Leep-Lazar Kathryn, Ma Chenjuan, Stimpfel Amy Witkoski
Rory Meyers College of Nursing, New York University, New York, New York, USA.
Res Nurs Health. 2025 Aug;48(4):429-440. doi: 10.1002/nur.22465. Epub 2025 Apr 14.
The ongoing regional nursing shortages in the United States, exacerbated by the COVID-19 pandemic, compromise patient safety and quality. Additionally, an aging workforce coupled with an aging population requiring more nursing care services limits organizations' ability to adequately staff their facilities. Nurses' turnover from the profession has been studied less than organizational turnover, thus, the purpose of this integrative review is to identify factors associated with intention to leave the nursing profession in the United States. Using Whittemore and Knafl's (2005) guidelines for integrative review methods, we conducted systematic searches in CINAHL, PubMed, and Web of Science in July 2024. There were 39 peer-reviewed studies that met inclusion criteria. Synthesis of findings resulted in four individual and four work-level themes associated with intent to leave the nursing profession. Individual themes included individual beliefs, health and wellbeing, individual work experiences, and career stability. Work-level themes included job characteristics, job demands/workload, resources and support, and work environment. Notably, job-level factors (i.e., workload, work environment, and support) were associated with professional turnover intention, which suggests that nurses do not believe their experiences will improve at another nursing job. Gaps in the literature include studies with nationally representative samples, studies using validated measures of health, and qualitative studies conducted with the aim of understanding why nurses want to leave the profession. To promote retention of nurses at the professional and organizational level, organizations should measure and modify relevant job-level factors, and the protection of nurses' wellness should be a top organizational priority.
美国持续存在的地区性护理短缺问题，因新冠疫情而加剧，这危及患者安全和护理质量。此外，劳动力老龄化以及需要更多护理服务的老年人口增加，限制了各机构为其设施配备充足人员的能力。对护士职业离职率的研究少于机构离职率，因此，本综合综述的目的是确定与美国护士离职意愿相关的因素。我们按照惠特莫尔和克纳夫（2005年）的综合综述方法指南，于2024年7月在护理及健康领域数据库（CINAHL）、医学期刊数据库（PubMed）和科学引文索引数据库（Web of Science）中进行了系统检索。有39项同行评议研究符合纳入标准。研究结果综合形成了与离职意愿相关的四个个人层面主题和四个工作层面主题。个人层面主题包括个人信念、健康与幸福、个人工作经历以及职业稳定性。工作层面主题包括工作特征、工作要求/工作量、资源与支持以及工作环境。值得注意的是，工作层面因素（即工作量、工作环境和支持）与职业离职意愿相关，这表明护士认为在另一份护理工作中他们的经历不会得到改善。文献中的空白包括具有全国代表性样本的研究、使用经过验证的健康测量方法的研究，以及旨在了解护士为何想要离职的定性研究。为了在职业和机构层面促进护士留任，各机构应衡量并调整相关的工作层面因素，保护护士的健康应成为机构的首要优先事项。
