Turnover intention and its influencing factors among male nurses in China: a national-scale descriptive study

A comprehensive, national-wide descriptive study was conducted to investigate turnover intentions of registered male nurses across China and provide insights into the factors contributing to their turnover intentions. The results were reported following the STROBE statement.

Participants were enlisted through targeted outreach conducted by the Male Nurses Working Committee of the Chinese Nursing Association. We employed stratified convenience sampling, wherein registered male nurses from 1,000 hospitals across China were invited to participated in an electronic survey. Hospitals were categorized into tertiary hospitals, secondary hospitals, and primary care facilities to enhance representativeness across various levels of healthcare services. Although stratification was used to include different types of hospitals, the use of convenience sampling may limit the representativeness of the sample, as participants were selected based on availability rather than random selection. This could introduce selection bias, as individuals who are more engaged with professional networks or those with particular experiences may have been more likely to respond to the survey [24]. Future studies should consider employing probability sampling methods to reduce potential biases and improve the generalizability of the findings to the broader population of male nurses in China. The survey was distributed and managed via the WeChat platform over the period from May to August, 2023. The following criteria were used for inclusion: (1) possessing a valid nursing license, (2) actively working in a hospital setting, (3) having at least one year of work experience in nursing, and (4) providing informed consent and participating voluntarily in the study. Individuals who were excluded from the survey due to leave of absence, further education, business trips, or any other reasons that prevent engagement during the study period.

According to the Kendall sample estimation criteria, to assess the psychometric properties of instruments, the sample size should be at least five to seven times the number of items, with a minimum of 100 participants for accounting for 20 variables [25]. However, to achieve more accurate and stable results, a larger sample sizes was recruited. Ultimately, 13,338 registered male nurses from over 1,000 hospitals across China participated in this survey, which provides robust data for analysis despite the use of convenience sampling.

This national survey was conducted with the assistance of the Chinese Nursing Association, which coordinated with local nursing associations to contact hospitals through email or telephone and invited them to participate. Hospitals were selected based on their type (tertiary, secondary, primary care) to ensure representative distribution. The research assistants shared the survey link through a professional online questionnaire platform with a WeChat group comprising all recruited registered male nurses from the participating hospital. It was emphasized that the questionnaire could only be completed once per IP address. Participants were assured that their confidentiality would be upheld and they had the freedom to withdraw from the study at any time. Furthermore, all participants remained anonymous and participation was entirely voluntary. A questionnaire was excluded if the respondent took less or more time to complete the survey. Finally, a total of 13,088 valid questionnaires were returned.

The research team developed three separate sections for this study, designed to assess demographic information, work attitudes, and turnover intentions among male nurses. Prior to the national survey, the survey instrument underwent rigorous pre-testing through a pilot study conducted in March 2023. The pilot involved 100 registered male nurses from two tertiary hospitals in Beijing and Shanghai. The purpose of the pilot was to evaluate the clarity, relevance, and reliability of the questions, as well as the overall user experience with the online platform. The feedback received was used to refine the wording of several questions and ensure cultural and contextual appropriateness. Additionally, face validity was established through consultation with nursing experts, who reviewed the instrument to confirm that it adequately covered the intended domains. Based on the pilot findings, the instrument was deemed suitable for the national survey. The English version of the detailed questionnaires is listed in the supplementary file.

Participation in this study by male nurses was entirely voluntary and safeguarded by anonymity. Prior to commencement, authorization to conduct this research was secured from the directors of each selected hospital and their corresponding nurse managers. The research was facilitated under the auspices of the Male Nurses Working Committee of the Chinese Nursing Association. This committee played a pivotal role in liaising with local committees dedicated to the welfare of male nurses, ensuring that participants were thoroughly informed and that their consent was explicitly obtained. Ethical clearance was granted by the Medical Ethical Committee of Peking University First Hospital (No.2024-519-001), confirming adherence to ethical standards in the conduct of this research.

Table 1 summarized the demographics of 13,088 registered male nurses. A significant majority are under 35 years old (85.6%) and primarily located in East China (27.3%). Most hold a bachelor’s degree (68.9%) and are married (51.8%), with 57.3% having no children. 71.7% of participants have obtained junior professional titles, and 75.1% have been working for 0–10 years. The majority work in public hospitals (93.5%), predominantly in tertiary hospitals (88.7%) and teaching hospitals (88.8%). Employment is largely contract-based (81.8%), and 23.4% are assigned to intensive care units (ICUs). Most do not hold management positions (90.5%).

Among the 13,088 registered male nurses surveyed, 28.4% have a low intention to leave, 43.3% have a medium intention, and 28.4% have a high intention. Occupational prestige is distributed with 35.4% at low, 40.9% at medium, and 23.7% at high levels. Work value is perceived as low by 21.9%, medium by 50.2%, and high by 27.9%. Regarding the pressure of getting married, 14.1% feel low pressure, 41.1% medium, and 44.8% high. Income satisfaction is low for 43.2%, medium for 42.8%, and high for 14%. Career development opportunities are seen as low by 26.3%, medium by 49%, and high by 24.6%. Career support from hospitals is rated low by 19%, medium by 54.7%, and high by 26.3%. Lastly, the extent to which nurses only execute medical orders is low for 61.6%, medium for 27.3%, and high for 11.2%.

The univariate analysis presented in Table 2 compares different characteristics of 13,088 registered male nurses based on their intention to leave. The results indicate significant correlations (p < 0.05) between intention to leave and various factors, including marital status, number of children, hospital level, employment type, management position, occupational prestige, work value, pressure of getting married, income satisfaction, career development, career support from the hospital, and the extent to which nurses only execute medical orders. Specifically, male nurses who were unmarried, had no children, worked in lower-level hospitals, were employed on a contract basis, or did not hold management positions showed a higher tendency to express medium or high turnover intention. Additionally, lower levels of occupational prestige, work value, income satisfaction, and career development opportunities were associated with higher turnover intentions. Higher pressure related to marriage and limited career support from hospitals also contributed to increased turnover intention. No significant differences were observed for other factors, including age, region, educational level, professional level, years of working, hospital type, teaching hospital status, and working unit.

These twelve variables which were found to be significant from the univariate analysis were further analyzed using multinomial logistic regression analysis, with the “low intention to leave” group as a reference. The parallel lines test (χ² = 12437.585, p < 0.001) suggested that the proportional odds assumption was violated, necessitating the use of multinomial logistic regression. Residual analysis yielded a Durbin-Watson value of 1.989, indicating the data met assumptions of linearity, independency, normal distribution, and equal variance. Collinearity diagnosis showed that the model tolerance was between 0.409 and 0.957, and variance inflation factor (VIF) between 1.045 and 2.447, indicating no multicollinearity among the independent variables. The multinomial logistic regression analysis in Table 3 identifies predictors of turnover intention among registered male nurses of China. For those with medium intention to leave compared to low intention, significant predictors include having no children (OR: 1.288), lower occupational prestige (OR: 1.659 for low and 1.474 for medium), lower work value (OR: 1.930 for low and 1.717 for medium), lower pressure of getting married (OR: 0.360 for low), lower income satisfaction (OR: 1.878 for low and 1.477 for medium), limited career development (OR: 2.547 for low and 1.802 for medium), lower career support from the hospital (OR: 1.687 for low and 1.165 for medium), and only executing medical orders (OR: 0.558 for low). For high turnover intention compared to low intention, significant predictors include having no children (OR: 1.388), lower occupational prestige (OR: 2.628 for low and 1.223 for medium), lower work value (OR: 3.224 for low and 1.391 for medium), lower pressure of getting married (OR: 0.145 for low and 0.295 for medium), lower income satisfaction (OR: 1.288 for low and 0.568 for medium), limited career development (OR: 2.784 for low and 1.237 for medium), lower career support from the hospital (OR: 2.143 for low and 1.348 for medium), and only executing medical orders (OR: 0.213 for low and 0.379 for medium)​​.

Our comprehensive analysis involving 13,088 registered male nurses across China has identified a substantial inclination towards turnover, with 71.6% displaying medium to high levels of turnover intention. Key findings indicate that turnover intention is notably higher among male nurses who are childless, possess lower occupational prestige, and hold less regard for work values. Additionally, dissatisfaction with income, constrained opportunities for career advancement, and a lack of hospital support are pivotal factors exacerbating turnover intentions within this demographic.

Traditionally, the nursing sector has been female-dominated. The presence of male nurses helps break down gender stereotypes and professional biases [7, 26], while also enhancing the diversity of medical care teams and fostering an inclusive work environment that delivers high-quality healthcare services to patients [27]. This study reveals that 71.6% of male nurses expressed a moderate to high intention to leave their positions. Predominantly working in critical and emergency care departments, male nurses face numerous clinical challenges and emergency situations, resulting, resulting in higher job stress and a greater inclination to leave [28, 29]. Although turnover intention is a widespread issue that affects all nurses and contributes to the global nursing shortage, addressing the retention of male nurses specifically is particularly important due to their unique challenges within a predominantly female profession. Male nurses often experience greater levels of occupational stress, discrimination, and lack of support, which contribute to their higher turnover intention compared to female nurses [7]. Retaining male nurses not only ensures gender diversity in healthcare, which has been shown to improve patient care outcomes, but also reduces the costs associated with frequent turnover including the loss of trained professionals, disruption of team dynamics, and additional recruitment and training expenses [30]. Nursing managers should prioritize retention strategies for male nurses by offering more tailored support, including mentoring, career development opportunities, and addressing workplace discrimination, to improve job satisfaction and organizational commitment [31]. Nursing offers a wide range of diverse career opportunities across clinical, educational, administrative, and research roles, ensuring that qualified nurses are rarely out of work. While leaving the field may involve challenges such as the potential loss of specific clinical experience or professional networks, nurses have the flexibility to explore various career pathways both within and outside the traditional healthcare setting [17]. Therefore, it is important for male nurses to carefully consider their career trajectory and leverage these opportunities for continuous professional development and growth, rather than making hasty decisions that might hinder their long-term career progression.

This study revealed several factors influencing turnover intention among Chinese registered male nurses. Male nurses without children possess greater energy to pursue their career advancement and explore various professional opportunities [32]. Furthermore, it is easier for them to maintain a balance between work and life, making them more receptive to resigning to seek employment that better suits their lifestyle [33]. In contrast, male nurses with children often bear greater family responsibilities, hence they tend to prioritize job stability to ensure economic security for their families [34].

Male nurse with higher occupational prestige reported lower turnover intention. When nurses’ work is widely recognized and respected by society and peers, they tend to develop a stronger sense of self-worth, organizational identification and occupational prestige [35]. In China, nursing has traditionally been viewed as a female-dominated profession, which has contributed to gender stereotypes surrounding male nurses [7]. Despite this perception, the profession is gradually gaining respect and recognition. However, the level of prestige associated with nursing varies across regions and demographic groups. In more urbanized and economically developed regions, nursing is increasingly seen as a reputable and respected career, particularly due to the essential role nurses play in healthcare delivery [36]. Yet, cultural biases persist in some areas, where nursing is still perceived as a role more suited to women. Male nurses, while accepted, often face challenges related to these traditional stereotypes, which can impact their professional identity and career satisfaction. Higher occupational prestige, when achieved, often signifies greater opportunities and benefits for career advancement, reducing the intentions of male nurses. Therefore, nursing managers should focus on enhancing the public image of male nurses [37], emphasizing their professional contributions and capabilities to foster a more positive and inclusive representation [38, 39].

Low work value was also found to be associated with high turnover intention in this study. When male nurses perceive that their work is recognized by patients, valued by organizations, and respected by society, their sense of work value will be enhanced [40]. At the same time, they feel a stronger sense of identity and pride in their professional skills and social roles, making them more inclined to stay in their nursing positions and exhibit superior job performance [41]. Nursing managers should acknowledge the contributions of male nurses, provide reasonable compensation, and establish a work environment based on mutual respect and trust [42, 43].

Our study also found that the pressure of getting married is the predictor of turnover intention. Nurses face a demanding workload, frequent night shifts, and limited social circles, making it challenging to find suitable partners for marriage and relationships [44]. Establishing a family marks a significant life milestone, leading to increased financial expenses. Male nurses might consider seeking employment with better compensation as a result [45]. Moreover, male nurses need to devote more time and energy to caring for their spouses and children, but it can be difficult for them to meet these family obligations fully [46]. Nursing managers should pay more attention to the marital and relationship status of young male nurses, organizing more activities such as matchmaking.

We found that low satisfaction to income was correlated to high turnover intention. Income is the livelihood guarantee of male nurses and the fundamental measure of their labor’s worth [47]. Male nurses often work in high-pressure departments such as emergency and intensive care units. A mismatch between their compensation and workload can lead to high turnover intentions of them [48]. Additionally, the higher the income of male nurses, the less stressful their lives are, enabling them to devote more energy to achieving their professional goals [49]. Nursing managers should implement a fair and equitable performance appraisal and compensation system to reward effort and excellence. This system should include attractive salaries and appropriate job allowances to decrease the turnover intentions among male nurses [42].

The more opportunities for career development were identified to be associated with low turnover intention. Male nurses in China typically possess high educational qualifications and have strong aspirations for professional expansion, further training, career advancement, and personal development [42]. It is essential for nursing managers to offer competitive salaries, a robust training system, extensive opportunities for growth, and clear career planning to male nurses [31]. By creating more opportunities for both horizontal and vertical growth, the pathways for male nurses’ career development can be broadened, encouraging their integration into advanced nursing teams.

More supports from hospitals for career development is another key factor influencing turnover intention among male nurses. In China, this support is typically provided at three levels: the hospital, the nursing department, and the departmental level, including opportunities for professional development, skill enhancement, and clear promotion pathways. Evidence suggests that structured support for career advancement not only enhances nurses’ skills and knowledge but also foster a stronger sense of belonging and organizational commitment, both of which are closely associated with reduced turnover intentions [50]. Additionally, when male nurses feel their contributions are recognized and supported through professional growth opportunities, they are more motivated to remain in their roles and pursue long-term career goals. Furthermore, hospital support helps create an inclusive work environment where male nurses feel accepted and respected, mitigating the effects of gender discrimination and bias, which in turn reduces their intention to leave.

Our study reveals that the traditional perception of nurses being primarily responsible for executing doctors’ orders significantly contributes to the turnover intentions among male nurses. Male nurses bring unique skills and perspectives to the nursing profession, and their presence is crucial in promoting diversity and addressing gender imbalances [10]. However, when their roles are confined to merely following directives, it diminishes their sense of autonomy and professional fulfillment [51, 52]. This perceived lack of control over their work can lead to frustration and dissatisfaction, ultimately increasing the likelihood of resignation. Furthermore, such limitations restrict their ability to apply their clinical knowledge and decision-making skills, hindering both personal growth and career development. It is essential for nursing managers to challenge these outdated perceptions by fostering environments that promote autonomy for all nurses, regardless of gender [35, 53]. Encouraging male nurses to set individualized career goals and creating pathways for professional development will not only support their personal growth but also enhance their contribution to the healthcare system. Providing more opportunities for leadership roles, skill enhancement, and decision-making responsibilities will ensure that male nurses can fully realize their potential and remain committed to the profession.

This study employed a large sample size of 13,088 registered male nurses to provides a robust data set for analysis. However, three limitations in this study should also be further interpreted. Firstly, the cross-sectional nature of the study limits the ability to infer causality between observed factors and turnover intentions. Therefore, longitudinal studies would be required to establish temporal relationships and causal effects. Secondly, the reliance on self-reported data can introduce biases such as social desirability bias or inaccurate recollections, which might affect the reliability of the data. Thirdly, although the sample size is large, the use of convenience sampling might limit the representativeness of the sample. This sampling method might not adequately reflect the diversity within the population of male nurses in China, potentially skewing the results. Fourthly, turnover intention was assessed using a single-item measure, which may not fully capture its multidimensional nature, including emotional, cognitive, and behavioral components. Future research should consider utilizing multi-item scales, such as the Turnover Intention Scale (TIS) or other validated instruments, to provide a more comprehensive evaluation of turnover intention. Lastly, a further limitation is the absence of validated survey instruments in our study, though a pilot study was conducted to improve the reliability and validity of the tools used.

The study provides essential insights into reducing turnover among male nurses in China and suggests practical strategies for workforce management. Enhancing male nurses’ visibility and recognition can help reduce turnover intention. Hospitals should promote male nurses’ unique contributions through mentorship programs, allowing senior male nurses to guide newer ones through their specific challenges. Support groups can also provide a sense of community where male nurses can share experiences and address gender-specific barriers. To address career development, hospitals should create clear career pathways that tackle barriers male nurses face, such as underrepresentation in leadership and workplace biases. Policies should actively dispel stereotypes that limit male nurses to medical orders, encouraging them to take on leadership and autonomous roles. Improving job satisfaction by offering competitive pay, clear career progression, and work-life balance options, especially for male nurses with family responsibilities, can help retain them.

This study reveals several significant predictors of turnover intentions among male nurses in China, emphasizing the importance of future research to developed tailored intervention strategies. Future studies should explore and evaluate programs aimed at improving occupational prestige, work value perception, and job satisfaction, especially focusing on income and career support from hospitals. Intervention programs could include structured mentorship systems and support networks specifically designed to tackled the professional isolation male nurses might experience. Further research is also needed to assess the impact of career development initiatives tailored for male nurses, particularly in overcoming gender-based career barriers. This can include the effectiveness of male nurse-specific training programs for leadership roles and interventions designed to counter occupational stereotypes. The relationship between familial expectations, such as the pressure to marry or have children, and job retention among male nurses also requires deeper investigation. Finally, given the importance of autonomy in job duties, future research should evaluate initiatives that encourage professional growth and empowerment for male nurses, such as allowing them to take on more decision-making responsibilities. Employing longitudinal designs could help assess the long-term effectiveness of these interventions and their impact on reducing turnover intentions.