What motivates critical care nurses to stay in their job? - Structural aspects for empowering intrinsic motivation in permissive professional contexts: A scoping review.

Abstract

Objective: In the wake of the COVID-19 pandemic, a significant number of critical care nurses have left their positions, citing overload, burnout, and moral distress. This scoping review is not just a theoretical exploration but a timely and crucial investigation into the aspects and structures of critical care nursing that can make the job fulfilling and appealing, thereby promoting intrinsic motivation and staff retention.

Methodology: A scoping review of studies reporting on factors that allow critical care nurses to fall back on their intrinsic job motivation. Qualitative, quantitative, and mixed methods studies from 2019 until 2023 that examined critical care nurses are included. This scoping review, which was conducted in 12 databases, follows the framework proposed by Arksey and O'Malley and the PRISMA framework.

Results: 22 studies met the inclusion criteria. The thematic synthesis identified 'meaning' as the overarching theme. Meaning can help critical nurses identify their intrinsic motivation and hold tight to it during professional challenges or low morale. Previous studies found meaning-making as an essential element of spirituality. In the present study, it is strongly related to the other subthemes: sense of pride and joy, personal relationships, thriving, and moral responsibility.

Conclusion: It makes sense for care management to create specific structures and work conditions, such as flexible scheduling, opportunities for professional development, and supportive team environments that encourage critical care nurses in their professional autonomy. Measures tailored to the individual needs and resources are also crucial. In this way, existing intrinsic motivation can be nurtured, and critical care nurses are enabled to autonomously discern values set by the employer into their own value system.

Implication for clinical practice: Institutions need to offer critical care nurses decision-making discretion whenever possible, broad information sharing, and a climate of trust and respect, in which the individual may feel autonomous and can develop personally and professionally.