Associations Between Stress, Psychological Capital, Well‐Being, Job Burnout, and Turnover Intention Among Chinese Nurses: A National Cross‐Sectional Study

BACKGROUND: The shortage of nurses is a worldwide issue. Turnover intention among nurses plays a critical role in shaping workforce stability and healthcare service quality. The inter-relationships between stress, psychological capital, job burnout, turnover intention, and well-being in nurses have not been fully clarified and warrant further study. AIM: This study aimed to investigate how stress affects turnover intention in Chinese nurses, focusing on the serial mediation of psychological capital and job burnout and the moderation of well-being. METHODS: Using a cross-sectional study design, registered nurses were recruited from 21 hospitals in eastern, central, and western China, with 4865 valid responses collected. Stress, psychological capital, well-being, job burnout, and turnover intention were measured using validated instruments. Associations among the variables were examined using a moderated serial mediation model (PROCESS Model 91), adjusting for demographic and occupational covariates. RESULTS: Stress was positively associated with turnover intention (r = 0.380, p < 0.01) and job burnout (r = 0.568, p < 0.01) but negatively associated with psychological capital (r = -0.374, p < 0.01) and well-being (r = -0.477, p < 0.01). Stress had a significant total effect on turnover intention (c = 0.290, p < 0.001), of which the direct effect (c' = 0.142, p < 0.001) accounted for 48.97% of the total effect. Psychological capital and job burnout significantly mediated this relationship. Specifically, the indirect effect through psychological capital was 0.016, accounting for 5.51% of the total effect, whereas the indirect effect through job burnout was 0.091, accounting for 31.38% of the total effect. Stress affected turnover intention through the serial mediation of psychological capital and job burnout (indirect effect = 0.041, 14.14% of the total effect). Well-being significantly moderated the association between psychological capital and job burnout, with an index of moderated mediation of -0.0008. The serial indirect effect decreased as well-being increased. CONCLUSION: Psychological capital and job burnout represent important mechanisms linking stress to nurses' turnover intention, and well-being moderates the pathway between psychological capital and job burnout. These findings provide evidence for multidimensional interventions to reduce nurses' turnover intention, including strengthening psychological capital assessment, improving occupational well-being, and optimizing workplace support systems. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators should adopt comprehensive strategies addressing stress, psychological capital, well-being, and job burnout to lower nurses' turnover intention and maintain workforce stability.