An integrative review of nursing staff experiences in high secure forensic mental health settings: Implications for recruitment and retention strategies

Abstract

Aims: To identify the experiences of nursing in high secure forensic mental health settings that may affect staff recruitment and retention. Background: Recruitment and retention of Registered Nurses is a vital international concern in the field of mental health. The high secure forensic setting presents unique challenges for the nurse. Studies of nurse's experiences in this setting have not previously been reviewed in the context of workforce sustainability pressures. Design: An integrative review (Whittemore and Knapfl, 2005). Data sources: A systematic search of data sources: MEDLINE (PubMed), PsycINFO, EMBASE, CINAHL, International Bibliography of the Social Sciences, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, ProQuest Social Sciences Premium collection (IBSS, PAIS, and Sociological Abstracts), and Web of Science from inception to December 2019. Review methods: Data extraction, quality appraisal, and convergent qualitative synthesis. Results: Fifteen papers were selected for inclusion in the review, describing 13 studies. Six studies were quantitative, all cross-sectional surveys. There were seven qualitative studies, using a variety of methodologies. Four themes were identified: engagement with the patient group, the ward social environment, impact on the nurse, and implications for practice. Conclusion: When policymakers address workforce shortages in high secure forensic nursing they must take account of the unique features of the setting and patient group. Nurses must be adequately prepared and supported to function in an ethically and emotionally challenging environment. Impact: This study identified factors affecting workforce pressures in the speciality of forensic mental health nursing. Findings are of interest to national nursing policymakers and workforce leads in mental health service provider organizations, seeking to promote forensic nursing as a career option and retain nursing staff.