Linking work-rest disruption to occupational burnout and turnover intention: evidence from a multilevel study among nurses in China

The complex issues of nursing turnover intention and occupational burnout challenge the sustainable development of healthcare system. These issues are associated with nurses’ physical and mental health concerns and patient safety risks. This study aims to explore the factors associated with turnover intention and burnout among nurses, specifically focusing on the associations of work-rest disruption with these outcomes and the hypothesized indirect associations through depression, as well as the specialty-aggregated moderating associations involving night-shift workload. Bayesian multilevel structural equation modeling (BMSEM) was employed to examine both individual-level and Specialty-aggregated factors. At the individual level, the model examined the associations of work-rest disruption with burnout and turnover intention, including hypothesized indirect associations through depression. At the specialty level, the model assessed the cross-level interaction involving specialty-aggregated night-shift busyness in the association from work rest disruption to depression. The results indicate that higher work-rest disruption scores were positively associated with turnover intention but did not show a statistically credible direct association with burnout; model-estimated indirect associations through depression were observed for both outcomes. At the aggregated Specialty, the estimated associations varied across nursing specialty groups. The findings are expected to provide valuable implications for hospitals to help nurses be devoted to work with a good psychological state, as well as maintain an effective healthcare system. The proposed index may inform future research on feasible assessment of work-rest conditions in nursing management. Potential approaches to adjusting night-shift schedules according to work demands and recovery opportunities warrant prospective evaluation for their relationships with nurses’ well-being and occupational outcomes.