The Effect of Quality of Nursing Work Life and Work-Related Stress on Turnover Intention Among Nurses with Burnout Syndrome: A Scoping Review

Abstract

Nurses’ turnover intention has become a global issue that affects healthcare service quality,  organizational stability, and patient safety. Several factors influencing turnover intention include Quality of Nursing  Work Life (QNWL), work stress, and burnout syndrome. However, scientific evidence regarding the relationships  among these variables remains fragmented and has not yet provided a comprehensive understanding. This  study aimed to map the scientific evidence regarding the influence of Quality of Nursing Work Life (QNWL) and work  stress on nurses’ turnover intention, with burnout syndrome acting as a mediating mechanism. This study  employed a scoping review design using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses  Extension for Scoping Reviews (PRISMA-ScR) approach. The Population was nurses, the Concept comprised Quality of Nursing Work Life (QNWL), job stress, burnout syndrome, and turnover intention, and the Context referred to healthcare settings or nursing practice. The initial literature search across PubMed, Scopus, Google Scholar, EBSCOhost, ProQuest, and SINTA. The reviewed articles consisted of Indonesian and English  publications published between 2020 and 2025. The keywords and Boolean operators used in the search strategy included: "Quality of Nursing Work Life" "occupational stress", "burnout syndrome" , "turnover intention"  AND "nurse" OR "nursing staff" OR  "perawat". Based on the selection process, 20 articles met the inclusion criteria from 253 article full papers and were included in the final synthesis. Results: The findings identified 253 articles. After removing 73 duplicate records, 180 articles remained for title and abstract screening. Of these, 82 articles met the initial inclusion criteria and underwent full-text assessment and 20 article included in these scoping review. This scoping review demonstrated that QNWL had a  negative association with turnover intention, while work stress showed a positive relationship with turnover intention,  particularly influenced by high workload, shift systems, and psychological pressure in the workplace. In addition,  burnout syndrome was identified as a dominant predictor as well as a mediating mechanism linking QNWL and work  stress to turnover intention. The emotional exhaustion dimension emerged as the burnout component with the strongest  influence on nurses’ intention to leave their jobs. Low QNWL and high levels of work stress contribute  to increased turnover intention among nurses, both directly and indirectly through the mediating role of burnout  syndrome. Therefore, improving quality of work life, managing work stress, and preventing burnout are essential  strategies to maintain nurse retention and sustain healthcare service quality.