Turnover intention among intensive care nurses and the influence of the COVID-19 pandemic: a scoping review.

Abstract

Background: The shortage of nurses has been an ongoing issue for many decades. An important contributing factor is voluntary turnover. Especially in intensive care (ICU) and critical care units (CCU) with high workloads, high mortality rates and stressful working conditions, the phenomenon has serious consequences. In addition, the COVID-19 pandemic has exacerbated the problem. This review examines the factors influencing the intention to leave (ITL) and intention to stay (ITS) among intensive care and critical care nurses and the influence of the COVID-19 pandemic.

Methods: A scoping review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed, Wiley, Scopus, APA PsycNet and Web of Science were searched. In addition, a forward search using Google Scholar was carried out. Empirical studies reporting on factors influencing the intention to stay or leave among ICU nurses published from 2000 to 2022 were included. The factors were qualitatively coded in MAXQDA, resulting in an inductive coding frame.

Results: Fifty-four studies, including 51 quantitative, one qualitative, and two mixed methods studies, were included in the review. The analysis of factors influencing the intention to either leave or stay in intensive care can be systematically classified into two categories: organisational factors and individual factors. The category of organisational factors encompasses factors, such as commitment and integration, leadership, professional collaboration and communication. Conversely, the category of individual factors comprises factors, such as professionalism, job satisfaction, mental health and social reasons. The pandemic has exacerbated certain aspects within individual and organisational factors, influencing the intention to leave intensive care. Notably, despite the significant impact of COVID-19, no "new" themes are directly attributable to it.

Conclusions: The results can help practitioners meet future challenges (maintaining adequate staffing levels in view of the existing shortage of nurses). It is the responsibility of nursing and hospital management to capitalise on the insights of this review. Future research should focus on longitudinal, interventional and qualitative study designs to understand voluntary turnover among ICU nurses.