What retains experienced NHS nurses: Results from a discrete choice experiment in England

BACKGROUND: Retaining experienced nurses in the late stages of their careers is a global challenge. The England National Health Service (NHS) is no exception. Approximately half of NHS nurses are aged 45 and above. Older nurses and those with over 20 years of experience are more likely to leave. Retaining them is crucial to preventing early retirement, maintaining workforce sustainability and ensuring safe care. OBJECTIVES: Using a Discrete Choice Experiment (DCE) to elicit the job preferences and potential trade-offs among later-career NHS nurses (aged 45-54). METHODS: DCEs sequentially present hypothetical job packages and respondents choose their preferred option. Eight job attributes were identified through qualitative approaches. A financial attribute was included to estimate marginal willingness to pay and trade-offs. A dual forced-choice design was used, allowing comparison between hypothetical and current jobs, improving realism in decision-making. The DCE formed part of a broader online questionnaire distributed by the Nursing and Midwifery Council. RESULTS: The final sample included 1988 nurses. The Multinomial Logit model showed all attributes were significant. The most valued factors were supportive work relationships, compassionate leadership, flexible working patterns and manageable workloads. Nurses were willing to sacrifice 5.9% of their annual income (£2,775.9) for cohesive teams, 5.8% (£2,735.7) for compassionate leadership, 5.3% (£2,497.8) for flexible working patterns and 5.2% (£2,449.8) for manageable workloads. CONCLUSION: Workplace improvement is key to retaining experienced nurses. Fostering team collaboration, conducting compassionate leadership training, enhancing flexible work reflecting the ageing workforce and introducing minimum safe staffing to reduce workload pressures should be prioritised.