these, 16 studies actually described interventions aimed specifically at mid-career nurses, rather than simply mentioning them as part of a broader sample. Among those 16 intervention studies, 10 focused on helping nurses stay in their current role or unit, while 6 aimed more broadly at keeping nurses in the organization even if they moved to a different position.

The authors grouped these interventions into three broad thematic areas. The first is optimizing role satisfaction, which includes strategies like offering more autonomy, creating clearer paths for career advancement, and giving nurses more varied or flexible career options within nursing rather than forcing them to choose between staying in the same role forever or leaving the profession. The second theme is work culture, which covers the organizational climate and the day-to-day relationships between coworkers, supervisors, and teams. The third theme is customized retention strategies, meaning approaches tailored to an individual nurse's career stage, life circumstances, or professional goals rather than one-size-fits-all programs.

While these three categories point to promising directions, the review's most important message is a cautionary one. The authors found that many of the studies had thin outcome data. In other words, even when a hospital or health system tried a new retention program, the reporting often didn't clearly show whether it actually worked. There was also little consistency in how success was measured, some studies looked at individual outcomes like job satisfaction, while others looked at organizational outcomes like overall turnover rates, and rarely both together. Very few studies examined whether these interventions might have unintended side effects, such as creating unfairness between staff who received extra support and those who didn't.

Perhaps most strikingly, the review found that there isn't even a widely agreed-upon definition of what counts as a "mid-career nurse." Some studies used years of experience, others used age or career stage, and this inconsistency makes it hard to compare findings across studies or build a solid evidence base.

For nursing students and new graduates, this study is a useful reminder that career-long retention is not automatic and depends on more than just a good orientation program. For those further along in their careers, it highlights that organizations often under-invest in supporting nurses once they move past the early-career stage. The authors conclude that healthcare systems need more focused, well-evaluated initiatives to keep mid-career nurses fulfilled and engaged, and that future researchers should prioritize rigorous evaluation of existing programs rather than simply proposing new ones without measuring whether they work.

For educators

Teaching and appraisal notes

This scoping review by Babysheva and Neiterman, published in the Canadian Journal of Nursing Research, addresses an underexamined segment of the nursing workforce literature: retention strategies aimed at mid-career nurses, as distinct from the extensively studied early-career transition-to-practice literature. The authors apply the Arksey and O'Malley scoping review framework, searching PubMed and CINAHL along with grey literature sources for studies published between January 2014 and February 2025. This is a methodologically appropriate choice given the review's exploratory aim of mapping the scope and nature of existing evidence and identifying gaps, rather than pooling effect sizes or grading intervention efficacy as a systematic review or meta-analysis would attempt.

Twenty-two studies from 10 countries met inclusion criteria, of which 16 described interventions specifically tailored to mid-career nurses. Of these 16, 10 targeted retention within the nurse's current role, and 6 targeted retention within the organization more broadly (i.e., allowing for role change but preventing departure from the employer or profession). The authors synthesized the intervention literature into three thematic categories: optimizing role satisfaction (autonomy, career advancement, diversified career pathways), work culture (organizational climate and interpersonal/team dynamics), and customized retention strategies (individualized approaches responsive to career stage and personal circumstance).

For faculty teaching research appraisal, this review is a strong teaching case for several reasons. First, it demonstrates the value of a scoping review methodology when a field lacks a mature evidence base suitable for effect-size synthesis; students can discuss why the authors chose scope-mapping over systematic review or meta-analysis. Second, the review's own limitations sections model good practice in evidence appraisal: the authors are explicit that many included studies had limited outcome data, lacked standardized or comparable outcome measures across individual and organizational levels, and rarely assessed unintended consequences of interventions (e.g., equity concerns if customized strategies advantage some staff over others). Third, and perhaps most pedagogically useful, is the finding that the field lacks a consensus definition of "mid-career nurse." This is a valuable discussion point for teaching how construct definition and operationalization affect the comparability and cumulative value of a body of literature; students can be asked to consider how they would operationalize career stage in a study design (years of experience, age, role, developmental stage models) and what trade-offs each choice carries.

Discussion in seminar could extend to workforce planning and health human resources policy implications, since mid-career attrition removes mentors and institutional knowledge from units at a formative stage for both patient safety and the development of early-career nurses. Instructors might also use this review to illustrate the difference between an intervention being theoretically promising (as role satisfaction, culture, and customization strategies appear to be, based on their conceptual alignment with known drivers of nurse engagement) and an intervention being empirically demonstrated to reduce turnover, which the authors are careful to note remains unclear given the state of the evidence.

Limitations for critical appraisal include the restriction to English-language, PubMed/CINAHL-indexed, and grey literature sources (with the specific grey literature search strategy and any language/publication restrictions not detailed in the abstract), the descriptive/mapping nature of the scoping methodology (which does not permit conclusions about effectiveness), and the heterogeneity of study designs and outcome measures across the 22 included studies, which the authors themselves flag as a barrier to synthesis. The review is best used to orient learners to a gap in the literature and to model rigorous, honest reporting of an evidence base's immaturity, rather than as a source of directly actionable, evidence-graded retention interventions.