Effects of Workplace Violence on Emergency Nurses’ Health: A Mediating and Moderating Role of Occupational Stress and the Work Environment

Abstract

Background: Emergency nurses are at the highest risk of experiencing workplace violence, which can negatively impact their physical and psychological health. However, the mechanisms by which workplace violence affects nurses’ health remain unclear. Therefore, further exploration of potential moderating factors is required to understand the impact of workplace violence on nurses’ health. Objectives: This study applied the effort–reward imbalance (ERI) model to investigate the mediating role of occupational stress in the relationship between workplace violence and health among emergency nurses, with the work environment serving as a moderating factor. Design: A cross-sectional study was conducted. Setting and participants: A questionnaire survey was administered to 1,540 emergency nurses from 30 tertiary hospitals in China between December 26, 2023, and January 18, 2024. Methods: An online questionnaire was used to obtain demographic information, along with data concerning workplace violence, work environment, occupational stress, and somatic symptoms. Latent moderate structural equations were employed to analyze the moderated mediation model, and the bootstrap method was used to test for mediating effects. Results: The path coefficient from workplace violence to occupational stress was significant (β = 0.526, P < 0.01), as was the coefficient from occupational stress to somatic symptom (β = 0.655, P < 0.01). Additionally, the direct effect of workplace violence on somatic symptoms was significant (β = 0.090, P < 0.01), with the mediating effect of occupational stress estimated at 0.433 (95% confidence interval [CI]: 0.374–0.493). The mediating effect of occupational stress on the relationship between workplace violence and somatic symptoms accounted for 79.2% of the total effect, indicating a significant mediation. Finally, the work environment moderated the impact of workplace violence on occupational stress (β = 0.063, P < 0.01). Conclusions: A moderated mediation model was developed, with occupational stress mediating the impact of workplace violence on the health of emergency nurses. The findings suggest the need for other measures to reduce the impact of workplace violence on emergency nurses’ health, as well as interventions to reduce occupational stress. The combined effects of the work environment and occupational stress emphasize the need for comprehensive interventions to create a supportive workplace for nurses, thereby reducing the fit between emergency nurses and a poor working environment.