
==== Front
Nurs Open
Nurs Open
10.1002/(ISSN)2054-1058
NOP2
Nursing Open
2054-1058
John Wiley and Sons Inc. Hoboken

10.1002/nop2.2231
NOP22231
NOP-2023-Jun-1034.R4
Brief Report
Brief Report
A questionnaire on the current situation of resignation intention of nurses in intensive care units in China – A descriptive quantitative study
He et al.
He Feng 1
Zhang Chunyan 2
Zhao Di 3
Zhang Chao 4
Zeng Liangnan 5
Liu Wei 6
Li Laiyou 2 lilaiyou@126.com

Gao Fei https://orcid.org/0009-0003-5470-9007
4 27909361@qq.com

1 The Second Hospital of Hebei Medical University Shijiazhuang Hebei China
2 Department of Nursing The Fourth Hospital of Hebei Medical University Shijiazhuang Hebei China
3 The Fourth Hospital of Hebei Medical University Shijiazhuang Hebei China
4 Hebei General Hospital Shijiazhuang Hebei China
5 Department of Nursing, Chengdu Fifth People's Hospital The Fifth People's Hospital Affiliated to Chengdu University of Traditional Chinese Medicine Chengdu Sichuan Province China
6 Hebei Psychological Counselor Association Shijiazhuang Hebei China
* Correspondence
Fei Gao, Hebei General Hospital, No. 348 Heping West Road, Shijiazhuang, Hebei 050000, China.
Email: 27909361@qq.com
Laiyou Li, Department of Nursing, The Fourth Hospital of Hebei Medical University, No. 12 Health Road, Shijiazhuang, Hebei 050000, China.
Email: lilaiyou@126.com

05 9 2024
9 2024
11 9 10.1002/nop2.v11.9 e223107 5 2024
03 7 2023
12 6 2024
© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Abstract

Aim

This study analysed and summarized the correlation between various indicators of ICU nurses' personal lives, hospital work situation, social opinion, psychological assessment, and their intention to resign.

Design

A descriptive quantitative study.

Methods

This study was a multicentre questionnaire on factors influencing intensive care unit (ICU) nurses' intention to resign. This study was completed through the Critical Care E Institute (CCEI) and China Calm Therapy Research Group Academic Organization (CNCSG) by contacting ICU nurses in three hospitals in 34 provinces in China. The questionnaire was in the form of a cell phone WeChat scan code. The survey included 22 indicators, including basic information about nurses (marital and child status, personal income, etc.), hospital work (weekly working hours, night shift, hospital environment, etc.), and psychological symptoms.

Results

A total of 1904 nurses were included in this study. Among them, 1060 (55.67%) had the intention to resign. In this study, among the 22 indicators involved, 16 factors, including hospital work hours, job title, satisfaction with current income, having children, and evaluation of the hospital, significantly impact nurses' intentions to resign (all p < 0.05). Logistic regression analysis showed that six indicators influenced nurses' choice of resignation intention (all p < 0.05), including hospital work time, professional title, income satisfaction, hospital work pride, satisfaction of nurses with the compassion and care given to them by their hospitals, and career vision score. The ROC curve showed that all six indicators were <0.70, but the model receiver operating characteristic (ROC) curve constructed for the indicators was 0.756.

In China, increasing the income of ICU nurses, fostering pride in hospital work, reducing working hours, ensuring smooth promotion processes, and enhancing career prospects can all decrease their likelihood of choosing to resign. Absorbing practical nursing management and work experience from other countries will help decrease the intention to resign within this group.

Patient or Public Contribution

No patient or public contribution.

intensive care unit
nurse
psychological assessment
questionnaire
resign intention
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:05.09.2024
He, F. , Zhang, C. , Zhao, D. , Zhang, C. , Zeng, L. , Liu, W. , Li, L. , & Gao, F. (2024). A questionnaire on the current situation of resignation intention of nurses in intensive care units in China – A descriptive quantitative study. Nursing Open, 11 , e2231. 10.1002/nop2.2231

Feng He, Chunyan Zhang and Di Zhao contributed equally to this paper.

Fei Gao: Lead contact.
==== Body
pmc1 INTRODUCTION

The shortage and turnover of nurses have become primary concerns of healthcare organizations worldwide (Buchan & Catton, 2023). The research report “2020 World Nursing Report” released by the World Health Organization reveals that the global number of hospital nursing workers has reached as many as 27.9 million (McCarthy et al., 2020). However, it continues to face a shortage of nurses. Without intervention, by 2030, the number of nurses will be approximately 5.7 million less than the anticipated demand. Chinese research data show that China has only 1.25 nurses per 1000 population, less than 1/3 of the global average (Fu et al., 2022). Compared with developed countries, the shortage of nurses in Chinese hospitals is even more severe. A study in 2017 in Taiwan showed that approximately 77.4% of hospitals reported difficulty recruiting nurses (Chen et al., 2021). A systematic review study conducted in 2020 revealed that Iran faces a statistically significant nursing shortage due to factors such as inadequate training and salaries, low societal status, and negative perceptions of nursing work within society (Shamsi & Peyravi, 2020). The statistically significant loss of capable nursing personnel is prevalent across various developing African countries (Ayalew et al., 2021). Even in some developed countries, the shortage of nurses remains very serious (Morgan, 2022; Tamata & Mohammadnezhad, 2023).

Corresponding to the shortage of nurses is a statistically significant number of resignations among medical personnel. The ongoing COVID‐19 pandemic, lasting for 3 years, has further exacerbated the phenomenon of resignations within this professional group (Falatah, 2021). The average national nurse turnover rate reported in the United States ranged from 8.8% to 37.0% (Haddad et al., 2022). China experiences a notable turnover rate among nursing staff, ranging from 0.68% to 12.71% in secondary hospitals and from 0.64% to 5.58% in tertiary hospitals, which collectively cater to most patients in the country (Cao et al., 2021; Chen et al., 2018). A study involving 96,158 hospital nurses in South Korea revealed that 49.7% (47,760 individuals) of the population experienced turnover events (Park & Ko, 2020). Common reasons for nurses' resignations may be increased personal stress due to high hospital workload, the imbalance between working hours and income, lack of career advancement opportunities and professional burnout (Chen et al., 2021; Zhu et al., 2021). Undoubtedly, widespread nurse resignations have increased hospital operational costs, leading to a relative shortage of nursing staff and increased training pressures; in turn, a shortage of nursing staff may lower the quality of patient care, resulting in decreased patient satisfaction and indirectly impacting patient recovery and treatment outcomes (Bae, 2022).

Among the various hospital departments, nurses in intensive care unit (ICU) departments can work up to 4–5 levels of intensity, and their turnover rate is much higher than that of other hospital departments (Lundgrén‐Laine & Suominen, 2007; Xu et al., 2023). Studies have shown that the willingness of ICU nurses to leave is positively related to stress (Whittaker et al., 2018). The increased work stress of ICU nurses is due to a combination of factors. Usually, ICU nurses are required to assume the roles of healthcare providers for critically ill patients, nursing researchers, nursing educators, coordinators of the doctor–patient relationship, and the role of hospital colleagues (Cai et al., 2015; Yan & Emergency Department, 2015). Nurses must balance between maintaining a healthy personal and social life beyond their professional responsibilities, all while ensuring the well‐being of older people and child family members. A study showed that more emergency and intensive care unit nurses left their jobs due to heavy work and family stress (Tan et al., 2014). Therefore, chronic work and life stress will psychologically impact the nursing population, influencing them to consider resigning.

In this study, we conducted a comprehensive questionnaire survey on the intention to resign by examining 22 indicators, including the basic situation of ICU nurses (including marriage, child status, and personal income), hospital work situation (working hours/week, night shift status, hospital environment, personal feelings about the importance of the hospital to employees, etc.), and Symptom Checklist‐90 (SCL‐90) psychological assessment, to find the reasons affecting the choice of intention to resign in this group and provide a reference for medical research units and hospitals to formulate appropriate policies.

2 MATERIALS AND METHODS

2.1 Experimental design

This study is a multicentre, China‐wide questionnaire involving factors influencing ICU nurses' intention to resign. The questionnaire ranged from December 2018 to January 2019. The study involved 34 provinces in China and 201 cities in the Central Committee of Critical Care Medicine through two academic organizations, Critical Care E Institute (CCEI) and China Calm Therapy Research Group Academic Organization (CNCSG). The questionnaire was sent as a QR code to the critical care committee group of the chiefs of critical care medicine in each tertiary hospital in each province [according to the “Hospital Classification Management Standards” issued by the Chinese health administrative authorities, hospitals in China are classified into a three‐tier, ten‐grade system. They are divided into first, second, and third tiers, with each tier further classified into Grade A, Grade B, and Grade C. Tertiary hospitals also include an additional special‐grade tier. Grade A tertiary hospitals must have more than 501 beds and are regional hospitals providing high‐level specialized medical and health services to surrounding areas and fulfilling higher education and research tasks (Ma et al., 2015; Zhou et al., 2018)]. The hospital directors then sent the questionnaire to their departmental workgroups and completed it with the nurses in each department by scanning the code. The questionnaire survey contained 22 indicators, including nurses' basic life situation (marriage, child status, and personal income), hospital work situation (working hours/week, night shift status, hospital environment, and importance to staff), and SCL‐90 psychological assessment. This study has obtained and passed ethical review by the Ethics Committee of the Second Hospital of Hebei Medical University. The data collection and processing are conducted in accordance with the ethical standards of non‐interventional research and the Helsinki Declaration, respecting the privacy of the respondents (World Medical Association, 2013). All questionnaires were voluntary responses from ICU nurses.

2.2 Inclusion and exclusion criteria

The inclusion criteria for this study included the following nurses: (1) working in the ICU at the time of the study; (2) the ICU nurses could complete the questionnaire using WeChat; (3) completing the questionnaire within a specific time frame of 5–60 min; (4) concealing personal information, including names; and (5) complete response to the questionnaire with no missing answers.

Exclusion criteria included (1) those who completed the questionnaire on a date other than the specified date; (2) perfunctorily and coped with the study, such as completing the questionnaire <5 min or > 60 min; (3) answered the questionnaire questions in their real names; and (4) did not complete all questions.

2.3 Experiment indicators

We assessed nurses' intention to resign by analysing 22 indicators, including their life, work, and related social influences. Patient's fundamental information indicators and their grouping include gender (male/female), education (associate degree/bachelor degree/master degree/PhD), professional title (primary/middle/vice‐senior/senior), marriage (yes/no), and child status (yes/no).

Various parameters related to hospital work and their grouping include hospital working year (0–5/6–10/11–15/>15), number of ICU beds (3–10/11–15/16–20/>20), ICU extra beds (daily extra bed serious/often/occasionally/rarely), on night duty bed ratio (number of nurses/beds, 1:5–10/1:11–15/1:16–20/1:>20/no regular), on night duty (2/3/4/5/6/>6/no shifts), weekly working hours at the hospital (<40/40–60/>60 h), time required to get to/from work (<30/30–60/60–90/90–120/>120 min), number of vacation days of annual in the past year (0/1–7/8–14/>14 days), and whether one has undertaken external training and research (yes/no).

Indicators such as work environment, social attitudes, personal income, and individual career aspirations can influence the psychological well‐being and attitudes of nurses, including income satisfaction (dissatisfied/general/satisfied), work environment satisfaction (dissatisfied/general/satisfied), pride in working in the hospital (very proud/general/no pride/bored), personal satisfaction with the hospital's compassion and care for healthcare workers (good/general/poor), the influence of social opinion guidance on nurses (very positive/general positive/general/general negative/very negative), nurse's satisfaction with the hospital's compassion and care for medical staff (positive/general/negative), visionary expectation of career (self‐assessment, 1–10 points), awareness of ICU presence in the hospital (very important/comparatively important/not important/not essential/despised), and total SCL‐90 score.

2.4 Statistical analysis

This study employed the Symptom Checklist‐90 (SCL‐90) to assess various aspects of the mental health of ICU nurses, including sensations, emotions, thoughts, behaviours, lifestyle habits, interpersonal relationships, diet, and sleep. This comprehensive evaluation aims to reflect the overall psychological well‐being of this group. The data were statistically analysed using the software SPSS 25.0 (IBM SPSS statistics). Comparative analysis of count data was described and calculated using ratio and chi‐square tests. The t‐test (normal distribution) or non‐parametric Mann–Whitney U test (non‐normal distribution) was used to compare continuous data between the two groups. The logistic regression model analysed the factors influencing nurses' intention to resign. The regression analysis was performed using a two‐step approach. Univariate analysis was performed first, followed by multivariate analysis for factors with p ≤ 0.1 in univariate analysis screening. ROC curves were used for the diagnostic description of each independent influencing factor of nurses' intention to resign. MedCalc software was used to graph the ROC curves. Differences were considered statistically significant when p < 0.05.

3 RESULTS

3.1 Baseline information collation of ICU nurses' intention to resign

A total of 1904 nurses completed the questionnaire in this study, of which 1060 (55.7%) had the intention to resign, and 844 (44.3%) did not have the intention to resign. Among them, nurses in the groups of resignation and non‐resignation were more satisfied with statistical differences in 16 indicators with each other in terms of their children's status, time of participation in work, job title, extra beds in ICU, number of night shift days, weekly hospital working hours, current income satisfaction, working environment satisfaction, hospital work pride, satisfaction with their hospital's consideration and care for medical and nursing staff, overall social opinion orientation, time spent on annual leave in the past year, going out for further training such as perceived status of ICU in the hospital, career prospect expectation, and total SCL‐90 score (all p < 0.05, respectively). The two groups had no statistical difference in the remaining six indicators (all p > 0.05, respectively); more detailed results are shown in Table 1.

TABLE 1 The baseline information for nurses.

Factors	Groups	Resign intention (n = 1060)	No‐resign intention (n = 844)	X 2/Z/t	p	
Gender	Male	126	107	0.274	0.601	
Female	934	737	
Degrees	Associate	307	224	3.183	0.204	
Bachelor	745	608	
Master+PhD	8	12	
Marriage	Yes	634	541	3.657	0.056	
No	426	303	
Children	Yes	525	460	4.656	0.031	
No	535	384	
Participation time (year)	0–5	484	358	26.391	<0.001	
6–10	399	277	
11–15	107	98	
>15	70	111	
Professional title	Primary	807	618	21.586	<0.001	
Intermediate	238	189	
Sub‐senior	11	36	
Senior	4	1	
ICU beds	3–10	165	118	3.271	0.352	
11–15	221	158	
16–20	301	264	
>20	373	304	
Extra bed	Serious	131	68	9.317	0.025	
Frequently	218	184	
Occasionally	359	297	
Hardly	352	295	
Night‐shift nurse bed ratio	1:1	40	37	6.790	0.147	
1:2	224	193	
1:3	411	339	
1:4	181	150	
>1:4	204	125	
Night shift (days)	2	106	62	24.231	<0.001	
3	260	204	
4	355	258	
5	197	153	
6	93	85	
>6	28	41	
Off‐duty	21	41	
Hospital hours (h/week)	<40	61	83	13.403	0.001	
40–60	752	596	
>60	247	165	
Satisfaction with income	Dissatisfaction	532	201	203.327	<0.001	
General	455	422	
Satisfaction	73	221	
Satisfaction with work environment	Dissatisfaction	373	147	152.200	<0.001	
General	533	386	
Satisfaction	154	311	
Hospital work pride	Very proud	76	223	192.457	<0.001	
General	528	454	
No pride	358	142	
Boredom	98	25	
Hospital satisfaction with physician compassion and care	Pretty good	147	304	183.062	<0.001	
General	553	432	
Less favourable	360	108	
Perception of social opinion	General front	150	239	62.186	<0.001	
General	462	340	
General negative	448	265	
Travel time to work (min)	<30	398	324	7.275	0.122	
30–60	451	348	
60–90	137	93	
90–120	37	49	
>120	37	30	
Annual leave days	0	459	286	19.015	<0.001	
1–7	445	411	
8–1	117	101	
>14	39	46	
Advanced studies	Yes	302	279	4.621	0.036	
No	758	565	
Evaluation of ICU's status in the hospital	Very important	204	261	78.684	<0.001	
Comparatively important	442	404	
Unimportant	197	89	
Not essential	100	39	
Despised	117	51	
Career Prospects		5.0 (3.0, 6.0)	6.0 (5.0, 8.0)	13.649	<0.001	
Total SCL‐90 score		93.0 (45.3, 156.0)	62.0 (23.0, 125.0)	7.684	<0.001	

3.2 Logistics regression analysis

The logistics regression analysis results showed that six indicators were independent influencing factors of nurses' intention to resign choice (detailed results are shown in Table 2). Among them, the time of participation in the workforce was an independent influencing factor for nurses' intention to resign (p = 0.017). The difference was statistically significant (p < 0.05) between the 10–15 years and >15 years groups, while there was no statistical difference between the <5 years and 5–10 years groups (p > 0.05).

TABLE 2 Logistic regression analysis of nurses' resignation intention.

Testing indicators	Multivariate analysis	Univariate analysis	
p	OR (95% CI)	p	OR (95% CI)	
Participation time (year)/(0–5)	<0.001		0.017		
6–10	0.545	1.065 (0.868, 1.308)	0.276	0.854 (0.644, 1.134)	
11–15	0.171	0.808 (0.595, 1.097)	0.029	0.606 (0.387, 0.949)	
>15	<0.001	0.466 (0.336, 0.648)	0.002	0.417 (0.237, 0.733)	
Professional title/(primary)	<0.001		0.019		
Intermediate	0.744	0.964 (0.776, 1.199)	0.134	1.276 (0.928, 1.755)	
Sub‐senior	<0.001	0.234 (0.118, 0.463)	0.201	0.567 (0.238, 1.351)	
Senior	0.317	3.063 (0.342, 27.475)	0.044	11.808 (1.067, 130.704)	
Satisfaction with income /(Dissatisfaction)	<0.001		<0.001		
General	<0.001	0.407 (0.330, 0.502)	0.002	0.663 (0.513, 0.857)	
Satisfaction	<0.001	0.125 (0.091, 0.170)	<0.001	0.363 (0.245, 0.539)	
Hospital work pride/(very proud)	<0.001		0.001		
General	<0.001	3.412 (2.556, 4.556)	0.001	1.826 (1.291, 2.583)	
No pride	<0.001	7.398 (5.345, 10.237)	<0.001	2.265 (1.480, 3.465)	
Boredom	<0.001	11.502 (6.903, 19.164)	0.003	2.631 (1.404, 4.931)	
Hospital satisfaction with physician compassion and care/(pretty good)	<0.001		0.015		
General	<0.001	2.647 (2.096, 3.344)	0.189	1.221 (0.906, 1.644)	
Less favourable	<0.001	6.893 (5.150, 9.227)	0.005	1.767 (1.186, 2.634)	
Career prospects	<0.001	0.742 (0.710, 0.776)	<0.001	0.892 (0.841, 0.945)	

The title was also an independent influencing factor for nurses' choice of intention to resign (p = 0.019). Among them, the intention to resign was statistically lower in the senior nurses than in the junior group (p = 0.044); the rest of the title groups were not statistically different from each other (p > 0.05, respectively).

Satisfaction with current income was also an independent factor affecting their intention to resign (p < 0.001). Compared to caregivers dissatisfied with their current income, the intention to resign was lower in both the perceived average and more satisfied income groups. Both differences were statistically significant (p = 0.002 and <0.001, respectively).

The nursing staff's pride in the hospital was also an independent influencing factor for their intention to resign (p = 0.001). Compared to the group of nursing staff who had great pride in the hospital, the intention to resign was 1.826, 2.265, and 2.631 times higher in the group with general pride, no pride, and boredom, respectively, and the differences were statistically significant (all p < 0.05, respectively).

Satisfaction with the hospital's compassion and care for nursing staff also influenced their intention to resign (p = 0.015). Compared to the dissatisfied group, the satisfied group had a lower intention to resign (p = 0.005). In contrast, there was no statistical difference between the groups with a perceived average (p = 0.189).

Career prospect score was also an independent influencing factor for healthcare workers' choice of intention to resign (p < 0.001). Moreover, for every 1‐point increase, the intention to resign healthcare workers decreased by 10.1%.

3.3 The results of ROC curve

In this study, the statistical analysis of the resignation diagnostic value of the six independent influencing factors of nurses' intention to resign in the ICU unit in the logistic regression analysis was performed. The results showed that the area under the ROC curve for all indicators was <0.700. The detailed results are shown in Table 3. Career aspirations had the best area under the ROC curve (0.679), and the threshold for resignation intention was a score of 6 (Figure 1).

TABLE 3 The result of the ROC curve.

Factors	AUC	SE	95% CI	Z	p	Youden index	Associated criterion	Sensitivity (%)	Specificity (%)	
Participation time (year)	0.538	0.013	0.516–0.561	3.061	0.002	0.081	≤2	83.30	24.76	
Hospital satisfaction with physician compassion and care	0.664	0.011	0.643–0.686	14.670	<0.001	0.222	>1	86.13	36.02	
Hospital work pride	0.665	0.011	0.644–0.687	14.733	<0.001	0.232	>2	43.02	80.21	
Career prospects	0.679	0.012	0.658–0.700	14.859	<0.001	0.242	≤6	83.30	40.88	
Satisfaction with income	0.671	0.011	0.649–0.692	15.092	<0.001	0.264	≤1	50.19	76.18	
Professional title	0.518	0.010	0.495–0.540	1.760	0.079	0.030	≤2	98.58	4.38	
Model	0.756	0.011	0.736–0.775	23.126	<0.001	0.391	0.579	68.68	70.38	

FIGURE 1 The result of receiver operating characteristic (ROC) curve.

The area under the ROC curve for the joint construction of the model for the six indicators is 0.756 (0.736–0.775). The sensitivity was 68.68%, the specificity was 70.38%, and the Youden index was 0.391 (Figure 1).

4 DISCUSSION

With the progress of society and the improvement of living standards, people's demand for quality healthcare requires nurses to provide high‐level and quality medical care services to patients (Fathi et al., 2017; Permarupan et al., 2020). These requirements will lead to more statistically significant challenges and pressure on nurses to carry out clinical nursing work (Li et al., 2019). However, there must be a general nursing shortage, high workload, low pay and benefits, and low social status in healthcare institutions. In particular, the outbreak of COVID‐19 in 2019 has had an unprecedented impact on the healthcare system (Haldane et al., 2021; Lal et al., 2021). This virus pandemic will undoubtedly put more work and psychological stress on nurses. A study in Finland suggests that nurses facing unstable employment during a pandemic may voluntarily revoke their nursing licences using recent legislation to draw attention to their plight (Cubelo, 2023). The study asserts that when skilled nurses exit the nursing profession, there can be a particular impact on patient safety, health welfare, and national productivity. In contrast to passive strategies such as recruiting foreign nursing staff, formulating national and hospital‐level policies that satisfy their needs should be more effective.

According to the data released by The Lancet Global Burden of Disease Study in 2016, China's Healthcare Accessibility and Quality (HAQ) index increased from 53.3 in 2000 to 77.9 in 2016, entering the top quartile of countries in the world (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). However, the problem of unbalanced development of healthcare resources across regions in China remains to be addressed (Dong et al., 2021). In addition to this, the shortage of nurses is still unresolved (Du et al., 2020). According to the World Health Organization, the global average number of nurses in 2017 was 58/10,000; Norway (181) had the most, followed by the United States (145), the United Kingdom (82), and South Korea (71), while China had only 26 (Vardell, 2020). Therefore, due to the relative lack of medical resources and the Chinese nurse population often under excellent work pressure in their work and the doctor–patient relationship, this group is prone to resign from their jobs.

This study is a research report on ICU nurses' resignations. The study also conducted a study on the intention of ICU physicians to resign. In this study, six independent indicators influenced the choice of ICU nurses' resignation intention. The study on physicians' intention to resign, conducted simultaneously with this study, showed that seven indicators influenced physicians' intention to resign. Among them, work experience years, income satisfaction, hospital work pride, and expectation of career prospects influenced the resignation intention for both physicians and nurse groups. The feeling of satisfaction with the compassion and care of nurses and the professional title were two indicators that this group highly valued. The above study shows that the nurse group pays more attention to the humanized management of the hospital and is more likely to be influenced by positive interactions with their hospitals. When nurses have a higher degree of title, their willingness to choose to resign decreases. This result is similar to the research findings of Bohyun Park and colleagues (Park & Ko, 2020). Their research further indicates that, compared to other career tenure stages, the resignation rate is significantly higher for nurses with less than 3 years or 1 year less of professional experience (p < 0.05).

On the other hand, the physician group was more sensitive to the weekly working hours in the hospital, the hospital working environment, and their mental health. In contrast, the doctor group would pay more attention to their feelings, considering factors such as the exact working hours per week, the working environment of the hospital, and the psychological impact of all hospital environments and policies. In summary, the physician group focuses more on factors relevant to their work and living environment and is more “rational” about the hospital, patients, and their situation. On the other hand, the nurse group focused more on interaction with hospitals, which may be related to the fact that most nurses were females. In a large multicentre study involving 2992 healthcare professionals, including doctors and nurses, working in 68 adult ICUs across 12 European countries and the United States, Bo Van den Bulcke et al. found that 782 healthcare workers (26.1%) expressed an intention to resign. Among them, 27% were nurses, 24% were junior doctors, and 22.7% were senior doctors. Their research revealed an independent correlation between the intention to resign among healthcare workers in ICU settings and the quality of the ICU ethical climate. Intervention measures aimed at reducing the intention to resign, mainly when focusing on improving mutual respect, interdisciplinary reflection, and positive decision‐making at the end of life, may decrease this intention. A survey conducted on ICU healthcare workers in Japan during the COVID‐19 pandemic revealed that 24% and 17% experienced symptoms of burnout and intention to resign, respectively (Kuriyama et al., 2023). From the above studies, it can be inferred that the turnover rate of ICU nurses in China is much higher than in developed countries like Europe and the United States and even in Japan, another Asian country.

Since the new ICU nurses have to bear the heavy workload and are at the primary title of the nursing group, the pressure they are under can be imagined (Guo et al., 2019; Zhou et al., 2022). In this study, the intention to resign was only 0.606 and 0.417 times higher for ICU nurses with 10–15 and >15 years of participation than those with <5 years. The intention to resign among the ICU nurses group tended to decrease as the years of work increased. The nurses who had worked for the first 5 years were all roughly in the age group of 20–30 years, which is a trial period in the exploration and establishment stage of their careers. Their dissatisfaction with their careers now tends to make them choose to change their careers to solve their various dilemmas. The age of 30–45 is a stable stage of career establishment, and the career has been determined. Therefore, ICU nurses at this stage and the age of >45 years are instead less willing to resign from their jobs (Kerzman et al., 2020).

Satisfaction with income and pride in the hospital are essential factors influencing nurses' intention to resign. Some studies have shown that the longer nurses work, the higher their monthly income and the lower their intention to leave (Chegini et al., 2019). Since nurses' work is relatively low‐income, when faced with the increasingly tense hospital and healthcare relationship in China, nurses' groups often need to bear substantial psychological pressure, and their efforts and income are sometimes only partially equal. Hence, the combination of the above factors triggers this group to resign from their job. Some studies have shown that the higher the pride of nurses in their hospital work, the lower their willingness to resign (Yun & Yu, 2021). This study shows that nurses' willingness to resign becomes more vital as pride in hospital work decreases.

The expectation of career prospects is also an independent influencing factor for the choice of intention to resign in the nurse's group. This study showed that nurses with higher ratings of their career plans had lower intentions to resign. For every 1‐point increase in career prospect score, the intention to resign decreased by 10.8%.

There are still some things that could be improved in this study, such as not including the age of the nurses who filled out the form. We will remedy this deficiency in the following study. Also, the nurses included in this study were from tertiary hospitals in each city. Because of the relatively good medical conditions in these hospitals, the salaries of doctors and nurses and medical conditions are generally higher than those in the general secondary hospital. Therefore, to obtain more objective conclusions, we will include secondary hospital nurses in the future so that the sample can represent the entire ICU nurse population more. The necessity of predefining a limited range of choices in the questionnaire inevitably restricts and simplifies the responses to related questions, thereby omitting more profound and complex information. Additionally, some questions are divided into five options, and respondents may choose answers that are not entirely consistent with their actual circumstances, leading to subjectivity and potential bias in the final statistical results. All of these shortcomings are aspects that we aim to minimize and continuously improve upon in further related research endeavours while adhering to the principles of the Helsinki Declaration.

5 CONCLUSION

More than half of the ICU nurses in China intend to resign, related to their seniority, income satisfaction, the subjective perception of the hospital's care for nurses, and career prospect expectations. Nursing managers need to reasonably arrange work shifts according to personal characteristics and work capacity, standardize the system, improve work efficiency, and reduce the work intensity of nurses in emergency departments and ICU units. Paying attention to and respecting nurses' hard work can also help improve their job satisfaction and reduce their willingness to leave. Practical and feasible policy reforms issued by China's health administrative authorities specifically targeting the conditions of the nursing workforce will significantly improve nurse retention. Cultivating a sense of humanity and responsibility among the nursing community will enhance their passion for the profession, positively affecting patient outcomes. Absorbing practical nursing management and work experience from other countries will help decrease the intention to resign within this group.

AUTHOR CONTRIBUTIONS

FH conceptualized and designed the study, collected the data, analysed the questionnaire, wrote the first draft, and revised the manuscript. CZ, DZ, CZ, LZ collected the data, analysed the questionnaire, and wrote the first draft. WL revised the manuscript. LL and FG conceptualized and designed the study, supervised the overall research process, and revised the manuscript. All authors have approved the final version of the manuscript.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no competing interests.

ETHICS STATEMENT

The study obtained and passed ethical review by the Ethics Committee of the Second Hospital of Hebei Medical University. All questionnaires were voluntary responses from ICU nurses.

ACKNOWLEDGEMENTS

We thank the help from Criticla Care E Institute (CCEI) and the Chinese Neurocritical Care Study Group (CNCSG).

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.
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