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. 2024 Nov 17;72(3):e13065. doi: 10.1111/inr.13065

Workload and intention to leave among nurses in Turkey: The mediating roles of organizational identification and work satisfaction

Esma Aslan Seki 1, Bilgen Özlük 2,✉
PMCID: PMC12206693  PMID: 39551617

Abstract

Aim

This study establishes the mediating roles of job satisfaction and organizational identification on the relationship between nurses’ workload and their intention to leave.

Background

The shortage of nurses is a prevalent global concern. International studies have shown that many variables are associated with nurses’ intention to leave. There is a shortage of literature on some of these variables, which this study is designed to address.

Methods

This study employs a descriptive, exploratory, and correlational design. It was conducted with 373 nurses from seven different hospitals in Turkey. The Workload Scale, the Minnesota Work Satisfaction Scale, the Organizational Identification Scale, and the Intention to Leave Scale were applied in the study.

Results

The structural equation model shows that the workload of nurses has a negative effect on work satisfaction (β = −0.74; p < 0.001) and organizational identification (β = −0.24; p < 0.001) and a positive impact on intention to leave (β = 0.30; p < 0.001). In addition, work satisfaction (β = −0.32; p < 0.001) and organizational identification (β = −0.24; p < 0.001 were found to affect the intention to leave negatively intention to leave. After the bootstrapping process, the indirect effect was found to be significant.

Discussion/conclusions

The research findings indicate that work satisfaction and organizational identification mediate the correlation between nurses’ workload and their intention to leave. The findings highlight the need for precautions by revealing the risks of nursing shortages anticipated both today and in the future.

Implications for nursing policy

In the global nursing crisis, healthcare managers and policymakers must develop strategies to protect the nursing workforce. Policymakers should make sustainable decisions by conducting national self‐assessments on the impact of workload, job satisfaction, and organizational identification on intention to leave to retain nurses.

Keywords: Intention to leave, mediator role, nurse, organizational identification, structural equation model, work satisfaction, workload

INTRODUCTION

The global nursing shortage negatively affects patient and nurse outcomes, both economic and noneconomic (Bae, 2022). The critical importance of strengthening the healthcare system and planning for a more qualified workforce has been recognized by both the administrators and society, particularly during the pandemic (Jo et al., 2021; Özlük & Bıkmaz, 2021). A meta‐analysis study reported that approximately one‐third of nurses considered leaving their jobs during the COVID‐19 pandemic (Ulupınar ve Erden, 2024). According to the International Council of Nurses (ICN) report, a worldwide demand for 5.9 million nurses is projected to escalate to 13 million in the coming years (ICN, 2020). Studies show that the leave rate of nurses is considerably high. A systematic review study involving 345 articles reports that the prevalence of intention to quit among nurses varies between 11.7% and 64.4% (De Vries et al., 2023). Another meta‐analysis study covering 14 countries reported that global turnover rates of nurses ranged from 8% to 36.6% (Ren et al., 2024). Nurses’ intention to leave rates are between 16.0% and 27.1% in the United States (NSI Nursing Solutions, 2023), while they fall between 8.9% and 13.6% in some European countries (Belgium, Italy, Poland, and the Netherlands) (Maniscalco et al., 2024). They are between 35.5% and 50.8% in Turkey (Aydoğmuş & Özlük, 2022), 19% in Asia, and 15% in North America (Ren et al., 2024; Wu et al., 2024). All these results demonstrate a need for precautions since it has become a rather serious issue (Malone, 2021).

The scarcity of nurses within the healthcare sector poses a significant threat to the quality and safety of patient care services (ICN, 2022). Research shows that many nurses are willing to leave their profession for preventable reasons. Factors such as workload, work satisfaction, practice environment, burnout, career satisfaction, wages, violence in health, and organizational identification that affect nurses’ intention to leave have been addressed in numerous studies (Ipek & Özlük, 2023; Lee et al., 2020; Li et al., 2023; Liu et al., 2024; Maniscalco et al., 2024; Shin et al., 2020; Tan Jr. et al., 2024). Although the factors causing the global nurse shortage crisis vary due to differences in the socioeconomics, culture, and health systems of each country, the problem of the nursing shortage in Turkey continues to grow, and great efforts are being made to understand why nurses leave the profession. As a result of studying the national and international literature, it is clear that the intention to leave work is complex, and there are many related causes. Although there are fragmentary studies on why nurses leave their jobs with different variables, there are still deficiencies and gaps in the literature about some of the variables. This study deals explicitly with workload, organizational identification, and work satisfaction.

In the literature reviewed above, the individual effects of most of the variables on nurses’ turnover have been shown. We know that many variables within the organizational context affect nurses’ intentions to quit at different levels. Studies with different and mediating variables will yield new results regarding the factors that cause nurses to leave their jobs, and we recommend this model. In this context, the study aimed to understand the effects of workload, work satisfaction, and organizational identification on nurses’ intention to leave their work. As far as we know, this study is the first to examine these four variables simultaneously among nurses. It is also the first in which work satisfaction and organizational identification were examined with mediating roles in the effect of workload on leaving work. The primary objective of this study was to investigate the mediating effect of work satisfaction and organizational identification on the correlation between nurses’ workload and their intention to leave.

Theoretical framework and research hypotheses

This study examined four main concepts: workload, work satisfaction, organizational identification, and intention to leave. The hypothetical model of the research is depicted in Figure 1. The study's hypotheses for evaluating the correlation between these concepts are proposed as follows.

FIGURE 1.

FIGURE 1

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Hypothetical model of the research.

Workload and work satisfaction

Workload refers to the amount of work assigned to a person (Subramony et al., 2024). Work satisfaction indicates employees’ psychosocial well‐being and a conducive work environment. The research results show that a high workload has a negative effect on work satisfaction (Duignan et al., 2024; Jäppinen et al., 2022). One of the adverse psychological effects of stress caused by workload on nurses is a decrease in work satisfaction (Jäppinen et al., 2022). A meta‐analysis study reports a negative correlation between workload and work satisfaction (Niskala et al., 2020). Moreover, nurses with low work satisfaction have a high mental perception of workload (Bazazan et al., 2019).

Hypothesis 1

Workload is negatively associated with work satisfaction.

Workload and intention to leave

High nurse–patient ratios are associated with many negative patient and nurse outcomes, including decreased patient care quality and intention to leave (Bae, 2022; Catania et al., 2024). Studies show that nurses’ workload effectively determines the intention to leave (Bae, 2024; Lee et al., 2020; Wu et al., 2024). Workload affects turnover, and strong workload management can keep nurses in the organization (Jarden et al., 2023). A study concluded that nurses leaving work increases the workload of other nurses (Subramony et al., 2024). This causes employees to distance themselves from their jobs and develop negative attitudes toward their profession. Therefore, the higher the nurses’ perception of workload, the higher the probability of leaving their jobs (Back et al., 2020).

Hypothesis 2

The workload is positively associated with intention to leave.

Workload and organizational identification

According to social identity theory, organizational identification emerges when employees feel they belong (Ashforth & Mael, 1989). A strong identification leads individuals to work toward organizational goals (Bharadwaj et al., 2022). Employees perceive the successes or failures of the organization and any praise or criticism directed at it as if it were directed at them (Onesti, 2023). A study showed that frontline nurses have a robust corporate identity and are willing to take responsibility given by the institution. They also take the initiative to complete various tasks and promote joint development through organizational and personal goals (Lyu et al., 2020). Another study shows that organizational identification positively relates to work satisfaction, organizational citizenship behavior, and organizational job participation (Greco et al., 2022). Further, the organizational identification level of nurses is decisive in their performance (Ma et al., 2023). Increasing organizational identification is, therefore, important for improving nurses' job performance. However, the increasing workload of nurses brings them more responsibilities (Udod et al., 2017). First, nursing managers should provide an organizational culture consisting of supportive work environments that reduce the workload for nurses and promote organizational identification (Ma et al., 2023). As a result of the current research, we found an indirect correlation between workload and organizational identification. We also propose an alternative, suggesting a correlation between workload and organizational identification based on the social identity theory.

Hypothesis 3

The workload is negatively associated with organizational identification.

Work satisfaction and intention to leave

Work satisfaction is related to employee retention, quality of care, and intention to leave work (Duignan et al., 2024). Low work satisfaction is one of the biggest obstacles preventing the organization from achieving its objectives. A study reported that work satisfaction was the most vital variable that increases the intention to leave work (Peter et al., 2024). A meta‐analysis and systematic review study found that nurses had a significantly higher rate of quitting when dissatisfied with their jobs (Wu et al., 2024). Work satisfaction has a robust inverse correlation with employee leave intention. Nurses with high work satisfaction are also more likely to remain within their profession (Alnuaimi et al., 2020). Work dissatisfaction directly predicts intention to leave work (Maniscalco et al., 2024). The increase in staff exchange may decrease the work satisfaction of health workers and trigger their intention to the profession (De Vries et al., 2023). There is a negative relationship between work satisfaction and the intention to leave the profession, and it has been clearly shown that work satisfaction is a protective factor for the intention to leave (Labrague et al., 2020).

Hypothesis 4

Work satisfaction is negatively associated with intention to leave.

Organizational identification and intention to leave

Organizational identification occurs when an employee perceives organizational membership as a meaningful part of their self‐concept and perceives the organization's fate as their destiny (Ashforth & Mael, 1989; Onesti, 2023). As the organizational identification level of individuals increases, the values, goals, and norms of the institution they work for are included in the self‐concept of the employees (Wang et al., 2017). Therefore, an employee with a high level of identification is willing to stay in the institution (Liu & Ngo, 2017). Organizational identification is one of the critical factors affecting the intention to leave work (Liu et al., 2024). It enables the individual to be loyal to the organization and reduces individuals leaving and their intention to leave (Nowak, 2021). It is known that individuals with a high level of organizational identification have more positive mental well‐being (Onesti, 2023). Employees who identify strongly with their organizations show a low intention to leave work (Bharadwaj et al., 2022; Greco et al., 2022).

Hypothesis 5

Organizational identification is negatively associated with intention to leave.

METHODS

Study design, participants, and setting

This study is descriptive, exploratory, and correlational. The population of the study consisted of all the nurses in Konya, which is located in the center of Turkey and is the largest province in terms of area. To exclude participants from outside Konya, the city where the nurses lived was asked to be “Konya” and “other” in the questionnaire. The population size was determined according to the number of nurses (7094 nurses) in the health statistics report published by the Ministry of Health in 2020 (Ministry of Health, 2022). The sample size was calculated as 365 with a 95% confidence interval and a 5% margin of error using the known population formula. In this study, 373 nurses who worked at seven hospitals, including public, private, and university hospitals, participated. The sample size consisted of all nurses who voluntarily participated in the study using the convenience sample method and were reached online between November 2021 and January 2022. A total of 392 nurses responded to the questionnaire. A total of 19 questionnaires were excluded from the study since 12 were from nurses who had worked in the organization for less than six months, and seven were excluded because they contained outlier data.

In the power analysis performed with G‐Power 3.1 after the study, the power of the study was found to be 99% when the effect size was calculated as 0.25% and α = 0.05. In studies of nursing in Turkey, there is an opinion requiring that nurses work in the same institution for at least six months to evaluate attitudes and behaviors at the organizational level (Aydoğmuş & Özlük, 2022). Therefore, only nurses with at least six months of professional experience in the same institution were included in the study to recognize the institution, perceive workload and work satisfaction, and evaluate organizational identification. This study's sample size and demographic distribution are similar to national studies conducted in Konya (Durmuş et al., 2024; Kaya et al., 2022). The informed consent form and other questionnaires were transferred to electronic media. The questionnaire link was forwarded to prospective participants through various channels such as email, social media platforms, and other online platforms for data sharing. In addition, the participants were asked to share the questionnaire with their friends using the snowball sampling method.

Instruments

The Demographic Questionnaire: The researchers created this form, which included questions to determine the age, gender, educational status, and duration of experience in the profession and the unit.

The Workload Scale (WS): The WS is an 11‐item self‐report scale (Duxbury & Higgins, 1991) used to assess the workload level. The rating system for all items employs a 5‐point Likert scale, with responses ranging from “Strongly disagree” (1) to “Strongly agree” (5) (e.g., “My job requires me to work long hours”). Cronbach's alpha coefficient for the Turkish version was 0.84 (Aycan & Eskin, 2005). In this study, Cronbach's alpha internal consistency coefficient was 0.87.

The Minnesota Satisfaction Questionnaire (MSQ): The MSQ is a 20‐item self‐report scale (Gillet & Schwab, 1975) used to assess work satisfaction. The rating system for all items employs a 5‐point Likert scale, with responses ranging from “Very dissatisfied” (1) to “Very satisfied” (5) (e.g., “The chance to work alone on the job”). Cronbach's alpha coefficient for the Turkish version was 0.80 (Baycan, 1985). In this study, Cronbach's alpha internal consistency coefficient was 0.93.

The Organizational Identification Scale (OIS): The OIS is a 6‐item self‐report scale (Mael & Ashford, 1992) used to assess organizational identification. The rating system for all items employs a 5‐point Likert scale, with responses ranging from “Strongly disagree” (1) to “Strongly agree” (5) (e.g., “When someone criticizes hospital, it feels like a personal insult”). Cronbach's alpha coefficient for the Turkish version was 0.88 (Şantaş et al., 2016). In this study, Cronbach's alpha internal consistency coefficient was 0.90.

The Intention to Leave Scale (ItLS): The ItLS is a 3‐item self‐report scale (Mobley et al., 1978) used to assess the level of intention to leave. The rating system for all items employs a 5‐point Likert scale, with responses ranging from “Strongly disagree” (1) to “Strongly agree” (5) (e.g., “I often think of quitting my current job.”). Cronbach's alpha coefficient for the Turkish version was 0.88 (Örücü & Özafşarlıoğlu, 2013). In this study, Cronbach's alpha internal consistency coefficient was 0.79.

Data analysis

An analysis was conducted at the study's outset to address any missing data. Later, the SPSS 21.0 was used to calculate frequency, percentile, standard deviation, mean, correlation, normality, and Cronbach's alpha values. Furthermore, the study involved analyzing direct and indirect effects between variables with structural equation modeling using the AMOS (version 19.0) program. χ2 / df < 5 for the criteria for the model's goodness of fit; RMSEA, SRMR < 0.08; NFI, GFI, CFI, TLI > 0.90 criteria were used. Finally, the packaging method was used to control and mitigate potential errors.

Ethical considerations

For this study, we obtained ethical approval from the Health Sciences Scientific Research Ethics Committee (No. 2020/8), author permission to use the scales, and participant consent through an informed consent form.

RESULTS

Preliminary analysis

Table 1 gives the characteristics of the nurses surveyed. According to collected data, 79.1% were female, 65.4% were married, 39.9% were 18–29, and 64.6% had a bachelor's degrees. The results also demonstrate that 40.8% of the nurses had a professional experience of 5 years or less, and 24.1% were working in intensive care units (Table 1).

TABLE 1.

Characteristics of nurses (n = 373).

n %
Gender
Female 295 79.1
Male 78 20.9
Age
Between 18 and 29 149 39.9
Between 30 and 39 99 26.5
40 years and above 125 33.6
Educational status
Health vocational high school 40 10.7
Associate's degree 49 13.1
Bachelor's degree 241 64.6
Master's degree 43 11.5
Duration of professional experience
5 years and less 152 40.8
6–10 years 100 26.8
10 years and more 121 32.4
Unit
Emergency 63 16.9
Operating room 19 5.1
Outpatient units 30 8.0
Surgical units 31 8.3
Internal units 72 19.3
Administrative (infection, quality, and education) 33 8.8
Pediatrics 35 9.4
Intensive care 90 24.1
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The potential influence of common method bias was explored by using Harman's single‐factor test. No single factor explained more than 50% of the explained variation. Correlation analysis results for scale scores are given in Table 2. A Pearson correlation finding revealed that nurses’ workload had a negative correlation with work satisfaction (r = −0.64, p < 0.001) and organizational identification (r = −0.17, p < 0.001) and a positive correlation with the intention to leave (r = 0.48, p < 0.001). In addition, nurses’ intention to leave had a negative correlation with work satisfaction (r = −0.54, p < 0.001) and organizational identification (r = −0.35, p < 0.001) (Table 2).

TABLE 2.

Mean, Cronbach's alpha, and correlation coefficients.

M SD Cronbach's alpha 1 2 3 4
1. Intention to leave work 7.71 3.01 0.87 – – – –
2. Workload 37.63 7.93 0.79 0.48 * – – –
3. Work satisfaction 2.81 0.72 0.93 −0.54 * −0.64 * – –
4. Organizational identification 3.38 0.89 0.90 −0.35 * −0.17 * 0.38 * –
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*

p ˂ 0.001.

Measurement model

The analysis was carried out in two stages. First, the structural model was created after the measurement model was tested. The measurement model included four latent variables (i.e., intention to leave, organizational identification, work satisfaction, and workload) and 13 indicators (three parcels of intention to leave, organizational identification, workload, and intrinsic and extrinsic satisfaction). Fit values for the measurement model fit indices of the model χ2/df = 2.72; CFI = 0.97; GFI = 0.95; NFI = 0.96; TLI = 0.96; SRMR = 0.05; RMSEA = 0.06 were found. Standardized regression coefficients ranged from 0.73 to 0.92 (p < 0.01). Standardized regression coefficients ranged from 0.73 to 0.92 (p < 0.01). Indicators represented latent variables significantly.

Structural model

The structural model was employed to examine the mediating role of work satisfaction and organizational identification in the correlation between workload and intention to leave. This model revealed a direct β = 0.30 and indirect β = 0.29 effect of workload on intention to leave. The structural model showed an acceptable goodness of fit. The fit index values of the model were found as χ2/df = 3.08; CFI = 0.97; GFI = 0.95; NFI = 0.95; TLI = 0.95; SRM = 0.07; and RMSEA = 0.07 (Figure 2).

FIGURE 2.

FIGURE 2

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A selected structural model describing the relationships between intention to leave, organizational identification, work satisfaction, and workload. (*Effect size for female; **effect size for male).

In addition, the structural model showed that workload had direct effects on β = −0.74 and β = −0.24 on work satisfaction and organizational identification, respectively, while work satisfaction and organizational identification had a direct impact on β = −0.32 and β = −0.24 on intention to leave, respectively. In the concluding remarks, squared multiple correlation values (R 2) indicated that the predictor variables explained 46% of the variance in intention to leave scores. Applying the bootstrapping method, the significance of the direct and indirect effects in the structural model was assessed. This method was performed with 5000 resampling at 95% confidence intervals. All paths of the model were found to be significant (Table 3).

TABLE 3.

Bootstrapping results.

Direct effect Standardized coefficients (β) 95% CI t p Gender differences (z) Hypothesis
H1 Workloads → Work satisfaction −0.74 −0.80 −0.66 −14.08 0.001 −1.33 Accepted
H2 Workload → Intention to leave 0.30 0.14 0.46 3.47 0.001 0.01 Accepted
H3 Workload → Organizational identification −0.24 −0.36 −0.13 −4.28 0.001 −2.53 Accepted
H4 Work satisfaction → Intention to leave −0.32 −0.51 −0.13 −3.43 0.001 1.20 Accepted
H5 Organizational identification → Intention to leave −0.24 −0.37 −0.11 −4.28 0.001 −0.81 Accepted
Indirect effect
Workload → Work satisfaction/Organizational identification → Intention to leave 0.29 0.16 0.44 0.001 – Accepted
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The critical ratio difference test was used to determine the moderating effect of gender. According to Byrne (2013), the critical ratio has a z‐score greater than 1.96, indicating a significant effect. Accordingly, the effect of workload on intention to quit is β = 0.29 for women and β = 0.27 for men, meaning that the moderating effect of gender was insignificant (z = 0.01). The effect of workload on job satisfaction was β = −0.73 for women and β = −0.76 for men, so the moderating effect of gender was also insignificant (z = −1.33). The effect of workload on organizational identification was β = −0.18 for women and β = −0.47 for men, meaning the moderating effect of gender was significant (z = −2.53). The effect of job satisfaction on intention to leave is β = −0.35 for women and β = −0.11 for men, meaning the moderating effect of gender was insignificant (z = 1.20). The effect of organizational identification on intention to leave is β = −0.21 for women and β = −0.40 for men, so the moderating effect of gender was insignificant (z = −0.81) (Table 3).

DISCUSSION

This study investigated the mediating roles of work satisfaction and organizational identification in the correlation between workload and intention to leave. As far as we know, this is the first study in which these four variables were examined together.

According to the theoretical framework in the literature, nurses’ intention to leave was expected to be high when the workload was high, and it would be high when job satisfaction and organizational identification were low. The findings supported that all expectations in the hypothetical model were significant.

This study found that a rise in workload, whether directly or indirectly, was an essential factor in increasing intention to leave. A meta‐analysis and systematic review study covering three continents (Asia, North America, and Europe) and 17 different countries reported that the worldwide leave rate of nurses was between 2.2% and 50%, and the collective prevalence was 18% (Wu et al., 2024). In the study, the reasons for leaving work were classified into three groups: demographic factors, organizational factors, and satisfaction, and it was stated that a higher workload among the organizational factors was associated with a high intention to leave work. Another meta‐analysis study reported that the global nurse turnover rate was 16% (Ren et al., 2024). A study conducted in Italy showed that a high level of intention to leave work in nurses and a higher nurse–patient workload were associated with a higher probability of in‐hospital death. It was found that a 10% increase in intention to leave increased the likelihood of death of inpatients by 14%, while an increase in the workload of nurses increased the possibility of death by 3.4% (Catania et al., 2024). A study conducted with a sample of nurses from 156 hospitals in the United States found that nurse workload was associated with a higher level of nurses leaving work, which in turn was associated with patient mortality (Subramony et al., 2024). Elsewhere, it was revealed that high stress among almost one in five nurse managers in Finland due to workload was associated with a high level of intention to leave the organization (Jäppinen et al., 2022). The factors affecting the intention to leave nurses were examined using the structural equation model, and the workload was an important factor affecting the intention to leave in New Zealand (Moloney et al., 2018). Further, comparable studies have indicated that the perceived workload is positively associated with the intention to leave. Thus, a high ratio of patients to each nurse results in a higher intention to leave (Bae, 2024).

Nurses’ work satisfaction is associated with positive healthcare outcomes and critical organizational outcomes. This study found the mediating role of work satisfaction in the correlation between workload and intention to leave. In four European countries, a study found that nurses’ work satisfaction is one of the determinants that directly and indirectly affect the intention to leave work (Maniscalco et al., 2024). An increase in workload is a critical factor that leads to decreased work satisfaction and a greater likelihood of intention to leave. A fair and manageable workload for nurses increases work satisfaction and adversely decreases the intention to leave (Shin et al., 2020). A significant inverse correlation was found between work satisfaction and intention to leave among most variables affecting nurses’ leaving work in Saudi Arabia (Alqahtani et al., 2024). In alternative research performed in Japan, a negative and moderate correlation was found between nurses’ workload and work satisfaction, and a positive but weak correlation was found between workload and intention to leave (Lee et al., 2020). In a study conducted in China, the role of work satisfaction as a mediating factor in the correlation between decent work and the intention to leave the work of nurses was strongly supported (Xue et al., 2024). In a supplementary study examining the factors affecting leaving the nursing profession in Italy, the intention to leave the profession was positively associated with staff shortages and negatively associated with work satisfaction (Sasso et al., 2019).

Although the studies in the current literature examine the relationship between different variables, as far as we know, a model based on a theoretical basis in which these three variables are considered together has yet to be published. In addition to previous research, this study modeled the mediating role of work satisfaction in the correlation between workload and intention to leave.

The concept of organizational identification has emerged as a key focus of research interest in recent years. This is because organizational identification is vital to explaining the bond between the employee and the organization. Therefore, it can illuminate essential attitudes and behaviors in the employee–organization relationship. This study found the mediating role of organizational identification in the correlation between workload and intention to leave. Improving organizational identification is critical as it is associated with various attitudes and behaviors, such as employee performance, work satisfaction, and lower intention to leave (Greco et al., 2022). Employees who identify with their organizations consider themselves a part of the organization and attribute the organization's goals, objectives, and general well‐being to them (Onesti, 2023). Therefore, employees will not evaluate the high workload negatively and will continue to work more robustly and productively. Fair practices within the organization also serve to increase the organizational identification of employees (Weisman et al., 2023). Employees who think a high workload is unfair will decrease their organizational identification and increase their intention to leave. From this point of view, it is important to focus on the role of management practices, which are the key to improving the organizational identification of employees.

As far as we know, this study is the first to show a direct correlation between organizational identification, workload, and intention to leave, as well as the mediating role of organizational identification between workload and intention to leave. In this study, we found that organizational identification is a factor in the correlation between workload and intention to leave, which leads to nurse retention. This result may lead to possible new studies and discussions about nursing and organizational identification which may be a successful intervention for retaining nurses. Therefore, this study contributes to the literature on organizational identification.

Implications for nursing and health policy

The research findings provide important implications about the factors affecting nurses’ intentions to leave. Healthcare managers, nurse leaders, and policymakers should be able to view high levels of workload and low levels of job satisfaction in nurses as an early warning system that affects nurse turnover. Considering the global shortage of nurses, factors affecting workload and job satisfaction should be identified and improved to keep nurses in the organization. Organizations should periodically self‐evaluate and determine strategies to alleviate nurses’ workload and increase job satisfaction. Reducing nurses' workload at the organizational level, increasing satisfaction by analyzing the conditions affecting job satisfaction, and ensuring organizational identification will also reduce the nurses’ intention to quit. Organizational strategies alone will not be sufficient to keep nurses at work. It is important for policymakers at the national level to determine policies that support the labor force. Governments must make legally and financially sustainable decisions to keep nurses at work.

The health transformation program initiated by politicians involved in planning health services in Turkey and the World Health Organization's “Health for All in the 21st Century” policy has increased the quality of service. However, these studies have not been adequate in preventing nurses from leaving the profession. In human resource planning, it is recommended that health managers and policymakers pay attention to the workload of their nurses to increase work satisfaction and organizational identification and prioritize studies to reduce the intention to leave work. Considering the variables examined in this study, no single factor affects nurses’ intention to leave, and the effect of different variables on retaining nurses should be tested with empirical studies.

Limitations

One of the limitations of the current study is that the course of intention to leave could not be examined. As the data were collected with self‐report scales, these are based on the participants’ opinions. Despite this, the research findings offer important implications about the factors affecting intention to leave. Although there are proven relationships between the variables of this study in international literature, studies have yet to be found addressing the concepts outlined in the current study. The structure formed by all the variables was modeled together. This study introduces a mediation model that reveals the impact of workload on various affective factors.

CONCLUSIONS

The results support the hypothesized mediating role of work satisfaction and organizational identification in the relationship between workload and intention to leave. These findings confirmed the proposed theoretical framework. Previous research shows that workload, work satisfaction, organizational identification, and intention to leave all have proven relationships with each other; however, their collective association is not addressed. The model proposed by this study demonstrates how different factors affect nurses’ intentions to leave. Based on the research findings, the increased workload of nurses increases the intention to leave. In addition, this effect indirectly occurs by reducing the nurses’ work satisfaction level and organizational identification.

AUTHOR CONTRIBUTIONS

Study design: Esma Aslan Seki and Bilgen Özlük. Data collection: Esma Aslan Seki. Data analysis: Esma Aslan Seki and Bilgen Özlük. Study supervision: Bilgen Özlük. Manuscript writing: Esma Aslan Seki and Bilgen Özlük. Critical revisions for important intellectual content: Bilgen Özlük.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

FUNDING INFORMATION

This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.

ETHİCS STATEMENT

For this study, we obtained ethical approval from the Necmettin Erbakan University Health Sciences Scientific Research Ethics Committee (No. 2020/8), author permission to use the scales, and participant consent through an informed consent form.

ACKNOWLEDGMENTS

We thank all nurses in this study for their participation and contribution.

Seki, E.A. & Özlük, B. (2025) Workload and Intention to Leave among Nurses in Turkey: The Mediating Roles of Organizational Identification and Work Satisfaction. International Nursing Review, 72, 1–10. 10.1111/inr.13065

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