The researchers recruited 143 nurses working in governmental and private healthcare organizations across 13 regions of Saudi Arabia. This geographic spread matters, because it captures the diversity of a health system that has been expanding rapidly under national transformation programs aimed at improving care quality and workforce stability. Participants completed two validated instruments: the Hospital Ethical Climate Survey, known as the HECS, which measures how nurses perceive the ethical environment of their organizations, and the Turnover Intention Scale, which quantifies the strength of a nurse’s thoughts about quitting. A cross-sectional, correlational design means the data capture a single moment in time, revealing associations rather than proving cause and effect, but the statistical relationships uncovered are robust enough to carry real weight for hospital administrators.

The statistical core of the study rests on a moderate negative correlation between ethical climate scores and turnover intention. The Pearson correlation coefficient was −0.483, with a p-value below 0.001, indicating that as nurses’ perceptions of their hospital’s ethical environment improved, their intention to leave declined in a statistically reliable way. In practical terms, a correlation of this magnitude suggests that roughly a quarter of the variability in turnover intention moves in tandem with how ethically sound nurses judge their workplaces to be. That is a substantial effect in organizational research, where many psychological and structural factors compete to explain why employees consider resignation.

When the researchers built a regression model combining ethical climate scores with sociodemographic variables, the result sharpened the message further. Hospital ethical climate emerged as the only significant predictor of turnover intention, with a standardized beta coefficient of −0.490 and a p-value below 0.001. The full model explained 25.5 percent of the variance in turnover intention, with an adjusted R-squared of 0.216. In plain language, more than a fifth of the differences in nurses’ desire to quit could be traced to measurable factors in this study, and the ethical environment outweighed every demographic characteristic tested. Age, experience, and other personal variables did not reach statistical significance once the ethical climate was accounted for.

Not all units were equal, however. Nurses working in oncology reported significantly higher turnover intention than their colleagues in intensive care and emergency departments, with a one-way analysis of variance yielding F = 3.34 and p = 0.038. This finding deserves attention from anyone who has spent time on an oncology ward. Oncology nurses manage prolonged relationships with patients whose trajectories often bend toward decline, navigate frequent end-of-life conversations, and shoulder the emotional labor of balancing hope with honesty. The study’s authors note that a positive ethical environment has previously been associated with improved job satisfaction and reduced turnover intention, and their new data suggest oncology settings may be where that protective effect is most needed.

The concept of ethical climate refers to the shared perception among staff about how their organization typically handles moral questions: whether managers model integrity, whether nurses feel safe raising concerns, whether conflicts between patient welfare and institutional pressures are resolved fairly. Researchers generally treat it as an organizational property rather than an individual trait, which is precisely why it is actionable. Unlike personality or personal circumstances, an ethical climate can be deliberately cultivated through leadership behavior, ethics committees, open reporting channels, and training. The study’s conclusion points in exactly this direction, recommending that healthcare organizations implement strategic interventions, including ethics training, to promote positive ethical climates that support effective retention of the nursing workforce.

The global context makes these findings resonate far beyond Saudi Arabia. Health systems worldwide have been grappling with nursing shortages intensified by pandemic-era burnout, and turnover intention is widely used in the literature as an early warning signal, because stated intent to leave often precedes actual resignation. Every departure of an experienced intensive care, oncology, or emergency nurse removes institutional memory, disrupts team cohesion, and imposes recruitment and orientation costs that can take months to recover. If a quarter of the variation in that intention traces back to something as tractable as the ethical environment, the economics of investing in ethics become compelling for hospital boards.

The methodological choices of the study strengthen confidence in its measurements. The Hospital Ethical Climate Survey is an established instrument designed specifically for nursing populations, and pairing it with the Turnover Intention Scale allows direct comparison with a broad body of prior research. The anonymity safeguards were rigorous: the online survey platform collected no identifying information, including names or hospital affiliations, and informed consent was obtained before participation. Institutional review board approval came from the Ethics Committee of King Saud University under reference KSU-HE-25-1405, and the study was conducted in accordance with the Declaration of Helsinki. Data were stored on a password-protected computer accessible only to the primary investigator and destroyed when the study concluded.

As with any cross-sectional design, some caveats apply. Because perceptions and intentions were measured at the same moment, the study cannot definitively establish that a poor ethical climate causes nurses to consider leaving; it is theoretically possible that nurses already inclined to leave rate their workplaces more harshly. The sample of 143 nurses, while drawn from 13 regions and both public and private sectors, is modest relative to the national nursing workforce, and the three specialty units studied, though high-acuity, do not represent all nursing roles. Longitudinal follow-up would help confirm the direction of the relationship and test whether improvements in ethical climate actually produce measurable drops in resignation over time.

Even with those limitations, the practical implications are clear and immediate. Hospital leaders who want to retain nurses in their most demanding units should look first at the moral fabric of the organization rather than assuming that demographics or unit assignment seal a nurse’s fate. Structured ethics training, visible support for nurses who raise moral concerns, fair handling of end-of-life conflicts, and leadership that models ethical behavior are concrete levers suggested by this evidence. The study, funded through the Ongoing Research Funding Program at King Saud University, adds to a growing consensus in nursing science: nurses stay where they feel their hospital stands for something. In an era when every retained nurse matters, ethical climate is not a soft abstraction but a measurable, manageable determinant of workforce survival.

Subject of Research: The relationship between hospital ethical climate and turnover intention among acute care nurses

Article Title: The impact of hospital ethical climate on turnover intention among nurses working in intensive care, oncology, and emergency department units: a cross sectional study

Article References: Hakamy, E., & Alharbi, A. (2026). The impact of hospital ethical climate on turnover intention among nurses working in intensive care, oncology, and emergency department units: a cross sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05397-y

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05397-y

Keywords: nursing, ethical climate, turnover intention, hospital ethics, intensive care, oncology, emergency department, nurse retention, cross-sectional study, Saudi Arabia, job satisfaction, moral distress

The research team, led by Maha Sanat Alreshidi of the University of Hail and colleagues from several Saudi universities, set out to test a deceptively simple question: does a nurse’s commitment to their organization protect against the intention to quit, and how do perceptions of the work environment shape that decision? Turnover intention is widely used in nursing research as a proxy for actual attrition, because the psychological act of deciding to leave typically precedes the resignation itself. By identifying which factors weaken that intention, administrators can intervene before nurses walk out the door, a window that matters enormously in high-risk units where a single departure can destabilize an entire team.

The study focused on registered nurses employed in five public hospitals in Hail City, in northern Saudi Arabia. The sample was deliberately weighted toward high-pressure clinical settings: roughly a third of respondents worked in emergency departments and nearly a fifth in acute care units, environments the authors identify as being at particularly high risk for both turnover and the patient safety consequences that follow it. Data were collected between June and July 2025 through an electronic survey administered on a secure, encrypted website, allowing nurses across all clinical areas to participate. The study received ethics approval from the University of Hail’s institutional review board and was conducted in accordance with the Declaration of Helsinki, with informed consent obtained from all participants.

Methodologically, the researchers combined descriptive statistics with Pearson’s correlation analysis and multiple regression modeling. Correlation analysis allowed them to measure the strength and direction of associations between perceived work environment, organizational commitment, and turnover intention. Multiple regression then went a step further, testing whether the two predictor variables explained a meaningful share of the variance in turnover intention when considered together, and which of them carried independent predictive weight. This distinction matters: two variables can both correlate with an outcome, yet only one may contribute uniquely once their overlap with the other is statistically accounted for.

The correlational results were striking. Perceived work environment correlated positively and strongly with organizational commitment, with a Pearson’s r of 0.58, a value that in behavioral research is generally considered a substantial association. Both variables correlated negatively with turnover intention, meaning that nurses who viewed their environment more favorably and felt more committed to their organizations were less likely to say they intended to leave. Taken at face value, this pattern seems to confirm the intuitive story: better workplaces produce happier, more loyal nurses who stay.

But the regression analysis complicated that narrative. Together, perceived work environment and organizational commitment explained approximately 10.9 percent of the variance in turnover intention, a statistically significant result with an F statistic of 22.08 across 2 and 361 degrees of freedom and a p value below 0.001. Yet when the two predictors competed within the same model, only organizational commitment emerged as a statistically significant independent predictor, with a standardized beta of -0.245 and p below 0.001. The perceived work environment fell just short of significance, with a beta of -0.12 and a p value of 0.051, hovering at the conventional threshold. In practical terms, once the researchers controlled for how committed nurses felt to their organizations, the perceived quality of the work environment added little unique predictive power.

The authors interpret this as evidence that organizational commitment functions as a modifiable protective factor, and crucially, one that sits under the direct control of hospital administrators. Commitment, in the organizational psychology literature, is generally understood as a psychological state that binds an employee to an institution, encompassing emotional attachment, perceived obligation, and awareness of the costs of leaving. Unlike personality traits or demographic characteristics, it can be strengthened through management practices: involving nurses in decision-making, recognizing their contributions, providing professional development, and demonstrating that the institution values their wellbeing. The Hail findings suggest that investments in these areas may yield retention dividends that physical improvements alone cannot match.

The study’s most provocative implication is that improving the work environment may have limited effectiveness if organizational commitment is not developed alongside it. This does not mean the work environment is irrelevant; its strong correlation with commitment suggests the two are intertwined, and a poor environment likely erodes commitment over time. Rather, the point is one of causal hierarchy and intervention design: policies that upgrade conditions without addressing the relational and psychological bond between nurse and institution may be building on sand. A nurse can work in a well-equipped, adequately staffed unit and still leave if they feel no loyalty to the organization behind it, while a deeply committed nurse may tolerate imperfect conditions because their identity and obligations are tied to the institution.

Translating these findings into policy, the authors recommend developing national nursing workforce retention standards that require the integration of commitment measures into hospital performance frameworks. In practice, this would mean hospitals routinely measuring organizational commitment the way they measure infection rates or patient satisfaction, treating it as a key performance indicator of workforce health. They also call for early warning systems in risk management: systematic identification of turnover risk based on individual nurses’ commitment levels, paired with targeted interventions for those in high-risk units such as emergency departments and acute care. Such systems would essentially function as predictive dashboards, flagging units or individuals where commitment has dropped below a threshold before resignations cascade.

The study has limitations worth noting. It captured turnover intention rather than actual resignations, and its cross-sectional design, with data collected over a single two-month window, cannot establish whether low commitment causes nurses to leave or whether nurses who have already decided to go simply report lower commitment. The sample, drawn from public hospitals in one Saudi city, may not generalize to private healthcare systems or other countries, and the model’s 10.9 percent of explained variance makes clear that most of what drives turnover intention lies outside these two variables, in factors such as pay, family circumstances, career opportunities, and burnout that the study did not measure. Still, the core message is actionable and timely. As health systems worldwide compete for a finite pool of nurses, the Hail results argue that retention is not merely a matter of better conditions but of building institutions that nurses genuinely want to belong to, and that this bond, once measured and managed, may be the most powerful retention tool an administrator possesses.

Subject of Research: The relationship between organizational commitment, perceived work environment, and turnover intention among hospital nurses in Saudi Arabia

Article Title: Organizational commitment as a correlate of turnover intention among nurses: implications for workforce retention and policy

Article References: Alreshidi, M. S., Alotni, M. A., Sankarapandian, C., Alamri, A. A., Gonzales, A., Gutierrez, J., Alatawi, N. A. H., Alasmari, A. A., Alharbi, A. A., Alreshidi, A. N., Thagam, M. M. N., Alrashidi, N. A., & Dominguez, A. J. (2026). Organizational commitment as a correlate of turnover intention among nurses: implications for workforce retention and policy. BMC Nursing. https://doi.org/10.1186/s12912-026-05413-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05413-1

Keywords: nurse retention, turnover intention, organizational commitment, work environment, Saudi Arabia, public hospitals, nursing workforce, patient safety, healthcare policy, workforce risk management, BMC Nursing, nursing research

The study was conducted by researchers affiliated with Kurdistan University of Medical Sciences in Sanandaj, Iran, together with a biostatistician at Hamadan University of Medical Sciences. They set out to answer a question that has become urgent for ministries of health worldwide: why do nurses decide to move abroad, and can anything short of a salary overhaul change their minds? Nurse migration is a double-edged phenomenon. For the country of origin, the departure of trained nurses drains the healthcare system of experienced clinicians who are expensive to replace and slow to substitute. For destination countries, large inflows can ease shortages but also create integration challenges and raise ethical questions about recruiting from systems that can least afford to lose staff. Understanding what drives the decision to leave is therefore crucial for corrective planning on both sides of the border.

To measure the phenomenon, the team used a cross-sectional design, surveying 424 nurses working in Iran. Participants completed three instruments: a demographic information form capturing characteristics such as age, sex, income, professional experience, and whether they had relatives living abroad; the Perceived Clinical Nurses’ Professional Dignity Scale, a validated instrument that quantifies how much dignity nurses feel their profession commands; and a Migration Intention Questionnaire that scores the strength of a nurse’s desire to move to another country. The researchers analyzed the data in SPSS version 16, reporting means, standard deviations, frequencies, and percentages. Because the score distributions were not normally distributed, they relied on non-parametric methods for bivariate comparisons, including Spearman’s correlation coefficient, the Mann–Whitney U test, and the Kruskal–Wallis test, before entering candidate predictors into a multiple linear regression model. A p-value below 0.05 was treated as statistically significant throughout.

The headline numbers tell a story of moderation on both sides. The mean migration intention score was 129.36 with a standard deviation of 28.04, and the mean professional dignity score was 64.27 with a standard deviation of 15.76, levels the authors characterize as moderate. In other words, the average nurse in this sample neither harbors an overwhelming urge to emigrate nor feels fully honored in their professional identity. That middle ground, however, is exactly where retention policy can matter most: nurses sitting at moderate levels of both dignity and migration intention are the ones who could tip either way depending on how their workplaces and health systems treat them.

The regression analysis then isolated which factors independently tracked with migration intention, and the results were revealing. Lower organizational dignity, one of the components of the professional dignity scale, was associated with higher migration intention, with a regression coefficient of −0.87 and a p-value below 0.001, making it the strongest independent factor in the model. Income satisfaction also mattered, but in a nuanced way. Compared with nurses reporting very low income satisfaction, those reporting low satisfaction and those reporting high satisfaction both showed significantly higher migration intention, with p-values of 0.001 and 0.002 respectively. The pattern suggests the relationship between pay and the desire to leave is not a simple straight line; the reference group of very dissatisfied nurses may already feel disengaged, while even highly satisfied nurses may see opportunities elsewhere, leaving the middle of the distribution as the zone of relative stability.

Social ties emerged as a second powerful lever. Nurses who had relatives living abroad scored, on average, 7.39 points higher on migration intention, a difference that was statistically significant at p = 0.002. This finding fits a well-established picture in migration research: established family networks abroad lower the practical and psychological barriers to moving by providing housing, job information, and emotional support in the destination country. Migration, in this sense, is partly a network phenomenon, and a nurse’s decision calculus includes not only workplace conditions at home but also the presence of a ready-made landing pad overseas.

Experience, by contrast, worked in the opposite direction. Nurses with more years of professional experience reported lower migration intention, an association that was highly significant at p < 0.001. The interpretation is intuitive: career longevity tends to anchor clinicians in their professional communities, their workplaces, and their home countries, while younger nurses with portable skills and fewer local ties face lower costs of relocation. For health planners, this implies that the window for retention efforts may be early in a nurse’s career, before the decision to leave has crystallized.

Taken together, the findings demonstrate a significant inverse association between nurses’ professional dignity and their migration intention: the more dignity nurses perceive, the less they want to leave. The authors emphasize that organizational dignity, the sense of being valued by the institution one works for, emerged as the strongest independent factor alongside income satisfaction and the presence of relatives abroad. This carries a practical implication that is both encouraging and demanding. Unlike macroeconomic conditions or exchange rates, organizational dignity is something hospital management can influence directly, through supportive leadership, fair treatment, recognition of professional contributions, and workplace cultures that treat nurses as respected clinicians rather than interchangeable labor. The study’s conclusion underscores the importance of organizational and economic strategies aimed at strengthening professional dignity, particularly through supportive management.

The economic dimension deserves its own reading. The finding that higher income satisfaction was associated with lower migration intention highlights its potential relevance to workforce stability, even if the relationship with migration intention proved more complicated than a simple pay-more-retain-more formula. Compensation policy interacts with dignity: pay that signals genuine professional worth may reinforce a nurse’s sense of being valued, while pay perceived as inadequate can erode it. For countries that are net exporters of nursing talent, the study suggests that retention strategies built solely on financial incentives may miss the deeper driver, and that investments in respectful, dignified working environments could yield returns that salary adjustments alone cannot achieve.

The research comes with the usual caveats of its design. As a cross-sectional study, it captures a snapshot in time and can identify associations, not prove that low dignity causes migration intention; nurses contemplating leaving may, for instance, retrospectively rate their workplace as less dignified. The sample was drawn from nurses in Iran, and while the mechanisms it probes, dignity, income, family networks, and experience, are plausibly general, the specific weights of each factor may differ across health systems and economies. Still, the study’s methodology was rigorous within its scope: it was conducted in accordance with the Declaration of Helsinki, approved by the Ethics Committee of Kurdistan University of Medical Sciences, and all participants gave written informed consent with data anonymity preserved. The authors declared no competing interests and received no external funding. As health systems worldwide continue to lose nurses to wealthier destinations, the message of this study is quietly radical: the cheapest and most powerful retention tool available to any hospital may be the everyday practice of treating its nurses with the dignity their profession deserves.

Subject of Research: The association between nurses' professional dignity, job-related factors, and migration intention

Article Title: Correlation between professional dignity and job-related factors with migration intention in nurses: a cross-sectional study

Article References: Zarei, M. F., Mahmudi, M., Mohammadi, T., & Vatandost, S. (2026). Correlation between professional dignity and job-related factors with migration intention in nurses: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05465-3

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05465-3

Keywords: nursing, migration intention, professional dignity, organizational dignity, income satisfaction, health workforce, cross-sectional study, Iran, nurse retention, health policy, BMC Nursing, workforce stability

The study, led by Åsa Tjulin of Mid Sweden University together with colleagues including Ann Rudman, interviewed 13 final-year nursing students from four Swedish universities between February and May 2025. Using semi-structured interviews conducted over Zoom—three individual sessions and four small-group interviews averaging around 80 minutes each—the researchers explored how students construct the notion of an attractive workplace during clinical placements. The Swedish nursing programme, a three-year bachelor’s degree of 180 ECTS credits, includes roughly 43 weeks of clinical practice in line with European Union requirements that at least half of training be clinically oriented. That substantial immersion in real healthcare settings, the researchers argue, makes placements a critical and previously underexamined arena where career decisions quietly take shape.

The analysis employed reflexive thematic analysis, an inductive, data-driven approach situated within a constructionist epistemology, meaning the researchers treated meaning as co-produced through participants’ accounts and their own interpretative work. Three authors engaged collaboratively and recursively in data familiarisation, coding, and theme development, treating coding as an evolving interpretative process rather than the application of a fixed frame. What emerged from this process was a striking four-part structure—Becoming, Belonging, Balancing, and Beyond—unified under an overarching pattern the researchers describe as looking ahead: workplace attractiveness as a socialisation process.

The first theme, Becoming, captures how decisively the quality of a student’s introduction shapes their verdict on a workplace. Students described placements where no one knew who they were, where no schedule existed, and where they did not even know whom to shadow. One student recalled receiving no introduction at all and concluded bluntly: ‘I’m never coming back here.’ Conversely, workplaces that offered structured onboarding—a list of key concepts, a group introduction, a clear schedule—produced an immediate sense of security. The supervisor emerged as the pivotal figure, capable of transforming a placement through warmth, tailored learning challenges, and expressed confidence in the student’s abilities. ‘My supervisor didn’t see me as a student but as a colleague in training—that made all the difference,’ one participant explained. Where supervision was absent or delegated to newly graduated nurses still uncomfortable with workplace routines themselves, students reported insecurity, passivity, and a corrosive sense of being unwanted.

The second theme, Belonging, revealed that the most enduring impressions of a workplace rarely concerned workload or patient cases at all. Instead, they revolved around co-workers: the person who asked how you were feeling, protected time for a coffee break, or created moments when the team genuinely felt like a team. Students described the significance of tone, jargon, and lunch-table dynamics, and singled out teams where mutual support was evident and questions were welcomed. ‘If you have a good manager and a good team, then for me personally, the other things are somewhat secondary,’ one student said. The inverse was equally powerful. Environments marked by gossip, complaints, and subtle exclusion created emotional distance that no engaging clinical task could overcome. As one student put it: ‘It wasn’t the patients who discouraged me—it was the colleagues.’

The third theme, Balancing, addressed the practical architecture of a sustainable working life. Students found workplaces attractive when schedules, geographical location, and organisational support could be reconciled with personal life and family obligations. Placements exposed them to the striking diversity of scheduling practices across primary care centres, hospital wards, emergency departments, and ambulance services, prompting reflection on how working hours would fit with leisure and family. Some discovered, with relief, that not all healthcare work meant evenings and weekends. Proximity to home and family emerged as vital for both emotional well-being and logistical sustainability, particularly for students with children or those hoping to remain in rural hometowns without sacrificing professional opportunity. Manageable workloads that allowed breaks, recovery, and reflection with supervisors fostered a sense of camaraderie—moments of laughter and genuine inquiry about one’s well-being that students read as signals of a workplace worth joining.

The fourth theme, Beyond, concerned growth and the future. Attractiveness was closely linked to optimism about professional development, to the desire not to ‘become another number in the region’s workforce statistics’ but to shape one’s own path with organisational support. Yet this theme also exposed a tension at the heart of clinical placements: the collision between education and recruitment. Students described being courted directly or subtly, sometimes within days of arriving, with phrases like ‘You’re welcome back later’ or ‘We’re looking for people.’ Some found these gestures affirming; others felt reduced to a staffing resource rather than a learner. ‘It felt like they mainly needed staff—not that they cared about how I was doing as a student,’ one participant said. Students also expressed ambivalence about temporary agency nursing, acknowledging its higher wages and scheduling freedom while worrying that fragmented teams, high turnover, and diminished continuity undermined both care quality and their own prospects for growth and belonging.

The researchers interpret these findings through the lens of organisational socialisation theory, which holds that successful adaptation to a workplace depends on three core processes: task mastery, role clarity, and social acceptance. These processes are known to predict well-being, performance, and retention among employees. The new study extends that framework backwards in time, showing that the evaluative work underlying recruitment and retention begins before employment does. The findings also draw on social identity theory, suggesting that when students are treated as future colleagues, they experience a shift in self-categorisation—from peripheral outsiders to legitimate members of the professional in-group. Being addressed as a colleague provides symbolic confirmation that the workplace recognises their potential to become nurses within it, and attractiveness functions as an assessment of whether that professional identity is realistically inhabitable there. Workplaces characterised by high turnover and fragmented teams were met with scepticism precisely because they offered unstable ground for identification.

The implications reach well beyond nursing education. With the World Health Organization and successive workforce reports documenting persistent global nursing shortages and turnover, the study suggests that recruitment strategies focused solely on structural reforms or employer branding may miss the point. Attractiveness, in this account, is not a fixed attribute of an organisation but a dynamic, relational process constructed through everyday interactions—being acknowledged, invited into conversation, entrusted with meaningful responsibility. The authors recommend structured onboarding that begins before placement, dedicated primary supervisors backed by additional support, regular feedback and reflection, and active inclusion in the wider team. Nurse managers, they argue, must ensure supervisors are formally appointed, adequately prepared, and given time and resources, while keeping educational goals primary so that staffing needs do not overshadow learning. Educational institutions, meanwhile, should help students articulate and critically examine their emerging perceptions rather than leaving those evaluations implicit.

The authors acknowledge limitations: the findings are situated in Swedish nursing education and may transfer differently to other national contexts, all participants were final-year students approaching graduation, and the Zoom-based, partly group-interview format may have shaped disclosure. Even so, the central message carries weight for any healthcare system confronting workforce crisis. Students are not waiting until graduation to evaluate employers; they are deciding, week by week and interaction by interaction, whether a workplace is somewhere they can imagine a sustainable professional life. Attractiveness, the study concludes, is not a promise a workplace makes but a lived practice it either sustains or squanders—one coffee break, one introduction, one moment of recognition at a time.

Subject of Research: How nursing students construct workplace attractiveness during clinical placements

Article Title: ‘Is This the Workplace for Me?’ A Qualitative Study of Nursing Students' Construction of Workplace Attractiveness in Clinical Placement

Article References: Tjulin, Å., Cederlund, J., Chaikiat Ståhl, Å., Brulin, E., Landstad, B. J., Jacobsson, M., Härgestam, M., & Rudman, A. (2026). ‘Is This the Workplace for Me?’ A Qualitative Study of Nursing Students' Construction of Workplace Attractiveness in Clinical Placement. Nursing Open, 13(10), Article e70868. https://doi.org/10.1002/nop2.70868

Image Credits: AI Generated

DOI: 10.1002/nop2.70868

Keywords: nursing students, clinical placement, workplace attractiveness, organisational socialisation, qualitative research, thematic analysis, nurse retention, workforce recruitment, supervision, belonging, social identity theory, healthcare workforce

The Anticipated Turnover Scale, or ATS, was developed by Jan R. Atwood and Ada Sue Hinshaw in 1983 and has long been prized for its simplicity and reliability. The instrument consists of twelve items rated on a Likert scale, asking nurses how strongly they agree or disagree with statements about their intention to leave their current position, whether by moving to another hospital or transferring within the same organization. In its original form, responses ranged from 1, strongly disagree, to 7, strongly agree, producing total scores between 12 and 84, with higher scores signaling a greater intention to leave. The scale deliberately mixes positively and negatively worded items to blunt response bias, and it takes only about five minutes to complete. In the original validation, Cronbach’s alpha, a standard measure of internal consistency, was 0.84, and factor analysis revealed two main factors explaining 54.9 percent of the variance. A later study of newly graduated nurses using a five-point format achieved an alpha of 0.90. Until now, however, no reliable Italian-language version existed.

That gap mattered because intention to leave is widely regarded as the single best early indicator of actual turnover. The cognitive and emotional process of considering, planning, and deciding to quit precedes resignation, and research consistently shows a strong association between stated intention and eventual departure. Known drivers include job dissatisfaction, burnout, stress, work-life conflict, low pay, weak professional engagement, patient safety concerns, and leadership styles, including toxic leadership that breeds organizational mistrust. The COVID-19 pandemic intensified the problem dramatically, with roughly one-third of nurses reporting that they considered leaving the profession because of burnout and psychological distress. Generational patterns add another layer: Millennials change jobs more readily than Baby Boomers or Generation X, though across all generations, workload and staffing shortages dominate the reasons for leaving, while leadership support and salary anchor retention. Giving nurse managers a validated tool to detect these intentions early is therefore essential for planning retention strategies before resignations cascade.

The Italian team, publishing in Nursing Open, began by securing official authorization from Atwood and Hinshaw themselves, including permission to adopt a five-point Likert format instead of the original seven-point scale. The researchers chose the simplified format to improve usability for respondents, consistent with its successful use in prior studies. Translation and cultural adaptation then followed a rigorous four-step protocol aligned with internationally recommended procedures. Four translators with deliberately different profiles produced independent translations: a certified translator with no healthcare background, a non-healthcare translator with bicultural Italian-American experience, a nurse translator, and a nurse translator with bicultural Italian-English experience. Each was instructed to translate the instrument and its instructions while noting any difficulties. A bilingual committee, including a Director of Health Professions, a Departmental Nursing Manager, a Nursing Coordinator, a Labor Sociologist, a Psychologist, and an Associate Professor of Nursing, then reviewed the versions using a decentralized approach to preserve meaning in both languages.

The third and fourth steps closed the loop on linguistic fidelity. Two independent native English-speaking translators, one with and one without a healthcare background, back-translated the Italian version into English without ever seeing the original instrument or its translations. The research team then compared the two back-translated English versions, discussed discrepancies, and proposed a final version that the original author confirmed. With the translated scale in hand, the team moved to preliminary validation in a real-world setting: a public university hospital in northeastern Italy. All hospital nurses were invited to participate, with freelance nurses and those in managerial positions excluded. A self-administered questionnaire was distributed by email, and to minimize response bias the ATS was administered first, before any socio-demographic or occupational questions. Data collection ran from October 31 to November 20, 2023, through an anonymous online platform. Of 300 questionnaires distributed, 172 were returned and 168 were deemed valid for analysis.

The psychometric evaluation examined three pillars: face validity, content validity, and the internal structure of the scale. A panel of six experts judged that the translated instrument clearly and appropriately captured the phenomenon of nursing turnover, confirming its face validity without modifications and highlighting its potential for both research and practice. Content validity told a more nuanced story. Experts rated each item on a four-point relevance scale, with scores converted into binary relevant or not relevant categories and analyzed with a binomial test. Items 2 and 12 achieved unanimous relevance ratings with statistically significant agreement, while items 1, 5, 6, and 11 showed high though non-significant agreement. But items 7 and 9 were judged not relevant by five of the six evaluators, yielding item-level content validity index values of just 0.17. The scale-level index stood at 0.68, rising to 0.78 when the two problematic items were excluded. The authors caution that with only six evaluators, a single disagreement can substantially shift these indexes, so the estimates deserve careful interpretation.

The internal structure was explored through Principal Axis Factoring with Promax rotation, and the data proved highly suitable for factor analysis, with a Kaiser-Meyer-Olkin value of 0.891 and a significant Bartlett’s test of sphericity. For the full twelve-item version, the analysis extracted three factors explaining 57.82 percent of the variance. The dominant first factor, accounting for 44.59 percent, appeared to reflect a general attitude toward staying in or leaving the current job, primarily capturing internal turnover, meaning movement within the same organization. The second factor seemed tied to external turnover, the inclination to leave the organization entirely, with item 11, which expresses serious doubts about remaining, loading at a full 1.0. The third factor was associated almost exclusively with item 9, which conveys uncertainty about how long to stay in the current role. When items 7 and 9 were removed, a second factor analysis on the remaining ten items produced two factors explaining 59.16 percent of the variance, mirroring the internal-versus-external distinction.

Reliability results strengthened the case for the shortened version. The full twelve-item Italian scale achieved a Cronbach’s alpha of 0.828, already indicating good internal consistency, but excluding items 7 and 9 pushed the coefficient to 0.901, a level considered excellent. The first factor extracted from the twelve-item analysis showed an alpha of 0.912, while the first factor of the ten-item solution reached 0.809. These values sit comfortably within the range reported across four decades of ATS research: the original 1983 study reported 0.84, a Portuguese validation in Lisbon found 0.87 for twelve items rising to 0.91 after item exclusions, and a meta-analysis by Barlow and Zangaro documented alphas between 0.85 and 0.94 with a mean of 0.89. The Italian coefficients are slightly lower but largely acceptable, and the improvement after removing items 7 and 9 echoes the Portuguese findings, suggesting those items may pose cultural or linguistic difficulties beyond Italy alone.

Comparing validations across languages and forty years of healthcare change requires caution, and the authors are explicit about the limits of their work. The original development involved 1,525 professionals from fifteen rural Arizona hospitals, while the Portuguese study of 259 nurses is more comparable in scale. The Italian factor structure differs from previous validations even though it explains a similar proportion of variance, and no confirmatory factor analysis was performed, which would be needed to verify the observed structures in an independent sample. Criterion validity could not be assessed because no Italian gold standard for turnover measurement exists, and establishing a clinical cut-off score was infeasible due to privacy and timing constraints. Temporal stability, or test-retest reliability, remains untested, and the six-member expert panel may have been too small to fully capture content validity.

Even with these caveats, the implications for nursing management are concrete. A validated Italian instrument for measuring intention to leave would let nurse managers monitor turnover risk in real time and design targeted, personalized interventions to boost job satisfaction, engagement, and well-being before resignations occur. The authors conclude that the ten-item version, with its stronger content validity and internal consistency, is closest to practical use, though the scale is not yet ready for routine application. Future research should confirm the factor structure with independent samples, establish test-retest reliability, and link scores to actual turnover to define a meaningful threshold. In the meantime, the study adds an important piece to the global puzzle of nurse retention, offering Italian healthcare systems a scientifically grounded way to hear, earlier and more clearly, the quiet signal that precedes a resignation letter.

Subject of Research: Italian translation and preliminary psychometric validation of the Anticipated Turnover Scale for measuring nurses' intention to leave

Article Title: Evaluation of Nurses' Intent to Leave: Italian Translation, Cultural Adaptation, and Initial Psychometric Assessment of the Anticipated Turnover Scale

Article References: Cignola, S., Bembich, S., & Sanson, G. (2026). Evaluation of Nurses' Intent to Leave: Italian Translation, Cultural Adaptation, and Initial Psychometric Assessment of the Anticipated Turnover Scale. Nursing Open, 13(10), Article e70848. https://doi.org/10.1002/nop2.70848

Image Credits: AI Generated

DOI: 10.1002/nop2.70848

Keywords: nursing, turnover intention, Anticipated Turnover Scale, psychometric validation, cross-cultural adaptation, nurse retention, health workforce shortage, Cronbach's alpha, factor analysis, content validity, burnout, hospital management

The research team, led by investigators affiliated with institutions in China, conducted a qualitative descriptive study drawing on in-depth, semi-structured interviews with 24 registered nurses from five large tertiary hospitals in mainland China. To be included, participants had to have experienced at least one work-related musculoskeletal disorder requiring sick leave or medical intervention within the previous two years. The sample, recruited purposively for maximum variation, included 20 women and 4 men with an average age of 34.5 years and an average of 12.4 years of clinical experience, working in intensive care units, emergency departments, operating rooms, and medical and surgical wards. Interviews lasted 30 to 60 minutes each and were conducted between January and June 2025, either in private rooms or by video call, with participants choosing the setting that felt safest.

Methodologically, the team followed the six-step thematic analysis approach of Braun and Clarke, transcribing every recording verbatim, coding the first five transcripts independently with two analysts reaching consensus on a preliminary codebook, and managing data in NVivo 12. Recruitment stopped after data saturation: the coding framework stabilized after the twentieth interview, and the final four interviews added depth but no new categories. Reporting adhered to the 32-item COREQ checklist, and a summary of findings was shared with five participants for member checking as one of several credibility checks, alongside reflexive journaling and regular team discussion. The researchers, themselves experienced nurses, explicitly reflected on how their insider status could breed common-sense assumptions, a discipline that proved pivotal when they realized nurses’ guilt about burdening colleagues was structurally produced by the absence of institutional staffing backups rather than merely an individual emotional response.

From the analysis emerged three core themes and twelve sub-themes. The first concerned what the researchers describe as a fractured dual-track support system. On one track sat the hospital’s formal machinery: injury reporting, sick-leave approval, and return-to-work procedures that nurses experienced as standardized, opaque, and strikingly indifferent to subjective pain. Unless an injury showed up on a CT scan, participants said, their suffering was treated as insufficiently serious. One nurse, given the code N16, recalled asking for leave while her back pain left her unable to stand straight, only for an administrator to ask, Is it really that serious? Another, N2, described the reporting process as a pile of forms in which human resources staff cared about diagnostic certificates, not about whether the nurse could sleep at night. Pain, in that process, seemed simply to not exist.

On the second track of this fractured system was informal, relational support, and here the nurse manager emerged as the single decisive figure. Participants unanimously identified their manager as the key person determining the quality of their post-injury experience. A proactive, empathetic manager could shield an injured nurse from administrative pressure, rearrange shifts for weeks, and advocate up the hierarchy for maximum recovery time. An overwhelmed or indifferent manager, by contrast, amplified the organization’s neglect. One participant reported being told, when her back was failing, that everyone’s back hurts and she should hang in there because the unit was short-staffed. The consequence, the researchers found, was a support experience that depended less on institutional policy than on the temperament and capacity of one’s immediate supervisor, effectively leaving injured nurses hostage to local luck.

Collegial camaraderie proved to be a double-edged sword of particular scientific interest. Co-workers rushed to help lift and turn patients, and without this informal network many injured nurses said they could not have lasted a day on the ward. Yet this help came with a psychological cost: a strong sense of guilt and indebtedness that pushed nurses back to work while still in pain, a textbook driver of presenteeism, the practice of attending work while unwell. One nurse described lying at home on sick leave, consumed by worry about whether the unit was going crazy and whether colleagues were talking behind her back, concluding that this pressure was worse than the physical pain itself. The researchers interpret this as evidence that informal support, however warm, cannot substitute for institutional solutions, because its relational price compounds rather than relieves the injury’s burden.

The second major theme exposed a chasm between what organizations said and what they did. Hospitals that proclaimed employees their greatest asset communicated, at the moment of injury, a fundamentally transactional message. Nurses reported that human resources calls checking in on them felt focused on the vacant position rather than the injured back. More concretely, participants described an implicit penalty for being injured: performance pay and year-end bonuses tied to attendance meant a month of sick leave translated directly into significant financial loss, and in some departments 15 or more days of leave disqualified nurses from year-end awards or promotion consideration. No explicit policy punished injury, yet nurses felt like flawed assets, disadvantaged in career progression and wary that managers saw them as physically unreliable. Compounding this, participants pointed to long-standing failures of prevention, with patient lifts broken or too cumbersome to use, ergonomic training reduced to annual theoretical formality, and no practical, ward-based instruction on moving agitated patients safely in confined spaces. Many concluded their injuries were avoidable.

The third theme traced the long arc of these experiences into professional identity and career trajectory. Feeling abandoned at their most vulnerable shattered what participants described as the psychological contract with their employer. Nurses who had once felt collective pride began to see themselves as replaceable cogs, and trust, once broken, did not return; several described emotionally detaching, working their shifts and collecting their salary while no longer treating the hospital’s fortunes as their own. For many, the injury and its aftermath became a catalyst for serious thoughts of leaving the position or the profession entirely, particularly among nurses in their early thirties confronting a lifetime of pain and medication. There was also a subtler erosion: weakened professional identity. Nurses who could no longer perform basic care without pain began to doubt their own competence and value, caught in the dissonance of being caregivers unable to care for themselves. And in the absence of any structured support, they had to become their own advocates, fighting alone for reasonable adjustments and negotiating with administrators, an exhausting emotional labor layered on top of physical injury.

Viewed through Organizational Support Theory, which holds that employees’ perceptions of how much their organization values their contributions and well-being drive commitment, engagement, or alternatively burnout and turnover, these findings carry a sharp theoretical point. The problem was not simply insufficient support but fractured support: relational warmth from managers and colleagues partially met nurses’ socioemotional needs, while formal systems signaled that their contribution was valued only when they remained fully productive. That mismatch weakened trust, affective commitment, and retention intention, exactly the negative outcomes the theory predicts. The authors argue the implications extend from ward to policy: hospitals should invest in lifting equipment, ergonomic redesign, practical training, and adequate staffing; should establish standardized, phased return-to-work programs specifying duties, duration, and assessment criteria; should protect injured nurses from disproportionate financial penalties, potentially through centralized occupational-health compensation; and should train nurse leaders to respond with advocacy rather than normalizing working through pain. National guidance on occupational injury management in healthcare, they suggest, is needed to make such standards consistent.

The study’s limitations deserve note. The sample came from large tertiary hospitals in a specific region of China, so findings may not generalize to smaller or primary care facilities. Retrospective interviews are vulnerable to recall bias, and the perspectives of hospital administrators and human resources personnel, whose behavior loomed so large in participants’ accounts, were absent; the authors call for multi-stakeholder research to complete the picture. Still, for a workforce already strained by shortages and rising demand, the message lands with force. Post-injury support, the researchers conclude, should be treated as a workforce-sustainability issue rather than an administrative chore. When a nurse’s back fails and the organization’s response is a pile of forms and a docking of pay, the loss is measured not just in one injury but in the slow unraveling of loyalty, identity, and ultimately the clinical workforce that patient care depends on.

Subject of Research: Organizational support experiences of Chinese nurses after work-related musculoskeletal disorders

Article Title: The Experiences and Perceptions of Organizational Support Among Chinese Nurses Following Work‐Related Musculoskeletal Disorders: A Qualitative Descriptive Study

Article References: Sunzi, K., Lin, Y., Huang, Q., Guo, L., Yang, Z., Li, F., Zhou, W., & Lei, C. (2026). The Experiences and Perceptions of Organizational Support Among Chinese Nurses Following Work‐Related Musculoskeletal Disorders: A Qualitative Descriptive Study. Nursing Open, 13(9), Article e70793. https://doi.org/10.1002/nop2.70793

Image Credits: AI Generated

DOI: 10.1002/nop2.70793

Keywords: nursing, musculoskeletal disorders, organizational support, qualitative research, occupational health, presenteeism, return-to-work, nurse retention, China, nurse managers, ergonomics, health workforce