title: Emergency room nurses' pathway to turnover intention: a moderated serial mediation analysis.
abstract: OBJECTIVE
  The aim of this study was to explore the association between the quality of the work environment, job characteristics, demographic characteristics and a pathway of job satisfaction, emotional exhaustion and turnover intention among nurses in emergency departments and perform subgroup analyses.
  
  
  BACKGROUND
  Turnover intention among nurses is high. Multiple causes have been described, mostly in large studies of nurses working on general wards, often without considering complementarity of conceptual models and showing scant interest in the consistency of associations across subgroups of nurses.
  
  
  METHODS
  Cross-sectional multicentre survey.
  
  
  METHODS
  Convenience sample of 294 nurses in 11 Belgian emergency departments during 2014-2015. Indirect effects in the form of mediation and serial mediation were estimated to assess the association between work environment (Magnet model), job characteristics (Job Demand Control Support model) and turnover intention via job satisfaction and emotional exhaustion. Consistency of these indirect effects across subgroups of nurses was examined using moderated mediation analysis (conditional indirect effects).
  
  
  RESULTS
  Several Magnet and Job Demand Control Support dimensions were related to turnover intention, either via job dissatisfaction (mediation) or via job satisfaction and emotional exhaustion (serial mediation). In the case of social support from supervisor, these indirect effects were only significant for female nurses, among whom turnover intention was higher. Last, nurses with more years of experience were less likely to indicate turnover intention.
  
  
  CONCLUSIONS
  To maximize prevention of turnover intention at emergency departments, interventions could target early career nurses, work environment and job characteristics. Female nurses in particular may also benefit from improved social support from their supervisor.
authors.affiliation: Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium.
authors.forename: Luk
authors.identifier: http://orcid.org/0000-0003-1209-692X
authors.initials: L
authors.lastname: Bruyneel
authors.affiliation: Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Thoelen
authors.affiliation: Institute of Psychology, Health Psychology, Leiden University, The Netherlands.
authors.forename: Jef
authors.initials: J
authors.lastname: Adriaenssens
authors.affiliation: Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
mesh_terms: D000328:Adult; D001530:Belgium; D002055:Burnout, Professional / Q000523:psychology*; D003430:Cross-Sectional Studies; D016529:Emergency Nursing; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010563:Personnel Turnover; D016526:Workload / Q000523:psychology*; D017132:Workplace / Q000523:psychology*
keywords: burnout; cross-sectional studies; emergency nursing; job satisfaction; models; professional; social support; statistical; survey; workload