Background
Across the globe, the nursing workforce is currently faced with considerable recruitment and retention challenges with an estimated shortage of approximately 5.9 million nurses worldwide [1]. Similarly, nursing retention remains a key priority for securing the future availability and sustainability of the healthcare workforce [1]. Described as “to hold or keep in possession” and to “engage the services of”, retention refers to an organisation’s attempt to foster a supportive environment which encourages an employee to remain within the organisation [2]. Despite approximately 90% of the global nursing workforce identifying as female [2], there is limited research exploring the experiences of nurses returning from maternity leave and the factors influencing their retention. Given that nursing is a gendered profession, this research gap is significant as issues relating to maternity leave could potentially affect a considerable portion of the current workforce, resulting in retention challenges whilst simultaneously facing a global health workforce crisis.
Returning to work after maternity leave can be a challenging time where working mothers need to adapt to balancing competing work and family needs, often with increased responsibilities from both sides [3]. It is characterised as a complex, and often emotional time where one must navigate their own inner conflict [3] whilst transitioning into a new phase in their career [4]. Furthermore, working mothers may also face a “motherhood penalty”, where it may be assumed they are less committed due to balancing parenting commitments and can subsequently lack career opportunities or progression [5]. Due to balancing career and family commitments, it is not uncommon for working mothers to take career breaks, work reduced hours, or leave the workforce altogether [5].
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This internal conflict which is experienced when balancing family and work commitments can be described as work-family conflict. Defined as the phenomenon that occurs when work affects one’s ability to fulfill family responsibilities or vice-versa, work-family conflict can result in high levels of stress, psychological distress, and can negatively impact workforce retention [6, 7]. Within the available literature, it is evident that work-family conflict has been identified as a significant contributor driving nurses’ intention to leave [8, 9]. Although not yet fully explored in a nursing context, it is evident within other industries that females face high levels of work-family conflict when returning to work following a period of maternity leave [7]. Furthermore, this is compounded by the fact that work-family balance has recently been identified as a key factor driving the recruitment, retention, and satisfaction of healthcare workers [10].
Whilst there are several factors impacting retention of nurses such as the effects from the Covid-19 pandemic, an ageing population, burnout, system pressures, and a lack of recognition [11], it is essential to explore nurses’ experiences returning to work following maternity leave and the factors influencing their retention. These findings may be used to broaden policy and decision-makers understanding of issues affecting nurses returning from maternity leave, as well as identify potential strategies to reduce work-family conflict, and improve retention [12, 13].
The significance of this review lies in its potential to highlight the way forward for health workforce retention following maternity leave. Through a scoping review of the literature, we aim to provide a comprehensive overview of the existing and emerging evidence on nurses’ experiences after maternity leave and the factors influencing their retention, whilst identifying gaps within the literature.
Method
Design
The scoping review was conducted following the Arksey & O’Malley framework [14], which was selected due to its systematic approach and popularity across multiple disciplines [15]. The framework involves the following six steps: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarising, and reporting the results [14]. The review was also undertaken in conjunction with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Ethical clearance was unnecessary given this study is a scoping review which synthesises existing literature and did not involve any primary data collection or direct interaction with participants.
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Identifying the research question
The initial step involved formulating a research question following a preliminary review of the literature. Given its recommended use for health and social care management, the ECLIPSE framework [16] was utilised which takes into consideration the following: expectation (E), client group (C), location (L), impact (I), professionals (P), and service (S) (see Table 1.) [16]. As a result, the following research question will guide the search strategy: “What are the experiences of nurses returning to work following maternity leave?”.
Table 1
ECLIPSE framework
Expectation | The study aims to understand the experiences of nurses returning to work after maternity leave |
Client group | The focus is specifically on nurses, a professional client group within healthcare. |
Location | The research may specify the location as a particular hospital, region, or country where the study is conducted |
Impact | The study looks at the impact of returning to work on nurses, potentially including emotional, professional, and social aspects. |
Professionals | Nurses are the professionals involved in the study. |
Service | Refers to the healthcare services where the nurses are employed. |
Identifying relevant studies
A search of the literature was initially conducted in August 2023 and updated in January 2024 to ensure any new studies were captured. Search strategies were developed in consultation with a health library scientist and were further developed in collaboration with the research team. The search was inclusive of qualitative, quantitative and mixed-methods studies, and included the following four databases: CINAHL PubMed, PsychInfo, and Embase. The databases, recommended by the library scientist were chosen for their prominence in healthcare, covering a wide selection of nursing and human sciences journals. A range of key terms, synonyms, Boolean operators and search modifiers were utilised as outlined in Table 2. Truncations were used in the search strategy to enhance the inclusion of relevant articles.
Table 2
Search strategy
Search Strategy | Key Words / Terms |
|---|---|
1 | Nurs* AND retention AND maternity leave OR parental leave |
2 | Nurs* AND maternity leave OR parental leave |
3 | Nurs* AND turnover |
4 | Nurs* AND flexible working |
5 | Nurs* AND work family conflict |
6 | Nurs* AND work-family conflict |
7 | Nurs* AND attrition AND maternity leave OR parental leave |
8 | Nurs* AND intention to leave AND maternity leave OR parental leave |
9 | Retention AND maternity leave OR parental leave |
Study selection
Development of the inclusion criteria was guided by the Joanna-Briggs institute “PCC” pneumonic: population, concept, and context [17]. Subsequently, the following inclusion criteria were applied for articles to be included in the review: (1) population: inclusive of nurses, (2) concept: return to work following maternity leave (3) context: studies from any country, as well as (4) Published within the past 5 years, (5) qualitative, quantitative, and mixed-methods design research studies. The eligibility criteria were selected to ensure contemporary, and peer reviewed studies were included. Given the gap in research, studies were not excluded based on methodological approach.
Exclusion criteria included: (1) articles not published in English, and (2) grey literature. The decision to exclude non-English articles was driven by practical considerations, primarily the research team’s linguistic abilities, limiting the ability to accurately assess and interpret findings from non-English sources. It is acknowledged that this limitation may have potentially excluded relevant studies in languages other than English. Grey literature was excluded from the study given it does not undergo quality assurance such as the peer review process, and the inability to apply rigour or quality assessments, ensuring the reliability and validity of findings. It is acknowledged that the exclusion of grey literature may have missed other valuable insights or perspectives.
Screening of relevant articles was completed with guidance and collaboration of the research team, with articles selected by two authors (EJ and EE). This was done according to the eligibility criteria, through use of a systematic review tool, Covidence ®.
Study selection is outlined in Fig. 1: PRISMA flow chart for study selection. The systematic search process returned a total of 9558 articles. After deduplication, the title and abstracts were screened prior to applying the inclusion and exclusion criteria to the remaining full text articles. A total of 6 studies were identified as meeting criteria and were included in the review.
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Fig. 1
PRISMA flow chart for study selection [18]
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Quality assessment
To ensure the inclusion of high-quality studies, the Mixed Methods Appraisal Tool (MMAT) [19] was utilised. The MMAT tool is designed to critically appraise the quality of qualitative research, quantitative research, mixed methods studies, randomised controlled trails, and non-randomised studies, through use of specific methodological quality criteria [19]. Two members of the research team were involved in the review process to ensure that findings were relevant, actionable and aligned with the needs of the healthcare workforce. Each study was assessed against the criteria relevant to the study design and included assessing the research question and whether this was addressed, assessing the methodology, data analysis, and bias. The research team agreed that only papers that answered “yes” to the screening questions, and “yes” to 4 or more criteria relevant to the study design were included in the review. Any discrepancies were resolved through discussion with the two reviewers, and further disagreements resolved through group discussion amongst all three members of the research team.
Results: collating, summarising, and reporting results
Once screened, data from eligible studies were extracted and charted within a word document table, including the following information: author, year of publication, location, population, study aims, methodology, outcome measures, and important results. This was completed by two reviewers (EJ & EE) and with collaboration of the research team. A data extraction table was formulated to systematically chart the data in a comprehensive manner, including the following information: author and year of publication, location of study, study aim, methodology, study population and sample size, and key findings. All 6 articles met MMAT criteria and are summarised in Table 3.
Table 3
Summary of studies included in this review
Author Country | Study aim | Methodology | Sample population Study site | Main findings | MMAT |
|---|---|---|---|---|---|
Chen et al. [23] China | To investigate tertiary hospital nurses’ work stress after returning to work from maternity leave following the birth of their second child. | Quantitative using convenience sampling. Tools: Work Stress Scale SDS General information questionnaire. | N = 448 Nurses who had returned to work within 1 year after their second child N = 23 hospitals across China | Demographics: Age: 26–43 Intention to leave: • Yes 27.3% • No 72.77% Work stress: Total work stress of all respondents: 90.40 ± 18.29 • Assume the role of mother: 15.31 ± 3.01 • Nursing work: 27.06 ± 6.34 • Patient care: 13.99 ± 3.22 • Family and work conflict: 18.46 ± 5.42 • Interpersonal relationships: 15.57 ± 4.53 Factors influencing work stress: • Family monthly income (p = 0.004) • Turnover intention (p = 0.000) • Time of returning to work (p = 0.000) • Maternity leave days (p = 0.021) • Presence of depressive symptoms (p = 0.000) Factors of work stress of nurses returning to work after the second child: • Constant (p = 0.000) • Monthly household income (p = 0.043) • Turnover intention (p = 0.000) • Return to work time (p = 0.000) • The age of the first child (p = 0.038) • Presence of depressive symptoms (p = 0.000) Self-rated depression: n = 272 (60.7%) reported positive depression scores • Mild 34.38% • Moderate 19.42 • Heavy 6.92% Moderate to severe depressions scores were associated with: • Maternity leave > 158days • Returning to work in the first three months • Family monthly income < 10,000 yuan | 5/5 |
Costantini et al. [20] Italy | To understand nurses’ experiences who have returned from maternity leave after 12 months or longer | Qualitative interpretive description using semi-structured interviews | Nurses from different districts in Northern Italy. N = 12 participants | Demographics: Mean age: 34.5 (range 31–43 years) Length of maternity leave taken: 1 year 1 month – 6 years 5 months. Time elapsed since maternity: 3–8 months Number of children: • 1 child n = 3 • 2 children n = 7 • 3 children n = 2 Work ratio: • 50% n = 9 • 75% n = 2 • 100% n = 1 Key themes: Children nurturing: • Importance of knowing the child is in good hands • Reliance on family support • Mother child separation concerns • Distress arising from partners inability to cope with children while the mother is at work Family and work: • Two worlds that enrich each other • Challenges of combining the two worlds • Economic gain • Positive emotions associated with contributing to society when working • Diminished time for leisure activities and for their children Rebuilding a profession: • Experiences as a novice & peer doubt/uncertainty regarding the returning nurses expertise • Co-workers’ support is crucial in rebuilding a positive work identity • Experiences of personal gain relating to empathy and improved personal resources after returning from maternity leave Handling the return to work • Challenges associated with shifts variability • Need for self-determination regarding employment status • Concerns regarding lack of supervisor and organisational support and flexibility | 5/5 |
Hill et al. [12] USA | Understand the experiences of emergency nurses who return to work after parental leave | Qualitative using semi-structured interviews and focus groups. | Emergency nurses from a large university health service in Midwest USA. Included nurses from 5 emergency departments. N = 19 participants | Demographics: Returned from maternity leave within 6 months: N = 11 Returned from maternity leave within 2 years: N = 8 Key themes: Work engagement: • Lack of communication • Perceived work engagement • Actual work engagement Lactation: • The act of pumping • Lactation breaks • Lactation rooms Childcare: • Heavy source of stress • Conflicted with work schedules • Cost • Covid impact | 5/5 |
Riaz & Condon [22] Pakistan | Explore the experiences of full-time nurses returning to work from maternity leave who are still breastfeeding | Qualitative Semi-structured interviews | Full-time registered nurses with a child between 0–1 years, who had returned from maternity leave and were still breastfeeding. N = 7 participants | Demographics: Mean age: 30 (range 25–35 years) First time mothers: N = 4 Second time mothers: N = 3 Key Themes: Child’s right to breastfeed • Spoke of benefits of breastfeeding • Child’s right to receive breastmilk • Lack of management support Institutional power • Extending maternity leave through use of annual leave was often refused • Felt their role as a nurse took priority over their role as a mother • Forced to bring their child to work to continue breastfeeding Partner and family support to facilitate continued breastfeeding • Switching from breast to bottle feeds was a source of stress • Shift work affecting the family unit as a whole | 5/5 |
Tseng et al. [24] Taiwan | To understand the experiences of female nurses applying for parental leave, through to returning to work. | Qualitative Semi-structured interviews | Female nurses from two medical facilities and a community hospital in northern Taiwan, who had previously applied for parental leave. N = 13 participants | Demographics: Mean age: 37.3 (range 28–47 years) Key Themes: Considerations when applying for parental leave • Lack of childcare help from family • Desire to raise their own child • Financial situation Support received from other parties • Support from family • Support from superiors • Wage subsidies Experience during parental leave • Happy to participate in developmental stages of child • Feeling trapped always caring for the child • Concerned about being disconnected from society Concerns regarding returning to work • Worried about not being able to resume previous work • Worried about child adapting to care Preparations for return to work • Arranging childcare • Adaptation and education to return to work | 5/5 |
Wu et al. [21] Taiwan | Investigate ICU nurses’ work and coping experiences in relation to their parenting role. | Qualitative Semi-structured interviews | Nurses working within ICU at a medical centre in Taiwan, with a child under 3 years old. N = 10 participants. | Demographics: Mean age: 32.5 (range 28–37 years) Key Themes: Challenges and conflicts of motherhood • Between professional and motherhood roles • Between old and new generation ideas of motherhood Dilemma in life and work • Difficulty exclusively breastfeeding while working • Shift and inflexible work conflict with childcare Maternal engagement • Becoming alert • Taking responsibility • Seeking resources and support • Continued learning | 5/5 |
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Description of included studies
The results included qualitative (n = 5) and quantitative (n = 1) studies, from a range of different countries including: China (n = 1), Italy (n = 1), America (n = 1), Pakistan (n = 1), and Taiwan (n = 2). The research methods included semi-structured interviews (n = 4), a combination of focus groups and semi-structured interviews (n = 1), completion of self-assessment tools, and questionnaires (n = 1). Six themes were identified across the literature, including shiftwork, supervisor support, breastfeeding, work-family conflict, childcare, and emotion and engagement. Table 4 provides an overview of the themes identified across the studies.
Results
Shift work
Shift work and rotating rosters were identified as a source of stress across multiple studies, particularly if supervisors were unable to support flexible schedules [12, 20]. In a Taiwanese study involving intensive care nurses, participants reported that they struggled engaging in a 24/7 rotating roster, stating that night shifts had become difficult since raising a child, coupled with natural ageing, and feeling “physically incompetent” [21]. Other findings indicated some nurses reported feeling distressed when leaving home for night shift due to their child crying and wanting them to stay at home [20].
The impact of shift work was not restricted to just nurses themselves, with one participant outlining it affected their family unit, citing: “My night duties are not only mine they are for my whole family” [22]. Similarly, another stated their husband must also “share the burden of parenting” and help when they are unable to care for their child due to shift work [21]. Others reported difficulties when their partner was unable to cope with caring for their child whilst they were required to attend work, resulting in a “crisis” [20].
Supervisor support
Supervisor support was identified to have a strong influence on participant’s return from maternity leave, and as a theme was present amongst all articles [12, 20‐24]. Some participants reported a desire to regularly check in with managers to discuss their individual needs and manager’s expectations, and that an inability from leaders to accommodate their needs resulted in them feeling devalued [12]. Furthermore, it was identified that it is important for managers to understand employee’s individual family situations due to higher levels of stress amongst those with subsequent children [23]. Once returning to work, participants reported feeling left “on their own” due to little or no re-orientation to the workplace and being expected to perform at the same level as they did prior to parental leave [12, 20].
Similarly, lack of support was evidenced within a Pakistani study where participants had requested to extend their 12-week parental leave entitlement through use of annual leave, however the majority were denied this request. This resulted in participants feeling as though the needs of the hospital took precedence over their role as mother and their child’s needs, at times resulting in distress [22].
Poor communication from supervisors also resulted in a perceived lack of support which was evident in multiple studies. Within an American study focusing on emergency nurses, participants reported feeling unsure whether their parental leave had been approved, and that many participants had relied on colleagues who had been on parental leave recently for information regarding their leave entitlements [12]. This contrasts with a study on nurses in Taiwan, where participants reported feeling supported by their supervisor, despite short staffing and hospital needs. Participants referred to their supervisor being able to empathise through their own personal experience as a mother [24].
Breastfeeding
Whilst one study focused predominantly on breastfeeding [22], this theme was evident across multiple studies [12, 21, 22]. Many participants reported feelings of guilt due to having to express milk or breastfeed whilst at work, despite policy supporting this [12, 21]. Some nurses reported feeling guilty asking for other staff to cover for their patient load whilst they took a lactation break, or feeling hesitant to take a break if it was going to be inconvenient for a colleague [12, 21]. It was voiced by one participant that existing policy does not reflect reality in their workplace [21]. Some results indicated that participants faced negativity from their colleagues or supervisors regarding breastfeeding, such as being encouraged to formula feed [22], overhearing colleagues speak negatively, and not having nursing tasks they had handed over completed for them whilst they were on a lactation break [12]. Nurses also reported feeling rushed during lactation breaks [12, 21]. One participant reported that whilst expressing, she could hear her patient’s ventilator alarming next door, following which a colleague interrupted her to ask why which subsequently ended her lactation break [21].
Participants also reported that despite breastfeeding policy outlining the requirement for a lactation room, this was either non-existent, or not practical given the distance from their department [12]. In one study based in Pakistan, three women brought their babies to work with them so they could breastfeed as they felt they had no other choice [22].
Work-family conflict
Work-family conflict was evident in all studies. While some participants reported feeling genuinely pleased to return to work, they struggled balancing their career with parental responsibilities [12, 21]. Across multiple studies, participants reported feeling stressed and concerned about leaving their child with somebody else whilst they attended work [12, 21, 24]. One participant reported feeling “torn” and questioned if it were right to put their child in care to allow them to attend work, describing it as a “dilemma” [21]. Furthermore, participants discussed the challenges of combining work and family demands, describing the desire to be perfect in both domains yet realising this is not realistic and that family comes first [20].
Participants also reported feelings of guilt or stress when unable to take emergent leave to look after their sick child due to workplace needs. These feelings were exacerbated due to having to take care of someone else’s sick child, which one participant reported as “contradictory” [21].
Childcare
Childcare was a prominent theme across multiple studies and appeared to be a strong source of stress [12, 20, 22, 24]. Participants reported feelings of guilt and reluctance when putting their child into care, concerns regarding their child’s transition to childcare, and if their child would be ok without them [12, 24]. Some participants also questioned whether it was financially beneficial to return to work due to the high costs of childcare [12]. The importance of family help was also evident across multiple studies [20, 22, 24], with one participant stating if they didn’t have family help and were required to put their child into care, they would have extended their maternity leave to mitigate this [20].
Within a study in Pakistan, the hospital had a childcare facility onsite, however this was limited to day-time hours only. Within this setting, participants reported they felt forced to either switch their child to bottle feeding or bring their child to work with them whilst on night shift [22].
Emotion and engagement
Workplace engagement and emotions following maternity leave varied amongst studies. Some participants reported feeling positive about returning to work, motivated, and enjoyed work as a means of taking a break from parenting. Others reported a range of emotions including heightened stress, anxiety, and worry regarding returning to work [12, 20, 24, 25]. Within one study, participants felt that their decreased levels of engagement would be temporary, with plans to increase their engagement levels later on in their careers [12].
Discussion
This scoping review aimed to systematically explore the existing literature on nurses’ experiences and retention after returning from maternity leave. The results identified a range of themes and challenges that nurses face when returning to work from maternity leave including challenges undertaking shift work, lack of supervisor support, breastfeeding, work-family conflict, issues with childcare, and emotion and engagement.
It was evident from the findings of this review that shift-work is a source of stress amongst nurses returning from maternity leave [12, 20]. Not only does the stress of shift work affect nurses themselves, but it can also result in increased stress on the family unit [20‐22]. Fatigue was also raised as a concern for nurses who work night shifts whilst also caring for young children [21]. This is consistent with other research showing that working irregular shift patterns can result in higher levels of work-family conflict and negatively impact mental wellbeing [26]. Shift work is also correlated with increased fatigue and exhaustion in parents, given their responsibility to fulfill family needs around changing work schedules, often resulting in inadequate rest [25]. Flexible, and supportive practices are imperative for reducing fatigue and work-family conflict, therefore improving the experience of nurses returning from maternity leave.
Supervisor support was a prevalent theme within this review, with many participants feeling they received inadequate support. This ranged from when they initially applied for maternity leave, through to their return to work which many participants reported feeling unsupported [12, 20]. Supervisors play a pivotal role in improving job satisfaction and reducing anxiety, and intention to leave among staff [27] as they are key facilitators for women returning to work after maternity leave [28]. Addressing non-supportive work cultures is essential for assisting with the re-integration of nurses back into the workplace. Honesty, patience, having an awareness of another staff member’s perspectives, and being empathetic are key supervisor characteristics that are deemed important in improving the return-to-work post-maternity leave experience of women [28]. Supportive and empathetic supervisors who encourage the prioritisation of families of nurses returning to work positively influence the return to work experience [24] and thereby also potentially reduce work-family conflict that might exist.
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Work-family conflict can be described as the experience felt when work negatively impacts one’s family [13]. Despite not necessarily being labelled as “work-family conflict”, the challenges faced when balancing work and family, and the subsequent impacts were evident throughout all the studies included in this review. Consistent with the wider literature [6, 8, 9, 29, 30] work-family conflict was identified as a key contributor to intention to leave in this review. Nurses working shiftwork have reportedly higher levels of work-family conflict when compared to other healthcare professionals [29]. This is perhaps due in part to nursing being a predominately female profession, however other potential factors include high workloads, shift-work, and lower job satisfaction [29]. Resolving shift work related work-family conflict and implementing supportive strategies for return-to-work mothers should be a priority for health organisations to support and promote nursing retention.
Within the study, there were significant issues identified surrounding breastfeeding with unsupportive practices from colleagues and organisations, inadequate facilities to express, and in some settings nurses even felt they had to bring their child to work on night shifts to facilitate breastfeeding them [12, 21, 22]. This was despite the existence of supportive breastfeeding policies, suggesting that these policies are either not abided by, or are ineffective. This aligns with recent evidence from the United Kingdom which found that only 30% of healthcare professionals involved in the study were aware of breastfeeding policy within their organisation, with only 7% of these being informed by their employer. Participants within this study also reported expressing milk in toilets, broom cupboards, and cars, as well as decreased rates of breastfeeding upon their return to work [31].
Currently, the World Health Organisation recommends exclusive breastfeeding for the first 6 months, followed by the introduction of solids with combined breastfeeding up to 2 years of age or more [32]. However, challenges, such as shift work requirements, perceived lack of supervisor support and ineffective policies as described within this review may make this WHO recommendation either unattainable or difficult to achieve for nurses returning to work following maternity leave in the first 6 months to years.
Childcare was also a significant source of stress for participants across multiple studies, with issues ranging from availability of childcare, feelings of guilt, concerns regarding their child’s transition to childcare, and the financial burden of placing a child into care [12, 24]. However, this was often ameliorated by good family support [20, 22, 24]. On-site and emergency childcare have been demonstrated to assist with the recruitment, retention [33] and the promotion of women in healthcare [34]. Improving access to childcare has been cited as a measure to help retain current healthcare staff, and has been included in the latest National Health Service workforce reform [35]. Despite this, it was clear that this was not available in the majority of the studies included in this review. Where it was available, the childcare was restricted to daytime hours only [22] thus making it challenging for nursing staff working shift work to access. Given the current and predicted global nursing workforce shortage, addressing the stress and needs related to childcare for nurses may assist in decreasing work-family conflict, resulting in improved recruitment, retention, and employee progression.
Returning to work following maternity leave is a challenging period for working mothers, which is complicated by an array of internal and external factors [36]. Emotions and engagement of nurses returning from maternity leave varied across all studies with some feeling motivated and excited, whereas others felt stressed, anxious, and guilty [12, 20, 24]. It was highlighted that these feelings and challenges may only be temporary, with some participants reporting that they planned to re-engage at higher levels later into their careers [12, 25]. Whilst levels of engagement varied across the studies, evidence suggests that engagement can be improved through leadership, relationships, and support, leading to a reduction in turnover [37].
Implications and recommendations
Our findings have several implications and recommendations for future research and practice. The findings from this study indicate that future workforce strategies should prioritise flexibility, supportive management and leadership, and consider the effectiveness of existing policy specifically surrounding lactation breaks. This is further supported by existing evidence which suggests strategies promoting staff engagement, strengthening relationships, and incorporating flexible working arrangements such as altered hours of work and job share opportunities which can lead to a reduction in nurses’ intention to leave [38]. Given the international scope of this review, these recommendations should take into consideration the various cultural norms and organisational contexts.
With six relevant studies included in the review, it is evident that this topic has not yet been fully explored, and that a research gap exists surrounding the factors influencing nursing retention following maternity leave. Globally, the health workforce currently faces significant challenges surrounding nursing retention and recruitment, along with other challenges such as inequitable access to healthcare, overwhelmed systems, financial pressures, and the ongoing impacts from the Covid-19 pandemic [39]. Because of these similarities, further insights gained would be relevant for many other countries and healthcare systems, particularly given the consistent themes identified internationally in this study. We recommend future research focuses on exploring the experiences of nurses returning to work following maternity leave and understanding the factors influencing their decision to stay or leave their positions.
Strengths and limitations
This study has many strengths and limitations. Firstly, strengths included gaining diverse cultural perspectives given the range of countries and cultures included in the study. Other strengths included a clear methodology with inclusion criteria, utilisation of 4 databases within the search strategy, and quality assessment of the included articles.
Limitations of this study included the size of the scoping review which included 6 articles, despite a comprehensive search of the literature. This indicates a clear gap in the research surrounding the retention of nurses following maternity leave, and the possibility of missing themes. Further limitations include the exclusion of grey literature, which may have resulted in bias given that relevant information and additional perspectives may have been overlooked, such as policy, reports, or other non-peer reviewed sources. Similarly, excluding studies not published in English may have also led to relevant studies being missed.
Conclusion
It is evident that returning to work following maternity leave is a complex and challenging period for nurses which is yet to be fully explored. The themes identified within the review included difficulty undertaking shiftwork, lack of supervisor support, difficulties surrounding breastfeeding despite policy, work-family conflict, challenges around childcare, and engagement in the workplace.
This is of particular concern given that work-family conflict is a notable issue resulting in increased turnover intention amongst nurses, which is consistent across multiple countries. Furthermore, current literature indicates that a lack of supervisor support to assist nurses in achieving a balance between their work and family roles is a significant factor influencing nurses’ intention to leave. With the workforce currently comprising of predominantly younger generations such as Millennials and Gen Z, who place a much stronger value on work-life balance, flexibility, and supportive leadership styles, the importance of minimising these challenges is a crucial factor in growing and sustaining our future workforce.
Acknowledgements
We would like to thank the Health Librarian Scientist who helped with designing the search strategy.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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