Work-Family Behavioral Role Conflict and Turnover Intention Among Clinical Nurses: Multiple Mediating Effects of Role Overload, Presenteeism, and Psychological Capital.

backgroundWork-family behavioral role conflict (WFBRC) is an important stressor in the nursing work environment and may be associated with turnover intention. However, the roles of role overload, presenteeism, and (PsyCap) in this relationship have rarely been examined simultaneously among Chinese clinical nurses.

aimsGuided by the Conservation of Resources (COR) theory, this study aimed to examine the relationship between WFBRC and turnover intention among Chinese clinical nurses, as well as the mediating and moderating roles of role overload, presenteeism, and PsyCap.

methodsThis was a multicenter cross-sectional study. A total of 1225 registered nurses from 12 tertiary hospitals in China completed validated instruments assessing WFBRC, role overload, presenteeism, PsyCap, and turnover intention. Data were analyzed using descriptive statistics, Pearson correlation analysis, and bias-corrected bootstrap analyses with 5000 resamples to test mediation and moderated mediation effects. Sensitivity analyses were conducted after controlling for demographic and occupational covariates.

resultsWFBRC was positively associated with role overload, presenteeism, and turnover intention and negatively associated with PsyCap. Parallel mediation analyses showed that role overload, presenteeism, and PsyCap jointly mediated the association between WFBRC and turnover intention, with role overload showing the strongest indirect effect, followed by presenteeism, whereas PsyCap showed a smaller but significant indirect effect. A significant serial pathway through role overload and presenteeism was also identified. Moderated mediation analyses suggested that PsyCap may buffer the associations of role overload and presenteeism with turnover intention in separate second-stage models; however, this pattern was not retained when both moderated pathways were entered simultaneously.

conclusionWFBRC was significantly associated with nurses' turnover intention through both direct and resource-related pathways. Role overload and presenteeism were the primary mediators, whereas PsyCap showed a smaller indirect effect and limited buffering effects in selected models. IMPLICATIONS FOR NURSING MANAGEMENT: Organizations and nursing managers should address WFBRC proactively. Routine assessment of role overload and presenteeism can enable early detection of risk and timely intervention, while efforts to strengthen nurses' PsyCap may further help break the resource-loss process and support workforce retention.