Presentation
When Mental Well-being Isn't Enough: A Moderated Mediation Model of Clinician Retention in Turkey.
SessionPoster Session 1
DescriptionBackground:
The deteriorating mental well-being of the healthcare workforce has become a primary crisis in modern healthcare. From a human factors perspective, this is a fundamental challenge, as the system's effectiveness and safety depend entirely on the cognitive and emotional capacity of its human operators. When healthcare professionals suffer from poor mental health, their ability to make complex decisions, communicate effectively, and perform reliably under pressure is compromised. One of the most visible and damaging outcomes of this crisis is the rising rate of professional turnover, as skilled individuals leave their jobs to escape an environment that has become detrimental to their well-being. A significant body of research has already established the individual links between these factors. It is well-documented that poor mental health, high levels of professional burnout, and low job satisfaction are all strong, independent predictors of an employee's intention to leave. However, treating these factors as separate, additive forces oversimplifies the psychological reality of the workplace. The critical gap is not if these factors matter, but how they together influence one another. It remains unclear, for example, through which pathway mental wellbeing improves job satisfaction to reduce turnover intention, and under what levels of burnout this transmission weakens or fails. Our study aims to clarify these interactive pathways and provide an actionable model of healthcare worker retention using data from Turkey, where resource strain and clinician migration intensify these interdependencies.
Application & Methodology: Our study's application is directly relevant to hospital administration and policy-making. We conducted a cross-sectional survey with a diverse sample of 336 frontline doctors and nurses in Turkish hospitals. To ensure the validity of our findings, we utilized internationally recognized and highly reliable instruments: the 7-item Warwick-Edinburgh Mental Wellbeing Scale (α=.82), a 4-item job satisfaction scale (α=.91), the 7-item Copenhagen Burnout Inventory (α=.94), and an 8-item intention to leave scale (α=.95). The core of our analysis is a sophisticated statistical technique known as moderated mediation (equivalent to Hayes PROCESS Model 14). The first equation models job satisfaction as a function of mental well-being and covariates; the second models intention to leave as a function of job satisfaction, mental well-being, burnout, their interaction (job satisfaction × burnout), and the same covariates (age, gender, marital status, years of experience, and professional role). Heteroskedasticity consistent (HC3) standard errors are reported. approach allowed us to precisely test our hypothesis by modeling the pathway from mental well-being to job satisfaction and subsequently to an employee's intention to leave, while simultaneously examining how the strength of this protective pathway is altered by varying levels of burnout. To quantify uncertainty around indirect pathways and their dependence on burnout, 5,000 bootstrap resamples provide percentile confidence intervals for the index of moderated mediation and for conditional indirect effects evaluated at low, average, and high burnout (one standard deviation below the mean, at the mean, and one standard deviation above the mean).
Presentation Overview & Takeaway Points: The presentation is structured to guide the audience from the macro-level problem of healthcare retention to our specific, actionable findings. We will begin by establishing the critical nature of the retention crisis. We will then introduce our central research question: How does burnout weaken the protective effect of job satisfaction on an employee's intention to leave? Does burnout weaken the degree to which higher job satisfaction offsets an employee’s intention to leave, and if so, by how much and for whom? We will visually and conceptually walk the audience through our statistical model: mental well-being is examined as an upstream resource that fosters job satisfaction; job satisfaction is the conduit through which well-being relates to lower intention to leave; burnout is the load condition hypothesized to attenuate this conduit. Findings from the Turkish sample will show a robust positive association between mental well-being and job satisfaction; a robust negative association between job satisfaction and intention to leave after adjusting for mental well-being; and a positive association between burnout and intention to leave. The interaction between job satisfaction and burnout will be presented with a simple slopes figure, illustrating that the protective slope of job satisfaction on intention to leave becomes flatter as burnout increases. Conditional indirect effects will be reported to quantify how much of the well-being to retention pathway survives at different burnout levels. Where role specific differences emerge (for example, stronger attenuation among nurses than physicians), the implications for targeting and equity will be discussed.
The main learning objectives and takeaway points for the audiences are clear direct. First, attendees will learn to beware the "satisfaction trap," understanding that job satisfaction, while important, is an incomplete and potentially misleading metric when viewed in isolation. Pair people-focused programs (recognition, learning and mastery opportunities, peer support) with work-system redesign that directly reduces burnout drivers (workload and schedule fairness, resource adequacy, control and feedback clarity). Second, the presentation show that burnout is not a passive state of exhaustion. It is a corrosive psychological process that actively degrades the positive bonds an employee has with their work, a reframing that provides a powerful argument for elevating burnout mitigation from a wellness initiative to a core strategic and safety imperative. Finally, attendees will understand the need to implement precision interventions. We find that comparing to doctor, nurses' retention is more sensitive to the interaction of satisfaction and burnout is a crucial piece of diagnostic information. This calls for a human-centered design approach, moving beyond generic, one-size-fits-all programs to develop targeted support systems and work redesigns aimed at the most vulnerable segments of the workforce.
In the presentation, we will show the process model, estimation and bootstrap results, simple-slope plots at low, average, and high burnout, and the physician–nurse contrast. We translate the coefficients into clear, actionable thresholds leaders can use to improve workforce resilience and patient-safety.
The deteriorating mental well-being of the healthcare workforce has become a primary crisis in modern healthcare. From a human factors perspective, this is a fundamental challenge, as the system's effectiveness and safety depend entirely on the cognitive and emotional capacity of its human operators. When healthcare professionals suffer from poor mental health, their ability to make complex decisions, communicate effectively, and perform reliably under pressure is compromised. One of the most visible and damaging outcomes of this crisis is the rising rate of professional turnover, as skilled individuals leave their jobs to escape an environment that has become detrimental to their well-being. A significant body of research has already established the individual links between these factors. It is well-documented that poor mental health, high levels of professional burnout, and low job satisfaction are all strong, independent predictors of an employee's intention to leave. However, treating these factors as separate, additive forces oversimplifies the psychological reality of the workplace. The critical gap is not if these factors matter, but how they together influence one another. It remains unclear, for example, through which pathway mental wellbeing improves job satisfaction to reduce turnover intention, and under what levels of burnout this transmission weakens or fails. Our study aims to clarify these interactive pathways and provide an actionable model of healthcare worker retention using data from Turkey, where resource strain and clinician migration intensify these interdependencies.
Application & Methodology: Our study's application is directly relevant to hospital administration and policy-making. We conducted a cross-sectional survey with a diverse sample of 336 frontline doctors and nurses in Turkish hospitals. To ensure the validity of our findings, we utilized internationally recognized and highly reliable instruments: the 7-item Warwick-Edinburgh Mental Wellbeing Scale (α=.82), a 4-item job satisfaction scale (α=.91), the 7-item Copenhagen Burnout Inventory (α=.94), and an 8-item intention to leave scale (α=.95). The core of our analysis is a sophisticated statistical technique known as moderated mediation (equivalent to Hayes PROCESS Model 14). The first equation models job satisfaction as a function of mental well-being and covariates; the second models intention to leave as a function of job satisfaction, mental well-being, burnout, their interaction (job satisfaction × burnout), and the same covariates (age, gender, marital status, years of experience, and professional role). Heteroskedasticity consistent (HC3) standard errors are reported. approach allowed us to precisely test our hypothesis by modeling the pathway from mental well-being to job satisfaction and subsequently to an employee's intention to leave, while simultaneously examining how the strength of this protective pathway is altered by varying levels of burnout. To quantify uncertainty around indirect pathways and their dependence on burnout, 5,000 bootstrap resamples provide percentile confidence intervals for the index of moderated mediation and for conditional indirect effects evaluated at low, average, and high burnout (one standard deviation below the mean, at the mean, and one standard deviation above the mean).
Presentation Overview & Takeaway Points: The presentation is structured to guide the audience from the macro-level problem of healthcare retention to our specific, actionable findings. We will begin by establishing the critical nature of the retention crisis. We will then introduce our central research question: How does burnout weaken the protective effect of job satisfaction on an employee's intention to leave? Does burnout weaken the degree to which higher job satisfaction offsets an employee’s intention to leave, and if so, by how much and for whom? We will visually and conceptually walk the audience through our statistical model: mental well-being is examined as an upstream resource that fosters job satisfaction; job satisfaction is the conduit through which well-being relates to lower intention to leave; burnout is the load condition hypothesized to attenuate this conduit. Findings from the Turkish sample will show a robust positive association between mental well-being and job satisfaction; a robust negative association between job satisfaction and intention to leave after adjusting for mental well-being; and a positive association between burnout and intention to leave. The interaction between job satisfaction and burnout will be presented with a simple slopes figure, illustrating that the protective slope of job satisfaction on intention to leave becomes flatter as burnout increases. Conditional indirect effects will be reported to quantify how much of the well-being to retention pathway survives at different burnout levels. Where role specific differences emerge (for example, stronger attenuation among nurses than physicians), the implications for targeting and equity will be discussed.
The main learning objectives and takeaway points for the audiences are clear direct. First, attendees will learn to beware the "satisfaction trap," understanding that job satisfaction, while important, is an incomplete and potentially misleading metric when viewed in isolation. Pair people-focused programs (recognition, learning and mastery opportunities, peer support) with work-system redesign that directly reduces burnout drivers (workload and schedule fairness, resource adequacy, control and feedback clarity). Second, the presentation show that burnout is not a passive state of exhaustion. It is a corrosive psychological process that actively degrades the positive bonds an employee has with their work, a reframing that provides a powerful argument for elevating burnout mitigation from a wellness initiative to a core strategic and safety imperative. Finally, attendees will understand the need to implement precision interventions. We find that comparing to doctor, nurses' retention is more sensitive to the interaction of satisfaction and burnout is a crucial piece of diagnostic information. This calls for a human-centered design approach, moving beyond generic, one-size-fits-all programs to develop targeted support systems and work redesigns aimed at the most vulnerable segments of the workforce.
In the presentation, we will show the process model, estimation and bootstrap results, simple-slope plots at low, average, and high burnout, and the physician–nurse contrast. We translate the coefficients into clear, actionable thresholds leaders can use to improve workforce resilience and patient-safety.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments