Date of Conferral

4-1-2025

Date of Award

April 2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Cheryl Anderson

Abstract

Background: Health care delivery in rural medical-surgical units is significantly hindered by nurse shortages, particularly in underserved areas. While various approaches to retention have been studied, there remains a lack of focus on sustainable strategies explicitly tailored for rural settings. Purpose: In this integrative review, guided by the situational leadership theory (SLT) framework, sustainable nurse retention strategies for rural medical-surgical units were investigated. The SLT emphasizes four leadership components, supporting, delegating, directing, and coaching, which were the foundation for categorizing themes and subthemes in this analysis. Method: A review of peer-reviewed literature published between 2019 and 2024 was conducted while applying the Johns Hopkins nursing evidence-based practice model, which has been used for quality appraisal and thematic analysis of synthesized findings across qualitative and quantitative studies, as a guide. Results: From thematic analysis, seven critical themes influencing nurse retention emerged: workplace well-being and engagement, work-life balance, leadership and organizational support, vacancy management, professional growth and career development, job embeddedness, and workplace environment. Conclusions: Findings demonstrate that the SLT provides a sustainable framework for improving nurse retention. By fostering leadership support, adequate staffing, mentorship, and flexible scheduling, the retention strategies identified in this review can replicate the success of Magnet-designated hospitals, reduce turnover costs, and improve patient care quality. These findings offer actionable insights for rural health care administrators striving to create resilient and thriving health care systems for underserved communities

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