Impact of a Healthy Work Environment on Retention and Intent to Leave Among Croatian Intensive Care Nurses

Objectives: To identify factors influencing nurse retention in critical care units and examine their relationship with the work environment. Design and Setting: A quantitative cross-sectional study using a self-administered HWEAT survey conducted in 2021/2022 among ICU nurses in Croatia. Methods: The Healthy Work Environment Assessment Tool (HWEAT), developed by the American Association of Critical-Care Nurses (AACN), was used to assess domains of the work environment. The survey also included measures of workplace violence, moral distress, intention to leave, retention factors, and sociodemographic characteristics. Convenience sampling was applied to recruit nurses employed in intensive care units. Results: A total of 277 ICU nurses participated, of which 257 responses were retained after excluding incomplete surveys. The mean age was 32.9 years (SD 9.8), with an average of 9.3 (SD 8.9) years of critical care experience. Overall, 30.4% of nurses reported being delighted with their job and 56% somewhat satisfied, yet 34.2% indicated an intention to leave their position. Nurses who frequently experienced moral distress had a 2.8-fold higher likelihood of intending to leave. Key reasons that would prompt nurses to reconsider leaving included higher salary and benefits (86%), better staffing (78%), and greater opportunities for professional development (75%). The main factors contributing to retention were competitive salaries and benefits, supportive interpersonal relationships, and effective leadership. Conclusion: Approximately one-third of ICU nurses reported an intention to leave their current role. These findings highlight the need for organizational strategies that reduce moral distress, improve staffing, increase salaries, and strengthen supportive and equitable work environments to enhance nurse retention and workforce stability.