Intentions to leave the job and nursing profession among nurses in Kenya's referral hospitals: exploring the effects of organizational culture, work-related stress and job satisfaction.

backgroundKenya's healthcare system, like many in Low- and Middle-Income Countries, is grappling with a severe shortage of nurses, yet experiences continuous mass exodus and high turnover. While understanding, and early suppression of nurses' job and professional turnover intentions is crucial for tackling this crisis, there are limited studies conducted in Kenya focusing on major predictors of nurse turnover intentions, including organizational culture, work-related stress and job satisfaction. This study therefore aimed to fill this gap.

aimTo explore the effects of organizational culture, work-related stress and job satisfaction on nurses' job and professional turnover intentions in Kenya.

methodsThis cross-sectional study surveyed 429 nurses in Kenya's major referral hospitals. Validated tools were used to assess organizational culture (OC), Work-Related Stress (WRS), job satisfaction (JS), job Turnover Intention (TI) and Profession Turnover Intention (ProfTI). Data were analysed using SPSS v28 with Chi-square, correlation and logistic regression at a 95% confidence level(P < .005).

resultsOur analysis revealed that 81.4% and 31.4% of Kenyan nurses intend to leave their jobs and the nursing profession respectively. The overall organizational culture was largely neutral with a slight inclination to positive (M = 2.54, SD = 0.62), work-related stress was moderately high (M = 2.92, SD = 0.51), and job satisfaction was low, with only 56.6% of nurses reporting satisfaction. Predictors of TI were Age (OR = 0.45, 95% CI [0.26,0.078], P = .004), years of work experience (OR = 0.40, 95% CI [0.17, 0.93], P = .033) and job satisfaction (OR = 0.45,95% CI [0.26, 0.77], P = .004). Contrary to many existing literature, WRS inversely predicted TI (OR = 0.63, 95% CI [0.40, 0.99], P = .046). Predictors of ProfTI were: marital status(OR = 3.19, 95% CI [1.70,5.99], P = .001), working in surgical wards (OR = 12.70, 95% CL [1.48,108.85], P = .020) or in ICU/renal/theatre (OR = 10.79, 95% CI [1.27, 91.45] P = .029), salary(OR = 4.91,95% CI[1.21,19.92], P = .026),Job satisfaction (OR = 35, 95% CI [0.23, 0.54], P = < 0.001) and WRS (OR = 1.74, 95%, CI [1.15. 2.61], P = .008). Organizational culture did not significantly predict TI or ProfTI.

conclusionKenya's major referral hospitals are facing a crisis, marked by high rates of both TI and ProfTI. Urgent action is required from hospital managers and administrators, policymakers, the Kenyan government, and all other key stakeholders to enhance job satisfaction, reduce work-related stress, foster a strong positive organizational culture, and improve salaries. CLINICAL TRIAL NUMBER: Not applicable.