{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:10:49Z","timestamp":1780665049127,"version":"3.54.1"},"reference-count":244,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health and Social Care Delivery Research (HSDR) Programme","doi-asserted-by":"publisher","award":["NIHR131016"],"award-info":[{"award-number":["NIHR131016"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Soc Care Deliv Res"],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social care staff shortages are having a detrimental impact across the health and care system. There are reports of care homes closing, stopping nursing services and not admitting new residents because of challenges with staff shortages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To develop an explanatory framework of strategies used to attract, recruit, and retain registered nurses and care workers working in care homes. Explain how and why strategies work, for whom, the conditions needed and the costs involved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>\n                      A realist synthesis approach was used. In step 1, strategies were identified and initial programme theories developed using data from stakeholder consultations (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u200510), theory gleaning interviews with registered nurses and care workers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u200513), and evidence retrieved from scoping literature searches (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u200550). Strategies (and initial programme theories) prioritised by sector stakeholders focused on staff recruitment and retention, and were taken forward for testing\/refinement. Step 2 involved searching academic databases and social care websites for evidence. Step 3 involved screening and selecting records relevant to the prioritised initial programme theories. Relevant data were extracted and analysed to identify context\u2013mechanism\u2013outcome configurations. To assess rigour, the appropriateness of research methods, and the plausibility\/transparency of grey literature were assessed. Step 4 involved testing and refining the programme theories, with programme theories sense checked\/refined by sector stakeholders. Existing and established theories were used to help further explain the programme theories and develop an overarching explanatory framework.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During step 1, strategies used to attract, recruit, and retain registered nurses and care workers were identified and initial programme theories developed (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u200522). Ten strategies and initial programme theories were prioritised for testing\/refining and were focused on recruitment and retention: staff recognition, flexible working, career development, salary package, early investment, induction, continuous feedback, caring community, effective interviewing and listening to all staff.\n                    <\/jats:p>\n                    <jats:p>From the focused literature searches, 153 papers were included and data from these were used to test and refine the prioritised strategies and initial programme theories, and throughout the process collated into five final theories: effective interviewing, career development, reward and recognition, promoting work\u2013life balance and caring conversations. These strategies do not operate independently; they interact and work together. Effective interviewing sets accurate expectations, and loyalty starts to develop through setting an accurate \u2018psychological contract\u2019 which is fulfilled over time. Opportunities for career development, rewarding and recognising staff, providing flexible working options and supporting staff with caring conversations help staff to feel listened to, respected and valued, which in turn, develops job satisfaction. Supportive leaders and a sense of inclusion and fairness are needed for these strategies to work. These strategies provide staff with positive experiences, and these are reciprocated through employee commitment and loyalty. Supporting staff through providing caring conversations and opportunities for career development also help staff feel empowered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first realist synthesis in this field. The findings provide practical strategies for improving staff recruitment and retention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>Stakeholder consultations did not include the views of staff who had left care work.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Future work<\/jats:title>\n                    <jats:p>Understanding how to attract new staff to the social care workforce remains an important research gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>This study is registered as PROSPERO CRD42021261112.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-9\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>\n                      This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131016) and is published in full in\n                      <jats:italic>Health and Social Care Delivery Research<\/jats:italic>\n                      ; Vol. 14, No. 21. See the NIHR Funding and Awards website for further award information.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/gjrd0408","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T08:11:52Z","timestamp":1744099912000},"page":"1-142","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Attracting, recruiting, and retaining registered nurses and care workers in care homes: the REACH realist review"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2834-8597","authenticated-orcid":true,"given":"Reena","family":"Devi","sequence":"first","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5013-1258","authenticated-orcid":true,"given":"Kirsty","family":"Haunch","sequence":"additional","affiliation":[{"name":"School of 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