The persistent attrition of nurses from the profession is a significant challenge for both healthcare policymakers and administrative bodies within numerous low-income countries. In Ethiopia, various cross-sectional studies have been conducted regarding nurses’ intention to stay in the nursing profession; however, the results have demonstrated inconsistency. Hence, this study aims to pool the level of nurses’ intention to persist in the nursing profession.
Methods
In our systematic review and meta-analysis, targeted findings were searched from a variety of electronic databases; including Pub Med, Google Scholar, African Journal Online, the Cochran Library, and Science Direct. To determine the pooled prevalence and associated factors of intent to stay in nursing profession among nurse in Ethiopia, all the necessary data was extracted by using a standardized data extraction format. We analyzed the data by using Stata 17 statistical software. Heterogeneity between the primary studies was assessed by I-square tests. A random-effect model was applied to estimate the pooled intention of nurses to continue within the nursing profession.
Result
We included a total of 12 full-text studies in our analysis. The findings of this meta-analysis revealed that the pooled prevalence of nurses' intention to stay in nursing profession among Ethiopian nurses was 45.57% (95% CI; 38.43, 52.72). The subgroup analysis data revealed that the highest pooled prevalence of intention to stay was reported in the Tigray region which is 56.1% (95% CI 52.24, 59.96). In contrast the lowest prevalence was documented in Addis Ababa city administration which was 19.4% (95% CI 15.56, 23.24). Factors such as job satisfaction (OR = 2.69, 95% CI = 1.11 – 6.53), professional development (OR = 2.49, 95%CI = 1.27- 4.9), level of education (OR = 2.7, 95% CI = 1.92–3.8), payment and benefit (OR = 1.9, 95%CI = 1.15- 3.19) all were the significant determinants of nurses’ intention to continue in the nursing profession.
Conclusion
The results of our investigation suggested that the degree of intention to continue in the nursing profession among Ethiopian nurses was inadequate. The nurses' intention to depart from the nursing profession is an alarming. Therefore, it’s imperative for healthcare policymakers and stakeholders to prioritize on retention strategies encompassing job satisfaction, recognition, incentives, career opportunities, professional support, and autonomy were necessary.
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Abkürzungen
AJOL
African Journals Online
CDC
Communicable Disease Control
ITS
Intent to Stay
PICO
Population Intervention Comparison Outcome
PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
WHO
World Health Organization
Introduction
Intent to stay (ITS) in nursing profession is defined as “the nurses decision to continue in the nursing field until retirement” [38]. Conversely, nurse turnover refers to a withdrawal process of leaving their working unit and healthcare institutions. Evidence in the literature revealed that nurses shortage is defined as not solely by a shortage of qualified professionals but also the failure of experienced nurses to sustain in the nursing profession until retirement [11]. The future of professional nursing is jeopardized by the current and impending shortage of experienced nursing personnel [3].
According to the World Health Organization (WHO), there exists a deficit of approximately 7.2 million healthcare professionals with regard to health needs, and furthermore the findings from the third global forum on human resources for health project that by 2035, the nursing deficit will escalate to 12.9 million [36, 39]. In addition, the WHO report predicts that within a decade, nearly 40% of nurses will exit their profession [36]. The global nursing shortage negatively affects the quality of healthcare and prolongs patient waiting time; however, this deficit can be mitigated by retaining nurses in profession until their retirement age [37]. According to Aiken the insufficient availability of experienced and sufficiently qualified nursing professionals significantly undermines the quality of nursing care, thereby exerting adverse impact on health care delivery system [2]. A number of nurses were quitting their profession to continue career in another profession in similar related fields or other fields; study done in United States University of Mississippi medical center reported that many of newly licensed nurses exit the profession with in four years post-graduation [9].
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The failure to address the experienced nursing shortage at any level within the healthcare delivery system will lead to the deterioration of the quality of healthcare service [21]. Presently, numerous factors are contributing to an increased demand for nurses professionals, including the prevalence of complex diseases, new infectious diseases, road traffic injuries and remerging once, the aging population, globalization, and substantial public trust placed in the nurse professionals [18]. According to Buchan the main causes of experienced nursing shortage are retention and return policies, ineffective use of the available nursing resource through inappropriate skill mix, poor incentive structure, low professional opportunity, unpaid overtime, work load, poor nurses physician communication, persistence of violence against nurses and inadequate career support often taking the lion share of causes [11].
Nurses comprise the lion’s share proportion of healthcare professionals, with almost 60% covered by the nursing workforce. Intention to leave among experienced and qualified nurses highly degrades the continuity of quality improvement activities in healthcare setup through the loss of accumulated expertise and experience. Furthermore, it costs in human resource management related to selection and training [19].
The prevalence of ITS in the nursing profession varies from study to study and is influenced by various factors such as job satisfaction, level of health institution, socio-demographic characteristics of nurse, organizational commitment, burnout, job distress, communication, professional commitment, organizational support, job autonomy, prevalence of emerging infectious disease, nurse-patient ratio, job security, health care policy, moral value, and level of income [1, 13, 20, 31, 29, 33]. Related to job satisfaction study correlates with a greater intent to stay. Those nurses who reported good satisfaction levels were more likely to remain in their profession [15, 25, 27]. Presence of managerial support and professional Commitment factors such as level of education, age, and work experience significantly influenced intent to remain [33, 35].
In Thailand and South Korea the prevalence of ITS in nursing profession among nurses was 61.3%, and 32.8% respectively [19, 33]. In Ethiopia, a high portion of nurses (61.3%) expressed an intention to leave the nursing profession, which highlights major concerns about healthcare service delivery [35]. Another correlational descriptive study conducted in Thailand among 390 nurses to assess the level of intention to leave nursing profession revealed that around 55.67% have intention to leave within a year period [34].
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Numerous nurses are changing their profession while some of them pursue careers in another profession and others are quitting their profession altogether. This result a lack of experienced nurse resources required to give adequate nursing care. Several previous researches conducted including a systematic review and meta-analysis were focused on turnover intention; but there is a paucity of data on the pooled prevalence and associated factors on intention to stay in the nursing profession. In this current study, we performed a systematic review and meta-analysis to examine the pooled prevalence and associated factors of intention to remain in the nursing profession among nurse in Ethiopia.
Methods
Protocol and registration
The review was registered in PROSPERO (International Prospective Register of Systematic Reviews), the University Of York Center for Reviews and Dissemination with a registration number CRD42024607264.
Study design and reporting
A systematic review and meta-analysis of observational studies was conducted on prevalence of intention to stay in the nursing profession and associated factors among nurses in Ethiopia. All studies on the prevalence of intention to stay in the nursing profession and associated factors among nurses in Ethiopia published up to October 30, 2024, were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines [28] (Supplementary file 1).
Search methods for screening of studies
We conducted a systematic and comprehensive search of the electronic databases of Science Direct, Cochrane Library, Medline, Center for Evidence-Based Medicine, African Journals Online (AJOL), Excerpta Medical Database, Global Health Library, Scopus, and Google Scholar to identify all relevant observational studies on the prevalence of ITS in the nursing profession and associated factors among nurses in Ethiopia up to October 30, 2024. The articles were downloaded, arranged, and referenced using the EndNote referencing manager version 20. To find more potentially relevant studies, a manual search was conducted using the reference lists of the retrieved articles. The investigation was restricted to works disseminated in the English language. The search was carried out using the following keywords: ‘prevalence’, ‘proportion’, (‘intent to stay, OR intention to leave) and (nurses or healthcare professionals) and (associated factors OR determinant factors OR predictors OR risk factors) AND (epidemiology OR prevalence OR proportion) AND (Ethiopia)). The search terminologies were used independently and in combination using ‘OR’ or ‘AND’. More details about the search strategies are provided in Supplementary file 2.
We considered studies that examined the prevalence of intention to stay in the nursing profession and associated factors among nurses in Ethiopia were relevant. Our imposed search limits restricted studies that were observational, published in the English, and involved healthcare professionals. The PubMed search engine with MeSH (Medical Subject Headings) and Boolean, databases were searched.
Eligibility criteria
Studies were included if they met the following requirements: i) study period: studies conducted or published until October 30, 2024; ii) study type: observational studies (cross-sectional); iii) population: research conducted on nurses’ intention to stay or leave; iv) outcome; prevalence (proportion); v) place of study: research conducted in Ethiopia; and vi) studies published in the English language. Review articles, case series, case reports, and letters to the editors were not included.
Study selection and data extraction
Retrieved studies were imported into EndNote (Version 20, for Windows, Thomson Reuters, Philadelphia, PA, USA), and Endnote was used to eliminate the 182 duplicated studies. Four independent reviewers (KEH, AAA, TZC, and GAK) screened all papers for eligibility requirements: first abstracts and titles were screened, and then, the full text was screened. Three investigators independently (YSA, AYG, and GAA) used a consistent data extraction format created in Microsoft Excel to extract data. Prior to the extraction process, the four independent researchers were blinded to the study data. Name of the author, publication year, country, region, sample size, prevalence, response rate, and quality rating score (Fig. 1) (Table 1).
Fig. 1
PRISMA flow diagram of the selection process of studies on level of intent to stay in nursing profession and associated factors among nurses in Ethiopia
Table 1
Characteristics of the 12 studies included in the systematic review and meta-analysis of level of ITS in nursing profession among nurses in Ethiopia
Study No
author
year of publication
Region
country
Study design
Study Population
prevalence
Sample Size
RR(%)
1
Eshetu, K et al
2024
Harari and D.D
Ethiopia
crossectional
nurse
49.3
413
97.82
2
Gizaw, AB et al
2017
Oromia
Ethiopia
crossectional
nurse
57.75
317
92.96
3
Engeda, E et al
2014
Amhara
Ethiopia
crossectional
nurse
39.8
389
91.9
4
Ayalew, et al
2015
Amhara
Ethiopia
crossectional
nurse
49.8
425
85%
5
Semachew, A et al
2017
Oromia
Ethiopia
crossectional
nurse
54.44
349
100
6
Tadesse, B et al
2023
Oromia
Ethiopia
crossectional
nurse
38.7
393
95.16
7
Woldekiros, A et al
2022
Addis Ababa
Ethiopia
crossectional
nurse
19.4
408
96.1
8
Ayalew, E et al
2020
Amhara
Ethiopia
crossectional
nurse
35.1
210
90.95
9
Asegid, A et al
2014
Sidama
Ethiopia
crossectional
nurse
50
242
87
10
Negarandeh, R et al
2020
Tigray
Ethiopia
crossectional
nurse
56.1
634
95.9
11
Adbaru, D et al
2019
Amhara
Ethiopia
crossectional
nurse
42.3
369
100
12
Mulisa, D et al
2022
Oromia
Ethiopia
crossectional
nurse
54.44
349
100
×
Quality assessment
Following the full-text review, the Newcastle–Ottawa Quality Assessment Scale (which was modified for cross-sectional studies) was used by three authors (AYG, GAK, and YSA) to evaluate the article’s quality [23]. Disagreements were settled by consensus and discussion. We employed the following elements as criteria for an appraisal: 1) the degree of representativeness of the sample (maximum score = 1) 2) the magnitude of the sample size (maximum score = 1) 3) the incidence of non-respondents (maximum score = 1) 4) the method of ascertainment of the exposure (risk factor)( maximum score = 2) 5) The subjects in different outcome groups are comparable, based on the study design(maximum score = 2) 6) Assessment of the outcome(maximum score = 2) 7) Statistical test (maximum score = 1). Articles with a score of ≥ 5 on the quality evaluation checklist criteria were considered studies with low risk, and these studies were included in the systematic review and meta-analysis. No study was excluded after obtaining a quality rating (Table 2).
Table 2
Quality rating for studies included in the systematic review and meta-analysis of level of ITS in nursing profession among Nurses in Ethiopia
Study
Selection Criteria
Comparability
Outcome
Representativeness of the sample
Sample size
Non respondents
Ascertainment of the exposure(maximum score = 2)
The subjects in different outcome groups are comparable, based on the study design or analysis. Confounding factors are controlled((maximum score = 2))
Assessment of the outcome(maximum score = 2)
Statistical test
Total(10)
Eshetu, K et al
1
1
1
2
2
1
1
9
Gizaw, AB et al
1
1
1
2
2
1
1
9
Engeda, E et al
1
1
1
2
2
1
1
9
Ayalew, et al
1
1
1
2
2
1
1
9
Semachew, A et al
1
1
1
1
2
1
1
8
Tadesse, B et al
1
1
1
2
1
1
1
8
Woldekiros, A et al
1
1
1
2
1
1
1
8
Ayalew, E et al
1
1
1
2
1
1
1
8
Asegid, A et al
1
1
1
1
1
1
1
7
Negarandeh, R et al
1
1
1
1
1
1
1
7
Adbaru, D et al
1
1
1
1
2
1
1
8
Mulisa, D et al
1
1
1
2
2
1
1
9
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Statistical analysis
The data were analyzed using STATA 17 software (StataCorp, College Station, Texas, USA). We used the DerSimonian and Laird method for random-effects models to calculate the pooled prevalence of intention to stay in the nursing profession and associated factors among nurses in Ethiopia [12]. The I2 statistical test was computed to check heterogeneity across studies. I2 values of 0%, 25%, 50%, and 75% were assumed to denote the absence of heterogeneity, a low level of heterogeneity, a moderate degree of heterogeneity, and a high degree of heterogeneity, respectively. Because significant heterogeneity was detected between studies, a meta-analysis using a random effects model was conducted to estimate pooled prevalence with 95% confidence intervals (CI). A forest plot was used to illustrate the findings of the meta-analysis.
The Egger’s test was employed to assess the existence of publication bias, and any possible publication bias was specified by visual examination of the funnel plot. To pinpoint the key studies that have the most significant influence on between-study heterogeneity, a leave-one-out sensitivity analysis was also conducted. By omitting each study individually, an analysis was conducted to determine the impact of each study on the pooled estimate prevalence of intention to remain in the nursing profession and associated factors among nurses in Ethiopia. The input variables needed by the cells of the two-by-two tables for factors related to intent to stay are binary data, or "prevalence of intention to stay," i.e., the proportion of nurses in each study's exposed and non-exposed groups who have and do not have intention to stay or leave. The odds ratio (OR), which was calculated based on the binary results of the included main studies, was used to evaluate all factors associated with intention to stay. The pooled odds ratio was calculated using a random-effects meta-analysis, and a 95% confidence interval was employed. The effect magnitude and 95% confidence intervals are shown through forest plots.
Result
Results of the search
A total of 2,372 scholarly articles were obtained, which had been published until October 30, 2024, through the use of electronic databases. In total, 182 articles were avoided due to the effort of duplication. Of the remaining 2,190 articles, 2,122 were removed by title and abstract, whereas 68 were read in full and assessed for eligibility criteria. No study was excluded due to failure to access the full text. Finally, 12 studies with a total of 4,498 study participants who fulfilled the eligibility requirements were included in this systematic review and meta-analysis (Fig. 1).
Characteristics of the included studies
Among the 12 included studies, 4 were conducted in the Amhara region [1, 6, 8, 14], 4 studies were conducted in Oromia region [16, 24, 31, 35], and the rest four studies were conducted in Sidama [5], Tigray [25], Addis Ababa [40], and Harar region [15]. Depending on the study population category, all studies included were nurses.
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Prevalence of ITS in the nursing profession among nurse
In our study, the pooled prevalence of ITS in the nursing profession among nurses in Ethiopia was 45.57 (95% CI, 38.43, 52.72). The forest plot in Fig. 2 shows a statistically significant heterogeneity (with I2 = 96.1%; p < 0.001) (Fig. 2). Therefore, a random-effects model was used to estimate the pooled prevalence of ITS in nursing profession among nurses in Ethiopia. Additionally, subgroup analysis was conducted to determine the potential source of heterogeneity among the studies because of the high degree of heterogeneity.
Fig. 2
Forest plot for the pooled prevalence of ITS in nursing profession among Nurses in Ethiopia
×
Subgroup analysis
Because of the significant heterogeneity among the studies, a subgroup analysis was conducted to identify potential sources of heterogeneity. Subgroup analysis was conducted depending on the study settings (region) (Fig. 3) and year of publication to identify possible sources of heterogeneity. Regarding the sub-group analysis by region, the highest pooled prevalence of ITS in the nursing profession was reported in the Tigray region which is 56.10% (95% CI 52.24, 59.96). In contrast the lowest was documented in Addis Ababa city administration which was 19.40% (95% CI 15.56, 23.24) (Table 3).
Fig. 3
Subgroup analysis based on study area (region) for the systematic review and meta-analysis of Level of ITS in nursing profession among Nurses in Ethiopia
Table 3
Subgroup analysis of the pooled prevalence of ITS in nursing profession among nurse in Ethiopia
Subgroups
Number of studies
Prevalence (95% CI)
Heterogeneity statistics
P-value
I2
Tau2
Region
Amhara
4
41.97(36.16 to 47.86)
15.28
0.002
80.4
28.88
Oromia
4
51.28(42.55 to 60.01)
34.25
< 0.0001
91.2
72.41
Addis Ababa
1
19.4(15.56 to 23.24)
0
< 0.0001
Tigray
1
56.1(52.24 to 59.96)
< 0.0001
Sidama
1
50.0(43.70 to 56.30)
Harar & D.D
1
49.3(44.48 to 54.12)
Overall
12
45.57(38.43 to 52.72)
279.2
< 0.0001
96.1
152.7
×
Publication bias
The graphical presentations of the Funnel plot indicate the presence of asymmetry (Fig. 4), and the result of the Egger test was also statistically significant with a coefficient of = 2.93, 95% CI (1.45, 4.42), and a p-value of 0.001 (Table 4). As a result, there is a potentially missed study.
Fig. 4
Funnel plot for publication bias for systematic review and meta-analysis of ITS in Nursing profession among nurses in Ethiopia
Table 4
Tests for Funnel plot Asymmetry (Eggers test) of ITS in Nursing profession among nurses in Ethiopia
Standard effect
Coefficient
Standard error
T
P > t
95% CI
Slope
2.93
0.67
4.4
0.001
(1.44 to 4.42)
Bias
0.33
0.27
1.24
0.243
(−0.26 to 0.93)
×
Sensitivity analysis
Leave-out-one sensitivity analysis
By excluding each study individually, a leave-out-one sensitivity analysis was used to assess the impact of each study on the pooled prevalence of ITS in the nursing profession among nurses in Ethiopia. The findings revealed that the studies that were removed had no discernible impact on the pooled prevalence of ITS in the nursing profession (Fig. 5).
Fig. 5
Sensitivity analysis for the systematic review and meta-analysis of ITS in Nursing profession among nurses in Ethiopia
×
Factors associated with the prevalence of ITS in nursing profession among nurse
To determine factors associated with the level of ITS in the nursing profession among nurses in Ethiopia, variables such as sex, age, work experience, having got adequate family member support, job satisfaction, level of educational status, organizational factors, managerial support, job-related stress, working unit, position, normative commitment, continence commitment, affective commitment, communication with other professionals, level of healthcare setup, autonomy, payment, and professional development, were extracted from the included studies. Among those variables educational level, autonomy, job satisfaction, payment, benefit, and professional development were identified as the significant predictors associated with level of ITS. Details of the result are reported in Table 5. However, in our review study, there was no significant association between marital status, age, sex, level of healthcare setup, job-related stress, working unit/ward, team spirit, service year, and position with level of ITS.
Table 5
Factors associated with the Level of ITS in nursing profession among Nurses
Association between ITS in the nursing profession and level of education
To identify the association between the level of education and ITS, two studies were included, all of which demonstrated a statistically significant association. Ultimately, our systematic review and meta-analysis revealed that nurses whose educational level was above BSC were 2.7 fold more likely to stay in the nursing profession than their counterparts (OR = 2.7, 95% CI = 1.92–3.8).
Association between ITS in the nursing profession and nurses autonomy
To identify the association between nurses autonomy and the level of ITS, four studies were included, all of which demonstrated a statistically significant association. Regarding the association of nurses who were autonomies’ were more likely to stay in the nursing profession by a factor of 5.34 times (OR = 5.34, 95% CI = 2.73–10.43).
Association between ITS in the nursing profession and job satisfaction
Among the extracted research data three studies showed a significant association between level of intention to remain in the nursing profession and nurse job satisfaction. The odds of being satisfied on job were 2.69 fold higher chance to remain in the nursing profession than those of nurses who were unhappy in their profession (OR = 2.69, 95% CI = 1.11 – 6.53).
Association between ITS in the nursing profession and payment-benefit
To identify the association between ITS and compensation in the nursing profession, five studies were included, all of which demonstrated a statistically significant association. Those nurses who are more paid were 1.9 times more likely to stay in the nursing profession when compared to that of less paid nurses (OR = 1.9, 95%CI = 1.15- 3.19).
Association between ITS in the nursing Profession and professional development
Four studies were included to determine the relationship between ITS in nursing profession and obtaining professional opportunities; each study showed a statistically significant association. Those nurses who have got different professional opportunities were 2.49 times more likely to remain in the nursing profession when compared to that of nurses who have got less professional opportunities (OR = 2.49, 95%CI = 1.27- 4.9).
Discussion
To determine the pooled prevalence of ITS within the nursing workforce in Ethiopia, we conducted a systematic review and meta-analysis. The result revealed that the pooled prevalence of ITS in the nursing profession was calculated to be 45.57%. This particular finding is relatively consistent with prior research conducted in Ghana [26], South Africa [32], and Japan [30] which reported prevalence rate of 49.6%, 53.9%, and 55.4% respectively.
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However, our pooled finding is lower than the findings of a multicenter European [17] and USA [41], where prevalence rate of 91% and 85.7%, respectively were documented for nurse intending to remain in their profession. This variation might be due to the fact that the existence of better remuneration, enhanced risk allowance, modernized healthcare setup, good leadership, good governance, professional opportunity, job satisfaction, career advancement, and organizational support were the better retention mechanism in European nations when compared to those in Ethiopia.
In our study job satisfaction and autonomy were positively correlated with ITS. Hence, the more satisfied and autonomous nurse in job was less inclined to shift away from their nursing profession. Nurse Job satisfaction interims of organizational support, incentive, communication, independent decision making, and extracurricular activity make them to remained more in the field. This finding is supported by previously conducted research in china [22] and Jordan [4] which stated that nurses with high level of job satisfaction tend to persist in their professional role. Furthermore, nurses who receive support provided by professional association, autonomous in decision-making on patient care and work challenges make them greater intend to continue in the profession [10].
Our study also demonstrated that ITS was significantly associated with the nurse’s level of education. This might be due to the fact that high level of educated nurses were more paid, developed independent patient care, and had good leadership quality which all makes them to retention in the profession. This report was supported by a systematic review conducted in sub-Saharan Africa study [7].
Regarding professional advancement opportunities; it was identified that nurses who had opportunities for professional development in education, training, and career development the nurses’ level of remaining will increase. The report was supported by finding from South Africa and Thailand study [32, 33]. The other significant predictors were pay and benefits; nurses who received comparatively better payment and benefits which is proportional to with their workload performed, increase the nurses’ level of intention to stay in the nursing profession, which is also a vital factor. Our finding was in line with previously published reported data in Jordan, China, and Ethiopia [4, 15, 22].
Overall, making nurses stay in their profession and identifying positive energy that inspires it and making nurses love nursing and wholehearted engagement is the obligation of every concerned body. The continuous departure of nurses from the profession for different reasons, especially due to job dissatisfaction, poor support, burnout, professional development, payment issues, job distress, socio-demographic factors, and organizational commitment factors resulted in hurting staying experienced nurses and the overall quality of healthcare systems.
Strengths and limitations of the study
Strengths of the study
The strength of our study lies in the fact that this was, to our knowledge, the first systematic review and meta-analysis to determine the overall prevalence of ITS in the nursing profession among nurses in Ethiopia, and all the studies included were of good methodological quality. Further, this systematic review and meta-analysis were performed and reported according to PRISMA guidelines.
Limitation of the study
The I2 test shows a significant heterogeneity. Therefore, we applied random-effect analysis model. The restriction of studies written in English, which limits the number of studies included in this meta-analysis. Further, our finding may be subject to unpublished and unaddressed issues and the other limitation is the nature of the cross-sectional study design.
Conclusion
To increase ITS in the nursing profession among nurses underlying issues such as job satisfaction, professional opportunity, autonomy, burnout, and leadership quality must be addressed to foster a more stable nursing workforce in the country. We recommend investing in potential strategies to improve the nurses’ intention to stay through performance standards, increased pay and benefits, clear reward mechanisms, participation in decision-making, and assessments of leaders’ behaviors.
Recommendations for policy makers and nursing administrator
Healthcare policymakers need to establish effective and supportive systems in healthcare setup to retain nurses. It is essential to take necessary actions to raise the currently low intention to remain in the nursing profession and promote systemic change. Key strategies involve collaborating with relevant government bodies and policymakers to create policies and initiatives that enhance nurses' job satisfaction, organizational commitment, and incentive structures, such as risk allowances. We recommend that future researchers undertake qualitative research and conduct a prospective cohort study.
Nursing management implication
Nursing care’s effectiveness and quality of care are determined by an adequate and experienced number of nursing staff. Strategies to improve retention should focus on enhancing job satisfaction, reducing burnout, and fostering a supportive work environment. Retention of nursing professionals is the key to sustaining and improving the healthcare system and quality healthcare delivery. Health policymakers should consider enacting policies and regulations for nurses’ benefits, such as allocating positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, readjustment of the current salary scale, risk allowance, and overtime payment to increase nurses’ intention to remain in the profession.
Acknowledgements
The researchers gratefully acknowledge the authors and participants of the studies included in this systematic review and meta-analysis.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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