The Impact of Moral Stress on Turnover Intention in Shift-Working Nurses: Test of a Moderated Mediation Model

Introduction: High employee turnover is a significant challenge among nurses. Turnover intention is a key indicator of future turnover. To address this issue effectively, it is important to understand the risk factors, mechanisms and conditional factors involved in the development of turnover intention. This study examined a moderated mediation model investigating 1) moral stress as a predictor for turnover intention, 2) burnout as a potential mediator, and 3) the personality traits conscientiousness and neuroticism as potential moderating variables.

Methods: The associations between the abovementioned factors and turnover intention were analyzed utilizing data from The Survey of Shiftwork, Sleep and Health (SUSSH), a longitudinal study conducted among Norwegian nurses with annual surveys. In total, 477 nurses provided responses to all study variables of interest collected in 2022 (personality traits) and 2023 (moral stress, burnout and turnover intention). The average age of the participants was 46.8 years (SD=7.57), and 88.9% were women. Moderated mediation analyses were performed using Hayes’ PROCESS macro.

Results: Moral stress was found to have a significant and positive association with turnover intention (B= 0.3260, p < .001). However, when examining the simultaneous association with moral stress and burnout on turnover intention, it was observed that burnout had a significant and positive impact on turnover intention (B=3057, P>.001) while the direct association between moral stress and turnover intention became non-significant (B=.0049, p=.84). These findings indicate that burnout fully mediates the relationship between moral stress and turnover intention. Additionally, the findings reveal that conscientiousness moderated the mediating effect of burnout on the relationship between moral stress and turnover intention (Index: 0.0122, Boot CI 95%: 0.0017-.0239). Specifically, the magnitude of the direct association between moral stress and burnout, as well as the indirect association between moral stress and turnover intention through burnout, were stronger among those with high scores on conscientiousness compared with those with low scores. Neuroticism did not moderate the relationship between moral stress and turnover intention, nor the mediating effect of burnout.

Conclusion: These findings highlight the importance of organizational efforts to support nurses working shift in managing moral stress. This is particularly pertinent for employees exhibiting high levels of conscientiousness, a personality trait associated with being well-organized, demonstrating self-control, and managing time. Such individuals are recognized as exemplary team members and diligent workers. Support: the Norwegian Nursing organization.

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Artikel online veröffentlicht:
08. Oktober 2025