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. 2023 Aug 21;10(11):7209–7214. doi: 10.1002/nop2.1973

Developing a talent management framework for domestically and internationally trained nurses and midwives in healthcare organizations: A mixed‐methods research protocol

Elaine Berkery 1,✉, Nuala Ryan 1, Bernadette O'Malley 2, Helen Purtill 3, Claire O'Donnell 4
PMCID: PMC10563405  PMID: 37605467

Abstract

Aim

The aim of this study is to gather evidence on talent management practices for nurses and midwives in an Irish hospital group, to identify any shortcomings in the current practices and to develop an evidence‐based talent management framework for the hospital group.

Design

This paper details a protocol for a mixed methods research study that will be used to (1) identify, critically evaluate and summarize academic scholarship on talent management strategies for both domestically and internationally trained nurses and midwives, leading to the development of a model of talent management for this study, (2) gather evidence from both domestic and internationally trained nurses and midwives, via questionnaires and focus groups within the hospital group on current talent management practices and (3) use the model previously developed to organize our findings and develop a talent management framework for the hospital group.

Methods

The study will adapt a mixed methods approach. Quantitative data will be analysed using SPSS, and qualitative data will be analysed using NVivo.

Results

Our findings will support a stakeholder approach to the development of talent management practices for both domestic and internationally trained nurses and midwives in healthcare organizations. Doing so should improve the pipeline of suitably qualified nurses and midwives for future roles, by assisting nurses and midwives to identify career paths and future educational opportunities. From an organizational perspective, this research will allow healthcare organizations to adapt their current workforce planning strategies, tailoring them to the needs of the current workforce, which should reduce turnover, ensuring a highly skilled workforce, with the appropriate numbers to provide the care required within that healthcare setting.

No Patient of Public Contribution

Contributions will be sought from nursing and midwifery staff and management within the hospital group.

Keywords: career aspirations, further education, mixed methods, nurses and midwives, nursing shortages, recruitment, retention, talent management

1. INTRODUCTION

“I consider the workforce challenge to be the greatest crisis that healthcare faces globally. Quite simply, there is too much work and too few workers. This crisis is as large as anything we've ever faced in healthcare” (Iacobucci, 2019).

Nurses and midwives are critical to the delivery of the promise of “leaving no one behind” and the global effort to achieve the Sustainable Development Goals (SDGs) (McCarthy et al., 2020). Investing in the nursing and midwifery profession will not only contribute towards health‐related SDGs but also to SDGs on education (SDG 4), gender (SDG 5) and decent work and economic growth (SDG 8) (McCarthy et al., 2020). Globally, healthcare organizations face enormous challenges as a result of ageing populations, the growth in chronic diseases and a lack of skilled workers (Giles et al., 2014). In speaking of these shortages, WHO (2022) indicate that for all countries to achieve the targets set out by SDG 3 on health and well‐being, the world will need an additional 9 million nurses and midwives by the year 2030. Worryingly, the pre‐pandemic shortage of nurses and midwives globally was estimated at about 5.9 million, with Buchan et al. (2022) highlighting how the pandemic has exacerbated this global shortage. They estimate that if an additional 4% of the nurses worldwide were to exit the profession, arising from the pandemic, it would increase the shortage of nurses and midwives by over one million, pushing the shortfall to 7 million. If governments worldwide are to address this shortage McCarthy et al. (2020) indicate that the total number of nurse graduates would need to increase by 8% per year on average up to 2030, alongside an improved capacity to employ and retain these graduates.

As a short‐term solution to the staffing crisis in nursing and midwifery, many healthcare organizations in developed countries have started to rely heavily on the recruitment of internationally trained nurses and midwives. For example, in 2019, nurses and midwives with international training made up 49% of new nursing and midwifery registrations in Ireland (INMO, 2020). It is undoubted that this group of nurses and midwives are crucial to the delivery of front‐line care; however, they only offer a temporary fix to a situation that will become worsened if this cohort decide to return home. Previous research conducted in Ireland found that more than half of the internationally trained nurses and midwives interviewed said they intended to leave the country within 5 years (Humphries et al., 2009). Therefore, employing international nurses and midwives to fill vacant positions is not sustainable in the long term, because firstly, it is drawing workers from lower‐income countries, that are also facing workforce shortages, to work in health services in higher‐income countries, and secondly, it is not addressing the issue of decreased domestic supply of nurses and midwives and the development of nurses and midwives in the workplace.

To create a more sustainable workforce, healthcare organizations should engage in talent management, a discipline that has evolved over the past two decades, and has received considerable attention in the private sector, although it has not been treated with the same regard in the healthcare sector. Talent management seeks “to attract, identify, develop, engage, retain and deploy individuals who are considered particularly valuable to an organization” (CIPD, 2022). In this regard, talent “refers to individuals who can make a significant difference to organisational performance, either through their immediate contribution or by reaching their highest levels of potential” (CIPD, 2022). Creating a talent management strategy in healthcare organizations does not mean starting anew with Human Resource (HR) policies. Instead, it focuses on enhancing existing policies and redesigning them where needed to create HR policies and practices so that existing talent within healthcare organizations can be identified. As a starting point, talent management strategies begin with workforce planning, to determine workforce needs based on supply and demand, demographical characteristics, shortages/surpluses faced by the profession, tightening labour markets and workplace trends such as flexible and more hybrid ways of working. Doing so will help identify recruitment, retention and progression opportunities for nurses and midwives, develop future leaders, create deployment pools, recognize the most suitable and effective workforce strategies and HR policies that best fits with healthcare design, protect the well‐being of nurses and midwives and improve patient outcomes in a manner that is both long‐term economically viable.

To date, “studies on talent management in health care organizations are scarce and the need for research is obvious” (Ingram & Glod, 2016, p. 339). To bridge this gap in our knowledge, the overall purpose of this research is to design an evidence‐based approach to develop talent management practices for nurses and midwives in healthcare organizations and to provide recommendations to address the current recruitment and retention challenges faced by healthcare organizations. To do this, we will first create a model of talent management for nurses and midwives based on the literature. Then taking the views and experiences of nurses and midwives within the hospital group, current practices within the hospital will be evaluated. Finally, the results of both the quantitative and qualitative findings will be evaluated based on the model of talent management designed for this study.

1.1. Background

A group of McKinsey consultants coined the phrase the War for Talent in 1997 (Collings & Mellahi, 2009), which has generated substantial interest on the subject of talent management in the literature (Collings & Mellahi, 2009). Talent Management is defined as “the systematic utilization of human resource management activities to attract, identify, develop, and retain individuals who are considered to be ‘talented’” (Meyers & Van Woerkom, 2014, p. 192). The concept encapsulates HR processes and policies at the organizational level implemented to attract, identify, develop, engage and retain employees (CIPD, 2022; Sparrow, 2020). Within healthcare organizations, talent management can improve patient outcomes, staff productivity, nurses’ and midwives' clinical abilities, and employee happiness (Hosseinzadeh & Sattari Ardabili, 2015). It can also create opportunities for nurses and midwives to progress within the organization, contribute to inclusion and diversity, encourage continuous learning and build a more sustainable workforce (CIPD, 2022). It is therefore vital for healthcare organizations to understand the importance of talent management as the success of the organization is dependent on those that provide direct care (Gallardo‐Gallardo et al., 2020). Without appropriate talent management practices, a healthcare organization's potential to recruit and keep “the best and the brightest nurses and midwives” is impeded (Elkady et al., 2019, p. 1). Healthcare organizations must therefore ensure their HR plan assists the organizations in acquiring the nursing and midwifery skills they need now and into the future (Haaland et al., 2019). Creating a future‐oriented workforce will healthcare organizations deal with the changing complexities of the sector and ensuring a workforce with the specific skills, attitudes and knowledge needed (Paans et al., 2017). Furthermore, global crises have also demonstrated the importance of placing competent individuals in key positions inside organizations to ensure the organization's long‐term sustainability, and so that organizations can respond rapidly to shifting priorities and service demand (Thunnissen et al., 2013). On the flipside, research has indicated that inadequate nurse staffing is associated with extended hospital stays, poor hospital outcomes like death, failure to save and nosocomial infections (De Cordova et al., 2014; Needleman et al., 2011; Robinson et al., 2016).

2. THE STUDY

2.1. Overall aim of the study

This study is the first of its kind to be conducted in Ireland hospital setting. The overall aim of this study, employing a stakeholder‐led evidenced‐based approach, is to develop a talent management strategy for the hospital group. To achieve this, the study will have three main phases (See Table 1):

  1. Evidence synthesis – this will be undertaken through a thorough review of current academic literature on the topics related to talent management for nurses and midwives, with the aim of developing a model of talent management for nurses and midwives.

  2. Evidence generation – this study will employ a sequential mixed methods research design. First, nurses and midwives across the group will be invited to take part in a questionnaire to help gain an understanding of the current talent management practices in place across the hospital group, in addition to aiding the identification of areas where further work is needed to address talent management practices within the hospital group. Following on from this, a series of focus groups will be held with nurses and midwives across the hospital group to deepen our understanding of talent management within the hospital group, focusing on areas that were highlighted as significantly important based on the findings of the questionnaire. The use of quantitative and qualitative data in combination will produce a more comprehensive understanding of the research topic than either approach alone (Cresswell & Plano Clark, 2011).

  3. Evidence translation – based on our analysis and findings, results will be presented to the participating hospital group and to the wider Health Service Executive (HSE) in Ireland. Resulting academic papers will be presented by the authors at national and international conferences as appropriate and in key journals within the nursing and midwifery management field and wider management journals to add to the current literature on talent management.

TABLE 1.

Sequence of this study.

Evidence synthesis
  • Completion of a literature review to identify gaps in our current knowledge and to identify areas warranting further investigation
  • A model of talent management for the sector will be developed based on existing literature
  • Specific research questions and hypotheses will be derived from the literature review
Evidence generation – phase 1
  • Quantitative data collection: All nurses and midwives across the hospital group will be invited to partake in the questionnaire. The questionnaire will be designed using existing scales from the literature
  • Qualitative data collection: An open‐ended question will be included at the end of the questionnaire so that participants can add any further comments
  • Questionnaires will be distributed through email, a QR code and manually on‐site
  • Quantitative data analysis: Questionnaire analysis will identify respondent demographics, relationships and correlations between different scales on the questionnaire and will identify key elements of current practice. This phase will also inform and help focus the qualitative data collection
Evidence generation – phase 2
  • Qualitative data collection: Focus groups will be held with nurses and midwives across the hospital group
  • Qualitative data analysis: Key themes related to talent management within the hospital group will be addressed and further exploration of the findings from the quantitative data
  • Each focus group will last 1 h, with a maximum of 6 participants per group. Focus groups will be carried out over a 3‐week period, on‐site in each hospital
Evidence translation
  • This phase will involve a combination of quantitative and qualitative analysis, synthesis and interpretation of the findings, the development of a talent management framework for the hospital group and dissemination of the findings
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Firstly, a thorough review of the literature will be conducted to classify, evaluate and synthesize current research on the area of talent management practices for nurses and midwives and develop a model of talent management for the sector. This will generate organized and trustworthy data from which inferences can be made, which will identify potential future research opportunities for talent management techniques aimed at nurses and midwives. It will help identify gaps in the literature and assist in developing specific research questions and identifying relevant existing scales for data collection from which hypotheses will be developed. Following on from this, all nurses and midwives within the hospital group will be invited to participate in our questionnaire. This data will be analysed to identify current talent management practices within the hospital group and may identify areas in which the hospital group is lagging or excelling with regard to talent management for this cohort of employees. Given the significant increase in the number of international nurses and midwives across the hospital group, we will carry out separate analysis for internationally trained nurses and midwives. Participants in the questionnaire will be asked to indicate their willingness to take part in subsequent focus groups, which will form the second phase of our data collection. This will allow us to explore the key findings from our questionnaire. With these mixed methods, we aim to gain a better understanding of both the career and educational aspirations of the nurses and midwives within the group, and turnover intentions for both domestic and international nurses and midwives, within the hospital group. The final phase of this project will be the dissemination of our results.

2.2. Study setting

This study will be carried out across a large hospital group in Ireland that serves a population of 380,000 people. The hospital group comprises six hospitals, one Model 4 hospital (University Teaching Hospital, Tertiary Referral and Higher Level Intensive Care), two Model 2 hospitals (Ambulatory Dare, Diagnostics, selected Medical In‐Patients, Medical Assessment and Local Injuries Unit), one Model 2‐S hospital (Ambulatory Dare, Diagnostics, selected Medical In‐Patients, Medical Assessment, Local Injuries Unit and Intermediate Elective Surgery) and two specialty hospitals (one maternity and one orthopaedic) and is partnered with a local University.

2.3. Sample

The strategy used to identify participants for the questionnaire and focus groups will ensure that all nurses and midwives across the hospital group will be given the opportunity to partake in the study. There are currently 2296 nurses and midwives employed within the hospital group. All nurses and midwives working in the hospital group will be invited to take part in the study. To encourage participation in the questionnaire a communication strategy will be developed, all nurses and midwives will be emailed (containing a link to our questionnaire) to encourage them to participate in our study, and posters and flyers with QR codes will be distributed across the six sites. Clinical Nurse/Midwife Managers, International Induction Nurse/Midwife Managers and Directors/Assistant Directors of Nursing and Midwifery will be briefed on the project. The research team will also have a physical presence across the six sites during the roll out of the questionnaire to inform nurses and midwives of the questionnaire. To identify participants for the follow‐on focus groups, those that complete the questionnaire in phase 1 will be provided with a separate link, on which they can provide their details to be included in the follow‐on focus groups.

3. METHODS

3.1. Study design and analysis

This cross‐sectional study uses a mixed methods approach, combining both quantitative and qualitative methods for empirical data gathering and analysis. The cross‐sectional nature of this study offers the advantage of efficiency that more longitudinal methods do not offer (Simha, 2023; Spector, 2019). Furthermore, asking healthcare workers to take time out of their already hectic schedules to complete multiple questionnaires at different phases would be “a rather Quixotic task” (Simha, 2023). Our study adapts a mixed method chronological design so that each phase dictates the next phase of the study. The mixed method techniques offer a framework for interpreting and supporting both organizational and social phenomena (Giles et al., 2014), as well as allowing for a more thorough and in‐depth analysis. The study design will allow for the identification of key issues at all phases, for example gaps in the literature will inform the questionnaire design, followed by findings from the questionnaire that will inform areas to be explored further in the focus groups. In addition, the use of previously developed and validated scales from the literature will improve the reliability and validity of the findings from our questionnaire (Giles et al., 2014; Guest et al., 2001).

3.2. Phase 1

All nurses and midwives (approximately 2296 in total) across the hospital group will be invited to take part in an online questionnaire, using Qualtrics as the hosting platform. Based on the findings of our literature review, questionnaires will be developed to collect demographic information of the respondents, as well as gathering data using validated scales from previous studies on talent management. The questionnaire will finish with an open‐ended question so that respondents can add further comments. SPSS will be used to analyse the quantitative data, while NVivo will be used to thematically analyse qualitative data. Initial analysis will be conducted to determine the demographic profile of the sample to ensure a representative sample across the hospital group and a representative sample of national and international trained nurses and midwives. Descriptive statistics will summarize quantitative data arising from the questionnaire. Differences in questionnaire outcome variables will be examined across demographics and career levels, using between‐group hypothesis tests; independent samples t‐test for numeric variables and chi‐square test for categorical variables. Associations between quantitative variables will be examined using correlation and regression analysis. A 5% level of significance will be used throughout. All analyses will be undertaken using IBM SPSS, Version 28.

3.3. Phase 2

Focus group participants will be selected from those that indicated their willingness to partake in focus groups during data collection in Phase 1. These focus groups will gather more in‐depth information and provide clarity for the findings from the questionnaire. This will improve our understanding of talent management practices and identify patterns of similarities and differences in the responses of national and international nurses and midwives. A total of 12 focus groups, comprising 5 participants each, will be conducted. Focus groups will be kept small so that participants will feel more comfortable in sharing their experiences. In addition, separate focus groups will be held for internationally trained and domestically trained nurses and midwives. Thematic analysis will be used to analyse the qualitative data, using NVivo software. Thematic analysis will be used to unearth patterns in information or accounts of experience (McLeod, 2011). To provide rigour in thematic analysis, it is important to follow a clear set of stages in the data analysis (Vaismoradi et al., 2013). This research will follow the steps outlined by Braun and Clarke (2006): – Step 1: Familiarize yourself with the data – Transcribing the data (if needed), reading the data and rereading the data, noting down ideas. Step 2: Generating initial codes – coding interesting features of the data in a systematic fashion across the entire dataset, collating data relevant to each code. Step 3: Searching for themes – Collating codes into potential themes, gathering all data relevant to each potential theme. Step 4: Reviewing themes – Checking if the themes relate to the coding extracts. Step 5: Defining and naming themes – ongoing analysis to refine the specifics of each theme. Step 6 Producing the report – The final opportunity for analysis, selecting vivid and compelling extract examples.

3.4. Ethical considerations

Full ethical research has been granted by both the hospital group and home university. Questionnaire participants and focus group participants will be briefed on the project prior to participating, and consent forms, which participants must read and agree to, will be included at all phases of the research. Participants will be informed of their right to refuse to participate and to withdraw from the study at any point. Any unforeseen safety issues that arise will be handled in line with the university policies and procedures. Participants will be assured full anonymity and their privacy will always be protected. Recordings from the focus groups will be protected by password and filed electronically, which will only be accessed by the research team. Once the audio files are transcribed, they will be deleted. All data will be password‐secured and kept in a locked office in the home university. Data will be stored for a maximum of three years as per the university's guidelines. Each participant will be anonymized in the research using a number key to maintain confidentiality.

4. CONCLUSION

“Health services researchers can influence policy making in four ways. They can identify critical problems, research the benefits and harms of policy solutions, estimate the costs and consequences of policy proposals, and actively participate in the policy process to aid real‐time decision making” (Clancy et al., 2012, p. 337). This research will seek to identify gaps in the literature of talent management for nurses and midwives, develop a model of talent management for the profession and address these gaps through undertaking quantitative and qualitative research. Through the dissemination channels, the researchers are confident that this work will aid decision‐making and practice and policy development in the talent management of this strategically important cohort of healthcare workers.

4.1. Possible limitations

The following are potential limitations of this research. As the data collected for this study will be from a single hospital group, the findings may not be generalizable across all hospital groups. Future plans for this research project are to conduct research across multiple hospital groups. Furthermore, the data collected will be self‐report data; however, given the nature of the data being collected it was not possible to collect the data in any other fashion.

AUTHOR CONTRIBUTIONS

EB and NR – Conceptualization; EB – Writing – original draft; BO'M, EB and NR – Funding acquisition; EB, NR and HP – Methodology; ALL – review, editing and agreeing on the final draft.

FUNDING INFORMATION

This research was funded by the Martha McMenamin Scholarship and partly funded by British Academy of Management. The funders of this study have no involvement in the study design, the collection and analysis of the data, or the writing of this manuscript.

CONFLICT OF INTEREST STATEMENT

The authors have no conflict of interests to declare.

ACKNOWLEDGEMENTS

The authors would like to thank the hospital group for their support in this research project, along with the funders. Open access funding provided by IReL.

Berkery, E. , Ryan, N. , O’Malley, B. , Purtill, H. , & O’Donnell, C. (2023). Developing a talent management framework for domestically and internationally trained nurses and midwives in healthcare organizations: A mixed‐methods research protocol. Nursing Open, 10, 7209–7214. 10.1002/nop2.1973

DATA AVAILABILITY STATEMENT

There is no data available for this paper

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Data Availability Statement

There is no data available for this paper

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