Development and Validation of a Nurse Turnover Intention Questionnaire
This 2024 mixed-methods study developed and validated a 40-item questionnaire with four distinct dimensions (individual, job-related, organizational, and extra-organizational) that demonstrates strong reliability and validity for assessing the factors influencing nurses' turnover intention to support evidence-based retention strategies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the complex machinery of a hospital, the most vital component is not the latest scanner or the most advanced medication, but the people who operate them. Among these workers, nurses form the largest group, serving as the constant presence at the bedside, managing treatment, and ensuring patient safety. Yet, this essential workforce faces a persistent and costly problem: many leave their jobs. When a nurse decides to quit, it is rarely a sudden impulse but rather the result of a slow accumulation of pressures. Researchers have long known that the desire to leave, known as turnover intention, is a powerful warning sign that a departure is coming. This desire is shaped by a mix of personal circumstances, the daily grind of the job, the culture of the hospital, and even the broader economic and social environment outside the hospital walls. Understanding exactly which of these forces pushes a nurse toward the exit is crucial for health systems trying to keep their teams intact, but existing tools to measure these pressures have often been too narrow, focusing on just one or two factors while missing the bigger picture.
To address this gap, a team of researchers at Tehran University of Medical Sciences set out to build a new, comprehensive tool to map the full landscape of why nurses want to leave. They began by casting a wide net, reviewing twenty-three previous studies and conducting in-depth conversations with fifty-four nurses who had already walked away from their positions. These interviews revealed a rich tapestry of reasons, from the stress of long shifts and unclear job roles to the feeling of being undervalued by management or the strain of economic inflation in the wider country. By combining these insights with existing literature, the team identified one hundred and thirty-one potential factors. They then worked to distill this massive list into a structured questionnaire, a process that required rigorous testing to ensure every question was clear, relevant, and measurable. After consulting with a panel of twelve experts to validate the content, they refined the list down to forty specific questions, organized into four distinct categories: individual factors like age and family responsibilities; job-related factors like workload and safety risks; organizational factors like leadership and salary; and extra-organizational factors like national policies and societal attitudes.
The researchers then put this new questionnaire to the test with a large group of seven hundred and sixty-three nurses working in twelve different hospitals in Tehran. The results confirmed that the tool worked well, showing strong consistency and a clear structure that could separate the different types of pressures nurses face. When the team analyzed the data, they found that the forty-item questionnaire successfully explained nearly seventy percent of the variation in why nurses wanted to leave. The analysis revealed that while personal issues and outside economic conditions played a role, the most significant drivers were found within the workplace itself. Job-related factors, such as heavy workloads and long hours, received the highest average scores, indicating that the daily demands of the job were the most immediate source of dissatisfaction. However, the organizational dimension, which included how managers treated staff and the overall hospital climate, accounted for the largest share of the explanation, suggesting that the way a hospital is run is the single most powerful force shaping a nurse's decision to stay or go.
This study does not claim to have solved the problem of nurse retention, nor does it offer a simple fix. Instead, it provides a precise map of the terrain. The researchers found that previous tools often looked at only a slice of the problem, such as just salary or just leadership, but this new instrument captures the entire ecosystem of factors that influence a nurse's mind. The data showed that nurses are most likely to consider leaving when they feel overwhelmed by their tasks, unsupported by their leaders, and disconnected from the broader community that values their work. The study also highlighted that while individual factors matter, they are less dominant than the structural issues within the hospital and the job itself. By offering a reliable way to measure these specific pressures, the new questionnaire gives hospital administrators and policymakers a practical way to identify exactly where the cracks are forming in their workforce. It allows them to move beyond guessing and instead target their efforts on the specific areas—whether it is improving shift schedules, training managers to be more supportive, or addressing resource shortages—that will actually help keep nurses at their posts.
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