Investigating the Retention and Attrition of Emergency Care Advanced Clinical Practitioners in the United Kingdom: Mixed‐Methods Research

AIM: Identify factors influencing retention and attrition among advanced clinical practitioners working in emergency care in the United Kingdom and explore how practitioners experience career sustainability. DESIGN: A convergent parallel mixed-methods study. METHODS: A national online questionnaire was completed by 320 EC-ACPs. Quantitative data were analysed descriptively using exploratory regression analyses. Free-text responses (n = 300) were analysed using reflexive content analysis. Semi-structured interviews were conducted with 12 ACPs who had left EC and analysed using reflexive thematic analysis. Quantitative and qualitative findings were integrated to examine convergence, complementarity and divergence. RESULTS: Fewer than half of respondents intended to remain in EC over the next 5 years (45%, n = 143), 36% (n = 116) were uncertain and 19% (n = 61) intended to leave. Having a defined career pathway was associated with intention to remain (p = 0.029), perceived lack of support for career development was associated with reduced retention intention (p < 0.001) and poorer self-reported mental wellbeing (p < 0.001). Extended sickness absence was associated with reduced intention to remain (p = 0.037). In contrast, credentialing was not associated with retention intention (p = 0.434). Qualitative findings contextualised these associations, identifying career stagnation, burnout, organisational devaluation, unsustainable working patterns and professional identity ambiguity. Despite these pressures, practitioners described strong attachment to EC and advanced practice, with portfolio working and role diversification as potential strategies for sustaining participation. CONCLUSION: EC-ACP retention appears to be associated with potentially modifiable organisational conditions, particularly career development, organisational support and sustainable role design. Commitment to EC can coexist with uncertainty about remaining, suggesting that attrition should not be interpreted as a loss of professional commitment. RELEVANCE TO CLINICAL PRACTICE: Retention strategies should extend beyond recruitment and individual resilience initiatives to include credible post-credentialing career pathways, professional recognition, supervision, sustainable rostering and opportunities for flexible or portfolio working. These approaches may help experienced ACPs remain engaged in EC across different career stages.