Too Demanding to Stay? Fatigue and Depressive Symptoms as Mediators of Turnover Intention in Romanian Anaesthesia and Intensive Care Nurses: A Cross-Sectional Study

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress.