Nurses constitute the backbone of healthcare systems, ensuring patient-centered care, high clinical competence, and a consistent commitment to promoting quality care (Fache & Foster, 2017; Ismail et al., 2018). The risk of burnout and the intention to leave one's job or the profession are among the most frequently studied issues in healthcare, as both represent primary challenges that healthcare systems must address (Hämmig, 2018). An increasing number of professionals express the intention to leave their employment or, in some cases, the profession altogether. The concept of “intention to leave” refers to an individual's propensity to resign from their position in search of new professional opportunities (Chen, Brown, et al., 2015). This intention is a decision-making process characterized by reflection and planning, which does not necessarily translate into actual resignation but serves as a predictive indicator of turnover (Sharififard et al., 2019). Nurse turnover occurs when a nurse voluntarily or involuntarily leaves their position for a different role within or outside their organization (O'Brien-Pallas et al., 2010). Leaving the hospital precedes the abandonment of the profession (De Oliveira et al., 2017). A 15 % annual nurse turnover rate is considered normal and not a cause of concern (Kenny, 2007).This phenomenon leads to adverse events for nurses, patients, and institutions; a high turnover rate imposes additional burdens on the organization, resulting in deteriorated quality of care and, indirectly, increased workload, work-related stress, and burnout risk for remaining nurses, who in turn may be driven to leave their employment (Park et al., 2019). The absence of adequate working and professional conditions, combined with nurses' expectations and professional opportunities, contributes to their turnover and occupational exit (Galbany-Estragués et al., 2024). Reasons for leaving the profession may include excessive workload, limited professional recognition, inadequate remuneration relative to nurses' needs, lack of professional development, and physical and emotional exhaustion (Galbany-Estragués et al., 2024).Nurses' intention to leave has been the focus of numerous studies and publications regarding how these intentions might be potentially influenced by nursing leadership and healthcare organizations to prevent the phenomenon (Heinen et al., 2013). Except for age, potential variables such as workload, burnout, and quality of care have been recognized as predictive factors for the intention to leave the job (Heinen et al., 2013). The intention to leave is a phenomenon that affects every structure, whether public or private, hospital or territorial, regardless of the care setting, suggesting the presence of a wide range of predictive factors (Tummers et al., 2013). Some studies have identified possible factors leading to the abandonment of the nursing profession, including lack of career prospects, generational barriers, work pressures, unsatisfactory working conditions, and low social visibility (Millones Trinidad & Alvarado Rivadeneyra, 2021; Roth et al., 2022). A study conducted in the United States in 2018, involving over three million nurses, reported that 60 % of them desired to leave their job or were considering doing so due to a stressful work environment and inadequate staffing (Shah et al., 2021). Globally, these figures are expected to rise due to ongoing nurse turnover and an increasing number of professionals intending to leave their organization (Labrague & de Los Santos, 2021). Hospitals are facing significant challenges in ensuring high-quality care in a rapidly evolving and continuously changing healthcare context due to the shortage of experienced nurses (Lee et al., 2015). An overwhelming amount of evidence indicates a close link between work environment characteristics and nursing outcomes (Choi et al., 2013). Work environment characteristics include nursing staff, resources, ward activities, organizational management, and professionalism. These aspects have been found to be significantly predictive of nursing job satisfaction and intention to leave. It is important to recognize that achieving positive care outcomes relies on a work environment that supports and sustains professional practice (Choi et al., 2013). A supportive work environment is associated with lower job dissatisfaction, burnout, and intention to leave, as well as improved patient outcomes (Van Bogaert et al., 2013). Improving the work environment offers a low-cost strategy to achieve a better patient experience during hospitalization (Aiken et al., 2012), reduce “unfinished nursing care” (Bruyneel et al., 2015), decrease nurse burnout, which is risky for patient safety, and reduce nurse turnover (Aiken et al., 2012; Heinen et al., 2013). In Europe, a satisfactory nurse-physician relationship and active participation in hospital organizational issues have been found to have a statistically negative correlation with intention to leave (Heinen et al., 2013). Continuous changes, emergencies, shift work, weekend duties, sleep disturbances, family issues, overtime, performing vital activities, responsibilities, time pressures, and staying updated with technological developments are factors that nurses face daily. When all these factors exceed, their management capacity can lead to an increase in the willingness to leave the job (İşsever & Bektas, 2021). The International Council of Nurses (2022) has stated that there are numerous common aspects among different nations influencing intention to leave, such as poor working conditions, which highlight the real challenges of the nursing work environment (Stewart et al., 2022). It is therefore more than reasonable that turnover rates and intention to leave are among the most frequently documented challenges and among the most studied outcomes in healthcare and hospital settings (Hämmig, 2018). Understanding the reasons for the phenomenon is crucial to identify early signs and develop strategies that could be used to support the healthcare system in overcoming the current nursing staff shortage issue (Bahlman-van Ooijen et al., 2023). If nurse leaders were aware of the factors causing professionals to leave the profession, they could support and encourage the development of appropriate leadership styles and address workplace issues to improve job satisfaction and prevent intention to leave and high turnover rates (Sasso et al., 2019).

In 2015, data were collected from 40 hospitals across 13 Italian regions and 3667 nurses (Sasso et al., 2017). The survey, part of a broader European study (RN4CAST), revealed an intention to leave rate of 36 %. Several years later, predictive factors for nurses' intention to leave were investigated (Sasso et al., 2019), along with the correlation between intention to leave, nursing workload, and patient mortality (Catania et al., 2024). Since the “original” 2015 study, no new intention to leave index has been collected in Italy, except when correlated with other factors, such as in Catania et al. (2024). Considering the continuous historical and sociodemographic evolution and the changes brought about by the COVID-19 pandemic, it would be interesting to maintain a high level of attention to this phenomenon, benefiting both patient safety and the nursing profession itself.

Considering the available evidence, this study aims to analyze the level of job satisfaction and intention to leave among nurses registered with the Order of the Nursing Profession (OPI) of Bergamo in Northern Italy.