abstract, title, and references

page 140, ABSTRACT: the aim of the study is clear, authors attempt to identify factors that cause termination among Filipino nurses working in the Saudi Ministry of health and recommendations to enhance retention. method: lack of significant information about sample size, study questionnaire, data collection procedure, and statistical analysis (it is a mixed method).

results: the study findings are clear: causes of termination are low salary and low nurse to patient ratio. while recommendations are better financial benefits and administrative support. the abstract generally needs a lot to improve in its current form. it will be difficult to replicate the current study.

page 140: the title is informative and key variables are included, however, it is suggested to mention that this is a mixed-method study.

References: 12 references used throughout the article, are relevant to study however major key studies on turnover nationally and internationally could be used to show the actual magnitude of nursing turnover on healthcare systems.

Introduction /background

page 140 paragraph 1, line 2-5: it discusses the international rates of turnover, meanwhile it miss the Saudi status quo regarding turnover and staffing ratio which the data is available in multiple resources and studies among which the(WHO statistics), the General authority of statistics in Saudi, and Ministry of Health yearly book of statistics.

page 140, paragraph 1, line 11: the study mainly focuses on Filipino nurses without justification of population, " choosing single nationality", it is suggested to highlight the numbers and percentages of Filipino nurses in Saudi ministry of health.

the introduction section suffers from serious inadequacy, many key elements that are important to understand nursing turnover are missing. it is not clear what is turnover even mean as authors use both turnover and termination these terms interchangeably, how turnover effect healthcare organization and why it is worthy to study. no logical progression in the introduction, more disjointed paragraphs, and unable to find a clear gap of knowledge.

no research question or an interrogative statement that explains what the current study set out to answer. however, there is a clear aim of the study.

methodology

sample size calculation is unclear. however, the small sample size and sampling method limit the ability to generalize any findings.

it could be helpful to provide the total number of nurses applying to hire in the Saudi Ministry of Health along with nurses who resigned and reapplied.

the criterion for participants selection specifically "nurses resigned and reapplied", it does not reflect actual reasons for nurses to return back unless conditions changed like better salary, better place of work which is not explained.

page 140, paragraph 2, line 5: study tool is developed by researchers but inadequate information about how it was developed? how many items? was it piloted? validity and reliability values?

process of data collection: no details at all.

overall, the methodology section does not provide enough details to replicate the current study.

Results:

2 table and 1 figure

page 141, paragraph 2, line 1: "of 63 invited, 142 agreed to participate (87%)" this sentence is not logical because the total number of invitations must be equal to or less than returned surveys. furthermore, by adding numbers in demographics (table 1) the sample size is not 142. it is clearly a wrong value.

page 141, figure 1: "reasons for turnover" the figure is clear, informative, and self-explanatory.

page 141, table 2: "recommendations to improve turnover rate" the item (assure safety) is ambiguous. item appreciation is suggested to move to work environment rather than the quality of life.

discussion and conclusions

page 142 paragraph 1: the relationship between working in remote areas and a low nurse to patients ratio was not discussed earlier and no evidence to support this statement in the results findings or current study literature. it is suggested to shed light on this issue in the literature.

page 142 paragraph 1 line 3: authors discussed the most rated recommendations that are suggested by participants that can mitigate turnover in which financial motivation (34%) and work environment (16%) discussed briefly. while they dismiss any discussion about administrative support (25%) and quality of life (25%) which scored higher rates than the work environment.

overall, the discussion section does not provide a thorough interpretation of the findings nor the findings compared to previous studies.

conclusion: is clear and directly correlates the study objectives. limitation: author indicated that the study is limited because of the sampling method. however, the sample size is small which also limits the generalization of the study findings.

overall statement: the article provide unique information about reasons and solutions of turnover among Filipino nurses worked in the Saudi Ministry of Health. in which major turnover factors were low salary and low nurse to patient ratio, meanwhile it suggested to improve the financial benefits and provide better administrative support to the staff.

strength: the study is useful to the Saudi Ministry of Health for better understand reasons the lead Filipino nurses turnover and help to retain those nurses using practical solutions.

weakness: the introduction does not provide a deep explanation of what is turnover. the logical building of the introduction needs further enhancement. The methodology section suffers from a serious lack of essential information, it does not provide enough details to replicate the current study. The discussion section does not provide a thorough interpretation of the findings nor the findings compared to previous studies.