Organizational factors outweigh demographics in retaining nurses and midwives in deprived southeastern Iran

Keeping nurses and midwives in hospitals serving some of Iran’s most deprived communities is a persistent struggle for health systems, and a new cross-sectional study from the Sistan region in southeastern Iran offers fresh evidence on which factors matter most.

Construct validity was confirmed with a Kaiser-Meyer-Olkin value of 0.93 and 80.5 percent of variance explained, indicating the instrument reliably captured the underlying dimensions it was designed to measure.

The overall mean perceived importance score across all retention factors was 4.43 out of a possible 5, with an observed range from 2.14 to 5.00. This high average suggests that nurses and midwives in these deprived-area hospitals regard nearly every dimension of their working conditions as important to whether they stay. Welfare facilities received the highest mean score at 4.48, while personality traits received the lowest at 4.35, though the gap between the highest and lowest dimensions was narrow.

Statistical analysis using Pearson correlation showed that all eight dimensions correlated strongly with the overall perceived importance score, with coefficients ranging from 0.797 to 0.916 and p-values below 0.001. This means that each individual factor moves closely in step with participants’ global assessment of what matters for retention, reinforcing that the dimensions are interconnected rather than isolated concerns.

When the researchers compared subgroups, several demographic characteristics showed no statistically significant differences at all. Marital status, having children, employment type, economic status, monthly salary, education level, age, and work experience were all unrelated to perceived importance scores, with every comparison yielding p-values above 0.05. This absence of demographic effects is notable because it suggests that retention priorities are broadly shared across the workforce rather than concentrated in particular personal circumstances.

A few individual characteristics did matter, but only in specific dimensions. Participants who were native to the area scored significantly higher only in job characteristics, with a p-value of 0.038. Those living far from the hospital rated welfare facilities, job facilities, and work environment as more important, with p-values of 0.009, 0.011, and 0.043 respectively. Having a second job was associated with higher scores in payment system, work environment, and overall perceived importance, with p-values of 0.009, 0.002, and 0.049. These patterns indicate that commuting distance and outside employment shape how certain organizational conditions are weighed, even as broader demographics do not.

The study’s conclusion places organizational factors ahead of individual demographic characteristics in explaining perceived importance of retention factors. Job motivation, welfare facilities, payment system, and job characteristics are highlighted as the dimensions most strongly associated with retention priorities among nurses and midwives in deprived areas. The authors suggest that improving motivational incentives, welfare benefits, fair payment systems, and enriching job characteristics, while taking local residence and commuting distance into account, may enhance workforce retention in underserved regions.

It is worth noting that the study measures perceived importance rather than actual turnover behavior. The questionnaire captures how much weight nurses and midwives place on each factor, not whether improving those factors directly causes people to stay or leave. The cross-sectional design also means that associations are observed at a single point in time and cannot establish causal direction. Nevertheless, the census approach and the strong internal consistency of the instrument lend weight to the finding that organizational conditions, rather than personal demographics, dominate how this workforce thinks about staying in a deprived-area hospital.

For health system planners in Iran and in other settings facing similar retention challenges, the results point toward practical levers. Because welfare facilities scored highest and payment system and job motivation ranked among the most strongly associated dimensions, investments in housing support, on-site amenities, transparent pay structures, and meaningful job design may resonate more broadly than policies targeting age, family status, or seniority. The narrow spread between the highest and lowest dimension scores also implies that no single fix will suffice; a coordinated approach across multiple organizational domains is likely needed to shift retention outlooks in hospitals where staffing shortages carry the greatest consequences for underserved communities.

Subject of Research: Factors associated with nurse and midwife retention in deprived areas of southeastern Iran

Article Title: Organizational versus individual factors: determinants of nurse and midwife retention in deprived areas of southeastern Iran: a cross‑sectional study

Article References: Moghadam, M. P., Shamsaei, M., Sarani, M., Bazi, A., & Isfahani, P. (2026). Organizational versus individual factors: determinants of nurse and midwife retention in deprived areas of southeastern Iran: a cross‑sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05272-w

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05272-w

Keywords: nurse retention, midwife retention, deprived areas, cross-sectional study, organizational factors, welfare facilities, payment system, job motivation, Iran, workforce retention, Organizational, versus