Attracting nursing talent to the intensive care unit: a qualitative study on how to create an appealing work environment

Research Article Attracting nursing talent to the intensive care unit: A qualitative study on how to create an appealing work environment Rafael-Jesús Fern´ andez-Castillo a,b , Luis Basco-Prado c,* , Marta Raurell-Torred` a c a Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Avenzoar St., 6, 41009 Sevilla, Spain b Intensive Care Clinical Unit, University Hospital Virgen Macarena, Dr. Fedriani St., 3, 41009 Seville, Spain c Departament d’Infermeria Fonamental i Clínica, Faculty of Nursing, Universitat de Barcelona, Carrer de la Feixa Llarga, 08907, L’Hospitalet de Llobregat, Barcelona, Spain ARTICLE INFO Keywords: Intensive care nursing Nursing shortage Professional engagement Qualitative study Talent attraction Staff recruitment ABSTRACT Introduction and objective: The global shortage of nurses who want to work in the intensive care unit (ICU) is alarming, putting at risk quality of care and patient safety. With efforts put into engagement strategies, optimized recruitment programmes are scarce, specifically in the ICU setting. The aim of this study is to describe and explore ICU nurses’ opinions on their work motivational factors that influenced the decision to work in the ICU setting. Design: A qualitative research was undertaken, with a descriptive exploratory interpretative approach, implementing a QUAL-QUAL design, where two data collection techniques are used simultaneously and complement each other. Experienced ICU nurses were interviewed by focus group, using in-depth interviews for novel nurses. A template content analysis as described by the model of Brooks was performed. Setting: The selected population was recruited from 6 different public hospitals in Spain. Findings: A total of 17 nurses participated in the study as we reached data saturation; seven in the focus group and ten by individual interviews. Four main themes emerged from the analysis divided into 13 subthemes: “ICU training and education”, “taking care of the intensive carer”, “optimized human resources management” and “intrinsic and extrinsic motivational factors”. Conclusion: Nurses consider that an attractive ICU in terms of job satisfaction is the one that is committed to quality continuous training programmes, welcoming professionals with well-designed mentoring, and taking care of its workers by promoting teamwork and work-life balance, burnout syndrome prevention strategies and motivation for intellectual development. Implications for clinical practice: The description of how to create attractive ICUs will help to build strategies with the aim of recruiting talented highly qualified professionals who will alleviate the need for nurses in the field, optimizing the care provided and generating benefits in management and quality of care. Introduction Nursing practice in the intensive care unit (ICU) requires advanced specific training, given the high complexity of patients and their associate nursing care activities in a very sensitive hospital setting [1]. However, ICU training is not always adequate, with nurses in some contexts being up to 50 % dissatisfied with it [2]. These units also present a great emotional burden for the professionals who work in them [3,4]. According to a recent systematic review with meta-analysis, 31 % of ICU nurses present emotional exhaustion, which has a significant relationship with the appearance of depression and personality factors [5]. Because of this, lately there has been evidence not only of a lack of nurses who want to dedicate themselves to intensive care [6], but also of the self-decided redeployment of professionals to other services considered as with less workload or complexity [7], with an 27 % prevalence of turnover intention worldwide [8]. Likewise, new graduated nurses have had little training in critical care during their degree [9], feeling little confident about their abilities to provide care in the ICU and not ensuring an adequate generational replacement [6]. This is an issue of great importance, because optimal staffing levels in the ICU are related to low patient mortality, nosocomial infection, decreased * Corresponding author. E-mail address: [email protected] (L. Basco-Prado). Contents lists available at ScienceDirect Intensive & Critical Care Nursing journal homepage: www.sciencedirect.com/journal/intensive-and-critical-care-nursing https://doi.org/10.1016/j.iccn.2024.103937 Received 27 May 2024; Received in revised form 5 December 2024; Accepted 22 December 2024 INTENS CRIT CARE NUR 87 (2025) 103937 Available online 8 January 2025 0964-3397/© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ). hospital costs and high nurse and family satisfaction [10]. All of this has been influenced globally by the COVID-19 pandemic, where ICU nurses have suffered great emotional stress having to adapt themselves to war medicine situations [11]. As a result of this, emergency educational programs were also created for all those nurses who were relocated, enhancing that a specific profile is necessary to work in the ICU [12]. In order to have enough nurses delivering optimal care to the intensive care patient, the concept of “staff engagement” it’s under study worldwide, due to high rates of turnover even for new graduated nurses [13]. Work engagement for ICU nurses is positively associated with agreeableness, conscientiousness and emotional stability [14]. On the other hand, a recent survey shows that a poor work environment and high workload perception are associated with higher intention-to-leave rates among ICU nurses in Europe [15]. As aforementioned, there are studies that focus on reasons for leaving the profession [15], factors affecting staff shortage [16] or strategies to develop engagement programmes to avoid the intention-to-leave [17] but, how do nurses feel that we could create an appealing ICU environment for talented workers? With the aim of focusing on attracting more than in retaining professionals, the objective of this research is to describe and explore the opinions of ICU nurses in relation to personal work motivational factors that influence the decision to work in the intensive care environment. Methods Design and setting A descriptive study was conducted using an exploratory interpretive approach, employing qualitative methods to achieve the outlined objective [18]. The project is built based on a multimethod design, known as QUAL +QUAL, where there are two central qualitative components that complement each other from an inductive theoretical framework [19]. In this case, a concurrent triangulation was carried out, where a single study involves two data collection happening at the same time, with no priority of one over the other [20]. Furthermore, the objective of this type of design is to validate the findings generated by each method, through evidence produced by the other [21]. Sampling and informants’ recruitment The study was carried out with ICU nurses from 6 regional hospitals in Spain. The hospitals are located in the Community of Andalucia and Catalonia, in the provinces of Sevilla and Barcelona. Each of the collaborating researchers of the project carried out an intentional nonprobabilistic sampling [22], according to the predefined inclusion and exclusion criteria. The inclusion criteria were, for the first group (FG): 1) nurses with more than five years of experience in the ICUs. The inclusion criteria for the second group (IDI) were: 1) nurses with more than one year and less than five years of experience in the ICU. The exclusion criteria were common to both groups: 1) nurses who do not sign the informed consent; 2) nurses currently working in units different than ICUs per se, such as post-surgical resuscitation units or intermediate care. There is no estimated number of interviews that were planned to be carried out, since nurses were recruited until theoretical data saturation occurs, where carrying out more interviews does not provide more information or data to those already collected [23]. Data collection strategies For both groups, sociodemographic data were collected such as age (20–30, 31–40, 41–50, 51–60, 61–70), sex (male, woman), work role (direct care, research, manager, academic or a combination of them), years of ICU experience (<1, 1–5, 6–10, 11–15, >15), marital status (single, couple, married, separated/divorced, widowed), mentoring of undergraduate and/or postgraduate students and scientific production. As a data collection instrument for the first group of informants (FG), the focus group tool was used. The discussion of the topics in a group and the interaction between its members, due to the idiosyncrasies of the participants, favors the enrichment of the obtained data [24]. For the second group of informants (IDI), in-depth interviews will be used. This is a tool that is characterized by a long, unstructured personal conversation, in order to request information on a specific topic. With this, we will ensure that the intimacy and individuality of data collection favors the sincerity of the participants and, therefore, optimizes the veracity of the results [25]. For both cases, a pre-established interview guide was used (Table 1) based on bibliography and expert consensus. This does not mean that the conversation must follow a fixed course, but rather that it is subject to its evolution, allowing the emergence of new topics, with the consequent enrichment of the tool. In order to collect the data, both techniques were conducted via Zoom® to facilitate the informants’ participation. Video call interviews are supported with enough evidence to be implemented as a reliable tool in qualitative data collection compared to in-person methods [26]. The screen was video recorded during the interview and notes were taken on what was considered important for posterior data analysis. All the information was transcribed verbatim. Data analysis and research rigour After the transcription of the recorded audio, an interpretive analysis was carried out following the Template Analysis model proposed by Brooks et al. [27]. The transcripts of the interviews, both individual and group, were returned to certain informants, to confirm that they felt represented by what had been obtained. After this, to ensure the quality of the analysis, triangulation was carried out with the researchers [28]. For the formation of themes, codes and subsequent interpretation, the qualitative data management software Atlas.ti® version 7 was used. This study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) [29] and the Standards for Reporting Qualitative Research (SRQR) [30]. The criteria defined by Lincoln and Guba [31] were used to report data in relation to its reliability, transferability, trustworthiness, and confirmability [32]. Ethical considerations Permissions were obtained from the heads of the clinical units or the supervisors of each of the participating units to develop the project. Similarly, ethical approval was obtained from the Research Ethics Committee of the participating hospitals (internal registration number: 0255-N-23). All participants signed an informed consent provided Table 1 Interview guide. 1. Why does a nurse choose to work in intensive care? 2. Is it a previous training needed? If so, how must be this training performed? 3. Do you think that intensive care nurses are recognized, valued and respected? 4. Is it important for you to have an established role and autonomous responsibilities in the intensive care unit? 5. How will you describe the intellectual stimulation and professional development that an intensive care nurse has? 6. Are teaching and learning opportunities a priority for you in the intensive care unit? ¿ 7. Please talk about work environment in the intensive care unit. How must it be? 8. How must be a good human resources management in the intensive care unit? 9. How must be life quality for an intensive care nurse? Please, describe it. 10. Which barriers do intensive care nurses to develop their work in the intensive care unit? 11. Which interventions/improvements in every field would help nurses to work in the intensive care unit in an effective way? R.-J. Fern´ andez-Castillo et al. Intensive & Critical Care Nursing 87 (2025) 103937 2 digitally, explaining the objective of the study and its development. Furthermore, participants were guaranteed the destruction of the screen recordings after their audiovisual transcription, preserving the anonymity and confidentiality of the data. Results The total sample of participants was comprised of 17 nurses, seven forming the FG and ten forming part of the IDI. Regarding the FG, 50 % were women, with an average of 39 (23 – 51) years and 14 (0.5 – 26) years of average experience in the ICU, while 78 % of the IDI nurses were women, with an average age of 25 years and 1.6 years of experience in the ICU. Almost 29 % of the FG nurses had a postgraduate degree in ICU, with 57 % dedicating themselves to research work (participating as research nurses or collaborating with data collection), 86 % to teaching (mentoring bachelor students or working as associate lecturers) and 29 % to management, all combined with direct patient care. On the other hand, the IDI participants obtained a postgraduate degree from UCI in 88 % of the cases and only 20 % carried out teaching tasks, combined with the care role. After data analysis, a total of four themes common to both data collection techniques and sample of informants were obtained, subdivided into 13 subthemes and grouped according to categorical relationship. The list of themes and subthemes, along with a graphic representation of the existing relationships between them according to the analysis carried out on the results, can be seen in Fig. 1. Intensive care training and education Pregraduate training Those interviewed agreed on the need for undergraduate training that motivates novice nurses to pursue postgraduate studies related to intensive care. This is achieved with training programs with optimized curricular practices, which facilitate access to master’s degrees that help to sharpen their skills: “Undergraduate training should be better designed, there should be more and better organized practices which should be more oriented toward job insertion […] the main barrier to working is the lack of training that motivates you and gives you self-confidence…” (FG5). Furthermore, novice nurses claimed that training is what mainly removes fear of working in the ICU: “…lack of knowledge leads to fear. […] prior quality training reassures when providing care” (IDI3). Specialized and continuous training For nurses, the ICU is the perfect environment to improve their skills in all facets of the profession, since they affirm that it is a place where they do not stop learning, innovating and continuously training themselves: “…in the ICU continuous training is very valued, there are many possibilities to learn and I love being able to do something new every day” (IDI2). This would be a fundamental attraction factor, necessary to work in this service and, at the same time, a motivation to stay: “I like to learn, advance and not remain static. The ICU is innovation and gives a lot of opportunities when it comes to developing yourself as a professional, you never stop recycling yourself” (IDI2). Taking care of the intensive carer Welcoming the new nurse Welcoming new personnel to the ICU is something of relevance for the interviewees. A warm welcome by experienced nurses is expressed as fundamental, being recognized as the responsibility of everyone and not just the heads of the unit: “…it would be very interesting for old nurses to be trained in welcoming the new one, not everything is the responsibility of nursing managers, we also have to do… explaining things, helping with the sicker patients… make that person feel supported…“ (GF2). Furthermore, the narratives repeat the need to change the description of the ICU as a closed unit, opening its doors to anyone who wants to work in it: “…the ICU has a reputation as a closed unit and that cannot be kept. We could create immersion or open-door days so that professionals who want can come see what the ICU really is…” (IDI4). Critical burnout The burnout syndrome is mentioned by veteran nurses in their entirety, mainly because it enhances the intention to leave of nurses due to the high workloads and the psychological impact of it: “…we don’t usually have chill shifts. Colleagues who have been there for many years change their job because they are tired and have physical and psychological Fig. 1. Themes and subthemes extracted from the findings and their categorical relationships. R.-J. Fern´ andez-Castillo et al. Intensive & Critical Care Nursing 87 (2025) 103937 3 problems” (GF1). Vocation is no longer enough to work in an ICU: there are alarming discourses about the early abandonment of new nurses incorporated into the unit: “…previously, people considered retiring in the ICU… now people in their 30 s who have been in the ICU for less than five years thinks the same…” (FG3). The solution given by the majority of participants is to reward this extra effort with fewer hours of work per week or by guaranteeing socio-family conciliation due to hardship: “you could gain in quality of life by offering more free days or fewer hours of work… we don’t need more salary, but more hours a month of leisure or with to spend time with your loved ones…” (GF4). Leadership and vertical support Caring about the other is something important for head nurses to pay attention to in order to attract professionals to the ICU: “…if the shift has been difficult and they have reached out to me, if they have asked how am I, if they have told me to talk if I have had a bad day…” (FG7). Nursing managers want to be seen as a leader and not as a boss, who offers psychological support and cares about humanizing professionals’ management: “…due to the idiosyncrasy of the ICU, we need humanized managers who strive to build a friendly environment at work so that people do not leave…” (IDI9). Optimized human resources management Hiring trained personnel The specificity of the ICU when managing nursing staff is a concern most frequently described by novice nurses. The interviewees express that the ICU is treated as a general unit, with its negative consequences in all aspects: “… the ICU is treated as a general ward, it is not taken into account that the people who enter there must have specific knowledge” (IDI1). The informants always suggest to incorporate professionals after in-depth interviews based on profiles (a situation that does not happen in our context), which guarantee excellent care delivery: “…many of the people who starts to work in the ICU doesn’t have any experience… in the end, a complete rejection to work in the unit is created, because it is 12 h of authentic suffering… and that extends to the rest of the staff, making no one want to work in the ICU” (ID5). Recompensed mentorship Without expressly knowing the existence of this concept, the majority of those interviewed expressed in the study the need for paid periods of adaptation to the new job: “the person would enter their job much calmer because they know the equipment, the patients… it would be much easier and people would dare to come to the ICU more” (ENF6). Furthermore, they present this modality as a help so that people do not reject work contracts when they find out about their destination in the ICU: “… I know colleagues who have rejected contracts because they came to ICU and since these contracts were very short in time, they did not have time to learn” (GF2). The team as a key part One of the most highlighted positive aspects described by the interviewees was the possibility of real teamwork, which allows professional fulfillment and generates an unbeatable environment: “I have had a very good experience with the physicians and with the nursing assistants… even though I am new, they have doubted my abilities […] communication with other colleagues is much easier than in other services” (IDI4). Furthermore, the fact of being a large group and feeling supported and protected by other nurses is essential and It’s very valued: “what calms me most is that there are a lot of people… you can have a hard time, but it’s incredible the amount of camaraderie there is… I had any problem and three colleagues appeared to help…” (FG6). Extrinsic and intrinsic motivations Competence autonomy and responsibility The main driving force of ICU nurses is the activities independence and the ability to make decisions with the autonomy that this requires. The interviewees highlight the attractiveness of the complexity of the care provided: “you have a lot of responsibility, but also autonomy […] in other wards I felt more like a technician than a nurse, I couldn’t make wellmade care plans” (FG6). Furthermore, they highlight the need for organization and structuring of work to provide quality care: “…knowing well what you have to do attracts, gives you confidence; you don’t go putting out fires like in other wards, where in the end you tend to burn yourself” (IDI6). Holistic care Another of the attractions of working in an ICU is the possibility of providing nursing care in all possible spheres, meeting the needs of the patients as a whole without forgetting any: “The ICU is a space where patients are more vulnerable, more unstable, where they are much more dependent on the care that we nurses provide… care that must be as close to perfection as possible… the margin of error is much smaller and you accompany patients and families for much longer“ (FG1). Working in ICU allows the individualization of care to its maximum extent, knowing the patients in depth and personalizing care according to their past and current context: “The care that you give to your ICU patient, you are not going to to be able to give them to him in another ward, you have the opportunity to meet him, he is not the patient from 430 to 2, he is “John or Maria”, whose daughter is very nice, who you know is from a certain city, who you know has such a background because she has had time to tell her story to you, that you have been able to clean him well, take care of all his things well, that you have given his medication on time…” (ENF8). Intellectual stimulation and professional development The informants describe the ICU as a ward that encourages progress as nurses, since it requires a wide field of knowledge: “It is a unit that covers many things, let me explain…we can have neurocritical patients, kidney patients, septic patients, and politraumatic patients. … I am a very curious person, I like to learn everything and if I can cover as much topics as possible, all the better” (GF7). Furthermore, this professional fulfillment stimulates work, despite the physical and emotional exhaustion that it may bring: “The tiredness that I felt once I finished an ICU shift, I haven’t felt anywhere else; because it’s twelve hours at your most… but how good you feel when you go out because you have really been able to take care in capital letters, that is not paid for” (IDI10). Fear of routine One of the aspects that made the participants choosing to work in the ICU was not wanting to stagnate in terms of knowledge: “[the ICU] does not have that routine part that other wards have; every day and every patient are different” (IDI4). The fact that it is a place far from the monotony of other units, where routines are very established, is an aspect that nurses highlight: “It wasn’t like in other wards, where I noticed the monotony of each day, the same type of patient… in the ICU it is like every day is an adventure and every day anything can happen to you, the constant adrenaline, being aware all the time” (GF6). Social recognition The concept of the “ICU nurse” that the rest of the people (general population and colleagues) have is important for our interviewees, since it makes them feel good and helps them maintain motivation: “ICU teams are well seen from the outside because they highly value the knowledge we have” (FG2). However, they believe that they should be more valued socially, since the population is unaware of the work of an ICU nurse until they experience it: “they believe that we do the same work as a general nurse and we don’t. They associate it with when they have had a family member admitted to the general ward” (IDI2). R.-J. Fern´ andez-Castillo et al. Intensive & Critical Care Nursing 87 (2025) 103937 4 Discussion With this article we have tried to understand the needs of nurses to feel attracted to work in an intensive care unit, given the lack of nurses in this field and its impact on patient safety, with the intention of building effective recruitment strategies. The study highlighted that attracting talented nurses to the ICU is based on emphasizing the need for restructuring undergraduate training to build confidence and reduce fear, alongside fostering continuous professional development. Key findings include the transformative impact of supportive onboarding, humanized leadership, and a collaborative team environment. The ICU’s unique blend of autonomy, holistic care, and intellectual stimulation were identified as powerful motivators for choosing to work in the ICU. Addressing burnout through work-life balance initiatives emerged as pivotal as well. These insights offer a perspective on how to create sustainable, high-performing ICU teams, reshaping recruitment and retention practices in this critical healthcare setting. According to his summary of findings, a recent scoping review about recruiting nurses in the health care workforce mentions as key initiatives some interventions related to leadership and support, ongoing professional development, social recognition, optimal work environment and flexible scheduling [33]. As claimed by Santana-Padilla et al. [34], training prior to professional practice in ICU has direct benefits for professionals and the health system. In this sense, our participants feel the need to be accompanied at every step of their ICU immersion, being very important that, during these training periods, coaching programmes in ICU are developed, with mentoring that increases satisfaction, peer support and opportunities for socialization [35]. This mentoring, in a recent systematic review, is recommended to be developed with individualized one-to-one programs or in the form of an internship [13]. Furthermore, the educational role of veteran staff should be promoted, since in-service training is often scarce, therefore relating to a decrease in the attraction to work in an ICU [36]. In this sense, already published evidence suggest that special attention should be paid to new nurses, since their work engagement has shown to be lower than the older ones, implementing specific support programs [17]. Nurses with less experience point that undergraduate programmes should take more into account the critical care setting in different forms. A recent qualitative study shows that facilitating practices for nursing students with subsequent mentoring helps to obtain a double benefit, increasing the teacher’s self-esteem and their professional fulfillment, as well as the confidence of the new nurse [37]. Furthermore, promoting the figure of a specialized nurse, such as the advanced practice nurse, ensures an improvement in length of stay, mortality and patient satisfaction [38]. This optimized training leads to another important point, which is holistic patient care. Those interviewed rate this care opportunity as a great attraction for the staff, since it is one of the strengths of the ICU, as well as the continuity of the care provided, a fundamental axis of care for critically ill patients, according to a recent cross-sectional study in our context [39]. Furthermore, Kvande et al. [40] agree with our interviewees that also the provision of humanized intensive care, including the family and the patient’s vision, is of great motivation for nurses and, therefore, a good strategy for attracting nursing talent. Specific values to the profession, such as intellectual stimulation, competence autonomy or professional development, are considered extremely important by our participants. Literature supports the high autonomy of the ICU nurse as a link to adequate emotional health and better teamwork functioning [41]. The professional development that ICU nurses obtain is essential to attract staff to the environment according to the informants as well. Improving nurses’ career growth not only helps to reduce talent loss, but also reduces nurse burnout, fosters enthusiasm for work, and produces more creative results [42]. Workrelated values are shown to be powerful motivating elements for the nurses interviewed. G´ omez-Salgado et al. [43] remark that if there is no physical involvement or emotional connection, nurses won’t offer the quality of care patients require; being this one of the main aspects that attract ICU nurses to this environment. Furthermore, the interviewees go to intensive care units for the acquisition of knowledge and skills, in addition to the nurse-patient ratio, which allows for more and better care of people. This is one of the main differences that we could point from other care contexts, just like general wards [44]. In reference to positive relationships with colleagues and the sense of teamwork, these are described as bringing joy to work and contributing to nurse attraction. Teamwork and cohesive relationships in the workplace are important contributors to job satisfaction and, consequently, attracting new staff [45]. The work environment is essential and, in the ICU specifically, it is related to a high attraction and loyalty of healthcare personnel [46], since the support of colleagues is positively associated with the work commitment of nurses [47]. To ensure good teamwork, adequate staff hiring is also considered essential. The abandonment of the profession has accelerated the need to improve working conditions, increasing indefinite contracts and decreasing migration episodes to other health systems [48], which is a problem we have been struggling with for a long time in our context. Social recognition and caring for the emotional health of the staff themselves is important for the interviewees. Verbal and written praise is highly valued and contributes to motivation and satisfaction [49]. Lack of recognition has been identified as a significant predictor of burnout [50]. Therefore, it is important to be aware that nurses may not be receiving positive feedback and to provide intentional and genuine praise. Job satisfaction is correlated with emotional health and, consequently, with the appearance of burnout, so its prevention is essential [51]. Furthermore, facilitating work-life balance is essential, since ICU nurses have complained on multiple occasions about marathon work days, isolated from their families to ensure their safety, and the emotional strain of dealing with ongoing death [52]. Galuska et al. [53] reassert that nursing supervisors are key in these matters, which should acquire the transformational leader role at every time, supporting and responding to their workers with opportunities for growth and professional fulfillment. Strengths and limitations The main limitation of this paper was that the interviews were carried out in only two autonomous regions of the country, and could have covered some more, increasing the transferability of the analyzed results. However, an attempt was made to ensure the quality of the data by including in the study two culturally different regions within the same national context, both in nursing training and in socioeconomic and job factors. To the best of our knowledge, this is the first study that investigates how to attract talent to the ICU in a qualitative design, instead of focusing on the intention-to-leave or on the engagement factors like much of the published evidence. Conclusions The creation of intensive care units that attract nursing talent is necessary to ensure quality care, given the complexity of the interventions and the pressing lack of motivated nurses. ICU nurses consider that a professionally appealing ICU is the one that is committed to quality continued training, developing mentorship programmes which favor professional autonomy and intellectual stimulation with the application of holistic care, all of this together with an optimal welcome for new professionals, where good teamwork is promoted and strategies for maintaining emotional health are developed with recognition, interventions to prevent burnout syndrome and motivation for teaching. Implications for practice and prospective The retirement of nursing professionals in all areas and, especially in R.-J. Fern´ andez-Castillo et al. Intensive & Critical Care Nursing 87 (2025) 103937 5 intensive care, makes it difficult to maintain optimal care coverage. This, added to the specificity of nursing skills in the ICU and the complexity of attracting nurses to intensive care units, becomes an impediment when it comes to ensuring an adequate and guaranteed generational replacement for patient care. The results of this study aim to know how to attract nursing talent to ICUs and what strategies to follow to convert these wards into appealing units for nurses. With this, we will be able to improve not only the quality of care for critically ill patients, but also the satisfaction of families, managers and fellow nurses with high experience in the ICU by hiring talented and professional nurses. Funding statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CRediT authorship contribution statement Rafael-Jesús Fern´ andez-Castillo: Writing – original draft, Visualization, Software, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Luis Basco-Prado: Writing – review & editing, Supervision, Investigation, Formal analysis, Conceptualization. Marta Raurell-Torred` a: Writing – review & editing, Supervision, Formal analysis. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgements We would like to show our most deep gratitude to all the participants who gave us their time and opinions, which are the key of this paper. We really hope that all of their job conditions do nothing but improve. References [1] Jafari-Pour F, Watson R, Jafaripour E, Jafarian R. 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