Unraveling the Impact of Workload on Nurses’ Turnover Intention in Hospital Settings: Scoping Review
This scoping review synthesizes evidence from 14 studies to demonstrate that excessive nursing workload significantly drives turnover intention primarily through burnout and stress, a relationship that can be mitigated by organizational resources like supportive leadership and schedule control rather than financial compensation alone.
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
The Big Picture: The "Tired Nurse" Problem
Imagine a hospital as a giant, high-speed train. The nurses are the engine crew keeping the train moving safely. But lately, the train is running on a schedule that is too fast, the tracks are too crowded, and the crew is running on empty.
This paper is a scoping review, which is like a librarian gathering all the recent books (14 specific studies from 2020–2025) on a specific topic to see what the whole story is. The topic is: Does having too much work make nurses want to quit?
The Main Finding: The "Heavy Backpack" Effect
The answer is a resounding yes.
Out of the 14 studies looked at, 13 confirmed that when nurses carry a "backpack" that is too heavy (excessive workload), they start thinking about leaving the train station (turnover intention).
- The Backpack: This isn't just about the number of patients. It includes the speed of work, the emotional stress of caring for sick people, the mental math of coordinating care, and the physical exhaustion of working overtime.
- The Result: When the backpack gets too heavy, the nurses don't just get tired; they get burned out. They feel emotionally drained (like a battery that won't recharge) and detached from their job. This feeling is the direct bridge that leads them to start looking for a new job.
How It Works: The "Domino Chain"
The paper explains that the heavy backpack doesn't just make you quit instantly. It triggers a chain reaction, like knocking over a line of dominoes:
- The Load: The nurse faces high demands (too many patients, not enough time).
- The Crack: This load breaks their emotional energy. They feel exhausted and stressed.
- The Shift: Because they are so drained, they stop enjoying their job and feel less connected to their hospital.
- The Exit: Finally, they decide to leave.
The paper calls this the "Health Impairment Pathway." Think of it like a car engine overheating. If you keep pushing the gas (workload) without stopping to cool down, the engine (the nurse's mental health) overheats, and the car breaks down (the nurse quits).
The Good News: The "Umbrella" and the "Life Jacket"
Here is the most important part of the paper: It's not inevitable.
Just because the rain is pouring down (high workload) doesn't mean the nurse has to get soaked and quit. The studies found that certain things act as an umbrella or a life jacket to protect them.
- Supportive Leaders: If the boss (head nurse or manager) is kind, listens, and helps out, it acts like a shield.
- Team Hugs: Having coworkers who support each other helps carry the load.
- Control: If nurses feel they have some say in their own schedule (like choosing when to take a break), it makes the heavy backpack feel lighter.
The Money Myth: "Just Pay Us More"
One of the paper's most interesting discoveries is about money.
Many people think, "If we just pay nurses more, they won't quit." The paper says: Not necessarily.
Think of salary like the floor of a house. If the floor is rotten (low pay), people will leave. But if you just fix the floor without fixing the leaking roof (bad work environment, no support, too much stress), people will still leave because the house is falling apart.
The research found that money alone cannot stop the "turnover cascade" if the work environment is toxic. You need to fix the roof (supportive leadership and manageable workloads) and the floor.
What the Researchers Didn't Do (The Limits)
The paper is careful to say what it didn't find:
- It didn't prove that one specific nurse quit because of one specific thing, because most of the studies were just snapshots in time (like a photo) rather than a movie (tracking them over years).
- It didn't test a new "cure" or a specific training program yet; it just mapped out what we already know.
- It noted that "workload" is measured in many different ways (some count patients, some ask how stressed the nurse feels), which makes comparing the studies a bit tricky.
The Bottom Line
The paper concludes that hospitals cannot just ask nurses to "toughen up" or "be more resilient." If the workload is too heavy, even the strongest nurse will eventually pack their bags.
To keep nurses, hospital leaders need to stop treating retention as a simple math problem (more money = happy nurses). Instead, they need to build a healthy ecosystem where leaders are supportive, teams stick together, and nurses have some control over their time. It's about changing the environment, not just the paycheck.
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