Healthcare workforce mobility and organisational turnover in Sweden, 2014-2024: a multi-method analysis across occupations and sectors.

Abstract

Labour shortages and high staff turnover pose major challenges for healthcare systems, yet most existing research relies on cross-sectional data, focuses on single occupations, and examines intention to leave rather than actual mobility. To address these gaps, this two-part study investigates healthcare staff mobility patterns across public and private employers and occupational groups in Sweden over the past decade (labour market mobility perspective), while also examining types of organisational turnover and the exit destinations of staff who voluntarily left their positions (an organisational turnover perspective). We employed a quantitative multi-method design covering four occupational groups (medical doctors, registered nurses, assistant nurses, and other licensed healthcare occupations). Consistent with the two-part design, the study combines two complementary components: (i) a national cohort dataset enabling analyses of occupational mobility and transitions between employers (Study A; labour market perspective), and (ii) register-based turnover data combined with organisational exit survey data from a large regional public healthcare provider (Study B; organisational perspective). Together, these two substudies capture mobility at both societal and organisational levels. Study A showed that healthcare staff mobility remained relatively stable over the past decade, but patterns varied notably by occupation. Most transitions occurred between public and private employment, with private sector employees showing the highest mobility. Nursing staff moved mainly between different public employments, in contrast to the other two occupational groups. Relatively few employees changed occupations, but those who did mostly switched to non-healthcare occupations. Study B revealed that external turnover rates (i.e., employees leaving the regional organisation) exceeded internal rates (i.e., employees changing jobs within the organisation) across all years and occupations; registered nurses had the highest average external turnover rate (8%), and an upward trend was observed for assistant nurses. While most had secured new jobs when leaving, many, especially assistant nurses, left without knowing their future employment situation. Healthcare staff mobility patterns in Sweden have remained relatively stable from 2014 to 2024, yet distinct patterns across various occupational groups reveal structural vulnerabilities. By integrating labour market and organisational perspectives, this study shows that mobility is not uniform but varies across occupations, sectors, and types of exit pathways.