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. 2023 Jan 22;10(6):3687–3695. doi: 10.1002/nop2.1621

Serial multiple mediation of psychological empowerment and job burnout in the relationship between workplace bullying and turnover intention among Chinese novice nurses

Liping Ren 1,2, Hyunli Kim 2,✉
PMCID: PMC10170934  PMID: 36683355

Abstract

Aim

This study aimed to examine the direct and indirect effects of workplace bullying on turnover intention using the serial multiple mediators of psychological empowerment and job burnout.

Design

A cross‐sectional study was conducted.

Methods

A convenience sample of 506 novice nurses from five Triple A hospitals in China's S province from November 2020 to February 2021 and were evaluated using online questionnaires on workplace bullying, psychological empowerment, job burnout, and turnover intention.

Results

The prevalence of turnover intention was 51.9%. In the serial multiple mediator model, workplace bullying had a direct effect (c = 0.452, p < 0.001) and indirect effect (c' = 0.229, p < 0.001) on turnover intention through the serial multiple mediators of psychological empowerment (B = −0.093, p = 0.020) and job burnout (B = 0.127, p < 0.001); hence, the proposed model explained the total variance of 32.2% in turnover intention.

Patient or public contribution

Nursing managers should use effective measures for strengthening the psychological empowerment to minimize novice nurse burnout and turnover intention resulting from workplace bullying.

Keywords: job burnout, novice nurses, psychological empowerment, turnover intention, workplace bullying

1. INTRODUCTION

The world is facing a healthcare crisis because of shortages in nurses (Turale & Nantsupawat, 2021), and a 13 million shortfall has been expected due to the aging of the nurse workforce and the growing COVID‐19 effect (International Council of Nurses, 2021), further exacerbating nurse turnover problems. Nurse turnover is recognized as a primary issue for hospitals, leading to financial loss, demoralizing employees, reducing efficiency and productivity, and undermining nursing care quality and patient safety (Back et al., 2020; Chan et al., 2021). Novice nurses are a critical resource for the nursing shortfall; however, they are especially vulnerable to leave the nursing profession (Chao & Lu, 2020; Kox et al., 2020). Many empirical studies support turnover intention as the immediate precursor for actual turnover; however, turnover intention triggered by a chain of workplace bullying, psychological empowerment, and job burnout in the professional life of novice nurses has been neglected by research. Thus, this study aimed to highlight several aspects of turnover intention by applying the social exchange theory (SET) and the conservation of resources (COR) theory. It proposed that novice nurses who experienced workplace bullying had a diminished sense of psychological empowerment, further affecting their level of job burnout and their intention to leave their organizations.

2. BACKGROUND

Turnover intention as the immediate precursor for actual turnover reflects “an employee's reported willingness to leave his or her organization within a given period of time” (Lazzari et al., 2022, pp. 279). Previous research revealed that nurses quit the nursing profession since they intend to leave. In Asian countries, nurse turnover rates include 57% in China (Fang, 2016) and 33% in South Korea (Yoon, 2020), and among Western countries, it ranges from 12% to 62.5% (Meler & Toygar, 2020). Individual variables, such as pay, years of experience, job title, and so on, have been linked to nurses' intention to stay or quit. However, workplace stress, workplace violence, work–family support, job satisfaction, burnout, organizational support, and organizational commitment, among other characteristics, all have an impact on turnover intention (Yang & Chen, 2020).

Novice nurses are registered nurses who have been in the nursing profession for 3 years or less (Zhang et al., 2018). They are a major resource for reversing the nursing shortage and representing the nursing profession's future; nevertheless, a previous study indicated that they are particularly susceptible to withdrawing from their occupation (Kox et al., 2020). Furthermore, young nurses had a higher rate of turnover intention. In China, newly licensed nurses tended to have a high turnover intention in 22.3% of cases (Cao et al., 2020). This was most likely due to the China's profit‐oriented healthcare reform, which reduced the ratio of permanent employees (Wu et al., 2017). New graduate nurses frequently face tough competition for a decent job as a permanent post; therefore, they are willing to change their work easily, prompting this study to assess the issue of turnover intention among novice nurses.

Workplace bullying has been identified as a contributory factor in the novice nurse turnover (Kox et al., 2020); it has been defined as unwanted, repeated, aggressive, or hostile actions that cause humiliation, offence, and distress; as well as threaten the performance of the healthcare team and/or lead to an unpleasant working environment (Ren & Kim, 2017). Experienced nurses should mentor and provide support to novice nurses; however, they are the major perpetrators of workplace bullying (Daws et al., 2020). A previous study has documented workplace bullying as having a significant and positive correlation with turnover intention (Liu et al., 2018). Workplace bullying and hierarchical structures have been pervasive in the nursing culture (Ren & Kim, 2017); additionally, novice nurses have been considered having poor work ability and insufficient skills, and incivility towards them in their workplace has been relatively common (Zhang et al., 2018). Thus far, an improved understanding of turnover intention caused by workplace bullying among Chinses novice nurses remains largely unexplored.

Psychological empowerment has been explained as a motivational construct described using four cognitions: meaning, competence, self‐determination, and impact (Spreitzer, 1995). Faraz's study (Faraz, 2017) indicated that novice nurses with high levels of psychological empowerment, which has been connected to effective practice and greater retention. However, nurses have a low degree of psychological empowerment (Ouyang et al., 2015). Empirical studies have demonstrated that workplace bullying leads to a decrease in psychological empowerment (Ren & Kim, 2017). Even without supervisory approval, psychologically empowered employees are likely to work properly, thus improving their job satisfaction and retention (Saira et al., 2021). However, limited research has been conducted to understand the relationship among the variables of workplace bullying, psychological empowerment, and turnover intention.

Job burnout has been defined as “a psychological syndrome that involves a prolonged response to chronic interpersonal stressors on the job” (Leiter & Maslach, 2009, pp. 332). The type of hospital, educational level, self‐evaluation, and professional status were found as important predictors of burnout (Alfuqaha et al., 2019). Previous studies found that younger nurses were more likely to face burnout (Chao & Lu, 2020) since they perceived that their profession lacked authority and power (Alfuqaha et al., 2019); moreover, 52.46% of novice nurses were reported as experiencing high levels of occupational burnout in China's public hospitals (Ma et al., 2021). Liu et al. (2018) demonstrated that workplace violence had a positively significant relationship with job burnout and turnover intention for Chinese nurses in a tertiary hospital. Moreover, job burnout was significantly related to turnover intention, indicating that nurses with high burnout scores are more inclined to have an intent to leave.

The social exchange theory (SET) emphasizes that individual actions are motivated by the reciprocation they are expected to bring and are actually produced from others (Blau, 1964). It contains three parts: (1) An initiating action that is an organizational agent treating a target individual positively or negatively; (2) Social exchange relationships that is a mediator variable which evolves when employers “take care of employees”; (3) A reciprocating response that the target chooses with their good or bad behaviours (Cropanzano et al., 2017). Workplace bullying is defined as initiating action (Cropanzano et al., 2017). Psychological empowerment is viewed as the social exchange relationship that transpires between an employee and the organization (Eldor & Vigoda‐Gadot, 2016); further, psychologically empowered staff feel that their organization cares for them (Akgunduz & Bardakoglu, 2017). Turnover intention is considered a reciprocating response. When an organization's member experiences workplace bullying, the employee's sense of psychological empowerment becomes insufficient, and to respond to it, they choose to leave.

The conservation of resources (COR) theory is defined as a “motivational theory that explains much of human behavior based on the evolutionary need to acquire and conserve resources for survival” (Hobfoll et al., 2018, pp. 104). People consume resources to respond to stress; if their resources are exhausted, they will enter a defensive mode that is often cautious, aggressive, and may become irrational to preserve the self (Hobfoll et al., 2018). Workplace bullying is described as a stressor, which is a mechanism that depletes the employees' resources (Nauman et al., 2019); the inability to replenish resources can lead to burnout (Gardner et al., 2016), followed by a wide range of consequences, for example, turnover intention (Laeeque et al., 2018).

As suggested previously, both psychological empowerment and job burnout are implicated in the association between workplace bullying and turnover intention; accordingly, there is an interrelationship between the two. Gong et al. (2021) suggested that enhanced psychological empowerment will, in turn, relieve job burnout. Using the SET framework and COR theory, workplace bullying, as disempowering acts, decreases psychological empowerment levels (Blau, 1964), which was originally a psychological resource and an important intrinsic motivator. However, nowadays, a lack of psychological empowerment increases the levels of burnout, which gains momentum and creates exponential resource losses, causing an intent to quit (Hobfoll et al., 2018).

Based on the SET and the COR theory and the empirical evidence obtained from previous studies, this study aimed to test the hypothesized model using the variables of workplace bullying, psychological empowerment, job burnout, and turnover intention among novice nurses. In addition, it explored the serial mediation effects of psychological empowerment and job burnout between workplace bullying and turnover intention, contributing novel findings to the current literature.

3. METHODS

3.1. Study design and participants

A cross‐sectional, descriptive survey was conducted to examine the relationship between the variables of workplace bullying, psychological empowerment, burnout, and turnover intention among novice nurses. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines (STROBE) was used as a checklist for this study. A convenience sample of 506 novice nurses from five Triple A hospitals (>500 beds) in the S province in China was recruited. The inclusion criteria were as follows: (a) novice nurses who had been working for more than 6 months and less than 3 years after graduation (Zhang et al., 2018); (b) who were employed in a Triple A hospital; and (c) who provided written consent indicating their voluntary participation in this study. The final sample consisted of 405 novice nurses, 101 were excluded due to outliers and missing data (effective response rate: 80.0%). According to Fritz and Mackinnon's study (Fritz & Mackinnon, 2007), the study sample of 405 is an acceptable number of subjects depending on this estimate.

3.2. Data collection

E‐mail invitations were sent to the participants who met the inclusion criteria. Each invitation included information regarding the participation's anonymous and voluntary nature, contact details for the researchers, particulars of the study, and a link to the web‐based questionnaire. The data were collected from November 2020 to February 2021.

3.3. Instruments

3.3.1. Workplace bullying

The Chinese version of Negative Acts Questionnaire‐Revised (NAQ‐R) generated from the NAQ‐R (Einarsen et al., 2009) was used to measure novice nurses' perceptions and experiences of workplace bullying (Xun et al., 2012). It consists of 22 items, each of which is rated for frequency and effect on a 5‐point Likert scale, scored from 1 never to 5 daily. An increased score indicates more bullying experience. The Cronbach's α coefficient for the NAQ‐R's Chinese version has been reported to be 0.92 (Xun et al., 2012).

3.3.2. Psychological empowerment

The Psychological Empowerment Instrument translated by Li et al. (2006) was employed to examine the nurses' active orientation towards their professional role (Spreitzer, 1995). It comprises 12 items that are rated using a 5‐point Likert scale ranging from 1 strongly disagree to 5 strongly agree, with high scores indicating high level of psychological empowerment. Furthermore, its Chinese version has good validity and reliability (Li et al., 2006).

3.3.3. Job burnout

The Chinese Maslach Burnout Inventory (Li et al., 2005), generated from the Maslach Burnout Inventory, was utilized to measure individual job burnout (Michaels & Spector, 1982). It consists of 15 items, rated using a 7‐point Likert scale ranging from 0 never to 6 every day, with high scores indicating job burnout. Its Cronbach's α coefficient has been reported to be 0.87 (Liu et al., 2018).

3.3.4. Turnover intention

The Turnover Intention Scale revised by Lee and Lee (1998) was used to assess the novice nurses' turnover intention. It comprises six items scored on a 4‐point Likert scale ranging from one never to four often. The total potential score is calculated by putting all the elements' scores together, and it runs from 6 to 24 points, with a higher score indicating a stronger desire to leave. The degree of turnover intention is classified into three categories based on the total average score of turnover intention. A total average score ranges between 1 and 2 shows that turnover intention is low, it is higher if it is between 2 and 3, and extraordinarily high when it exceeds 3. The Cronbach's α coefficient ranged from 0.77 to 0.86 (Lee & Lee, 1998; Liu et al., 2018).

3.4. Ethical considerations

Ethical approval for this study was obtained from the Jining Medical University Institutional Review Board (Approval number: jnmc‐2019‐zr‐0023) and the nursing department of each hospital. All data were fully anonymized to guarantee the research participants' privacy and confidentiality. Furthermore, all participants were assured that their data would be used for research purposes only.

3.5. Data analysis

The data analyses were performed using the IBM SPSS v26.0 (IBM Corporation) and PROCESS macro (Hayes, 2018). All the data sets were examined to ensure accuracy and completeness prior to any statistical analyses. Descriptive statistics were performed to explain the general characteristics of the study participants. Independent‐samples t‐test (gender, marital status, have children, and academic title), one‐way analysis of variance (education level and staffing), and Pearson' correlation (age, work experience) were calculated to control for the influence of any covariate on the turnover intention. The relationships among the variables were assessed using Pearson' correlation coefficients. Moreover, Mahalanobis distance values were employed to delete outliers exceeding the chi‐square critical value. Hayes (2018) recommended that the assumptions of normality, linearity, and homoscedasticity should be checked before using PROCESS macro; all three assumptions were satisfied after removing the outliers. The serial multiple mediation model 6 was performed to measure the effect of workplace bullying (independent variable) on turnover intention (dependent variable) through psychological empowerment and job burnout (two mediators). The bootstrap method was conducted to assess the significance of each indirect effect with 10,000 bootstrap samples and 95% percentile bootstrap confidence intervals (95% CI) not containing zero (Hayes, 2018).

4. RESULTS

4.1. Participant characteristics

The average age of the sample was 24.7 ± 1.79 years. Overall, 87.7% of the novice nurses were female. Less than one‐quarter of the participants were junior college graduates (21.0%); 77.8% had a bachelor's degree, while only 0.2% held a master's degree. Furthermore, 23.2% of the participants were married, and only 7.4% of novice nurses reported having children. Most respondents were nurses (99.3%), and their work experience was 22.9 months (SD = 9.60). Only 0.7% of the novice nurses were permanent staffing of government‐affiliated institutions (see Table 1).

TABLE 1.

Participant characteristics (N = 405)

Characteristics Categories n (%)
Gender Female 355 (87.7)
Male 50 (12.3)
Education level Junior college 85 (21.0)
Bachelor 315 (77.8)
Master 5 (0.2)
Marital status Single 311 (76.8)
Married 94 (23.2)
Have children No 375 (92.6)
Yes 30 (7.4)
Academic title Nurse 402 (99.3)
Senior nurse 3 (0.7)
Staffing Staffing of government‐affiliated institutions 3 (0.7)
Staffing of personnel agent 297 (73.3)
Contract employee 105 (25.9)
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4.2. Preliminary statistics

Normality for workplace bullying, psychological empowerment, job burnout, and turnover intention was confirmed by the values of skewness and kurtosis (both absolute values were <1), ranging from −0.322 to −0.976 and −0.625 to −0.061, respectively. Thus, no significant deviation was indicated from the normal distribution (see Table 2). The scatterplot matrices verified the assumptions of linearity and homoscedasticity, showing that no assumptions were violated.

TABLE 2.

Means (SD), skewness, kurtosis, and correlations among variable (N = 405)

Mean (SD) Skewness Kurtosis 1. 2. 3. 4.
1. Workplace bullying 25.1 (3.27) 0.976 −0.083 1
2. Psychological empowerment 37.5 (4.50) 0.264 −0.061 −0.248*** 1
3. Job burnout 30.9 (3.21) −0.322 −0.509 0.372*** −0.310*** 1
4. Turnover intention 13.1 (4.06) 0.176 −0.625 0.362*** −0.278*** 0.520*** 1
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Abbreviation: SD, standard deviations.

***

p < 0.001.

4.3. Means, standard deviations, and relationships of the main variables

A total average turnover intention score of 2 to 3 (including three) and greater than 3 was considered higher turnover intention and extremely high turnover intention, respectively (Liu et al., 2018). In this study, the total average score was 2.2 ± 0.68, 42.5% (172) and 9.4% (38) of the novice nurses had higher and very high turnover intentions, respectively, indicating a high prevalence of turnover intention in the sample. Moreover, excepting work experience (r = 0.124, p = 0.013), no significant differences in turnover intentions were found regarding their gender, education level, marital status, having children, academic title, staffing, and age.

The means, standard deviations, and correlations were calculated among the four variables (see Table 2). Turnover intention was negatively related to psychological empowerment (r = −0.278, p < 0.001) and positively associated with workplace bullying (r = 0.362, p < 0.001) and job burnout (r = 0.520, p < 0.001).

4.4. Mediation analyses

The bootstrap method was used to verify the direct and indirect effects of workplace bullying on turnover intention through psychological empowerment and job burnout; furthermore, non‐standardized beta coefficients were calculated to reduce type I errors (Hayes, 2018). The results of the serial multiple analysis have been demonstrated in Figure 1. In the analyses, work experience was employed as a covariate because it was positively and significantly associated with turnover intention.

FIGURE 1.

FIGURE 1

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Serial‐multiple mediation of psychological empowerment and job burnout in the relationship between workplace bullying and turnover intention with non‐standardized beta values and standard error. Note: *p < 0.05; **p < 0.01; ***p < 0.001.

As displayed in Figure 1, workplace bullying had a total effect on turnover intention (c = 0.452, SE = 0.057, t = 7.900, p < 0.001) without controlling for psychological empowerment and job burnout and was significantly associated with them (B = −0.342 and B = 1.275, respectively; p < 0.001). Furthermore, psychological empowerment (the first mediating variable) had a significantly direct effect on job burnout (the second mediating variable; B = −0.675, SE = 0.136, t = 4.963, p < 0.001). Further, psychological empowerment (B = −0.093, SE = 0.040, t = −2.338, p = 0.020) and job burnout (B = 0.127, SE = 0.014, t = 9.001, p < 0.001) had a significantly direct effect on turnover intention. After controlling the two mediating variables, the direct effect of workplace bullying on turnover intention decreased (c' = 0.229, SE = 0.056, t = 4.103, p < 0.001). It was revealed that workplace bullying, psychological empowerment, and job burnout explained 32.17% variance in turnover intention; moreover, the model supported the mediational hypothesis (R 2 = 0.322, F = 47.423, p < 0.001).

The specific indirect effects of workplace bullying on turnover intention through psychological empowerment and job burnout were calculated (see Table 3). Workplace bullying had a significant total indirect effect on turnover intention (point estimate = 0.2230, SE = 0.0316, 95% CI = 0.1643 and 0.2898). In addition, the mediators of psychological empowerment and job burnout in the hypothetical model were tested. The results showed the mediation of psychological empowerment (point estimate = 0.0317, SE = 0.0159, 95% CI = 0.0023 and 0.0643), and that of job burnout (point estimate = 0.1620, SE = 0.0273, 95% CI = 0.1122 and 0.2186); further, the serial multiple mediations of the two (point estimate = 0.0293, SE = 0.0091, 95% CI = 0.0143 and 0.0499) were statistically significant.

TABLE 3.

Comparison of indirect effect workplace bullying on turnover intention mediated by psychological empowerment and job burnout (N = 405)

Variables Product of coefficients Bootstrap confidence intervals (CI)
Point estimate Boot SE Boot LL CI Boot UL CI
Effect
Total indirect effect of X on Y 0.2230 0.0316 0.1643 0.2898
Indirect effect 1: X → M1 → Y 0.0317 0.0159 0.0023 0.0643
Indirect effect 1: X → M2 → Y 0.1620 0.0273 0.1122 0.2186
Indirect effect 1: X → M1 → M2 → Y 0.0293 0.0091 0.0143 0.0499
Contrasts
Model 1 versus Model 2 −0.1304 0.0335 −0.1991 −0.0680
Model 1 versus Model 3 0.0023 0.0181 −0.0356 0.0363
Model 2 versus Model 3 0.1327 0.0280 0.0808 0.1902
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Note: Number of bootstrap samples for percentile bootstrap confident intervals: 10,000. Level of confidence for all confidence intervals: 95%. X, workplace bullying; M1, psychological empowerment; M2, job burnout; Y, turnover intention. Model 1, workplace bullying‐psychological empowerment‐turnover intention; Model 2, workplace bullying‐job burnout‐turnover intention; Model 3, bullying experience‐psychological empowerment‐job burnout‐turnover intention.

Abbreviations: LL, lower level; UL, upper level.

Furthermore, the effects of each indirect effect were compared with each other (Table 3). Based on the 95% CI, model 1 (the mediator of psychological empowerment) was statistically and significantly weaker than model 2 (the mediator of job burnout; CI = −0.1991 and −0.0680); it was not statistically different from model 3 (the serial multiple mediations of psychological empowerment and job burnout; CI = −0.0356 and 0.0363). Moreover, model 2 was significantly stronger than model 3 (CI = 0.0808 and 0.1902).

5. DISCUSSION

This study found that the prevalence rate of turnover intention was high, which was consistent with Fang' study (Fang, 2016). Individual attributes such as young age, less years of nursing experience, a lower job title, unmarried status, contract employment (such as, staffing of personnel agent, contract employee), and lower pay were associated with novice nurses' high turnover intention (Chao & Lu, 2020; Yang & Chen, 2020), meanwhile, health administrators are advised to apply the job rotation approach by enhancing job satisfaction and reducing job conflict and turnover (Alfuqaha et al., 2021). Furthermore, the results indicated that workplace bullying was significantly correlated with turnover intention, and the indirect effect was mediated through psychological empowerment and job burnout.

Regarding the relationship between workplace bullying and turnover intention, this study found a significant positive correlation between workplace bullying and turnover intention among novice nurses in China, which was in agreement with previous findings (Daws et al., 2020). When novice nurses participate in rotation training, the supportive workplace culture helps them develop the required healthcare‐specific knowledge and practical skills. However, occasionally, workplace culture is indifferent to early‐career nurses' learning needs; they are often exposed to poor workplace behaviours and bullying (Daws et al., 2020). Malik et al. (2020) have reported that experiencing bullying behaviours may lead to an increased turnover intention for novice nurses because leaving the organization as a positive coping strategy completely removes them from the root cause of the problem. Therefore, bullying as a stressful experience may easily negatively influence the transfer to different departments and the intention of novice nurses (Nauman et al., 2019).

The effect of workplace bullying on turnover intention was significantly and partly mediated by psychological empowerment, which was consistent with previous research that a high level of perceived abusive supervision resulted in reduced psychological empowerment and increased turnover intention (Lyu et al., 2019); moreover, psychological empowerment was a mediation variable between abusive supervision and turnover intention (Lyu et al., 2019). Workplace bullying as a workplace stressor could negatively impact novice nurses' energy levels and make them feel disempowered to work in the healthcare environment (Ren & Kim, 2017). According to the SET, novice nurses' actions are motivated by the return they are expected to bring and typically do bring from others (Blau, 1964). As mentioned previously, novice nurses may not be as psychologically empowered as expected, becoming less self‐confident, unenergetic, negative, inactive, with a decreased feeling of responsibility to positively affect the work environment and leaving the organization (Akgunduz & Bardakoglu, 2017; Saira et al., 2021).

The findings also revealed that job burnout is a mediator between workplace bullying and turnover intention, which was supported by previous studies (Kim et al., 2019; Laeeque et al., 2018). Workplace bullying threatens novice nurses' adjustment to workplace health and contributes to their burnout (Laschinger et al., 2010); additionally, burnout is found to be a strong predictor of nurses' turnover intention (Laeeque et al., 2018). Bullying is a barrier to a successful transition, a critical period in novice nurses' new careers (Kim & Shin, 2020). Due to their relatively low status in the nursing hierarchy and their job performance reflecting a need for further skills, they experience more workplace bullying (Kim et al., 2019). According to the COR theory, novice nurses consume resources to respond to workplace bullying, and when novice nurses' resources have been fully exhausted and no additional options are available, they experience burnout that further causes them to display counterproductive work behaviours, including turnover intention (Barling, 1996).

In particular, a serial‐multiple mediator model was tested to determine the potential mechanism between workplace bullying and turnover intention. The results provided new insights into a serial multiple mediation model of psychological empowerment and job burnout, thus linking workplace bullying and turnover intention. The relationships mentioned in previous studies were empirically examined (Back et al., 2020; Gong et al., 2021; and Lyu et al., 2019), Lyu et al. (2019) revealed that workplace bullying harmed nurses' sense of psychological empowerment. Moreover, when individuals experience a lower level of psychological empowerment, job burnout increases (Gong et al., 2021). Finally, job burnout had a positive correlation with turnover intention, and nurses with higher levels of burnout had greater turnover intention (Back et al., 2020).

This study adopted the SET and the COR theory to understand the associations among the before‐mentioned variables with more clarity, rigour, and depth. Psychological empowerment as the social exchange relationship could have produced effective work behaviour and positive employee attitudes. Unfortunately, bullying in the workplace lowers psychological empowerment levels and novice nurses who have lower levels of psychological empowerment experience more negative feelings towards their organizations, thereby causing burnout (Cropanzano et al., 2017); this, in turn, gains momentum for further resource loss in the form of increased turnover intention. Collectively, these findings remind researchers to focus beyond whether workplace bullying impacts turnover intention by paying attention to psychological empowerment and job burnout as well. This is imperative for developing interventions to provide novice nurses with the utilization of resources training.

5.1. Limitations

This study has several limitations. First, it used a convenience sample that included only five Triple A hospitals; however, they were representative of China's Triple A hospitals regarding hospital size and type. Further research may help collect data from other hospital types to increase the results' generalizability. Second, the cross‐sectional design did not allow for conclusive inferences in favour of a causal link between workplace bullying and turnover intention; moreover, the variables psychological empowerment and job burnout changed longitudinally. Hence, a longitudinal study is needed to confirm the longitudinal change in each variable over time. Additionally, intervention research is required for decreasing novice nurses' turnover intention; the interventions should include efforts for reducing workplace bullying as well as providing psychological empowerment to reduce job burnout. Third, this study does not account for the impact of COVID‐19, the reality shock, on high turnover intentions of novice nurses experienced in this study. Future studies should focus on gaining more understanding about factors on turnover intention.

6. IMPLICATIONS FOR NURSING PRACTICE

This study has several practical implications. First, it further verified the high prevalence rate of turnover intention among novice nurses in China. To reduce the impact produced by turnover among them, it is necessary to explore the related factors and determine the potential mechanism between them and turnover intention. Age, less years of nursing experience, a lower work title, single status, and contract employment were all connected with novice nurses' high desire to leave (Chao & Lu, 2020; Yang & Chen, 2020). It is critical that efficacy interventions are applied immediately to reduce the danger of increased nurse turnover and promote nurse retention. Appropriate job retention intervention is needed, for example, those focusing on professional recognition (Theodosius et al., 2021) could be recommended for reducing the turnover intention of novice nurses. Second, organizational and individual awareness of workplace bullying should be aroused (Lee, 2018). Nursing managers should listen to the nurses' complaints instead of treating them as unimportant or transferring the harassing nurses to other departments with fewer nurses (Lee, 2018). Moreover, nurses disregard the presence of workplace bullying due to negatively learned inertia as they remain silent about this painful experience (Lee, 2018). Thus, nursing managers must verify the problem caused by workplace bullying and develop procedures and policies to support nurses and improve the health organization culture. Third, the conceptual–theoretical–empirical structure visualizes the linkages of the propositions of the SET and the COR theory. Additionally, this study had a significant theoretical implication by synthesizing these two theories. Based on the serial multiple mediation model's results, workplace bullying was found as having not only a statistically significant direct influence on turnover intention but also an indirect one through psychological empowerment and job burnout among novice nurses. Therefore, interventions for improving psychological empowerment should be included to tackle job burnout and turnover intention resulting from workplace bullying. It is necessary to implement a mentoring programme for teaching and holding novice nurses accountable and an institutional strategy for supporting and encouraging them to have responsibility. A time underpinned empowering experience for novice nurses would provide them with psychological resources to handle workplace bullying as well as improve their sense of organizational belonging, thus reducing turnover intention.

7. CONCLUSION

The findings revealed a high turnover intention for Chinese novice nurses in the Triple A hospitals. Furthermore, this study integrated literature from the COR theory and the SET to examine the direct and indirect effects of workplace bullying on turnover intention through psychological empowerment and job burnout. It contributes significant empirical evidence to the literature on turnover intention. Further, its findings have significant implications for the understanding of how workplace bullying reduces the level of psychological empowerment, leads to job burnout, and finally causes turnover intention. The results suggest that turnover intention is a critical issue among novice nurses; hence, a programme aimed towards teaching novice nurses how to recognize workplace bullying is required. In addition, a set of practical guidelines are necessary for promoting psychological empowerment that can help reduce job burnout and turnover intention resulting from workplace bullying.

FUNDING INFORMATION

This research was supported by research fund of Chungnam National University.

CONFLICT OF INTEREST

All authors declare that there is no conflict of interest with this original study.

RESEARCH ETHICS COMMITTEE APPROVAL

This study was approved by the Institutional Review Board of Jining Medical Univerisity (no. jnmc‐2019‐zr‐0023).

ACKNOWLEDGEMENTS

The authors would like to acknowledge the cooperation of the nurses who participated in this study.

Ren, L. , & Kim, H. (2023). Serial multiple mediation of psychological empowerment and job burnout in the relationship between workplace bullying and turnover intention among Chinese novice nurses. Nursing Open, 10, 3687–3695. 10.1002/nop2.1621

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are openly available in Mendeley Data at http://doi.org/10.17632/vyh54p3wcn.1, reference number V1.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are openly available in Mendeley Data at http://doi.org/10.17632/vyh54p3wcn.1, reference number V1.

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