Effectiveness of retention strategies in addressing shortages of nurses and midwives in developing countries: a systematic review

Background: Nurses and midwives form the largest proportion of frontline health professionals and their contribution is recognised as essential for meeting the Millennium Development Goals (MDGs) and improving the health and wellbeing of the global population. Shortages of nurses and midwives are a global concern and factors associated with these shortages are complex making it difficult to find the best strategy to address them. This problem is more critical in developing countries where the disease burden is also high. Aim: This systematic review aims to identify the most effective strategies for addressing shortages of nurses and midwives in developing countries. Method: Studies that investigated retention strategies to address shortages of nurses and midwives in developing countries with measures including intent to stay and nurse retention were considered. The interventions of included studies were categorised into three main domains related to employment, intrinsic factors, and education. Four major databases were searched and studies assessed against set inclusion criteria. Included studies were critically appraised for methodological quality using instruments from the Joanna Briggs Institute. Data were extracted independently by two reviewers. Because of heterogeneity in the methods of synthesis by individual authors, a meta-analysis was not done. Results: Critical assessment of 14 included descriptive studies was undertaken. A narrative summary was used to present the findings of the results. Strong positive results were recorded in six studies that investigated the relationship between job satisfaction and intent to stay. Positive results were also reported in studies that investigated the relationship between intent to stay and social support. Results on demographic variables showed mixed responses. Only one study measured retention as an outcome while 13 studies used intent to stay as an outcome measure. Conclusion: The review demonstrated some positive effects of retention interventions on intent to stay and retention. Job satisfaction is reported as the strongest predictor of intent to stay and is likely to improve retention of nurses and midwives in developing countries.