Nurse turnover threatens the stability and performance of healthcare organizations, yet existing evidence remains fragmented across individual and organizational domains. This study synthesizes multilevel determinants of turnover intention among Korean clinical nurses and identifies actionable organizational and managerial priorities.
A PRISMA 2020-guided systematic review and meta-analysis was conducted using 284 quantitative studies (N = 67,930) published between 2010 and 2023. Variables reported in ≥ 10 studies were classified into microsystem, mesosystem and exosystem levels based on ecological systems theory and analyzed using random-effects models. Subgroup analyses examined changes before versus during/post-COVID-19.
Across 18 determinants, burnout (r = 0.53) and organizational commitment (r = −0.53) showed the largest effects at the microsystem level. At the mesosystem level, role conflict (r = 0.38) and workplace bullying (r = 0.32) were associated with higher turnover intention, whereas social support (r = −0.31) was associated with lower turnover intention. At the exosystem level, a positive work environment showed a moderate protective association (r = −0.39). Subgroup analyses suggested that, during and after COVID-19, the protective relationship for organizational commitment weakened, while the adverse relationship for workplace bullying strengthened. Importantly, several strong correlates were linked to modifiable organizational conditions rather than individual traits.
This study advances nurse retention research by integrating multilevel evidence into a management-oriented framework. The findings identify key organizational levers – work environment, leadership, social support and anti-bullying systems – that can be targeted by healthcare managers and policy-makers to reduce turnover intention and strengthen workforce sustainability.
