Turnover Intention Among Nurses: The Role of Burnout Dimensions and Interprofessional Relationships With Physicians
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Abstract
Job burnout and the professional relationship between nurses and physicians affect the nurses’ intention to leave their profession and ultimately the quality of care. In this study, we determine the prevalence of turnover intention among nurses and its relationship with personal and occupational characteristics, as well as burnout domains and the professional relationship between nurses and physicians. In this cross-sectional study, 296 nurses from hospitals affiliated with Tehran University of Medical Sciences were selected using a multi-stage sampling method. Burnout is assessed via the Maslach Burnout Inventory. The physician-nurse professional relationship and intention turnover were evaluated using the Shokri and Cammann questionnaires, respectively. SPSS 26 software was applied for data analysis. The rate of turnover intention among nurses was 61.5%. A significant negative relationship was found between the nurse's age, work experience, and number of children and their intention to leave the job. (P<0.01). The turnover intention was higher among nurses with rotating shifts compared to those with fixed shifts (P=0.04). The results of the Pearson correlation analysis revealed a significant positive relationship between the burnout dimensions of emotional exhaustion and depersonalization, and turnover intention (P<0.01), as well as a negative relationship between the dimension of personal achievement and the nurse’s abandonment tendency (P<0.01). Additionally, there was a significant negative relationship between the doctor-nurse professional relationship and nurses’ intention to quit (P<0.01). Our findings indicate that emotional exhaustion and a positive nurse-physician professional relationship significantly increase turnover intention among nurses, while personal accomplishment decreases it. Depersonalization did not have a significant impact on turnover intention. These results highlight the importance of addressing burnout factors and fostering collaborative interprofessional relationships to reduce turnover intention and enhance retention in healthcare settings.
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2. Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Glob Health 2022;7:9316.
3. Heinz D. Hospital nurse staffing and patient outcomes: a review of current literature. Dimens Crit Care Nurs 2004;23:44-50.
4. Buerhaus PI, Donelan K, Ulrich BT, Norman L, DesRoches C, Dittus R. Impact of the nurse shortage on hospital patient care: comparative perspectives. Health Aff Millwood 2007;26:853-62.
5. May JH, Bazzoli GJ, Gerland AM. Hospitals’ responses to nurse staffing shortages. Health Aff Millwood 2006;25:w316-w323.
6. Jones CB. Revisiting nurse turnover costs: adjusting for inflation. J Nurs Adm 2008;38:11-8.
7. Morrell K, Loan-Clarke J, Wilkinson A. Unweaving leaving: The use of models in the management of employee turnover. Int J Manag Rev 2001;3:219-44.
8. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors among nurses: a multi-center cross-sectional study. Front Public Health 2023;11.
9. Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A meta-analysis. Nurs Crit Care 2023;28:159-66.
10. Chan ZCY, Tam WS, Lung MKY, Wong WY, Chau CW. A systematic literature review of nurse shortage and the intention to leave. J Nurs Manag 2013;21:605-13.
11. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors among nurses: a multi-center cross-sectional study. Front Public Health 2023;11.
12. Halter M, Boiko O, Pelone F, Beighton C, Harris R, Gale J, et al. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Serv Res 2017;17.
13. ICD-11 classifies burnout as an occupational condition | Sedgwick. (Accessed at Sep, 02, 2024, https://www.sedgwick.com/blog/icd-11-classifies-burnout-as-an-occupational-condition/?loc=eu.)
14. Young S. Influences of Job Stress and Burnout on Turnover Intention of Nurses. J Korean Acad Nurs Adm 2010;16:507-16.
15. Nantsupawat A, Kunaviktikul W, Nantsupawat R, Wichaikhum OA, Thienthong H, Poghosyan L. Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. Int Nurs Rev 2017;64:91-8.
16. Critical Care Medicine. (Accessed at Sep 02, 2024, https://journals.lww.com/ccmjournal/abstract/1999/09000/association_between_nurse_physician_collaboration.45.aspx.)
17. The Impact of Work Stress on Turnover Intentions among Palliative Care Nurses in Saudi Arabia. Int J Nurs. (Accessed at Sep, 07, 2024, https://ijn.thebrpi.org/vol-6-no-2-december-2019-abstract-8-ijn.)
18. Filian E. Evaluation of burnout and its correlation with coping mechanisms in nurses of educational hospitals of Tehran [dissertation]. Tehran University of Medical Sciences 1993;45.
19. Cleary R. Dictionary of Statistics and Methodology. J Am Stat Assoc 1999;94:657.
20. Shokri A, Yazdan Panah A, Vahdat S. The Professional Relationship between the Nurses and Physicians from their Own Point of View. Arumshcj 2013;15:69-76.
21. Lawler E, Cammann C, Nadler D, Jenkins D. Michigan organizational assessment questionnaire. J Vocat Behav 1979.
22. Hayati D, Neisi A, Arshadi N. The Effect of Pay Satisfaction on Turnover Intention: Mediating Role of Job Satisfaction, Organizational Commitment, and Work Motivation. Psychol Achiev 2012;19:19-42.
23. Heinen MM. Nurses’ intention to leave their profession: a cross sectional observational study in 10 European countries. Int J Nurs Stud 2013;50:174-84.
24. Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A meta-analysis. Nurs Crit Care 2023;28:159-66.
25. Mosadeghrad AM. Occupational Stress and Turnover Intention: Implications for Nursing Management. Int J Health Policy Manag 2013;1:169.
26. Sokhanvar M, Kakemam E, Chegini Z, Sarbakhsh P. Hospital nurses’ job security and turnover intention and factors contributing to their turnover intention: A cross-sectional study. Nurs Midwifery Stud 2018;7:133.
27. Ariapooran S, Mosavi SV, Amirimanesh M. Turnover Intention of Nurses in the outbreak of COVID-19: The Role of Compassion Fatigue, Compassion Satisfaction and Burnout. Q J Nurs Manag 2021;10:80-93.
28. Takase M, Teraoka S, Yabase K. Retaining the nursing workforce: factors contributing to the reduction of nurses’ turnover intention in Japan. J Nurs Manag 2016;24:21-9.
29. Takase M, Teraoka S, Yabase K. Retaining the nursing workforce: factors contributing to the reduction of nurses’ turnover intention in Japan. J Nurs Manag 2016;24:21-9.
30. He R, Liu J, Zhang WH, Zhu B, Zhang N, Mao Y. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open 2020;10.
31. Kaddourah B, Abu-Shaheen AK, Al-Tannir M. Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: A cross-sectional survey. BMC Nurs 2018;17:1-7.
32. Haji Mohammad Hoseini M, Asayesh H, Amaniyan S, Sharififard F, Elahi A, Yaghoubi Kopaie S. Role conflict and role ambiguity as predictors of turnover intention among nurses. J Nurs Midwifery Sci 2021;8:49-53.
33. Yu M, Kang KJ. Factors affecting turnover intention for new graduate nurses in three transition periods for job and work environment satisfaction. J Contin Educ Nurs 2016;47:120-31.
34. Ayalew F. Factors Affecting Turnover Intention among Nurses in Ethiopia. World Health Popul 2015;16:62-74.
35. Halter M. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Serv Res 2017;17.
36. Kim SO, Moon SH. Factors Influencing Turnover Intention among Male Nurses in Korea. Int J Environ Res Public Health 2021;18:9862.
37. Chen H, Li G, Li M, Lyu L, Zhang T. A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China. Int J Nurs Sci 2018;5:396-402.
38. Cao J, et al. Nurses’ turnover intention and associated factors in general hospitals in China: A cross-sectional study. J Nurs Manag 2021;29:1613-22.
39. Kavaklı BD, Yildirim N. The relationship between workplace incivility and turnover intention in nurses: A cross-sectional study. J Nurs Manag 2022;30:1235-42.
40. Ki J, Ryu J, Baek J, Huh I, Choi-Kwon S. Association between Health Problems and Turnover Intention in Shift Work Nurses: Health Problem Clustering. Int J Environ Res Public Health 2020;17:4532.
41. Shimizu T, Eto R, Horiguchi I, Obata Y, Feng Q, Nagata S. Relationship between turnover and periodic health check-up data among Japanese hospital nurses: a three-year follow-up study. J Occup Health 2005;47:327-33.
42. Yan S, et al. The prevalence of turnover intention and influencing factors among emergency physicians: a national observation. Hum Resour Health 2021;19:1-9.
43. Wang S, Liu Y, Wang L. Nurse burnout: personal and environmental factors as predictors. Int J Nurs Pract 2015;21:78-86.
44. Spooner-Lane R, Patton W. Determinants of burnout among public hospital nurses. Aust J Adv Nurs 2007;25:8-16.
45. Kar S, Suar D. Role of Burnout in the Relationship between Job Demands and Job Outcomes among Indian Nurses. Indian J Public Adm 2014;39:23-37.
46. Malach-Pines A. Nurses’ burnout: an existential psychodynamic perspective. J Psychosoc Nurs Ment Health Serv 2000;38:23-31.
47. Karimi L, Raei M, Parandeh A. Association Between Dimensions of Professional Burnout and Turnover Intention Among Nurses Working in Hospitals During Coronavirus Disease (COVID-19) Pandemic in Iran Based on Structural Model. Front Public Health 2022;10:860264.
48. Xiaoming Y, Ma BJ, Chang CL, Shieh CJ. Effects of workload on burnout and turnover intention of medical staff: A study. Stud Ethno-Med 2014;8:229-37.
49. Ran L, Chen X, Peng S, Zheng F, Tan X, Duan R. Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction. BMJ Open 2020;10.
50. Lee SY, Kim CW, Kang JH, Yoon TH, Kim CS. Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention. J Prev Med Public Health 2014;47:258.
51. Poku CA, Donkor E, Naab F. Impacts of Nursing Work Environment on Turnover Intentions: The Mediating Role of Burnout in Ghana. Nurs Res Pract 2022;2022:1310508.
2. Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Glob Health 2022;7:9316.
3. Heinz D. Hospital nurse staffing and patient outcomes: a review of current literature. Dimens Crit Care Nurs 2004;23:44-50.
4. Buerhaus PI, Donelan K, Ulrich BT, Norman L, DesRoches C, Dittus R. Impact of the nurse shortage on hospital patient care: comparative perspectives. Health Aff Millwood 2007;26:853-62.
5. May JH, Bazzoli GJ, Gerland AM. Hospitals’ responses to nurse staffing shortages. Health Aff Millwood 2006;25:w316-w323.
6. Jones CB. Revisiting nurse turnover costs: adjusting for inflation. J Nurs Adm 2008;38:11-8.
7. Morrell K, Loan-Clarke J, Wilkinson A. Unweaving leaving: The use of models in the management of employee turnover. Int J Manag Rev 2001;3:219-44.
8. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors among nurses: a multi-center cross-sectional study. Front Public Health 2023;11.
9. Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A meta-analysis. Nurs Crit Care 2023;28:159-66.
10. Chan ZCY, Tam WS, Lung MKY, Wong WY, Chau CW. A systematic literature review of nurse shortage and the intention to leave. J Nurs Manag 2013;21:605-13.
11. Liu Y, Duan Y, Guo M. Turnover intention and its associated factors among nurses: a multi-center cross-sectional study. Front Public Health 2023;11.
12. Halter M, Boiko O, Pelone F, Beighton C, Harris R, Gale J, et al. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Serv Res 2017;17.
13. ICD-11 classifies burnout as an occupational condition | Sedgwick. (Accessed at Sep, 02, 2024, https://www.sedgwick.com/blog/icd-11-classifies-burnout-as-an-occupational-condition/?loc=eu.)
14. Young S. Influences of Job Stress and Burnout on Turnover Intention of Nurses. J Korean Acad Nurs Adm 2010;16:507-16.
15. Nantsupawat A, Kunaviktikul W, Nantsupawat R, Wichaikhum OA, Thienthong H, Poghosyan L. Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. Int Nurs Rev 2017;64:91-8.
16. Critical Care Medicine. (Accessed at Sep 02, 2024, https://journals.lww.com/ccmjournal/abstract/1999/09000/association_between_nurse_physician_collaboration.45.aspx.)
17. The Impact of Work Stress on Turnover Intentions among Palliative Care Nurses in Saudi Arabia. Int J Nurs. (Accessed at Sep, 07, 2024, https://ijn.thebrpi.org/vol-6-no-2-december-2019-abstract-8-ijn.)
18. Filian E. Evaluation of burnout and its correlation with coping mechanisms in nurses of educational hospitals of Tehran [dissertation]. Tehran University of Medical Sciences 1993;45.
19. Cleary R. Dictionary of Statistics and Methodology. J Am Stat Assoc 1999;94:657.
20. Shokri A, Yazdan Panah A, Vahdat S. The Professional Relationship between the Nurses and Physicians from their Own Point of View. Arumshcj 2013;15:69-76.
21. Lawler E, Cammann C, Nadler D, Jenkins D. Michigan organizational assessment questionnaire. J Vocat Behav 1979.
22. Hayati D, Neisi A, Arshadi N. The Effect of Pay Satisfaction on Turnover Intention: Mediating Role of Job Satisfaction, Organizational Commitment, and Work Motivation. Psychol Achiev 2012;19:19-42.
23. Heinen MM. Nurses’ intention to leave their profession: a cross sectional observational study in 10 European countries. Int J Nurs Stud 2013;50:174-84.
24. Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A meta-analysis. Nurs Crit Care 2023;28:159-66.
25. Mosadeghrad AM. Occupational Stress and Turnover Intention: Implications for Nursing Management. Int J Health Policy Manag 2013;1:169.
26. Sokhanvar M, Kakemam E, Chegini Z, Sarbakhsh P. Hospital nurses’ job security and turnover intention and factors contributing to their turnover intention: A cross-sectional study. Nurs Midwifery Stud 2018;7:133.
27. Ariapooran S, Mosavi SV, Amirimanesh M. Turnover Intention of Nurses in the outbreak of COVID-19: The Role of Compassion Fatigue, Compassion Satisfaction and Burnout. Q J Nurs Manag 2021;10:80-93.
28. Takase M, Teraoka S, Yabase K. Retaining the nursing workforce: factors contributing to the reduction of nurses’ turnover intention in Japan. J Nurs Manag 2016;24:21-9.
29. Takase M, Teraoka S, Yabase K. Retaining the nursing workforce: factors contributing to the reduction of nurses’ turnover intention in Japan. J Nurs Manag 2016;24:21-9.
30. He R, Liu J, Zhang WH, Zhu B, Zhang N, Mao Y. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open 2020;10.
31. Kaddourah B, Abu-Shaheen AK, Al-Tannir M. Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: A cross-sectional survey. BMC Nurs 2018;17:1-7.
32. Haji Mohammad Hoseini M, Asayesh H, Amaniyan S, Sharififard F, Elahi A, Yaghoubi Kopaie S. Role conflict and role ambiguity as predictors of turnover intention among nurses. J Nurs Midwifery Sci 2021;8:49-53.
33. Yu M, Kang KJ. Factors affecting turnover intention for new graduate nurses in three transition periods for job and work environment satisfaction. J Contin Educ Nurs 2016;47:120-31.
34. Ayalew F. Factors Affecting Turnover Intention among Nurses in Ethiopia. World Health Popul 2015;16:62-74.
35. Halter M. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Serv Res 2017;17.
36. Kim SO, Moon SH. Factors Influencing Turnover Intention among Male Nurses in Korea. Int J Environ Res Public Health 2021;18:9862.
37. Chen H, Li G, Li M, Lyu L, Zhang T. A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China. Int J Nurs Sci 2018;5:396-402.
38. Cao J, et al. Nurses’ turnover intention and associated factors in general hospitals in China: A cross-sectional study. J Nurs Manag 2021;29:1613-22.
39. Kavaklı BD, Yildirim N. The relationship between workplace incivility and turnover intention in nurses: A cross-sectional study. J Nurs Manag 2022;30:1235-42.
40. Ki J, Ryu J, Baek J, Huh I, Choi-Kwon S. Association between Health Problems and Turnover Intention in Shift Work Nurses: Health Problem Clustering. Int J Environ Res Public Health 2020;17:4532.
41. Shimizu T, Eto R, Horiguchi I, Obata Y, Feng Q, Nagata S. Relationship between turnover and periodic health check-up data among Japanese hospital nurses: a three-year follow-up study. J Occup Health 2005;47:327-33.
42. Yan S, et al. The prevalence of turnover intention and influencing factors among emergency physicians: a national observation. Hum Resour Health 2021;19:1-9.
43. Wang S, Liu Y, Wang L. Nurse burnout: personal and environmental factors as predictors. Int J Nurs Pract 2015;21:78-86.
44. Spooner-Lane R, Patton W. Determinants of burnout among public hospital nurses. Aust J Adv Nurs 2007;25:8-16.
45. Kar S, Suar D. Role of Burnout in the Relationship between Job Demands and Job Outcomes among Indian Nurses. Indian J Public Adm 2014;39:23-37.
46. Malach-Pines A. Nurses’ burnout: an existential psychodynamic perspective. J Psychosoc Nurs Ment Health Serv 2000;38:23-31.
47. Karimi L, Raei M, Parandeh A. Association Between Dimensions of Professional Burnout and Turnover Intention Among Nurses Working in Hospitals During Coronavirus Disease (COVID-19) Pandemic in Iran Based on Structural Model. Front Public Health 2022;10:860264.
48. Xiaoming Y, Ma BJ, Chang CL, Shieh CJ. Effects of workload on burnout and turnover intention of medical staff: A study. Stud Ethno-Med 2014;8:229-37.
49. Ran L, Chen X, Peng S, Zheng F, Tan X, Duan R. Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction. BMJ Open 2020;10.
50. Lee SY, Kim CW, Kang JH, Yoon TH, Kim CS. Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention. J Prev Med Public Health 2014;47:258.
51. Poku CA, Donkor E, Naab F. Impacts of Nursing Work Environment on Turnover Intentions: The Mediating Role of Burnout in Ghana. Nurs Res Pract 2022;2022:1310508.
| Files | ||
| Issue | Vol 63 No 3 (2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/acta.v63i3.19717 | |
| Keywords | ||
| Burnout Nurses Personnel turnover Interprofessional relations | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Faghirpour N, Khajehnasiri F, Effatpanah M. Turnover Intention Among Nurses: The Role of Burnout Dimensions and Interprofessional Relationships With Physicians. Acta Med Iran. 2025;63(3):171-179.
