Impact of workplace violence against Korean nurses on turnover intention before and during the COVID-19

Abstract

Workplace violence (WPV) is a severe threat to nursing retention globally. In particular, Korean nurses might experience WPV at a rate of over 40%, which is a predictor of turnover intention. The outbreak of the coronavirus disease 2019 (COVID-19) pandemic exacerbated WPV and turnover intention among nurses. The relationship between WPV and turnover intention has been widely demonstrated; however, its mechanism, a plausible, systematic explanation of the process engendering this relationship, remains unclear. In this thesis, I aim to add novel knowledge about WPV among Korean nurses including an evaluation of its prevalence and perception, its associated factors, and the underlying mechanism linking WPV and turnover intention before and during the pandemic. A two-wave cross-sectional online survey of 319 and 325 eligible Korean nurses was conducted before (January–February 2020) and during COVID-19 (August–October 2021), respectively. To ensure the reliability and validity of the Korean measurements, I translated and validated the Korean Trivialization of Workplace Violence Scale, the shortened version of the Perception of Aggression Scale, the abbreviated version of the Coping Orientation to Problems Experienced inventory, and the Anticipated Turnover Scale. I used structured multiphase regression analysis to identify the associated factors and conducted moderated mediation analyses to examine the roles of potential mediators and moderators in the relationship between WPV and turnover intention. Before the pandemic, more prevalent and more trivialized WPV, were significantly and commonly associated with a higher educational level (OR = 0.45, 95% CI: 0.22–0.93; unstandardized coefficient = -0.76, 95% CI -1.47 to -0.06), a history of psychiatric consultation (24.59, 95% CI: 3.09–195.39; 3.32, 95% CI: 2.07–4.56), a shorter employment duration (0.87, 95% CI: 0.77–0.98; -0.12, 95% CI: -0.20 to -0.05), absence of encouragement to report WPV (2.37, 95% CI: 1.35–4.16; 1.17, 95% CI: 0.69–1.64), and more stress symptoms (1.25, 95% CI: 1.17–1.34; 0.09, 95% CI: 0.00–0.18). During the pandemic, more prevalent and more trivialized WPV were significantly and commonly associated with a history of psychiatric consultation (3.94, 95% CI: 1.71–9.10; 1.56, 95% CI: 0.87–2.25), a shorter employment duration (0.86, 95% CI: 0.76–0.97; -0.12, 95% CI: -0.17 to -0.06), and more depressive symptoms (1.13, 95% CI: 1.08–1.19; 0.13, 95% CI: 0.10–0.15). The moderated mediation analysis showed that the experience of WPV and/or caring for patients with COVID-19 did not moderate the mediation of psychological distress in the relationship between the perception of WPV and turnover intention before (0.17, 95% CI: -0.20–0.56) and during the pandemic (0.14, 95% CI: -0.06–0.41). A further moderated mediation investigating the impact of the pandemic on the relationship between the experience of WPV and turnover intention indicated that caring for patients with COVID-19 did moderate the mediation of psychological distress in this relationship (3.45, 95% CI: 1.44–5.55). This study underscores the importance of offering and/or modifying psychological support services for Korean nurses. Moreover, developing future studies and interventions to provide tailored psychological support to front-line and non-front-line nurses is necessary to promote nursing retention.