Cultivating Retention: Exploring Transformational Leadership Dynamics in Military Nursing through Qualitative Inquiry

Background: The shortage of nurses heightened the need to retain nurses in the workforce, particularly within military treatment facilities (MTFs). Despite quantitative analyses on factors affecting nurse retention, qualitative aspects of nurses’ free-text responses in routine surveys remain unexplored. Objective: This study explored the impact of leadership, using qualitative data from the 2016 and 2018 Military Nursing Practice Environment Surveys, through the lens of the transformational leadership theory on preventable nurse attrition within the military health system (MHS). Methods: Free-text responses from 1372 nurses in MTFs were analyzed using thematic content analysis methodology. Results: Leadership emerged as the most prevalent concern, with 647 comments referencing leadership’s impact on preventable loss. Analysis revealed 25 leadership subcodes, highlighting negative sentiments about manager and executive leader presence and engagement, lack of acknowledgment, and ineffective communication, constituting 61.3% of negative comments. Conclusions: This study highlighted the importance of leadership in nurse retention within the MHS. The findings align with Bass’s transformational leadership theory, emphasizing the need for idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration. Dissatisfaction with leadership trends resonates with the four pillars, suggesting that adopting a transformational leadership culture could positively impact MHS nurse retention. The recommendations include enhancing leadership visibility, improving communication channels, and fostering a supportive environment to address nurse dissatisfaction and prevent turnover.