Factors and Organisational Strategies Associated with Nurse Retention and Turnover Intention in Public Healthcare Settings: A Systematic Literature Review
Abstract
Background: Nurse retention is a critical workforce priority as public healthcare systems face staffing shortages, increasing service demands, and continuing workforce pressures. High turnover can disrupt continuity of care, increase workload among remaining staff, and impose additional recruitment and training costs. Objectives: This systematic literature review aimed to (1) synthesise evidence on factors and organisational strategies associated with nurse retention and turnover intention among nurses in public healthcare settings and (2) develop a thematic framework to inform workforce sustainability. Methods: A systematic literature review was conducted using Scopus and Web of Science following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Peer-reviewed English-language empirical studies published between 2021 and 2025 were screened using predefined eligibility criteria and an adapted six-item quality appraisal checklist. The protocol was registered with PROSPERO (CRD420251186033). Twenty studies meeting the predefined quality threshold were synthesised using descriptive and thematic approaches guided by the a priori Job Demands–Resources framework. Results: Fourteen studies (70%) were conducted in Asia. Five interconnected themes were identified: supportive organisational culture, workload management, career development, psychological well-being, and reward and recognition. The findings indicate that retention and turnover intention are associated with interacting organisational, occupational, and individual factors. Technology-based retention strategies were minimally represented. Conclusion: Nurse retention in public healthcare settings requires an integrated perspective addressing organisational resources, occupational demands, and individual well-being. Future research should strengthen longitudinal and intervention-based evidence across diverse public healthcare contexts.