Abstract
BACKGROUND: Nurses' turnover intention has long been a global concern due to its impact on the stability of the nursing workforce and the quality of healthcare services. Numerous studies have highlighted a strong relationship between psychological distress and turnover intention. However, very little is known about how psychological distress influences turnover intention among nurses. This study aims to explore the relationship between psychological distress and turnover intention, focusing on the mediation role of job satisfaction and the moderating role of social support among Chinese nurses. METHODS: A multicenter cross-sectional design was used. A total of 699 nurses were recruited from hospitals in two major cities of China (Chengdu and Kunming). Data regarding demographic information, Depression, Anxiety, and Stress Scale-21 (DASS-21), Job Satisfaction Index (JSI), Multidimensional Scale of Perceived Social Support (MSPSS), and Nurse Turnover Intention Scale (NTIS) were collected through online survey questionnaires. The moderated mediation model was tested via the PROCESS macro (Model 4 and Model 7) of SPSS 25.0. RESULTS: Psychological distress was negatively associated with turnover intention among nurses, and job satisfaction partially mediated this association. Social support moderated the association between psychological distress and job satisfaction, with the negative relationship between psychological distress and job satisfaction being stronger for nurses with higher levels of social support. As social support increased, the indirect effect of job satisfaction became stronger. CONCLUSION: Psychological distress increases the risk of turnover intention through decreasing nurses' job satisfaction, while social support moderates this mechanism. Healthcare organizations should prioritize strategies to reduce psychological distress and improve workplace satisfaction, particularly for nurses with high social support, ultimately promoting nurse retention and enhancing the quality of patient care. CLINICAL TRIAL NUMBER: Not applicable.