Stay or leave? Retention factors in intensive care medicine from a multiprofessional cross-sectional nationwide survey in Germany

BACKGROUND: Intensive care unit (ICU) demand is increasing, while healthcare professional shortages and turnover threaten capacity, care quality, and patient safety. This nationwide survey quantified intention to stay (ITS), leave (ITL), or being undecided among ICU professionals in Germany and assessed associated determinants. METHODS: An anonymous, nationwide, cross-sectional online survey of ICU physicians, registered nurses, and allied health professionals was conducted by the Young German Interdisciplinary Association of Critical Care and Emergency Medicine between December 2024 and February 2025. Primary outcome was ITS in the ICU for at least three years. Determinants were examined using multinomial logistic regression. RESULTS: Of 1524 questionnaires, 1243 were eligible; median ICU experience was 7 years. 51.1% of respondents were physicians, 39.1% registered nurses and 9.8% allied health professionals. Overall, 45.4% reported ITS, 23.2% ITL, and 31.2% were undecided. A 10-point higher job satisfaction was associated with greater ITS versus being undecided (OR 1.34, 95%-CI[1.24-1.45], p < 0.001) and ITL (OR 1.49, 95%-CI[1.37-1.62], p < 0.001). Similarly, higher perceived family-friendliness was associated with greater ITS versus ITL (OR 1.11, 95%-CI[1.02-1.20], p = 0.013). Rotating day-night shift work was associated with higher ITL (OR 0.56, 95%-CI[0.34-0.92], p = 0.021). Association of annual career development dialogues were attenuated after adjustment, consistent with indirect effects via job satisfaction. CONCLUSIONS: More than half of ICU professionals were at risk of leaving intensive care within three years. Job satisfaction and family-friendliness emerged as key correlates of retention. Prospective studies are needed to determine whether these aspects are potentially modifiable factors to improve retention.