Nurse turnover intention in university hospitals in Iran

Nurse turnover poses a significant challenge to healthcare systems worldwide, with direct implications for patient care quality. This study aimed to identify the factors influencing nurses’ intention to leave their positions in hospitals affiliated with the Tehran University of Medical Sciences (TUMS), Tehran, Iran. A large-scale, descriptive-analytical cross-sectional study was conducted in 2024 across all 14 TUMS hospitals using stratified proportional quota sampling with systematic random selection (strata: hospital and nursing role) ( n = 763; >92% response rate from a target of 5,411 eligible nurses). A rigorously validated 40-item questionnaire (Cronbach’s α = 0.93; CVR 0.6–1.0) assessed four domains: individual, job-related, organizational, and external factors. Data were analyzed using SPSS v26 with descriptive statistics, Pearson correlations, partial correlations (controlling for demographics), and ANOVA/Kruskal-Wallis tests ( p < 0.05). Nurses reported a very high intention to leave (mean = 4.1, 95% CI: 4.09–4.19), with 97% expressing moderate-to-very high intent. Among the four dimensions, job-related factors had the highest overall mean (mean = 4.1), with heavy workload identified as the most influential component (mean = 4.5). Organizational factors followed (mean = 3.9), driven primarily by low salary and compensation (mean = 4.9). External factors ranked next (mean = 3.8), with economic pressures exerting the strongest impact (mean = 4.7). Individual factors showed the lowest mean (mean = 2.9), where anxiety and depression emerged as the most significant component (mean = 4.0). Organizational factors demonstrated the strongest correlation with turnover intention ( r = 0.92), whereas individual factors exhibited the weakest correlation ( r = 0.62). High turnover intention was observed among nurses at TUMS hospitals. To address this problem, nursing administrators should implement comprehensive retention strategies that extend beyond mere recognition. Fostering a supportive culture, offering professional growth opportunities, and ensuring fair working conditions are critical for improving job satisfaction and retaining a skilled nursing workforce.