Nursing Job Dropout; A Systematic Review
Keywords:
nursing turnover, dropout, intention to leave, retention, workforce shortageAbstract
Nursing workforce dropout represents a critical global challenge, contributing to persistent staff shortages, compromised patient safety, and reduced health system sustainability. High levels of turnover and intention-to-leave threaten not only organizational performance but also the capacity of health systems to deliver safe and effective care. This systematic review aimed to synthesize evidence on the prevalence, determinants, and outcomes of nursing job dropout, encompassing both actual professional exit and turnover intention. Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, and relevant grey literature sources between 2019 and 2025. Eligible studies included quantitative, qualitative, and mixed-method designs focused on practicing nurses, published in English. Data extraction followed a standardized matrix, and study quality was appraised using JBI and MMAT tools. Thirty studies met the inclusion criteria. Prevalence estimates of turnover intention ranged from 20% to over 50%, with the highest levels reported in high-stress hospital environments. Determinants clustered into three categories: individual factors (burnout, mental health, job satisfaction, demographics), workplace factors (staffing ratios, leadership style, organizational climate, peer support), and systemic factors (wages, contracts, regulatory policies). Outcomes of dropout included compromised patient safety, increased financial and operational costs for healthcare organizations, and reduced workforce stability at national and global levels. Nursing dropout is driven by multi-level factors that interact to create persistent risks of attrition. Effective solutions require integrated retention strategies that address structural inequities, organizational support, and personal well-being. Policy frameworks that ensure safe staffing, equitable compensation, and supportive work environments are essential to safeguarding both nurses and the patients they serve.
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