Background: Globally, healthcare systems struggle to retain critical care nurses (CCNs) due to high turnover intentions. The mediating roles of emotional intelligence and sense of belonging in mitigating moral distress, stress, and fatigue are insufficiently explored. Objective: This study investigates how moral distress, work stress, and fatigue influence CCNs' turnover intentions through the mediating pathways of emotional intelligence and a sense of belonging. Study design and methods: A multicentre, cross-sectional survey was conducted across eight public and private hospitals. The study enrolled 432 CCNs between May 20 and July 31, 2024. Each participant completed a validated, structured questionnaire that was self-administered and paper based. Descriptive statistics, ANOVA, independent samples t-tests, and path analysis were utilised for data analysis. Results: CCNs reported high mean scores for fatigue (21.50), moral distress (65.10), and turnover intention (14.75). Path analysis indicated a direct significant positive effect of moral distress on fatigue (β= .69), work stress (β= .38), and indirectly on turnover intention (β= .12). Fatigue further intensified work stress (β=.40). Notably, significant moral distress was inversely associated with emotional intelligence (β=-.24) and positively with sense of belonging (β= .24). In turn, both emotional intelligence (β=-.31) and a sense of belonging (β= -.27) were negatively associated with turnover intentions. Conclusions: This study elucidates the significant influence of adverse workplace factors, specifically moral distress, fatigue, and work stress, on the CCNs' turnover intentions. Such stressors erode core nursing competencies and present a tangible risk to patient care standards. Importantly, the results underscore the protective functions of emotional intelligence and a strong sense of belonging, which appear to attenuate the negative impact of these occupational stressors. Implications for research, policy, and practice: By mitigating the impact of moral distress and cultivating a more supportive work environment, healthcare organisations can foster environments that reduce occupational stress, alleviate fatigue, and consequently decrease nurses' turnover intentions. Addressing these detrimental workplace dynamics is essential for enhancing the work environment for nurses and ensuring the provision of optimal patient care within healthcare settings.
Talal Ali Hussein Alqalah (Mon,) studied this question.