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This study examined the moderating effects of income inequality and nurse–patient relationships on the association between occupational stress and nurse turnover intentions in large urban hospitals in China, providing evidence for developing targeted retention strategies.
A cross-sectional study.
Data from 13,298 nurses in 46 hospitals in Xi'an, China (October–December 2023) were analysed using hierarchical regression to assess associations between occupational stress, organisational and professional turnover intentions and the moderating roles of the expected income achievement rate (calculated as [actual/expected income] × 100%) and nurse–patient relationship quality.
Eighty-three percent of nurses reported moderate-to-severe occupational stress. Compared to nurses experiencing mild stress, those with moderate/severe stress demonstrated significantly higher organisational and professional turnover intentions. After adjusting for covariates, significant interaction effects were observed. Higher expected income achievement rate showed a modest but significant moderating effect, associated with reduced turnover intentions. While the nurse–patient relationship also moderated this relationship, its protective effect was attenuated under conditions of severe stress. Despite small effect sizes, the consistent patterns and theoretical coherence of these interactions warrant further investigation.
Occupational stress significantly predicts nurse turnover intentions in urban Chinese hospitals, with income inequality and nurse–patient relationship quality serving as modifiable moderating factors. Interventions should integrate equitable compensation, nurse–patient relationship enhancement programmes and stress management initiatives.
This study demonstrates that equitable income consistently buffers the effects of occupational stress on nurse turnover, while nurse–patient relationships show stress-level-dependent moderation. By implementing region-specific compensation benchmarks and structured communication training, healthcare policymakers can effectively address economic security and relational care quality in workforce stabilisation.
The study has been reported following the STROBE guidelines.
No patient or public contribution.
To investigate the experience and perceptions of the effectiveness of retention strategies of nurses and nursing associates in district nursing services.
Mixed methods cross-sectional online survey.
Electronic invitations were circulated via district nursing professional networks to complete an online survey in England. The survey questions were developed from international evidence-based guidance. Quantitative data were analysed descriptively and using multinomial regression analysis, tested the variation in experienced strategies by job and work characteristics. Content analysis informed qualitative data analysis.
Three hundred and forty-five completed surveys were received. Over 60% of respondents reported experiencing strategies related to a safe working environment (75%), flexible work schedules (65%), well-being (64%) and professional development opportunities (60%). The least frequently reported strategies experienced were involvement in service policymaking (26%), reducing job demands (31%); and creating cohesive nursing teams (40%). Nurses on lower pay grades were statistically less likely than those on the higher pay bands to experience strategies involving professional growth opportunities and involvement in service decision-making. Nurses working in affluent areas were statistically more likely to report experiencing more types of retention strategies than those working in socio-economically deprived areas. Participants' views on effective strategies were mixed but attention to financial aspects (particularly travel costs), manageable workloads, flexibility in work scheduling plus tailored induction/support for those new to district nursing were given the most testimony as effective.
Retention strategies are created and enacted by those within employing organisations, district nursing services and district nursing teams, but within the context of a wider health care and labour market system. We suggest the findings could be the starting point for review by district nursing services experiencing high vacancy rates. Our findings raise questions for subsequent investigation across health systems.
This paper adhered to the relevant Equator guideline A Consensus-Based Checklist for Reporting of Survey Studies (CROSS), https://doi.org/10.1007/s11606-021-06737-1.
This study did not include patient or public involvement in its design, conduct or reporting.
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