Background: The rapid population growth in Saudi Arabia, projected to reach 39.5 million by 2030, have significantly pressured the healthcare system. Vision 2030’s healthcare transformation underscores the urgent need for reforms in Saudi nursing, emphasizing retention and professional development to ensure high-quality care. Purpose: This study examines factors influencing Saudi nurses' retention within a university hospital, focusing on job satisfaction, leadership, and work environment. Methods: Using a descriptive cross-sectional design, data was collected from 82 Saudi nurses. Results: Retention factors included the type of patients cared for (50%), workplace relationships (42.7%), and the feeling of making a difference (37.8%). Time off and professional development opportunities (28%) were also significant. Conversely, limited career promotion (69.5%) and inadequate salary (67.1%) were key reasons for leaving, alongside stressful conditions (48.8%), unsafe staffing (48.8%), and lack of leadership support (35.4%). Conclusions/Implications for Practice: Adapting Saudi healthcare policies to align with cultural and religious values is more crucial than ever. Policies that integrate these aspects are vital for supporting the predominantly nurse female workforce and ensuring their long-term engagement and satisfaction.