What is behind the high turnover intention among hospital nurses during the full liberalization of COVID-19 and the postpandemic era in China: a 2-wave multicentre cross-sectional comparison study.

BACKGROUND

The COVID-19 pandemic has posed unprecedented challenges to the nursing profession, exacerbating occupational stress, attrition rates, and staffing shortages. Although prior studies have examined factors influencing nursing turnover intention, no research has compared turnover intention among Chinese hospital nurses during the full liberalization of COVID-19 and the postpandemic era. The aim of this study was to investigate the prevalence and associated factors of turnover intention during these two critical periods.

METHOD: A 2-wave multicentre cross-sectional online survey was conducted in 25 hospitals in Guangdong, China. Data were collected during the full liberalization of COVID-19 (T1: 27 December 2022 to 7 January 2023, N = 1,766) and the postpandemic era (T2: 11 May to 23 May 2023, N = 2,643). A structured questionnaire was used to assess sociodemographic and work-related factors, such as perceived stress (10-item Perceived Stress Scale), depression (9-item Patient Health Questionnaire), anxiety (7-item Generalized Anxiety Disorder), insomnia (Insomnia Severity Index), intolerance of uncertainty (Intolerance of Uncertainty Scale), life satisfaction (Satisfaction with Life Scale), and turnover intention (Turnover Intention Scale). Statistical analyses, including descriptive statistics, chi-square tests, Pearson correlation, binary and multiple logistic regression, and hierarchical regression, were performed using SPSS 26.0.

RESULTS

The prevalence rates of turnover intention were 73.33% and 72.34% at T1 and T2, respectively. Dissatisfaction with nursing work (aOR: 2.393-8.659, Ps < 0.001), lack of interest in nursing (aOR: 2.713-3.077, Ps < 0.001) and depression (aOR: 1.437-2.113, Ps < 0.05) were associated with an increased risk of turnover intention. In addition, life satisfaction (aOR: 0.282-0.687, Ps < 0.05) was associated with a reduced risk of turnover intention.

CONCLUSIONS

Turnover intention among hospital nurses remained alarmingly high during both the full liberalization of COVID-19 and the postpandemic era. Dissatisfaction with work, lack of interest in nursing, and depression were significant risk factors, whereas life satisfaction served as a protective factor. Early identification of turnover intention and targeted interventions are essential to address these challenges and improve nurse retention during and after public health crises.

CLINICAL TRIAL NUMBER: Not applicable.