Elisa Lovino 1,2, Anna Rita Marucci 1,3, Florin Sandu 2, Francesco Zaghini 4, Flavio Marti 1,3,4,*
- School of Nursing and Midwifery, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Medicasa Italia S.p.A., Via Bisceglie 66, 20152 Milan, Italy
- Department of Health Profession, San Camillo Forlanini Hospital, C.ne Gianicolense 87, 00152 Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Montpellier, 1, 00133 Rome, Italy
* Corresponding author: Flavio Marti, School of Nursing and Midwifery, Faculty of Medicine and Psychology, Sapienza University of Rome, San Camillo Forlanini Hospital, 00152 Rome, Italy – ORCID: https://orcid.org/0000-0001-9569-3329 – E-mail: flavio.marti@uniroma1.it
Cite this article
ABSTRACT
Introduction: Intention to leave (ITL) is a relevant predictor of nurse turnover and workforce instability. While extensively studied in hospital settings, evidence in community, home care, and primary health care remains limited despite the growing relevance of these services.
Objective: To map the available evidence on ITL among nurses working in community, home care, and primary health care settings and to identify associated factors.
Materials and Methods: A scoping review was conducted and reported according to the PRISMA-ScR framework. Six electronic databases were searched, applying a publication-date restriction from January 2016 to May 2026. Studies focusing on ITL among nurses working in out-of-hospital settings were included and analyzed using a narrative synthesis approach.
Results: Thirty studies were included. Findings indicate that ITL is influenced by a complex interaction of factors, which can be grouped into two main domains: management factors (e.g., leadership, organizational support, professional autonomy) and context factors (e.g., workload, burnout, moral distress, work environment characteristics).
Conclusion: These findings suggest that ITL emerges when job demands exceed available resources, in line with the Job Demands–Resources model. Unlike evidence derived predominantly from hospital settings, this review suggests that intention to leave in community and home care is shaped not only by common organizational factors but also by setting-specific characteristics, including the dual role of professional autonomy, professional isolation, and delegation practices. These findings extend current evidence by providing a context-specific framework for interpreting ITL in out-of-hospital nursing services.
Keywords: intention to leave; community nursing; home care nursing; nurse retention; organizational support
INTRODUCTION
Over recent decades, intention to leave (ITL) is regarded as an important predictor of professional turnover. This concept refers to the intentional, yet not enacted, decision to leave one’s current job or, in some cases, the profession itself. ITL represents an intermediate stage between job dissatisfaction and actual turnover and is therefore relevant for understanding and potentially preventing the loss of qualified nursing personnel [1].
Although research on nursing turnover has developed substantially in hospital settings [2,3], evidence on nurses working in community, primary health care and home care settings remains limited. This gap is increasingly relevant given the growing shift of healthcare systems towards community-based models of care in response to population ageing, the growing prevalence of chronic conditions, and the need for greater continuity of care [2,4,5].
Although terminology and service organization vary across healthcare systems, these settings share the provision of nursing care outside hospital environments. Community, primary health care and home care nurses play an essential role in health promotion, integrated care pathway management, care of frail people and family support [6].
Working in these settings often involves substantial professional autonomy, limited direct supervision, physical distance from teams, and the management of complex situations in non-standardized environments such as patients’ homes [4,7]. When adequate organizational and professional support is lacking, these characteristics may contribute to professional isolation, stress, and ITL [8].
Objective
The aim of this review was to map the available evidence on ITL among nurses working in community, home care, and primary health care settings and to identify associated factors, addressing a gap in the literature on out-of-hospital nursing contexts.
MATERIALS AND METHODS
This study is a scoping review conducted and reported in accordance with the JBI methodology for scoping reviews [9] and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [10,11]. This approach was chosen due to the exploratory nature of the research question and the heterogeneity of the available evidence in terms of study designs, settings, and definitions of ITL, which required a broad mapping of the literature rather than a narrowly focused synthesis. In line with JBI guidance, the review adopted the PCC (Population, Concept, Context) framework to define the research question and eligibility criteria.
Search Strategy
The final literature searches were conducted on May 26, 2026, across six electronic databases: PubMed, Scopus, CINAHL (via EBSCOhost), Web of Science Core Collection, PsycINFO (via EBSCOhost), and the Cochrane Library, using the database-specific search strategies reported in Table 1. The publication-date restriction (January 2016 to May 2026) was applied using the database interface filters rather than being incorporated into the search strings. To identify keywords to be included in the search strategy, two researchers (EL, FM) independently performed a preliminary review of the literature on the topic. Any disagreements between reviewers were resolved by discussion with a third researcher (ARM). The search strategy primarily relied on free-text terms to maximize sensitivity across databases with different indexing systems, in a field characterized by heterogeneous terminology. A consistent core search strategy was applied across databases to ensure comparability, with minor adaptations where appropriate. The use of multiple databases with complementary indexing systems was intended to enhance overall coverage and reduce the risk of missing relevant studies. Grey literature was not included because the primary aim of this review was to map evidence derived from peer-reviewed scientific literature. Restricting the review to peer-reviewed sources was considered appropriate to ensure methodological consistency and comparability across studies.
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Search Strategy |
Database |
Search date |
Results |
|
((nurs*[tiab] OR nurse[tiab] OR nurses[tiab] OR "Nurses"[Mesh] OR "Community Health Nursing"[Mesh] OR "Public Health Nursing"[Mesh]) AND (turnover[tiab] OR "turnover intention"[tiab] OR "turnover intentions"[tiab] OR "intention to leave"[tiab] OR "intent to leave"[tiab] OR "intention-to-leave"[tiab] OR "intention to stay"[tiab] OR "intent to stay"[tiab] OR retention[tiab] OR attrition[tiab] OR resignation[tiab] OR "intention to quit"[tiab] OR "intent to quit"[tiab] OR "Personnel Turnover"[Mesh]) AND ("community care nursing"[tiab] OR "primary health care nursing"[tiab] OR "home healthcare nursing"[tiab] OR "transitional care"[tiab] OR "care continuum"[tiab] OR "hospital to home"[tiab] OR "community nursing"[tiab] OR "community health nursing"[tiab] OR "primary care nursing"[tiab] OR "primary healthcare nursing"[tiab] OR "primary health care"[tiab] OR "home care nursing"[tiab] OR "home health care nursing"[tiab] OR "home nursing"[tiab] OR "home care"[tiab] OR "domiciliary care"[tiab] OR "district nursing"[tiab] OR "community-based care"[tiab] OR "community-based nursing"[tiab] OR "community healthcare"[tiab] OR "community health services"[tiab] OR "local health services"[tiab] OR "out-of-hospital care"[tiab] OR "ambulatory care"[tiab] OR "continuity of care"[tiab] OR "Primary Health Care"[Mesh] OR "Home Care Services"[Mesh] OR "Home Nursing"[Mesh] OR "Community Health Services"[Mesh] OR "Community Health Nursing"[Mesh] OR "Continuity of Patient Care"[Mesh] OR "Transitional Care"[Mesh] OR "Ambulatory Care"[Mesh])) |
PubMed |
May 26, 2026 |
1643 results |
|
((MH "Nurses+") OR (MH "Community Health Nursing+") OR (MH "Public Health Nursing+") OR TI nurs* OR AB nurs*) AND ((MH "Personnel Turnover+") OR TI (turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR quitting OR "leaving the profession" OR resignation OR "intention to quit" OR "intent to quit") OR AB (turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR quitting OR "leaving the profession" OR resignation OR "intention to quit" OR "intent to quit")) AND ((MH "Primary Health Care+") OR (MH "Home Health Care+") OR (MH "Home Nursing+") OR (MH "Community Health Services+") OR (MH "Community Health Nursing+") OR (MH "Continuity of Patient Care+") OR (MH "Transitional Care+") OR (MH "Ambulatory Care+") OR TI ("community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "territorial nursing care" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "home care nursing" OR "home nursing" OR "home care" OR "district nursing" OR "public health nursing" OR "family nursing" OR "visiting nurses" OR "visiting nurse" OR "domiciliary care" OR "community-based care" OR "community health services" OR "out-of-hospital care" OR "continuity of care" OR "primary health care") OR AB ("community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "territorial nursing care" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "home care nursing" OR "home nursing" OR "home care" OR "district nursing" OR "public health nursing" OR "family nursing" OR "visiting nurses" OR "visiting nurse" OR "domiciliary care" OR "community-based care" OR "community health services" OR "out-of-hospital care" OR "continuity of care" OR "primary health care")) |
CINAHL |
May 26, 2026 |
915 results |
|
((nurs* OR nurse OR nurses) AND (turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention-to-leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR resignation OR "intention to quit" OR "intent to quit") AND ("community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "primary healthcare nursing" OR "primary health care" OR "home care nursing" OR "home health care nursing" OR "home nursing" OR "home care" OR "domiciliary care" OR "district nursing" OR "community-based care" OR "community-based nursing" OR "community healthcare" OR "community health services" OR "local health services" OR "out-of-hospital care" OR "ambulatory care" OR "continuity of care")) |
Cochrane Library |
May 26, 2026 |
7 results |
|
( ( nurs* OR nurse OR nurses) AND ( turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention-to-leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR resignation OR "intention to quit" OR "intent to quit") AND ( "community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "primary healthcare nursing" OR "primary health care" OR "home care nursing" OR "home health care nursing" OR "home nursing" OR "home care" OR "domiciliary care" OR "district nursing" OR "community-based care" OR "community-based nursing" OR "community healthcare" OR "community health services" OR "local health services" OR "out-of-hospital care" OR "ambulatory care" OR "continuity of care")) |
Scopus |
May 26, 2026 |
698 results |
|
((DE "Nurses" OR DE "Community Health Nursing" OR TI(nurs* OR nurse OR nurses) OR AB(nurs* OR nurse OR nurses)) AND (DE "Employee Turnover" OR TI(turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention-to-leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR resignation OR "intention to quit" OR "intent to quit") OR AB(turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention-to-leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR resignation OR "intention to quit" OR "intent to quit")) AND (DE "Primary Health Care" OR DE "Home Care" OR DE "Community Health Services" OR TI("community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "primary healthcare nursing" OR "primary health care" OR "home care nursing" OR "home health care nursing" OR "home nursing" OR "home care" OR "domiciliary care" OR "district nursing" OR "community-based care" OR "community-based nursing" OR "community healthcare" OR "community health services" OR "local health services" OR "out-of-hospital care" OR "ambulatory care" OR "continuity of care") OR AB("community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "primary healthcare nursing" OR "primary health care" OR "home care nursing" OR "home health care nursing" OR "home nursing" OR "home care" OR "domiciliary care" OR "district nursing" OR "community-based care" OR "community-based nursing" OR "community healthcare" OR "community health services" OR "local health services" OR "out-of-hospital care" OR "ambulatory care" OR "continuity of care"))) |
PsycInfo |
May 26, 2026 |
128 results |
|
(((nurs* OR nurse OR nurses) AND (turnover OR "turnover intention" OR "turnover intentions" OR "intention to leave" OR "intent to leave" OR "intention-to-leave" OR "intention to stay" OR "intent to stay" OR retention OR attrition OR resignation OR "intention to quit" OR "intent to quit") AND ("community care nursing" OR "primary health care nursing" OR "home healthcare nursing" OR "transitional care" OR "care continuum" OR "hospital to home" OR "community nursing" OR "community health nursing" OR "primary care nursing" OR "primary healthcare nursing" OR "primary health care" OR "home care nursing" OR "home health care nursing" OR "home nursing" OR "home care" OR "domiciliary care" OR "district nursing" OR "community-based care" OR "community-based nursing" OR "community healthcare" OR "community health services" OR "local health services" OR "out-of-hospital care" OR "ambulatory care" OR "continuity of care"))) |
Web of Science |
May 26, 2026 |
375 results |
Table 1. Search strategy.
Inclusion and Exclusion Criteria
The review question was developed according to the JBI methodology for scoping reviews [9] using the Population, Concept and Context (PCC) framework, which guided the definition of review objectives and inclusion and exclusion criteria.
Population: Studies involving nurses who provide direct patient care in community, home care, and primary health care settings were included. Studies conducted on samples composed of students, other healthcare professionals or hospital staff were excluded.
Concept: This scoping review examined the relationship between the work setting and ITL. Regarding the organizational context, all studies investigating predictive or protective factors associated with ITL were included, without restriction to specific variables.
Context: This scoping review included studies investigating intention to leave in community, home care, and primary health care settings, excluding hospital-based or residential institutional care contexts. For the purpose of this review, setting classification was based primarily on the characteristics of the service and care delivery model described in the full text, rather than solely on the terminology used by the original authors, given the variability of definitions across healthcare systems. For classification purposes, home care referred to nursing care delivered primarily in patients’ homes; primary health care to nursing care delivered within first-contact, community-based primary care services; and community care to nursing services delivered outside hospital and residential institutional settings to individuals or populations within the community. Mixed-setting studies were considered eligible when the community, home care, or primary health care component was clearly identifiable. When setting-specific findings could not be separately extracted, these findings were not interpreted as direct evidence specific to out-of-hospital nursing. Studies conducted in long-term care facilities, nursing homes, residential aged-care settings, or other institutional care environments were excluded, as these settings are characterized by organizational structures, workforce models, and care processes that differ substantially from community-based nursing services. To enhance the applicability of findings to routine community nursing practice, studies conducted exclusively on working conditions during the acute COVID-19 emergency and whose findings were confined to the pandemic crisis context were excluded. Studies examining experiences across the pandemic and the subsequent transition or recovery period were considered eligible when they provided findings relevant to intention to leave or workforce retention beyond the acute emergency phase. Studies focused on highly specific rural or remote community contexts were also excluded, given the exceptional circumstances and contextual factors that may limit transferability to broader community care settings.
Evidence Sources and Selection
Primary and secondary studies were considered for inclusion, regardless of methodological design, provided they were published in English or Italian. Potential overlap between primary studies included directly in the review and primary studies represented within the included secondary evidence sources was assessed by cross-checking the studies included in each review against the primary studies included in the present scoping review. To ensure the inclusion of contemporary evidence relevant to current community nursing practice and workforce dynamics, only studies published between January 2016 and May 2026 were considered eligible. Studies involving populations other than nurses, editorials and articles published in languages other than English or Italian were excluded. In addition, backward and forward citation tracking (snowballing) was undertaken for all included studies to enhance the comprehensiveness of the search process and reduce the risk of missing relevant evidence. Records identified through citation tracking were screened independently by two reviewers and assessed against the same eligibility criteria applied to studies retrieved from electronic databases.
Study Selection
Results retrieved from database searches were uploaded to Rayyan [12], which enabled the removal of duplicates and the initial screening of titles and abstracts by two reviewers (EL and FM). Any disagreements were resolved through consultation with a third independent reviewer (ARM). Full-text eligibility assessment was subsequently conducted independently by the same two reviewers (EL and FM) against the predefined inclusion and exclusion criteria. Disagreements at this stage were resolved through discussion and, when necessary, consultation with the third reviewer (ARM). A complete list of reports excluded after full-text assessment, including reports identified through database searching and citation tracking, together with the primary reason for exclusion, is provided in Table 2 (Appendix, pp. 51–55). The screening process was subsequently reported using the PRISMA flow diagram [13].
Data Extraction
Data were extracted from the included studies in accordance with the JBI Manual [9]. A structured data extraction form was used, and the process was conducted independently by two reviewers, with discrepancies resolved through discussion with a third reviewer. Extracted data included author(s), year, aim, study design, setting, sample, factors associated with ITL, and key findings relevant to the review objective.
Data Synthesis
The extracted data were synthesized using a narrative approach and presented in tables, as recommended by the JBI Manual [9]. Thematic categories were developed through an iterative process of grouping and comparison of the extracted data. Factors associated with ITL were first examined for conceptual similarity and then compared across studies. Similar factors were iteratively grouped into broader thematic categories through discussion among the reviewers until consensus was reached. Data were finally aggregated and summarized within the identified thematic areas according to their conceptual similarity and relevance to the review objective.
RESULTS
By applying the previously described selection criteria, of the 3,766 articles initially identified through the database search, 1,236 duplicates retrieved from multiple sources were removed. Therefore, a total of 2,530 records remained. Blind screening of titles and abstracts led to the exclusion of 2,468 studies. Of the 62 articles that met the criteria based on title and abstract, a further 38 were excluded after full-text review because they did not meet the inclusion criteria and were not consistent with the review question (wrong outcome, 12; wrong population, 22; wrong publication type, 4). Twenty-four studies met the eligibility criteria following full-text assessment. An additional six studies were identified through citation tracking and met the eligibility criteria, resulting in a total of 30 studies included in the final synthesis (Figure 1, Appendix, p. 50).
Study Characteristics
Among the 30 articles included, 21 were primary studies and 9 were secondary evidence sources [14–22], including systematic, integrative, and qualitative reviews. No primary study included directly in the present review was also represented within the included secondary evidence sources. The publication period ranged from 2016 [14,23–26] to 2026 [15,27,28].
The geographical area most represented among the primary studies was the United States, with seven studies [23,24,28–32]. The remaining studies were conducted in Canada [25,26,33], United Kingdom [27,34], Australia [35], Brazil [36], China [37], Italy [38], Sweden [39], Japan [40], North Macedonia [41] and Portugal [42], while one study [43] was conducted across healthcare institutions in multiple European countries and included a community/home care subgroup. Most primary studies were conducted in community or primary health care settings [24,27,30–32,34,37], four studies were carried out in home care settings [26,36,38,40], while ten studies analyzed data from multiple care settings [23,25,28,29,33,35,39,41–43].
Regarding study design, most of the primary studies (sixteen studies) were cross-sectional surveys [23–28,30–32,36–42]. In addition, two qualitative research [33,34], a mixed-methods study was identified [35], a retrospective analysis [29] and one longitudinal study [43] were identified. The sample sizes ranged from 107 participants [35] to 1,625,288 participants [28]. The main characteristics of the included studies are reported in Table 3 (Appendix, pp. 56–62).
The main factors associated with higher ITL among community and home care nurses were low job satisfaction [18]; burnout, particularly emotional exhaustion [19,36]; excessive workload, demanding shifts, and operational or care-related difficulties [16,19,21,28,34,38]; unfavorable organizational contexts and inadequate management practices [16,19,21]; insufficient organizational and managerial support [16,34,35,37]; difficulties in collaboration, poor teamwork, and professional isolation [21,35]; moral distress and disillusionment with the profession [19,21,34]; low organizational commitment [18,42]. Conversely, the protective factors against ITL identified across the included studies were high job satisfaction [18]; organizational support, perceived fairness, and work engagement [16,37]; organizational commitment [18,42]; supportive leadership, mentoring, orientation, and structured preceptorship programs [14,24,34]; decision-making autonomy and opportunities for delegation [29]; a better work-life balance, positive work experiences, and the meaningfulness of relationships with patients and families [35]; and nurses’ participation in organizational processes, better scheduling management, and adequate employment benefits [23]. Based on the narrative synthesis and the iterative grouping process described in the Methods section, the factors associated with ITL were organized into two main thematic domains: Management Factors and Context Factors. These domains were used to organize and summarize the factors identified across the included studies according to their conceptual similarity.
Management Factors
Management-related factors were frequently reported across the included studies. Leadership [21], organizational support [14], professional empowerment, participation in organizational processes [21,29], professional development and career progression [14,16,34] and organizational commitment emerged as factors associated with ITL or retention [42]. Across the available evidence, supportive leadership, structured orientation, mentoring, preceptorship,teamwork, and perceived organizational support were associated with lower ITL, whereas inadequate management practices, limited support, poor recognition, and perceived unfairness were associated with higher ITL. In home care settings, opportunities for appropriate task delegation were also reported as a factor associated with lower ITL and turnover [29]. Job satisfaction was also reported as a relevant factor associated with ITL. The included studies linked job satisfaction to organizational support, professional autonomy, participation in organizational processes, perceived fairness, and the extent to which the nursing role was valued, and opportunities for professional growth and career development. Job satisfaction was associated with lower ITL or greater retention across the included evidence, while some studies also reported persistent operational challenges and missed care [16,18,23,37,38].
Context Factors
Regarding contextual factors, one of the most recurrent themes in the included studies was nurses’ workload, considered in both quantitative and qualitative terms. This construct referred not only to the number of tasks to be performed, but also to the complexity of care needs, the inadequacy of human and material resources, the presence of additional duties, role ambiguity, professional isolation, and the need to work in non-standardized home care environments such as patients’ homes [21,28,34,35,38]. Across the included studies, workload was described in relation to task volume, organizational constraints, care complexity, and resource inadequacy, and was associated with higher ITL [21,28,35,36,38]. Burnout, particularly emotional exhaustion, was reported as a factor associated with higher ITL [19,36] and with poorer perceived quality of care. Emotional strain, stress, excessive responsibility, and fear of failure were also described among the conditions contributing to nurses’ intention to leave [19,34]. Moral distress was reported in relation to ethical dilemmas, difficulties in interprofessional collaboration, unclear role boundaries, and the perception of being unable to provide care consistent with professional values, and was associated with higher ITL [19,21,35]. Overall, the included evidence described a range of management-related and contextual factors associated with ITL among community and home care nurses. The identified factors reflected organizational, professional, and contextual characteristics reported across the included studies.
DISCUSSION
The findings suggest that ITL among community and home care nurses arises from the interplay of organizational, contextual, and professional factors rather than from a single determinant. ITL tends to increase when care-related and organizational demands exceed available resources and to decrease when nurses perceive support, recognition, autonomy, and opportunities for professional development [18,19,21,36,37]. The findings are consistent with an interpretation based on the Job Demands-Resources (JD-R) model, according to which high job demands contribute to professional strain and increased ITL, whereas adequate professional and organizational resources exert a protective effect. Within this framework, workload, emotional demands, and moral distress can be interpreted as job demands, whereas organizational support, leadership, autonomy, and delegation opportunities may function as job resources. The imbalance between these dimensions appears to play a central role in shaping intention to leave [19,29].
Organizational and Management Factors
Retention in community services appears to be associated not only with the nature of the work, but also with the quality of the organizational environment [16,19,30]. Supportive leadership, mentoring, structured orientation pathways, participation in organizational processes, and the perception of being supported by the organization all emerge as factors associated with retention [14,24,34]. Similarly, Noguchi-Watanabe et al. found that regular opportunities for communication with nurse managers and colleagues were independently associated with home care nurses’ intention to remain [40]. These findings are further supported by Tourangeau et al. [26], who identified positive relationships with supervisors as an independent predictor of home care nurses’ intention to remain employed, and by Watts Isley et al. [32], who found that nurses intending to remain reported significantly higher perceptions of recognition, professional support, and mentoring within their organizations. The review by Halter showed that organizational interventions based on preceptorship, teamwork, and leadership oriented toward group cohesion are associated with reduced ITL and longer employment retention [14]. Similarly, Huang [37] found that organizational support and perceived fairness were associated with lower ITL through work engagement, while Callado [42] reported an association between greater organizational commitment and lower ITL. Consistent with these findings, Orava identified positive administration–nurse practitioner relationships and work–life balance as significant predictors of intention to remain in primary care [25]. This interpretation is further supported by Karlsson et al. [39] who found that poor leadership climate, limited collegial support, change fatigue, poor health, and working more than 40 hours per week were independently associated with high turnover intention and low job satisfaction among primary healthcare nurses. In addition, stronger structural capabilities within primary care practices were associated with lower burnout, higher job satisfaction, and lower intention to leave [31]. Job satisfaction also appears to function more as an intermediate outcome of the balance between demands and resources than as an isolated factor. Al Zamel [18] identified it as one of the main elements associated with either retention in community settings or ITL, whereas Ashley [35] linked positive experiences following transition to primary health care with greater autonomy, the meaningfulness of relationships with patients and families, and an improved work-life balance. Similarly, Tourangeau et al. [26] demonstrated that meaningfulness of work, work–life balance, income stability, and satisfaction with salary and benefits independently predicted nurses’ intention to remain in home care employment. Job satisfaction may be negatively affected by limited organizational and professional support, poorly structured orientation pathways, and the perception of losing competencies previously developed in acute care [24,34,35]. Charlie [23] reported that greater participation in organizational processes was associated with lower levels of burnout and job dissatisfaction. In contrast, among home care nurses, specific concerns persist about employment conditions, particularly work schedule organization and the limited adequacy of employment benefits [23,34].
Workload, Burnout, and Moral Distress
Workload was among the factors most frequently associated with ITL. Across the included studies, workload encompassed not only task volume but also care complexity, resource adequacy, role ambiguity, additional duties, and work in non-standardized environments such as patients’ homes [19,21,28,34,36,38]. Candon adds a particularly relevant element for the home care context, showing that greater opportunities to delegate tasks to support staff are associated with lower turnover. This finding suggests that task redistribution may represent a relevant component of workload management in home care settings [29]. Burnout, particularly emotional exhaustion, was also consistently associated with ITL. Lorenz [36] found that emotional exhaustion was associated with greater ITL and poorer perceived quality of care among family health nurses. Bahlman-van Ooijen [19] similarly identified stress, exhaustion, and excessive responsibility among nurses’ motivations for leaving the profession. Together, these findings support interpreting burnout as a potential consequence of a persistent imbalance between job demands and available professional and organizational resources [19,36,41]. Moral distress also emerged as a factor associated with ITL, particularly in relation to ethical dilemmas, high responsibility, unclear role boundaries, and the perceived inability to provide care consistent with professional values and patients’ needs [19,21]. These findings suggest that moral distress may reflect a mismatch between professional values and the conditions under which community nursing practice is carried out [19,21,35].
Setting-Specific Characteristics of Out-of-Hospital Nursing
A further theme concerns characteristics specific to community and home care settings. Ashley [35] described transition to primary health care as offering greater autonomy, improved work–life balance, and meaningful relationships with patients and families, while also involving limited support, challenging role transition, and perceived loss of acute-care competencies. McCreary [17] similarly identified autonomy, flexibility, and long-term relationships with patients as factors supporting retention in home health nursing. These characteristics are consistent with broader evidence describing community nursing as a distinct practice environment, where professional roles, organizational structures, and patterns of care differ substantially from hospital settings [15].Taken together, these findings suggest that professional autonomy may play a dual role in out-of-hospital nursing, acting as a valuable resource while potentially contributing to professional isolation when organizational support is insufficient. Tourangeau et al. [26] also identified continuity of patient care as an independent predictor of home care nurses’ intention to remain employed. Working in community and home care settings may also involve relative professional isolation and additional organizational demands [15,34]. Qualitative evidence also identified staffing shortages and professional isolation as challenges to retention in community services [33]. These findings support considering out-of-hospital nursing as a distinct organizational context when examining ITL and retention [34,35]. Overall, the evidence suggests that ITL reflects a dynamic interaction between management-related and contextual factors, in which organizational resources may buffer, but not fully offset, workload, isolation, emotional strain, and poor professional recognition. In this sense, the Job Demands-Resources model appears particularly useful not only for interpreting the findings of this review, but also for guiding future retention strategies and efforts to improve professional well-being. Recent meta-analytic evidence further supports this interpretation, showing that higher job embeddedness is consistently associated with lower turnover intention among nurses, particularly through organizational dimensions that strengthen employees’ attachment to their workplace [22].
Implications for Retention and Future Research
From a practical and managerial perspective, supportive leadership, structured orientation and mentoring programs, continuing professional development, and sustainable workload management may represent relevant areas for organizational attention in community and home care settings [14,20,24,27,29,34,37]. However, given the exploratory nature of this scoping review and the heterogeneity of the included evidence, these considerations should be interpreted as potential directions for organizational practice rather than evidence-based recommendations. Specific approaches identified across the included studies included strengthening team coordination, providing structured mentorship for newly recruited nurses, and promoting appropriate delegation practices within existing professional and regulatory frameworks [14,24,29,37]. These approaches warrant further evaluation in future primary studies before firm recommendations can be made.
CONCLUSION
This scoping review provides a structured synthesis of the factors associated with intention to leave among nurses working in community, home care, and primary health care settings, offering a context-specific perspective on an area that has received considerably less attention than hospital-based nursing. The available evidence suggests that ITL in out-of-hospital settings is associated with a combination of management-related and contextual factors while also highlighting characteristics that appear to be particularly relevant in these settings, including the dual role of professional autonomy, professional isolation, and delegation practices. Given the limited number and heterogeneity of the available studies, these findings should be interpreted as an exploratory mapping of the current evidence rather than as definitive evidence of causal relationships. Nevertheless, this review provides a context-specific framework for interpreting ITL in out-of-hospital nursing and may inform future research aimed at testing and refining these emerging patterns through more robust and context-sensitive study designs.
Limitations
This study has some limitations that should be considered when interpreting the findings. First, the search and selection process was limited to publications in Italian and English, with the potential risk of excluding relevant contributions published in other languages. This restriction may have introduced a language bias and limited the representativeness of the evidence, particularly in non-English-speaking contexts. Furthermore, the included studies were heterogeneous in terms of design, care settings, sample characteristics, and definitions of ITL. This heterogeneity may have limited the comparability of findings and influenced the narrative synthesis, which should therefore be interpreted with caution. In accordance with the scoping review methodology, no formal critical appraisal of the included evidence sources was undertaken. Consequently, the inclusion of individual findings should not be interpreted as an indication of their methodological quality, strength, or reliability. Furthermore, the exclusion of grey literature may have limited the comprehensiveness of the evidence mapping, particularly with regard to organizational reports, workforce documents, and policy-related evidence relevant to community and home care nursing. Consequently, the findings should be interpreted as a synthesis of the peer-reviewed scientific literature rather than as a comprehensive representation of all available evidence. Finally, although the Job Demands–Resources model provided a useful interpretative framework, it may not fully capture the complexity of ITL in community and home care settings, particularly with regard to contextual, cultural, and system-level factors.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Funding Statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.
Conflict of Interest
The authors report no conflict of interest.
Authors’ Contribution
E.L.: Writing – original draft, Writing – review & editing. F.M.: Supervision, Writing – review & editing. F.Z.: Supervision. F.S.: Writing – review & editing. A.R.M.: Conceptualization. All authors have read and agreed to the published version of the manuscript.
Data Availability Statement
No new data were generated or analyzed in this study. All data supporting the findings of this study are included in this article.
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Appendix: The figures and tables included in this section are provided as supplementary material to support the main text.
Figure 1. PRISMA Flow Diagram.
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Full bibliographic reference |
Identification source |
Primary reason for exclusion |
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De Simone S, Planta A, Cicotto G. The role of job satisfaction, work engagement, self-efficacy and agentic capacities on nurses’ turnover intention and patient satisfaction. Applied Nursing Research. 2018;39:130–140. https://doi.org/10.1016/j.apnr.2017.11.004. |
Citation tracking |
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Fasbender U, Van Der Heijden BIJM, Grimshaw S. Job satisfaction, job stress and nurses’ turnover intentions: The moderating roles of on-the-job and off-the-job embeddedness. Journal of Advanced Nursing. 2019;75(2):327–337. https://doi.org/10.1111/jan.13842. |
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Hariyati RTS, Nurdiana N. Retention Strategy to Minimize Nurse Turnover: A Systematic Review. International Journal of Nursing and Health Services. 2018;1(2):99–109. https://doi.org/10.35654/ijnhs.v1i2.47. |
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Hegedüs A, Schürch A, Bischofberger I. Implementing Buurtzorg-derived models in the home care setting: a Scoping Review. International Journal of Nursing Studies Advances. 2022;4:100061. https://doi.org/10.1016/j.ijnsa.2022.100061. |
Citation tracking |
Wrong population |
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Karakachian A, Colbert A. Nurses’ Moral Distress, Burnout, and Intentions to Leave: An Integrative Review. Journal of Forensic Nursing. 2019;15(3):133–142. https://doi.org/10.1097/JFN.0000000000000249. |
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Kox JHAM, Groenewoud JH, Bakker EJM, Bierma-Zeinstra SMA, Runhaar J, Miedema HS, Roelofs PDDM. Reasons why Dutch novice nurses leave nursing: A qualitative approach. Nurse Education in Practice. 2020;47:102848. https://doi.org/10.1016/j.nepr.2020.102848. |
Citation tracking |
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Lartey S, Cummings G, Profetto-McGrath J. Interventions that promote retention of experienced registered nurses in health care settings: a systematic review. Journal of Nursing Management. 2014;22(8):1027–1041. https://doi.org/10.1111/jonm.12105. |
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Wrong population |
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Mohammadi P, Gheiasi SF, Bayat R, Bulfone G, Amini K. Nurses’ Intention to Leave the Profession and Its Related Factors: A Cross-sectional Study. Evidence Based Care. 2023;12(4). https://doi.org/10.22038/ebcj.2022.67012.2756. |
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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: The Journal of Health Care Organization, Provision, and Financing. 2023;60:00469580231200602. https://doi.org/10.1177/00469580231200602. |
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Woodward KF, Willgerodt M. A systematic review of registered nurse turnover and retention in the United States. Nursing Outlook. 2022;70(4):664–678. https://doi.org/10.1016/j.outlook.2022.04.005. |
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Table 2. Reports excluded after full-text assessment and primary reason for exclusion
|
First Author |
Year |
Aims |
Design |
Context |
Sample |
Results |
Determinants of ITL/Retention |
|
Al Zamel [18] |
2020 |
To synthesize the evidence on factors influencing nurses’ intention to leave or remain in healthcare organizations. |
Integrative review |
Nursing organizations across healthcare settings |
Thirty-seven studies using heterogeneous designs and measurement instruments. |
Intention to leave or stay was associated with job satisfaction, organizational commitment, quality of work life, work environment, leadership style, workplace bullying, family reasons and job security. |
Job satisfaction; organizational commitment; quality of work life; work environment; leadership style; bullying; family reasons; job security |
|
Alkan [27] |
2026 |
To explore nurses’ and nursing associates’ experiences and perceptions of retention strategies implemented in district nursing services. |
Mixed-methods cross-sectional |
District nursing services, England |
345 nurses and nursing associates employed in district nursing services. |
Participants reported frequent exposure to strategies promoting safe working environments, flexible working arrangements, staff wellbeing and professional development. Retention was perceived to improve when workloads were manageable, organizational support was tailored to staff needs and financial assistance, including travel reimbursement, was provided. |
Safe work environment; flexible scheduling; staff wellbeing; professional development; manageable workload; involvement in decision-making; team cohesion; induction and mentoring; financial and travel support. |
|
Ashley [35] |
2018 |
To examine registered nurses’ experiences of transitioning from acute care to primary healthcare and their future career intentions. |
Mixed-methods |
Primary healthcare, Australia |
Registered nurses who had transitioned from acute care to primary healthcare employment. |
Most participants described the transition positively, highlighting improved work–life balance, greater role diversity and stronger relationships with patients and families. Challenges included insufficient orientation, perceived loss of acute care competencies and salary disparities, although the majority intended to remain in both primary healthcare and the nursing profession. |
Transition support; work–life balance; role diversity; patient and family relationships; orientation; remuneration; professional competence; intention to remain. |
|
Bagnasco [38] |
2023 |
To investigate working conditions, missed nursing care and intention to leave among home care nurses in Italy. |
Descriptive cross-sectional |
Home nursing care, Italy |
2,549 home care nurses and 4,709 patients from 45 local healthcare units across 18 Italian regions. |
Although nurses generally reported high job satisfaction and relatively low workplace criticality, missed nursing care remained common and approximately one-fifth expressed an intention to leave. Patients reported high levels of satisfaction with care, suggesting that workforce challenges coexist with positive patient experiences. |
Job satisfaction; workload; missed nursing care; workplace criticality; quality of care; organizational resources; intention to leave. |
|
Bahlman-van Ooijen [19] |
2023 |
To synthesize qualitative evidence on nurses’ motivations for leaving the nursing profession. |
Qualitative systematic review |
Nursing profession across healthcare settings |
Nine qualitative studies involving nurses who had considered or experienced leaving the profession. |
Four overarching themes explained nurses’ decisions to leave, including adverse work environments, emotional distress, disillusionment with professional expectations and experiences of hierarchy or discrimination. Poor managerial support, limited career opportunities, workplace stress and bullying consistently contributed to turnover decisions. |
Work environment; emotional distress; managerial support; career development; bullying; discrimination; work-related stress; professional disillusionment. |
|
Bass [20] |
2023 |
To identify organizational and individual factors associated with nurse burnout and retention in primary and ambulatory care settings. |
Narrative literature review |
Primary care and ambulatory/specialty care offices |
Nine studies identified through CINAHL and PubMed. |
Four major domains influencing burnout and retention emerged, including personal characteristics, organizational factors, leadership and team relationships, and ethical considerations. The review emphasized the central role of nursing leadership in improving work environments and supporting workforce retention. |
Burnout; personal characteristics; organizational factors; leadership; team relationships; ethical climate; retention strategies. |
|
Callado [42] |
2023 |
To assess turnover intention and organizational commitment among primary healthcare nurses. |
Cross-sectional |
Primary healthcare, Portugal |
297 primary healthcare nurses. |
Most nurses intended to remain in their current workplace and reported high levels of organizational commitment. Stronger organizational commitment was significantly associated with lower turnover intention, highlighting commitment as an important protective factor for workforce retention. |
Organizational commitment; job attachment; intention to remain; turnover intention; workforce retention. |
|
Candon [29] |
2023 |
To examine the association between delegation policies and nurse turnover in home healthcare services. |
Retrospective cross-sectional |
Home healthcare, United States |
1,820 licensed practical nurses and 3,309 registered nurses working across 30 states between 2016 and 2018. |
Turnover rates differed between licensed practical nurses and registered nurses. Greater authority to delegate selected clinical tasks to unlicensed aides was associated with lower turnover among licensed practical nurses, suggesting that delegation may reduce workload-related turnover in home healthcare settings. |
Task delegation; scope of practice; workload; professional autonomy; unlicensed assistive personnel; turnover; home healthcare. |
|
Chamanga [16] |
2020 |
To identify factors influencing the recruitment and retention of registered nurses working in adult community nursing services. |
Integrative review |
Adult community nursing |
Ten studies included in the review. |
Retention was primarily influenced by work pressure, working conditions and the degree of managerial recognition and appreciation. Evidence regarding recruitment factors was limited, indicating the need for further research in community nursing workforce planning. |
Work pressure; working conditions; managerial appreciation; recruitment; retention; community nursing workforce. |
|
Chamanga [34] |
2025 |
To explore factors influencing recruitment and retention among adult community nurses. |
Qualitative |
Adult community nursing services |
Registered nurses and service managers employed in adult community nursing organizations. |
Eight interconnected themes shaped recruitment and retention, including professional fulfilment, organizational values, career development opportunities, workplace flexibility and compassionate leadership. Conversely, staffing shortages, administrative burden, limited career progression and family responsibilities negatively influenced retention. |
Workplace flexibility; professional identity; organizational values; compassionate leadership; staffing shortages; administrative burden; career development; family responsibilities. |
|
Charlie [23] |
2017 |
To compare job outcomes among public health, school and home health nurses and identify modifiable work environment factors associated with burnout, job dissatisfaction and intention to leave. |
Secondary cross-sectional |
Public health, school nursing and home health nursing, United States |
529 public health nurses, 1,208 school nurses and 3,079 home health nurses from the RN4CAST-US study. |
More favorable work environments were consistently associated with lower burnout, greater job satisfaction and reduced intention to leave across all settings. Home health nurses experienced the highest levels of burnout and turnover intention, whereas public health nurses reported dissatisfaction with salary, career advancement and professional autonomy. |
Work environment; salary; career advancement; professional autonomy; burnout; job dissatisfaction; intention to leave. |
|
Drennan [15] |
2026 |
To examine workforce challenges affecting recruitment and retention in district and community nursing services. |
Scoping review |
District and community nursing, United Kingdom |
Evidence derived from published literature and workforce reports on district and community nursing services. |
The review highlighted persistent workforce shortages, an ageing nursing workforce and increasing service demands. Sustainable retention depended on clear professional roles, educational opportunities, career pathways, supportive service models and organizational investment. |
Workforce planning; role clarity; education; career pathways; service models; organizational support; retention. |
|
Faraz [24] |
2017 |
To investigate factors influencing novice nurse practitioners’ transition to primary care and turnover intention during the first year of practice. |
Cross-sectional |
Primary care, United States |
177 novice nurse practitioners employed in primary care for 3–12 months. |
Professional autonomy emerged as one of the strongest predictors of lower turnover intention during the transition period. Adequate organizational support and structured transition programs facilitated successful role adaptation and promoted workforce retention. |
Professional autonomy; transition support; organizational support; role adaptation; job satisfaction; turnover intention. |
|
Halter [14] |
2017 |
To synthesize evidence from systematic reviews on interventions designed to reduce nurse turnover in adult healthcare services. |
Overview of reviews |
Adult healthcare services in developed economies |
Seven systematic reviews evaluating turnover and retention interventions. |
Evidence supporting retention interventions was generally limited and of moderate methodological quality. Preceptorship programs for newly qualified nurses and leadership interventions promoting team cohesion demonstrated the most consistent benefits for improving retention and reducing turnover. |
Preceptorship; leadership; team cohesion; transition support; retention interventions; turnover reduction. |
|
Huang [37] |
2019 |
To examine the relationships among organizational justice, organizational support, work engagement and turnover intention among community nurses. |
Cross-sectional |
Community nursing, China |
410 community nurses. |
Organizational support directly reduced turnover intention and indirectly influenced it through increased work engagement. Organizational justice improved turnover outcomes by strengthening perceived organizational support, highlighting the importance of supportive organizational climates. |
Organizational justice; organizational support; work engagement; turnover intention; community nursing. |
|
Karlsson [39] |
2024 |
To explore working conditions associated with turnover intention and job dissatisfaction among primary healthcare nurses. |
Cross-sectional |
Primary healthcare, Sweden |
466 registered nurses working in Swedish primary healthcare. |
Approximately one-fifth of participants reported job dissatisfaction and had considered leaving their position. Poor leadership, limited colleague support, change fatigue, poor health status and long working hours were independently associated with higher turnover intention. |
Leadership climate; colleague support; change fatigue; working hours; health status; job satisfaction; turnover intention. |
|
Lessi [21] |
2025 |
To synthesize qualitative evidence on nurses’ experiences of leaving healthcare organizations or the nursing profession. |
Qualitative systematic review |
Healthcare organizations and nursing profession |
Twelve qualitative studies synthesizing 282 qualitative findings. |
Poor management emerged as the most consistent reason underlying nurses’ decisions to resign. Excessive workload, inadequate teamwork, work–life imbalance, limited career opportunities, salary dissatisfaction, bullying and moral distress further contributed to leaving both organizations and the profession. |
Management quality; workload; teamwork; work–life balance; career opportunities; salary; bullying; moral distress; resignation. |
|
Lorenz [36] |
2018 |
To investigate family health nurses’ perceived quality of care, professional exhaustion and intention to leave their current job or the nursing profession. |
Cross-sectional |
Family health nursing, Brazil |
198 family health nurses. |
Although nurses generally perceived the quality of care as good, emotional exhaustion was common and significantly associated with poorer care quality and greater intention to leave both their current position and the nursing profession. |
Burnout; emotional exhaustion; perceived quality of care; intention to leave; organizational resources. |
|
McCreary [17] |
2020 |
To review factors influencing job satisfaction and retention among home health nurses in response to increasing demand for home care services. |
Narrative review |
Home health nursing, United States |
Narrative synthesis of literature addressing home health nursing workforce issues. |
Job satisfaction was identified as a key determinant of nurse retention. Positive relationships with patients, professional autonomy, flexible work arrangements and supportive colleagues promoted retention, whereas workload, documentation burden, uncompensated working time and inadequate salary contributed to turnover. |
Job satisfaction; patient relationships; professional autonomy; work flexibility; peer support; workload; documentation burden; salary; retention. |
|
Nizzer [33] |
2024 |
To explore how the COVID-19 pandemic influenced the working experiences, motivations and attitudes of home and community care nurses. |
Qualitative |
Home and community care, Canada |
Sixteen home and community care nurses working in the Greater Toronto Area. |
Participants described staffing shortages, increased workload and inconsistent organizational support as major challenges during the pandemic. Professional commitment remained strong for some nurses, whereas others developed intentions to leave, highlighting preparedness, improved wages and supportive workplaces as key retention strategies. |
Staffing resources; workload; workplace flexibility; isolation; organizational support; wages; pandemic preparedness; professional commitment; intention to leave. |
|
Noguchi-Watanabe [40] |
2021 |
To examine factors associated with home-care nurses’ job satisfaction and intention to remain in their workplace. |
Cross-sectional |
Home care nursing, Japan |
Home-care nurses employed in home-visit nursing agencies. |
Supportive work environments, effective supervision and opportunities for professional development were associated with higher job satisfaction and stronger intention to remain. Collaboration and manageable workloads contributed positively to workforce retention. |
Job satisfaction; intention to remain; supervisory support; collaboration; workload; professional development; home care. |
|
Orava [25] |
2017 |
To investigate factors influencing nurse practitioner retention in primary healthcare. |
Cross-sectional |
Primary healthcare, Ontario, Canada |
273 primary healthcare nurse practitioners. |
Positive relationships with administrators, satisfactory work–life balance and supportive organizational characteristics significantly increased nurses’ intention to remain employed in primary healthcare. |
Administration–NP relationships; work–life balance; family situation; organizational characteristics; intention to remain; retention. |
|
Poghosyan [30] |
2020 |
To investigate the association between organizational support and primary care nurse practitioner outcomes. |
Cross-sectional |
Primary care, United States |
398 primary care nurse practitioners. |
Higher organizational support was associated with greater job satisfaction, lower intention to leave and better perceived quality of care. Organizational support emerged as a key resource promoting workforce stability. |
Organizational support; job satisfaction; organizational resources; intention to leave; quality of care. |
|
Samson [28] |
2026 |
To compare turnover rates and predictors among home health and hospital registered nurses. |
Secondary cross-sectional |
Home health and hospital nursing, United States |
National Sample Survey of Registered Nurses including more than 5 million registered nurses across survey years. |
Turnover rates were comparable across settings. Longer professional experience generally protected against turnover, whereas working more than 40 hours per week increased turnover among home health nurses. |
Career tenure; work setting; weekly working hours; schedule stability; home health turnover; retention. |
|
Schlak [31] |
2023 |
To examine the association between structural practice capabilities and nurse practitioner job outcomes. |
Secondary cross-sectional |
Primary care practices, United States |
1,110 nurse practitioners from 1,002 primary care practices. |
Practices with stronger structural capabilities reported lower burnout, lower job dissatisfaction and lower intention to leave. Organizational infrastructure supported workforce participation and retention. |
Structural capabilities; organizational resources; burnout; job dissatisfaction; intention to leave; practice support. |
|
Stefanovska – Petkovska [41] |
2021 |
To investigate psychological distress, burnout, job satisfaction and intention to quit among primary healthcare nurses. |
Cross-sectional |
Primary healthcare, North Macedonia |
173 primary healthcare nurses. |
Higher burnout and psychological distress together with lower job satisfaction were associated with greater intention to leave the profession. Mental wellbeing represented an important determinant of retention. |
Psychological distress; burnout; job satisfaction; mental health; intention to quit. |
|
Tourangeau [26] |
2017 |
To develop and test a model of work-related factors associated with home-care nurses’ intention to remain employed. |
Cross-sectional |
Home care, Ontario, Canada |
Home-care nurses employed by a large home-care organization. |
Meaningful work, continuity of care, supportive supervision, work–life balance and stable income significantly increased nurses’ intention to remain employed over time. |
Meaningful work; continuity of care; supervisor relationships; work–life balance; income stability; salary and benefits; intention to remain. |
|
Van der Heijden [43] |
2018 |
To examine whether job demands, job resources and professional experience predict occupational turnover intention and actual turnover. |
Longitudinal |
Mixed healthcare settings (hospitals, nursing homes, and community/home care) across six European countries |
753 nurses employed in European healthcare institutions. |
In the overall mixed-setting sample, higher job demands were associated with greater occupational turnover intention, whereas job resources and professional experience were associated with lower occupational turnover intention. Professional experience was also negatively associated with actual occupational turnover. |
Job demands; emotional demands; work–home interference; job resources; professional experience; development opportunities; occupational turnover. |
|
Wang [22] |
2024 |
To synthesize evidence on the relationship between job embeddedness and nurses’ turnover intention. |
Systematic review and meta-analysis |
Nursing workforce across healthcare settings |
Forty-seven studies including 15,742 nurses from seven countries. |
Job embeddedness demonstrated a moderate negative association with turnover intention, with on-the-job embeddedness showing the strongest protective effect. Stronger organizational attachment promoted workforce retention. |
Job embeddedness; on-the-job embeddedness; fit; links; sacrifice; education; career experience; turnover intention. |
|
Watts Isley [32] |
2022 |
To assess public health nurses’ perceptions of work environment, stress, job satisfaction and intention to remain. |
Cross-sectional |
Public health nursing, North Carolina, United States |
672 non-supervisory public health nurses. |
Despite generally high job satisfaction, many nurses perceived retention problems and considered leaving within three years. Poor work environments and higher stress levels were consistently associated with lower intention to remain. |
Work environment; job satisfaction; occupational stress; intention to remain; salary; retention. |
Table 3. Characteristics of included studies.