Aims: This review's primary objective is to explore factors causing turnover and turnover intention in nurses working in KSA and to identify ways to prevent turnover and reduce turnover intention in the KSA nursing workforce.

Design: Qualitative evidence synthesis (QES).

Data sources: MEDLINE/Ovid/PubMed, Web of Science, PsychINFO, CINAHL, and Google Scholar (GS) underwent a structured search for articles. Articles were selected for inclusion if they reported primary studies with qualitative or mixed methods study designs published in English or Arabic in the peer-reviewed literature or as a thesis or dissertation.

Review methods: In order to determine which type of synthesis to choose, we applied the RETREAT framework recommended in the Cochrane handbook and used by other researchers. Thematic synthesis was the most applicable choice, so this approach was selected.

Results: Seven studies published in nine reports in the years 2016 through 2022 were included. The final coding framework included five predominant themes related to 19 subthemes. Three main findings were that there are leadership challenges at all levels in the KSA healthcare system leading to nurse turnover, a complex web of discrimination discourages nurses from remaining in the Saudi healthcare workforce, and societal pressure experienced by both Saudi and non-Saudi nurses leads to turnover and turnover intention.

Conclusions: KSA leaders should focus on intervening in the leadership challenges found at all levels of the KSA healthcare system. Addressing this issue could also positively impact the related issues of discrimination and societal pressure in the workplace and could begin to take steps toward improving occupational conditions and reducing nurse turnover and turnover intention.

Impact: Addressing the serious problem of the leadership challenges in healthcare would likely have a strong positive impact on the other two findings that relate to discrimination and societal pressure.

Patient or public contribution: Not applicable.

Keywords: Saudi Arabia; leadership; literature review; non‐Saudi nurses; nurses; nursing; personnel turnover; retention; review; turnover intentions.

© 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.