Factors Influencing Retention Intention among Nurses in University-Affiliated Hospitals in Guangxi Province, China

Abstract

The present study aims to analyze the structural relationships among key variables that influence nurses’ intention to remain in their profession within university hospitals in Guangxi Province, China. Specifically, it investigates the effects of transformational leadership, quality of work life, organizational commitment, and adaptability on professional retention, and further proposes practical approaches to reduce turnover rates among nursing personnel. A mixed-methods design was employed. Quantitative data were obtained from 935 nurses working in nine university-affiliated hospitals under Guilin Medical University and Guangxi Medical University through an online survey. Descriptive statistics and Structural Equation Modeling (SEM) were used to examine inter-variable relationships. For the qualitative phase, in-depth semi-structured interviews were conducted with 27 nurses of varying seniority levels. The interview transcripts were analyzed using content analysis to interpret and complement the quantitative findings. The results revealed that all examined variables scored at high levels, with retention intention showing the highest mean value, followed by transformational leadership, quality of work life, organizational commitment, and adaptability. Path analysis confirmed that the proposed model was consistent with empirical data (χ² = 1035.329; df = 106; p = 0.146; CFI = 0.938; GFI = 0.905; AGFI = 0.831; RMSEA = 0.098; CMIN/DF = 10.058). Among the predictors, work-life balance (β = 0.82, p < 0.05) exerted the strongest influence on nurses’ intention to stay, followed by career advancement and job security (β = 0.77, p < 0.05), individualized consideration (β = 0.77, p < 0.05), and continuance commitment (β = 0.75, p < 0.05). All causal paths were statistically significant at the 0.05 level, confirming that leadership, organizational environment, and adaptive capacity jointly explain the intention to remain in the nursing profession. The study provides a structural understanding of nurse retention mechanisms and offers evidence-based strategies for hospitals to improve leadership practices, enhance work-life quality, and strengthen long-term workforce stability.