Brigita SKELA-SAVIČ 1*  , Walter SERMEUS 2  , Mateja BAHUN 3  , Sanela PIVAČ 3  , Tit ALBREHT 4 
REASONS FOR THE INTENTION TO LEAVE AMONG NURSES WORKING 
IN INTERNAL MEDICINE AND SURGERY DEPARTMENTS OF SLOVENIAN 
HOSPITALS – A CROSS SECTIONAL STUDY
1 Department for Health Care Sciences, Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270 Jesenice, Slovenia
2 Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
3 Department for Nursing Care, Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270 Jesenice, Slovenia
4 Healthcare System Centre, National Institute of Public Health, Trubarjeva cesta 2, 1000 Ljubljana, Slovenia
Received: May  19, 2025
Accepted: Jul 25, 2025
Original scientific article
*Correspondence: bskelasavic@fzab.si
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
160
RAZLOGI ZA ZAPUŠČANJE DELOVNEGA MESTA MED MEDICINSKIMI 
SESTRAMI NA INTERNISTIČNIH IN KIRURŠKIH ODDELKIH 
SLOVENSKIH BOLNIŠNIC – PRESEČNA RAZISKAVA
© National Institute of Public Health, Slovenia. 
Skela-Savič B, Sermeus W, Bahun M, Pivač S, Albreht T. Reasons for the intention to leave among nurses working in internal medicine and surgery departments of Slovenian hospitals 
– a cross sectional study. Zdr Varst. 2025;64(3):160-166. doi: 10.2478/sjph-2025-0021.
ABSTRACT
Keywords
Nurses
Retention
Job satisfaction
Emotional 
exhaustion 
managers
Career 
development
Status
Profession
IZVLEČEK
Ključne besede 
medicinske sestre
ohranjanje kadra
zadovoljstvo na 
delovnem mestu
emocionalno 
izčrpavajoči vodje
razvoj kariere
status
profesija
Aim
To investigate the reasons for leaving the hospital and recommending the hospital among nurses employed at internal 
diseases and surgical departments.
Methods
A cross-sectional explorative design was employed. Eight general hospitals and two clinical centres participated 
in the study. All adult surgery and internal medicine departments were included. A total of 1010 registered nurses 
and healthcare assistants filled out the questionnaire.  Demographic and job characteristics data were collected. 
Permission to conduct the study was obtained from the National Medical Ethics Committee.
Results
A total of 51.5% of respondents expressed the intent to leave the hospital within the next year and 14% of them 
considered leaving nursing. The “intention to leave the hospital” was explained in 37.7% – 50.3% by younger age 
(p<0.001), poor evaluation of the professional aspect of the work (status of nurses) (p<0.001), emotional exhaustion 
(p<0.001), non-resolution of problems by leaders and managers (p<0.001), dissatisfaction with the current work 
(p<0.001) and overtime hours (p=0.005).  
Conclusions
Our study highlights the role of hospital management and leadership as an important factor in nurse retention. The 
most critical group showing the intention to leave the hospital are the younger employees. There is therefore a need 
to design strategies for their adequate introduction to work and to implement professional development in nursing in 
accordance with international recommendations. 
Namen
Raziskati razloge za namero zapuščanja delovnih mest v bolnišnicah s strani medicinskih sester, zaposlenih na internih 
in kirurških oddelkih.
Metode
Uporabljen je bil presečni raziskovalni načrt. V raziskavi je sodelovalo osem splošnih bolnišnic in dva klinična centra. 
Vključeni so bili vsi oddelki za kirurgijo odraslih in interno medicino. Vprašalnik je izpolnilo skupno 1010 diplomiranih 
medicinskih sester in tehnikov zdravstvene nege. Zbrani so bili demografski podatki in podatki o delovnih značilnostih. 
Dovoljenje za izvedbo raziskave je podala Komisija za medicinsko etiko v Sloveniji. 
Rezultati
Skupaj 51,5 % anketirancev je izrazilo namen, da bodo v naslednjem letu zapustili bolnišnico, 14 % pa jih je razmišljalo o 
tem, da bi zapustili poklic v zdravstveni negi. »Namero odhoda iz bolnišnice« je v 37,7–50,3 % mogoče razložiti pri mlajših 
anketirancih (p < 0,001), s slabo oceno profesionalnega statusa medicinske sestre v bolnišnici (p < 0,001), čustveno 
izčrpanostjo (p < 0,001), slabo odzivnostjo vodij in managerjev pri reševanju težav pri delu (p < 0,001), nezadovoljstvom 
s trenutnim delom (p < 0,001) in nadurnim delom (p = 0,005). 
Zaključki
Raziskava poudarja vlogo vodstva in vodenja bolnišnice kot pomembnega dejavnika pri ohranjanju medicinskih sester. 
Najbolj kritična skupina, ki izkaže namero po zapustitvi bolnišnice, so mlajši zaposleni, zato je potrebno pripraviti strategije 
za njihovo ustrezno uvajanje v delo in v skladu z mednarodnimi priporočili implementirati karierni razvoj v zdravstveni negi. 
1 INTRODUCTION
The retention of qualified nurses is a global healthcare 
workforce problem that has been exacerbated by the 
COVID-19 epidemic (1). The Organisation for Economic Co-
operation and Development (OECD) (2) reports a decline 
in interest in studying nursing in half of the member 
countries of the OECD community.
1.1 Background
A systematic study of evidence looking at intentions to 
leave and the determinants of retention among nurses 
found that job satisfaction, career development and 
work-life balance were the most important determinants 
of retention (3). Job satisfaction is an important 
pull factor, while lack of job satisfaction is a push 
factor (4, 5). Furthermore, emotional exhaustion and 
depersonalisation have been found to be negative factors 
for nurse retention (6-9). Advancement opportunities and 
decision-making authority in patient care were also rated 
as important in retaining nurses (3, 5, 10-13), as were 
training opportunities (14), the opportunity for renewal 
(15), and positive professional experiences (16). Nurses 
want to feel empowered, to have autonomy and control 
over their work, and to feel that their work aligns with 
their personal and professional standards (17, 18). De 
Vries et al. (9) investigated the intention to leave the 
workplace during the COVID-19 epidemic and found six 
themes of determinants affecting the intention to leave 
the workplace: personal characteristics, job demands, 
employment services, working conditions, working 
relationships and organisational culture. The meta-
analysis found that the most important determinants of 
intention to leave the workplace were fear of COVID-19, 
age, experience, burnout symptoms and support. French 
et al. (19) have shown that nurses in hospitals and nursing 
homes reported poor working conditions, high burnout 
and poor patient safety and quality of care even before 
the COVID-19 pandemic.
Williamson et al. (20) noted the importance of leadership 
and staff support, continuing professional development, 
recognition of nurses’ work, a positive work environment, and 
flexible work schedule. Effective local leaders who promote 
relationship building, professional autonomy and a positive 
workplace culture can positively influence nurse retention 
(21). In a study that looked at nurses who terminated their 
employment in healthcare between 2018 and 2021, Muir 
et al. (22) found that the factors that could improve nurse 
retention are reducing and preventing burnout, improving 
nurse staffing, and supporting nurse work-life balance, as 
these fall under the purview of employers.
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
161
Griffiths et al. (23) found in the pre-COVID era that 
European nurses working more than 12 hours and those 
working overtime in a shift were more likely to rate the 
quality of patient care on their ward as mediocre or poor, 
to rate patient safety as mediocre or poor, and to report 
more unfinished nursing tasks on their last shift than nurses 
working eight hours and no more than the contracted 
hours. Azzellino et al. (24) found that unfinished nursing 
tasks or missed care are closely associated with increased 
job dissatisfaction, which in turn significantly increases 
the likelihood that nurses will consider leaving their job. A 
meta-analysis on the prevalence of intention to leave among 
nurses during the COVID-19 pandemic found that 38% of 
nurses expressed the intention of leaving their current job 
(9). In Italy, Sasso et al. (8) found in the pre-COVID era that 
35.5% of nurses intended to leave their current job due to 
job dissatisfaction and 33.1% of them intended to leave the 
nursing profession. Push factors included understaffing, 
emotional exhaustion, lack of patient safety, performing 
non-nursing tasks and being female. Pull factors included 
positive perceptions of quality and safety of care, and 
performing core nursing activities. 
Demographic data is also important when it comes to 
the intention of leaving nursing. Length of experience 
in nursing is directly related to higher job satisfaction; 
nurses who have been in the profession longer have 
a higher level of intrinsic or learned ability to handle 
pressure, which enables them to cope better with working 
conditions (25). Younger and inexperienced nurses have 
been found to have limited personal resilience to cope 
with complex and stressful working conditions (26), which 
consequently negatively affects job satisfaction and 
increases the intention to quit. Park et al. (27) found in 
Korean nurses that satisfaction with salary level was the 
most visible and enduring predictor of turnover intention. 
Among other listed factors, satisfaction with salary was 
also found to be an important factor for intention to leave 
the hospital in less developed countries (28, 29). Wang et 
al. (30) found that both compensation and psychological 
rewards can influence turnover intention.
The Registered Nurse Forecasting (RN4CAST) study 
(31) was conducted in Slovenia in 2020. The variance 
in the working environment of nurses in the study 
can be explained by the following factors: promotion 
opportunities, educational opportunities, satisfaction with 
current job, professional status and educational leave. 
The average value determined for the work environment 
index in nursing was one of the lowest among the studies 
conducted to date (32).
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
1.2 The aim
The aim was to analyse the self-reported intentions and 
reasons for leaving a hospital due to job dissatisfaction 
by nurses in Slovenian hospitals. We included a range 
of reasons previously identified in meta-analyses of the 
evidence, covering demographic data as well as self-
reported satisfaction with current job and career choice 
in nursing, job characteristics, workload and evaluation of 
hospital management performance.
2 METHODS
2.1 Study design 
A cross-sectional study was conducted. We followed the 
RN4CAST research protocol (31).
2.2 Sample and settings
All Slovenian general hospitals (N = 10) and university 
hospitals (N=2) were invited to participate in the study. 
Of these, eight from the former group and two from 
the latter decided to participate. All employed nurses 
and healthcare assistants working in direct patient care 
and in adult surgery and internal medicine departments 
were included (31) (N=2813). The response rate was 
35.91% (n=1010); 848 (83.96%) of respondents were female 
and 160 were male (15.84%). The sample included 403 
nurses (40%) and 605 (60%) healthcare assistants (HCAs). 
On average, they had been employed for 21.42 years 
(SD=3.40). In nursing, the average length of employment 
was 15.34 years (SD=11.12). Respondents’ average age was 
37.02 years (SD=10.65). 
2.3 Instrument
We employed the Emotional Exhaustion subscale of the 
Maslach Burnout Inventory for Human Services Survey (MBI-
HSS) (33). The scale has seven response options (0–never, 
1–a few times a year or less, 2–once a month or less, 3–a 
few times a month, 4–once a week, 5–a few times a week, 
6–every day). A higher score implies a higher degree of 
emotional exhaustion. The use of the emotional exhaustion 
subscale is conceptually and empirically well justified, as 
it is considered a core element of burnout (34, 35). Good 
scale reliability was achieved (n=9; α=0.883).
Regarding the respondents’ work characteristics, data was 
collected using the RN4CAST survey methodology (31): 
satisfaction with current work and professional aspects 
of work (1–very dissatisfied, 2–somewhat dissatisfied, 3–
moderately satisfied, 4–very satisfied) (n=10; α=0.891). 
Various scales with one question were used to describe 
the conditions in the working environment (1–bad, 2–fair, 3–
good, 4–excellent), intention to leave the hospital (1–yes, 2–
no), and satisfaction with the decision to work in nursing (1–
very dissatisfied, 2–somewhat dissatisfied, 3–fairly satisfied, 
4–very satisfied). Various scales with one question were 
162
used to review the confidence of hospital management 
in resolving patient care issues, and patient readiness for 
discharge (1–not at all confident, 2–somewhat confident, 3–
reliably confident, 4–very confident), the overall score for 
patient safety (1–failing, 2–poor, 3–acceptable, 4–very good, 
5–excellent) and the overall quality of patient care on the 
ward/department (1–poor, 2–adequate, 3–good, 4–excellent) 
(31). Data on overtime in the last month was collected. We 
used the previously developed recommendations for the 
translation process (36). 
2.4 Ethical approval and data collection 
The Slovenian National Medical Ethics Committee approved 
the study (No. 0120-488/2019/6, January 7, 2020). The 
study was conducted in accordance with the Helsinki 
declaration (37). The participants gave their written 
consent to participate in the study and gave permission 
to publish the results of the study in scientific journals 
(online, open-access). The data was collected before the 
outbreak of the epidemic in Slovenia from 10 February 
to 7 March 2020. The period of data collection was two 
weeks for each hospital. The management appointed 
research coordinators who administered questionnaires 
printed on paper. The respondents returned them at the 
agreed collection point in a sealed envelope.
2.5 Data analysis 
The statistical package SPSS 22 was used for data analysis. 
Univariate, bivariate statistical analyses and multivariate 
analyses were performed. Statistical significance was 
defined at p<0.05.
3 RESULTS
One in two respondents (n=515; 51.5%) expressed the 
intention of leaving the hospital within a year because 
they were dissatisfied with their current job, and 14% 
(n=139) of them intended to leave nursing. A total of 555 
respondents (55.7%) would recommend the hospital as a 
good work place to other nurses. On the last working day 
before completing the questionnaire, the nurses’ average 
daily working time was 9 hours and 42 minutes (SD=5.518). 
Table 1 describes the average satisfaction score with 
different job characteristics, emotional exhaustion, 
the results by variable, and the differences between 
respondent groups according to whether they intended to 
leave the hospital or stay, the relationship between the 
variables and the decision to recommend the hospital 
to other nurses as a good work place. For all observed 
variables in Table 1, we found significant differences 
between respondents who intend to leave the hospital and 
those who do not. We linked the observed independent 
variables with the variable “recommendation of the 
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
163
The results by variable and the differences between respondent groups in terms of the intention to leave the hospital or stay.
Note 1. n – Number of answers, M – Mean (4-point scale), SD – Standard deviation, t – t test, r – bivariate correlation coefficient, p - 
P-value. **Correlation is significant at the 0.01 level (2-tailed). 
Note 2. The data on various aspects of the job have already been published (31).
Independent variables
Leave the hospital 
NO M (SD)
M (SD) t (p)Leave the hospital 
YES M (SD)
Dependent variables
n
Table 1.
Burnout (ordinal 0-6)
Emotional exhaustion
Aspects of satisfaction (ordinal 1-4)
Current job
Decision to work in nursing
Professional aspects of job (ordinal 1-4)
Management and patient safety
Management resolve problems in patient 
care that I report. (ordinal 1-4)
Overall grade on patient safety in 
my department. (ordinal 1-5)
Overtime hours per month (continues)
Quality of nursing care in 
department (ordinal 1-4)
Readiness of patients for discharge (ordinal 1-4)
Undone necessary activities (continues)
18.90 (9.544)
3.29 (0.616)
3.11 (0.754)
3.05 (0.552)
2.89 (0.781)
 
3.70 (0.780)
 
14.17 (14.359)
3.19 (0.656)
 
3.01 (0.583)
1.73 (0.233)
23.62 (10.589)
2.96 (0.733)
2.89 (0.791)
2.73 (0.675)
2.57 (0.882)
 
3.54 (0.858)
 
16.53 (15.237)
3.03 (0.746)
 
2.87 (0.664)
1.69 (0.244)
15.338 (<0.001)
-15.427 (<0.001)
-10.228 (<0.001)
-14.983 (<0.001)
-11.927 (<0.001)
 
-5861 (<0.001)
 
4.367 (<0.001)
-6.876 (<0.001)
 
-6.546 (<0.001)
-4.958 (<0.001)
28.14 (9.479)
2.64 (0.699)
2.62 (0.748)
2.43 (0.630)
2.26 (0.865)
 
3.38 (0.897)
 
18.70 (15.652)
2.88 (0.790)
 
2.74 (0.706)
1.66 (0.245)
931
1.003
988
790
998
 
999
 
853
1005
 
1004
1003
hospital to a colleague as a good workplace” and found 
significant positive and negative correlations (Table 1). 
No differences were found between educational level and 
gender for the variables in Table 1.
Following the significant associations in Table 1, we 
performed a logistic regression (Enter method) to identify 
the factors for the variable “intention to leave the 
hospital” using the multivariate method. The model in 
Table 2 contains 11 independent variables that explain the 
variance of “intention to leave the hospital within a year 
because of job dissatisfaction”. The full model of included 
factors was statistically significant (χ² (10, N=582)=17.101, 
p<0.001), indicating that the constructed model identifies 
the differences between those who intend to leave the 
hospital and those who do not. Variance in ‘intention to 
leave the hospital’ was explained in 37.7% (Cox & Snell 
R-squared model) and 50.3% (Nagelkerke R-squared 
model). Six independent variables were found to be 
statistically significant and described the relationship with 
Logistic regression model for intention to leave the hospital for nurses in internal medicine and surgery departments of 
Slovenian hospitals.
“YES, I will leave the current hospital within a year because of job dissatisfaction.”
B dfS.E. Sig.
Lower
Wald Exp(B) 95% C.I. for EXP(B)
Upper
Table 2.
Satisfaction with current job
Management resolve problems in patient care
Overall grade on patient safety
Emotional exhaustion
Professional aspects of job
Age
Overtime hours per month
Decision to work in nursing
Quality of nursing care in department
Readiness of patients for discharge
Undone necessary activities
Constant
-1.020
-0.604
0.210
0.452
-0.919
-0.047
0.021
-0.317
0.060
-0.002
0.262
7.020
1
1
1
1
1
1
1
1
1
1
1
1
0.265
0.155
0.164
0.115
0.230
0.011
0.007
0.166
0.190
0.194
0.297
1.280
<0.001
<0.001
0.201
<0.001
<0.001
<0.001
0.005
0.057
0.750
0.992
0.379
<0.001
0.215
0.403
0.894
1.255
0.254
0.934
1.007
0.526
0.732
0.682
0.725
14.874
15.181
1.638
15.486
15.972
18.789
8.047
3.626
0.101
0.000
0.774
30.071
0.361
0.547
1.234
1.572
0.399
0.954
1.021
0.729
1.062
0.998
1.299
1119.11
0.605
0.741
1.703
1.969
0.626
0.974
1.037
1.009
1.541
1.460
2.327
164
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
“intention to leave the hospital within a year because 
of job dissatisfaction”. These include a younger age 
(OR=0.95, p<0.001), a lower evaluation of the professional 
aspects of the job (OR=0.39, p<0.001), a higher level of 
emotional exhaustion (OR=1.57, p<0.001), a lower ability of 
management to solve problems in patient care (OR=0.55, 
p<0.001), a lower level of satisfaction with the current job 
(OR=0.36, p<0.001) and a higher number of overtime hours 
per month (OR=1.02, p=0.005) (Table 2).
4 DISCUSSION 
Our aim was to investigate the reasons for leaving the 
hospital due to job dissatisfaction among nurses working 
in the internal medicine and surgery departments of 
Slovenian hospitals. The data were collected before the 
outbreak of the epidemic in Slovenia. Compared to other 
European countries, the study in Slovenia revealed the 
highest proportion (51.5%) of respondents expressing an 
intention to leave their hospital within a year because 
of job dissatisfaction in the pre-COVID 19 period (8, 9, 
26, 35). The most recent studies in Greece showed an 
intention to leave of 50.2% (38), and in Ireland 30% (39); 
the data for both studies was collected in 2023. De Vries 
et al. (9) calculated in a meta-analysis that the intention 
to leave the workplace in European studies at the time 
of COVID 19 was on average 38% and Aiken et al. (40) 33% 
in five EU countries. The Slovenian intention to leave the 
hospital at the beginning of 2020 was very high.
The nurses in our survey worked an average of 16 hours per 
month beyond the agreed one month working time of 174 
hours. The excessive workload can lead to exhaustion, which 
reduces nurses’ job satisfaction (40), and is the strongest 
predictor of intention to leave (38). In our study, nurses 
who intended to leave their hospital also felt significantly 
more exhausted. Some variables reported in international 
studies were not found to be typical in our study, such as 
education level (41) and gender (5, 8, 11, 42).
The variables observed in our study (Table 1) have also 
been associated with intention to leave the hospital in 
other studies and are also summarised by the authors for 
the period before (6-8, 10, 11, 14-18), during and after 
COVID-19 (9, 12, 13, 44, 45).
For the “intention to leave the hospital within a year 
because of job dissatisfaction”, we identified six significant 
variables which explained the variable in a maximum 50%. 
The strongest factors in our model, also recognised in 
other pre-COVID studies and those during COVID 19 (6-9, 
43), were younger age, professional aspect of job (status 
of nurses) and emotional exhaustion. The performance of 
management in solving problems at work and satisfaction 
with current job was the next level of factors for intention 
to leave the hospital. Previous studies showed that 
management that responds poorly or does not respond 
to problems raised by employees regarding patient work 
significantly encourages the departure of nurses from the 
hospital (20, 21, 41). Next, overtime hours were significant 
in our multivariate model and revealed a lot about the work-
life balance as experienced by the respondent. In other 
studies, advancement opportunities and decision-making 
authority in patient care were also found to be important 
in retaining nurses in the profession (5, 17, 18, 42).
4.1 Implications for managers in healthcare system 
Aiken et al. (44) pointed out that most hospitals have 
not made significant improvements in staffing or the 
working environment in the last decade; policy makers 
should require hospitals to meet safe minimum standards 
for nurse staffing. Continuing chronic understaffing and 
unacceptable working conditions in hospitals will not 
restore public and nurses’ confidence in hospitals. The 
importance of the number of nurses employed for patient 
health outcomes appears to be an explanatory factor in 
the Slovenian study (46).
One of the most important tasks of managers and leaders 
is to create a favourable working environment for nurses 
with effective and qualified leaders. Managers need 
to understand that a salary increase for nurses is not 
enough to retain these workers; salary and adequate 
working conditions are important, their absence leads 
to dissatisfaction, while achievements and recognition 
increase job satisfaction and performance. Policies aimed 
at increasing nurse autonomy, allowing post-graduate 
specialisations, recognising Master of Nursing degrees 
in clinical settings, providing recognition and improving 
communication are effective in increasing job satisfaction 
and decreasing turnover. 
4.2 Limitations
First, the results reflect the views and experiences of 
the nurses who participated in the survey.  The response 
rate was relatively modest and may have led to response 
bias—especially if those with stronger opinions were 
more likely to respond. Secondly, the study focused 
exclusively on internal medicine and surgical departments 
and excluded other hospital areas that may have 
different organisational cultures and working conditions. 
Thirdly, the use of self-report data raises the possibility 
that certain responses may be both over- and under-
reported because work environment and job satisfaction 
perceptions are inherently subjective and may vary over 
time and between individuals. Finally, the study is cross-
sectional and thus narrows our capacity for drawing causal 
conclusions. While the regression models show significant 
relationships, they do not allow conclusions to be drawn 
on the direction or time course of these relationships. 
165
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
5 CONCLUSIONS
This study highlights the variables of nurse retention 
which are in the domain of tasks and responsibilities of 
hospital managers and leaders. Factors for nurse retention 
that should be considered by management and national 
healthcare policy are preventing emotional exhaustion, 
creating conditions for a stimulating work environment, 
solving problems highlighted by staff and prioritising the 
professional development of nurses, thus improving their 
status at the hospital. 
ACKNOWLEDGEMENTS
The paper presents, in part, the results of a broader non-
profit applied project entitled “Hospitals and faculties 
together for prosperous and scientific based healthcare 
(ProCare)”.
INFORMED CONSENT
The participants gave their written informed consent to 
participate in the study and gave permission to publish 
the results of the study in scientific journals (online, open-
access). The study was conducted in accordance with the 
Helsinki Declaration.
CONFLICTS OF INTEREST
The authors report no conflicts of interest. The manuscript 
has not been published and is not under consideration for 
publication elsewhere.
FUNDING 
The research was financed by ERASMUS +, Action KA2 
(Project No. 601092-EPP-1-2018-1-SI-EPPKA2-KA) in the 
period 2018-2021. 
ETHICAL APROVAL
The Slovenian National Medical Ethics Committee approved 
the study (No. 0120-488/2019/6, 7 January 2020).
AVAILABILITY OF DATA AND MATERIALS
The data sets used and/or analysed during the current 
study are available from the first author of this article. 
ORCID  
Brigita Skela Savič: 
https://orcid.org/0000-0002-1028-5383  
Walter Sermeus: 
https://orcid.org/0000-0002-5915-1845
Mateja Bahun: 
https://orcid.org/0000-0002-6912-6950
Sanela Pivač: 
https://orcid.org/0000-0003-2372-9497
Tit Albreht: 
https://orcid.org/0000-0002-1812-4381
REFERENCES
1. Virkstis K, Boston-Fleischhauer C, Rewers L, Critchley N, Whitemarsh 
K, Paiewonsky A, et al. 7 executive strategies to stabilize the 
nursing workforce. J Nurs Adm. 2022; 52(4):194-196. doi: 10.1097/
NNA.0000000000001129.
2. OECD / EU. Fewer young people want to become nurses in half of 
OECD countries. Paris: OECD Publishing; 2024.
3. de Vries N, Boone A, Godderis L, Bouman J, Szemik S, Matranga D, et al. 
The race to retain healthcare workers: A systematic review on factors 
that impact retention of nurses and physicians in hospitals. Inquiry. 
2023;60:00469580231159318. doi: 10.1177/00469580231159318.
4. Al Sabei SD, Labrague LJ, Miner Ross A, Karkada S, Albashayreh A, Al 
Masroori F, et al. Nursing work environment, turnover intention, job 
burnout, and quality of care: The moderating role of job satisfaction. 
J Nurs Scholarship. 2020;52:95-104. doi: 10.1111/jnu.12528.
5. Ejebu OZ, Turnbull J, Atherton I, Rafferty AM, Palmer B, Philippou 
J, et al. What might make nurses stay? A protocol for discrete choice 
experiments to understand NHS nurses’ preferences at early- career 
and late-career stages. BMJ Open. 2024;14:e075066. doi: 10.1136/ 
bmjopen-2023-075066. 
6. Van der Heijden B, Mahoney CB, Xu Y. Impact of job demands and 
resources on nurses’ burnout and occupational turnover intention 
towards an age-moderated mediation model for the nursing 
profession. Int J Environ Res Public Health. 2019; 16(11):2011. doi: 
10.3390/ijerph16112011.
7. McKenna J, Jeske D. Ethical leadership and decision author ity effects 
on nurses’ engagement, exhaustion, and turnover intention. J Adv 
Nurs. 2021; 77(1):198-206. doi: 10.1111/jan.14591. 
8. Sasso L, Bagnasco A, Catania G, Zanini M, Aleo G, Watson R, et al. 
Working Group. Push and pull factors of nurses’ intention to leave. J 
Nurs Manag. 2019;27(5):946-54. doi:10.1111/jonm.12745.
9. de Vries N, Maniscalco L, Matranga D, Bouman J, de Winter JP. 
Determinants of intention to leave among nurses and physicians in a 
hospital setting during the COVID-19 pandemic: A systematic review 
and meta-analysis. PLoS One. 2024;19(3):e0300377. doi: 10.1371/
journal.pone.0300377.
10. Çamveren H, Kocaman G. Factors influencing a university hospital 
nurses’ intentions to leave the unit, organisation and profession: A 
cross-sectional study. J Health Manag. 2021;23(2):240-250.
11. Pressley C, Garside J. Safeguarding the retention of nurses: A 
systematic review on determinants of nurse’s intentions to stay. 
Nursing Open. 2023;10:2842-2858. doi: 10.1002/nop2.1588.
12. Alkan E, Cushen-Brewster N, Anyanwu P. Organisational factors 
associated with healthcare workforce development, recruitment, 
and retention in the United Kingdom: A systematic review. BMC Nurs. 
2024;23:604. doi: 10.1186/s12912-024-02216-0.
166
10.2478/sjph-2025-0021 Zdr Varst. 2025;64(3):160-166
30. Wang L, Tao H, Bowers BJ, Brown R, Zhang Y. When nurse emotional 
intelligence matters: How transformational leadership influences 
intent to stay. J Nurs Manag. 2018; 26(4):358-365. doi: 10.1111/
jonm.12509.
31. Sermeus W, Aiken LH, Van Den HK, Rafferty AM, Griffiths P, Moreno-
Casbas MT, et al. Nurse forecasting in Europe (RN4CAST): Rationale, 
design and methodology. BMC Nurs. 2011;10:6. doi: 10.1186/1472-6955-
10-6.
32. Skela Savič B, Sermeus W, Dello S, Squires A, Bahun M, Lobe B. 
How nurses’ job characteristics affect their self-assessed work 
environment in hospitals: Slovenian use of the practice environment 
scale of the nursing work index. BMC Nurs. 2023;22:1-12. doi: 10.1186/
s12912-023-01261-5.
33. Maslach C, Jackson SE, Leiter M. Maslach burnout inventory: Manual. 
3rd ed. Palo Alto, CA: Consulting Psychologist Press; 1996.
34. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 
2001; 52:397-422. doi: 10.1146/annurev.psych.52.1.397.
35. Schlak AE, Aiken LH, Chittams J, Poghosyan L, McHugh M. Leveraging 
the work environment to minimize the negative impact of nurse 
burnout on patient outcomes. Int J Environ Res Public Health. 
2021;18:610. doi: 10.3390/ ijerph18020610.
36. Squires A, Aiken LH, van den Heede K, Sermeus W, Bruyneel L, 
Lindqvist R, et al. A systematic survey instrument translation process 
for multi-country, comparative health workforce studies. Int J Nurs 
Stud. 2013;50(2):264-273. doi: 10.1016/j.ijnurstu.2012.02.015.
37. World Medical Association. World Medical Association Declaration 
of Helsinki, ethical principles for medical research involving 
human subjects. JAMA. 2013;310(20):2191-2194. doi: 10.1001/
jama.2013.281053.
38. Galanis P, Moisoglou I, Katsiroumpa A, Gallos P, Kalogeropoulou M, 
Meimeti E, et al. Workload increases nurses’ quiet quitting, turnover 
intention, and job burnout: Evidence from Greece. AIMS Public Health. 
2025;12(1):44-55. doi: 10.3934/publichealth.2025004. 
39. O’Callaghan C, Sadath A. Exploring job satisfaction and turnover 
intentions among nurses: Insights from a cross-sectional study. Cogent 
Psychology. 2025;12(1):2481733. doi: 10.1080/23311908.2025.2481733.
40. Aiken LH, Sermeus W, McKee M, Lasater KB, Sloane D, Pogue 
CA, et al. Physician and nurse well- being, patient safety and 
recommendations for interventions: Cross-sectional survey in 
hospitals in six European countries. BMJ Open. 2024;14:e079931. doi: 
10.1136/ bmjopen-2023-079931.
41. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors 
among nurses: A multi-center cross-sectional study. Front Public 
Health. 2023;11:1141441.  doi: 10.3389/fpubh.2023.1141441.
42. Heinen MM, Achterberg T, Schwendimann R, Zander B, Matthews A, 
Kózka M, et al. Nurses’ intention to leave their profession: A cross 
sectional observational study in 10 European countries. Int J Nurs 
Stud. 2013;50(2):174-184. doi: 10.1016/j.ijnurstu.2012.09.019.
43. Al Yahyaei A, Hewison A, Efstathiou N, Carrick-Sen D. Nurses’ 
intention to stay in the work environment in acute healthcare: 
A systematic review. J Res Nurs. 2022; 27(4):374-397. doi: 
10.1177/17449871221080731.
44. Enea M, Maniscalco L, de Vries N, Boone A, Lavreysen O, Baranski K, 
et al. Exploring the reasons behind nurses’ intentions to leave their 
hospital or profession: A cross-sectional survey. Int J Nurs Stud Adv. 
2024;7:100232. doi: 10.1016/j.ijnsa.2024.100232. 
45. Aiken LH, Sloane DM, McHugh MD, Pogue CA, Lasater KB. A repeated 
cross-sectional study of nurses immediately before and during 
the COVID-19 pandemic: Implications for action. Nurs Outlook. 
2023;71(1):101903. doi: 10.1016/j.outlook.2022.11.007. 
46. Skela-Savič B, Albreht T, Sermeus W, Lobe B, Bahun M, Dello S. 
Patient outcomes and hospital nurses’ workload: A cross-sectional 
observational study in Slovenian hospitals using the RN4CAST survey. 
Zdr Varst. 2023;62(2):59-66. doi: 10.2478/Sjph-2023-0009.
13. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors 
among nurses: A multi center cross sectional study. Front Public 
Health. 2023;11:2023. doi: 10.3389/fpubh.2023.1141441.
14. Burmeister EA, Kalisch BJ, Xie B, Doumit MAA, Lee E, Ferraresion 
A, et al. Determinants of nurse absenteeism and intent to leave: An 
international study. J Nurs Manag. 2019; 27(1):143-153. doi: 10.1111/
jonm.12659.
15. Karlsson A, Gunningberg L, Bäckström J, Pöder U. Registered nurses’ 
perspectives of work satisfaction, patient safety and intention to stay 
– a double-edged sword. J Nurs Manag. 2019; 27(7):1359-1365. doi: 
10.1111/jonm.12816.
16. Leineweber C, Chungkham HS, Lindqvist R, Westerlund H, Runesdotter 
S. Nurses’ practice environment and satisfaction with schedule 
flexibility is related to intention to leave due to dissatisfaction: A 
multi-country, multilevel study. Int J Nurs Stud. 2016; 58:47-58. doi: 
10.1016/j.ijnurstu.2016.02.003.
17. Eltaybani S, Noguchi-Watanabe M, Igarashi A, Saito Y, Yamamoto-
Mitani N. Factors related to intention to stay in the current workplace 
among long- term care nurses: A nationwide survey. Int J Nurs Stud. 
2018; 80:118-127. doi: 10.1016/j.ijnurstu.2018.01.008. 
18. Yarbrough S, Martin P, Alfred D, McNeill C. Professional values, job 
satisfaction, career development, and intent to stay. Nurs Ethics. 
2017; 24(6):675-685. doi: 10.1177/0969733015623098.
19. French R, Aiken LH, Fitzpatrick-Rosenbaum KE, Laseter KB. Conditions 
of nursing practice in hospitals and nursing homes before COVID-19: 
Implications for policy action. J Nurs Regulation. 2022; 13(1):45-53. 
doi: 10.1016/S2155-8256(22)00033-3. 
20. Williamson L, Burog W, Taylor R. A scoping review of strategies used to 
recruit and retain nurses in the healthcare workforce. J Nurs Manag. 
2022;30(7):2845-2853. doi: 10.1111/jonm.13786. 
21. Cardiff S, Gershuni O, Giesbergen-Brekelmans A. How local, first-
line nurse leaders can positively influence nurse intent to stay and 
retention: A realist review. J Clin Nurs. 2023;32(19-20):6934-6950. doi: 
10.1111/jocn.16813. 
22. Muir K, Porat-Dahlerbruch J, Nikpour J, Leep-Lazar K, Lasater K. 
Top factors in nurses ending health care employment between 
2018 and 2021. JAMA Netw Open. 2024; 7(4):e244121. doi: 10.1001/
jamanetworkopen.2024.4121. 
23. Griffiths P, Dall Ora C, Simon M, Ball J, Lindqvist R, Rafferty AM, et al. 
Nurses’ shift length and overtime working in 12 European countries: 
The association with perceived quality of care and patient safety. Med 
Care. 2014; 52(11):975-81. doi: 10.1097/MLR.0000000000000233. 
24. Azzellino G, Dante A, Petrucci C, Caponnetto V, Aitella E, Lancia L, et 
al. Intention to leave and missed nursing care: A scoping review. Int J 
Nurs Stud Advances. 2025;8:100312. doi: 10.1016/j.ijnsa.2025.100312. 
25. Gholami M, Saki M, Hossein P, Amir H. Nurses’ perception of 
empowerment and its relationship with organizational commitment 
and trust in teaching hospitals in Iran. J Nurs Manag. 2019; 27(5):1020-
1029. doi: 10.1111/jonm.12766. 
26. Kerzman H, Van Dijk D, Siman-Tov M, Friedman S, Goldberg, S. 
Professional characteristics and work attitudes of hospital nurses who 
leave compared with those who stay. J Nurs Manag. 2020; 28(6):1364-
1371. doi: 10.1111/jonm.13090. 
27. Park JH, Park MJ, Hwang HY. Intention to leave among staff nurses in 
small-and medium-sized hospitals. J Clin Nurs. 2019;28:1856-1867. doi: 
10.1111/jocn.14802.
28. Tadesse B, Dechasa A, Ayana M, Tura MR. Intention to leave nursing 
profession and its associated factors among nurses: A facility based 
cross-sectional study. Inquiry. 2023;60:469580231200602. doi: 
10.1177/00469580231200602. 
29. Kiptulon EK, Zrínyi M, Siket AU. Intentions to leave the job and nursing 
profession among nurses in Kenya’s referral hospitals: Exploring 
the effects of organizational culture, work-related stress and job 
satisfaction. BMC Nurs. 2025;24(1):823. doi: 10.1186/s12912-025-
03422-0.