Patient Safety Culture and Nurses' Turnover Intention: The Serial Mediating Roles of Burnout and Job Satisfaction

Abstract

Aim: To investigate whether patient safety culture is associated with nurses' turnover intention and to examine correlational sequential pathways involving burnout and job satisfaction, drawing on Conservation of Resources theory. Design: A descriptive, correlational design. Methods: This study used data collected during 2023 from a hospital-wide patient safety culture survey conducted in four hospitals in South Korea. The sample comprised 3082 nurses from diverse units. Relationships among patient safety culture, burnout, job satisfaction, and turnover intention were examined using a mediation model within a structural equation modelling framework (WLSMV estimator with probit link), controlling for age and hospital tenure. Results: Patient safety culture was associated with lower burnout and higher job satisfaction. Burnout was associated with lower job satisfaction and with a higher likelihood of turnover intention, whereas job satisfaction was associated with a lower likelihood of turnover intention. When burnout and job satisfaction were considered together, the association between patient safety culture and turnover intention was explained through these two factors rather than by a direct pathway. Conclusion: Patient safety culture functions as an organizational resource that relates to reduced burnout and enhanced job satisfaction, which together relate to lower intention to leave. Implications for the Profession: Strengthening patient safety culture—alongside efforts to reduce strain and foster positive job attitudes—may support nurse well-being and improve retention, thereby supporting continuity and safety of patient care. Impact: This study addresses persistent nurse turnover intention in hospitals and identifies patient safety culture as an organizational lever that operates through reduced burnout and improved job satisfaction. The findings can guide nurse leaders and policymakers in hospitals to implement culture-focused strategies that support staff well-being, enhance retention, and sustain safe patient care. Reporting Method: STROBE guidelines were followed. Patient or Public Contribution: No patient or public contribution.