When Nurses Leave Nursing: Leadership Priorities to Prevent Professional Exit in Somalia and Other Resource Limited Settings: An Evidence Informed Commentary

Abstract: Nurses are central to safe and continuous care delivery, yet in many fragile and resource limited systems an increasingly urgent problem is professional exit from nursing itself. In Somalia and comparable settings, nurses may leave the profession when compensation is unreliable, workload is chronically high, practice environments are under resourced and unsafe, supportive supervision is weak, and career progression is limited. This commentary argues that professional exit is shaped by a combination of individual circumstances and modifiable organizational and system factors, including leadership and governance conditions, with direct consequences for patient safety, service continuity, and workforce sustainability. It synthesizes published evidence and policy documents using a narrative approach and proposes a pragmatic leadership agenda feasible in low resource health systems. Priorities include transparent and reliable employment conditions, minimum safe staffing and essential supply reliability, supportive supervision that reduces blame culture, workplace violence prevention, structured continuing professional development linked to clinical roles, and credible career ladders that reward competence and experience. Retaining nurses should be positioned as a high yield patient safety intervention and a core leadership responsibility, supported by measurable retention indicators and accountability. Keywords: nursing retention, professional exit, turnover, leadership, job satisfaction, low resource settings, Somalia