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International Journal of Mental Health Nursing (2015) 24, 262–271 doi: 10.1111/inm.12126

Feature Article
Nursing practice environment: A strategy for
mental health nurse retention?
Robina Redknap,1,2 Di Twigg,1 Daniel Rock3,4,5 and Amanda Towell1
1
School of Nursing and Midwifery, Edith Cowan University, Joondalup, 2Graylands Hospital, North Metropolitan
Health Service, Mental Health, 3North Metropolitan Health Service, Mental Health, 4School of Psychiatry and
Clinical Neurosciences, and 5School of Population Health, The University of Western Australia, Perth, Western
Australia, Australia

ABSTRACT: Historically, mental health services have faced challenges in their ability to attract and
retain a competent nursing workforce in the context of an overall nursing shortage. The current
economic downturn has provided some respite; however, this is likely to be a temporary reprieve, with
significant nursing shortages predicted for the future. Mental health services need to develop strategies
to become more competitive if they are to attract and retain skilled nurses and avoid future shortages.
Research demonstrates that creating and maintaining a positive nursing practice environment is one
such strategy and an important area to consider when addressing nurse retention. This paper examines
the impact the nursing practice environment has on nurse retention within the general and mental
health settings. Findings indicate, that while there is a wealth of evidence to support the importance
of a positive practice environment on nurse retention in the broader health system, there is little
evidence specific to mental health. Further research of the mental health practice environment is
required.
KEY WORDS: mental health, nurse retention, nursing, nursing shortage, practice environment.

INTRODUCTION development of compassionate and caring therapeutic

nurse–patient relationships; integrating nursing theory
Mental health nursing has historically been seen as a less
into practice; and the ability for nurses to use their per-
attractive career option for nurses. Major advances
ception, thoughts, and feelings in the identification of
occurred during the 1950s–1980s, and can be attributed
patient needs (McCarthy & Aquino-Russell 2009; Moses
to the rapid expansion in understanding the important
1994; Potter & Tinker 2000). This had a dramatic effect
influence that nursing practice had on mental health
on mental health nursing practice, and resulted in greater
patient outcomes. This understanding primarily evolved
recognition for the therapeutic influence that mental
through the influence of nurse theorists, such as
health nurses have in ensuring positive patient outcomes
Travelbee, Peplau, and Orlando. These theorists empha-
and a reduction in the medical dominance and servility of
sized the importance of interpersonal relationships in the
mental health nurses (Hayman-White et al. 2007; Holmes
2002; The Sainsbury Centre for Mental Health 2005).
Correspondence: Robina Redknap, Graylands Hospital, Brockway
Road, Mt Claremont, Western Australia 6010, Australia. Email: However, the attraction and retention of nurses by
redknapr@gmail.com mental health services continued to be problematic
Robina Redknap, RMHN.
Di Twigg, PhD MBA, B Hlth Sc (Nsg) Hons, RN, RM, FACN,
(Happell 2009). Patients and staff continue to hold differ-
FACHSM. ent perceptions of the ward environment, with different
Daniel Rock, PhD, MN. factors influencing the satisfaction they feel (Friis 1986;
Amanda Towell, D Cur, M Cur, B Cur (Ed et Adm), DCH, RCCN,
RN. Roos 1997; Rossberg & Friis 2004). This has left today’s
Accepted December 2014. mental health nurse leaders with significant challenges to

© 2015 Australian College of Mental Health Nurses Inc.

A STRATEGY FOR MENTAL HEALTH NURSE RETENTION?
attract and retain a mental health nursing workforce
essential to delivering quality nursing care. This is of sig-
nificant concern, as nursing workforce shortages are pre-
dicted for the future across most developed countries.
Global nursing shortages have been acknowledged as a
significant issue (Happell 2009), and are not considered a
new phenomenon. In the past, international nursing
shortages have had a significant impact on the Australian
nursing workforce, with demand outstripping supply. The
global shortage of nurses in future is once again likely to
have a significant impact on Australia, with the population
demand for nurses in Australia predicated to outstrip
supply by 6.3%, or 20 079 nurses in 2016, increasing to
28% or 109 490 nurses in 2025 (Health Workforce
Australia 2012). Mental health has been identified as one
of the areas that will be most affected (Health Workforce
Australia 2012), thereby leaving mental health nursing
particularly vulnerable when competing for the limited
available workforce. Added to this, mental health nursing
is faced with a double disadvantage. The first disadvant-
age can be attributed to the secondary stigma associated
with working within mental health services, despite the
implementation of stigma-reduction strategies (Australian
Health Workforce Advisory Committee 2003). Second,
the expectation that a large proportion of the workforce is
likely to retire within the next 10–15 years, with 61.1% of
the mental health nursing workforce over the age
of 45 years, and 27.2% over 55 years (Australian Institute
of Health and Welfare 2012), exacerbating the already
existing shortage of nurses within mental health. As
private health providers re-enter the market of mental
health-care provision and new contemporary services are
established, these issues are likely to compound the diffi-
culties traditional services face, particularly in the public
sector, to compete for the smaller pool of nurses who
choose mental health as a career.
A review of the literature has determined that a major
contributing factor to general nursing shortages appears
to be related to nurses unwilling to work in certain prac-
tice environments, rather than a lack of qualified staff
(Buchan 2000; 2006; Buchan & Aiken 2008). It is
acknowledged that the practice environment has the
ability to influence employee job satisfaction, regardless
of the industry in which they work (Samson & Daft 2012).
The importance of a positive practice environment is
further supported by work undertaken by the American
Nurses’ Credentialing Centre (ANCC) during the 1970–
1980 nursing shortages. The ANCC developed a set of
criteria known as the Magnet Principles or the Forces of
Magnetism (Gaguski 2006). These criteria were consid-
ered characteristics of hospitals that were able to attract
© 2015 Australian College of Mental Health Nurses Inc.
263
and retain nurses, despite shortages. These criteria reflect
what researchers consider to be the critical elements of a
positive practice environment, including effective leader-
ship, collegial support, and access to professional and
career development opportunities (Aiken et al. 2011a;
Buchan 2006; Buchan & Aiken 2008; Happell 2009;
Norman 2013; Spence Laschinger 2008; Van Bogaert
et al. 2010). Within general nursing, there has been a lot
of work undertaken that demonstrates that improving the
practice environment is an important factor and can have
a significant impact on the attraction and retention of staff
(Aiken et al. 2008; Hanrahan et al. 2010; Spence
Laschinger 2008; Twigg & McCullough 2014). In com-
parison, a review of the literature has revealed a paucity of
studies undertaken in mental health. Researchers have
identified that a number of factors, such as stigma, per-
ceived workload, containing clinical risk, and the lack of
investment in mental health resources, contributes to the
challenges in attracting and retaining a skilled mental
health workforce (Brown et al. 2007; Morrissette 2011;
O’Connor & Vize 2003). However, further research is
needed within mental health on the nursing practice envi-
ronment, to assess its impact on mental health nurse
retention.
The aim of this paper was to provide a review of the
literature, which has examined the association between
the nursing practice environment and retention of nurses,
both in general and mental health settings. This will assist
in providing mental health nurse leaders a greater under-
standing of the significance of creating and maintaining
positive nursing practice environments as a nurse-
retention strategy.
METHOD
A combined search of the following databases – CINAHL
Plus with full text, Medline, PsycARTICLES,
PsycBOOKS, PsycINFO, and Embase – was undertaken
from February 2013 to June 2014. Google Scholar and
Western Australian and Commonwealth Health Depart-
ment websites were accessed to retrieve health policy
documents and reports that had relevance to the study
topic. The search was limited to English language articles
published from 1990 to 2013. Search terms related to the
study topic were used (Fig. 1). The initial search found
17 287 articles. A Boolean and truncated search method
was used to further refine the initial search. This search
method allows the researcher to search for keywords in
both their singular and plural forms. By entering ‘opera-
tors’, such as ‘and’ or ‘not’, the researcher is able to narrow
264 R. REDKNAP ET AL.

Search conducted

February 2013–June 2014

Database

CINHAL, full-text
Medline
Psychlnfo
PsycARTICLES,
PsycBOOKS
Embase

Initial search terms Refined search

(boolean and truncated search)
S1: Mental health nurs*
S2: Global nurs* shortage* S9: S3 and mental health nurs*
S3: Nurs* practice environment S10: S3 and patient outcome*
S4: Nursing leadership S11: S3 and nurs* outcome*
S5: Foundation* of nurs* care S12: S3 and quality care
S6: Standard* of nurs* care S13: S2
S14: S5
Total retrieved: 17 287
Total retrieved: 284

Abstract review
for
inclusion criteria
English language, peer
reviewed, related to the
mental health or general
health nursing-practice
environment and articles,
which linked the nursing
practice environment and
nurse-retention strategies

Total retrieved: 47
FIG. 1: Literature search methodology.

a search by retrieving documents that contain the com-
bined specified words. The revised search retrieved 284
articles.
The abstract of each article was reviewed to assess
relevance to the study. The inclusion criteria for this
review was limited to articles that were written in the
English language, peer reviewed, related to the mental
health or general health nursing practice environment,
and articles that linked the nursing practice environment
with nurse-retention strategies. Where required, the full
article was reviewed to determine relevance. A total of 49
journal articles were selected for this review. In addition,
relevant texts, reports, and Australian state and territories’
and Commonwealth Health Department policy docu-
ments and reports identified through the search or from
the knowledge of the researcher were also reviewed.

© 2015 Australian College of Mental Health Nurses Inc.

A STRATEGY FOR MENTAL HEALTH NURSE RETENTION? 265

Foundations for quality

nursing care
Nursing philosophy
Role definition
Culture of learning Leadership
Support and direction
Empowerment
Innovation

Staffing and resources

Nursing-practice environment Adequate staff
Appropriate skill mix
Adequate support

Participation in
hospital affairs
Professional autonomy
Collegial physician/nurse Control over practice
relationships Empowerment
Cohesive teamwork
Increased confidence
Decrease depersonalisation
FIG. 2: Elements of the nursing practice
environment.

NURSING PRACTICE ENVIRONMENT
The nursing practice environment is a ‘complex con-
struct to conceptualize and measure’ (Lake 2002), but
remains a critical factor in the ability of organizations to
attract and retain nursing staff and optimize patient out-
comes (Aiken et al. 2011B). The practice environment
comprises of factors within an organization, which have
a psychological impact on staff and affect the quality and
safety of care delivered to patients. These factors
include perceived collegial support, leadership, and
access to professional and career development opportu-
nities (Norman 2013). The Practice Environment Scale
of the Nursing Work Index (PES-NWI) is considered
the most useful and reliable instrument to measure the
climate of the practice environment (Aiken et al. 2011B;
Lake 2007; Twigg & McCullough 2014; Warshawsky &
Havens 2011). The PES-NWI was derived by Lake from
the original NWI and was constructed from research on
hospitals that had successfully attracted and retained
nurses during the nursing shortages in the early 1980s
(Lake 2002). The PES-NWI has been used in studies at
least 37 times between 2002 and 2010, with results pub-
lished in 23 peer-reviewed international journals (Twigg
& McCullough 2014; Warshawsky & Havens 2011). The
PES-NWI identifies five key elements as critical areas in
the practice environment that link directly to a positive
psychological impact on staff: (i) foundations of nursing;
(ii) leadership; (iii) staffing and resources; (iv) collegial
nurse–physician relationships; and (v) participation in
hospital affairs (Aiken et al. 2011b; Buchan 2006;
Buchan & Aiken 2008; Happell 2009; Spence
Laschinger 2008; Van Bogaert et al. 2010). Aiken et al.
(2011b) identified that each of these elements indepen-
dently contributes to nurse and patient outcomes, sup-
porting that if they are improved collectively, they create
the ability for services to achieve high standards of
quality patient care, increase staff satisfaction, and
reduce intention to leave (Fig. 2).
Nursing practice environments that have varying
sample size and within considerably differing health-care
systems have been extensively studied at an international
level. While a number of differing factors have been

© 2015 Australian College of Mental Health Nurses Inc.

266
identified as contributing to the climate of the practice
environment, many of these studies conclude that the
critical elements of the practice environment have dis-
tinct similarities worldwide, with a strong link to increased
retention rates, decreased burnout in staff, and adverse
patient outcomes (Aiken et al. 2011; Hinno et al. 2012;
Nantsupawat et al. 2011; Papastavrou et al. 2012; Spence
Laschinger 2008; Walker et al. 2010). Studies have found
that negative perceptions of the practice environment are
predictors of disengagement by nurses with their profes-
sion and intent to leave (Unruh & Ning 2013). The major-
ity of these studies have been conducted within general
health settings, with Roche and Duffield (2010) identify-
ing that of those that have been undertaken, few have
been within mental health-care settings. This has resulted
in minimal guidance to mental health nurse leaders to
promote positive practice environments within their
health services.
In Australia, there has been increased focus on pro-
moting mental health nursing as an attractive career
option in the hope that workforce shortages could be
addressed (Australian Health Workforce Advisory
Committee 2003). However, it is becoming increasingly
evident that while such strategies might have had some
success in attracting nurses, they have had little effect
on the long-term retention rates (Hinno et al. 2012),
resulting in the need to explore alternative attraction
and retention initiatives. With a review of the literature
demonstrating that the practice environment is the basis
of nurses’ satisfaction and their intention to leave in
general settings (Aiken et al. 2008; Choi et al. 2012;
Hanrahan et al. 2010; Spence Laschinger 2008), this
becomes an important area for mental health nurse
leaders to explore. The need for further research to be
undertaken to understand the influence and benefits
that each of the five elements of a positive practice envi-
ronment has on retention of mental health nurses has
never been more important, particularly as these nurses
are reported to evaluate their environments more nega-
tively than nurses in other specialties (Hanrahan &
Aiken 2008).
Foundations for quality nursing care
The principles of the foundation for quality nursing care
form the building blocks of the nursing profession on
which nursing standards, ethical practice, and regulatory
requirements are based (Middleton et al. 2008). These
principles are endorsed by the ANCC, who have deter-
mined that they support the foundation for excellence in
nursing care (McCrae 2012). Kerr et al. (2011) identified
that the ownership by nurses for the quality and standard
R. REDKNAP ET AL.
of their own practice is a critical element of creating
positive practice environments. Literature demonstrates
that there is growing momentum among researchers to
stress the importance of a nursing model of care delivery
as a major principle, which provides structure and
empowerment for nurses to rationalize and own the
quality of care they provide to their patients (Lake 2002;
Roche & Duffield 2010; Wimpenny 2002).
While little research appears to have been conducted
within mental health settings (Hanrahan & Aiken 2008),
the literature has shown that an absence of a nursing
model within general health settings has found to contrib-
ute to nurses feeling constrained in their work, inhibiting
their inability to practice to their full potential (Carlyle
et al. 2012; Kerr et al. 2011; McCrae 2012). With research
findings proposing that the presence of nursing models
are likely to impact on the standards of nursing care and
the intention of nurses to remain within the organization
(Aiken et al. 2008; Armstrong et al. 2009; Roche et al.
2011), it is important that mental health services consider
further exploration in this area when considering factors
that influence the practice environment.
Leadership
Leadership has been recognized as having a direct influ-
ence on the resolution of conflict and staff engagement,
behaviour, and performance within any organization
(Handy 1999; Samson & Daft 2012). Effective leadership
is widely recognized as the facilitator of innovation, and is
seen as pivotal to successfully achieving the vision and
goals at both individual and organizational level (Stanley
2011). Research conducted in health-care settings con-
sistently support its importance, identifying that effective
leadership ‘has a substantial indirect effect on all other
elements of the nursing practice environment’, and is
seen as the starting point from which to influence others
(Leiter & Spence Laschinger 2006; Pretorius & Klopper
2012; Spence Laschinger 2008). Duffield et al. (2009)
supports this by suggesting that ‘the effectiveness of
strong nursing leadership at ward level to job satisfaction,
satisfaction with nursing and intent to leave, cannot be
overstated’ (p. 11). A review of the literature further
determines that nursing practice environments, which
support their staff through visible and accessible leader-
ship and open communication, are instrumental in the
perception of empowerment, clarity of roles, and a sense
of value by nursing staff (Hansen et al. 2007; Laschinger
et al. 2009; Ng 2011; Roche et al. 2011; Van Bogaert et al.
2010).
Leadership is seen as a significant predictor for the
standard of care delivered by nurses and the level of
© 2015 Australian College of Mental Health Nurses Inc.
A STRATEGY FOR MENTAL HEALTH NURSE RETENTION?
commitment they have to the organization (Spence
Laschinger 2008). As such, leadership needs to be recog-
nized as an important consideration in the nursing prac-
tice environment and a critical factor in planning to
address future nursing shortages. Despite this, it is note-
worthy that investment in leadership development has not
always been considered a priority within the health-care
industry, notwithstanding the recognition by leading
international corporations that heavy investment in this
area is critical to innovation and success (Samson & Daft
2012). Although leadership development has been
gaining momentum within the Australian health system, it
is evident that the nursing profession will need to channel
its efforts into investing in current and future nurse
leaders if it is to effectively attract and retain skilled
nursing staff. What cannot be argued is that effective
leadership is a key driver to the relationship and interac-
tion between the other four elements of the nursing prac-
tice environment (Spence Laschinger 2008). By providing
clarity of roles and direction for nursing practice, it is
considered to be the central factor to the satisfaction
nurses feel in their profession (Hansen et al. 2007; Roche
et al. 2011), and ultimately their intention to stay.
Staffing and resources
The current global economic crisis has placed increased
political scrutiny on the use of resources internal and
external to the health industry. This has intensified the
challenges nurse leaders face in determining and ensuring
appropriate numbers and skill mix of nurses to provide
safe, quality care at an efficient cost. Policy makers need
to be mindful that increased workloads and dissatisfaction
of nurses have, in the past, shown to exacerbate nursing
shortages at times of growing health costs and reduction
in nursing resources (Stone & Tourangeau 2003).
To date, studies that have examined the relationship
between nurse staffing resources, and nurse and patient
outcomes, have predominantly focused on the general
health setting, with a paucity of research evident within
mental health. It is acknowledged that the roles and
responsibilities of a nurse working in a mental health
setting differ to that of a general nurse by the very nature
of the patients they care for. However, the principles
behind the relationship between staffing resources and
patient outcomes appear to be inherently similar within
both health-care settings, supporting its importance in
mental health (Roche & Duffield 2010).
When examining the relationship of staffing and
resources on the practice environment, it is important to
consider the findings by Lake and Friese (2006), which
indicate that staffing ratios, levels of nurses’ professional
© 2015 Australian College of Mental Health Nurses Inc.
267
education, and other elements of the practice environ-
ment are intimately entwined. Extensive studies, in both
mental health and general health settings, have evidenced
that better staffing levels in hospitals, more highly-
educated nurses, and improved practice environments
are associated with lower mortality rates, resulting from a
more rapid response to the deteriorating patient and
decreased failure to rescue (Aiken et al. 2011a; Cheung
et al. 2008; Choi et al. 2012; Hanrahan & Aiken 2008;
Hinno et al. 2012; Shuldham et al. 2009; Twigg et al.
2011). Studies conducted in the USA by Aiken et al.
(2008) clearly identified that these factors have the poten-
tial to reduce patient mortality rates by approximately
40 000 deaths per year, reduce staff burnout and stress,
and are a significant precursor of intention to leave (Aiken
et al. 2008; 2011; Spence Laschinger 2008). More recent
studies continue to support the findings that lower nurse-
to-patient ratios negatively impact on patient mortality,
with an increased risk of inpatient deaths, while an
increase in nurses with a bachelor degree has been asso-
ciated with a decrease risk of adverse outcomes (Aiken
et al. 2014; Twigg & McCullough 2014). With this in
mind, it is essential that nurse leaders employ strategies to
provide adequate staffing and skill mix in their nursing
workforce to ensure positive patient outcomes and to
optimize the retention of staff.
Collegial physician–nurse relationships
Magnet Principles support the importance of collegial
relationships between physician and nurse, and have rec-
ognized it as one of the fundamental criteria for excel-
lence in nursing care and nurses’ satisfaction in their work
(Aiken et al. 2011; Buchan 2006; Buchan & Aiken 2008;
Happell 2009; Spence Laschinger 2008; Van Bogaert
et al. 2010). The importance of collegial physician–nurse
relationships is twofold: (i) to promote the confidence of
nurses to freely and effectively communicate with physi-
cians in relation to patient care; and (ii) to promote a
feeling of value and satisfaction in the care they provide
(Van Bogaert et al. 2010). Studies undertaken by Van
Bogaert et al. (2010) found that supportive and collegial
physician–nurse relationships decreased the deperso-
nalization of nursing staff and promoted a cohesive and
constructive team approach to the care of the patient.
These supportive relationships are extensively recognized
as a key factor affecting the degree of stress and burnout
experienced by nurses and their intent to stay (Aiken et al.
2008; 2011b; Van Bogaert et al. 2010).
The ability of mental health medical and nursing staff
to develop strong working relationships is likely to be of
significant importance in Australia, where models of care
268
have a strong multidisciplinary approach to care delivery.
Roche and Duffield (2010) report that mental health
nurses consider that collaborative and collegial relation-
ships and support of their colleagues have a significant
influence on their sense of value and job satisfaction
(Roche & Duffield 2010). Research also supports a direct
link between the effectiveness of the mental health
physician–nurse relationship and patient outcomes, par-
ticularly in the incidence of threats of violence and seclu-
sion and restraint (Duffield et al. 2009; Roche & Duffield
2010).
A review of the literature indicates that over 75% of
nurses working in mental health inpatient settings are
reported to have experienced violence and aggression
from patients, with it being cited as the leading cause of
staff-related stress and physical injury (Patient Safety
Surveillance Unit 2013; Ward 2013). With clear evidence
that the support of nurses by physicians contributes to the
empowerment of nursing teams, the creation of a greater
capacity for nurses to cope with complex and challenging
patient care, and ultimately, the impact on their intent to
remain in nursing (Lake & Friese 2006; Manojlovich
2005; Papastavrou et al. 2012; Van Bogaert et al. 2010),
the relationship between nurses and physicians is an
essential element of the mental health nursing practice
environment for nurse leaders to consider.
Participation in hospital affairs
The need for individuals to feel secure, needed, and
appreciated was identified in 1954 through Maslow’s
empirical work, and conceptualized by what is commonly
known as Maslow’s Hierarchy of Needs (Benson &
Dundis 2003). Through the fulfilment of these needs
comes a sense of empowerment and the ability to achieve
one’s full potential, or self-actualization. A critical
element to attain self-actualization requires the belief by
the individual that they have the opportunity to contrib-
ute to their environment and that their opinions are seen
as important and valuable. It is hardly surprising, there-
fore, that the ability of nurses to influence decision-
making in their workplace is seen as an important element
of this process and critical to the creation of positive
practice environments.
The ability for nurses to participate in hospital affairs
encompasses a number of components, each seen as an
important element of the practice environment (Aiken
et al. 2011a; Armstrong et al. 2009; Lake 2002; 2007;
Leiter & Spence Laschinger 2006; Roche & Duffield
2010; Roche et al. 2011; Spence Laschinger et al. 2010).
These components are considered to promote and foster
empowerment in the nursing workforce, and include an
R. REDKNAP ET AL.
inclusive commitment to staff participation, prompt
responsiveness to concerns, and the opportunity for
nurses to have their voices heard (Armstrong et al. 2009;
Spence Laschinger 2008; Spence Laschinger et al. 2010).
This empowerment is recognized as generating confi-
dence in nurses, enabling them to influence their practice
environment, increase their sense of autonomy and per-
ception of control over their practice, and generate an
increased sense of accomplishment in their work and
commitment to the organization (Middleton et al. 2008;
Roche et al. 2011).
While seen as critical, there are risks that need to be
managed when promoting professional autonomy. Roles
and responsibilities must remain within the nurses’
clearly-defined scope of practice, and meet standards of
care that will ensure patient safety and positive health
outcomes (Hansen et al. 2007; Huntington et al. 2011).
Roche and Duffield (2010) support the autonomy of
nurses, suggesting that increased participation in hospital
decision-making and policy development will strengthen
role competency and confidence in the nursing
workforce.
A feeling of lack of control and autonomy, and the
inability to participate in practice and hospital decision-
making, contribute to decreased nurse satisfaction and
retention in general health settings (Leiter & Spence
Laschinger 2006; Papastavrou et al. 2012). Studies exam-
ining this concept in the mental health setting are
minimal (Roche & Duffield 2010). With the consistent
argument from researchers that the empowerment,
acknowledgement, and value of nurses is intricately
linked to the ability to participate in hospital decision-
making, this is a significant gap for mental health services,
which will compromise their competitiveness to attract
and retain staff in times of nursing shortages. Further
research to understand and enhance nurses’ ability to
contribute to the internal governance of mental health
services is required.
SUMMARY
Mental health nursing is considered to be particularly
vulnerable to future nursing shortages, with supply
unlikely to meet workforce demand (Health Workforce
Australia 2012). Mental health nurse leaders urgently
need to identify strategies to improve mental health nurse
retention in preparation for future shortages. Failure to
do so has the potential to significantly impact on the
quality of care delivered to patients and the satisfaction
nurses feel in their work.
© 2015 Australian College of Mental Health Nurses Inc.
A STRATEGY FOR MENTAL HEALTH NURSE RETENTION?
International research undertaken in general health
settings has clearly established the link that strategies,
which successfully promote supportive nursing practice
environments, have a direct association to lower levels of
stress, greater job satisfaction, higher attraction and
retention rates, and ultimately, better patient outcomes
(Aiken et al. 2008; Choi et al. 2012; Hanrahan et al. 2010;
Spence Laschinger 2008). However, a review of the lit-
erature has evidenced that, to date, minimal research has
been undertaken to determine the effects of these strat-
egies on the mental health practice environment. With
future nursing shortages expected to significantly impact
on mental health services, and mental health nursing seen
as a less attractive career option, further research to
bridge this gap needs to occur, and nurse leaders need to
urgently explore strategies to create positive mental
health practice environments if they are to become the
employers of choice in the future. Researchers must also
partner with nurse leaders to undertake rigorous review
and evaluation of strategies as they evolve.
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