Abstract
Background
Nurses and midwives are vital in addressing global healthcare workforce shortages, yet workplace bullying undermines their well-being and retention. This study examines the impact of workplace bullying on emotional exhaustion, job engagement, and turnover intentions among nurses in Ghana, with a focus on the moderating role of climate for conflict management (CCM).
Methods
Data were collected from 527 nurses in Ghana using structured questionnaires. The study employed partial least squares structural equation modeling (PLS-SEM) and Hayes macro-PROCESS to analyze the relationships between exposure to bullying, emotional exhaustion, job engagement, CCM, and turnover intentions. The constructs were measured using validated scales, and common method bias was assessed to ensure data reliability.
Results
Exposure to bullying was found to positively influence emotional exhaustion and turnover intentions. Emotional exhaustion mediated the relationship between bullying and turnover intentions. Surprisingly, bullying initially increased job engagement, but job engagement did not mediate turnover intentions. A favorable CCM moderated the relationship between bullying and emotional exhaustion, reducing its negative impact. However, CCM did not significantly moderate the relationship between bullying and job engagement.
Conclusions
The findings highlight the detrimental effects of workplace bullying on nurses’ emotional well-being and turnover intentions. These results emphasize the importance of fostering supportive organizational climates and effective conflict management strategies to mitigate the adverse effects of bullying, enhance nurse well-being, and reduce turnover intentions. Healthcare organizations should prioritize interventions that address workplace bullying and promote a positive work environment to retain a motivated and engaged nursing workforce.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40359-025-03008-0.
Keywords: Exposure to bullying, Climate for conflict management, Emotional exhaustion, Job engagement, Turnover intention, Nurses: Ghana
Introduction
The global healthcare sector is facing an alarming shortage of nurses and midwives, a challenge that threatens to undermine efforts toward improved population health [1, 2]. The World Health Organization (WHO) projects that by 2030, the demand for nurses and midwives will rise to 9 million, with these professionals accounting for more than half of the current deficit [3]. While every region is impacted, shortages of nurses disproportionately endanger Southeast Asia and Africa, where healthcare systems are already strained by limited resources [3]. The issue is further compounded by a high rate of brain drain, as many skilled nurses migrate in search of better opportunities [4, 5]. This migration pattern is particularly severe in African countries, where developing healthcare systems struggle to retain homegrown talent due to limited support structures and challenging working conditions [6]. Moreover, the existing healthcare workforce in these regions is often plagued by high turnover rates [7, 8].
This extant study focuses on Northern Ghana is justified by the acute healthcare workforce challenges unique to this region. The nursing profession in Ghana faces a severe retention crisis, with 69% of nurses reporting intentions to leave their positions [9]. The Northern, Savannah, Upper East, and Upper West regions selected for this research have critically low nurse-to-population ratios, just 1.46 to 1.89 nurses per 1,000 people [10], substantially below the WHO’s recommended 2.5 per 1,000. These regions represent a distinct context where workplace dynamics are shaped by Ghana’s high-power-distance culture and severe resource constraints, creating conditions where workplace bullying may have particularly profound effects on nurse retention [11]. Healthcare facilities in these regions operate with inadequate supplies and infrastructure, forcing staff to adopt problematic coping strategies that increase workplace stress [12]. These distinctive challenges make Northern Ghana an ideal setting for examining how workplace bullying affects nurse turnover through mechanisms like emotional exhaustion and decreased job engagement. In Ghana’s Upper West region for instance, over 50% of nurses cite workplace bullying and depression as key turnover drivers, compounded by the professional isolation and logistical barriers previously mentioned [13]. These resource-scarce and culturally distinct conditions justify using the Job Demands-Resources and Conservation of Resources frameworks to examine bullying’s effects on nurses’ retention. Further, by addressing non-economic factors like bullying, this study aims to inform interventions to improve nurse retention and healthcare quality in Ghana’s strained healthcare system. It is also imperative to address the high turnover rate among nurses in Ghana to mitigate the broader challenges of healthcare worker shortages and ensure the sustainability of healthcare delivery in a limited resource environment like Ghana.
Turnover intention refers to the subjective likelihood that an individual will leave their current position in the near future [14]. Several factors have been identified as contributing to healthcare workers’ intentions to quit, including job dissatisfaction, low compensation, and poor leadership support [15, 16]. One workplace factor that has been linked to high turnover intention, yet has received limited attention in the literature, is workplace bullying. Workplace bullying, is defined as prolonged negative behaviors directed at an individual by co-workers or superiors [17]. Bullying has been consistently associated with employees’ intention to quit. In the healthcare industry, for instance, studies have shown that exposure to bullying significantly increases employees’ intentions to leave their positions [18, 19]. Similarly, exposure to bullying has been found to lead to emotional exhaustion, a core aspect of job burnout, where individuals feel drained and unable to cope with emotional demands [20, 21]. According to Kim, Lee [22] there is a substantial correlation that experiences of bullying were significantly associated with higher emotional exhaustion, depersonalization, compassion fatigue, ultimately affecting their and intentions to leave their jobs. Despite these findings, studies on bullying among nurses, particularly in the context of Ghana, have received little attention [11]. While the relationships between bullying, emotional exhaustion, and turnover intention have been examined separately, little is known about how these variables interact and collectively impact healthcare workers, especially nurses in the Northern part of Ghana, where the healthcare infrastructure is already under significant strain. In Ghana, the high power distance in workplaces exposes lower-level employees to increased bullying, which further exacerbates the challenges faced by healthcare professionals. However, little is known about how bullying contributes to emotional exhaustion, which ultimately leads to turnover intention among nurses in Ghana. This study aims to fill this gap by answering research question 1: How does exposure to bullying affect emotional exhaustion and ultimately turnover intention among Ghanaian nurses?
Furthermore, research suggests that job engagement has been found to promote a sense of connection to the organization, fostering a collaborative, innovative, and committed work atmosphere that reduces turnover intentions [23]. However, bullying has been shown to detract from job engagement, which in turn exacerbates turnover intentions [24–27]. Nonetheless, it has been discovered that being bullied at work has a detrimental impact on job engagement [28–30]. However, little attention has been given to how workplace bullying affects employees’ job engagement and ultimately, their intentions to leave. This study further examines how job engagement mediates the relationship between workplace bullying and turnover intentions, thus research question 2: How does job engagement mediate the relationship between workplace bullying and turnover intention.
Moreover, a limited number of research have thus far explored the variables that could potentially safeguard organisations from instances of bullying, either through preventing the occurrence of such incidents or alleviating their adverse repercussions [31–33]. This research investigates the moderating role of Climate for Conflict Management (CCM). CCM refers to employees’ perceptions of organizational policies, procedures, and culture regarding conflict resolution [34]. Previous studies suggest that CCM can reduce the negative impact of workplace stressors, including bullying, on employee well-being by establishing clear and equitable conflict resolution procedures [34, 35]. We hypothesize that CCM moderates the relationship between bullying and emotional exhaustion as well as bullying and job engagement, potentially alleviating the negative effects of bullying by promoting open communication and conflict resolution.
By illuminating these dynamics, the research aims to furnish healthcare organisations and policymakers with valuable information, enabling them to implement evidence-based strategies to combat bullying, foster a culture of appreciation, and, ultimately, retain a motivated and engaged nursing workforce. This study is innovative in nature as it tests multiple parallel mediation interactions. Unlike previous studies that often focus on individual factors like coworker bullying, emotional exhaustion, job engagement, and turnover intentions separately, this research delves into the intricate interplay between these variables. Secondly, explicitly focusing on Ghanaian healthcare workers sheds light on the unique challenges nurses and midwives face in Ghana, directly addressing the pressing issue of high turnover intention reported in this context. Thirdly, exploring climate for conflict management (CCM) as a novel moderating factor represents a significant innovation, investigating how CCM can possibly lessen the detrimental effects of exposure to bullying on job engagement and emotional exhaustion, a relatively underexplored aspect. Lastly, drawing upon established theoretical frameworks, such as the Job Demands- Resources model (JD-R model) [36] and the Conservation of Resources theory (COR theory) [37], this research explores the pathways through which exposure to bullying influences nurses’ emotional exhaustion, job engagement, and their propensity to leave their current employment (see Fig. 1 for proposed conceptual framework). The findings can highlight the complex interaction between these factors, uncovering potential mediating variables that shape nurses’ experiences and career decisions. By addressing the challenges of coworker bullying and inadequate rewards, healthcare organisations can ensure a more supportive and nurturing work atmosphere, promoting the retention of skilled and dedicated nurses. Ultimately, this research endeavors to contribute to the broader discourse on fostering a robust and sustainable healthcare workforce that can deliver high-quality patient care while safeguarding the well-being of healthcare professionals.
Fig. 1.
Conceptual framework of the study
Theoretical development and hypothesis development
The Job Demands-Resources (JD-R) model and Conservation of Resources (COR) framework are employed as complementary theoretical lenses to elucidate the complex interplay between workplace bullying, emotional exhaustion, job engagement, climate for conflict management (CCM), and turnover intentions among nurses. The JD-R model posits that workplace dynamics are shaped by two categories: job demands, which require sustained physical or psychological effort and are associated with strain (e.g., emotional exhaustion), and job resources, which foster engagement and mitigate negative outcomes [38]. In this study, exposure to bullying is conceptualized as a job demand that depletes emotional resources, leading to strain outcomes like emotional exhaustion and turnover intentions, while CCM serves as a job resource that buffers these effects. The JD-R model is particularly suitable for this study as it provides a flexible framework to examine how job demands and resources interact to influence employee well-being and organizational outcomes in high-stress healthcare settings. The COR framework complements the JD-R model by focusing on resource loss and gain dynamics [37]. It posits that individuals strive to acquire, retain, and protect resources (e.g., self-esteem, psychological safety), and stressors like bullying threaten these resources, leading to emotional exhaustion and coping responses such as turnover intentions. The COR framework is critical for understanding why nurses experiencing bullying may prioritize resource conservation by contemplating leaving their jobs. By integrating these frameworks, the study captures both the strain pathway (JD-R’s focus on demands leading to emotional exhaustion) and the motivational pathway (COR’s emphasis on resource protection influencing engagement and retention).
The integration of JD-R and COR frameworks offers a comprehensive lens to examine the interaction between workplace bullying, emotional exhaustion, job engagement, CCM, and turnover intentions. The JD-R model’s strength lies in its ability to categorize workplace factors into demands and resources, while the COR framework provides depth by explaining the psychological mechanisms of resource depletion and conservation. For instance, Tuckey and Neall [39] applied the COR framework to demonstrate how workplace bullying erodes job and personal resources through emotional exhaustion. While Coetzee and van Dyk [40] explored work engagement as a mediator between bullying and turnover intention, they did not fully address resource loss dynamics. Conversely, Schaufeli and Bakker [41] utilized the JD-R model to link job resources to engagement and turnover intention but did not explicitly examine bullying. The JD-R model posits that job resources predict engagement, while job demands primarily predict burnout [41]. Integrating these perspectives could provide a more comprehensive understanding of how workplace bullying affects employee outcomes through resource depletion and engagement processes. Further, by combining these frameworks, this study captures both the strain pathway (bullying leading to emotional exhaustion and turnover) and the motivational pathway (CCM fostering engagement to reduce turnover), addressing inconsistencies in prior research and tailoring the analysis to Ghana’s unique healthcare challenges.
The combined use of the JD-R and COR frameworks is particularly justified given the complex, resource-scarce environment of Ghana’s Northern Region healthcare system. The JD-R model’s focus on job resources like CCM aligns with findings from Rosander and Nielsen [42] who showed that a supportive conflict management climate mitigates bullying’s impact on employee well-being. Meanwhile, the COR framework’s emphasis on resource threats explains why nurses, facing chronic bullying, may experience heightened turnover intentions [43]. The dual-theoretical approach addresses calls for integrative models in workplace bullying research [44] and responds to the need for context-specific studies in African healthcare settings. Leveraging both frameworks, this study provides a nuanced understanding of how bullying influences nurses’ emotional and professional outcomes, offering actionable insights for reducing turnover through organizational interventions like CCM.
Exposure to bullying and emotional exhaustion
The COR theory offers a valuable framework for understanding the connection between exposure to bullying and emotional exhaustion. According to COR theory, people strive to obtain, maintain, and protect valued resources, such as self-esteem, social support, and a sense of control [37]. When individuals experience bullying, they may either lose valued resources or feel that these resources are threatened, leading to negative psychological and emotional outcomes, such as emotional exhaustion [45]. Workplace bullying has consistently been linked to emotional exhaustion across various contexts. For example, bullying was identified as a major predictor of emotional exhaustion in a study conducted in the hotel industry [46]. This suggests that the depletion of personal resources, as proposed by the COR theory, is a crucial pathway through which bullying impacts employees. Bullying can be a significant source of stress, draining employees’ emotional resources and contributing to emotional exhaustion [47].
Furthermore, while the relationship between bullying and emotional exhaustion appears consistent across various sectors, research suggests that occupational and cultural contexts may contribute to this relationship, particularly in nursing. The healthcare sector presents unique contextual factors that may intensify this relationship. For instance, Giorgi, Mancuso [48] found that hierarchical structures in healthcare organizations can exacerbate the impact of bullying on emotional exhaustion, as power imbalances limit nurses’ ability to confront or escape bullying situations. Additionally, cultural differences influence how bullying is perceived and experienced. In collectivist cultures, the isolation resulting from bullying may be particularly detrimental to nurses’ emotional resources [49], while in contexts with high power distance, the inability to challenge bullying behaviours from superiors may accelerate resource depletion [50]. The nursing profession itself contains occupation-specific stressors such as emotional labour demands and moral distress that, when combined with bullying experiences, can create a particularly potent catalyst for emotional exhaustion [51]. Based on the aforementioned literature, we hypothesize that:
H1
Exposure to bullying positively influences nurses’ emotional exhaustion.
Emotional exhaustion and turnover intention
The JD-R model has been adapted to demonstrate that job demands like performance expectations and centralization are positively linked to emotional exhaustion, which is positively linked to the intention to quit [52]. Further, the COR framework supports the notion that emotional exhaustion is associated with voluntary turnover and job performance [53]. Employees experiencing emotional exhaustion demonstrate a lack of inclination towards fostering positive and amicable relationships with their colleagues, consequently resulting in job dissatisfaction and contemplation of exiting the organization, as evidenced by the research study of Khan, Khan [54].
Additionally, robust evidence has been presented by multiple empirical investigations demonstrating the connection between emotional exhaustion and turnover intentions across various occupational sectors. For instance, Workplace bullying has varying impacts on employees, leading to heightened intentions to depart from the organization, elevated levels of frustration within the workforce, and significant repercussions on their overall professional trajectory [55]. In the airline industry, role stress factors such as overload, ambiguity, and conflict have been identified as antecedents of emotional exhaustion, leading to voluntary turnover [56]. Similarly, the COVID-19 epidemic was said to have added pressures for healthcare professionals, including emotional exhaustion and a rise in nurses’ intentions to leave their jobs due to job stress and state rage [57]. The literature reveals a consistent pattern: emotional exhaustion is connected with an increased likelihood of intention to quit.
Empirical studies across sectors, such as the airline industry [56] and healthcare [57] confirm that emotional exhaustion is a robust predictor of turnover intentions. However, it is critical to distinguish between turnover intention and actual turnover. Turnover intention reflects an employee’s desire or plan to leave, influenced by emotional and psychological states, whereas actual turnover involves the physical act of leaving, which may be constrained by external factors such as job market conditions or financial dependencies [58]. While turnover intention is a strong predictor of actual turnover, the relationship is not absolute, as situational factors may prevent employees from acting on their intentions. For instance, nurses during the recent health pandemic experienced intensified emotional exhaustion, increasing turnover intentions due to heightened job stress [57] but actual turnover may have been lower due to workforce shortages or economic uncertainty.Therefore, we hypothesize that:
H2
Emotional exhaustion positively impacts turnover intentions.
Exposure to bullying and turnover intentions
The widespread problem of workplace bullying has been connected to some unfavourable outcomes, such as workers’ intentions to quit. Bullying within the professional setting yields adverse consequences on the general workplace ambiance and productivity, as well as on employees’ commitment to the organization and the efficiency of teams, thereby fueling the growing inclination of employees to seek alternative employment [59]. Reducing bullying in the workplace may be a tactic to reduce turnover rates, as Hsiao, Ma [60] found in a study involving clinical nurses that bullying at work increased the impact of burnout on turnover intentions. Similarly, analyses conducted across cultures also demonstrated that exposure to bullying at work increased intentions to depart from the company by adversely influencing affective well-being [61]. Departing from an institution where one works at represents the most notable response to instances of bullying according to Bohle, Knox [62].
Furthermore, a three-wave prospective study of Danish healthcare professionals revealed that exposure to bullying significantly increased the chance of quitting. The study found that 9.2% of respondents reported being bullied, with a strong relationship between being frequently bullied and subsequent turnover. Push factors such as low social support did not significantly alter this relationship, highlighting the direct impact of bullying on staff turnover [43]. Bullying leads employees to perceive their workplace as dysfunctional and politicized, which directly increases their desire to leave, especially when they lack creative coping skills or supportive relationships with colleagues and supervisors [63]. The negative impact of bullying is further amplified by its detrimental effects on affective well-being, work engagement, and burnout, all of which mediate the relationship between bullying and turnover intentions [40]. Even indirect exposure such as working in units characterized by bullying or experiencing environmental bullying, raises turnover intentions, as it erodes secure workplace attachment and satisfaction [64]. The consistent positive correlation between bullying and turnover intentions across diverse settings and cultures highlights the urgent need for organizations to address bullying to retain talent and maintain a healthy work environment [65]. We therefore hypothesize that:
H3
Exposure to bullying positively influences turnover intentions.
Job engagement and turnover intention
The JD-R model offers a perceptive viewpoint on how job engagement affects the intention to leave, especially in the health industry. Highly engaged workers tend to have a stronger sense of connection to their work and the company, frequently resulting in a decreased desire to quit [66]. This is particularly pertinent in the health sector, where the sense of fulfilling a meaningful purpose can be a strong motivator. Job engagement promotes resilience against the stressful and emotionally taxing aspects of healthcare jobs, thereby reducing the likelihood of turnover intentions [23]. Engaged healthcare professionals may tend to tackle challenges proactively, feel accomplished in their roles, and maintain a positive outlook towards their work and workplace. Moreover, job engagement can also create an environment that supports teamwork, innovation, and a shared sense of commitment. This positive environment can further decrease turnover intentions, as employees who are part of a supportive and dynamic team are less inclined to seek opportunities elsewhere [67].
Furthermore, according to Alarcon and Edwards [24], work engagement predicts job satisfaction and intentions to quit significantly. This indicates that higher engagement may result in greater job satisfaction and decrease intentions to leave a job. Job embeddedness also moderates this relationship, with stronger embeddedness weakening the turnover intention [25]. Job crafting positively impacts work engagement and job satisfaction, reducing intentions to quit. This suggests that enabling employees to craft their jobs could be a strategy to enhance engagement and reduce turnover [26]. Also, employees with better work-life balance tend to be more engaged and less expected to intend to leave [27].
Additionally, there are variations in job engagement across demographic factors and work units within healthcare, contextualizing these findings. For instance, younger nurses or those with less tenure may exhibit lower engagement due to limited experience or weaker organizational ties, increasing their turnover intentions [68]. Younger nurses or those with less tenure tend to display lower work engagement because they have not yet built robust organizational ties or accumulated sufficient experience, which undermines their sense of commitment and increases their turnover intentions [69]. Work unit characteristics, such as intensive care versus outpatient settings, may influence engagement levels. Nurses in high-pressure units may experience lower engagement due to elevated stress, while those in collaborative units benefit from stronger team dynamics, reducing turnover intentions [70]. These variations highlight the need for targeted engagement strategies tailored to demographic and unit-specific factors in healthcare settings. Based on these we hypothesize:
H4
Job engagement negatively influences turnover intention.
Exposure to bullying and job engagement
An area of emerging interest in organizational research is the connection between exposure to workplace bullying and job engagement. An engaged worker is enthusiastic and fully committed to their task and is typically lost in it. Workers who exhibit high work engagement typically possess a strong sense of self-identification and high energy levels [71]. According to Albrecht, Bakker [72], employee engagement is critical to competitive advantage for human resource management strategies. Gaining insight into the factors contributing to employee engagement will help one better understand employee engagement. In a study, [29] discovered a negative association between exposure to bullying and job engagement and bus driver’s job satisfaction. Also, Rodríguez-Muñoz, Baillien [30] also indicated in their study that a partially direct causal connection between workplace bullying and engagement existed. Moreover, exposure to bullying is commonly known as a factor contributing to detrimental effects on employees’ welfare in the workplace, resulting in the weakening of victims and a decline in their level of involvement in work tasks [73]. As highlighted by Goodboy, Martin [28], the financial implications for organizations due to each instance of workplace bullying are substantial, reaching tens of thousands of dollars annually and accumulating to billions of dollars on a national scale. Even though in environments with high-performance work systems or supportive job crafting, bullying disrupts the positive effects of these interventions on engagement, further emphasizing its negative impact [74]. While some research explores moderating factors such as the presence of active bystanders or job crafting that can buffer the negative effects, there is no evidence in the literature to support the argument that bullying exposure enhances job engagement; instead, it consistently impairs it [75]. Given the psychological and financial burdens associated with bullying, it becomes crucial to explore how bullying exposure affects nurses’ intentions to quit. Given the previously described logic, the following hypothesis is proposed:
H5
Exposure to bullying negatively affects nurses’ job engagement.
The mediating role of emotional exhaustion on the relationship between exposure to bullying and turnover intentions
The COR theory posits that individuals strive to acquire and retain valued resources, and workplace bullying, as a significant stressor, depletes these resources, leading to emotional exhaustion [37]. The JD-R model complements this by suggesting that high job demands, such as bullying, drain psychological and physical resources, fostering emotional exhaustion, which in turn increases turnover intentions [38]. Empirical studies validate emotional exhaustion as a key mediator in the bullying-turnover intentions nexus. For instance, Srivastava and Agarwal [44] found that bullying increases turnover intentions through emotional exhaustion, with supervisory support moderating this effect. Similarly, Khan, Ali [59] reported a significant indirect effect of emotional exhaustion in the relationship between bullying and turnover intentions, while Ribeiro, Gomes [76] demonstrated that burnout, encompassing emotional exhaustion, fully mediates this link in Portuguese organizations.
Emotional exhaustion can mediate the bullying-turnover relationship primarily by depleting employees’ emotional and cognitive resources, reducing their capacity to cope with workplace demands. This depletion can lead to diminished organizational commitment and job satisfaction, both of which are strong predictors of turnover intentions [77]. The mechanism is particularly pronounced in high-stress environments like healthcare, where nurses face intense emotional labor. Emotional exhaustion acts as a proximal outcome of bullying, directly linking the stressor to withdrawal behaviors like intending to quit as a means of escaping the stressful environment [46]. Compared to other mediators, emotional exhaustion is often a stronger and more immediate driver of turnover intentions due to its direct impact on employees’ psychological well-being and energy levels, making it a critical pathway in the bullying-turnover nexus. Based on the above literature discussed we hypothesize that.
H6
Emotional exhaustion mediates the nexus between exposure to bullying and turnover intentions.
The mediating role of job engagement on the relationship between exposure to bullying and turnover intentions
According to the JD-R theory, workplace bullying represents a job demand that depletes employees’ resources, while job engagement, as a personal and job resource, can mitigate bullying’s negative effects, reducing turnover intentions [38]. Job engagement, characterized by vigor, dedication, and absorption, fosters a sense of purpose and fulfillment, counterbalancing the adverse experiences of bullying [78]. Empirical studies support job engagement as a mediator in the bullying-turnover intentions relationship. For instance, Coetzee and van Dyk [40] found that bullying reduces vigor and dedication, lowering engagement and increasing turnover intentions, with engagement partially mediating this link. Similarly, GADI and Kee [79] reported that employee engagement mediates the connection between HRM practices, workplace bullying, and intentions to quit, suggesting that organizations should address these issues to reduce turnover. Similarly, work engagement was discovered to mediate the link between workplace bullying and intentions to leave among academic staff in Nigerian public universities [80].
Job engagement can mediate the bullying-turnover relationship by buffering the psychological impact of bullying through enhanced motivation and connection to work. Unlike emotional exhaustion, which directly depletes resources and prompts withdrawal, job engagement operates by sustaining employees’ positive psychological states, enabling them to remain committed despite bullying [32]. However, its mediating effect is typically less potent than that of emotional exhaustion because engagement requires active resource investment (e.g., through supportive work environments or personal resilience), which may be challenging under persistent bullying. Emotional exhaustion and job engagement often operate in tandem, with exhaustion amplifying turnover intentions through resource loss and disengagement reducing intentions by fostering resilience. For nurses, emotional exhaustion may dominate due to the intense emotional demands of their roles, but job engagement can complement this by promoting a sense of purpose, particularly when organizational support is present [40]. This interplay suggests that interventions targeting both mediators reducing exhaustion and boosting engagement could synergistically mitigate turnover intentions. Based on this the study hypothesize that:
H7
Job engagements mediate the relationship between exposure to bullying and turnover intentions.
The moderating role of CCM on the nexus between exposure to bullying and emotional exhaustion
This study explores the moderating effect of CCM on the relationship between exposure to workplace bullying and emotional exhaustion, proposing that a favorable CCM weakens this relationship. The JD-R model frames bullying as a job demand that depletes resources, leading to emotional exhaustion when not balanced by job resources like a supportive CCM [81]. A strong CCM, characterized by fair conflict resolution, open communication, and proactive intervention, acts as a buffer, reducing the psychological toll of bullying. Empirical studies support this moderating role. Rosander and Nielsen [42] found that CCM mitigates the relationship between bullying exposure and work fatigue, while Ekmekcioglu, Nabawanuka [82] demonstrated that CCM alleviates bullying’s impact on work-related depression. Hamre, Fauske [33] showed that a robust CCM prevents bullying escalation, reducing emotional exhaustion, and Pecino, Mañas [83] reported lower stress and fatigue in positive CCM environments.
However, the operationalization and measurement of CCM vary across studies, potentially affecting the consistency of findings. For instance, Rosander and Nielsen [42] measured CCM using employee perceptions of organizational conflict resolution fairness and support, focusing on subjective experiences. In contrast, Hamre, Fauske [33] operationalized CCM through observable practices, such as documented conflict management policies and training programs, emphasizing structural aspects. Ekmekcioglu, Nabawanuka [82] combined both perceptual and structural indicators, assessing CCM via scales that capture communication openness and managerial intervention efficacy. These variations, subjective versus objective measures, individual versus organizational focus, may lead to differences in reported effect sizes, as perceptual measures are more susceptible to personal biases, while structural measures may overlook contextual nuances in healthcare settings like nursing. Despite these differences, the consistent finding that CCM buffers bullying’s effects suggest robustness, though future research should standardize CCM measurement to enhance comparability, particularly in high-stress environments where nurses face unique demands. Based on this evidence, we hypothesize that:
H8
The correlation between emotional exhaustion and exposure to bullying is tempered by CCM, such that a favorable CCM reduces the favorable relationship between bullying exposure and emotional exhaustion.
The moderating role of CCM on the nexus between exposure to bullying and job engagement
The JD-R model and COR theory provide frameworks for understanding how CCM moderates the relationship between bullying exposure and job engagement. A positive CCM, as a job resource, can mitigate bullying’s detrimental effects by promoting effective conflict resolution and supporting nurses’ resource conservation, thereby enhancing job engagement [84]. Empirical evidence supports this role. Hamre, Fauske [33] found that a strong CCM fully buffers the progression of bullying behaviors over time, preserving engagement. Zahlquist, Hetland [35] reported that team-level perceptions of CCM weaken the link between job demands and bullying exposure, while Leon-Perez, Medina [85] showed that proactive conflict management prevents conflict escalation, sustaining engagement. Einarsen, Skogstad [32] noted that CCM’s moderating effect is most pronounced when CCM is low, as strong CCM provides employees with social support and control, enhancing engagement.
The operationalization and measurement of CCM in these studies vary, which may influence the consistency of findings. For example, Zahlquist, Hetland [35] measured CCM through team-level surveys assessing perceived fairness and collaboration in conflict resolution, emphasizing collective perceptions. Conversely, Leon-Perez, Medina [85] used individual-level scales focusing on employees’ experiences of problem-solving communication, which may capture personal rather than organizational dynamics. Einarsen, Skogstad [32] employed a mixed approach, combining self-reported perceptions with supervisor ratings of conflict management practices. These differences team versus individual focus, perceptual versus multi-source data can affect findings, as team-level measures may mask individual variations, while individual measures may be biased by personal experiences. In nursing, where team dynamics and hierarchical structures are critical, these measurement variations could explain inconsistent effect sizes across studies. Standardizing CCM measurement, such as integrating both perceptual and structural indicators, could improve reliability and applicability to healthcare contexts. Nevertheless, the consistent buffering effect of CCM on bullying’s impact on engagement highlights its importance. Based on this we hypothesize that:
H9
The correlation between exposure to bullying and job engagement is tempered by CCM, such that a favourable CCM reduces the favourable relationship between bullying exposure and job engagement.
Methodology
Participants and procedure
This current study adopted a quantitative cross-sectional survey design to examine the influence of workplace bullying on emotional exhaustion, job engagement, and turnover intentions among registered nurses working in the Northern sector of Ghana. A total of 643 registered nurses were initially targeted across the three administrative regions, Savanna, Upper East and Upper West, out of which 527 provided valid responses, yielding a response rate of 82%. This high response rate enhances the representativeness and reliability of the findings. To ensure that the sample was representative of the population and captured diversity of workplace contexts, a stratified sampling method was employed followed by simple random sampling within each stratum. The sampling process began with stratification by hospital type, which include three categories: public regional hospitals, district hospitals, and mission/private hospitals. This was done to ensure that nurses from different levels of healthcare facilities were proportionately represented in the study. Within each hospital type, a list of eligible hospitals in the three Northern regions (Savanna, Upper East, and Upper Wesst) was compiled. The second level of stratification was based on geographical regions, ensuring that all the three regions contributed to the sample proportionately based on the number of hospitals and nurses available in each region. After the strata were established, the simple random sampling technique was applied within each stratum. Specifically, a list of registered nurses was obtained from each eligible hospital selected with the help of the hospital administrators. Each nurse as then assigned a unique identifier, to facilitate the random process. The “RAND ()” function in excel was then used to selected participants from these lists, ensuring that each registered nurse had equal chance of being selected. This approach ensured that every eligible nurse within each hospital and regions has equal chance of being included in the study. Overall, this multistage sampling process was designed to improve representativeness, reduce sampling bias, and enhance the generalizability of the study findings across different hospital settings and regions in the Northern part of Ghana. Notably, participation was entirely voluntary, and the study protocol was approved by the Institutional Review Board of Jiangsu University Medical Ethics Committee. Informed consent was obtained electronically at the beginning of the survey, and all participants were assured of anonymity and confidentiality in line with ethical standards, including the Declaration of Helsinki.
Measures
The constructs in this study were assessed using structured questionnaires developed from validated instruments cited in peer-reviewed literature. The instrument was divided into three major sections. Section 1 captured demographic variables including age, gender, education level, and tenure at the current facility. Sections 2 and 3 measured the psychological and organizational constructs of interest: exposure to workplace bullying, emotional exhaustion, job engagement, turnover intentions, and climate for conflict management. Exposure to workplace bullying was assessed using 4 items adapted from Simons, Stark [86], while turnover intention was measured using 3 items derived from Singh, Verbeke [87]. Job engagement was captured using 9 items from the Utrecht Work Engagement Scale (Schaufeli, Bakker [88]. Emotional exhaustion was evaluated using the 8-items exhaustion subscale of the Burnout Assessment Tool (BAT-C) adopted from Schaufeli, Desart [89], and the climate for conflict management was assessed with 4 items adapted from Rivlin [34]. To measure the aforementioned constructs, both 5-point and 7-point Likert scales were employed. The 5-point scale was used for constructs such as exposure to bullying and turnover intention to provide simple responses for constructs that are more behavioural oriented and less nuanced in perception. In contrast, the 7-point Likert scale was applied to measure job engagement and emotional exhaustion, which are psychologically complex and subjective states requiring finer granularity to capture subtle differences in intensity or agreement. Notably, the summary of the various items adopted in measuring the study constructs of interest and their respective sources is outlined in Appendix Table A1. This mixed-scale approach is consistent with common practices in psychological organizational research, where the nature of the construct often dictates the scale type. Moreover, this decision was informed by prior validated studies from which the scale items were adopted. To mitigate any potential respondent fatigue or confusion, careful attention was given to formatting, scale instructions, and item grouping, and the questionnaire was pilot-tested to ensure clarity and consistency.
Pilot testing and content validation
A pilot study was conducted with a sample of nurses representing approximately 10% of the main study sample to test the clarity, reliability of the instrument (questionnaire), and to allay worries about sampling and non-sampling errors. This allowed for the refinement of questions to make them more straightforward and precise, resulting in reliable information from respondents. Notably, to guarantee the coherence, dependability, and uniformity of the measurements included in the research questionnaire, a few alterations were made to the survey instrument. Specifically, some questionnaire items were reworded to improve clarity and cultural relevance to the Ghanaian nursing context. Technical or unfamiliar terms were simplified to ensure ease of understanding among participants, most of whom were young and early-career nurses. These modifications were informed by insights gained during the pilot testing phase and feedback from the local nursing supervisors and subject matter experts. The rationale behind these changes was to enhance response comprehension, minimize ambiguity, and ensure the questions reflected the local healthcare environment without altering the underlying constructs being measured. To preserve content validity, the revised items were reviewed and cross-checked against the original validated scales, ensuring that conceptual consistency was maintained.
Data collection and analysis
Following the pilot testing, data were collected using the finalized (revised) structured self-administered questionnaire distributed to registered nurses across the selected healthcare facilities in the Northern sector of Ghana. The finalized questionnaire was distributed in both paper-based format and digitally via Google forms, depending on the logistical reference and internet accessibility of the target health facility. With the assistance from nursing supervisors and hospital administrators, participants were approached during staff meetings, break times, or through direct outreach. Participation was entirely voluntary, and informed consent was obtained from all respondents, consistent with ethical research protocols as already indicated. Each participant was given clear instructions on how to complete the questionnaire, and measures were taken to ensure confidentiality. Responses were anonymous, and no personally identifiable information was collected. The entire data collection process took place over a six-week period, ensuring ample time for follow-up and increased participation. Following the data collection, the responses were screened for completeness and accuracy. A total of 527 valid responses were retained for the analysis after excluding incomplete or inconsistent entries. Data analysis was performed using SmartPLS version 4.0 to estimate both direct and indirect relationships among the study constructs. The choice the SmartPLS was based on its strength in handling complex models involving mediators and moderators, and its suitability for both large and moderate sample sizes [90]. This analytical method also makes fewer distributional assumptions compared to covariance-based SEM, allowing greater flexibility in exploring theory-driven models in social science research. Prior to the structural analysis, a rigorous assessment of the measurement model was conducted. Specifically, the reliability and validity of the constructs were confirmed using Cronbach’s alpha, composite reliability, and average variance extracted (AVE). Discriminant validity was also confirmed through the Fornell–Larcker criterion and the Heterotrait-Monotrait (HTMT) ratio techniques. To assess the potential common method bias, procedural and statistical remedies were employed. Procedurally, the instrument design ensured respondent anonymity, clear item wording, and counterbalanced item order. Statistically, Harman’s single-factor test was conducted revealing no single factor accounted for more than 50% of the variance, specifically, the largest factor only explained 23%, indicating that common method variance was not a significant concern [91]1. The structural model was then evaluated using the path coefficients, t-values, and confidence intervals via bootstrapping with, 5000 resamples. The model’s predictive power was examined using the coefficient of determination (R²) and the Stone-Geisser Q² index.
Results
Sample characteristics
With respect to the sample of 527 registered nurses who provided complete and usable responses, yielding a response rate of approximately 82%, 28% of them were males, while 72% were females. This aligns with broader trends in the nursing profession, where caregiving is predominantly occupied by women [92], particularly within the socio-cultural context of Ghana. Further, the average age of respondents was approximately 25.5 years, indicating a relatively young nursing workforce in the Northern sector. In terms of educational attainment, 39% of the respondents reported holding a four-year bachelor’s degree or higher, while the remaining majority possessed a diploma in nursing. These figures are consistent with the prevailing qualification structure in Ghana’s nursing profession. With respect to tenure, the average duration of employment at respondents’ current healthcare facilities was approximately 2.5 years.
Reliability and validity analysis
According to Hair Jr, Matthews [93], reliability, convergent validity, and internal consistency should be rigorously examined before estimating relationships among latent variables. Table 1 presents the results of the reliability and validity assessments for all the latent constructs. Composite reliability (CR) values ranged from 0.765 to 0.901, exceeding the acceptable threshold of 0.7. Similarly, Cronbach’s alpha coefficient of climate for conflict management (CCM), emotional exhaustion (EMX), exposure to bullying (EXB), job engagement (JEG), and turnover intention (TOI) were 0.884, 0.830, 0.809, 0.893, and 0.746, respectively, each above the 0.7 benchmark. These results indicate satisfactory internal consistency reliability across all constructs. Convergent validity was assessed using the average variance extracted (AVE). As shown in Table 1, AVE values for all constructs, CCM (0.742), EMX (0.522), EXB (0.636), JEG (0.609), and TOI (0.662), exceeded the recommended minimum of 0.50 [94]. These findings affirm that a substantial proportion of variance in each construct is explained by its indicators. Discriminant validity was also evaluated using both the Fornell-Larcker criterion and the Heterotrait-Monotrait (HTMT) ratio. Table 2 confirms that for each construct, the square root of its AVEs which ranges from 0.723 to 0.861 exceeded the correlations with all other constructs, satisfying the Fornell-Larcker criterion. This is as well supported by the HTMT values for all constructs pairs correlations which are all less than the 0.85 threshold. These outcomes thus support the discriminant validity of the measurement model. To assess indicator consistency and multicollinearity, factor loadings and variance inflation factor (VIF) values were examined, reported in Table 3. Following Hair Jr, Howard [95], items with loadings below the threshold of 0.7 were considered for removal due to insufficient indicator reliability. Simultaneously, a VIF threshold of 5.0 was adopted, in line with Kock [96], to identify problematic collinearity. Based on these criteria, three items were excluded from further analysis: JEG8 and JEG9, which had loadings of 0.390 and 0.421, respectively as well as EMX4 had a VIF of 5.4. The removal of these items enhanced the construct measurement quality by improving reliability and reducing multicollinearity. All retained items demonstrated loadings greater than 0.7 and VIF values well below the cut-off, confirming that multicollinearity is not a concern in the refined measurement model. Taken together, the items and constructs with respect to the measurement model exhibits strong construct reliability, convergent validity, and discriminant validity, providing a sound basis for subsequent structural model evaluation.
Table 1.
Construct reliability and validity test
| Construct | Composite reliability | Cronbach’s alpha | Average variance explained |
|---|---|---|---|
| Climate for conflict management | 0.901 | 0.884 | 0.742 |
| Emotional exhaustion | 0.835 | 0.830 | 0.522 |
| Exposure to bullying | 0.859 | 0.809 | 0.636 |
| Job engagement | 0.894 | 0.893 | 0.609 |
| Turnover intention | 0.765 | 0.746 | 0.662 |
Table 2.
Discriminant validity (Fornell–Larcker criterion and heterotrait–monotrait ratio)
| CCM | EMX | EXB | JEG | TOI | |
|---|---|---|---|---|---|
| CCM | 0.861 | ||||
| EMX | 0.205 (0.228) | 0.723 | |||
| EXB | 0.158 (0.184) | 0.309 (0.362) | 0.797 | ||
| JEG | 0.28 (0.311) | 0.343 (0.396) | 0.272 (0.31) | 0.78 | |
| TOI | 0.14 (0.117) | 0.281 (0.346) | 0.238 (0.287) | 0.187 (0.224) | 0.814 |
Notes: The square roots of the AVE are bolded and oriented diagonally. The correlations between the values of the construct are located beneath the diagonal elements. In brackets are the heterotrait–monotrait ratio of correlation values. Abbreviations: EMX – emotional exhaustion; EXB – exposure to bullying; JEG – job engagement; TOI – Turnover intention; CCM – Climate for Conflict Management
Table 3.
Measurement items factor loading and VIFs
| Measurement items | Factor loading | VIF |
|---|---|---|
| Conflict for climate management | ||
| CCM1 | 0.773 | 1.776 |
| CCM2 | 0.893 | 2.676 |
| CCM3 | 0.883 | 2.53 |
| CCM4 | 0.89 | 2.576 |
| Emotional exhaustion | ||
| EMX1 | 0.779 | 2.248 |
| EMX2 | 0.86 | 4.137 |
| EMX3 | 0.794 | 2.63 |
| EMX5 | 0.817 | 3.049 |
| EMX6 | 0.785 | 2.796 |
| EMX7 | 0.781 | 1.787 |
| EMX8 | 0.707 | 1.765 |
| Exposure to bullying | ||
| EXB1 | 0.902 | 2.247 |
| EXB2 | 0.78 | 1.628 |
| EXB3 | 0.720 | 1.516 |
| EXB4 | 0.776 | 1.642 |
| Job engagement | ||
| JEG1 | 0.749 | 2.336 |
| JEG2 | 0.741 | 2.414 |
| JEG3 | 0.785 | 2.776 |
| JEG4 | 0.781 | 2.409 |
| JEG5 | 0.770 | 2.407 |
| JEG6 | 0.842 | 3.637 |
| JEG7 | 0.789 | 2.495 |
| Turnover intentions | ||
| TOI2 | 0.753 | 1.418 |
| TOI3 | 0.861 | 1.612 |
| TOI1 | 0.824 | 1.489 |
Abbreviations: EMX – emotional exhaustion; EXB – exposure to bullying; JEG – job engagement; TOI – Turnover intention; CCM – Climate for Conflict Management
Structural model path analysis
The structural model was assessed using several criteria, including the coefficient of determination (R²), predictive relevance (Q²), and path coefficients with bootstrapped confidence intervals with results outlined in Table 4. Specifically, R² values indicate that the model accounts for 13.2% of the variance in emotional exhaustion, 13.3% of the variance in job engagement and 10.9% of the variance in turnover intention. This indicates moderate predictive precision in accordance with the study of Cohen [97]. The predictive relevance of the model was evaluated using the Stone-Geisser Q² statistic, which was found to be 0.912 for emotional exhaustion, 0.910 for job engagement, and 0.902 for the case of turnover intentions, further supporting he model’s predictive accuracy. Moreover, bootstrapped path coefficients revealed that exposure to bullying positively and significantly predicts emotional exhaustion (β = 0.292, p < 0.001) and turnover intention (β = 0.209, p < 0.001) supporting hypotheses H1 and H2. In addition, emotional exhaustion positively influences turnover intention (β = 0.153, p = 0.002) supporting hypothesis 3. However, hypotheses 4 and 5 were not supported since engagement was evidenced to have positive but insignificant effect on turnover intentions (β = 0.073, p = 0.122) whereas exposure to bullying was characterized by significant effect but positive on job engagement (β = 0.236, p < 0.001).
Table 4.
Testing direct relationships
| Hypothesis | Relationships | β | S. D. | T statistics | P values | Results |
|---|---|---|---|---|---|---|
| H1 | EXB → EMX | 0.292 | 0.045 | 6.443 | 0.000 | Supported |
| H2 | EMX → TOI | 0.209 | 0.051 | 4.051 | 0.000 | Supported |
| H3 | EXB → TOI | 0.153 | 0.049 | 3.158 | 0.002 | Supported |
| H4 | JEG → TOI | 0.073 | 0.047 | 1.548 | 0.122 | Not supported |
| H5 | EXB → JEG | 0.236 | 0.048 | 4.895 | 0.000 | Not supported |
| R² | R² Adjusted | f² | Q²predict | |||
| EMX | 0.132 | 0.126 | 0.041 | 0.912 | ||
| JE | 0.133 | 0.128 | 0.062 | 0.901 | ||
| TOI | 0.108 | 0.104 | 0.023 | 0.902 |
Abbreviations: EMX – emotional exhaustion; EXB – exposure to bullying; JEG – job engagement; TOI – Turnover intention; CCM – Climate for Conflict Management
Further, Table 5 presents the summary of results concerning the mediating effect of emotional exhaustion and job engagement in the linkage between exposure to bullying and turnover intentions. The results unveil that emotional exhaustion (β = 0.061, t = 3.683, p < 0.000) positively and significantly mediates the connection between exposure to bullying (EXB) and turnover intention indicating that EXB increases EMX, which in turn increases TOI. This thus supports Hypothesis 6. However, the results do not support hypothesis H7, with reason being that though job engagement positively mediates (β = 0.017, p = 0.145), the relationship amid exposure to bullying and turnover intention, the effect is insignificant.
Table 5.
Mediation and moderation path analysis
| Hypothesis | Relationships | β | S. D. | T statistics | P values | Results |
|---|---|---|---|---|---|---|
| Mediation path | ||||||
| H6 | EXB → EMX → TOI | 0.061 | 0.017 | 3.683 | 0.000 | Supported |
| H7 | EXB → JEG → TOI | 0.017 | 0.012 | 1.458 | 0.145 | Not Supported |
| Moderation path | ||||||
| H8 | CCM * EXB→EMX | -0.0604 | 0.0221 | -2.7321 | 0.0065 | Supported |
| H9 | CCM * EXB→JEG | -0.0290 | 0.0225 | -1.2881 | 0.1983 | Not Supported |
Abbreviations: EMX – emotional exhaustion; EXB – exposure to bullying; JEG – job engagement; TOI – Turnover intention, CCM – Climate for Conflict Management
Again, from the moderation path of Table 5, conflict of climate management is evidenced to significantly moderate the nexus of exposure to bullying and emotional exhaustion, with a negative moderating effect (β = -0.0604, p = 0.0065) which supports hypothesis 8. This indicates that higher levels of CCM weaken the positive effect of EXB on EMX. Notably, simple slope analysis in Fig. 2 is executed for descriptive purposes to explore the nature of the interaction. From the mentioned figure, the slope representing low levels of CCM shows a steeper positive relationship between exposure to bullying and turnover intention compared to high levels of CCM, suggesting a potential buffering effect. Contrarily, conflict of climate management does not significantly moderate the nexus between exposure to bullying and job engagement with an estimated coefficient of -0.0290 and a significant value of 0.1983, which is greater than the 5% level of significance. This thus does not support the proposed hypothesis 9. Summarily all the results pertaining to the supported and unsupported hypotheses are outlined in Table 6, whereas the estimated paths (total direct effects) concerning the study’s proposed structural model are illustrated in Fig. 3.
Fig. 2.
The moderating effect of CCM on the nexus between EXB and EMX
Table 6.
Tests of hypotheses
| Hypotheses | Description | Sign and significance | Conclusion |
|---|---|---|---|
| H1 | Exposure to bullying positively influences nurses’ emotional exhaustion | + and significant | Supported |
| H2 | Emotional exhaustion positively impacts turnover intentions. | + and significant | Supported |
| H3 | Exposure to bullying positively influences turnover intentions | + and significant | Supported |
| H4 | Job engagement negatively influences turnover intention | + and insignificant | Not supported |
| H5 | Exposure to bullying negatively affects nurses’ job engagement | + and significant | Not supported |
| H6 | Emotional exhaustion mediates the nexus between exposure to bullying and turnover intentions. | + and significant | Supported |
| H7 | Job engagements mediate the relationship between exposure to bullying and turnover intentions. | + and insignificant | Not Supported |
| H8 | The correlation between emotional exhaustion and exposure to bullying is tempered by CCM, such that a favorable CCM reduces the favorable relationship between bullying exposure and emotional exhaustion. |
 and significant |
Supported |
| H9 | The correlation between exposure to bullying and job engagement is tempered by CCM, such that a favorable CCM reduces the favorable relationship between bullying exposure and job engagement. |
 and insignificant |
Not supported |
Fig. 3.
Structural equation model
Conditional process analysis
To further examine the underlying mechanisms and contextual influences on turnover intention, a conditional process analysis was conducted. Hayes macro PROCESS Model 7 was specifically used to test the moderated on each path of the model (strain and motivation path).This approach allowed for the assessment of moderated mediation by evaluating whether the indirect effect of exposure to bullying on turnover intention via emotional exhaustion or job engagement varied depending on levels of climate for conflict management. The model tested two theoretical pathways: the strain path (EXB → EMX → TOI) and the motivation path (EXB → JEG → TOI), each assessed at low, medium, and high levels of the moderator.
As shown in Table 7, the conditional indirect effect via emotional exhaustion was significant at all levels of CCM. Specifically, at low levels of CCM, the indirect effect was β = 0.0823 with a 95% confidence interval of [0.0397, 0.1320]; at medium levels, the effect was β = 0.0615, 95% CI [0.0320, 0.0952]; and at high levels, the effect was β = 0.0406, 95% CI [0.0162, 0.0697]. The index of moderated mediation for the strain path was statistically significant and negative (β = -0.0149, 95% CI [-0.0320, -0.0014]), indicating that the strength of the indirect effect decreases as CCM increases. This suggests that a stronger climate for conflict management may buffer the emotional exhaustion mechanism linking bullying to turnover intention.
Table 7.
Conditional process analysis
| Probing indirect relationships (Strain Path) | Effect | SE | LLCI | ULCI |
|---|---|---|---|---|
| Low level of CCM | 0.0823 | 0.0236 | 0.0397 | 0.1320 |
| Medium level of CCM | 0.0615 | 0.0160 | 0.0320 | 0.0952 |
| High level of CCM | 0.0406 | 0.0138 | 0.0162 | 0.0697 |
| Index of moderated mediation | -0.0149 | 0.0078 | -0.0320 | -0.0014 |
| Probing indirect relationships (Motivation Path) | Effect | SE | LLCI | ULCI |
| Low level of CCM | 0.0423 | 0.0171 | 0.0146 | 0.0808 |
| Medium level of CCM | 0.0356 | 0.0128 | 0.0138 | 0.0638 |
| High level of CCM | 0.0290 | 0.0116 | 0.0089 | 0.0543 |
| Index of moderated mediation | -0.0048 | 0.0051 | -0.0163 | 0.0032 |
Abbreviations: CCM – Climate for Conflict Management
In contrast, moderation of the motivation path was not statistically supported. The interaction between exposure to bullying and CCM in predicting job engagement was not significant (β = -0.0290, p = 0.1983). However, the indirect effect through job engagement remained significant across all levels of CCM. At low CCM, the effect was β = 0.0423, 95% CI [0.0146, 0.0808]; at medium CCM, β = 0.0356, 95% CI [0.0138, 0.0638]; and at high CCM, β = 0.0290, 95% CI [0.0089, 0.0543]. The index of moderated mediation for this path was not statistically significant (β = -0.0048, 95% CI [-0.0163, 0.0032]), suggesting that CCM does not meaningfully alter the motivational mechanism linking bullying to turnover intention.
Discussion
This research seeks to unveil the interplay between exposure to bullying, emotional exhaustion, job engagement, the climate for conflict management, and turnover intention within the nursing staff of the healthcare system in Ghana. The research attempted to explore the moderating influence of the climate on conflict management as well as the mediating role of emotional exhaustion and job engagement based on the COR and JD-R models. Bullying at work has received less attention in many organizations, leading to many significant employee departures resulting in enormous costs for the organizations [32]. This study uniquely combined the JD-R model and the COR theory, unlike previous studies that have used only the COR theory [44, 59]. It is crucial to highlight that the JD-R Model and COR theory are not mutually exclusive; they can work together to better explain the intricate interplay between job demands, job resources, and employee outcomes. This seeks to answer the call of previous studies, specifically Srivastava and Agarwal [44], who suggested that other organizational antecedents should be explored further as moderators of the association between workplace bullying and turnover intentions. The study’s findings have been detailed in 2 subheadings for easy comprehension and understanding.
Strain path
First and foremost, hypothesis 1 is supported because the study’s empirical results established a positive and substantial association between emotional exhaustion and bullying exposure. The findings align the JD-R model and the COR theory. The JD-R Model states that job demands that involve prolonged physical or psychological effort, such as exposure to bullying, can result in strain and burnout (emotional exhaustion) [36]. According to the COR theory, individuals put a lot of effort into obtaining and protecting important resources since the possibility of losing them can cause stress and burnout [37]. Exposure to bullying which is considered a job demand and a threat to one’s personal resources, such as self-esteem and well-being, can lead to emotional exhaustion. This finding also means that nurses who experience bullying at work are more likely to feel emotionally drained and depleted, which can undermine their psychological wellbeing and the quality of care they provide to patients [98]. Consistent with this finding are the works of Kim, Lee [22] who both reported that continuous exposure to bullying behaviors, such as verbal abuse, intimidation, or social exclusion, can drain nurses’ emotional and psychological resources, leading to a state of emotional exhaustion. Thus, emotionally exhausted nurses may perceive their work as more demanding, leading to an increased desire to leave the organisation or quit the nursing profession (i.e., higher turnover intentions). Exposure to bullying can be considered a job demand and a threat to personal resources, such as self-esteem and well-being, leading to emotional exhaustion. Thus, bullying in the workplace can cause emotional exhaustion, worry, and anxiety, leading individuals to either leave the organization or cope with the burden.
Secondly, the findings validated hypothesis 2 by revealing a positive and significant correlation between emotional exhaustion and turnover intentions. This discovery is in tandem with previous studies conducted by [44, 59]. Negative organizational outcomes, such as turnover intention, can result from job strain and burnout, including emotional exhaustion, according to the JD-R Model [38]. The COR theory proposes that individuals aim to minimize resource loss and seek resource gain; when resources are worn out due to emotional exhaustion, an employee may consider leaving their jobs as a means of resource conservation or acquisition [99]. When nurses experience high emotional exhaustion, they may perceive their emotional resources as critically depleted without adequate replenishment opportunities. This perception of significant resource loss typically leads them to consider leaving their position as a strategic attempt to protect remaining psychological resources. The emotional strain experienced in high-stress healthcare environments creates a resource-draining cycle that, when unmitigated, culminates in heightened turnover intentions as employees seek equilibrium between demands and available resources. This protective response mechanism explains the increased turnover intentions observed among emotionally exhausted nurses, as they instinctively attempt to escape situations perceived as threatening to their well-being and professional efficacy. The continuous expenditure of emotional energy without corresponding resource replenishment creates a psychological deficit that motivates withdrawal behaviors. In healthcare settings specifically, where emotional labor is particularly intense due to patient care responsibilities, resource conservation becomes an essential survival strategy for professionals experiencing burnout symptoms. While the positive link between emotional exhaustion and turnover intention is well-established, several studies highlight factors that can weaken or moderate this relationship. For instance, employees who perceive strong support from colleagues or supervisors, or who work in environments characterized by fairness and justice, report lower emotional exhaustion and are less likely to consider leaving, even when job demands are high [100, 101].
Further, a substantial and positive direct relationship between bullying exposure and turnover intentions was found in this study. As per the JD-R Model, job demands like exposure to bullying can not only lead to strain and burnout but also directly impact organizational outcomes such as turnover intention [81]. Recent research by Sharma and Prasad [102]found that bullying creates excessive psychological demands that can trigger what they term as psychological contract violation, where employees perceive that the implicit agreement of workplace safety and respect has been breached. In practical terms, this manifest when employees experience repeated instances of public humiliation, exclusion from team activities, or having their work sabotaged. For example, when a department head consistently criticizes a nurse’s work in front of colleagues or deliberately excludes them from important meetings, these behaviors can create sustained psychological strain that cannot be effectively managed through typical coping mechanisms. Hoel, Cooper [103] reported that targeted employees reported spending up most of their workday anticipating or recovering from bullying incidents, demonstrating the overwhelming nature of this job demand (bullying). The JD-R Model further explains that when such intense job demands persist without sufficient offsetting resources, employees may initiate a health impairment process that can ultimately lead to withdrawal behaviours, including turnover intentions [104]. Kim, Lee [22] found that clinical nurses experiencing workplace bullying showed higher turnover intentions compared to their non-bullied counterparts, demonstrating the powerful impact of this specific job demand on withdrawal intentions. The COR theory aligns with the findings of this research, which proposes that exposure to bullying can be perceived as a threat to personal resources, such as psychological safety and well-being, leading individuals to consider leaving their job to protect or regain those resources [37]. Workplace bullying represents a significant threat to multiple personal resources, including self-esteem, social connections, sense of control, and professional identity [98]. Practical examples of this resource conservation response can be observed when targeted employees begin updating their résumés immediately after bullying incidents, start networking with contacts outside their organization, or reduce their emotional investment in their current workplace.
Specifically, the strain path of the study provided evidence in support of the JD-R model and COR theory by indicating that emotional exhaustion is a mediator in the connection between exposure to bullying and turnover intention. This strain pathway manifests in observable ways, for instance, when a charge nurse repeatedly criticizes a new nurse’s documentation in front of colleagues, eventually leading to physical symptoms, emotional depletion, and job-seeking behaviours. Similarly, when, for example, a specialized nurse experiences systematic exclusion from decision-making processes, they may initially compensate by working longer hours but ultimately become emotionally withdrawn before reducing work hours and applying for positions elsewhere. These examples illustrate how bullying depletes nurses’ emotional resources, with recent studies showing emotional exhaustion explaining up to 47% of the variance in the relationship between bullying and turnover intentionsn [44]. Conversely, emotional exhaustion is linked to unfavourable outcomes like a greater propensity to leave [105]. The COR hypothesis proposes that people seek to obtain, preserve, and maintain valued resources as a complement to the JD-R paradigm. An individual may get stressed out and run out of resources when they feel their resources are being threatened or lost. In the context of the finding, exposure to bullying is a significant job demand that can lead to emotional exhaustion, a core dimension of burnout. Emotional exhaustion then mediates the nexus between bullying and turnover intention, suggesting that the more emotionally exhausted the nurse feels, the more likely he or she may consider leaving their job. This implies that continuous exposure to bullying can drain nurses’ emotional and psychological resources, leading to a state of emotional exhaustion characterised by feelings of being strained emotionally and exhausted and may lead to a desire to leave the job to protect the resources they have left. Thus, continuous bullying may create a vicious cycle where resource loss fuels emotional exhaustion, pushing nurses toward exit strategies to protect their well-being.
Moreover, hypothesis 8 is supported by the discovery that CCM moderates the nexus between emotional exhaustion and bullying exposure. The moderating effect of CCM indicates that a favourable CCM can weaken the connection between exposure to bullying and emotional exhaustion. This implies that bullying has a less detrimental impact on workers’ emotional exhaustion when an organisation promotes a culture where disagreements are resolved amicably and productively. A supportive CCM can be considered as a job resource that aids employees in managing the demands of bullying and safeguarding their personal resources [35]. Effective conflict resolution mechanisms, open communication channels, and a supportive organizational culture can provide employees with a sense of fairness, control, and psychological safety, which can counteract the resource-depleting effects of bullying. For example, a nurse facing bullying, such as being unfairly criticized by a charge nurse during a shift handover, may experience less emotional exhaustion if the hospital promotes a CCM where conflicts are resolved through facilitated discussions or peer mediation programs. According to the JD-R model, such resources counteract the depleting effects of job demands, reducing burnout [106]. A practical instance is a hospital implementing a safe space forum where nurses can anonymously report bullying incidents, followed by restorative meetings with trained mediators. This can foster a sense of fairness and control, weakening the link between bullying and emotional exhaustion, enabling nurses to better manage workplace stressors while maintaining their emotional resilience. Through the lens of the COR theory, the availability of resources can help individuals better manage and cope with stressful situations and resource threats [95]. In this case, a favourable CCM can provide employees with resources, such as support systems, fairness, and a sense of control, which can help them conserve and replenish personal resources that may be threatened by exposure to bullying. Research by [32, 33] supports this, showing that positive conflict management climates in work settings reduce the psychological impact of bullying by enhancing coping mechanisms.
Lastly, the moderated mediation index was significant and negative. This implies that the indirect impact of bullying exposure on turnover intention due to emotional exhaustion diminishes with increasing CCM. This finding further suggests that when nurses perceive their organization as having effective conflict management approaches, the harmful impact of bullying on emotional well-being and subsequent desire to leave is reduced. This buffering effect aligns with the COR theory, which posits that supportive resources such as a favorable CCM can help individuals better manage stressful situations and resource threats, thereby mitigating the emotional exhaustion and turnover intentions resulting from workplace bullying [82, 107]. For example, in environments where managers actively address conflicts and provide clear resolution procedures, nurses experiencing bullying may feel more supported and less likely to develop the emotional exhaustion that typically drives turnover intentions. However, the persistence of a significant indirect effect, even with high levels of CCM, highlights that while a positive conflict management climate can weaken the negative impact of bullying, it cannot entirely eliminate its detrimental effects. This finding supports the Job Demands-Resources (JD-R) model, which suggests that job resources can buffer the negative effects of job demands like bullying, though they may not completely neutralize them [46, 108]. In practical terms, even organizations with excellent conflict resolution mechanisms may still need additional interventions to fully address bullying, as employees experiencing severe or persistent bullying might still develop emotional exhaustion despite organizational support systems. These findings highlight the importance of comprehensive organizational interventions that not only foster a supportive conflict management climate but also directly address and prevent workplace bullying behaviours to fully mitigate their negative consequences on employee well-being and retention.
Motivation path
Contrary to our study expectation, hypothesis 4 of the study findings revealed an insignificant positive association between job engagement and turnover intentions among nurses in Ghana. The researchers acknowledge that such relationships hardly occur in routine studies; hence, this may be due to other influencing factors out of the study’s control. Further studies may be needed to investigate the reasons accounting for such outcomes.
Strangely, the study results provide new evidence indicating a positive significant association between exposure to bullying and job engagement, which makes hypothesis 5 unsupported. Disengagement from work can result from workplace demands, as per the JD-R Model [38]. Similarly, COR theory posits that exposure to bullying can be perceived as a threat to personal resources, leading individuals to disengage from their work as a means of resource conservation [37]. The possible explanation for the positive effect observed in this study’s findings indicates that nurses may initially respond to exposure to bullying by engaging more in their work rather than disengaging immediately. This counterintuitive reaction can be understood as a coping mechanism or an attempt to regain resources that have been threatened or lost due to the bullying experience. However, in the context of bullying, nurses may initially increase their engagement as a way to counteract the negative effects of bullying, thus challenging the traditional understanding of the model [109]. For instance, when individuals first experience bullying or harassment at work, they may respond by increasing their job engagement to cope with the situation or prove their worth and competence. This heightened engagement could be an attempt to regain a sense of control, self-esteem, or professional identity that the bullying may have threatened. However, it is imperative to note that this increased engagement is likely a temporary coping mechanism or an initial reaction to the bullying experience. If the bullying persists or escalates over time, the prolonged exposure to this job demand and the continued threat to personal resources may eventually lead to disengagement from work, as predicted by the JD-R Model and COR theory. While the findings suggest a potential initial increase in engagement among bullied nurses, it is essential to consider that prolonged exposure to bullying typically leads to negative outcomes, including burnout and turnover intentions [110]. The research of Glasø, Bele [29] and Park and Ono [73] who found a negative significant association between bullying exposure and workplace engagement, contradicts our findings.
Furthermore, this study surprisingly revealed that job engagement does not mediate the nexus between exposure to bullying and turnover intentions. This can possibly be explained by the overwhelming impact of bullying as a threat to personal resources, as posited by the COR theory. Thus, when faced with the substantial resource loss or threat posed by bullying, individuals may prioritize resource conservation and consider leaving the organization as a direct response, overshadowing the potential mediating effect of job engagement. Prolonged exposure to bullying can lead to disengagement, as predicted by the Job Demands-Resources (JD-R) model, complicating the expected mediating effect of job engagement on turnover intentions [40]. Furthermore, the finding that exposure to bullying initially increased job engagement (as a coping mechanism or attempt to regain resources) but likely led to eventual disengagement with prolonged bullying, as predicted by the JD-R model, may further complicate the mediating role of job engagement. Essentially, job engagement’s expected mediation effect in this situation was lessened by the direct impact of bullying on turnover intention and the intricate link between bullying and job engagement. While the findings suggest that job engagement does not mediate the relationship between bullying and turnover intentions, it is essential to consider that some employees may still find ways to engage positively in their work despite adverse conditions. This resilience can vary significantly based on individual circumstances, such as length of service, which may provide a buffer against the negative impacts of bullying [111].
Lastly, the study discovered that CCM did not moderate the link between bullying exposure and job engagement even though negative but statistically insignificant results was found. This suggests that while a better CCM may slightly weaken the bullying–job engagement connection, the effect is not substantial. The implications are multifaceted, that is, there’s a limited buffering effect of CCM practices on bullying’s impact on job engagement. Also, the dynamics between these variables are likely more complex than anticipated; simply improving conflict management climate may not sufficiently protect job engagement from bullying effects; and more targeted interventions might be necessary. This inconclusive finding emphasizes the need for further research to better understand these intricate workplace dynamics and highlights the challenges in addressing bullying’s impact on job engagement. This complexity highlights the need for more targeted interventions that address the multifaceted dynamics between these variables, as the relationship may be influenced by additional factors not captured by CCM alone [112]. Moreover, the complex nature of workplace bullying and its effects on job engagement necessitates further exploration. Research indicates that workplace bullying can lead to severe consequences, including reduced motivation and productivity, as well as mental health issues for victims [32]. Additionally, the role of personal resources, such as workplace attachment styles, can complicate the relationship between bullying and engagement, suggesting that individual differences may play a critical role in how employees respond to bullying [84]. Therefore, while improving CCM is a step in the right direction, a comprehensive approach that includes understanding individual and organizational factors is essential for effectively addressing the impact of bullying on job engagement.
Theoretical implication
The research makes very significant contributions from theoretical standpoints. The results of the study contribute to the corpus of information currently accessible regarding the intention of healthcare workers to resign. The study offers a thorough understanding of the interaction between work demands (exposure to bullying), job resources (a climate for conflict management), and personal resources (emotional exhaustion and job engagement) by drawing on well-established theoretical frameworks like the JD-R model and the COR theory. The findings support the JD-R Model’s proposition that job demands can lead to strain outcomes, such as emotional exhaustion, and negative organizational consequences, like turnover intentions [36].
Additionally, the study sheds light on the COR theory’s applicability in the healthcare setting. The results demonstrate that exposure to bullying represents a significant threat to personal resources, leading to emotional exhaustion and a desire to leave the organization to conserve remaining resources. The study also emphasizes the value of contextual resources in lessening the unfavorable effects of occupational demands on personal resources, such as a supportive environment for dispute resolution. The study adds to an improved comprehension of the complex dynamics impacting nurses’ intents to leave their jobs, emotional exhaustion, and job engagement in the face of workplace bullying by incorporating various theoretical views.
Lastly, this study enhances the theoretical landscape of workplace bullying’s effects on nurses’ turnover intentions by merging the JD-R model with the COR theory, offering new perspectives on employee outcomes in Ghana’s healthcare sector. It establishes bullying as a critical job demand that erodes personal resources, fostering emotional exhaustion and driving turnover intentions, thereby reinforcing the JD-R model’s strain pathway and COR’s focus on resource loss. The unexpected finding that bullying heightens job engagement challenges conventional assumptions as a defensive response expands JD-R theory, resonating with recent studies on temporary coping strategies in stressful workplaces [109]. Additionally, the CCM as a supportive resource reduces the impact of bullying on emotional exhaustion, aligning with current research on organizational buffers [32]. This combined approach addresses the demand for region-specific research in African healthcare and opens avenues for exploring short-term resilience tactics and resource protection in demanding work environments.
Practical implication
This study holds significant practical and context-specific implications for healthcare organizations, particularly in regions facing critical nursing shortages like Ghana. The results highlight the critical necessity for health organizations to put strong rules, evidence-based and procedures in place to address and prevent bullying behaviours within their workforce by illuminating the negative effects of workplace bullying on emotional exhaustion and turnover intentions. The detrimental consequences of bullying on nurses’ emotional health and the likelihood of quitting their positions can be lessened by creating a supportive work environment that values open communication, efficient dispute-resolution techniques, and a culture of respect and support. Culturally adaptive training and workshops are needed to educate all staff about maintaining acceptable and respectful behaviours in the work setting while emphasizing the detrimental effects of bullying on individuals and the organization. Anonymous reporting systems should also be established to allow nurses to voice any issues or concerns they may have safely. Management should cultivate a genuinely supportive culture where nurses feel respected, valued, and comfortable providing feedback without repercussions. Leadership should ensure that their behavior models respect and fairness, as supported by the study’s findings on CCM’s buffering role, can cultivate a culture of psychological safety, encouraging nurses to report issues without fear of retaliation.
Furthermore, the study highlights the importance of investing in comprehensive strategies to manage conflicts within the healthcare setting. By promoting a favorable climate for conflict management, organizations can equip nurses with the necessary resources and support systems to cope with the demands of their profession effectively. This can help alleviate the impact of job demands, such as exposure to bullying, on emotional exhaustion and subsequent turnover intentions. Ultimately, healthcare organizations may improve job satisfaction, encourage staff retention, and guarantee high-quality patient care by prioritizing the well-being of nurses and fostering a supportive work environment. Importantly, these strategies not only enhance nurse retention but also support high-quality patient care by sustaining a motivated workforce.
Limitations and future research
This study offers valuable insights into factors influencing turnover intentions among Ghanaian healthcare workers but is subject to several limitations that affect the interpretation of findings. First, its focus on Ghana’s Northern region limits generalizability to other cultural or geographical contexts, as the region’s unique healthcare and labor dynamics may shape the observed relationships differently elsewhere in Ghana or beyond. Second, reliance on self-report measures introduces potential common method bias, which may inflate associations among variables such as exposure to bullying, emotional exhaustion, and turnover intentions. This bias could particularly affect mediation results (for instance, emotional exhaustion mediating bullying and turnover intentions) and moderation effects (e.g., climate for conflict management’s role), potentially overestimating path coefficients [113]. Future research should incorporate diverse data sources, such as peer or supervisor evaluations and objective performance metrics, to mitigate this bias and validate the strength of these relationships.
Third, the cross-sectional design restricts causal inferences, especially for mediation analyses implying directional effects (e.g., bullying leading to emotional exhaustion and subsequent turnover intentions). This limitation is critical, as temporal precedence cannot be established, potentially misrepresenting the causal pathways [114]. Longitudinal or experimental designs could better establish causality among bullying, emotional exhaustion, job engagement, and turnover intentions. Additionally, the study’s quantitative approach may overlook nuanced experiences of healthcare workers. Qualitative methods, such as interviews, could provide deeper insights into nurses’ perceptions of bullying and conflict management, enriching future investigations.
Conclusion
In conclusion, this study sheds light on the factors influencing turnover intentions among Ghanaian healthcare workers, particularly emphasizing the role of exposure to bullying, climate for conflict management, emotional exhaustion, and job engagement. The findings highlight the detrimental impact of workplace bullying, acting as a significant job demand that threatens personal resources and contributes to emotional exhaustion and increased turnover intentions. Notably, emotional exhaustion mediated the relationship between bullying and turnover intentions, highlighting the strain pathway. Surprisingly, job engagement initially increased as a coping response to bullying but did not mediate the relationship with turnover intentions. Significantly, the climate for conflict management moderated and weakened the effect of bullying on emotional exhaustion, suggesting organizations can mitigate negative consequences by fostering effective conflict resolution mechanisms. While not a panacea, promoting a supportive organizational climate equips nurses with resources to cope with job demands, alleviate emotional exhaustion, and reduce turnover risk. These findings have profound implications for healthcare policies and practices to combat bullying, support nurse well-being, and retain a resilient nursing workforce to deliver quality patient care.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Author contributions
S.A contributed to the conceptualization, investigation, methodology, writing of the original draft, and revising and editing the manuscript. H. C was responsible for funding acquisition, project administration, and supervision. F. A contributed to writing the literature review for the study, as well as reviewing and editing the original manuscript. I.A. M contributed to the methodology, formal analysis, and reviewing and editing the original manuscript. N. Y. N. K and B. S. M contributed to the data curation, software, validation, and visualization of the study results.
Funding
This research was funded by the National Social Science Foundation of China (NSSFC: 24AGL008).
Data availability
The data supporting this study’s findings are available from the corresponding author, upon reasonable request.
Declarations
Ethics approval and consent to participate
The research obtained ethical approval from the Institutional Review Boards and Jiansgu University Medical Ethics at Jiangsu University in Zhenjiang, Jiangsu Province, China. Participation was voluntary, and the initial page provided relevant information about the research and its objectives before commencing the completion of the survey. All participants provided informed consent, and details regarding the study were presented at the beginning of the online questionnaire. Participants expressed their agreement by selecting a designated checkbox, thereby obtaining entry to the survey. Adherence to the principles of anonymity was ensured per the regulations stipulated in Organic Law 3/2018 of December 4th concerning Personal Data Protection and Guarantee of Digital Rights. The study adhered to the ethical standards enshrined in the Helsinki Declaration throughout the process.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Herman’s exploratory factor analysis test, according to Fuller et al. (2016) and Podsakoff et al. (2003), indicates that common method bias is present if the unrotated solution (with all measurement items included) yields one factor that accounts for more than 50% of the variation.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Materials
Data Availability Statement
The data supporting this study’s findings are available from the corresponding author, upon reasonable request.