Exploring the intention to leave the nursing profession: a descriptive qualitative study in Italy

Introduction: Nurses and nursing assistants working in high-intensity hospital settings are exposed to demanding workloads, organizational pressure, and substantial emotional strain, factors commonly associated with job dissatisfaction and an increased intention to leave the profession. Intention to leave is a recognized predictor of actual turnover and is particularly relevant in high-intensity cardio-thoracic-vascular units, where care complexity and emotional burden are especially pronounced. This study aimed to explore the experiences, perceptions, and motivations of nurses and nursing assistants working in a high-intensity cardio-thoracic-vascular setting with regard to their intention to leave. Methods: A descriptive qualitative study was conducted at an Italian university hospital in accordance with the Consolidated Criteria for Reporting Qualitative Research. Four focus groups were carried out between May and June 2025 and involved nurses and nursing assistants employed in a high-intensity cardio-thoracic-vascular unit. All discussions were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Methodological rigor was ensured through researcher triangulation and participant validation. Results: Five main themes emerged from the analysis: (1) motivation and professional identity, (2) working in high-intensity care, (3) interprofessional relationships, (4) symbolic representation of professional roles, and (5) intention to leave and job dissatisfaction. Participants described emotional exhaustion, workload imbalance, and a perceived lack of professional recognition as primary drivers of intention to leave. Conversely, strong teamwork, supportive peer relationships, and empathetic leadership were identified as protective factors. Discussion: Intention to leave among nurses and nursing assistants arises from the interaction of emotional, relational, and organizational dimensions. These findings highlight the need for interventions focused on supportive leadership, structured communication, and staff wellbeing initiatives to strengthen motivation, reduce attrition, and enhance the sustainability and quality of care in high-intensity clinical settings. Conclusion: These findings deepen understanding of intention to leave in high-intensity care and may inform future retention strategies.