BACKGROUND: Nurses are the backbone of healthcare and vital to patient outcomes. Newly qualified nurses face significant challenges, with many leaving the profession within 2 years, worsening the nursing shortage. METHODS: This study aimed to examine how work-to-family conflict, job demands, job control, and social support influence the career intentions of nursing students in the Czech Republic. A nationwide cross-sectional survey was conducted between August and December 2023 using a self-administered online questionnaire. The instrument was adapted from the Nurses Early Exit Study and included validated measures related to psychosocial working conditions and work-to-family balance. Data were analyzed using IBM SPSS Statistics to explore associations between these factors, health-related characteristics, and students' intentions to remain in or leave the nursing profession. RESULTS: Among 559 respondents, WAI scores were significantly associated with gender, self-perceived health (ρ = 0.531), and exhaustion (ρ = -0.542). Social support improved training expectations alignment (AOR = 1.021, p < 0.001) and increased likelihood of pursuing nursing qualifications (AOR = 1.308, p=0.004). Conversely, exhaustion negatively influenced endurance (AOR = -0.247, p=0.030) and increased the likelihood of switching careers (AOR = 1.145, p=0.019). Work ability positively predicted endurance (AOR = 0.309, p < 0.001) and reduced career-shift intentions (AOR = 0.891, p=0.003). Despite strong training endurance, 55.6% considered leaving nursing, citing exhaustion and work-family conflict as key factors. CONCLUSION: Social support emerged as a protective factor, aligning training expectations with clinical experiences and encouraging further nursing qualifications. Work ability promoted endurance in training and reduced career shift. In contrast, exhaustion, work-family conflict, poor health, and negative clinical experiences-including bullying-undermined retention. Nursing education administrators and healthcare managers should prioritize supportive environments, strengthen mentorship and peer support, and implement interventions to reduce stress and improve clinical placements to enhance retention and workforce sustainability.

Department of Health Sciences Faculty of Medicine Masaryk University Brno Czech Republic

Department of Public Health Faculty of Medicine Masaryk University Brno Czech Republic

Masaryk Centre for Global Health Department of Public Health Faculty of Medicine Masaryk University Brno Czech Republic

Zobrazit více v PubMed

Canzan F., Saiani L., Mezzalira E., Allegrini E., Caliaro A., Ambrosi E. Why Do Nursing Students Leave Bachelor Program? Findings From a Qualitative Descriptive Study. BMC Nursing . 2022;21(1):p. 71. doi: 10.1186/s12912-022-00851-z. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966353/pdf/12912_2022_Article_851.pdf . PubMed DOI PMC

Visiers-Jiménez L., Kuokkanen L., Leino-Kilpi H., et al. Graduating Nursing Students’ Empowerment and Related Factors: Comparative Study in Six European Countries. Healthcare (Basel) . 2022;10(5):p. 754. doi: 10.3390/healthcare10050754. https://mdpi-res.com/d_attachment/healthcare/healthcare-10-00754/article_deploy/healthcare-10-00754-v2.pdf?version=1650428973 . PubMed DOI PMC

Kim J., Chae D., Yoo J. Y. Reasons Behind Generation Z Nursing Students’ Intentions to Leave Their Profession: A Cross-Sectional Study. Inquiry: The Journal of Health Care Organization, Provision, and Financing . 2021;58 doi: 10.1177/0046958021999928. PubMed DOI PMC

Hu H., Wang C., Lan Y., Wu X. Nurses’ Turnover Intention, Hope and Career Identity: The Mediating Role of Job Satisfaction. BMC Nursing . 2022;21(1):p. 43. doi: 10.1186/s12912-022-00821-5. PubMed DOI PMC

Koskinen S., Burke E., Fatkulina N., et al. Graduating Nurse Students’ Interest in Older People Nursing-A Cross-Sectional Survey in Six European Countries. International Journal of Older People Nursing . 2022;17(3):p. e12446. doi: 10.1111/opn.12446. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9285737/pdf/OPN-17-0.pdf . PubMed DOI PMC

Alkan E., Cushen-Brewster N., Anyanwu P. Investigating Healthcare Workforce Recruitment and Retention: A Mixed-Methods Study Protocol. BMJ Open . 2024;14(2):p. e074100. doi: 10.1136/bmjopen-2023-074100. PubMed DOI PMC

Hambridge K., Banerjee S., Winfield L., Gripton J. Origins, Characteristics and Destination of Nursing Students in South West England. BMC Nursing . 2023;22(1):p. 71. doi: 10.1186/s12912-023-01210-2. PubMed DOI PMC

Karasek R. Job Demands, Control, and Support Model . 1979. https://www.researchgate.net/publication/232495335_Job_Demands_Control_and_Support .

Häusser J. A., Mojzisch A., Niesel M., Schulz-Hardt S. Ten Years On: A Review of Recent Research on the Job Demand–Control (-Support) Model and Psychological Well-Being. Work & Stress . 2010;24(1):1–35. doi: 10.1080/02678371003683747. DOI

Luchman J. N., González-Morales M. G. Demands, Control, and Support: A Meta-Analytic Review of Work Characteristics Interrelationships. Journal of Occupational Health Psychology . 2013;18(1):37–52. doi: 10.1037/a0030541. PubMed DOI

Lyu X.-C., Huang S.-S., Ye X.-M., Zhang L.-Y., Zhang P., Wang Y.-J. What Influences Newly Graduated Registered Nurses’ Intention to Leave the Nursing Profession? An Integrative Review. BMC Nursing . 2024;23(1):p. 57. doi: 10.1186/s12912-023-01685-z. PubMed DOI PMC

Maier C. B., Köppen J., Kleine J., McHugh M. D., Sermeus W., Aiken L. H. Recruiting and Retaining Bachelor Qualified Nurses in German Hospitals (Bsn4hospital): Protocol of a Mixed-Methods Design. BMJ Open . 2023;13(8):p. e073879. doi: 10.1136/bmjopen-2023-073879. PubMed DOI PMC

Li L., Xu R., Wang S., et al. Moderating Effect of Family Structure on the Relationship Between Early Clinical Exposure and Emotional Labor of Nursing Students: A Cross-Sectional Study. BMC Nursing . 2024;23(1):p. 606. doi: 10.1186/s12912-024-02149-8. PubMed DOI PMC

Bakker E. J. M., Kox J. H. A. M., Boot C. R. L., Francke A. L., van der Beek A. J., Roelofs P. D. D. M. Improving Mental Health of Student and Novice Nurses to Prevent Dropout: A Systematic Review. Journal of Advanced Nursing . 2020;76(10):2494–2509. doi: 10.1111/jan.14453. PubMed DOI PMC

Navajas-Romero V., Ariza-Montes A., Hernández-Perlines F. Analyzing the Job Demands-Control-Support Model in Work-Life Balance: A Study Among Nurses in the European Context. International Journal of Environmental Research and Public Health . 2020;17(8):p. 2847. doi: 10.3390/ijerph17082847. PubMed DOI PMC

Wong K. P., Zhang B., Xie Y. J., et al. Impacts of Job Demands on Turnover Intention Among Registered Nurses in Hong Kong Public Hospitals: Exploring the Mediating Role of Burnout and Moderating Effect of Pay Level Satisfaction. Journal of Nursing Management . 2024;2024(1):p. 3534750. doi: 10.1155/2024/3534750. PubMed DOI PMC

Asiedu E. E. A., Annor F., Amponsah-Tawiah K., Dartey-Baah K. Juggling Family and Professional Caring Role Demands, Work-Family Conflict and Burnout among Registered Nurses in Ghana. Nursing Open . 2018;5(4):611–620. doi: 10.1002/nop2.178. PubMed DOI PMC

Tóthová V., Sedláková G. Nursing Education in the Czech Republic. Nurse Education Today . 2008;28(1):33–38. PubMed

Czech Statistical Office (CZSO) Students and Graduates of Universities in the Czech Republic–2001–2021 . 2022. https://csu.gov.cz/produkty/studenti-a-absolventi-vysokych-skol-v-ceske-republice .

Hasselhorn H.-M., Mueller B. H., Tackenberg P. Working Conditions and Intent to Leave the Profession Among Nursing Staff in Europe 9 . 2003. Investigating Premature Departure From the Nursing Professions in Europe–The European Next-Study.

Hasselhorn H.-M., Hans Müller B., Tackenberg P. Next Scientific Report July 2005 . University of Wuppertal; 2005.

Bakker E. J. M., Kox J. H. A. M., Miedema H. S., et al. Physical and Mental Determinants of Dropout and Retention Among Nursing Students: Protocol of the Spring Cohort Study. BMC Nursing . 2018;17(1):p. 27. doi: 10.1186/s12912-018-0296-9. PubMed DOI PMC

Ilmarinen J. The Work Ability Index (WAI) Occupational Medicine . 2006;57(2):p. 160. doi: 10.1093/occmed/kqm008. DOI

Haslam D., Filus A., Morawska A., Sanders M. R., Fletcher R. The Work–Family Conflict Scale (WAFCS): Development and Initial Validation of a Self-Report Measure of Work-Family Conflict for Use With Parents. Child Psychiatry and Human Development . 2015;46(3):346–357. doi: 10.1007/s10578-014-0476-0. PubMed DOI

Bakker E. J. M., Verhaegh K. J., Kox J. H. A. M., et al. Late Dropout From Nursing Education: An Interview Study of Nursing Students’ Experiences and Reasons. Nurse Education in Practice . 2019;39:17–25. doi: 10.1016/j.nepr.2019.07.005. PubMed DOI

NHS England. NHS Long Term Workforce Plan . 2023. https://www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2 .

Lin Y., Hu Z., Danaee M., Alias H., Wong Li P. The Impact of the COVID-19 Pandemic on Future Nursing Career Turnover Intention Among Nursing Students. Risk Management and Healthcare Policy . 2021;14:3605–3615. doi: 10.2147/RMHP.S322764. PubMed DOI PMC

Alghtany S., Madhuvu A., Fooladi E., Crawford K. Assessment of Academic Burnout and Professional Self-Concept in Undergraduate Nursing Students: A Cross-Sectional Study. Journal of Professional Nursing . 2024;52:7–14. doi: 10.1016/j.profnurs.2024.03.003. PubMed DOI

Wongkoey D. The Difference in Achievement Motivation Based on Planning, Participation, Diligence, Responsibility, and Endurance Among Asia Pacific University Students. APHEIT International Journal of Interdisciplinary Social Sciences and Technology . 2024;13(2):13–29.

Connelly D. M., Hay M. E., Guitar N. A., Prentice K. Bridging Educational Grant in Nursing (BEGIN) Students’ Intentions for Retention in Long-Term, Home and Community Care: A Survey Protocol. BMJ Open . 2024;14(5):p. e084744. doi: 10.1136/bmjopen-2024-084744. PubMed DOI PMC

Al Sabei S. D., Al Harthy M. S., Al Harthy A. S., Al Harthy S. S., Al Harthy S. S. Nursing Work Environment, Turnover Intention, Job Burnout, and Perceived Quality of Care Among Nurses in Oman. Journal of Nursing Management . 2020;28(5):1130–1137. doi: 10.1111/jonm.13028. DOI

Pien L. C., Cheng W. J., Chou K. R., Lin L. C. Effect of Work-Family Conflict, Psychological Job Demand, and Job Control on the Health Status of Nurses. International Journal of Environmental Research and Public Health . 2021;18(7):p. 3540. doi: 10.3390/ijerph18073540. PubMed DOI PMC

Martinez M. C., Latorre M. D. R. D. D. O., Fischer F. M. Factors Associated With Work Ability and Intention to Leave Nursing Profession: A Nested Case-Control Study. Industrial Health . 2021;60(1):29–39. doi: 10.2486/indhealth.2021-0085. PubMed DOI PMC

Zhang J., Shields L., Ma B., et al. The Clinical Learning Environment, Supervision and Future Intention to Work as a Nurse in Nursing Students: A Cross-Sectional and Descriptive Study. BMC Medical Education . 2022;22(1):p. 548. doi: 10.1186/s12909-022-03609-y. PubMed DOI PMC

Lundell Rudberg S., Westerbotn M., Sormunen T., Scheja M., Lachmann H. Undergraduate Nursing Students’ Experiences of Becoming a Professional Nurse: A Longitudinal Study. BMC Nursing . 2022;21(1):p. 219. doi: 10.1186/s12912-022-01002-0. PubMed DOI PMC