The Determinants of Employee Engagement in Nursing: A Systematic Review

Abstract

Employee engagement in nursing has become a strategic concern because engaged nurses are more likely to remain in post, sustain performance under pressure, and support safer care delivery. This systematic review synthesized the determinants of employee engagement in nursing and developed an integrated multilevel framework. Following PRISMA 2020 guidance, searches were conducted across major health and interdisciplinary databases and were supplemented with Google Scholar for English-language studies published between January 2015 and December 2025. After screening, eligibility assessment, and methodological appraisal using MMAT 2018, 53 studies were included in the final narrative synthesis. The evidence indicated that engagement in nursing is shaped by interacting individual, relational, work-design, and contextual determinants. Leadership, structural empowerment, favorable practice environments, psychological capital, emotional intelligence, core self-evaluation, self-efficacy, resilience, meaningful work, decent work, social support, and job crafting consistently strengthened engagement. By contrast, burnout, hindrance stress, compassion fatigue, perceived overqualification, organizational dehumanization, illegitimate tasks, and poor work-life fit weakened engagement or limited its sustainability. More recent evidence also suggests that digital literacy and nursing informatics capability function as emerging job resources rather than peripheral technical attributes. The literature remains dominated by cross-sectional self-report designs, limiting causal inference and weakening understanding of how engagement is built and sustained over time. This review contributes a clearer analytic structure by distinguishing foundational job resources, personal resources, and demand-related constraints. It also offers practical guidance for nursing leaders seeking to strengthen retention, well-being, and quality of care through deliberate engagement-building strategies.