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Recruitment and Retention Challenges Faced by English Adult Community Nursing Services within Three NHS Trusts: A Qualitative Study

Chamanga, E. (2024). Recruitment and Retention Challenges Faced by English Adult Community Nursing Services within Three NHS Trusts: A Qualitative Study. (Unpublished Doctoral thesis, City, University of London)



The recruitment and retention of nurses in England has been a persistent challenge over the years, with different interventions implemented to address this issue. However, policy and research have focused mainly on investing and investigating the recruitment and retention of acute (hospital) nurses with less emphasis on community nursing (invisible workforce). This is despite changes in population demographics, health policies and models of care which bring care out of acute settings into the community. The provision of adequate community nurses is critical to safety in supporting the provision of care closer to home. This is further complicated by community nursing contractual agreements such as block contracts and the need for practical caseload profiling tools to determine demand and capacity with evidence indicating that some English regions are better at retaining nursing staff than others.


This research aimed to illustrate and describe factors influencing the recruitment and retention of adult NHS community nurses within three geographical areas.


The research design used an exploratory qualitative approach for data collection using virtual (Microsoft Teams®) semi-structured interviews, to answer the question “What factors influence the recruitment and retention of nurses in English adult community nursing services within NHS Trusts?”. Fifty community nurses employed in three English NHS Trusts (urban, rural and coastal) were interviewed. The participants were heterogeneous, with each Trust having community nurses with permanent contracts, temporary contracts and service managers as part of the study sample. Heterogeneity was further enhanced by participants being employed in different job roles, of which 45 identified as women, four as men and one did not identify with either gender, all within varying age ranges between 20 and 70. Following data collection, the framework approach was used to support data analysis, thus, providing a systematic and robust process to data analysis. NVivo 12®, a computer assisted qualitative data analysis software, was also used alongside the framework approach to aid data management.


The research identified eight main themes and twenty-four subthemes, which are specific to the English community nursing context. The main themes include: The perfect job, Finding true self, Identification with organizational values, Prior development and transitional experience, Job dissatisfaction, Shift in traditional practices, Lack of compassionate leadership, and Family commitments. In addition, unique new knowledge emerged from the data, presented by the following theme and subthemes: Prior development and transitional experience, Organizational reputation, Being loyal to the NHS, Lack of identity, and Financial constraints. These main themes and subthemes revealed that multiple factors influenced the recruitment and retention of adult community nurses in England. These factors were discussed using the Herzberg two factor theory as theoretical framework of employee motivation and dissatisfaction. Some factors between recruitment and retention were inversely related, meaning a change in one factor affected the other. However, these factors did not influence each community nurse’s decision on recruitment or retention in a similar way at the same time.


Adult community nursing recruitment and retention challenges are multi-faceted, requiring a tailored management approach for each individual nurse. The findings contribute new knowledge to community nursing workforce research. They also contribute towards the understanding of community nurses’ experiences, informed by their views and hypothesis of service managers, which were informed by their opinions. Owing to the discovery of new knowledge, practical recommendations and implications for further research are proposed.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Chamanga thesis 2023 PDF-A.pdf] Text - Accepted Version
This document is not freely accessible until 28 February 2027 due to copyright restrictions.


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