The effects of emotional exhaustion and resilience on the relationship between the practice environment and turnover intentions among acute care nurses: A moderated mediation analysis

Background Nursing shortage is a complex national crisis compounded by high turnover of qualified nurses, particularly during and in the post-pandemic period. Objectives To examine the effects of emotional exhaustion and resilience on the relationship between the practice environment and turnover intentions among acute care nurses. Design Cross-sectional descriptive online survey study. Setting (s) Acute care hospital settings in the United States. Participants A total of 240 acute care nurses were recruited between October 2023 and April 2024. Methods Participants completed four validated instruments: Practice Environment Scale-Nursing Work Index, Workplace Resilience Scale, Maslach Burnout Inventory-Human Service Survey for emotional exhaustion, and Anticipated Turnover Scale. Data were analyzed using moderated mediation regressions with Hayes’ PROCESS macro in SPSS version 28.0. Results Emotional exhaustion mediated the relationship between practice environment and turnover intentions ( B = −0.79, 95% CI [−1.22, −0.35], p < .001). Resilience moderated the pathway between practice environment and emotional exhaustion ( B = 9.81, 95% CI [1.89, 17.73], p = .015), such that the association was stronger among nurses with lower resilience. The model explained 30% of the variance in turnover intentions. Conclusions Emotional exhaustion is a central mechanism linking practice environment conditions to turnover intentions. Resilience functions as a preventative moderator, buffering the impact of practice environment on emotional exhaustion. Implications for clinical practice The findings support multilevel strategies that address both work conditions and resilience to promote retention among acute care nurses.