Effects of effort-reward imbalance on emergency nurses' health: a mediating and moderating role of emotional exhaustion and work-family conflict

Abstract

Background: Effort-reward imbalance (ERI) is a prevalent issue in the healthcare sector, particularly in the high-intensity, high-risk, and high-stress environment of the emergency department. This results in emergency department nurses bearing heavier workloads, responsibilities, and time commitments compared to their counterparts in other departments. ERI poses significant risks to their physical, psychological, and sleep quality. Therefore, it is essential to explore the mechanisms through which ERI influences the health of emergency department nurses.

Objective: The aim of this investigation is to analyze if work-family conflict moderates the mediating influence emotional exhaustion has on the association between ERI and somatic symptoms and sleep disorders.

Design: A cross-sectional study.

Settings: The emergency nurses (N = 1,540) were included from 30 tertiary hospitals in 20 provinces or autonomous regions (Northeast, North, East, Central, South, Southwest, and Northwest China) of mainland China between December 26, 2023, and January 18, 2024.

Methods: Participants were recruited using stratified cluster sampling, obtaining data through web-based questionnaires. The study investigated the mediating and moderating effects using the PROCESS macro for SPSS. The mediation effect is tested by the bias correction Bootstrap sample size was set to 5,000.

Result: Considering emotional exhaustion as a mediating variable, the direct predictive influence of ERI on somatic symptoms and sleep disorders continues to be statistically significant (β = 0.271, 0.137, p < 0.01). Compared to the high-level work-family conflict group, the positive moderating effect of low-level work-family conflict on the relationship between ERI and emotional exhaustion was more pronounced (simple slope = 0.479, 0.757, p < 0.01). The moderated mediation effects of emotional exhaustion on somatic symptoms and sleep disorders are -0.063 (95%CI: -0.077 ~ -0.050) and -0.044 (95%CI: -0.056 ~ -0.033) respectively.

Conclusion: The study findings indicate that ERI was correlated with heightened emotional exhaustion, somatic symptoms, and sleep disorders among emergency department nurses. As a result, interventions should be implemented to improve ERI, alleviate emotional exhaustion among nurses, monitor work-family conflict levels, and mitigate the effects of these factors on nurses' overall well-being.

Keywords: effort-reward imbalance; emergency department nurses; mediation model; sleep disorders; somatic symptoms.

Figure 1

Simple slopes analysis of work–family conflict.

Figure 2

Moderated mediation models.