Why nurses quit: Job demands, leadership and voluntary nurse turnover in adult care in the Netherlands

Nurse turnover is a prominent issue in Dutch healthcare, causing staff shortages and operational disruptions. The literature reports myriad factors triggering nurse turnover, but little attention is given to how motives arise at multiple organizational levels and whether these affect distinct groups of nurses differently. Using qualitative and exploratory methods, we examine motives at multiple levels and for distinct nurse categories. We apply thematic and cluster analysis to motives from semi-structured interviews conducted between 2019 and 2020 with 56 nurses who left a healthcare employer but continued working in adult care in the Netherlands. We provide an empirical nuance to understanding and analysing motives by differentiating between all motives reported by each participant and the single most important motive: reported most responsible for their turnover decision. Our exploratory analysis suggests heterogeneity among nurses in their expressed multi-level and multifaceted motives. A universal theoretical model is, therefore, unlikely to explain and predict nurse turnover. Job-demands resources theory and leader-member exchange theory appear most relevant in explaining multi-level and multifaceted motives for two distinct groups of nurses. The most important motives explained by job-demands resources theory are hierarchy and structural changes. The most important motives explained by leader-member exchange theory include increased workload and not being listened to by leaders. Our study has significant managerial and policy implications, highlighting the need to develop different retention strategies tailored to distinct groups of nurses characterized by their expressed motives. The most important motives are within the control of the organization, suggesting scope for healthcare organizations to address nurse turnover more effectively.