From behavior to burnout and moral distress: the costs of low performance and turnover intentions through a serial mediation process

Purpose Research and practice have largely prioritized employee performance and retention over employee well-being. This study examines whether quality of care (QoC) and professional turnover intention (PTI) are associated with burnout and moral distress directly and indirectly through serial pathways involving patient recognition, leader-member exchange (LMX), and satisfaction of the basic psychological needs for autonomy, belonging, and competence. It also compares the hypothesized model with its reverse. Design/methodology/approach Data were obtained from a voluntary, open, bilingual web-based survey of 939 Canadian healthcare workers. The hypothesized and reversed models were compared using structural equation modeling, and indirect effects were tested with bootstrapping. Findings The hypothesized partial-mediation model fit the data better than the alternatives. QoC and PTI were directly associated with burnout and moral distress. Indirect associations were supported for QoC and burnout, PTI and burnout, and PTI and moral distress through patient recognition, LMX, and autonomy or belonging need satisfaction. Originality/value The study extends mutual-gains, Job Demands-Resources, and Self-Determination Theory perspectives by positioning performance and work attitudes as potential correlates of relational resources, need satisfaction, and employee ill-being.