Factors impacting Registered Nurse attrition in Acute Care using Maslow's Hierarchy of Needs as a conceptual framework

Abstract

The global shortage of Registered Nurses (RNs) has deteriorated since COVID-19, with the WHO reporting a 5.9 million shortfall. In the UK 26,755 nurses left in 2023, many under 45 and earlier than planned. Acute care settings are severely affected, as understaffing increases patient morbidity and mortality. Factors contributing to RN attrition are many, varied and inter-related, reflecting the complexity of this issue. A review of three data bases was undertaken to retrieve literature pertaining to post registration RN retention in acute care from 2000- 2024. Findings were narratively synthesised and mapped to Maslow’s Hierarchy of Needs, used as a framework to explore issues relating to RN attrition. Unmet needs at all levels contribute to attrition. Breaks, safety, and fair pay are neglected, while a lack of team culture, recognition, and career growth hinders belonging and self-actualisation. A holistic, needs-based approach is vital to improve nurse retention and workforce sustainability in acute care.