Predictors of Intention to Stay in Healthcare Among Healthcare Students and Professionals in Czechia and Slovakia.

BACKGROUND: Workforce stability remains a major challenge for sustainable healthcare systems. Retention research increasingly distinguishes between organizational conditions, professional identification, and mobility or place-related preferences. However, less is known about how these factors operate within closely related Central European contexts and in samples that include respondents connected to healthcare education and practice. This study examined whether workplace relationships and leadership, professional commitment, and place-related mobility preferences predict intention to stay in healthcare and compared these associations in the Czech Republic and Slovakia. METHODS: A descriptive, correlational, cross-sectional study was conducted among healthcare students and professionals in the Czech Republic and Slovakia. The analytical sample included 2103 respondents, comprising 1011 participants from the Czech Republic and 1092 from Slovakia. Data were collected using an author-developed questionnaire focused on workplace relationships and leadership, professional commitment, place-related mobility preferences, and related aspects of the work and educational environment. Exploratory and confirmatory factor analyses were used to examine the latent structure of the instrument and assess reliability, followed by multiple linear regression and cross-national comparison. RESULTS: The final model supported three interpretable dimensions: workplace relationships and leadership, professional commitment, and place-related mobility preferences. In the Czech and Slovak samples, the regression models explained 23.2% and 23.3% of the variance in intention to stay, respectively. In the regression analyses, Q41 was used exclusively as the dependent variable and was not included in the professional-commitment predictor composite. Within the tested model, professional commitment showed the largest standardized association with intention to stay in both national samples, workplace relationships and leadership showed a significant but smaller association, and place-related mobility preferences were not statistically significant predictors. Although the omnibus country comparison reached statistical significance, differences in individual dimensions were trivial or very small, indicating substantial similarity between the Czech and Slovak samples. CONCLUSION: In these cross-sectional data, intention to stay in healthcare was more strongly associated with professional commitment than with workplace relationships and leadership or place-related mobility preferences. The findings should be interpreted with caution because the outcome was assessed using a single, conditionally worded item and because the sample included respondents connected to both healthcare education and practice. Nevertheless, the results suggest that retention strategies may benefit from combining improvements in organizational conditions with deliberate support for professional meaning, commitment, and identification with the healthcare role. IMPLICATIONS FOR NURSING MANAGEMENT: The findings suggest that nursing managers, educators, and healthcare leaders should not rely solely on structural or logistical retention measures, such as staffing arrangements, geographic flexibility, or financial incentives. Although supportive workplace relationships and leadership remain important, the largest association with intention to stay was observed for professional commitment within the tested model. Retention strategies should therefore include systematic efforts to strengthen professional meaning, value congruence, identification with the healthcare role, mentoring, recognition, and supportive leadership practices. Nursing management interventions may be most effective when they create working and learning environments that reinforce professional commitment rather than addressing workplace conditions in isolation.