Title : Institutional and workplace determinants of foreign nurse retention: A literature-informed comparative study of Japan and Germany
Abstract:
Background: The global nursing shortage has intensified international recruitment, yet retention of foreign nurses remains a persistent challenge. While Japan and Germany have both expanded acceptance policies, their institutional designs differ substantially. However, cross-national, theory-informed syntheses of how these differences shape retention remain limited.
Objective: This study aims to provide a theory-informed comparative synthesis of research on foreign nurse acceptance and retention in Japan and Germany, with particular attention to how institutional frameworks and methodological approaches shape the conceptualization of retention.
Methods: A structured literature review was conducted using international academic databases and German-language primary sources. Studies were systematically extracted using a review matrix and analyzed through a three-step process: descriptive mapping of study characteristics, coding into meaning units, and thematic synthesis. The analysis was guided by the Sunrise Model to enable theory-driven comparison across contexts.
Results: The findings reveal a fundamental divergence in both policy orientation and research framing. In Japan, foreign nurse policies are tightly coupled with licensure and language requirements, and research predominantly frames retention as an issue of individual adaptation. In contrast, Germany adopts a labor market–oriented model centered on qualification recognition and systemic workforce integration, accompanied by more methodologically diverse research. Across both contexts, retention emerges as a multi-layered phenomenon shaped by the dynamic interplay of institutional structures and cultural factors.
Conclusion: Foreign nurse retention cannot be adequately explained solely by individual-level adaptation; rather, it requires a multi-level perspective that integrates institutional, individual, and workplace factors. The findings of this study contribute to the development of more context-sensitive and structurally informed support strategies and underscore the importance of comparative and theory-driven approaches in global nursing workforce research.
