Predictors of Turnover Among Nurses in a Level II Hospital

Authors

Hazel B. Mudanza, Rn

Faculty of the School of Nursing Graduate School San Pedro College, Davao City Master of Arts in Hospital Administration (Philippines)

Article Information

DOI: 10.51244/IJRSI.2026.1303000068

Subject Category: Hospital Management

Volume/Issue: 13/3 | Page No: 732-786

Publication Timeline

Submitted: 2026-03-13

Accepted: 2026-03-18

Published: 2026-03-31

Abstract

Nature and Scope of the Paper: Turnover intentions among nurses refer to their thoughts, attitudes, and plans for leaving their current nursing positions or the profession. High turnover intentions can have significant implications for healthcare organizations, as nursing turnover can be costly and disruptive.
Objective or Purpose: This study aimed to find out the factors influencing job satisfaction, organizational factors, and turnover intentions among nurses in a hospital setting.
Research Method: This study employed a mixed-methods explanatory sequential design. The study was conducted at a Level II hospital in Kidapawan City, which has a 100-bed capacity and employs 149 nurses. Participants included nurses who had been in service for at least six months.
Results: The study found that both supportive aspects, such as work-life balance and collegiality, and dissatisfying factors, including low salary, limited recognition, career stagnation, and heavy workloads, influenced nurses’ job satisfaction. While organizational strengths included nurse-physician collaboration, concerns were raised about weak leadership and exclusion from decision-making. Although quantitative data showed no significant links between job satisfaction, organizational factors, and turnover intentions, qualitative responses revealed that dissatisfaction with pay, leadership, and growth opportunities strongly affected nurses’ desire to leave. Addressing these areas is essential to improving retention.
Conclusion: The findings revealed that nurses are generally satisfied with their job and organizational environment, but they have a high intention to leave. Job satisfaction was positively influenced by supportive relationships with colleagues and training opportunities. However, dissatisfaction with salary, career growth, and recognition contributed to higher turnover intentions. The study highlighted the complex relationship between job satisfaction and turnover intention, emphasizing the need for targeted interventions to improve nurse retention.

Keywords

Job Satisfaction, organizational factors, Qualitative, nurses’ intention to leave, explanatory sequential mixed design

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References

1. McDermid F, Peters K, Daly J, Jackson D. The rise of nurse turnover: a global analysis. J Health Serv Res Policy. 2020;25(1):60-8. [Google Scholar] [Crossref]

2. Poon A, Leung K, Chen H. Staffing dilemmas: nurse turnover and its organisational impact. Int J Nurs Stud. 2022;129:104201. [Google Scholar] [Crossref]

3. Kelly LA, Gee PM, Butler RJ. Emotional Ethe Impact of emotional exhaustion on Nurse Turnover Intentions. J Adv Nurs. 2021;77(5):2310-8. [Google Scholar] [Crossref]

4. Labrague LJ, Santos JAA, Resurreccion CA. Turnover intentions and associated factors among hospital nurses in the Philippines. Asian Nurs Res. 2020;14(4):219-25. [Google Scholar] [Crossref]

5. Aljohani KA, Alomari AH. Workplace satisfaction and turnover intention among Filipino nurses in international settings. J Nurs Manag. 2018;26(6):708-16. [Google Scholar] [Crossref]

6. Edwards-Dandridge K, Clarke C, Taylor R. Psychological predictors of nurse turnover: burnout, satisfaction and resilience. Nurs Manag Today. 2020;28(3):45-52. [Google Scholar] [Crossref]

7. Navarro DL, Reyes JM. Organisational climate and its effects on nurse retention in Southeast Asian hospitals. Asian J Nurs Leadersh. 2022;18(1):78-94. [Google Scholar] [Crossref]

8. Anderson T, Kim S. A comprehensive review of predictors influencing global nurse turnover. Int J Health Workforce Res. 2021;32(3):142-57. [Google Scholar] [Crossref]

9. Lee M, Liu S. Determinants of turnover intention among hospital nurses: a meta-analytic review. Int J Nurs Stud. 2022;129:104208. [Google Scholar] [Crossref]

10. Johnson JA, Miller TR, Reyes MC. Turnover intention as a predictor of actual turnover: a longitudinal study in healthcare. Hum Resour Health. 2021;19(1):45. [Google Scholar] [Crossref]

11. Gómez C, Wang Y, Patel R. Understanding voluntary and involuntary turnover in healthcare: a systems perspective. J Health Organ Manag. 2020;34(5):623-39. [Google Scholar] [Crossref]

12. Nguyen TT, Carter M, Huang L. Nurse turnover and patient-care outcomes: a systematic review. BMC Nurs. 2022;21(1):112. [Google Scholar] [Crossref]

13. Winter V, Schreyögg J, Thiel A. Hospital staff shortages: environmental and organisational determinants and implications for patient satisfaction. Health Policy. 2020;124(4):380-8. [Google Scholar] [Crossref]

14. International Council of Nurses. Nurse retention and migration: policy brief. Geneva: ICN; 2019. [Google Scholar] [Crossref]

15. Liang Y, Wang H, Tao X, Zhang Y. Global nursing workforce shortage and its implications: a WHO perspective. Lancet Glob Health. 2021;9(3):e250-1. [Google Scholar] [Crossref]

16. Kim H, Seo Y. The role of nurse retention in sustaining healthcare quality: a review of institutional strategies. J Nurs Manag. 2022;30(2):312-20. [Google Scholar] [Crossref]

17. Setiawan A, Kusuma D. Predictors of nurse turnover in Indonesian hospitals: A cross-sectional study. Asian Nurs Res. 2023;17(1):34–41. [Google Scholar] [Crossref]

18. Zhang Y, Wu J, Fang J, Li X. Demographic predictors of turnover intention among Chinese nurses: A national survey. Nurs Outlook. 2021;69(4):567–75. [Google Scholar] [Crossref]

19. Kim H, Seo Y. The role of nurse retention in sustaining healthcare quality: A review of institutional strategies. J Nurs Manag. 2022;30(2):312–20. [Google Scholar] [Crossref]

20. Gao Y, Li J. Professional dissatisfaction and intention to leave among highly educated nurses in tertiary hospitals. Int J Nurs Stud. 2022;127:104182. [Google Scholar] [Crossref]

21. Mahmoud MA, Hunter D. Educational attainment and nurse turnover: addressing development gaps in low-skilled clinical staff. J Healthc Manag. 2020;65(3):176–83. [Google Scholar] [Crossref]

22. Ng P, Lam C. Marital status and nurse turnover intention: A comparative analysis. Asian J Nurs Stud. 2022;9(2):88–95. [Google Scholar] [Crossref]

23. Lee M, Chen Y. Financial responsibilities and work-life balance among married nurses: Impact on retention. Int Nurs Rev. 2021;68(1):56–64. [Google Scholar] [Crossref]

24. O’Brien AP, McNeil K, Dawson A, Fitzpatrick JJ. Stress and turnover intention among nurses in high-acuity units. J Clin Nurs. 2020;29(15–16):2890–900. [Google Scholar] [Crossref]

25. Singh R, Kaur A. Resilience and retention: Coping strategies that reduce turnover among nurses. J Nurs Adm. 2023;53(2):85–92. [Google Scholar] [Crossref]

26. Patel N, Shah R. Seniority and satisfaction: Retention of long-tenured nurses in acute care settings. J Nurs Manag. 2022;30(6):1433–41. [Google Scholar] [Crossref]

27. Martínez F, Rivera A. Promotion barriers and turnover among experienced hospital nurses. Health Care Manag. 2021;40(2):123–30. [Google Scholar] [Crossref]

28. Cao J, Jia Z, Zhu C, Li Z, Liu H, Li F, Li J. Nurses’ turnover intention and associated factors in general hospitals in China: A cross-sectional study. J Nurs Manag. 2021;29(6):1613–22. [Google Scholar] [Crossref]

29. Wang XX, Wang LP, Wang QQ, Fang YY, Lv WJ, Huang HL, et al. Related factors influencing Chinese psychiatric nurses’ turnover: A cross-sectional study. J Psychiatr Ment Health Nurs. 2022;29(5):698–708. [Google Scholar] [Crossref]

30. Chang HE, Cho SH. Turnover intention and retention of newly licensed nurses in their first job: A longitudinal study. Int Nurs Rev. 2023;70(3):338–44. [Google Scholar] [Crossref]

31. Kim SO, Moon SH. Factors influencing turnover intention among male nurses in Korea. Int J Environ Res Public Health. 2021;18(18):9862. [Google Scholar] [Crossref]

32. Marufu TC, Collins A, Vargas L, Gillespie L, Almghairbi D. Factors influencing retention among hospital nurses: systematic review. Br J Nurs. 2021;30(5):302–8. [Google Scholar] [Crossref]

33. Xue B, Feng Y, Hu Z, Chen Y, Zhao Y, Li X, et al. Assessing the mediation pathways: how decent work affects turnover intention through job satisfaction and burnout in nursing. Int Nurs Rev. 2024;71(4):860–7. [Google Scholar] [Crossref]

34. Lin Y, Wu X. Designing integrated compensation packages for hospital nurses: balancing wages and non-wage benefits. J Health Econ Manag. 2022;18(2):101–9. [Google Scholar] [Crossref]

35. Ahmed M, Khan S, Malik A. Linking remuneration structures to staff motivation in tertiary hospitals. Int J Health Policy Manag. 2021;10(4):215–22. [Google Scholar] [Crossref]

36. Rahman R, Nas Z. Pay dissatisfaction and turnover among clinical staff nurses: a cross-sectional study. Nurs Ethics. 2021;28(6):857–66. [Google Scholar] [Crossref]

37. Choudhury M, Banerjee D. Career ceilings and recognition gaps: effects on nurse retention in South-Asian hospitals. Hum Resour Health. 2020;18(1):71. [Google Scholar] [Crossref]

38. Attar Z, Alsharqi O. Factors influencing non-Saudi nurse turnover in a military hospital. J Health Inform Dev Ctries. 2021;15(2):1–15. [Google Scholar] [Crossref]

39. Park JH, Park MJ, Hwang HY. Intention to leave among staff nurses in small- and medium-sized hospitals. J Clin Nurs. 2019;28(9-10):1856–66. [Google Scholar] [Crossref]

40. Akinyemi B, George B, Ogundele A. Relationship between job satisfaction, pay, affective commitment and turnover intention among Nigerian nurses. Glob J Health Sci. 2022;14(2):37–45. [Google Scholar] [Crossref]

41. Gebregziabher D, Berhanie E, Berihu H, Belstie A, Teklay G. The relationship between job satisfaction and turnover intention among nurses in Axum Comprehensive and Specialized Hospital, Tigray, Ethiopia. BMC Nurs. 2020;19:1-8. [Google Scholar] [Crossref]

42. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors among nurses: a multi-centre cross-sectional study. Front Public Health. 2023;11:1141441. [Google Scholar] [Crossref]

43. Hu H, Wang C, Lan Y, Wu X. Nurses’ turnover intention, hope and career identity: the mediating role of job satisfaction. BMC Nurs. 2022;21(1):43. [Google Scholar] [Crossref]

44. Ofei AMA, Poku CA, Paarima Y, Barnes T, Kwashie AA. Toxic leadership behaviour of nurse managers and turnover intentions: the mediating role of job satisfaction. BMC Nurs. 2023;22(1):374. [Google Scholar] [Crossref]

45. Xue B, Feng Y, Hu Z, Chen Y, Zhao Y, Li X, et al. Assessing the mediation pathways: how decent work affects turnover intention through job satisfaction and burnout in nursing. Int Nurs Rev. 2024;71(4):860-7. [Google Scholar] [Crossref]

46. Ding J, Wu Y. The mediating effect of job satisfaction and emotional exhaustion on the relationship between psychological empowerment and turnover intention among Chinese nurses during the COVID-19 pandemic: a cross-sectional study. BMC Nurs. 2023;22(1):221. [Google Scholar] [Crossref]

47. Akinyemi B, George B, Ogundele A. Relationship between job satisfaction, pay, affective commitment and turnover intention among registered nurses in Nigeria. Glob J Health Sci. 2022;14(2):37-45. [Google Scholar] [Crossref]

48. Boamah SA, Hamadi HY, Havaei F, Smith H, Webb F. Striking a balance between work and play: the effects of work–life interference and burnout on faculty turnover intentions and career satisfaction. Int J Environ Res Public Health. 2022;19(2):809. [Google Scholar] [Crossref]

49. Smokrović E, Kizivat T, Bajan A, Šolić K, Gvozdanović Z, Farčić N, Žvanut B. A conceptual model of nurses’ turnover intention. Int J Environ Res Public Health. 2022;19(13):8205. [Google Scholar] [Crossref]

50. Zhao Y, Wang H, Sun D, Ma D, Li H, Li Y, et al. Job satisfaction, resilience and social support in relation to nurses’ turnover intention based on the theory of planned behaviour: a structural-equation modelling approach. Int J Nurs Pract. 2021;27(6):e12941. [Google Scholar] [Crossref]

51. Ma Y, Chen F, Xing D, Meng Q, Zhang Y. Study on the associated factors of turnover intention among emergency nurses in China and the relationship between major factors. Int Emerg Nurs. 2022;60:101106. [Google Scholar] [Crossref]

52. Kim SO, Moon SH. Factors influencing turnover intention among male nurses in Korea. Int J Environ Res Public Health. 2021;18(18):9862. [Google Scholar] [Crossref]

53. Kim Y, Kim HY. Retention rates and the associated risk factors of turnover among newly hired nurses at South Korean hospitals: a retrospective cohort study. Int J Environ Res Public Health. 2021;18(19):10013. [Google Scholar] [Crossref]

54. Bae SH. Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute-care hospitals: a systematic review. BMC Nurs. 2023;22(1):31. [Google Scholar] [Crossref]

55. Robbins SP. Essentials of Organizational Behavior. 9th ed. Upper Saddle River (NJ): Prentice Hall; 2005. [Google Scholar] [Crossref]

56. Gawel JE. Herzberg’s theory of motivation and Maslow’s hierarchy of needs. Practical Assessment, Research & Evaluation. 1997;5(11):1–3. [Google Scholar] [Crossref]

57. Herzberg F, Mausner B, Snyderman BB. The Motivation to Work. New York: John Wiley & Sons; 1959. [Google Scholar] [Crossref]

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