BACKGROUND: Saudi Arabia has a unique nursing profile, as the majority of the nursing workforce are expatriates. The Saudi health care system relies on contracted expatriate nurses to provide most of the direct patient health care. For nurses from other countries, Saudi Arabia can be a challenging place to work due to a range of factors including personal, policy and organisational variables. There is a high turnover of expatriate nurses, and this has been long-standing problem for the Saudi Arabian health care system.

METHOD: A cross-sectional survey design among nurses in Saudi Arabia including 502 nurses, of whom 83.7% are female. Structural equation modelling is used to examine the relationships between the study variables. Confirmatory factor analysis is used to create and validate the measurement models for variables.

RESULTS: The analysis of the survey data identifies that Filipino nurses are more likely to intend to leave their current position than other expatriates, including Malaysian, Pakistani, Indian or local Saudi nurses. Many expatriates identify discrimination as an important contributing factor for their intention to leave, citing that the national salary remuneration for nurses should be based on competency and delivery of care. Furthermore, several independent variables are found to be significant predictors of anticipated turnover, including discrimination; social support from immediate supervisor; organisational commitment; and autonomy.

CONCLUSIONS: This study provides the most comprehensive information available to date about the factors that influence nurses' desire to leave their current job and provides evidence for better health workforce planning in Saudi Arabia. This study strongly indicates that the main factor related to turnover is the unfair and unequal salaries paid to nurses of different nationalities in Saudi Arabia.