ArticleJournal of nursing management2026
Empathy as a Conditional Resource: System-Level Moral Distress as an Indirect Pathway in the Associations of Empathy with Burnout and Turnover Intention.
Article in Journal of nursing management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
backgroundEvidence regarding the relationship between empathy and burnout among nurses remains inconsistent. Moral distress may help explain this complexity. Given the associations of moral distress and burnout with turnover intention, it remains insufficiently understood how empathy is linked to these outcomes through multidimensional moral distress, which is a critical concern for nursing management.
aimThis study examined how empathy relates to burnout and turnover intention among nurses, focusing on indirect associations involving multidimensional moral distress and burnout.
methodsA cross-sectional web-based survey was conducted among Japanese nurses (n = 412). Empathy was assessed using the Jefferson Scale of Empathy, burnout using the Burnout Assessment Tool, and moral distress using the Measure of Moral Distress for Healthcare Professionals, which captures multiple dimensions of moral distress. Turnover intention was measured using a single-item scale. Mediation and moderation analyses were performed.
resultsIn the primary parallel mediation analysis, with all four moral distress domains considered simultaneously, positive indirect associations involving system-level moral distress were statistically significant for burnout and turnover intention using 95% bootstrap confidence intervals. Supplementary separate-domain sensitivity analyses also identified indirect associations involving clinical-/patient-level moral distress. The interaction between empathy and burnout in relation to turnover intention was significant. The negative indirect association of empathy with turnover intention through burnout and the positive serial indirect association through system-level moral distress and burnout were both conditional on empathy level.
conclusionsThe opposing indirect associations suggest that empathy should not be viewed as a uniformly protective resource in relation to turnover intention. System-level moral distress showed the most consistent domain-specific pattern across the analyses. The cross-sectional design does not establish temporal or causal relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may consider staffing adequacy, ethical climate, decision-making autonomy, and organizational support alongside individual-focused approaches to empathy and resilience.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.