Actual Nurse Turnover in Iranian University Hospitals: (2021-2024)

Introduction: Nurse turnover is a critical global health workforce challenge, threatening the quality and sustainability of healthcare systems. This study aimed to determine the turnover rate and identify the underlying causes of nurse turnover in the Tehran University of Medical Sciences (TUMS) hospitals, Iran. Methods This study used a qualitative design. Telephone interviews were conducted with 54 nurses who had resigned from TUMS hospitals. The interviews were recorded and supplemented with note-taking. Data analysis was performed using Braun and Clarke’s six-phase thematic analysis approach. Results overall, 590 nurses (12.3%) left their jobs in the TUMS hospitals between 2021 and 2024. Nineteen reasons for nurses’ turnover were identified, which were classified into four categories: individual factors (family responsibilities and problems, long distance between place of residence and workplace, migration, and physical problems), job-related factors (high quantitative and qualitative workload, lack of regular rest breaks during work, unclear job descriptions and responsibilities, lack of professional autonomy, and not receiving appropriate feedback from managers), organizational factors (staff shortages, low salaries, weaknesses in the management system, discrimination among nurses, little attention to nurses’ needs and expectations, poor communication and tension with managers), and extra-organizational factors (economic problems and inflation, inadequacy of modern technologies, and climate changes). Conclusion Nurse turnover in TUMS hospitals is primarily driven by excessive workload, inadequate compensation, and poor management. Addressing these root causes through systemic interventions targeting work environment, fair pay, and supportive leadership is essential to improve retention and ensure quality patient care. Implications for Nursing Management: Healthcare organizations should develop targeted talent management initiatives that address workload management, provide leadership training, and implement fair, transparent human resource policies to mitigate turnover.