You could train as a midwife, neonatal nurse, health visitor, or district or practice nurse. You could also move into management, as a matron or director of nursing. With a postgraduate qualification, you could become an advanced nurse practitioner or clinical nurse specialist, then a nurse consultant. There are opportunities to go into teaching and research.
You could also become self-employed or work overseas. You can find out more about career progression from the Royal College of Nursing. Current opportunities Find apprenticeships, courses and jobs available near you. Criteria for considering studies for review This overview included data from qualitative, quantitative and mixed methods reviews published in English from onwards.
Inclusion criteria were as follows: Population: the reviews should be focused on those delivering adult nursing i. Comparison: any comparators, if any, used within the included reviews. Review design I for all stages of the overview : any form of literature review e.
Review design II for narrative synthesis : any review that had carried out and reported a methodological quality assessment of its included primary studies. Exclusion criteria were as follows: Reports from any types of primary studies; reviews published in language other than English; reviews that did not evaluate adult nursing turnover as described in the inclusion criteria or presented data on nurses working across settings that could include the care of children or in specific mental health settings; reviews that did not report empirical findings; reviews published only in abstract form; any form of literature review using informal and subjective methods to collect and interpret evidence, commentaries and non peer-reviewed reviews; any review in which majority of included articles were non-peer reviewed publications and reviews that did not report an appraisal of the quality of the studies they included.
Search strategies were guided by a systematic approach to the research questions [ 35 ] and a Medline search strategy was developed Table 1 and converted or modified to run on other databases Additional file 1. After duplicate articles were removed, relevant reviews were selected according to eligibility criteria using a two-step screening process: Title and abstract screening.
Two authors FP and MH reviewed in parallel the titles and abstracts of all the articles resulted to ascertain their eligibility for full text retrieval. Disagreements were resolved by peer discussion and a third view from the project lead VMD if required.
Full-text screening. Data extraction Three authors MH, OB and CB extracted data from the included reviews using a predefined extraction form and spreadsheet on: general characteristics of the review: e. Discrepancies were resolved through discussion among the data extractors.
This tool has been widely used in previous similar overviews and it is considered to be a valid and reliable instrument [ 38 ]. Reviews that scored eight or higher were considered at low risk of bias high quality , between five and seven were at moderate risk of bias moderate quality and four or less were at high risk of bias poor quality.
The primary studies included in each review were also listed and compared across the reviews to assess the degree of overlap in the reviews comprising our overview. Data analysis Because of the heterogeneous nature of the focus, inclusion criteria and outcome measures of the included studies data were analysed thematically.
Following the detailed reading involved for data extraction, the resultant spreadsheet was examined and a thematic index of determinants and consequences developed using reviews that met our inclusion criteria for including a methodological assessment of their primary studies as well as those that did not. The thematic index Additional file 2 was applied to each data extraction and four main groupings of determinants individual, professional, interpersonal and organisational and one of cost consequences was used to analyse across reviews, using Microsoft Excel to record the decisions applied for all reviews considered Additional file 3.
A narrative account of the findings from the reviews containing an assessment of the methodological quality of included primary studies has been structured using the risk of bias in the review as the primary grouping level and the thematic content analysis as the second level, also drawing on the number and quality of the included primary studies.
Results Review selection, study characteristics and quality assessment Review selection The flow chart representing study selection, including reasons for exclusion, is summarised in Fig. A total of nine reviews met the inclusion criteria and were included in the review. Study characteristics The characteristics of the nine included systematic reviews are presented in Table 2. The included reviews were all published in English; four were authored from the United States of America [ 41 , 42 , 43 , 44 ], and one each from Australia, [ 45 ] Canada, [ 46 ] Finland, [ 11 ] Singapore [ 47 ] and UK [ 48 ].
Of these, six had been published since Eight reviews had been published in four academic journals about nursing Journal of Nursing Management, [ 41 , 42 , 43 , 46 ] Journal of Advanced Nursing, [ 44 ] International Journal of Nursing Studies [ 48 ] and Nursing Ethics [ 45 ] , and one in the International Journal of Evidence-Based Healthcare. None was a Cochrane review. The majority of the reviews limited their searches to the English language, with the exception of Flinkman et al.
The majority of the reviews did not restrict their searches by geographical region. The included reviews contained a range of seven to 31 primary studies. Of the primary studies in the nine systematic reviews, 21 were included in at least two reviews, and only two primary studies [ 49 , 50 ] were included in three reviews Table 3.
In the included systematic reviews, observational study designs were the most frequently reported in the included primary studies; a small number of qualitative studies were also included. Table 3 Articles most frequently included in the reviews assessed Full size table Quality assessment of included reviews Figure 2 presents the critical appraisal scores for individual reviews.
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