Factors Influencing Nurse Retention in Conflict Zones: A Systematic Review

Clara Cassandra Resubun; Ferry Efendi; Sylvia Dwi Wahyuni

doi:10.37287/ijghr.v7i2.5302

Clara Cassandra Resubun Universitas Airlangga
Ferry Efendi Universitas Airlangga
Sylvia Dwi Wahyuni Universitas Airlangga

DOI: https://doi.org/10.37287/ijghr.v7i2.5302

Keywords: conflict zones, emotional support, intervention strategies, job satisfaction, nurse retention

Abstract

Nurse retention in conflict zones remains a critical global issue, significantly influencing the sustainability of healthcare services. Nurses in these areas face numerous challenges, including safety risks, emotional stress, and inadequate compensation, which impact their decision to continue working in such environments. This systematic review aims to identify and analyze factors influencing nurse retention in conflict zones and propose intervention strategies to address these challenges. A systematic review was conducted following PRISMA guidelines. Data were extracted from Scopus, PubMed, Web of Science, and CINAHL databases. Studies focusing on nurse retention in conflict zones were included, with data extraction guided by the PICOS framework. The quality of the included studies was assessed using Joanna Briggs Institute tools. A total of fifteen studies were reviewed, identifying key factors for nurse retention. These include improved working conditions, adequate safety measures, financial incentives (e.g., risk allowances), and emotional support systems. Job satisfaction, influenced by job security and a supportive work environment, was also a significant determinant of retention. Emotional and psychological support systems were found to reduce burnout, thereby fostering nurse retention. A multifaceted approach, incorporating improved working conditions, enhanced financial incentives, and robust emotional support, is essential for retaining nurses in conflict zones. Future research should focus on the long-term impact of these strategies and their adaptation to region-specific needs.

References

Al-Qathmi, A., & Zedan, H. (2021). The Effect of Incentive Management System on Turnover Rate, Job Satisfaction and Motivation of Medical Laboratory Technologists. Health Services Research and Managerial Epidemiology, 8. https://doi.org/10.1177/2333392820988404

Altare, C., Castelgrande, V., Tosha, M., Bwenge Malembaka, E., & Spiegel, P. (2021). From Insecurity to Health Service Delivery: Pathways and System Response Strategies in the Eastern Democratic Republic of the Congo. www.ghspjournal.org

Arage, M. W., Kumsa, H., Asfaw, M. S., Kassaw, A. T., Dagnew, E. M., Tunta, A., Kassahun, W., Addisu, A., Yigzaw, M., Hailu, T., & Tenaw, L. A. (2023). Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16983-z

Barati, H., Ramozi, M., Mousavi, S. H., Kaneda, Y., & Ozaki, A. (2023). Health Challenges After a Ban on Women Working in Non-governmental Organizations in Afghanistan. Cureus. https://doi.org/10.7759/cureus.41137

Bogale, B., Scambler, S., Mohd Khairuddin, A. N., & Gallagher, J. E. (2024). Health system strengthening in fragile and conflict-affected states: A review of systematic reviews. PLOS ONE, 19(6), e0305234. https://doi.org/10.1371/journal.pone.0305234

Campbell, K. A., Van Borek, N., Marcellus, L., Landy, C. K., & Jack, S. M. (2020). “The hardest job you will ever love”: Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada. PLOS ONE, 15(9), e0237028. https://doi.org/10.1371/journal.pone.0237028

Campbell, K. A., van Borek, N., Marcellus, L., Landy, C. K., & Jack, S. M. (2020). “The hardest job you will ever love”: Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada. PLoS ONE, 15(9 September). https://doi.org/10.1371/journal.pone.0237028

Elnakib, S., Elaraby, S., Othman, F., BaSaleem, H., Abdulghani AlShawafi, N. A., Saleh Al-Gawfi, I. A., Shafique, F., Al-Kubati, E., Rafique, N., & Tappis, H. (2021). Providing care under extreme adversity: The impact of the Yemen conflict on the personal and professional lives of health workers. Social Science & Medicine, 272, 113751. https://doi.org/10.1016/j.socscimed.2021.113751

Hallett, E., Simeon, E., Amba, V., Howington, D., McConnell, K. J., & Zhu, J. M. (2024). Factors Influencing Turnover and Attrition in the Public Behavioral Health System Workforce: Qualitative Study. Psychiatric Services, 75(1), 55–63. https://doi.org/10.1176/appi.ps.20220516

Halliday, B., van der Laan, L., & Raineri, A. (2024). Prioritizing Work Health, Safety, and Wellbeing in Corporate Strategies: An Indicative Framework. Safety, 10(1), 18. https://doi.org/10.3390/safety10010018

Han, P., Sun, Y., Chen, H., Liu, Y., Liu, S., Wang, J., Chi, C., Dai, Z., Chen, J., Zeng, L., & Jiang, J. (2024). The early career resilience experience of generation Z newly graduated registered nurses in standardized training in the emergency department: a qualitative study in Shanghai. BMC Nursing, 23(1), 391. https://doi.org/10.1186/s12912-024-02043-3

Healy, C. M., & McKay, M. F. (2000). Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses. Journal of Advanced Nursing, 31(3), 681–688. https://doi.org/10.1046/j.1365-2648.2000.01323.x

Kamselem, K. M., Nuhu, M. S., Lawal, K. A. A., Liman, A. M., & Abdullahi, M. S. (2022). Testing the nexus between reward system, job condition and employee retention through intervening role of employee engagement among nursing staff. Arab Gulf Journal of Scientific Research, 40(1), 34–53. https://doi.org/10.1108/AGJSR-05-2022-0061

Kurniati, A., Efendi, F., Ismawiningsih, I., Mulyani, N., Zakaria, Z., Ambarwati, R., Prasetyo, H., Muljandari, E., Damayanti, I., Noor, A., McKenna, L., & Nurlinawati, I. (2024). Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment. Journal of Multidisciplinary Healthcare, Volume 17, 2215–2225. https://doi.org/10.2147/jmdh.s459158

Lee, J. Y., & Lee, M. H. (2022). Structural Model of Retention Intention of Nurses in Small-and Medium-Sized Hospitals: Based on Herzberg’s Motivation-Hygiene Theory. Healthcare (Switzerland), 10(3). https://doi.org/10.3390/healthcare10030502

Legesse, A. Y., Hadush, Z., Teka, H., Berhe, E., Abera, B. T., Amdeselassie, F., Abraha, H. E., Gebre, D., & Bazzano, A. N. (2024). Lived experience of healthcare providers amidst war and siege: a phenomenological study of Ayder Comprehensive Specialized Hospital of Tigray, Northern Ethiopia. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-10655-3

Mani, Z., Kuhn, L., & Plummer, V. (2024). Emergency Nurse Roles, Challenges, and Preparedness in Hospitals in the Context of Armed Conflict. Disaster Medicine and Public Health Preparedness, 18. https://doi.org/10.1017/dmp.2024.7

Okoroafor, S. C., Ongom, M., Mohammed, B., Salihu, D., Ahmat, A., Osubor, M., Nyoni, J., & Alemu, W. (2021). Perspectives of policymakers and health care managers on the retention of health workers in rural and remote settings in Nigeria. Journal of Public Health (United Kingdom), 43, I12–I19. https://doi.org/10.1093/pubmed/fdaa262

Parray, A. A., Dash, S., Ullah, M. I. K., Inam, Z. M., & Kaufman, S. (2021). Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.704811

Pressley, C., & Garside, J. (2023). Safeguarding the retention of nurses: A systematic review on determinants of nurse’s intentions to stay. Nursing Open, 10(5), 2842–2858. https://doi.org/10.1002/nop2.1588

Prust, M. L., Kamanga, A., Ngosa, L., McKay, C., Muzongwe, C. M., Mukubani, M. T., Chihinga, R., Misapa, R., Van Den Broek, J. W., & Wilmink, N. (2019). Assessment of interventions to attract and retain health workers in rural Zambia: A discrete choice experiment. Human Resources for Health, 17(1). https://doi.org/10.1186/s12960-019-0359-3

Segev, R. (2023). Learning from critical care nurses’ wartime experiences and their long-term impacts. Nursing in Critical Care, 28(2), 253–260. https://doi.org/10.1111/nicc.12819

Shiri, R., El-Metwally, A., Sallinen, M., Pöyry, M., Härmä, M., & Toppinen-Tanner, S. (2023). The Role of Continuing Professional Training or Development in Maintaining Current Employment: A Systematic Review. Healthcare, 11(21), 2900. https://doi.org/10.3390/healthcare11212900

Stanford, F. C. (2020). The Importance of Diversity and Inclusion in the Healthcare Workforce. Journal of the National Medical Association, 112(3), 247–249. https://doi.org/10.1016/j.jnma.2020.03.014

Witter, S., Wurie, H., Chandiwana, P., Namakula, J., So, S., Alonso-Garbayo, A., Ssengooba, F., & Raven, J. (2017). How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia. Health Policy and Planning, 32(suppl_3), iii3–iii13. https://doi.org/10.1093/heapol/czx112.