Work Intensification and Occupational Well-Being: A Moderated Mediation Model of Unfinished Nursing Care and Psychological Capital Among Emergency Nurses

Abstract

Background: Emergency departments (ED) are experiencing an unprecedented demand for care services, resulting in a continuous pressure to increase work efficiency and output levels or work intensification (WI). Persistent exposure to such conditions may place ED nurses at greater risk for poor occupational well-being. Psychological capital (PsyCap)—defined as an individual’s positive psychological state, including self-efficacy, resilience, hope, and optimism—may hold potential as an untapped resource to cope with occupational stress. Little is known about the associations between PsyCap and WI and the effect on provider outcomes in the ED. Purpose: To test a theoretical model examining the relationship between WI and occupational well-being (burnout [emotional exhaustion, depersonalization, and personal accomplishment] and work engagement), integrating the mediating effect of unfinished nursing care and the moderating effect of PsyCap among ED Registered Nurses (RNs) across Nova Scotia, Canada. The Challenge-Hindrance Framework of Occupational Stress was the foundation of the proposed theoretical model. Methods: This is a predictive, non-experimental, cross-sectional survey study. Participants completed items from the Utrecht Work Engagement scale, Psychological Capital Questionnaire©, Intensification of Job Demands scale, and the abbreviated Maslach Burnout Inventory© via an anonymized online survey. Ordinary least squares regression and path analysis was used to test the hypothesized mediation and moderated mediation models. Results: In total, 508 RNs from 10 regional and tertiary care EDs were approached to participate, with 127 RNs recruited (response rate 25%). High to very high levels of unfinished nursing care were reported (85%, n = 108). WI was a moderate predictor of unfinished nursing care (β = .43, p < .001) and positively associated with emotional exhaustion (β = .20 p = .03) and depersonalization (β = .24, p < .01). Unfinished nursing care mediated the relationship between WI and depersonalization (β = .22, 95% CI [.03, .49]) only. Psycap was associated with nurses’ well-being (β = - .26 to .51, p < .01) but did not moderate the effects of WI. Conclusion: WI is associated with diminished occupational well-being among ED nurses and has a significant impact on the quality of patient care. Optimizing work environments and nurses’ psychological resources to minimize WI demands is recommended.