Factors associated with the chronicization of psychological responses and intention to stay among nurses 18 months after the 2024 Noto Peninsula earthquake: a cross-sectional study

The 2024 Noto Peninsula earthquake caused extensive infrastructure damage and increased the burden on human resources in an already depopulated and aging region. In major hospitals in the Oku-Noto area, approximately 18% of nursing staff left, which led to a near-collapse of the regional healthcare delivery system. Although many studies have documented the immediate mental health effects of disasters, there is a lack of evidence on the factors that affect nurses’ intention to stay in their current workplace during the recovery phase (18 months post-disaster). This study aimed to identify the predictors of intention to stay among hospital nurses in the earthquake-affected regions of Noto, Japan. We conducted a cross-sectional survey from August to September 2025 among staff nurses working at disaster-affected medical institutions in the Noto Peninsula. Participants were recruited through all 106 medical and long-term care facilities in the affected municipalities. Using “intention to stay in the current workplace” as the dependent variable and adjusting for confounding variables, we performed binary logistic regression analysis (stepwise method) to identify associations between intention to stay and individual attributes (e.g., age, sex), geographical factors, psychosocial burden, and perceived organizational support. Among the 578 total respondents (response rate: 48.4%), 358 staff nurses working in hospitals were analyzed (mean age: 43.2 years). No statistically significant associations were found between intention to stay in the current workplace and birth origin, workplace location, or personal disaster-related damage. Conversely, logistic regression analysis identified two significant predictors: “absence of anxiety or depressive symptoms” (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.03–2.69) and “perception of a well-established psychological support system within the workplace” (OR: 2.30, 95% CI: 1.39–3.81). Our findings suggest that internal organizational support systems are more important for nurse retention in the Noto region than individual disaster status or geographical factors. During the recovery phase, external aid provision should shift from direct individual interventions to supportive roles that strengthen local institutional support frameworks. Furthermore, establishing mechanisms to identify and monitor staff with chronic psychological burdens is important for maintaining healthcare delivery systems in depopulated and aging regions.