Turnover Intention and Its Relationship With Work-Related Factors Among Nurses in Spain: A Cross-Sectional Study.

Abstract

Background: Nurse turnover intention is a multifactorial construct shaped by individual, occupational, organizational, and policy-level factors. Although widely studied in some regions, evidence from Southern Europe, particularly Spain, remains scarce. Understanding these factors in diverse healthcare contexts is essential for designing effective retention strategies that are both locally relevant and internationally informative. Objective: This study aims to explore turnover intention prevalence and associated factors among nurses across different care settings in Spain. Design: A cross-sectional study. Settings: Primary care, hospitals, emergency services, or social healthcare settings. Participants: A total of 20,316 actively employed nurses. Methods: An online survey was disseminated by the Spanish Ministry of Health and other institutional channels. Turnover intention was the primary outcome and was measured with a single item asking whether nurses intended to leave the profession within the next 10 years (yes/no). Work-related variables and perceptions of care quality and patient safety were also collected. Multivariable logistic regression was used to identify key predictors across care settings. Results: Of the 20,316 participants, most were women (84.8%) and 50.3% were under 35 years. Overall, 39.58% reported an intention to leave the nursing profession within 10 years. Turnover intention was significantly associated with perceptions of care quality (OR = 1.706, p < 0.001) and patient safety (OR = 1.809, p < 0.001), regional disparities, and temporary employment contracts (OR = 1.333, p < 0.001). In primary care, working as a generalist and on afternoon shifts increased turnover risk, while in hospitals, long shifts (> 7.5 h) were influential. Conclusions: This study provides novel insights into nurse turnover intention in Spain, highlighting the interplay of modifiable institutional factors and regional disparities in a decentralized health system. Turnover intention was strongly associated with organizational conditions, reinforcing the urgent need for tailored, context-sensitive retention strategies. Standardizing definitions, measurements, and temporal frameworks remains critical for advancing comparative research and developing effective, evidence-based interventions to strengthen the nursing workforce.