Linking Work Environment to Turnover Intention: The Mediating Role of Moral Distress Among Emergency Nurses

Background/Objectives: While previous research has explored the effects of moral distress and the work environment separately, there is limited evidence on how these two factors are associated with nurses’ turnover intention. Therefore, in this study, we assessed the mediating role of moral distress in the correlation between nurses’ work environments and turnover intention. Methods: This study employed a multicenter cross-sectional design of emergency nurses from April to June 2025. The Measure of Moral Distress—Healthcare Professionals, Practice Environment Scale of the Nursing Work Index (PES-NWI), and Turnover Intention Scale were used to collect data. The mediating effect was analyzed using Hayes’ PROCESS macro (Model 4, Version 4.2) software with the bootstrap technique (5000 repetitions, 95% bias-corrected confidence interval). Statistical significance was set at a threshold of p < 0.05. Results: Mediation analysis revealed that work environment had a significant negative effect on moral distress (β = −0.251, B = −45.293, 95% CI [−70.376, −20.210], p < 0.001). Moral distress significantly increased nurse turnover (β = 0.202, B = 0.008, 95% CI [0.003, 0.012], p = 0.003), while the work environment had a significant negative direct effect on turnover (β = −0.391, B = −2.629, 95% CI [−3.507, −1.751], p < 0.001). The total effect of work environment on nurse turnover was also significant (β = −0.442, B = −2.970, 95% CI [−3.837, −2.102], p < 0.001). Bootstrapping confirmed a significant indirect effect of moral distress (β = −0.051, 95% CI [−0.092, −0.016]), indicating partial mediation. Conclusions: This study revealed that nurses’ work environment was significantly associated with turnover intention, both directly and indirectly, through moral distress. Moral distress acted as a statistically significant but modest partial mediator of the association between the work environment and turnover intention, suggesting that it may partially explain this relationship. Strategies by healthcare organizations should be organized to optimize proactive work environments and mitigate moral distress among nurses.