title: Nurses' intention to leave their profession: a cross sectional observational study in 10 European countries.
abstract: BACKGROUND
  As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market exists or is predicted for most European countries. There are no adequate solutions for this shortage yet, and recruitment of future nurses is difficult. Therefore, retaining nurses for the profession is urgent.
  
  
  OBJECTIVE
  To determine factors associated with nurses' intention to leave the profession across European countries.
  
  
  METHODS
  A multi-country, multi-centre, cross-sectional analysis of survey data.
  
  
  METHODS
  2025 surgical and medical units from 385 hospitals in ten European countries that participated in the RN4Cast study. Hospital selection was based on a stratified randomised selection procedure.
  
  
  METHODS
  All nurses from the participating medical and surgical hospital wards received a survey. 23,159 nurses (64%) returned the survey.
  
  
  METHODS
  The nurse survey included questions about intention to leave the profession, nurse characteristics, factors related to work environment, patient-to-nurse staffing ratio, burnout and perceived quality and safety of care. Multilevel regression analyses with 'intention to leave the profession' as dependent variable were conducted for all 10 countries combined as well as per country.
  
  
  RESULTS
  Overall, 9% of the nurses intended to leave their profession. This varied from 5 to 17% between countries. Seven factors were associated with intention to leave the profession at European level: nurse-physician relationship (OR 0.86; 95%CI 0.79-0.93), leadership (OR 0.78; 95% CI 0.70-0.86), participation in hospital affairs (0.68; 95%CI 0.61-0.76), older age (OR 1.13; 95%CI 1.07-1.20), female gender (OR 0.67; 95%CI 0.55-0.80), working fulltime (OR 0.76; 95%CI 0.66-0.86) and burnout (OR 2.02; 95%CI 1.91-2.14). The relevance of these factors differed for the individual countries. Nurse perceived staffing adequacy, patient-to-nurse staffing ratio, perceived quality and safety of care and hospital size were not associated with intention to leave at a European level.
  
  
  CONCLUSIONS
  Burnout is consistently associated with nurses' intention to leave their profession across the 10 European countries. Elements of work environment are associated with intention to leave the nursing profession but differ between countries, indicating the importance of national contexts in explaining and preventing nurses' intention to leave their profession.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.heinen@iq.umcn.nl
authors.forename: Maud M
authors.initials: MM
authors.lastname: Heinen
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.forename: René
authors.initials: R
authors.lastname: Schwendimann
authors.forename: Britta
authors.initials: B
authors.lastname: Zander
authors.forename: Anne
authors.initials: A
authors.lastname: Matthews
authors.forename: Maria
authors.initials: M
authors.lastname: Kózka
authors.forename: Anneli
authors.initials: A
authors.lastname: Ensio
authors.forename: Ingeborg Strømseng
authors.initials: IS
authors.lastname: Sjetne
authors.forename: Teresa
authors.initials: T
authors.lastname: Moreno Casbas
authors.forename: Jane
authors.initials: J
authors.lastname: Ball
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
mesh_terms: D002321:Career Choice; D003430:Cross-Sectional Studies; D005060:Europe; D009740:Nursing Staff / Q000523:psychology*