Actual nurse turnover in Iranian university hospitals: (2021–2024)

Nurse turnover is a critical global health workforce challenge, threatening the quality and sustainability of healthcare systems. This study aimed to determine the turnover rate and identify the underlying causes of nurse turnover in the Tehran University of Medical Sciences (TUMS) hospitals, Iran. This qualitative study was conducted using semi-structured telephone interviews with 54 nurses who had resigned from TUMS hospitals. Interviews were recorded and supplemented with note-taking and continued until data saturation was achieved. Data were analyzed using Braun and Clarke’s six-phase thematic analysis approach. The data analysis showed that 590 nurses (12.3%) left their jobs in the TUMS hospitals between 2021 and 2024. Nineteen reasons for nurses’ turnover were identified, which were classified into four categories: individual factors (family responsibilities and problems, long distance between place of residence and workplace, migration, and physical problems), job-related factors (high quantitative and qualitative workload, lack of regular rest breaks during work, unclear job descriptions and responsibilities, lack of professional autonomy, and not receiving appropriate feedback from managers), organizational factors (staff shortages, low salaries, weaknesses in the management system, discrimination among nurses, little attention to nurses’ needs and expectations, poor communication and tension with managers), and extra-organizational factors (economic problems and inflation, inadequacy of modern technologies, and climate changes). Organizational factors accounted for the largest number of identified codes, indicating that issues related to organizational structure and management played the most prominent role in nurses’ turnover. Nurse turnover in TUMS hospitals is primarily driven by excessive workload, inadequate compensation, and poor management. Addressing these root causes through systemic interventions targeting work environment, fair pay, and supportive leadership is essential to improve retention and ensure quality patient care. Given that organizational factors were the predominant drivers of turnover, nursing management should prioritize targeted, system‑level interventions. Greater attention to nurses’ professional and personal needs, promoting organizational equity, and clarifying job roles and expectations may further enhance retention. Implementing these organizational improvements can substantially reduce turnover and support a stable, high‑quality nursing workforce.