A national survey of factors leading to health care worker turnover in Canadian intensive care units.

purposeIntensive care unit (ICU) staff attrition has been exacerbated by the COVID-19 pandemic. We sought to determine what factors have led Canadian health care workers to leave or consider leaving their ICU positions since the onset of the pandemic and to identify targets for intervention.

methodsWe designed an electronic survey and distributed it to national and provincial health professional organizations between August and December 2023. The survey was developed by a multidisciplinary team and informed by existing literature, including validated measures of well-being, workplace satisfaction, and moral distress.

resultsOf 490 health care workers who responded, most were from Alberta (44%), British Columbia (32%), and Ontario (20%). Represented professions included nurses (68%), respiratory therapists (9%), physicians (5%), and social workers (3%). Half (51%) had left an ICU position since 2020. Among those still employed, 72% thought about leaving at least monthly and 19% daily. For 58%, the COVID-19 pandemic contributed to their decision or desire to leave. The most important factors contributing to intent to leave included excessive workload (69%), inadequate staffing (68%), inadequate work-life balance (64%), decreased professional efficacy (51%), and dissatisfaction with organizational leadership (60%) and culture (53%). Unit-based (54%) and organization-based (20%) interventions were deemed most important to improve retention. Staff with intent to leave had similarly poor workplace satisfaction and well-being compared with staff who had already left.

conclusionsIntent to leave and workplace dissatisfaction remained high among ICU staff following the COVID-19 pandemic. Interventions should target unit- and organization-level factors, including staffing, workload, leadership, and culture.