Nurses’ intention to resign and avoidance of emergency department violence: A moderated mediation model

Abstract Background Studies that examined the negative impact of violence in emergency departments on nurses' leave and avoidance behavior are well-documented. However, few studies provided an integrated model of how and when violence influences their leave and avoidance behavior. Purpose The study adopted Affective Events Theory to propose and examine a model of violent events, negative emotions, and (leave and avoidance) behaviors on nurses in emergency departments and further analyzed whether the model is salient to nurses' occupational burnout, nursing experience, and nursing rank. Method The sample included 123 emergency department nurses at a teaching hospital in northern, Taiwan. Results All participants had experienced violent incidents within the preceding 6 months. Moderated mediation analysis suggested that nurses experienced one of two emotional processes following violent incidents: "violence-negative feelings toward work-intention to resign" or "violence-negative emotion and physical symptoms-avoidance tendencies." Moreover, nurses with high burnout levels expressed weaker intention to resign after violent incidents, while nurses with more experience and higher rank were less likely to avoid violence after violent incidents. Conclusion Emergency nurses do not simply elect to escape but may engage in avoidance behavior. This study revealed that how violent incidents affect nurses' resignation or avoidance behaviors depends on how they feel. Occupational burnout and nurses' attributes affected their behavior.