Understanding Nurse Turnover in Island-Based District Hospitals: Building Strategies for Retention and Workplace Support
DOI:
https://doi.org/10.65339/ijsair.V2.I2.639Keywords:
Burnout, Compensation, Coron District Hospital, Island-Based Hospital, Nurse Retention, Nurse Turnover, Staffing Shortage, Thematic Analysis, WorkloadAbstract
This study explored the lived experiences, workplace challenges, and contextual factors influencing nurse turnover at Coron District Hospital, an island-based district hospital in Palawan. Anchored on the Job Demands–Resources Model, Maslow’s Hierarchy of Needs, Benner’s From Novice to Expert Theory, Leininger’s Transcultural Nursing Theory, and Johnson’s Behavioral System Model, the study examined how organizational and contextual conditions shaped nurses’ retention and resignation decisions. A qualitative descriptive research design was employed using semi-structured interviews with ten purposively selected participants, composed of five currently employed nurses and five former nurses who had resigned within the past one to three years. Data were analyzed through thematic analysis. Findings showed that nurses experienced supportive teamwork, camaraderie, and collegial relationships; however, these positive conditions were weakened by resource limitations, inadequate staffing, heavy workload, burnout, delayed salary, insufficient compensation, limited benefits, unclear promotion pathways, leadership inconsistency, transportation and housing concerns, geographic isolation, and family-related obligations. Delayed salary, workload imbalance, career stagnation, and weak organizational support emerged as major reasons for dissatisfaction and resignation. The study concluded that nurse turnover was shaped by cumulative demographic, professional, organizational, and island-based contextual factors rather than a single cause. It recommended timely salary release, improved compensation, staffing reforms, workload redistribution, leadership development, career progression pathways, mentorship, adequate resources, psychosocial support, and context-sensitive assistance such as housing and transportation support. The study aligned with SDG 3, SDG 4, SDG 8, SDG 16, and SDG 17 by addressing healthcare quality, professional development, decent work, institutional governance, and coordinated workforce responses. Its sustainability impact lies in strengthening healthcare workforce stability, service continuity, institutional support, and equitable access to care in geographically isolated healthcare settings.
References
Abd-Elwareth, F., Obied, H. K., & Abou Ramadan, A. H. (2022). Nursing staff perspectives regarding career plateau management strategies and its relation to job satisfaction.
Alanazi, R., Bahari, G., Alzahrani, Z. A., Alhaidary, A., Alharbi, K., Albagawi, B. S., & Alanazi, N. H. (2023). Exploring the factors behind nurses’ decision to leave clinical practice: Revealing causes for leaving and approaches for enhanced retention. Healthcare, 11(24), 3104.
Ali Alkhatib, A. E., Elghabbour, G. M., & Mohammed, H. A. (2024). Career plateau and dark leadership at healthcare organizations: Care from nurses’ perspective.
Alibudbud, R. (2023). Addressing the burnout and shortage of nurses in the Philippines. SAGE Open Nursing, 9, 23779608231195737.
Amilhamja, K. G., Jalilul, A., & Sabdani-Asiri, M. (2024). Work commitment and job satisfaction among nurses under the nurse deployment program in Sulu.
Bae, S. H. (2024). Nurse staffing, work hours, mandatory overtime, and turnover in acute care hospitals affect nurse job satisfaction, intent to leave, and burnout. International Journal of Public Health, 69, 1607068.
Barandino, J. P., & Soriano, G. P. (2019). Practice environment and work-related quality of life among nurses in a selected hospital in Zamboanga, Philippines. Nursing Practice Today, 6(4), 223–228.
Bragadóttir, H., Kalisch, B. J., Flygenring, B. G., & Tryggvadóttir, G. B. (2023). The relationship of nursing teamwork and job satisfaction in hospitals. SAGE Open Nursing, 9, 23779608231175027.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Buchan, J., & Catton, H. (2020). COVID-19 and the international supply of nurses. International Council of Nurses.
Cao, J., Zhao, J., Zhu, C., Li, Z., Liu, H., Li, F., & Li, J. (2021). Nurses’ turnover intention and associated factors in general hospitals in China. Journal of Nursing Management, 29(6), 1613–1622.
Carthon, J. M. B., Travers, J., Hounshell, D., Udoeyo, I., & Chittams, J. (2021). Disparities in nurse job dissatisfaction and intent to leave.
Chavez-Nicer, D. J. B., & Faller, E. M. (2024). Rural nurses’ work-life balance and home-life satisfaction in a Level 1 government hospital in Leyte: A qualitative study.
Colorafi, K. J., & Evans, B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16–25.
Cornito, R. S. B., & Cunanan, G. M. (2020). Effects of burnout and nurse job satisfaction on turnover intention among nurses in Northern Mindanao, Philippines. Asian Journal of Health, 9(1).
Corpuz, J. C. G. (2023). Advancing Filipino healthcare: The plight of Filipino nurses in a postpandemic world. SAGE Open Nursing, 9, 23779608231220872.
Crisostomo, S. (2020, September 6). Online classes may cause feelings of isolation.
DiRenzo, M. S., Tosti-Kharas, J., & Powley, E. H. (2021). Called to serve: Exploring the relationship between career calling, career plateaus, and organizational commitment in the U.S. military. Journal of Career Assessment.
Eseadi, C., & Diale, B. M. (2020). Correlation of career satisfaction with burnout among Nigerian nurses. International Medical Journal, 27(4), 447–449.
Failla, K. R., Ecoff, L., Stichler, J. F., & Pelletier, L. R. (2021). A 1-year accredited nurse residency program’s effect on intent to leave.
Falguera, C. C., Labrague, L. J., Firmo, C. N., De Los Santos, J. A. A., & Tsaras, K. (2022). Relationship of work engagement with nurse-work and patient outcomes among nurses in the Central Philippines.
Fasbender, U., Van der Heijden, B. I. J. M., & Grimshaw, S. (2019). Job satisfaction, job stress, and nurses’ turnover intentions. Journal of Advanced Nursing.
Halcomb, E. J., & Davidson, P. M. (2006). Is verbatim transcription of interview data always necessary? Applied Nursing Research, 19(1), 38–42.
Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965.
Kondo, A., Wang, C., & Ganchuluun, S. (2023). Job satisfaction and intention to leave among foreign-educated nurses in Japan. Journal of Nursing Management.
Labrague, L. J., De Los Santos, J. A. A., Falguera, C. C., Nwafor, C. E., Galabay, J. R., Rosales, R. A., & Firmo, C. N. (2020). Predictors of nurses’ turnover intention at one and five years’ time. International Nursing Review.
Labrague, L. J., McEnroe-Petitte, D. M., Tsaras, K., & Colet, P. C. (2018). Factors influencing turnover intention among registered nurses in Samar Philippines. Applied Nursing Research, 39, 200–206.
Legaspi, R. S. E. (2019, March 14). A comparison of job satisfaction among Filipino nurses employed in the Philippines and overseas.
Lindquist, M. (2023, January 30). The cost of nurse turnover by the numbers.
Lucas, P., Jesus, É., Almeida, S., Costa, P., Cruchinho, P., Teixeira, G., & Araújo, B. (2025). The nursing practice environment and job satisfaction. Nursing Reports, 15(7), 224.
Marcomini, I., Pendoni, R., Pauciulo, V., Sansone, V., Milani, L., Terzoni, S., Zibaldo, A., & Rosa, D. (2024). Nurse-to-nurse collaboration.
Mathew, M., John, A., & Ramachandran, R. V. (2025). Nurse stress and patient safety in the ICU. BMJ Open Quality, 14, e003109.
Mikkelson, A. C., Sloan, D., & Hesse, C. (2017). Relational communication messages and leadership styles. International Journal of Business Communication, 56(1), 3–21.
Nantsupawat, A., Poghosyan, L., Wichaikhum, O. A., Kunaviktikul, W., Fang, Y., Kueakomoldej, S., Thienthong, H., & Turale, S. (2022). Nurse staffing and quality of care. Journal of Nursing Management, 30(2), 447–454.
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1–13.
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling in mixed methods research. Administration and Policy in Mental Health, 42(5), 533–544.
Pattali, S., Sankar, J. P., Al Qahtani, H., Menon, N., & Faizal, S. (2024). Effect of leadership styles on turnover intention. BMC Health Services Research, 24(1), 199.
Phillippi, J., & Lauderdale, J. (2018). A guide to field notes for qualitative research. Qualitative Health Research, 28(3), 381–388.
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Pressley, C., & Garside, J. (2023). Safeguarding nurse retention: A systematic review. Nursing Open, 10(5), 2842–2858.
Price, S., & Reichert, C. (2017). Continuing professional development and career satisfaction. Administrative Sciences, 7(2), 17.
Rhéaume, A., Breau, M., & Boudreau, C. (2025). When nurses leave: A critical incident study. Journal of Clinical Nursing, 34(7), 2981–2991.
Sadang, J. M. (2021). The lived experience of Filipino nurses’ work in COVID-19 quarantine facilities: A descriptive phenomenological study.
Samuelsson, C., & Thach, O. (2018, June). Nurses’ experiences in work-related health in the Philippines.
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340.
Skillman, D., & Toms, R. (2022). Factors influencing nurses’ intent to leave acute care hospitals.
Sutanto, M., Purwati, W. D., & Pamungkas, R. A. (2023). Increasing retention of nurses through compensation strategies. International Journal of Nursing and Health Services, 6(3), 191–196.
Tamata, A. T., & Mohammadnezhad, M. (2023). Factors affecting nursing workforce shortage. Nursing Open, 10(3), 1247–1257.
Tripathy, M. (2020, October). Dimensions of critical thinking in workplace management and personal development: A conceptual analysis.
Ubas-Sumagaysay, N. A., & Oducado, R. M. F. (2020). Perceived competence and transition experience of new graduate Filipino nurses.
Ventimiglia, G., Setti, I., & Maffoni, M. (2026). Mentoring in hospital settings. Healthcare, 14(4), 505.
Villarante, D. M., O’Donoghue, S. C., Medeiros, M., Milton, E., Walsh, K., O’Donoghue, A. L., Celi, L. A., Hayes, M. M., & DiLibero, J. (2023). A national survey of stress and burnout in critical care nurses. Dimensions of Critical Care Nursing, 42(5), 248–254.
Zhu, H., Xu, C., Jiang, H., & Li, M. (2021). Experiences and attributions for resigned nurses with a career plateau. International Journal of Nursing Sciences, 8(3), 325–331.
