Objectives: First, to examine the impact of nursing practice environments, nurse
staffing and nurse education on nurse reported intention to leave the hospital. Second,
to provide understanding of which best practices in the organization of nursing care
are being implemented to provide sound practice environments and to retain nurses.
Methods: 3186 bedside nurses of 272 randomly selected nursing units in 56 Belgian acute
hospitals were surveyed. A GEE logistic regression analysis was used to estimate the
impact of organization of nursing care on nurse reported intention to leave controlling for
differences in region (Walloon, Flanders, and Brussels), hospital characteristics
(technology level, teaching status, and size) and nurse characteristics (experience,
gender, and age). For the second objective, in-depth semi-structured interviews with the
chief nursing officers of the three high and three low performing hospitals on reported
intention to leave were held.
Results: 29.5% of Belgian nurses have an intention-to-leave the hospital. Patient-tonurse staffing ratios and nurse work environments are significantly (p < 0.05)
associated with intention-to-leave. Interviews with Chief Nurse Officers revealed that
high performing hospitals showing low nurse retention were – in contrast to the low
performing hospitals – characterized by a flat organization structure with a
participative management style, structured education programs and career opportunities for nurses.
Conclusion: This study, together with the international body of evidence, suggests that
investing in improved nursing work environments is a key strategy to retain nurses