Globally, the nursing workforce is of critical concern, with shortages recorded in all clinical areas [1], including the emergency department (ED) [2], [3]. In 2015, the annual rate of nursing turnover in Australia was 15%, with an average cost of AUD$49,255 per Full Time Equivalent nurse [4]. Internationally, the ED nursing vacancy rate is approximately 11% of the total nursing workforce [3], [5]. High levels of nursing turnover and vacancies within ED can have subsequent patient implications. These implications consist of longer patient wait times, decreased patient satisfaction, and an increase in ambulance diversions [2].

Employee turnover is a standard measure used when comparing staff “leaving” within a system or organisation [6]. Turnover intention (or intention to leave) is described as an “employee’s reported willingness to leave the organisation within a defined period of time” and can be used as a predictor of employee turnover [7]. High turnover can ultimately lead to higher attrition rates (i.e., unable to replace vacancies) [2]. Attrition is the reduction in the size of the workforce due to not replacing (or the inability to replace) staff [8]. COVID-19 has adversely impacted the ED nursing workforce with regards to turnover. Prior to COVID-19 the annual nursing turnover rate was reported as 15% [4]. Post onset of COVID-19, turnover within Australian EDs was reported to be as high as 50% [9]. This high turnover has implications for an already challenged ED working environment [2], [10].

Given the patient impact and cost implication associated with nursing turnover, it is imperative that efforts are made to retain ED nurses. Retention refers to the “various measures taken by organisations to encourage its employee to remain with it for a longer duration of time” [11]. Retention is however a multifaceted issue [1]. The term ‘retention’ is often used interchangeably with ‘intention to stay’ [12], that is, the “behavioural intention which leads to the outcome of retention” [13]. Studies undertaken with general nurses (i.e., from a variety of clinical areas) suggest that they are more willing and likely to stay in their present job when they perceive they are supported by their organisation [13], [14] where leadership practices are transformational or relational in nature [13], are facilitated to achieve career success [13], [14], have positive self-esteem at work [14], are recognised and feel valued, encouraged to participate in decision making, and autonomous in their practice [13]. However, limited research exists as to whether this is also the case with ED nurses. Understanding factors that promote ED nursing retention is thus imperative to support a sustainable workforce.

The aim of this scoping review was to synthesise the evidence and assess the scope of literature regarding: i) contributing and protective factors of ED nursing turnover and ii) contributing and protective factors for ED nursing workforce retention. The question guiding this scoping review was: ‘what factors prevent and contribute to nursing turnover and retention within the ED setting?’ The knowledge generated in this review can be used to inform the development and implementation of workforce strategies to reduce nursing turnover.