Turnover Intentions Among Intensive Care Healthcare Workers: Key Factors Influencing Decisions to Stay or Leave

Turnover among healthcare workers (HCWs) is highly prevalent in intensive care units (ICUs). Due to demanding workloads, stressful conditions, and increasing pressure to work more efficiently, this problem is likely to persist. Consequently, implementing proactive strategies to support HCWs retention is needed. This study aimed to examine associations between work environment factors and ICU HCWs' intentions to quit.

Based on data from a prospective, open-cohort, multicenter study of hospital frontline workers conducted during the four main waves of the COVID‑19 pandemic in Norway, we analyzed self-reported data from HCWs who completed the final survey, which included two outcomes relevant to turnover: (1) frequent thoughts of quitting and (2) intention to look for a new job. A work-environment -factor tool assessing occupational risk and characteristics in emergencies (FORCE-index). Hierarchical linear regression was used to examine associations between work environment factors and the two turnover outcomes.

Among 977 frontline HCWs (median age 45 years, 75% women, median 16 years of work experience), several work environment factors showed protective association with turnover intention. Across both outcomes, familiarity with colleagues and surroundings and social support from colleagues and immediate superiors were the most important protective factors, linked to fewer thoughts of quitting and a lower intention to seek a new job. For frequent thoughts of quitting, additional protective factors included better stress management, workload manageability, infection safety, and social safety. Younger age was a consistent risk factor for both outcomes, while working in the ICU and experiencing morally distressing situations were specifically associated with thoughts of quitting. Pandemic exposure variables were not significantly associated with either outcome.

Turnover intention among ICU HCWs at four Norwegian university hospitals during the fourth time point of the COVID‑19 pandemic was associated with work environment factors. Work in the ICU, younger age, and morally distressing experiences were associated with frequent thoughts of quitting, whereas several work environment factors were protective. Familiarity and social support were also protective against actively looking for a new job, suggesting that strengthening these factors may be particularly important for reducing turnover intention and retaining HCWs in the ICU.