Nursing Capstone Literature Support

Literature Support

Currently, the number of nurses in the USA is on a downward trajectory given the increased staff turnover as well as aging nursing population. Such a trend necessitates the development of new ways to remedy the situation. A befitting example of such strategies is the utilization of innovative leadership styles such as transformational leadership for the improvement of nursing retention.Primarily, this paper seeks to provide practical details of the efficacy of transformational leadership on bettering nursing retention. Central to the analysis are various aspects that are worth noting. They include a review of literature focusing on the impact of transformational leadership on nursing retention, search strategy for evidence and description of internal and external validity.

Search Strategy

Of utmost significance to the adopted search strategy was the use of two online databases, namely, CINAHL and PubMed. The keywords used for the literature search in both databases included transformational leadership, retention, intent to stay, intent to leave, and nurse turnover. The limiters used to increase the accuracy and relevancy of studies included in the literature review included English language, and studies carried out between 2013 and 2018. Five studies met these criteria and thus considered for inclusion in this literature review.

Evidence Summary

Chan, Tam, Lung, Wong, and Chau, (2013) in their systematic review aimed at establishing reasons for nurses’ intent to leave their current employment. Central to the determination of their findings was the use of electronic databases in which they identified English studies concerned with their aim. Precisely, the researchers identified nurse staff ratios, organizational commitment, leadership styles such as participative leadership, and supportive education programs as important factors influencing nurse retention.

In another systematic review, the researchers aimed establishing the efficacy of strategies utilized in retaining nurses. The review identified twelve relevant studies in which they targeted to establish factors that affect nurse retention. Most of the included studies showed high nursing retention levels when strategies such as participatory leadership, mentorship and orientation were readily available (Lartey, Cummings, &Profetto-McGrath, 2014).

Also, in another non-experimental quantitative research, the study pioneerstargeted to establish the association between critical care nurses’ organizational commitment and their job satisfaction. In this study, the researchers concluded the need for leaders implementing strategies that will increase job satisfaction levels of their subordinates if the latter are to stay in the same organization for the unforeseeable future (Moneke, &Umeh, 2013).

Notwithstanding, Nei, Anderson, and Litwiller, (2014) in their meta-analysis aimed at identifying the reasons of nurse turnover. Central to the meta-analysis were 106 primary studies thataddressed this issue. The meta-analysis established that supportive leadership, employee engagement and network centrality to be the most predominant factors influencing nurse turnover. Other variables noted to affect nurse retention include job strain, control and complexity, motivating factors (rewards), work-family conflict as well as team cohesion.

Lastly, in another research conducted in 56 Belgian acute hospitals, the researchers aimed at examining the influence of nursing environments on nurses’ retention. The study established that 29.5% of the 3186 surveyed had intent of leaving their area of work(Van den Heede, Florquin, Bruyneel, Aiken, Diya, Lesaffre, &Sermeus, 2013). Central to the nurses’ intent to leave their hospitals were two factors, namely, nurse staff ratios and nursing practice environments.  A nurse environment characterized by participative leadership, supportive education programs as well as nursing career growth opportunities translated to a motivated workforce and thereby high nursing retention levels.

Strengths and Limitations

Concisely, allthe reviewed studies have a notable strength of the ability to measure the intended research variables. Similarly, the researches have certain limitations that are worth noting. For example, the small sample size in the non-experimental study carried out by Moneke, and Umeh, (2013)is a weakness that limits generalization of results. Another limitation noted in the reviewed studies is the limited number of voluntary participants and bias (Van den Heede, Florquin, Bruyneel, Aiken, Diya, Lesaffre, &Sermeus, 2013).


Precisely, the internal validity of the researches included in the review is not in question since it is intact but some of the studies’ external validity is questionable. For instance, Moneke, andUmeh in their non-experimental study utilized a limited sample size that jeopardizes the external validity of this study since the small sample size limits generalization of results (2013).Also, the restriction of the research to critical care nurses further affects the external validity of this study. The rest of the studies have intact internal and external research validity.


Concisely, this paper aimed at providing practical details of the efficacy of transformational leadership on bettering nursing retention. Central to the realization of this aim was the review of literature for evidence, details of the literature search method, and description of validity of internal and external research. A learning point earned from the review is the need for leaders adopting innovative leadership styles such as transformational leadership if they are to increase the nurses’ intent to stay in the organization. As such, going forward, there is need for such a consideration if nursing retention level is to remain high.




Chan, Z.C.Y., Tam, W., Lung, M., Wong, W., &Chau, C. (2013).A systematic literature review of nurse shortage and the intention to leave. Journal of Nursing Management, 21, 605 – 613.

Lartey, S., Cummings, G., &Profetto-McGrath, J. (2013). Interventions that promote retention of experienced registered nurses in health care settings: A systematic review. Journal of Nursing Management, 22(8), 1027 – 1041.

Moneke, N., &Umeh, O. (2013). How leadership behaviors impact critical care nurse job satisfaction. Nursing Management, 44(1), 53 – 55.

Nei, D., Anderson, L.S., &Litwiller, B. (2014).Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover.Health Care Management Review. Advance online publication. doi: 10.1097/HMR.0000000000000025

Van den Heede, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E, &Sermeus, W. (2013).Effective strategies for nurse retention in acute hospitals: A mixed method study. International Journal of Nursing Studies, 50(2), 185 – 194.