Aim: To describe and explain the level of nurse engagement in the period 2019-2022 and identify related background variables and drivers of nurse engagement in hospital settings.

Design: An analytical cross-sectional multicentre study with a 4-year time series.

Methods: Data were collected annually from 2019 to 2022 from 24,653 nurses (staff nurses, midwives, and assistant nurse managers) in Finnish hospitals (n = 9) using a modified version of the Nurse Engagement Survey and analysed statistically. The STROBE checklist was used as the reporting guideline.

Results: Nurse engagement varied over the study period, with 10.0%-4.2% of nurses being engaged, 33.1%-17.0% content, 31.4%-28.8% ambivalent, and 25.5%-50.0% disengaged. The proportion of disengaged nurses increased, while the proportions of content and engaged nurses decreased over the 4 years. All background variables and drivers of nurse engagement were statistically significant in relation to the level of nurse engagement.

Conclusion: This study produced novel findings on nurse engagement and related factors in a hospital setting, based on unique, national-level data collected over 4 years. The results raise concerns considering the attractiveness of the nursing profession and nurse retention. The study provides insights for nurse leaders to strengthen leadership practices and create more engaging work environments. To support nurse engagement, healthcare organisations should routinely assess the engagement of their nursing workforce and prioritise leadership strategies aimed at attracting, retaining, and enhancing nurse engagement.

Implications for nursing management: It is important that nurse leaders promote nurse engagement throughout nurses' careers and recognise nurses of all generations, as nurse engagement is a key factor in staff retainment and impacts directly on the quality and outcomes of patient care. To keep nurses engaged, nurse leaders and managers should keep patient care manageable and also offer other tasks that match the nurses' interests and career opportunities.

Keywords: hospital; nurse; nurse engagement; time series study.