Stopping the healthcare exodus: Strategic responses to workforce attrition in medical and nursing professions

Abstract

Background: Healthcare workforce attrition among nurses and physicians has emerged as a major challenge to the sustainability and resilience of health systems. Unfavorable work environments, chronic understaffing, excessive workload, burnout, work–life conflict, and limited professional development may contribute to disengagement and intention to leave. Aim: To synthesize evidence on the structural, psychological, organizational, and policy-level determinants of workforce attrition among medical and nursing professionals and to identify strategies that may support workforce retention and healthcare system sustainability. Method and Material: This narrative review followed the principles of the Scale for the Assessment of Narrative Review Articles (SANRA). A structured search of PubMed, Scopus, Web of Science, and CINAHL was conducted for publications from January 2000 to March 2025. Following screening and full-text assessment, 39 sources, including empirical studies, systematic and umbrella reviews, and international policy reports, were retained for thematic synthesis. Results: The literature identified several interconnected determinants of workforce attrition. Chronic understaffing, excessive workload, unfavorable work environments, inadequate organizational support, ineffective leadership, workplace violence, burnout, moral distress, work–life conflict, and limited career development were consistently associated with job dissatisfaction, disengagement, and intention to leave. Evidence also suggested that organizational and policy-level interventions are more likely to support sustainable retention when combined with individual well-being initiatives, supportive leadership, adequate staffing, professional development, and coordinated workforce planning. Conclusions: Healthcare workforce attrition is a multifactorial and systemic challenge that cannot be addressed through isolated interventions. Sustainable retention requires coordinated action across individual, organizational, and policy levels, with particular attention to working conditions, workforce planning, leadership, professional development, and healthcare worker well-being.