The effects of effort-reward imbalance on emergency nurses' turnover intention: The mediating role of depressive symptoms.

Abstract

This study investigated the effects of effort-reward imbalance (ERI) on emergency nurses' turnover intention and the role of depressive symptoms between ERI and turnover intention. Turnover intention is crucial for clinical practice due to its relationship with turnover behaviour and destructive effect on stability of nursing staff. The ERI is a mainstream model to explain job stress, which seems to be one of the key variables, but the direct evidence is not adequate. In addition, there have been only a few studies looking into the complexity of the relationship between ERI and turnover intention, and more research is needed. This is a cross-sectional study conducted from July to August 2018, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed. We employed a standardised questionnaire to collect sociodemographic information and target turnover intention. Hierarchical multiple logistic regression and mediation analyses were performed for the data analyses. This study included responses from 17,582 emergency nurses in China. On turnover intention, ERI exerted both direct effect and indirect mediating effect. The results also indicate that depressive symptoms partially mediated the effect of ERI on turnover intention, and that 27.4% of this effect can be explained by mediating effects. To improve the turnover intention, it is necessary to consider reducing ERI and depressive symptoms of emergency nurses as powerful measures not to be ignored. This study provides important insights regarding how nursing administrators should better reduce the workload of caregivers and improve depressive symptoms to avoid turnover intention.