“I’m a bit middle class, a bit working class, a bit white and a bit Caribbean” - the retention of nurses in general practice and the intersection of professional and societal level cultural and structural issues: a qualitative interview study

The global nursing workforce crisis has worsened since the Covid-19 pandemic. In England 10% of nursing posts are unfilled, with the general practice nursing workforce being particularly vulnerable across England and Wales. Similar challenges are reflected internationally and pose a risk to patient care and the long-term future of general practice. However, primary care nursing is under-researched and factors which support or challenge retention of nurses in general practice are poorly understood. In this paper we aim to explore the influence of the intersection of cultural and structural factors underpinning retention of nurses in general practice. An exploratory qualitative interview study was conducted. Professional and social media networks and snowballing techniques were used to recruit. Forty-one participants were interviewed who were either working in, or who had worked in, nursing teams in general practice across England and Wales, as well as nurse leaders. Data were collected between October 2023-June 2024. Framework Analysis was used with Bourdieu’s concept of Capital used as a sensitising concept. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained and the study was funded by the General Nursing Council Trust. Professional and societal level constructs influenced and impacted on cultural and structural issues associated with retention of nurses working in general practice in our study. Gender, social class, race, ethnicity and age intersected with each other, alongside medical hegemony and professional identity to shape nursing in general practice. Analysis indicates nurses in general practice lack, or - just as importantly - are perceived to lack, social, economic and cultural capital and this impacts on their position within general practice, results in perpetuation of social disadvantage, reproduces inequality and contributes to the devaluing of nursing, ultimately contributing to attrition. The intersection of the underpinning cultural and structural factors identified indicate why retention of nurses in general practice is difficult to resolve. We suggest that the first steps are to raise these factors to a conscious level and argue that unless they are acknowledged, and work to address them is undertaken, strategies to support retention of nurses working in general practice may be unsuccessful. Registered at Open Science Framework: https://osf.io/2byxc/ .