Intention to Leave Nursing Profession and Its Associated Factors Among Nurses: A Facility Based Cross-Sectional Study

Abstract

Nurses’ intention of leaving their profession is the main challenge for healthcare and hospital administrators in many countries. It has significant impact on the performance, stability and productivity of health facilities. However, there is limited evidence on the nurses’ intention to leave their profession and associated factors among nurses in developing countries including Ethiopia. This study was aimed to assess intention to leave nursing profession and its associated factors among nurses working in West Shoa Zone public Hospitals, Oromia region, Central Ethiopia, 2020. Institution based cross-sectional study was conducted among 393 nurses working in West Shoa zone public hospitals, Ethiopia from May 1 to 30, 2020. Simple random sampling technique was used to select the study participants. Structured self- administered questionnaire was used to collect data. Data were cleaned and entered into Epi-data version 3.1 then exported to SPSS version 25 for analysis. Descriptive statistics such as frequency mean and standard deviation was computed to describe variables of the study. All covariates that were significant at P value <0.25 in bivariate logistic regression analysis were considered for further multivariable logistic regression analysis. Backward stepwise logistic regression model was fitted, crude ratio and odds ratio were calculated for factors at 95% confidence interval (CI). Level of statistical significance was declared at P value <0.05. In this study, the overall nurses’ intention to leave nursing profession was 61.3% [95% CI (56.5%, 66.2%)]. Nurses’ educational status, age, working experience, working position, professional commitment, job stress, job satisfaction and organizational factor were significantly associated with nurses’ intention to leave their profession. The overall nurses’ intention to leave their profession was high. Reducing this level of leaving intention needs collaborative intervention related to factors like safety of working environment, job related stress, job satisfaction, professional commitment and education opportunities which are a big homework for managers on health sectors of West Shoa zone public Hospitals and higher level health sector managers.

• What is already known

• • Nurses’ intention of leaving their profession is a challenge for healthcare in many countries

• • Hospitals are facing difficulties to provide a consistent level of quality nursing care due to the shortage of experienced nurses

• What this research contribute to the field

• • This study found that different factors such as working in unsafe environment, had low professional commitment, and had a job stress were identified factors to made nurses to leave nursing profession

• • Majority of the nurses in the study area had an intention to leave their profession.

• What this research’s implications towards theory, practice or policy

• • Strategies of enhancing nurses intention to stay in their profession that focuses on creating safe organizational environment and enhance nurse’s job satisfaction should be implemented. The strategies will include involving nurses to participate in all levels of decision making in the health care system to improve their professional commitments and motivation to stay within the profession. Involving nurses in the decision making positions will be important to develop a sense of belonging and improving job satisfaction among nurses and in turn improving their commitments.

• • Nurse managers should focus to implement the organizational strategies of carrier development, educational opportunities, and staff retention in order to reduce the nurses’ intention to leave their profession.

Introduction

Nurses’ intention to leave is a process of thinking, planning, and decision about leaving a profession and it is one step before the actual leaving. This intention ends to actual performance of an action if conditions are not managed early. ¹ Due to this; nursing shortage is receiving considerable courtesy from the healthcare industry. ² Globally, the needs-based shortage of healthcare workers in 2013 is estimated to be about 17.4 million, of which over 9 million are nurses and midwives. The largest needs-based shortages of health workers are in South-East Asia at 6.9 million and Africa at 4.2 million. The most severe challenges are in the African Region; the needs-based shortage is actually forecast to worsen between 2013 and 2030. ³ Therefore, World Health Organization (WHO) forecasted to increase nurses/midwives from 20.7 million to 32.3 million nurses/midwives globally by 2030. ⁴ The total numbers of Nurses/midwives needed for Africa to reach the sustainable developmental goal (SDG) threshold forecasted for 2030 is 4.1 million.^5,6

Nurses are essential workforce and form the largest professional group, which comprises healthcare workforce within the healthcare system in contributing significantly in delivering quality healthcare services, and assisting in the improvement of health outcomes for individuals, families and communities either through preventative and curative measures. Their intention of leaving their profession is a challenge for healthcare and hospital administrators in many countries. ⁷ Hospitals are facing difficulties to provide a consistent level of quality nursing care in a fast changing health environment due to the shortage of experienced nurses which is a critical global issue. ⁹

Regional disparities exist between countries with sub-Saharan Africa requiring an almost 140% increase in the health workforce in order to overcome the crisis of the health workforce. ¹¹ Report on Health Care Professional Supply Estimates (Professionals Per 1000 Population) For 39 Countries In Sub-Saharan Africa (2015) indicated that, nurse and midwife density per 1000 population in Ethiopia was 0.41 while Shortage Estimates (nurse and midwife Per 1000 Population) was 1.32.^10,12 Health and health related indicator report by FMOH showed, density of public sector health professionals per 10 000 populations is 4.93 nurses/10 000 populations for the country and 4.06 nurses/10 000 population for Oromia regional state.^8,13 This is below WHO standard which is recommended as 2.2 nurses/1000populations. ¹⁴ This will have a serious economic implication in the country as the low work force density of the public sectors of a country have positive correlation with the poor health outcomes including high disease burden and high maternal and infant mortality rate.

This shows; Ethiopia, like other countries with limited resources, has been suffering from human resources for health (HRH) crisis in nursing. In recognition of this, Ethiopian Federal Ministry of Health has developed an HRH strategy (2018) as a first step to addressing health workforce challenges and developing the health workforce strategy of the country.^15,23

Even though, Ethiopia designed a curriculum on nursing specialties to retrain experienced nurses in nursing; currently, nurses are leaving their profession to join non-nursing career like innovative medicine and public health profession. Therefore, assessing the nurses’ intention to leave their profession and associated factors has a paramount importance in helping to determine the strategies of retaining experienced nurses in the health care industries and minimize nurses’ intention to leave nursing profession.

Methods

Study Design, Area and Period

Institutional based cross sectional study design was conducted in West Shoa Zone public hospitals from May 01 to 30, 2020. West Shoa Zone is located in Oromia regional state, Ethiopia. Ambo is the capital city of West Shoa Zone located 114 km away from Addis Ababa. In this zone there were 526 Health Posts, 92 Health Centers and 8 public Hospitals (one referral hospital, 3 General Hospitals and 4 primary Hospitals). Currently, in these public Hospitals 475 nurses are serving the community.

Source Population and Study Population

All nurses working in public hospitals of West Shoa zone were source populations, while all randomly selected nurses working in public hospitals in West Shoa zone were study populations.

Sample Size Determination

The sample size for the study was calculated using the single population proportion formula with a 95% confidence interval, a margin of error of 5%, and the prevalence of intention of nurses to leave their profession = 42.25%. ¹⁶

$$\begin{array}{c}\mathrm{By}\mathrm{using}\mathrm{the}\mathrm{formula}:\mathrm{n}=\frac{\left(\mathrm{Z}\mathrm{\alpha }/2\right)2\mathrm{p}\left(1-\mathrm{p}\right)}{{\mathrm{D}}^2}\\ =\frac{\left(1.96\right)2*0.4225\left(1-0.4225\right)}{{\left(0.05\right)}^2}=375.\end{array}$$

By adding a 10% non-response rate the total sample size was 413 nurses. Where: N = the required minimum sample size, P = the prevalence of nurses intention to leave nursing profession, D = the margin of error, Z α/2 = critical value at 95% confidence level.

Sampling Technique

The 7 public hospitals in West Shoa zone; namely Ambo university referral hospital, Ambo, Gedo and Gindeberet General Hospitals, Jeldu, Incini and Bako primary hospitals were included in the study. Number of nurses working in each hospital was obtained from human resource manager office and calculated sample size was proportionally allocated to each hospital based on the number of nurses they had. Lastly, the individual nurse was selected by using simple random technique and computer generated number used until intended study subjects were obtained. Respondents were identified and contacted by using their registration number, work unit and work shift at the hospitals. The data collectors introduced the purpose of the study, the confidentiality of the data collected, the voluntariness of the participation, the time it may take to complete and the risk and benefits associated with participation. Then after gave the questionnaire when nurses were agreed to participate.

Data Collection Tool and Measuring Instruments

Data were collected by using a structured, self-administered questionnaire which was adopted from the different previous study. ¹⁹ - ²² The questionnaire was prepared in English. The contents of data collection tools and method of variable measurement were discussed as follows;

• Socio-demographic characteristics: Is composed of 7 questions with multiple response option. Organizational and Work environment factor: It contains 6 questions with a “yes” or “no” response options. Each of the 7 items addresses organizational environment safety, participation in hospital affairs, recipient of on job training, perception of work load, availability of support from co-workers and experience of autonomy in the hospital.

• Nurses-physician relationship: this contains 6 questions with “yes” or “no” response option

• Intent to leave nursing profession: intention to leave nurse was measured by giving a question stated as “Do you have an intention to leave nursing profession?” with a “yes” or “no” response option. Those nurses who responded “yes” to the question was categorized as “intended to leave” and those responded “no” were categorized as “not intended to leave.” ¹⁷

• Job-satisfaction: was measured by using an instrument that constitutes 17 items of a five-point Likert scale ranging from 1, strongly dissatisfied to 5, strongly satisfied and categorized under the dimensions of indirect working environment, direct working environment, salary and promotion, work challenge, interaction, leadership style. The response score of respondents range from minimum of 17 to a maximum of 85. Accordingly respondents who scored >51.88 were categorized as “satisfied” with their job whereas respondents those scored≤ 51.88 were categorized as “unsatisfied.”

• Organizational commitment: It is a commitment in which employees committed to their organization generally feel a connection with their organization, feel that they fit in and they understand the goals of the organization. ¹⁸ It was measured with a 22-item scale that included 3 subscales ¹⁹ : Affective commitment (8 items), continuance commitment (7 items) and normative commitment (7items). Items with Likert scale were used to measure, the items with response options ranging from 1, strongly disagree to 5, strongly agree. Those respondents who scored value below mean score were categorized as “low commitment” and respondents who scored above the mean had “high commitment” for each dimension.

• Affective commitment: Affective commitment is concerned with the employee’s dedication to meet a particular goal within the organization. Affective commitment is measured by using 8 items with 5 point likert scale response option. The response scales range from 1, strongly disagree to 5, strongly agree. The score value of the item ranges from 8, the minimum to 5, the maximum. Respondents who scored <23.94 the mean were categorized as “had low affective commitment” and respondents who scored mean ≥23.94 categorized as “had high affective commitment.”

• Continuance commitment: Continuance commitment is a sense of loyalty to the organization because the employee perceives of few options for leaving the organization. Respondents continuance commitment was measured by using 7 items with 5 point likert scale response options ranging from 1, strongly disagree to 5, strongly agree. The score value ranges from 7, the minimum score to 35, the maximum score. Respondents who scored <22.3, the mean was categorized as “had low Continuance commitment” and those respondents who scored ≥22.3 categorized as “had high Continuance commitment.”

• Normative commitment: Normative commitment is a sense of responsibility employees feel for their job or organization that holds them back from quitting. Respondent’s continuance measurement was measured by using a 7 items with a 5 point likert response scale ranging from 1, strongly disagree to 5, strongly agree. The score value ranges from 7, the minimum to 35, the maximum. Respondents who score <22.56 had “low Normative commitment” and those respondents who score ≥22.56 had “high Normative commitment.”

• Professional commitment: is a congruency between a person’s personal beliefs and the goals of a profession, with greater congruency leading to greater individual efforts on behalf of the profession. Ten (10) items were used to measure nurses professional commitment where each item is measured using a 5-point scale (1strongly disagree to 5strongly agree). ²¹ Respondents with less than a mean score, >34, were categorized as “had high professional commitment” and respondents who score greater than or equal to mean, ≤ 34, were categorized as “had low professional commitment.”

• Job related stress: 21 items with four-point Likert item represents each of the items. Likert item has options from 1 to 4 where 1 represents “if the condition is never a cause of stressful,” 2 “if the condition is sometimes stressful,” 3 “if the condition is frequently stressful” and 4 “if the condition is always stressful.” Respondents were asked to indicate how often the causes of job stress expressed in the questionnaire occur in their work life. ²⁰

• Respondent with score of <55 being the mean were categorized as “not stressful” and respondents those who score ≥ 55 were categorized as “stressed.”

• Job burnout: was measured by instrument that constitutes 22 items of a seven-point Likert scale (0 Never to 6 every day) and the dimension of emotional exhaustion (9items), depersonalization (5 items) and personal accomplishment (8 items). ²² Respondents with mean score <28.39 had low emotional exhaustion & those with mean score >28.39 had high emotional exhaustion.

Data Quality Control and Management

Data were collected by BSc nursing profession, 7 for data collectors and 2 for supervisors. One day training was given for both data collectors and supervisors by investigators. Five percent of the questionnaire was pre-tested at Tulu Bolo Hospital to assess clarity, sequence, consistency, understandability and for total time it takes before the actual data collection. The result of reliability tests showed that Cronbach’s alpha for overall job satisfaction scale, professional commitment scale, organizational commitment scale, burnout scale and job related stress scale were 0.87, 0.89, 0.801, 0.879, and 0.825, respectively on pre-test.

The principal investigator and supervisors were actively involved in supervision of the data collection. The completed questionnaire was checked for missed values and completeness on daily basis.

Data Processing and Analysis

Data were checked for its completeness and correctness. Data were also coded and entered into Epi data version 3.1, then exported to SPSS version 23 for analysis. Descriptive statistics such as frequency, measure of central tendency (mean and standard deviation) and percent were computed to describe variables of the study. All covariates which were significant at P value <.25 in bivariate logistic regression analysis was considered for further multivariable logistic regression analysis. Multicolinearity was checked by using the standard error. Crude Odds ratio (COR) and Adjusted Odds ratio (AOR) were calculated at 95% confidence interval. Level of statistical significance was set at P value <.05.

Results

Socio-Demographic Characteristics of Study Participants

Among 413 study participants to whom questionnaire was distributed, 393 respondents returned the questionnaires which make response rate 95.16%. The mean age of the study participant was 28.76 ± 5.686, this ranges from 20 to 56 years. Among the total study participants 213(54.2%) were male, and 203 (51.7%) of nurses were married. Majority of the study participants 266 (67.7%) were Bachelor Degree nurses and the rest were Diploma holder. The minimum monthly income of the study participant is 2100 and the maximum monthly income10 024 Ethiopian birr with median value of 6000. The average service years of study participants was 5 years; having minimum and maximum service of 10 months to 30 years (Table 1).

Table 1.

Socio-Demographic Characteristics of Nurses Working in Public Hospitals in West Shoa Zone, Oromia Region, Ethiopia, 2020(n = 393).

Variables		Frequency	Percent
Age	<25	140	35.6
	25-29	111	28.2
	30-34	77	19.6
	≥35	65	16.6
Sex	Female	180	45.8
	Male	213	54.2
Religion	Protestant	237	60.3
	Orthodox	121	30.8
	Muslim	16	4.1
	Others	19	4.8
Marital status	Married	203	51.7
	Single	190	48.3
Educational status	Diploma	127	32.3
	BSc degree	266	67.7
Monthly Salary	≥6000	192	48.9
	<6000	201	51.1
Working experience in years	≤3	128	32.60
	4-7	149	37.90
	8-11	55	14.0
	>11	61	15.50

Work Related Characteristics

Regarding to study participants position, most of the respondents were staff nurses (75.1%). Concerning to Working Unit/department, the top 5 units in which majority of nurses working include: Surgical ward, OPD, Medical ward, Chronic OPD and Obstetrics and gynecology which account 72 (18.3%), 63 (16%), 54 (13.7%), 41 (10.4%) and 40 (10.2%) respectively. Regarding to the safety of working environment, 51.1% of nurses are replied that they are working in unsafe environment and 58.5% of nurses are exercising low degree of autonomy. Additionally, 54.5% of nurses have low continuous organizational commitment, 56.7% of nurses are dissatisfied with a job, 51.4% of nurses are experiencing job stress and 54.2% of nurses have emotionally exhaustion as shown on the table below (Table 2).

Table 2.

Work Related Characteristics of Nurses Working in Public Hospitals in West Shoa Zone, Oromia Region, Ethiopia, 2020 (n = 393).

Variables		Frequency	Percent (%)
Working position	Staff Nurse	295	75.1
	Head nurse	98	24.9
Department	Medical ward	54	13.7
	ICU	25	6.4
	Major OR	36	9.2
	Obstetrics and Gynecology	40	10.2
	Chronic follow	41	10.4
	TB clinic	13	3.3
	Surgical ward	72	18.3
	OPD	63	16.0
	Pediatrics	30	7.6
	ART clinic	19	4.8
Organization and working environment
Safety of working environment	Yes	192	48.9
	No	201	51.1
Nurses participation in hospital affairs	Yes	250	63.6
	No	143	36.4
On job training	Yes	194	49.4
	No	199	50.6
Support from co-worker	Yes	234	59.5
	No	159	40.5
Organizational commitment
Affective organizational commitment	High	200	50.9
	High	200	50.9
Continuous organizational commitment	Low	214	54.5
	High	179	45.5
Normative organizational commitment	High	179	45.5
	Low	194	49.4

Nurses’ Intention to Leave the Profession

In this study, the overall nurses’ intention to leave nursing profession was 61.3% [95% CI (56.5%, 66.2%)]. The reasons why nurses intended to leave their profession were low salary (78.4%), work burden (70.9%), poor organizational leadership (63.9%), and lack of professional development (46.3%), disrespect from co-workers (40.2%) and exposure to infectious diseases (27.4%).

Factors Associated With Intention to Leave Nursing Profession

Binary logistic regression was applied for determining candidate variables for the multiple logistic regressions. Nurse’s age, marital status, working position, working experience, educational status, income, job satisfaction, professional commitment, Organizational commitment, safety of working environment, job stress, burnout and nurse-physician work relationship had association with nurses’ intention to leave nursing in bivariate logistic regression analysis. All variables that have association with the outcome variables during bivariate logistic regression analyses were included into multiple logistic regression models. After controlling for the effects of potentially confounding variables using multiple logistic regression; nurses’ Age, educational status, working experience, working position, monthly income, professional commitment, Job stress, job satisfaction and Organizational factor (safety of working environment) were significantly associated with nurses’ intention to leave their profession. Diploma nurses were 3.7 times [AOR = 3.69; 95% CI: (1.01-13.489)] more likely to leave the profession than BSc degree nurses. Similarly nurses with work experience of <3 years were nearly 5 times [AOR = 4.901; 95% CI: (1.915, 12.543)] and 4 to 7 years were 4.5 times [AOR = 4.484; 95% CI: (1.902, 10.574)] more likely to leave nursing profession when compared nurses with work experience of 11 years and above. Nurses with monthly income less than 6000ETB are 3.2 times [AOR = 3.217; 95% CI: (1.991-5.20)] more likely to leave the profession comparing with nurses whose monthly income is greater or equal to 6000ETB. Additionally, nurses who perceives as working in unsafe environment were 5.4 times [AOR = 5.368; 95% CI: (3.084, 9.341)] more likely to leave nursing profession comparing with those nurses those perceiving as working in a safe environment. Nurses with low professional commitment were 3.7 times [AOR = 3.745; 95% CI: (2.117, 6.626)] more likely to leave nursing profession than nurses who had high professional commitment as well as nurses those were unsatisfied with their job were nearly 4 times [AOR = 3.689; 95% CI: (2.407, 5.653)] more likely to leave nursing profession than nurses who satisfied with the job. Finally, nurses who had a job stress were 2.1 times [AOR = 2.097; 95% CI: (1.119, 3.675)] more likely to leave nursing profession compared with nurses with no job stress (Table 3).

Table 3.

Bivariate and Multivariable Analysis for the Factors Associated With Intention of Nurses to Leave Their Profession Among Nurses Working in West Shoa Zone Public Hospitals, Oromia region, Ethiopia, 2020 (n = 393).

Variable categories		Intention to leave nursing (n = 393) profession		COR (95% CI)	AOR (95% CI)	P-value
		Yes	No
Age	<25	105 (26.7%)	35 (8.9%)	9.187 (4.6-18.17)	2.798 (1.137-6.889)	.025 *
	25-29	78 (19.8%)	33 (8.4%)	7.239 (3.6-14.52)	3.496 (1.500-8.145)	.004 *
	30-34	42 (10.7%)	35 (8.9%)	3.675 (1.79-7.56)	1.818 (0.790-4.184)	.160
	>35	16 (4.1%)	49 (12.5%)	1.00
Educational status	Diploma	91 (23.2%)	36 (9.1%)	1.96 (1.24-3.038)	3.690 (1.01-13.489)	.004 *
	BSc Degree	150 (38.2%)	116 (29.5%)	1.00
Marital status	Single	131 (33.3%)	59 (15%)	1.88 (1.24 -2.88)	1.524 (0.822-2.826)	.181
	Married	110 (28%)	93 (23.7%)	1.00
Working position	Staff Nurse	198 (48.6%)	97 (22.1%)	2.61 (1.64 -4.16)	2.42 (1.367 –4.282)	.002 *
	Head Nurse	43 (9.4%)	55 (11.5%)	1.00
Work experience	≤3 years	91 (23.2%)	37 (9.4%)	6.91 (3.48-13.75)	4.90 (1.94 –12.54)	<.001 *
	4-7 years	108 (27.5%)	41 (10.4%)	7.41 (3.78-14.54)	4.484 (1.90-10.57)	<.001 *
	8-11 years	26 (6.6%)	29 (7.4%)	2.52 (1.16-5.49)	1.887 (0.715-4.98)	.20
	>11 years	16 (4.1%)	45 (11.5)	1.00
Monthly income	<113$	146 (37.1%)	55 (14%)	2.71 (1.78-4.12)	3.217 (1.991-5.20)	<.001 *
	≥113$	95 (24.2%)	97 (24.7%)	1.00
Safety of the working environment	Yes	79 (20.1%)	113 (28.8%)	1.00
	No	162 (41.2%)	39 (9.9%)	5.94 (3.78-9.34)	5.37 (3.084-9.341)	<.001 *
On job training	Yes	100 (25.4%)	94 (23.9%)	1.00
	No	141 (35.9%)	58 (14.8%)	2.29 (1.51-3.46)	1.209 (0.703-2.078)	.493
Affective commitment	Low	138 (35.1%)	55 (14.0%)	2.36 (1.556-3.59)	0.80 (0.442-1.449)	.463
	High	103 (26.2%)	97 (24.7%)	1.00
Continuous commitment	low	146 (37.2%)	68 (17.3%)	1.89 (1.26-2.86)	1.29 (0.738-2.245)	.374
	High	95 (24.2%)	84 (21.4%)	1.00
Normative commitment	low	146 (37.2%)	48 (12.2%)	3.33 (2.17-5.11)	0.999 (0.53-1.888)	.998
	High	95 (24.2%)	104 (26%)	1.00
Professional commitment	low	144 (36.6%)	35 (8.9%)	4.96 (3.14-7.84)	3.745 (2.117,6.626)	<.001 *
	High	97 (24.7%)	117 (29. %)	1.00
Over all job satisfaction	Unsatisfied	166 (42.2%)	57 (14.5%)	2.07 (1.25-3.42)	3.689 (2.407-5.65)	.004 *
	Satisfied	75 (19.1%)	95 (24.2%)	1.00
Over all job stress	Stressful	138 (35.1%)	65 (16.5%)	1.79 (1.19-2.70)	2.10 (1.197-3.68)	.01 *
	Not stressful	103 (26.2%)	87 (22.1%)	1.00

^*The variable is statistically significant.

Discussion

The current study revealed that, 61.3% nurses are intended to leave nursing profession. This result is lower when compared with a study conducted in Egypt on staff nurses in which was 71.11% of the nurses were intended to leave their profession ¹⁹ and the difference may be attributed to the development level of the 2 nations where there most probably be a low alternative job opportunities for nurses in Ethiopia. This study finding is similar with Study conducted in Amhara region and higher than study conducted at Jimma zone, Ethiopia where 60.2% and 42.25% of nurses were intended to leave nursing profession. ¹⁶ Regardless of the figure difference the findings of the study at all areas may indicate the necessity of strong nurses retention mechanism.

In the current study nurses with age less than 29 years were more likely intended to leave their profession which is supported by study done at Amhara Region in which age group 20 to 29 years were 4 times more likely intend to leave their profession than aged 40 to 49 years. ¹⁵ This implies that youngest and fresh employees intend to leave their profession. The association of nurses experience and the intention to leave the profession is also more illustrative to this. The findings of the current study also indicate that more nurses with low experiences have in intention to leave their profession when compared to those having a relative high experiences. A study conducted in Swedish, 10 European countries Amhara region, Ethiopia, also showed that nurse with less years of working experiences were more likely intended to quite their profession.^9,25,26 The underlying factors that are related with young nurses and nurses having low year of work experiences intention to leaving their profession may be a research agenda. But this may be due to the facts like stressful nature of hospital environments, low salary associated with low work experience, alternative educational opportunity like the new initiative medical education in Ethiopia.

Diploma nurses are more likely intended to leave nursing profession when compared with BSc degree nurses. As level of education increases, the salary, money from working in leadership position and from night and holly day duty increases. This is supported by study conducted in Amhara in which diploma nurses were 2 times more likely intended to leave nursing profession comparing with Bachelor degree nurses and study done at Taiwan University.^9,15 Nurses who had no leadership position (staff nurses) are more intended to leave nursing when compared with nurses those are working in leadership position which is supported by the study conducted in Brazil that reveals subjects who did not hold a leadership position were 28% more likely to leave nursing profession. ²⁴

In the current study, nurses‟ monthly income is also significantly associated with nurses’ intention to leave nursing Profession in which nurses with relative low income are found to more likely intend to leave the profession comparing with nurses high income. This finding may indicate that an income may be one of the reason for seeking an alternative job opportunity where employees with low income searches for other alternatives where they can earn a relative favorable income. This may inform hospitals and the health care system to consider means of increasing the income of the employees specially nurses, in their staff retention strategies and policies.

Concerning to working environment, unsafe working environment is significantly associated with nurses’ intention to leave the profession; in this case nurses those are working in an unsafe environment are more prone to leave the profession comparing with those who perceive that their working environment is safe. This is supported by study conducted in Jimma zone South West Ethiopia and Tehran University of Medical Sciences, Iran which states that working environment and organizational factors respectively makes the strongest contribution to explaining the intention to leave nursing profession in which it is significantly affects the nurses‟ intention to quite own profession.^16,27 This may indicate that strong commitment of hospital managements to sustainably implement the available initiative such as clean and safe hospital (CaSH) will be supportive in reducing nurses intention to leave their profession.

In this study, nurses with low Professional Commitment are more intended to leave nursing Profession than those having the commitment. This may indicates that workers with low commitment are those workers that do not devote themselves to their profession and do not solve problems instead of leaving the profession. This result is consistent with the study done in Jima Zone in which it revealed that professional Commitment is significant predictor of nurses‟ intention to leave their profession. ¹⁶ Identifying the factors associated with nurses organizational and professional commitment will be supportive in improving the commitment of employees which in turn will contribute in reducing their intension of leaving the profession.

Job satisfaction is significantly associated with nurse intention to leave their profession, suggesting that nurses those are unsatisfied with the job are more likely intend to leave nursing profession compared with nurses those satisfied with the job. This finding is inconsistent with the finding of the study done in Turkey which revealed that nurses dissatisfied with the job are significantly intended to leave the profession. ²⁸ It is a general true that dissatisfied employee holds negative attitude toward their job, organization and intend to leave their job and profession. This also can have a negative impact on organizational performance and the health care system at the largest. Hospital managers and the general health care system should be conscious in positively influencing the nurses job satisfaction for reversing their intention to leave nursing profession.

The current study result also showed that, job related stress was statistically significantly associated with nurses intention to leave nursing profession. This finding is consistent with the finding of a study conducted in Jimma zone. ²⁰ This most probably suggests that identifying the source of nurse’s stress and developing strategies of reduction will be the means of improving nurses intension to stay in their profession and their organizations.

Limitation

This study contributes significantly to knowledge development in the area of nurses’ intention to leave their profession and associated factors. However, one of the limitations of this study was not include both quantitative and qualitative study. There may be more factors that can be qualitatively explored with in-depth interview. The study was also base on the self-reported data; these could have a contribution social desirability bias of respondents.

Conclusion

In generally, the overall nurses’ intention to leave their profession was high in the study area. This may increase work load on nurses remain in their profession, nurses experience of burnout and job dissatisfaction. It has also a negative impact on nursing professional development and health institutions. Educational status, age, income, working experience, working at leadership position, professional commitment, job stress, job satisfaction and safety of working environment were significantly associated with nurses‟ intention to leave their profession. Knowing these factors enables to tackle nurse’s intention of leaving nursing profession and prevent the shortage of staff which affects the quality of health care.