The retention of nurses and in particular the retention of those in their first year of practice after qualification, has been an issue of global concern for many years. Across high- and middle-income countries, the forecast deficit of nurses in the workforce over the forthcoming decade has focused attention on the need to develop interventions that support nurses to stay in their role and in the profession.

There is widespread recognition that the transition period spanning the final year of an undergraduate nurse education programme and the first year of qualified practice is a point of high risk for attrition from the profession (Wray, et al., 2021). The first year after qualification is a time when nurses are vulnerable to some of the individual level determinants of turnover such as stress and burnout, job dissatisfaction and lack of commitment (Halter et al., 2017, Flinkman and Salanter, 2015).

Review of evidence shows that the work environment has a causal relationship with retention (Mills et al., 2017, Duffield et al., 2009, Laschinger, 2012) and as such plays a significant role in career choices. The influence of work environment (Camveren et al., 2020, Mills et al., 2017), including workload, work-life balance, shortage of nurses (D’Ambra and Andrews, 2014) and the difference between expectation and reality (Camveren et al., 2020, Duchscher, 2009) are highlighted as areas that affect nurses in this career stage. New nurses are particularly influenced, especially if they perceive there to be poor clinical practice and patient care (Flinkman and Salanter (2015)), which may cause them moral distress and lead to outcomes such as burnout, dissatisfaction and intention to leave (Aiken, et al., 2012). Conversely, positive practice environments are associated with retention (Dawson, et al., 2014) and new nurses who can engage with high quality patient care, hospital decision-making, effective multi-professional relationships and supportive leadership (Twigg and McCullough, 2014), are more likely to settle into the workplace environment and have fewer transition-related concerns (Kramer, et al., 2013).

The challenges that newly qualified nurses face have been attributed in part to the phenomenon of transition shock (Duchscher, 2009), where newly qualified nurses struggle to assimilate the reality of their new roles and work environment with their expectations, potentially in the context of low self-efficacy. Transition shock highlights the contrast between the familiarity of the academic environment and the new roles, responsibilities and relationships of the qualified practice setting. In addition to environmental factors, individual factors influence the extent of transition shock and in turn the intentions of a newly qualified nurse to remain in their role or the profession. The impact of the role of mentors and preceptors in mitigating transition shock is also recognised (Chen et al., 2021, Su et al., 2021, Powers et al., 2019). The behaviour of clinical educators is important, as access to social support systems established in higher education may be lost in the transition to qualified nurses (Ankers, et al., 2018). The preceptor or mentor role is also pivotal in the socialisation of the students or newly graduated nurses into the profession.

Issues with an impact on transition shock and consequently, retention of early career nurses, therefore need to be addressed. Early career has been the focus of much international research and there is growing understanding of the factors that influence transition (Kenny et al., 2021, Van Rooyen et al., 2018) but there is little robust evidence of the impact interventions to enhance transition have on retention (Wray, et al., 2021). Broadly speaking, focused initiatives fall into two categories: those implemented during the undergraduate nursing education programme, with the intention of reducing the likelihood of leaving once qualified and those implemented in the first few months or year after graduation, with the intention of retaining newly qualified nurses in their role or the profession. Interventions implemented in the first year of qualified practice are well documented (Brook, et al., 2019) but less is known about the benefits on retention of implementing interventions in the final year of undergraduate programmes to better equip student nurses for their transition. Interventions in this period can be categorised according to one of six descriptors that broadly indicate the type of intervention implemented. These categories are capstone project; internship; externship; preceptorship; clinical immersion programme; psychological wellbeing programme; and other.

The intervention types differ in their content and delivery but all aim to ease the transition from student to practitioner. This is achieved by either supporting learners with a mentor or preceptor, immersing them in the clinical environment to enhance opportunities for learning and socialising into the profession, developing critical thinking and practical nursing skills, or providing strategies to relieve stress and enable coping mechanisms in the face of challenging situations. Interventions may be implemented jointly between the Higher Education Institute and the Healthcare organisation, by the prospective employer, or the higher education institute independently. All interventions attempt to increase student competence, confidence and perception of self-efficacy (Cowin and Hengstberger-Sims, 2006) so they feel better prepared to enter the qualified workforce. Advantages related to retention are less easily articulated and benefits are primarily associated with easing the transition from student to accountable practitioner. Intervention categories do not have strict boundaries and interventions assigned to each category vary in characteristics, duration, content and delivery mechanism.

This literature review was conducted to understand what interventions targeted student nurses with the goal of reducing likelihood of leaving their role once working as early career nurses, what the interventions tried to do and what evidence there was of intervention success. The review aimed to answer the question: what is the effectiveness of interventions to increase retention of early career nurses, when implemented during the undergraduate programme?