Staying Despite the Intention to Leave: Insights from Frontline Nurses and Nurse Managers from a Qualitative...

Background/Objectives: The global nursing workforce shortage has heightened concerns about burnout, workload, and nurse retention, with an increasing intention to leave the profession and the unit, especially in the post-pandemic context. Although intention to leave has been widely studied, limited attention has been paid to nurses who continue to provide high-quality care and persist despite expressing a desire to leave. This study aimed to explore the reasons for persistence among nurses who intend to leave the organization and the profession. Methods: A descriptive qualitative study was conducted involving frontline nurses and nurse managers working in a large university healthcare trust in Northern Italy. Data were collected through three focus groups, using a semi-structured interview, until data saturation was achieved. Data were analyzed using inductive content analysis. Findings were reported in accordance with COnsolidated criteria for REporting Qualitative research guidelines. Results: Thirty-two participants were included. Overall, two main themes emerged: 'Reasons that are inside of me' and 'Reasons that are outside of me but influence my decisions to stay', with eight and six subthemes respectively. Internal reasons included professional passion, commitment, autonomy, perceived usefulness, and supportive collegial relationships. External reasons included organizational flexibility, opportunities for internal mobility and professional development, responsiveness to nurses' expectations, and, in some cases, limited external employment alternatives. Conclusions: Persistence represents a distinct and underexplored dimension within the intention-to-leave continuum. While internal reasons reflect deeply rooted professional identity, external organizational reasons are modifiable and play a critical role in promoting retention. Organizational strategies aligned with nurses' values, expectations, and professional development needs may enhance workforce stability and inform more targeted retention interventions.