Making nursing a better place: a discrete choice experiment to elicit the job preferences of early-career nurses in England

BACKGROUND: In England, disproportionate numbers of registered nurses leave the National Health Service (NHS) early in their careers. Retaining early-career nurses could ease supply challenges. Most evidence-largely from outside the UK-indicates that retention factors among early-career nurses are within their employers' control. Research is needed to understand the job preferences of early-career NHS nurses to inform and develop tailored retention policies. OBJECTIVES: To identify the job preferences of early-career NHS nurses and estimate the potential trade-offs between these job characteristics. DESIGN AND METHODS: A cross-sectional discrete choice experiment (DCE) administered through an online survey distributed by the Nursing and Midwifery Council. A DCE is a quantitative stated-preference method that presents respondents with hypothetical job scenarios with varying attributes and levels. Nurses chose their preferred job package from each set of alternatives, enabling the estimation of their job preferences and trade-offs. Following established practice, we employed qualitative work, including a literature review, focus groups and consultation with academic experts and stakeholders, which was undertaken before the DCE to inform the selection of attributes and levels. Quantitative findings are reported separately. We specified a mixed logit model to estimate the job preferences of early-career NHS nurses and explore preference heterogeneity. SETTING: England, NHS. PARTICIPANTS: 11 early-career nurses participated in the qualitative focus groups that informed DCE development, and 5696 early-career nurses were included in the final DCE analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The DCE included eight job attributes: career development, organisational support, teamwork, management, personalised working, work pressure, recognition and salary. Salary was included as a continuous attribute to estimate the amount of annual salary respondents would be willing to forgo for improvements in the non-monetary job attributes. RESULTS: Early-career NHS nurses preferred good teams with good collaboration,[Formula: see text]supportive and accessible managers [Formula: see text] and low work pressure [Formula: see text]. They were willing to forgo £9419 in annual salary for good teamwork and collaboration, £6534 for supportive and accessible managers and £6055 for low-pressure work environments. CONCLUSIONS: Good teamwork and collaboration, supportive and accessible managers and low work pressure were highly valued by early-career NHS nurses. Healthcare managers should prioritise workplace environments that reflect these preferences as part of broader retention strategies.