Breaking the Retention Crisis: Cognitive Rumination and Psychological Fortitude as Predictors of Departure...

Psychiatric nurses are essential to the provision of mental health care, but they are especially prone to workplace stressors, causing an escalating retention crisis worldwide and negatively affecting their mental health.

A descriptive cross-sectional correlational research design was conducted among psychiatric nurses working in Port Said and New Damietta Mental Health and Addiction Treatment Hospitals, Egypt. A convenience sample of 265 nurses was recruited. Data were collected using three standardised tools: the Fortitude Questionnaire (20 items, four-point Likert scale ranging from does not apply to applies very strongly), the Ruminative Response Scale (10 items comprising two subscales: brooding and reflection; responses rated on a four-point Likert scale from 1 = 'never' to 4 = 'always'), and the Turnover Intention Scale (3 items rated on a five-point Likert scale from 1 = 'strongly disagree' to 5 = 'strongly agree'). Data were collected over a three-month period from July to September 2025.

Findings revealed that cognitive rumination was positively correlated with turnover intention and negatively correlated with psychological fortitude. Regression analysis indicated that both cognitive rumination and psychological fortitude significantly predicted turnover intention. Regarding demographic variables, significant differences were observed in cognitive rumination, psychological fortitude, and turnover intention based on personal characteristics. Specifically, nurses living in rural areas reported higher cognitive rumination and turnover intention, and lower psychological fortitude compared to those living in urban areas (p < 0.05). In addition, sex, age, education level, and years of experience were also significantly associated with the study variables.

This study addresses a critical gap in the literature on psychiatric nurses in Egypt by highlighting the significant interplay between cognitive rumination, psychological fortitude, and turnover intention. The findings suggest that higher levels of maladaptive cognitive rumination are associated with lower psychological fortitude, whereas greater psychological fortitude is associated with reduced turnover intention. These results underscore the importance of psychological resilience-building interventions to reduce turnover risk among psychiatric nurses.

The results have particular relevance for mental health nursing, where psychiatric nurses face emotionally intense, trauma-related, and cognitively demanding work. Psychological fortitude emerges as a key protective factor, mitigating intrusive rumination and decreasing departure inclination. Strengthening fortitude among psychiatric nurses is therefore vital for workforce retention, enhancing well-being, and sustaining high-quality care in mental health settings.