Abstract
-
Purpose
During the coronavirus disease 2019 (COVID-19) pandemic, anxiety and need satisfaction may predict turnover intention among emergency room nurses, with need satisfaction negatively influencing turnover intention. This study aimed to examine the mediating effect of need satisfaction on the relationship between COVID-19–induced anxiety and job turnover intention among emergency room nurses during the pandemic.
-
Methods
This descriptive cross-sectional study recruited 206 emergency room nurses from 11 hospitals in South Korea. Data were collected using a questionnaire from December 2022 to February 2023.
-
Results
High COVID-19–induced anxiety was associated with increased turnover intention among nurses. Physiological needs partially mediated the relationship between COVID-19–induced anxiety and turnover intention. However, safety and belongingness needs showed no mediating effect.
-
Conclusion
During the COVID-19 pandemic, if physiological needs were not satisfied, reducing anxiety and turnover intention among emergency room nurses proved challenging, even when other needs were met. Therefore, physiological needs should be prioritized and addressed before focusing on other types of needs.
-
Key Words: Anxiety; Intention; Personnel turnover; Physiological need; Safety
INTRODUCTION
The coronavirus disease 2019 (COVID-19) pandemic, which began in late 2019 in China, rapidly spread worldwide. Throughout this prolonged pandemic, ensuring the sustainability of healthcare systems has required a deeper understanding of the challenges faced by healthcare professionals [
1]. The shortage of nursing staff, a longstanding issue, has been exacerbated by the prolonged nature of the pandemic [
2]. Therefore, nurses have experienced an increased risk of excessive workload, potentially leading to resignation [
3]. In 2020, during the COVID-19 pandemic, nurses’ turnover intention increased significantly compared to pre-pandemic levels. One study reported that 33.5% of nurses expressed an intention to leave their current jobs during the pandemic [
4], with particularly elevated turnover intention observed among emergency room nurses [
5]. In public health crises, proactive management of nurses’ turnover intentions is critical for effectively controlling and managing infectious diseases before actual turnover occurs. Recognizing the importance of this issue, the current study aimed to address it.
In this study, we focused on COVID-19–induced anxiety as a factor influencing turnover intention among emergency room nurses during the COVID-19 pandemic. Generally, when an infectious disease spreads, psychological anxiety increases, and economic and social activities are disrupted [
6]. Particularly during the extended spread of COVID-19, nurses have demonstrated high levels of COVID-19–related anxiety [
7,
8]. Emergency room nurses are usually among the first responders to emerging infectious diseases [
4] and often provide direct care to patients without adequate medical information [
9]. Therefore, assessing their anxiety levels during the COVID-19 pandemic is essential. Furthermore, several previous studies have identified anxiety as a crucial predictor of turnover intention during this period [
2,
5]. Anxiety resulting from COVID-19 has made it difficult for healthcare professionals to perform their duties effectively, ultimately increasing their turnover intention [
5]. However, the specific variables significantly increasing turnover intention in relation to anxiety have yet to be empirically researched.
This study focused on physiological, safety, and belongingness needs—based on Maslow’s hierarchy of needs—as potential mediators in the relationship between nurses’ anxiety and turnover intention during the COVID-19 pandemic. According to Maslow’s hierarchy of needs (a pyramid consisting of five ascending levels), physiological needs are most essential, followed by safety, belongingness, esteem, and self-actualization [
10]. As economies develop and survival is relatively secure, the satisfaction of needs higher than physiological ones has become increasingly prioritized [
11]. However, during disaster situations such as the COVID-19 outbreak, healthcare professionals prioritize basic needs, including sufficient food, rest, and safety [
1]. A qualitative study on healthcare professionals’ experiences during the COVID-19 pandemic reported that receiving support from colleagues within healthcare institutions reduced feelings of isolation and contributed to psychological stability [
12]. Thus, outbreaks of emerging infectious diseases highlight the importance of fulfilling physiological, safety, and belongingness needs (hereafter referred to as need satisfaction).
While Maslow’s hierarchy includes esteem and self-actualization, these higher-level needs become secondary during crises when fundamental needs are threatened. Previous studies demonstrated that in disaster situations, individuals prioritize physiological, safety, and belongingness needs over higher-order needs, as survival and security take precedence [
13]. Research involving healthcare professionals during the COVID-19 pandemic similarly indicated that nurses primarily focused on physical well-being, workplace safety, and social support rather than professional growth or self-fulfillment [
14]. Given this theoretical and empirical background, this study focuses explicitly on physiological, safety, and belongingness needs as critical mediators during the pandemic. Need satisfaction can mediate the relationship between anxiety and turnover intention [
15]. Anxiety during the COVID-19 pandemic has been associated with sleep disorders, exhaustion, decreased quality of life, and low social functioning [
4,
16]. Anxiety is also predicted to correlate with need satisfaction [
17]. Additionally, need satisfaction influences job turnover intention [
18]. A study [
3] of healthcare professionals during the COVID-19 pandemic highlighted the importance of managing turnover intention by reducing COVID-19–related anxiety and providing a safe working environment with adequate rest and nutrition. Therefore, a significant relationship exists among COVID-19–induced anxiety, need satisfaction, and turnover intention.
Previous studies have produced meaningful findings regarding the relationship among COVID-19–induced anxiety, need satisfaction, and turnover intention. However, these studies examined the relationships between these variables in a fragmented manner. Therefore, the current study aimed to assess COVID-19–induced anxiety, need satisfaction, and job turnover intention among emergency room nurses during the COVID-19 pandemic and to examine the mediating effects of physiological, safety, and belongingness need satisfaction on the relationship between COVID-19–induced anxiety and turnover intention. The ultimate goal of this study is to mitigate job turnover intention and provide insights for improving nurses’ work environments during infectious disease crises.
The aim of this study was to examine the mediating effect of need satisfaction in the relationship between COVID-19–induced anxiety and turnover intention among emergency room nurses during the COVID-19 pandemic.
METHODS
1. Study Design
This study employed a descriptive cross-sectional design. Participants were emergency room nurses recruited via convenience sampling from 11 hospitals located in Daegu, Gangwon Province, Gyeongbuk Province, and Chungcheong Province in South Korea. Specifically, these 11 hospitals included four tertiary hospitals, six general hospitals, and one hospital-level institution. Geographically, four hospitals were located in Daegu, two in Gangwon Province, three in Gyeongbuk Province, and two in Chungcheong Province. The average number of hospital beds was 731 (±328). This study was conducted and reported in accordance with the STROBE reporting guideline.
2. Study Participants
The inclusion criteria required nurses to be currently working in emergency rooms and to have experienced the COVID-19 pandemic between 2020 and 2021. Nurses hired after 2021 were excluded.
The sample size was determined using G*Power 3.1.9 [
19]. Setting a significance level of .05, a medium effect size of .15, and a statistical power of .95 for multiple regression analysis yielded a required minimum sample size of 184. Considering an anticipated dropout rate of 30%, 240 questionnaires were distributed. A total of 216 responses were collected, but 10 questionnaires with incomplete responses were excluded. Ultimately, 206 valid responses were analyzed.
1) COVID-19–induced anxiety
COVID-19–induced anxiety was assessed using the COVID-19–induced Anxiety Scale (CIAS) [
20]. The CIAS was translated into Korean, and its accuracy was ensured through independent back-translation. The scale comprises 10 items, each rated on a 5-point Likert scale ranging from 1 (“totally disagree”) to 5 (“totally agree”). Total scores range from 10 to 50, with higher scores indicating higher levels of COVID-19–induced anxiety. Cronbach’s alpha coefficient was .78 both in the study of Riad et al. [
20] and in the present study.
2) Need satisfaction
Need satisfaction was measured using the Nurse Needs Satisfaction Scale, based on Maslow’s hierarchy of needs theory [
21]. This scale includes subdomains of physiological needs, safety needs, belongingness needs, esteem needs, and self-actualization needs. For the purposes of this study, only physiological, safety, and belongingness needs were used. The scale consists of 18 items, with each subdomain comprising six items. Each item is rated on a 5-point Likert scale from 1 (“strongly disagree”) to 5 (“strongly agree”). Total scores range from 18 to 90, with higher scores indicating greater satisfaction of nurses’ needs. Cronbach’s alpha coefficients were reported by Kim and Shin [
21] as .80 for physiological needs, .76 for safety needs, .81 for belongingness needs, and .90 overall; in the present study, these values were .83, .81, .86, and .82, respectively.
3) Turnover intention
Turnover intention was measured using the Nurse Turnover Intention Scale (NTIS) [
22]. The NTIS comprises 10 items across three subdomains: job satisfaction (4 items), interpersonal relationships (3 items), and work performance (3 items). Each item is rated on a 5-point Likert scale from 1 (“strongly disagree”) to 5 (“strongly agree”). Total scores range from 10 to 50, with higher scores indicating higher levels of nurse turnover intention. Cronbach’s alpha coefficient was .83 in Yeun and Kim’s study [
22]; in the current study, it was .82.
Prior to using all instruments—the CIAS, the Nurse Needs Satisfaction Scale, and the NTIS—we obtained permission from the original authors via email.
4. Data Collection
We sought permission from the nursing departments of the target hospitals by providing detailed explanations of the study’s purpose and procedures. After obtaining approval, we personally visited emergency rooms to collect data. Throughout the data collection period, cooperation and assistance were provided by the head nurses of the emergency rooms. Data collection occurred from December 22, 2022, to February 3, 2023. Before interacting with participants, researchers completed COVID-19 vaccinations and confirmed negative COVID-19 status using self-diagnostic kits. Proper hand hygiene was maintained, and KF94 masks were consistently worn to minimize the risk of COVID-19 transmission. Participants received comprehensive explanations regarding the study, including its purpose and procedures. Only those who voluntarily agreed to participate were included, and written informed consent was obtained from all participants before conducting the survey.
5. Ethical Considerations
The participants were provided with copies of participant information sheets and informed consent forms, clearly explaining the study’s purpose and procedures. They were informed of their right to withdraw from the study at any time without negative consequences. The participant information sheet outlined potential benefits and risks associated with the research, and participants were assured their survey responses would be used solely for research objectives. Only individuals who fully understood the study and voluntarily signed written informed consent forms participated. The questionnaire collected no personally identifiable information. Completed questionnaires were securely stored, and coded data were protected, ensuring access only by the researchers. After study completion, data will be retained for the legally required storage period and then properly disposed of. This study was approved by the institutional review board of Kyungpook National University (approval No. 2023-0272).
6. Data Analysis
Descriptive statistics (frequency, percentage, mean, and standard deviation) were calculated to analyze demographic characteristics and key variables. Differences in turnover intention according to demographic characteristics were analyzed using the independent sample t-test.
The relationships among COVID-19–induced anxiety, need satisfaction, and turnover intention were explored using Pearson correlation coefficients. To examine the mediating effect of need satisfaction on the relationship between COVID-19–induced anxiety and turnover intention, Hayes’ PROCESS Macro Model 4 was utilized, controlling for variables found significant in univariate analyses. Subsequently, the statistical significance of the mediating effect was tested using the bootstrapping method with 5,000 iterations. Data analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA) and SPSS PROCESS Macro 3.14.
RESULTS
1. Demographic Characteristics and Differences in Turnover Intention According to Demographic Characteristics
The mean age of the participants was 31.13 years. Most participants were female (78.2%), unmarried (69.9%), and held a bachelor’s degree (77.7%). Regarding clinical career length, the mean total work experience was 7.42 years. Univariate analyses indicated that turnover intention significantly differed by educational level (t=−3.27,
p=.001) and career length (t=−2.32,
p=.022) (
Table 1).
The mean score for COVID-19–induced anxiety was 2.36±0.62, while the mean score for need satisfaction was 2.95±0.48. Among the subdimensions of need satisfaction, belongingness needs scored the highest (3.80±0.63), followed by safety needs (2.85±0.69) and physiological needs (2.21±0.80). The mean turnover intention score was 3.91±0.62 (
Table 2).
COVID-19–induced anxiety exhibited significant negative correlations with physiological need (r=−.22,
p=.036) and belongingness need (r=−.17,
p=.028), subdimensions of need satisfaction. However, COVID-19–induced anxiety was not significantly correlated with safety need. COVID-19–induced anxiety demonstrated a significant positive correlation with turnover intention (r=.18,
p=.031). Regarding relationships between turnover intention and need satisfaction subdimensions, turnover intention significantly negatively correlated with physiological need (r=−.40,
p<.001) and safety need (r=−.24,
p=.001). No statistically significant correlation was found between turnover intention and belongingness need (
Table 3).
Table 4 presents the mediating effects of need satisfaction on the relationship between COVID-19–induced anxiety and turnover intention. In analyzing the mediation effects, educational level and clinical career length—significant in the univariate analyses—were controlled. In Step 1, COVID-19–induced anxiety showed a significant negative relationship with physiological need satisfaction (β=−.22,
p<.001). COVID-19–induced anxiety was not significantly related to safety needs (
p=.884) or belongingness needs (
p=.166). In Step 2, COVID-19–induced anxiety demonstrated a positive association with turnover intention (β=.18,
p=.010).
When all subdimensions of need satisfaction were simultaneously included in the model (Step 3), physiological needs exhibited a significant negative relationship with turnover intention (β=−.34, p<.001). Additionally, COVID-19-induced anxiety retained a significant positive relationship with turnover intention (β=.14, p=.043). Furthermore, the relationship between safety needs and turnover intention was also significant (β=−.20, p=.004). Considering the significant relationship between COVID-19–induced anxiety and physiological needs identified in Step 1 and the outcomes of Steps 2 and 3, physiological need satisfaction was found to partially mediate the relationship between COVID-19–induced anxiety and turnover intention.
To confirm the partial mediation effect of physiological need satisfaction between COVID-19–induced anxiety and turnover intention, a bootstrap test was performed.
Table 5 presents the bootstrap results and mediation effects. The mediating effect of need satisfaction on the relationship between COVID-19–induced anxiety and turnover intention was assessed via bootstrap analysis. For physiological needs, which played a statistically significant role as a mediator, values are presented for total effects (effect=.08, 95% CI=.02–.15), indirect effects (effect=.03, 95% CI=.01–.06), and direct effects (effect=.05, 95% CI=.01–.09). For safety and belongingness needs—which were not statistically significant—only total effects are presented to clearly highlight significant mediation paths. The mediating effect of physiological need satisfaction was statistically significant (effect=.08, Boot 95% CI=.02–.15). Thus, physiological need satisfaction serves as a partial mediator in the relationship between COVID-19–induced anxiety and turnover intention (
Figure 1).
DISCUSSION
This study aimed to examine the mediating effect of need satisfaction on the relationship between COVID-19–induced anxiety and turnover intention among emergency room nurses who experienced the COVID-19 pandemic. Our findings indicated that physiological need satisfaction among emergency room nurses partially mediated the relationship between COVID-19–induced anxiety and turnover intention. This result suggests that while anxiety induced by COVID-19 can directly increase nurses’ turnover intention, adequately meeting nurse’ physiological needs can indirectly mitigate this effect. Therefore, to reduce nurses’ turnover intention during the COVID-19 pandemic, health organizations should not only help nurses manage their anxiety but also actively support the satisfaction of their physiological needs.
Emergency room nurses were particularly vulnerable to unmet physiological needs due to the nature of their work during the pandemic [
23]. They managed a continuous influx of high-acuity patients, necessitating constant attention and rapid clinical decisions [
24]. Additionally, they performed physically demanding tasks such as cardiopulmonary resuscitation, along with COVID-19–related responsibilities, significantly intensifying their workload. The prolonged use of heavy personal protective equipment (PPE), including coveralls, face shields, and N95 or KF94 masks, severely limited their ability to take breaks, use restrooms, breathe fresh air, or maintain adequate hydration. Consequently, their basic physiological needs often went unmet.
This demanding environment likely contributed to the increased turnover intention observed in our study. The mean turnover intention score among emergency room nurses was higher than the integrated turnover intention score (3.28 points) reported for hospital nurses in a systematic review conducted in South Korea [
25]. The heightened workload, combined with unmet physiological needs, likely exacerbated nurses’ intentions to leave their jobs [
26]. To address these challenges, practical and targeted institutional measures should be implemented. These measures could include increasing staffing levels, optimizing shift scheduling, and providing nurses sufficient time and designated spaces to meet their essential physiological needs, even under pandemic conditions.
Safety and belongingness needs did not serve as mediators in this study. Thus, providing a safe working environment and enhancing organizational belongingness alone may be insufficient strategies to mitigate COVID-19–induced anxiety and turnover intention. In other words, during the COVID-19 pandemic, if physiological needs remain unsatisfied, lowering anxiety and turnover intention among emergency room nurses may be difficult, even if other needs are met. Typically, as economic conditions improve and survival becomes more assured, attention shifts toward higher-level rather than lower-level needs, based on Maslow’s hierarchy of needs [
11]. However, during disaster periods such as the COVID-19 pandemic, physiological needs—essential for survival—are emphasized. One study reported that healthcare professionals prioritized satisfying basic needs, including sufficient food intake, rest, and safety, during the COVID-19 outbreak [
1], aligning with our findings.
Although safety need satisfaction did not mediate the relationship between COVID-19–induced anxiety and turnover intention, it directly influenced turnover intention. Previous studies similarly indicated that job security significantly influences turnover intention among hospital nurses [
27,
28]. To reduce turnover intention among emergency room nurses, hospital administrations should ensure sufficient provision of PPE, offer appropriate support in cases of infection, and establish reasonable compensation systems for nurses’ work.
Moreover, this study revealed that COVID-19–induced anxiety had a significant positive correlation with turnover intention. This result aligns with multiple previous studies demonstrating higher turnover intention among healthcare professionals experiencing elevated COVID-19–induced anxiety [
2,
5,
29,
30]. Therefore, during infectious disease crises, in-depth assessments should be conducted to identify anxiety levels and their underlying causes among emergency room nurses. Additionally, anxiety management programs should be implemented effectively, and therapeutic interventions should be provided when necessary.
The relationships between COVID-19–induced anxiety and subdimensions of need satisfaction observed in this study are summarized as follows. COVID-19–induced anxiety had a significant negative impact on physiological need satisfaction. Anxiety has been significantly linked to sleep disorders among nurses caring for COVID-19 patients [
16], and higher anxiety levels correlate with increased physical and emotional fatigue [
3]. Thus, a close relationship between COVID-19–induced anxiety and physiological need satisfaction exists. However, COVID-19–induced anxiety showed no significant effect on safety need satisfaction. This finding might relate to our study participants reporting receiving adequate institutional support for events such as infections or medical accidents, which may have fulfilled their safety needs to some extent. Given the current scarcity of research examining the relationship between COVID-19–induced anxiety and safety needs, further studies on this topic are warranted. Furthermore, COVID-19-induced anxiety demonstrated a significant negative correlation with belongingness need satisfaction. Anxiety induced by COVID-19 can negatively influence organizational socialization and relationship-building through emotional exhaustion [
31], partially aligning with the current study’s findings.
Physiological and safety need satisfaction demonstrated significant negative correlations with turnover intention. This result is consistent with previous studies [
18], which reported that satisfying nurses’ physiological and safety needs can reduce their turnover intention. However, belongingness need satisfaction did not emerge as a predictor of turnover intention in our study. This finding is inconsistent with results from a study by Kim and Shin [
21], which identified belongingness need as significantly related to turnover intention. Given the limited research examining the relationship between belongingness needs and turnover intention during the COVID-19 pandemic, further investigation is necessary to confirm whether nurses’ belongingness needs directly influence turnover intention during infectious disease crises.
In this study, COVID-19–induced anxiety was relatively low overall. Specifically, 83% of respondents answered “strongly disagree” or “disagree” to the statement, “I am afraid to die if I get infected by COVID-19.” This study was conducted approximately two years after the onset of COVID-19, a period marked by high vaccination rates and increased availability of effective treatments. Consequently, the participants’ anxiety levels regarding COVID-19 likely decreased compared to the early stages of the outbreak. However, 42.2% of participants indicated moderate or higher anxiety levels in response to the statement, "When I or any family member go outside home during this COVID-19 outbreak, I feel anxious." Although the overall level of COVID-19–induced anxiety was not severe, a significant proportion of participants still experienced anxiety related to COVID-19 in their daily lives.
In the present study, physiological and safety need satisfaction were moderate to low, whereas belongingness need satisfaction was above average. A previous study investigating nurses’ experiences while caring for COVID-19 patients [
32] reported problems such as skin rashes caused by non-ventilated protective clothing, difficulties with urination and defecation, and reduced food and water intake. Additionally, a substantial proportion of nurses reported dissatisfaction regarding compensation and welfare benefits. These unfavorable working conditions might have contributed to the lower satisfaction scores for physiological and safety needs observed in this study. Meanwhile, belongingness needs received the highest satisfaction scores among the subdomains. This finding aligns with previous research [
32], wherein nurses caring for COVID-19 patients expressed experiencing a heightened sense of camaraderie and solidarity with colleagues, surpassing prior experiences.
The results of this study may have limited generalizability, as participants were recruited via convenience sampling from specific regions in South Korea, namely Daegu, Gangwon-do, Gyeongsangbuk-do, and Chungcheongbuk-do. Future research should strive to enhance sample representativeness to ensure broader applicability of findings. Moreover, the cross-sectional survey design used in this study limits the ability to establish clear causal relationships between nurses’ turnover intention and the examined variables. Thus, future research employing a longitudinal approach to measure key variables at multiple time points according to the evolving COVID-19 situation is recommended.
Despite these limitations, the present study is significant as it empirically examined the relationships among COVID-19–induced anxiety, turnover intention, and need satisfaction, specifically incorporating need satisfaction as a mediating variable. The focus on emergency room nurses during the COVID-19 pandemic adds valuable insights into the interconnected pathways and relationships among these important variables.
CONCLUSION
This descriptive survey study investigated the mediating effect of need satisfaction on the relationship between COVID-19–induced anxiety and turnover intention among emergency room nurses employed during the COVID-19 pandemic. Results indicated that emergency room nurses’ physiological need satisfaction significantly mediated the relationship between COVID-19–induced anxiety and turnover intention. Therefore, health organizations should not only assist nurses in managing anxiety to reduce turnover intention but, more importantly, develop strategies to effectively satisfy their physiological needs. These findings underscore the importance of exploring practical measures that can substantially increase nurses’ ability to satisfy patients’ fundamental physiological needs.
-
CONFLICTS OF INTEREST
Myung Kyung Lee, a contributing editor of the Korean Journal of Adult Nursing, was not involved in the editorial evaluation or the decision to publish this article. The other author has declared no conflicts of interest.
-
AUTHORSHIP
Study conception and/or design acquisition, analysis, or interpretation of the data, and drafting or critical revision of the manuscript for important intellectual content - YS and MKL.
-
FUNDING
None.
-
ACKNOWLEDGEMENT
This article is a revision of the first author's master’s thesis from Kyungpook National University.
-
DATA AVAILABILITY STATEMENT
The data can be obtained from the corresponding authors.
Figure 1.Partial mediating effect of physiological need satisfaction in the relationship between coronavirus disease 2019 (COVID-19)–induced anxiety and turnover intention.
Table 1.Demographic Characteristics and Differences in Turnover Intention According to Demographic Characteristics (N=206)
|
Variables |
Categories |
n (%) |
M±SD |
t (p) |
|
Age (year) |
|
|
31.13±6.67 |
|
|
<30 |
117 (56.8) |
37.46±9.10 |
|
|
≥30 |
89 (43.2) |
39.56±6.40 |
0.73 (.464) |
|
Sex |
Male |
45 (21.8) |
36.60±6.64 |
|
|
Female |
161 (78.2) |
38.83±8.43 |
–1.64 (.103) |
|
Marital status |
Married |
62 (30.1) |
39.29±6.61 |
|
|
Single |
144 (69.9) |
37.96±8.66 |
1.08 (.279) |
|
Educational level |
Diploma |
46 (22.3) |
35.14±12.82 |
|
|
≥Bachelor |
160 (77.7) |
39.35±5.66 |
–3.27 (.001) |
|
Clinical career length (year) |
< 5 |
91 (44.2) |
36.88±9.96 |
|
|
≥ 5 |
115 (55.8) |
39.47±6.20 |
–2.32 (.022) |
Table 2.Descriptive Findings for Key Variables (N=206)
|
Variables |
Range |
M±SD |
|
COVID-19–induced anxiety |
1–5 |
2.36±0.62 |
|
Need satisfaction |
1–5 |
2.95±0.48 |
|
Physiological needs |
1–5 |
2.21±0.80 |
|
Safety needs |
1–5 |
2.85±0.69 |
|
Belongingness needs |
1–5 |
3.80±0.63 |
|
Turnover intention |
1–5 |
3.91±0.62 |
Table 3.Correlations between COVID-19–Induced Anxiety, Need Satisfaction, and Turnover Intention (N=206)
|
Variables |
COVID-19–induced anxiety |
Need satisfaction |
Turnover intention |
|
Physiological needs |
Safety needs |
Belongingness needs |
|
COVID-19–induced anxiety |
1 |
|
|
|
|
|
Need satisfaction |
|
|
|
|
|
|
Physiological needs |
−.22 (.036) |
1 |
|
|
|
|
Safety needs |
.01 (.884) |
.22 (.001) |
1 |
|
|
|
Belongingness needs |
−.17 (.028) |
.06 (.434) |
.34 (<.001) |
1 |
|
|
Turnover intention |
.18 (.031) |
−.40 (<.001) |
−.24 (.001) |
−.01 (.864) |
1 |
Table 4.Mediating Effect of Need Satisfaction in the Relationship between COVID-19–Induced Anxiety and Turnover Intention (N=206)
|
Variables |
B |
β |
t |
p
|
|
Step 1.COVID-19–induced anxiety → mediation variable |
|
|
|
|
|
COVID-19–induced anxiety → physiological need satisfaction†
|
−0.17 |
−.22 |
−3.18 |
<.001 |
|
COVID-19–induced anxiety → safety need satisfaction†
|
0.01 |
.01 |
0.15 |
.884 |
|
COVID-19–induced anxiety → belongingness need satisfaction†
|
−0.02 |
−.10 |
−1.67 |
.166 |
|
Step 2. COVID-19–induced anxiety → turnover intention†
|
0.18 |
.18 |
2.61 |
.010 |
|
Step 3. COVID-19–induced anxiety, physiological need satisfaction, safety need satisfaction, belongingness need satisfaction → turnover intention†
|
|
|
|
|
|
COVID-19–induced anxiety → turnover intention |
0.13 |
.14 |
2.20 |
.043 |
|
Physiological need satisfaction → turnover intention |
−0.43 |
−.34 |
−5.05 |
<.001 |
|
Safety need satisfaction → turnover intention |
−0.30 |
−.20 |
−2.94 |
.004 |
|
Belongingness need satisfaction → turnover intention |
0.16 |
.10 |
1.44 |
.152 |
Table 5.Effects for Mediator Models (N=206)
|
Mediating path |
Effect |
SE |
95% BC CI |
|
Mediation variable: Physiological need satisfaction |
|
|
|
|
Total effect of COVID-19–induced anxiety → turnover intention |
.08 |
0.01 |
.02 to .15 |
|
Direct effect of COVID-19–induced anxiety → turnover intention |
.05 |
0.02 |
.01 to .09 |
|
Indirect effect via physiological need satisfaction |
.03 |
0.07 |
.01 to .06 |
|
Mediation variable: Safety needs |
|
|
|
|
Total effect of COVID-19–induced anxiety → safety need satisfaction → turnover intention |
−.00†
|
0.02 |
−.04 to .03 |
|
Mediation variable: Belongingness needs |
|
|
|
|
Total effect of COVID-19–induced anxiety → belongingness need satisfaction → turnover intention |
−.02 |
0.02 |
−.06 to .01 |
REFERENCES
- 1. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020;368:m1211. https://doi.org/10.1136/bmj.m1211
- 2. Falatah R. The impact of the coronavirus disease (COVID-19) pandemic on nurses' turnover intention: an integrative review. Nurs Rep. 2021;11(4):787-810. https://doi.org/10.3390/nursrep11040075
- 3. Tolksdorf KH, Tischler U, Heinrichs K. Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review. BMC Nurs. 2022;21(1):174. https://doi.org/10.1186/s12912-022-00949-4
- 4. Bingol U, Bilgin N, Cetinkaya A, Kutlu A. Variables that predict nurses' job stress and intention to leave during the COVID-19 pandemic in Turkey. J Adv Nurs. 2025;81(2):878-86. https://doi.org/10.1111/jan.16287
- 5. Tabur A, Elkefi S, Emhan A, Mengenci C, Bez Y, Asan O. Anxiety, burnout and depression, psychological well-being as predictor of healthcare professionals’ turnover during the COVID-19 pandemic: study in a pandemic hospital. Healthcare (Basel). 2022;10(3):525. https://doi.org/10.3390/healthcare10030525
- 6. Brenner MH, Bhugra D. Acceleration of anxiety, depression, and suicide: secondary effects of economic disruption related to COVID-19. Front Psychiatry. 2020;11:592467. https://doi.org/10.3389/fpsyt.2020.592467
- 7. Cho KH, Kim B. The psychological responses of nurses caring for COVID-19 patients: a Q methodological approach. Int J Environ Res Public Health. 2021;18(7):3605. https://doi.org/10.3390/ijerph18073605
- 8. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic: a review. Asian J Psychiatr. 2020;51:102119. https://doi.org/10.1016/j.ajp.2020.102119
- 9. Kim SO, Kim KH. Factors influencing emergency nurses' infection control practices related to coronavirus disease 2019 in Korea. Australas Emerg Care. 2023;26(1):30-5. https://doi.org/10.1016/j.auec.2022.07.004
- 10. Pardee RL. Motivation theories of Maslow, Herzberg, McGregor & McClelland. A literature review of selected theories dealing with job satisfaction and motivation Washington, DC: Education Resources Information Center. United States of America; 1990 [cited 2025 April 9]. Available from: https://coilink.org/20.500.12592/l1pdg9f
- 11. Inglehart R. Modernization and postmodernization: cultural, economic, and political change in 43 societies. Princeton, NJ: Princeton University Press; 1997.
- 12. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790-8. https://doi.org/10.1016/S2214-109X(20)30204-7
- 13. Donahue DA, Cunnion SO, Balaban CD, Sochats K. The all needs approach to emergency response. Homel Secur Aff. 2012;8(1):1-17.
- 14. Suh J, Horvitz E, White RW, Althoff T. Population-scale study of human needs during the COVID-19 pandemic: analysis and implications. Paper presented at: Proceedings of the 14th ACM International Conference on Web Search and Data Mining; 2021 March 8-12; Virtual event.
- 15. Boudrias V, Trepanier SG, Foucreault A, Peterson C, Fernet C. Investigating the role of psychological need satisfaction as a moderator in the relationship between job demands and turnover intention among nurses. Employee Relat. 2020;42(1):213-31. https://doi.org/10.1108/ER-10-2018-0277
- 16. Al Maqbali M. Sleep disturbance among frontline nurses during the COVID-19 pandemic. Sleep Biol Rhythms. 2021;19(4):467-73. https://doi.org/10.1007/s41105-021-00337-6
- 17. Schwinger M, Trautner M, Karchner H, Otterpohl N. Psychological impact of corona lockdown in Germany: changes in need satisfaction, well-being, anxiety, and depression. Int J Environ Res Public Health. 2020;17(23):9083. https://doi.org/10.3390/ijerph17239083
- 18. Chen X, Ran L, Zhang Y, Yang J, Yao H, Zhu S, et al. Moderating role of job satisfaction on turnover intention and burnout among workers in primary care institutions: a cross-sectional study. BMC Public Health. 2019;19(1):1526. https://doi.org/10.1186/s12889-019-7894-7
- 19. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60. https://doi.org/10.3758/BRM.41.4.1149
- 20. Riad A, Huang Y, Zheng L, Elavsky S. The associations of COVID-19 induced anxiety, related knowledge and protective behavior. Health Psychol Res. 2021;9(1):24768.
- 21. Kim HJ, Shin SH. Development and validation of the nurse needs satisfaction scale based on Maslow's hierarchy of needs theory. J Korean Acad Nurs. 2020;50(6):848-62. https://doi.org/10.4040/jkan.20195
- 22. Yeun EJ, Kim H. Development and testing of a nurse turnover intention scale (NTIS). J Korean Acad Nurs. 2013;43(2):256-66. https://doi.org/10.4040/jkan.2013.43.2.256
- 23. Gonzalez-Gil MT, Gonzalez-Blazquez C, Parro-Moreno AI, Pedraz-Marcos A, Palmar-Santos A, Otero-Garcia L, et al. Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services. Intensive Crit Care Nurs. 2021;62:102966. https://doi.org/10.1016/j.iccn.2020.102966
- 24. Benjamin E. Innovations in emergency nursing: adapting patient flow management to emergency department overcrowding. J Emerg Nurs. 2025;51(2):261-8. https://doi.org/10.1016/j.jen.2024.10.002
- 25. Lee Y, Kang J. Related factors of turnover intention among Korean hospital nurses: a systematic review and meta-analysis. Korean J Adult Nurs. 2018;30(1):1-17. https://doi.org/10.7475/KJAN.2018.30.1.1
- 26. Xu S, Yang Q, Xie M, Wang J, Shan A, Shi F. Work experience of triage nurses in emergency departments during the prevalence of COVID-19. Int Emerg Nurs. 2021;56:101003. https://doi.org/10.1016/j.ienj.2021.101003
- 27. Sokhanvar M, Kakemam E, Chegini Z, Sarbakhsh P. Hospital nurses' job security and turnover intention and factors contributing to their turnover intention: a cross-sectional study. Nurs Midwifery Stud. 2018;7(3):133-40. https://doi.org/10.4103/nms.nms_2_17
- 28. Laine M, van der Heijden BI, Wickström G, Hasselhorn HM, Tackenberg P. Job insecurity and intent to leave the nursing profession in Europe. Int J Hum Resour Manag. 2009;20(2):420-38. https://doi.org/10.1080/09585190802673486
- 29. Kokubun K, Ino Y, Ishimura K. Social and psychological resources moderate the relation between anxiety, fatigue, compliance and turnover intention during the COVID-19 pandemic. Int J Workplace Health Manag. 2022;15(3):262-86. https://doi.org/10.1108/IJWHM-07-2021-0142
- 30. Modaresnezhad M, Andrews MC, Mesmer-Magnus J, Viswesvaran C, Deshpande S. Anxiety, job satisfaction, supervisor support and turnover intentions of mid-career nurses: a structural equation model analysis. J Nurs Manag. 2021;29(5):931-42. https://doi.org/10.1111/jonm.13229
- 31. Ungureanu P, Bertolotti F. Backing up emergency teams in healthcare and law enforcement organizations: strategies to socialize newcomers in the time of COVID-19. In: Wardman JK, Lofstedt R, editors. COVID-19: confronting a new world risk. Oxford: Routledge; 2022. p. 56-69.
- 32. Lee H, Lee SE, Sang S, Morse B. The lived experience of nurses who volunteered to combat the COVID-19 pandemic in South Korea: a qualitative phenomenological study. J Nurs Manag. 2022;30(4):864-71. https://doi.org/10.1111/jonm.13571
E-SUBMISSION
