Organizational versus individual factors: determinants of nurse and midwife retention in deprived areas of southeastern Iran: a cross‑sectional study

Retention of nurses and midwives in deprived areas is a major challenge for health systems. This study aimed to determine the factors associated with retention of nurses and midwives working in hospitals located in the deprived areas of Sistan region, southeastern Iran. This cross-sectional study was conducted from December 2024 to February 2025 in four hospitals affiliated with Zabol University of Medical Sciences. A census approach was used, and all 311 eligible nurses and midwives participated. Data were collected using a validated 35-item questionnaire measuring perceived importance of eight retention dimensions (payment system, welfare facilities, job facilities, job characteristics, work environment, regulations, personality traits, and job motivation) on a five-point Likert scale. Descriptive statistics, Pearson correlation, independent t-tests, and one-way ANOVA with Tukey’s post-hoc test were used for data analysis. The overall mean perceived importance score for retention-related factors was 4.43 (SD = 0.65) out of 5 (observed range: 2.14–5.00). Welfare facilities received the highest mean score (4.48; range: 2.17–5.00) and personality traits the lowest (4.35; range: 2.20–5.00). All dimensions strongly correlated with the overall perceived importance score ( r = 0.797–0.916, p < 0.001). Native participants scored significantly higher only in job characteristics ( p = 0.038). Those living far from the hospital scored higher in welfare facilities ( p = 0.009), job facilities ( p = 0.011), and work environment ( p = 0.043). Having a second job was associated with higher scores in payment system ( p = 0.009), work environment ( p = 0.002), and overall perceived importance ( p = 0.049). No statistically significant differences were found for marital status, having children, employment type, economic status, monthly salary, education level, age, or work experience (all p > 0.05). Construct validity was confirmed (KMO = 0.93, 80.5% variance explained). Organizational factors—particularly job motivation, welfare facilities, payment system, and job characteristics—are more strongly associated with perceived importance of retention factors among nurses and midwives in deprived areas than individual demographic characteristics. Improving motivational incentives, welfare benefits, fair payment systems, and enriching job characteristics, while considering local residence and commuting distance, may enhance workforce retention in underserved regions.