Volume 22, Issue 4 (12-2025)
J Res Dev Nurs Midw 2025, 22(4): 45-51 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Karimi M A, Akrami R, Assarroudi A, Heshmati Nabavi F, Heidarian Miri H. The role of work schedule characteristics in shaping nurses’ emigration intention in Iran. J Res Dev Nurs Midw 2025; 22 (4) :45-51
URL: http://nmj.goums.ac.ir/article-1-2171-en.html
URL: http://nmj.goums.ac.ir/article-1-2171-en.html
Mohammad Amin Karimi1 
, Rahim Akrami2 , Abdolghader Assarroudi3 , Fatemeh Heshmati Nabavi4 , Hamid Heidarian Miri5
, Rahim Akrami2 , Abdolghader Assarroudi3 , Fatemeh Heshmati Nabavi4 , Hamid Heidarian Miri5
1- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2- Department of Epidemiology and Biostatistics, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
3- School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
4- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ,heshmatinf@mums.ac.ir
5- Nation Cancer registry Ireland, Cork, Ireland
2- Department of Epidemiology and Biostatistics, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
3- School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
4- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ,
5- Nation Cancer registry Ireland, Cork, Ireland
Abstract: (121 Views)
Background: Nurse emigration exacerbates the growing nursing shortage. As undesirable work schedules are linked to job burnout and emigration intention, this study aimed to comprehensively investigate the association between work schedule characteristics and nurses' intent to emigrate in Iran.
Methods: This was a cross-sectional study conducted on 560 nurses working in the medical and surgical wards of four affiliated university hospitals in the eastern part of Iran in 2025. Sampling was performed using a multistage cluster sampling method with proportional allocation, followed by simple random sampling within each ward. Data were collected using a demographic questionnaire, an adapted tool from the Trinkoff instrument for work schedule characteristics, and a dichotomous question (Yes/No) assessing intent to emigrate. Data analysis was performed using logistic regression in Stata software version 17, with a significance level of P < 0.05.
Results: A total of 39.1% of nurses reported an intent to emigrate. In the adjusted model, daily working hours of 13 to 18 hours were associated with a significantly increased intent to emigrate (OR = 2.12; 95% CI: 1.12 - 3.99). Nurses working rotating shifts had a higher likelihood of intent to emigrate compared with those working morning shifts (OR = 2.89; 95% CI: 1.73 - 4.83), and this likelihood was even higher among those working combined morning and night shifts (OR = 5.26; 95% CI: 2.54 - 10.89). Furthermore, quick returns (short rest periods between shifts) were identified as a significant predictor (OR = 2.16; 95% CI: 1.28 - 3.65).
Conclusion: The findings of this study indicate that long daily working hours, rotating and combined shifts, and quick returns are among the most significant factors associated with nurses' intent to emigrate. Recommendations for health policymakers and administrators include implementing strict limits on daily working hours to eliminate quick returns and restructuring schedules to significantly increase predictability and nurse autonomy. Addressing these stressors can reduce emigration intent and enhance healthcare system stability.
Methods: This was a cross-sectional study conducted on 560 nurses working in the medical and surgical wards of four affiliated university hospitals in the eastern part of Iran in 2025. Sampling was performed using a multistage cluster sampling method with proportional allocation, followed by simple random sampling within each ward. Data were collected using a demographic questionnaire, an adapted tool from the Trinkoff instrument for work schedule characteristics, and a dichotomous question (Yes/No) assessing intent to emigrate. Data analysis was performed using logistic regression in Stata software version 17, with a significance level of P < 0.05.
Results: A total of 39.1% of nurses reported an intent to emigrate. In the adjusted model, daily working hours of 13 to 18 hours were associated with a significantly increased intent to emigrate (OR = 2.12; 95% CI: 1.12 - 3.99). Nurses working rotating shifts had a higher likelihood of intent to emigrate compared with those working morning shifts (OR = 2.89; 95% CI: 1.73 - 4.83), and this likelihood was even higher among those working combined morning and night shifts (OR = 5.26; 95% CI: 2.54 - 10.89). Furthermore, quick returns (short rest periods between shifts) were identified as a significant predictor (OR = 2.16; 95% CI: 1.28 - 3.65).
Conclusion: The findings of this study indicate that long daily working hours, rotating and combined shifts, and quick returns are among the most significant factors associated with nurses' intent to emigrate. Recommendations for health policymakers and administrators include implementing strict limits on daily working hours to eliminate quick returns and restructuring schedules to significantly increase predictability and nurse autonomy. Addressing these stressors can reduce emigration intent and enhance healthcare system stability.
Keywords: Shift Work Schedule, Emigration and Immigration, Personnel Staffing and Scheduling, Nursing Staff, Work Schedule Tolerance
Type of study: Original Article |
Subject:
Nursing
References
1. Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage? BMJ Global Health. 2022;7(6):e009316. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Villamin P, Lopez V, Thapa DK, Cleary M. Retention and turnover among migrant nurses: A scoping review. Int Nurs Rev. 2024;71(3):541-55. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Sweileh W. Research trends and patterns on international migration of health workers (1950-2022). Sage Open. 2024;14(4):21582440241. [View at Publisher] [DOI] [Google Scholar]
4. Afshari A, Masoumi SZ, Borzou SR, Safdari A, Khazaei A. Prioritizing drivers of nursing migration: a summative content analysis of influential factors. BMC Nurs. 2025;24(1):632. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Mayta-Tristán P, Dulanto-Pizzorni A. Prevalencia y factores asociados con la intención de emigración en internos de medicina de una universidad pública, Lima 2007. Revista Peruana de Medicina Experimental y Salud Publica. 2008;25(3):274-8. [View at Publisher] [DOI] [Google Scholar]
6. Van Dalen HP, Henkens K. Emigration intentions: Mere words or true plans? Explaining international migration intentions and behavior. 2008. [View at Publisher] [DOI] [Google Scholar]
7. Salih SAA, Bashir WAH, Hamid AM, Hassan AA, Alhussin EM, Mohammed Merghani M, et al. The Intentions of Migration Among Graduated and Postgraduate Sudanese Nursing Students 2022. Nurs Res Pract. 2025:2025:5550685. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Ajayi DO, Tanova C, Bayighomog S, Akinwande AS. Decent Work Conditions and Nigerian Nurse Emigration: The Role of Burnout and Commitment.
Acta Psychol. 2025;259:105294. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Adam F, Nelson S, Salami BO, Grundy Q, Wahab O. African nurses on the move: decisions, destinations and recruitment practices-a scoping review. BMC Health Serv Res. 2025;25(1):419. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Min A, Hong HC. Work schedule characteristics associated with sleep disturbance among healthcare professionals in Europe and South Korea: a report from two cross-sectional surveys. BMC Nurs. 2022;21(1):189. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. De Castro AB, Fujishiro K, Rue T, Tagalog EA, Samaco‐Paquiz L, Gee GC. Associations between work schedule characteristics and occupational injury and illness. Int Nurs Rev. 2010;57(2):188-94. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Dall'Ora C, Ball J, Recio-Saucedo A, Griffiths P. Characteristics of shift work and their impact on employee performance and wellbeing: A literature review. Int J Nurs Stud. 2016;57:12-27. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Åkerstedt T, Kecklund G. What work schedule characteristics constitute a problem to the individual? A representative study of Swedish shift workers. Appl Ergon.2017;59(Pt A):320-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Salehi T, Mirzaee M, Haghani S, Salehinia N. Assessment of the relationship between intention to migrate with workload and a healthy work environment of nurses. JCCNC. 2023;9(2):113-22. [View at Publisher] [DOI] [Google Scholar]
15. Yürümezoğlu HA, Çamveren H. Why are Turkish nurses migrating? A mixed‐methods study. Int Nurs Rev. 2025;72(1):e13019. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Toyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, et al. Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review. BMJ Glob Health. 2023;8(5):e012338. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil Nurs. 2014;39(1):16-25. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Ejebu O-Z, Dall'Ora C, Griffiths P. Nurses' experiences and preferences around shift patterns: a scoping review. PloS one. 2021;16(8):e0256300. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Varghese B, Joseph CM, Al-Akkam AAA, AL-Balawi RMdOA, Swallmeh E, Singh K. Nurse's experience working 12-hour shift in a tertiary level hospital in Qatar: a mixed method study. BMC Nurs. 2023;22(1):213. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Bae S-H. Association of work schedules with nurse turnover: A cross-sectional national study. Int J Public Health. 2023;68:1605732. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Stimpfel AW, Sloane DM, Aiken LH. The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Aff (Millwood). 2012;31(11):2501-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Ball J, Maben JE, Murrells TJ, Day TL, Griffiths P. 12‐hour shifts: prevalence, views and impact. 2015. [View at Publisher] [Google Scholar]
23. Li LZ, Yang P, Singer SJ, Pfeffer J, Mathur MB, Shanafelt T. Nurse burnout and patient safety, satisfaction, and quality of care: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(11):e2443059-e. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Woo T, Ho R, Tang A, Tam W. Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. J Psychiatr Res. 2020;123:9-20. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Dall'Ora C, Ejebu O-Z, Griffiths P. Because they're worth it? A discussion paper on the value of 12-h shifts for hospital nursing. Hum Resour Health. 2022;20(1):36. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. Turunen J, Karhula K, Ropponen A, Shiri R, Hämäläinen K, Ervasti J, et al. Evaluating quick return restrictions on sickness absence in healthcare employees: A difference-in-differences study. Int J Nurs Stud. 2025;163:104996. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Hatukay AL, Shochat T, Zion N, Baruch H, Cohen R, Azriel Y, et al. The relationship between quick return shift schedules and burnout among nurses: a prospective repeated measures multi-source study. Int J Nurs Stud. 2024;151:104677. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Safieh S, Shochat T, Srulovici E. The Mediating Role of Sleep Quality in the Relationship Between Quick-Return Shift Work Schedules and Work-Family Conflict: A Cross-Sectional Study. J Nurs Res. 2025;33(2):e378. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Vedaa Ø, Harris A, Waage S, Bjorvatn B, Thun E, Buchvold HV, et al. A longitudinal study on the association between quick returns and occupational accidents. Scand J Work Environ Health. 2020;46(6):645-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Van den Oetelaar W, Van Stel HF, Van Rhenen W, Stellato RK, Grolman W. Mapping nurses' activities in surgical hospital wards: A time study. PLoS One. 2018;13(4):e0191807. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: a systematic review of longitudinal studies. Int J Nurs Stud. 2022;134:104311. [View at Publisher] [DOI] [PMID] [Google Scholar]
32. Lee A, Cheung YSL, Joynt GM, Leung CCH, Wong W-T, Gomersall CD. Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Ann Intensive Care. 2017;7(1):46. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Bujang MA, Sa'at N, Bakar TMITA, Joo LC. Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data. The Malaysian journal of medical sciences: MJMS. 2018;25(4):122. [View at Publisher] [DOI] [PMID] [Google Scholar]
34. Trinkoff AM, Johantgen M, Storr CL, Gurses AP, Liang Y, Han K. Nurses' work schedule characteristics, nurse staffing, and patient mortality. Nurs Res. 2011;60(1):1-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
35. Griffiths P, Dall'Ora C, Simon M, Ball J, Lindqvist R, Rafferty A-M, et al. Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Med Care. 2014;52(11):975-81. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Vedaa Ø, Harris A, Erevik EK, Waage S, Bjorvatn B, Sivertsen B, et al. Short rest between shifts (quick returns) and night work is associated with work-related accidents. Int Arch Occup Environ Health. 2019;92(6):829-35. [View at Publisher] [DOI] [PMID] [Google Scholar]
37. Adam F, Nelson S, Salami BO, Grundy Q, Wahab O. African nurses on the move: decisions, destinations and recruitment practices - a scoping review. BMC Health Serv Res. 2025;25(1):419. [View at Publisher] [DOI] [PMID] [Google Scholar]
38. Ajayi DO, Tanova C, Bayighomog S, Akinwande AS. Decent work conditions and Nigerian nurse emigration: The role of burnout and commitment. Acta Psychol (Amst). 2025;259:105294. [View at Publisher] [DOI] [PMID] [Google Scholar]
39. Chiang S-L, Tzeng W-C, Chiang L-C, Lee M-S, Lin C-H, Lin C-H. Physical activity patterns, sleep quality, and stress levels among rotating‐shift nurses during the COVID‐19 pandemic. Int Nurs Rev. 2025;72(1):e12997. [View at Publisher] [DOI] [PMID] [Google Scholar]
40. Al‐Hammouri MM, Rababah J, AL‐Jdeetawey NaA. How Shift Schedules Shape Nurses' Sleep and Compassion: A Comparative Study. Int Nurs Rev.
2025;72(3):e70085. [View at Publisher] [DOI] [PMID] [Google Scholar]
41. He Q, Zhang D, Cao S. Presenteeism and Chinese clinical nurses' turnover intention: the mediating role of frustration and job burnout. BMC Nurs. 2025;24(1):633. [View at Publisher] [DOI] [PMID] [Google Scholar]
42. Widera E, Chang A, Chen HL. Presenteeism: a public health hazard. J Gen Intern Med. 2010;25(11):1244-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
43. Gautam PK, Gautam DK, Bhetuwal R. Work-life balance, job satisfaction and turnover intentions among nurses. Int J Organ Anal. 2025;33(3):538-57. [View at Publisher] [DOI] [Google Scholar]
44. Dousin O, Collins N, Bartram T, Stanton P. The relationship between work‐life balance, the need for achievement, and intention to leave: Mixed‐method study. J Adv Nurs. 2021;77(3):1478-89. [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
