1 Introduction

The nursing profession, a keystone in healthcare organisations, is critical to ensuring healthcare quality and patient outcomes. However, nurses have a significant problem due to high turnover rates. Nurse turnover is defined as the rate at which nurses leave their current positions, move to another organisation, change professions, or retire (Hu et al. 2022). Nursing turnover leads to the fragmentation of patient care, disrupts team cohesion and increases expenses for healthcare organisations, including recruitment and training costs during transition periods (Andrews et al. 2024; Church et al. 2023). These transition periods can also adversely affect patient satisfaction, patient care, organisational stability and additional stress on remaining staff members (Guixia and Hui 2020; Randa and Phale 2023). Moreover, the loss of highly experienced nurses can impact negatively on the quality of patient care, as newly hired nurses may not be as familiar with patient needs or organisational procedures (Randa and Phale 2023). Additionally, the remaining nurses may experience increased stress and workloads, which lead to increased turnover rates.

The healthcare sector is characterised as a dynamic development sector that is marked by modifications in healthcare policies, changes in patient needs, and developments in technology. Nursing turnover is one of the dynamic issues in the healthcare sector around the world. Healthcare institutions need to create a healthy workplace setting for nurses to reduce the turnover rate by providing opportunities for professional development and fostering positive leadership practices. This will create a more stable and efficient healthcare environment to meet the patient's needs (Vardaman et al. 2020). Healthcare organisations can improve nurse retention, enhance the quality of patient care, and guarantee the sustainability and stability of the nursing workforce when determining the reasons for nurse turnover. Determining the primary reasons behind nurse turnover is essential for developing strategies to reduce the chance of nurses quitting their positions. These strategies require a comprehensive approach and ongoing studies to determine how these reasons influence nurses' decisions to leave.

2 Background of the Study

Extensive studies have investigated several reasons that impact nurse turnover. These reasons included workload, organisational climate, interpersonal relationships, job dissatisfaction, burnout and leadership styles (Cho et al. 2022; Lee et al. 2020; Liu et al. 2023; Magbity et al. 2020; Phillips 2020). Workload refers to the amount of care and time that one staff nurse spends on patient care, workplace tasks, and professional development (Alghamdi 2016; Phillips 2020). Handling the workload can lead to high care quality and job satisfaction, as well as reduced turnover rates.

Organisational climate is the culture and overall environment inside the organisation. A healthy organisational climate is characterised by effective communication, collaboration, and mutual respect. This climate can reduce turnover and enhance job satisfaction (Laschinger et al. 2012). Interpersonal relationships, particularly with colleagues and supervisors, are critical for reducing turnover rates (Liu et al. 2023). Negative relationships can lead to stress and burnout, while supportive relationships can enhance job satisfaction and increase retention rates.

Another reason contributing to nurse turnover is job dissatisfaction. Studies indicate that dissatisfaction with the work environment, organisational support and workload leads to increased turnover rates (Lee et al. 2020). Burnout is associated with increased intentions to leave their positions. Burnout is a prolonged response to chronic stressors on the job. Maslach et al. (2001) determined burnout to be characterised by depersonalization, emotional exhaustion and reduced personal accomplishment. High levels of burnout are also closely linked to nurse turnover (Jun et al. 2021).

As previously mentioned, various reasons influence nurse turnover; however, the role of nurse leaders is particularly significant. Nurse leaders' styles and behaviours directly affect job satisfaction, the work environment and the retention of nursing staff (Cho et al. 2022). The autocratic leadership style has been shown to increase turnover rates due to poor communication, centralised decision-making, a lack of trust and support, and insufficient guidance (Magbity et al. 2020). Conversely, transformational leadership is characterised by motivating and inspiring nurses, which is significantly associated with reduced turnover rates among nurses (Magbity et al. 2020). Under the transformational style, nurses foster professional development, engage with their team members and create a sense of purpose and community.

The COVID-19 pandemic impacts nursing staff turnover, workload, and job satisfaction. According to a systematic review by Yaraghi et al. (2022), leadership plays a critical role in addressing the challenges faced by healthcare workers during the pandemic. Leadership can create a supportive workplace environment that provides emotional and logistical support, which leads to fostering job satisfaction and reducing turnover intentions among nurses. The study also highlighted significant financial strains, which were unable to offer adequate financial incentives to retain staff. These financial constraints combined with increased workloads contributed to the limited ability to offer competitive wages or bonuses. These constraints suggest that healthcare leaders must adopt a holistic approach to reduce staff turnover, focusing not only on financial compensation but also on fostering a supportive work environment that addresses the psychological and emotional well-being of staff.

Negative and abusive leadership behaviours include a lack of empathy, lack of support, lack of respect, poor communication, selfishness, and favouritism, which contribute to job dissatisfaction and increased turnover intentions (Lavoie-Tremblay et al. 2016). On the other hand, healthy leadership behaviours include encouraging teamwork, fostering professional development opportunities, acknowledging achievements, offering adequate resources, encouraging to give suggestions and feedback, and focusing on two-way communications which can lead to reducing turnover rates and enhancing job satisfaction among nurses (Cziraki et al. 2020). This study used a descriptive phenomenological approach to identify the reasons for nursing turnover.

3 Methodology

4 Findings

5 Discussion

This study's themes reflect different ways in which negative leadership practices can contribute to nurses' decisions to leave their positions. Addressing these practices can help create a healthy working environment and reduce the nurse turnover rate. High turnover rates affect the financial stability of healthcare organisations, the quality of patient care, and the overall morale of nursing staff (Andrews et al. 2024; Church et al. 2023). The findings of this study reveal five predominant themes: poor communication, lack of leader support, unreasonable workloads and staffing issues, lack of professional growth opportunities, and inconsistent leadership and policies. Each of these themes highlights the essential role that nurse leaders play in either reducing or increasing turnover rates.

One of the most pressing concerns is the negative effect of perceived limited support from nurse leaders. The study's participants consistently reported feelings of being invisible, neglected, unappreciated and undervalued, which made eight out of 12 nurses seek employment elsewhere. Effective and clear communication is a keystone of nurse leaders within healthcare settings (Fowler 2023). Lack of leader support not only impacts job satisfaction but also increases the likelihood of turnover and burnout (Grossman 2021; Hult et al. 2023). Many of the interviews highlighted several instances where poor communication from nurse leaders caused mistakes, confusion, and feelings of frustration among nurses. Unclear communication about changes, procedures, and policies created an environment of uncertainty within the healthcare setting. Participants experienced a lack of trust in their leaders when they felt left in the dark about essential procedures or policy updates. This unclarity in communication can lead to an extra workload for nurses as they are challenged to manage unclear job expectations, adjust to unexpected changes, and clarify tasks (Fowler 2023). Moreover, poor communication may exacerbate workload issues at the healthcare organisation by reducing the timely allocation of resources or constraining adequate support (Guixia and Hui 2020). The literature confirmed that improving communication strategies could significantly reduce turnover rates (Duru and Hammoud 2022).

Many nurses reported feelings of instability with frequent changes in policies and nurse leaders. These changes create a difficult work environment to provide reliable patient care and establish consistent daily operations. Inconsistency in expectations and rules not only disrupts routines but also damages nurses' trust and confidence in their supervisors (Wang et al. 2022). Stability and continuity in leadership are required to be addressed in healthcare settings to ensure that changes are properly implemented and well communicated.

This study also found that the limited opportunities for career advancement and professional development are concerns raised by participants. Many new graduate nurses expressed disappointment in limited opportunities for continuous academic degrees such as a master's degree, further training programs, specialisation and promotion. These limitations influence feelings of frustration and a lack of motivation to stay in the healthcare sector. Most nurses reported that healthcare organisation's management often failed to offer the necessary encouragement and support for their staff needs. This leads to reduced job satisfaction, job stagnation, burnout, and higher turnover rates (Shi et al. 2015; Waltz et al. 2020; Wei et al. 2020). Moreover, the participants expressed dissatisfaction with potential misalignment between the realities of their new role and their expectations at hiring. New nurses may expect career growth immediately after hiring, including certifications, further education or specialty training, which are usually unavailable immediately after hiring. This could lead to a sense of stagnation and frustration.

The final theme centers on chronic understaffing and workloads. Nurses consistently reported feeling their concerns and requests for additional staffing were ignored by their organisation's management. The literature confirmed that excessive workload leads to emotional and physical exhaustion among nurses, which not only places high pressure on nurses but also compromises the quality of patient care (Peng et al. 2023; Subramony et al. 2024). The theme of chronic understaffing and workloads interacts with lack of leader support. Nurses who report a lack of leader support face challenges in managing heavy workloads, exacerbating stress and frustration. Also, inadequate staffing is interrelated with feelings of neglect and disempowerment when leadership does not provide necessary resources or address workload concerns. Lack of the leader's support during times of heavy workloads not only affects the performance of the nurse but also damages team dynamics. Nurses may become stressed, dissatisfied, and less motivated if they feel their feedback is ignored. Therefore, effective leadership is critical in actively managing workloads and fostering a supportive environment. Leader's support has positive effects on decreased workloads, improved job satisfaction and reduced turnover rates.

Leadership provides valuable insights into reducing nurse turnover rates. Effective nurse leader creates an empowering work environment by promoting open communication, supporting and recognising staff contributions, ensuring fairness and equity, providing professional development opportunities, and stabilising leadership and concertizing policies (Cziraki et al. 2020). This can significantly enhance nurses' retention and job satisfaction. Highlighting the potential reasons that cause an increase in nurse turnover rates can help healthcare settings develop targeted interventions to maintain a stable healthcare system and retain their nursing workforce.

6 Conclusion

The current study highlights valuable insights into the role of nurse leaders in impacting nurse turnover. This study offers clear evidence that nurse leaders' practices significantly influence nurses' decisions to leave their positions. Poor communication, lack of leader support, unreasonable workloads and staffing issues, inconsistent leadership and policies, and lack of professional growth opportunities have been the main reasons that contribute to nursing turnover. Highlighting these reasons can develop strategies and interventions to create a healthy workplace environment that encourages nurses to stay longer at the same organisation. As a result, productivity, overall morale, quality of patient care, and service will be positively affected inside the healthcare organisation.

Author Contributions

Saleem Al-Rjoub: made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. Saleem Al-Rjoub: involved in drafting the manuscript or revising it critically for important intellectual content. Saleem Al-Rjoub: given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. Saleem Al-Rjoub: agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethics Statement

The study was approved by the Institutional Review Board (IRB) of The Hashemite University university on November 19, 2023 (No: 26-1-2023-2024). Informed consent was gained from all participants. The confidentiality of all participants is assured by assigning a number for each participant, which was used to analyse and collect the findings.

Conflicts of Interest

The author declares no conflicts of interest.