Nurses’ intention to leave their profession: A cross sectional observational study in 10 European countries

Abstract

Background

As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market exists or is predicted for most European countries. There are no adequate solutions for this shortage yet, and recruitment of future nurses is difficult. Therefore, retaining nurses for the profession is urgent.

Objective

To determine factors associated with nurses’ intention to leave the profession across European countries.

Design

A multi-country, multi-centre, cross-sectional analysis of survey data.

Setting

2025 surgical and medical units from 385 hospitals in ten European countries that participated in the RN4Cast study. Hospital selection was based on a stratified randomised selection procedure.

Participants

All nurses from the participating medical and surgical hospital wards received a survey. 23,159 nurses (64%) returned the survey.

Methods

The nurse survey included questions about intention to leave the profession, nurse characteristics, factors related to work environment, patient-to-nurse staffing ratio, burnout and perceived quality and safety of care. Multilevel regression analyses with ‘intention to leave the profession’ as dependent variable were conducted for all 10 countries combined as well as per country.

Results

Overall, 9% of the nurses intended to leave their profession. This varied from 5 to 17% between countries. Seven factors were associated with intention to leave the profession at European level: nurse–physician relationship (OR 0.86; 95%CI 0.79–0.93), leadership (OR 0.78; 95% CI 0.70–0.86), participation in hospital affairs (0.68; 95%CI 0.61–0.76), older age (OR 1.13; 95%CI 1.07–1.20), female gender (OR 0.67; 95%CI 0.55–0.80), working fulltime (OR 0.76; 95%CI 0.66–0.86) and burnout (OR 2.02; 95%CI 1.91–2.14). The relevance of these factors differed for the individual countries. Nurse perceived staffing adequacy, patient-to-nurse staffing ratio, perceived quality and safety of care and hospital size were not associated with intention to leave at a European level.

Conclusion

Burnout is consistently associated with nurses’ intention to leave their profession across the 10 European countries. Elements of work environment are associated with intention to leave the nursing profession but differ between countries, indicating the importance of national contexts in explaining and preventing nurses’ intention to leave their profession.

Introduction

As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market either exists or is predicted for most European countries (Hasselhorn et al., 2003, Simoens, 2005, Vernooij-Dasssen et al., 2009). Whereas the use of technology could increase optimal use of nurses’ time to some extent, it is unlikely to resolve the issue (Vernooij-Dasssen et al., 2009).

Migration of health professionals across countries, attracting young people to join the nursing workforce and retention of existing staff are three possible approaches to tackle current and future nurse shortages. In theory, migration of nurses across European countries could lead to efficient employment of nurses where they are most needed. In practice however, migration across European states is often hindered by language and cultural barriers as well as qualification and social security issues (de Veer et al., 2004). Moreover, migration of nurses often comes with an exodus of nurses from low income countries, thus relocating rather than solving problems (Lesniowska, 2008).

Educating and recruiting more future professionals for nursing requires time and attention, but is crucial with a view to the future. Yet, nursing is often perceived as not very appealing as well as underpaid (Coombs et al., 2003). While recruitment is somewhat easier in times of economic recession, fewer young people are available for the labour market, thus stressing the need for retention of nurses for the profession.

Nurses’ intention to leave their job has been the focus of many studies and publications, as these intentions could be potentially influenced by nurse managers and health care organisations in order to prevent actual leave. Apart from age, many potentially modifiable factors such as workload, burnout and quality of care at the workplace have often been reported as important predictors of nurses’ intention to leave their job (Aiken et al., 2002, Estryn-Behar et al., 2010, van Bogaert et al., 2009, van der Heijden et al., 2010). Furthermore, evidence shows that early signs of departure are strong predictors of the actual behaviour (Murrells et al., 2008).

Whereas many studies addressed intention to leave the current job or employer, fewer studies looked into intention to leave the nursing profession (Hayes et al., 2006). While changing jobs might be beneficial to individual nurses or even the nursing profession at large, leaving the profession is necessarily problematic in the light of societal investment in training and existing shortages. Disentangling reasons behind job changes within nursing vs. reasons for leaving the profession is crucial in order to determine and develop adequate interventions for nurse retention for the current employer as well as for the profession.

In an integrative review, Flinkman et al. (2010) included 31 international empirical studies to address nurses’ intention to leave the profession. The proportion of nurses who intended to leave their profession varied from 4% to 54%, although large variations in the definition of ‘intention to leave’ could account for this variability. In several studies, male, younger and more qualified nurses were more likely to leave the profession. Evidence for negative effects of low commitment to the profession, as well as dissatisfaction with job content, salaries or possibilities for development was also identified. Furthermore, burnout, stress, work–family conflicts and having a family situation where the nurses’ income was not essential also correlated to a higher intention to leave. A main conclusion from the review by Flinkman et al. (2010) however, relates to the many limitations of primary studies in this area, thus indicating the need for more rigorous studies in order to arrive at more exact estimates and confirm findings on factors related to intention to leave the profession.

We present data from the RN4CAST study, a study in various European countries, which provided data on intention to leave the nursing profession due to job dissatisfaction and data on potentially related factors (Sermeus et al., 2011). Previously, Aiken et al. (2012) reported effects of work environment and staffing ratio on intention to leave the current job based on RN4CAST data.

This study investigated factors associated with intention to leave the profession due to job dissatisfaction of hospital-based nurses in 10 European countries. The following research questions were formulated:

• Which characteristics of nurses and their work environment are associated with nurses’ intention to leave the profession across European countries?

• Do these associations differ between European countries?