Healthcare systems in the Netherlands and other Western countries are under increasing strain due to growing demand for care and a shrinking workforce. A critical challenge is understanding why nurses choose to remain in the profession, particularly in high-pressure settings such as hospital emergency departments. This thesis investigates how a systems science approach can contribute to understanding nurses’ workload and their intention to stay in the profession, using a case study of the Emergency Department at Erasmus MC.

Drawing on System Dynamics modeling and participatory Group Model Building with nurses, the study explores the complex relationships among perceived workload, job satisfaction, stress, and team dynamics. The research combines literature review, participatory modeling sessions, and simulation using Exploratory Modeling and Analysis to identify the conditions under which nurses are most likely to remain in the profession.

Findings show that perceived workload has a stronger influence on the intention to stay than objective measures such as patient-to-nurse ratios. A key insight is the concept of “shift balance,” which captures whether nurses experience more positive than negative shifts over time. This metric proved more meaningful than traditional workload indicators. The study also highlights the importance of eustress, a motivating form of stress, and the need to distinguish it from other stress types.

By applying systems science tools to a complex workforce issue, the thesis offers practical guidance for designing interventions that support nurses' long-term commitment to their profession. It has deepened the understanding of stress and workload dynamics around the nurses' intention to stay in the profession.