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.
