title: How does collegial support increase retention of registered nurses in homecare nursing agencies? a qualitative study.
abstract: BACKGROUND
  Collegial workplace support has been linked to higher registered nurse (RN) retention in various clinical settings. In Japan, homecare agencies experience high RN turnover. The purpose of this study was to develop a conceptual framework to describe how perceived support from colleagues affects RNs' decision to remain in an agency.
  
  
  METHODS
  A qualitative research method based on grounded theory was used. Participants were RNs with at least 4 years of experience at the same homecare agency. Participants were theoretically sampled via managers of 12 homecare nursing agencies. Semi-structured interviews and supplementary participant observations were conducted. Data were analyzed using a constant comparative technique, and the process of how workplace support affected participants' decision to remain at their agency was clarified.
  
  
  RESULTS
  In total, 26 RNs were interviewed, 23 of whom were observed in their practice setting. Participants' perception of support from colleagues was framed as being "encouraged to grow in one's own way", which comprised practicing with protected autonomy in an insight-producing environment. Participants reported that they were able to practice with protected autonomy, receiving 1) mindful monitoring, 2) semi-independent responsibility, 3) help as needed, and 4) collegial empathy and validation. RNs also felt supported in an insight-producing environment by 1) enlightening dialogue, 2) being set for one's next challenges, and 3) being able to grow at one's own pace. Reportedly, these were defining characteristics in their decision to continue working in their agencies.
  
  
  CONCLUSIONS
  For RNs to willingly stay at a homecare nursing agency, it is essential that they are able to practice with protected autonomy in an insight-producing environment that encourages them to grow in their own way. Further research is needed to explore ways to create and enhance such environments to lower RN turnover.
authors.affiliation: Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033 Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Noguchi-Watanabe
authors.affiliation: Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033 Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Yamamoto-Mitani
authors.affiliation: School of Nursing, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-machi, Maebashi, Gunma 371-0052 Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Takai
keywords: Collegial support; Homecare nursing agency; Qualitative research; Registered nurse; Retention; Turnover