Cross-sectional study links job satisfaction with turnover intention and well-being among Saudi and non-Saudi critical care and emergency nurses

A cross-sectional study of 494 critical care and emergency nurses in five cities in northwestern Saudi Arabia found moderate job satisfaction and turnover intention, with higher job satisfaction associated with lower turnover intention. Non-Saudi nurses reported greater perceived job distress and turnover intention than Saudi nurses, while several employment, physical-health and psychological characteristics were associated with the odds of reporting high job satisfaction.

Researchers recruited registered nurses from intensive care units, coronary care units and emergency departments in governmental and private hospitals in Medina, Tabuk, Jeddah, Makkah and Yanbu. Eligible participants had at least six months of clinical experience in one of these hospital-based settings and could read and understand English. The online survey was conducted from November 2025 through January 2026 using convenience sampling.

Participants completed the 31-item McCloskey/Mueller Satisfaction Scale, the four-item Turnover Intention Scale, the two-item Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2, and a 27-item questionnaire covering eight domains of perceived organizational retention strategies. Job satisfaction was analyzed as a continuous score and categorized for regression, with a mean item score of at least 4.0 treated as high satisfaction. The PHQ-2 and GAD-2 were screening instruments; scores of at least 3 indicated possible symptoms requiring further assessment rather than clinical diagnoses.

Overall, 57.9% of participants had moderate job satisfaction, and 51.8% had moderate turnover intention. The mean job satisfaction score was 3.42 on the five-point item scale, while the mean turnover intention score was 3.21. Job satisfaction and turnover intention were negatively correlated (r = −0.435, p = 0.021), meaning that nurses with higher satisfaction scores tended to report less intention to leave. Because all measures were collected at one point, the study cannot establish which preceded the other or whether either caused the other.

Saudi and non-Saudi nurses differed significantly in perceived job distress and turnover intention. High perceived job distress was reported by 37.5% of non-Saudi nurses and 28.8% of Saudi nurses (p = 0.043), while non-Saudi nurses also had higher turnover intention (p = 0.039). Their mean job satisfaction scores differed only slightly and were not statistically significantly different (p = 0.074). Cardiovascular symptoms were reported more often by Saudi nurses, 35.9% compared with 25.5%, and moderate-to-severe back pain was reported more often by non-Saudi nurses, 38.4% compared with 29.4%.

Multiple logistic regression identified several characteristics associated with high job satisfaction after adjustment for the variables entered into the model. Nurses earning at least 10,000 Saudi Riyals per month had higher odds of high satisfaction (aOR = 2.68, 95% CI 1.21–3.29), as did those working in governmental hospitals (aOR = 3.14, 95% CI 1.27–3.41) and emergency departments (aOR = 1.92, 95% CI 1.09–2.53). Lower perceived job distress (aOR = 2.62, 95% CI 1.73–3.79), absence of anxiety symptoms (aOR = 2.47, 95% CI 1.61–3.58), lower back-pain severity (aOR = 1.86, 95% CI 1.22–2.74), and absence of depressive symptoms (aOR = 1.58, 95% CI 1.02–2.36) were also associated with higher odds of high satisfaction. These were statistical associations, not causal effects.

The most frequently endorsed potential retention strategies were availability of personal protective equipment, reported by 34.0% of nurses; entertainment and recreational activities, 33.6%; flexible working schedules, 33.2%; infection-control protocols and training, 32.2%; and hazard pay during infectious-disease outbreaks, 31.0%. The questionnaire was a descriptive checklist developed by the researchers, and its results represent nurses’ reported preferences rather than measures of implemented interventions or their effects on satisfaction or turnover.

Item-level results showed that the largest proportions of satisfied or very satisfied nurses reported satisfaction with relationships with physicians, work-related social interaction and weekend-off arrangements. The greatest dissatisfaction concerned childcare services, publication opportunities, research opportunities, maternity-leave policies, career advancement and benefit packages. These findings identify reported areas of satisfaction and dissatisfaction but do not show whether particular workplace conditions preceded or resulted from job satisfaction.

The findings require caution because the convenience sample was recruited online, the number of eligible nurses who received the invitation was unknown, and no response rate could be calculated. The sample was limited to selected northwestern hospitals, all measures were self-reported, job satisfaction was dichotomized for regression, and multiple comparisons were made without adjustment for multiple testing. The cross-sectional design cannot establish temporal relationships or causality, and the results may not represent all critical care and emergency nurses in Saudi Arabia.

Subject of Research: Associations of job satisfaction, turnover intention, distress and health with employment characteristics among Saudi and non-Saudi critical care and emergency nurses

Article Title: Job satisfaction among Saudi and Non-Saudi critical care and emergency nurses: associations with psychological distress, turnover intention, and perceived retention strategies

Article References: Saleh, Z. T., Al-Za’areer, M. S., Elshatarat, R. A., Alasmari, A. A., Almagharbeh, W. T., Alshameri, F. A., Zaiton, H., Allugmani, A. R., Aljuhani, B. H., Aloufi, R. S., Al-Sayaghi, K. M., Alsulami, G. S., Amoush, A. H., & Ismail, M. S. (2026). Job satisfaction among Saudi and Non-Saudi critical care and emergency nurses: associations with psychological distress, turnover intention, and perceived retention strategies. BMC Nursing, 25(1), Article 861. https://doi.org/10.1186/s12912-026-05349-6

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05349-6

Keywords: job satisfaction, turnover intention, Saudi nurses, non-Saudi nurses, psychological distress, critical care nursing, emergency nursing, cross-sectional study, workforce retention, satisfaction, Saudi, Non-Saudi