An ageing workforce is forcing health systems to confront a question that recruitment campaigns alone cannot answer: what makes experienced nurses stay? New research involving almost 2,000 NHS nurses in England suggests that the answer lies less in any single financial incentive than in the texture of everyday working life. For nurses in the later stages of their careers, workplace culture, relationships with colleagues, leadership style, flexibility and workload were among the strongest influences on decisions about whether to remain in the profession. The findings offer a detailed picture of the conditions that can either anchor highly experienced clinicians to the NHS or push them towards early retirement, reduced hours or a complete departure from healthcare.
The issue is becoming increasingly urgent because approximately half of NHS nurses are aged 45 or over, placing a large proportion of the workforce within an age group that may be approaching major career decisions. Nurses with more than two decades of experience are especially important to the resilience of healthcare systems, yet they are also among those most likely to consider leaving or retiring early. Their departure would create more than a numerical gap in staffing rotas. Experienced nurses carry accumulated clinical knowledge, familiarity with complex patient needs and the ability to recognise subtle changes in condition that may not be obvious to less experienced colleagues. They also supervise, coach and informally educate younger nurses, making their retention central to the transmission of expertise across generations.
The study, published in Health Policy, used a discrete choice experiment, a research method designed to identify how people value different features of a decision. Rather than asking participants a broad question such as whether they were satisfied with their jobs, researchers presented nurses with hypothetical employment packages containing varying combinations of workplace characteristics. Participants then selected the option they preferred. By systematically changing the attributes of each package, investigators could estimate the relative importance of factors such as leadership, workload, flexibility and relationships with colleagues. This approach is useful because employment decisions are rarely driven by one consideration alone. A nurse may value higher pay, for example, but may also weigh that benefit against exhaustion, inflexible schedules or a lack of support from managers.
The strongest preferences were linked to the social and organisational environment in which nurses work. Supportive relationships between colleagues emerged as a particularly influential factor, indicating that teamwork is not simply a desirable feature of professional life but a key component of retention. In clinical settings, collaboration affects how safely information is exchanged, how rapidly staff respond to emergencies and how effectively responsibility is shared during demanding shifts. When teams are cohesive, nurses may be more willing to ask for help, discuss mistakes and manage emotionally difficult cases. When relationships are strained, routine pressures can become sources of isolation and conflict. The study therefore suggests that retention strategies should treat team culture as an operational issue directly connected to patient safety, rather than as an optional workplace benefit.
Compassionate leadership was another major influence on nurses’ preferences. In technical terms, compassionate leadership involves managers recognising staff distress, responding constructively to problems and creating conditions in which employees feel respected and heard. For nurses, this may include meaningful participation in decisions, fair treatment, recognition of professional expertise and practical support after difficult clinical incidents. Leadership affects whether organisational policies are experienced as helpful safeguards or as additional pressures imposed from above. A manager who communicates clearly and responds to fatigue may help prevent a temporary staffing crisis from becoming a permanent loss of personnel. Conversely, poor leadership can amplify stress even when the underlying workload is unchanged. The findings indicate that leadership development should extend beyond administrative competence to include emotional intelligence, listening skills and the ability to build trust.
Flexible working arrangements also ranked highly, reflecting the changing needs of an older and more diverse workforce. Flexibility can include predictable scheduling, part-time roles, phased retirement, self-rostering, compressed hours or opportunities to adjust shifts around health, caring responsibilities and recovery time. For experienced nurses, such arrangements may make it possible to remain clinically active without continuing under the intensity of a full-time pattern that is no longer sustainable. Flexibility does not necessarily mean reducing commitment to patient care. Properly designed systems can retain clinical capacity by allowing staff to work in ways that match their circumstances. However, flexibility must be supported by adequate staffing and careful planning; otherwise, it can simply transfer pressure to colleagues or create instability for patients and teams.
Manageable workloads were similarly central to nurses’ decisions. Workload is not determined only by the number of patients assigned to a nurse. It also includes patient acuity, documentation requirements, interruptions, staffing gaps, overtime, emotional demands and the complexity of coordinating care across departments. Persistent overload can produce fatigue and burnout, conditions associated with sickness absence, reduced morale and intentions to leave. It can also compromise patient safety by limiting the time available for assessment, communication and follow-up. The researchers’ recommendations therefore include maintaining safe staffing levels and reducing unnecessary administrative demands. These measures address the mechanism through which workload affects retention: when skilled professionals repeatedly feel unable to provide the standard of care they believe patients deserve, dissatisfaction becomes a moral and professional problem as well as a personal one.
The results carry implications beyond the NHS because many health systems are facing the same demographic and workforce pressures. Recruiting new nurses is essential, but recruitment cannot compensate indefinitely for the loss of experienced staff. New entrants require supervision, clinical education and time to develop expertise, all of which depend on the presence of senior colleagues. If large numbers of experienced nurses leave simultaneously, remaining staff may face heavier workloads, fewer mentors and greater exposure to risk, potentially creating a feedback loop in which deteriorating conditions trigger further departures. Retention can interrupt that cycle. Investment in workplace culture, compassionate leadership and flexible employment may therefore function as a form of infrastructure, preserving the human capability on which hospitals and community services depend.
The study’s findings do not suggest that pay and broader workforce policy are unimportant. Fair compensation, career progression, pension arrangements and adequate staffing remain essential components of any credible retention programme. Instead, the evidence indicates that these measures should be combined with reforms to the daily experience of work. Dr Joanne Turnbull of the University of Southampton described experienced nurses as the backbone of safe patient care and emphasised their role in mentoring the next generation. Lead author Dr Zoé Ejebu said that preventing early departure would require investment in team culture, compassionate leadership and workloads that respect the value of experienced professionals. Professor Shabbar Jaffry of the University of Portsmouth similarly argued that workplace improvements should sit alongside recruitment, fair pay and wider workforce strategy. Together, the findings point to a practical conclusion: retaining senior nurses is not achieved by asking them to endure difficult conditions for longer, but by redesigning those conditions so that remaining in the profession is both possible and worthwhile.
Subject of Research: People
Article Title: What retains experienced NHS nurses: Results from a discrete choice experiment in England
News Publication Date: 5-Aug-2026
Web References: https://www.sciencedirect.com/science/article/pii/S0168851026001569; https://doi.org/10.1016/j.healthpol.2026.105719
References: Health Policy, DOI: 10.1016/j.healthpol.2026.105719
Keywords: NHS nurses, nurse retention, healthcare workforce, workplace culture, compassionate leadership, flexible working, workload, patient safety, nursing workforce, England
