Effects of Emergency Nurses’ Experiences of Violence, Resilience, and Nursing Work Environment on Turnover Intention: A Cross-Sectional Survey

Published:December 31, 2022DOI:



      Emergency nurses are vulnerable to violence, because they closely face patients or caregivers in emergency situations, where tension and conflicts are heightened. This is known to increase their turnover intentions. This study aimed to analyze the effects of emergency nurses’ experiences of violence, resilience, and nursing work environment on turnover intentions.


      This descriptive study analyzed a questionnaire administered to emergency nurses from March 2020 to April 2020. Its participants included 100 emergency nurses from 4 emergency medical centers. The collected data were analyzed using the SPSS/WIN 25.0 program (IBM SPSS Statistics) by frequency, percentage, mean, SD, t test, analysis of variance, and multiple regression


      The main factors affecting the turnover intentions of emergency nurses were resilience (β = −0.32, P = .003), frequency of violence by patients (β = 0.27, P = .003), and nursing managers’ leadership and support for nurses (β = −0.25, P = .021). The explanatory power of these 3 variables was 29.3%.


      To reduce emergency nurses’ turnover intentions, it may be necessary to conduct resilience programs for them. In addition, safety measures to prevent violence at the organizational level and improve nursing managers’ abilities, leadership, and support for nurses can reduce nurses’ intention to leave.

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        • Duan X
        • Ni X
        • Shi L
        • et al.
        The impact of workplace violence on job satisfaction, job burnout, and turnover intention: the mediating role of social support..
        Health Qual Life Outcomes. 2019; 17: 93
        • D’Ettorre G
        • Pellicani V
        • Mazzotta M
        • Vullo A
        Preventing and managing workplace violence against healthcare workers in emergency departments.
        Acta Biomed. 2018; 89: 28-36
        • Wirth T
        • Peters C
        • Nienhaus A
        • Schablon A
        Interventions for workplace violence prevention in emergency departments: a systematic review.
        Int J Environ Res Public Health. 2021; 18: 8459
      1. Health and medical workers survey current status and actual condition of emotional labor of health and medical workers (2019. 6. 20.). National Health and Medical Industry Labor Union. Accessed March 15, 2021.

        • Alshawush K
        • Hallett N
        • Bradbury-Jones CJ
        The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review.
        Clin Nurs. 2022; 31: 2398-2417
        • Shapiro D
        • Duquette CE
        • Zangerle C
        • Pearl A
        • Campbell T
        The seniority swoop: young nurse burnout, violence, and turnover intention in an 11-hospital sample.
        Nurs Admin Q. 2022; 46: 60-71
        • Najafi F
        • Fallahi-Khoshknab M
        • Ahmadi F
        • Dalvandi A
        • Rahgozar M
        Antecedents and consequences of workplace violence against nurses: a qualitative study.
        J Clin Nurs. 2017; 27: e116-e128
        • Luthar S.S.
        • Cicchetti D.
        • Becker B.
        The construct of resilience: a critical evaluation and guidelines for future work.
        Child Dev. 2000; 71: 543-562
        • McDermid F.
        • Judy Mannix J.
        • Peters K.
        Factors contributing to high turnover rates of emergency nurses: a review of the literature.
        Aust Crit Care. 2020; 33: 390-396
        • Al Sabei S.D.
        • Labrague L.J.
        • Miner Ross A.
        • et al.
        Nursing work environment, turnover intention, job burnout, and quality of care: the moderating role of job satisfaction.
        J Nurs Scholarsh. 2020; 52: 95-104
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.G.
        ∗Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Chen H.
        • Li G.
        • Li M.
        • Lyu L.
        • Zhang T.
        A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China.
        Int J Nurs Sci. 2018; 5: 396-402
      2. WHO. Global Campaign for Violence Prevention: significant progress for many countries. Inj Prev, 2006: 62
        • Yeon S.J.
        • Kim W.
        • Won Y.S.
        • Rhee K.
        • Hong Y.O.
        The Structure and Culture of Violence in School Sports, Hospitals and Workplaces of Foreign Employees.Vol. 13. Korean Inst Criminol Justice, 2008: 1-405
        • Park MM
        • Park JW
        Development of resilience scale for nurses.
        J Korean Acad Fundam Nurs. 2015; 23: 32-41
        • Cho E
        • Choi M
        • Kim EY
        • Yoo IY
        • Lee NJ
        Construct validity and reliability of the Korean version of the practice environment scale of nursing work index for Korean nurses.
        J Korean Acad Nurs. 2011; 41: 325-332
        • Price JL
        • Mueller CW
        A causal model of turnover for nurses.
        Acad Manag J. 1981; 24: 543-565
        • Michaels C.E.
        • Spector P.E.
        Causes of employee turnover: a test of the Mobley, Griffeth, Hand, and Meglino model.
        J Appl Psychol. 1982; 67: 53-59
        • Aljohani B.
        • Burkholder J.
        • Tran Q.K.
        • Chen C.
        • Beisenova K.
        • Pourmand A.
        Workplace violence in the emergency department: a systematic review and meta-analysis.
        Public Health. 2021; 196: 186-197
        • Sachdeva S.
        • Jamshed N.
        • Aggarwal P.
        • Kashyap S.R.
        Perception of workplace violence in the emergency department.
        J Emerg Trauma Shock. 2019; 12: 179-184
        • Kim S.
        • Gu M.
        • Sok S.
        Relationships between violence experience, resilience, and the nursing performance of emergency room nurses in South Korea.
        Int J Environ Res Public Health. 2022; 19: 2617
        • Kim S.J.
        Workplace Violence Experience, Resilience and Job Stress of Nurses in Emergency Unit. Master’s Thesis.
        Catholic University, 2017
        • Bae Y.H.
        • Yeom H.A.
        Structural equation modeling of person-centered nursing in hospital nurses.
        Healthcare (Basel). 2022; 10: 514
        • Lake E.T.
        Development of the practice environment scale of the nursing work index.
        Res Nurs Health. 2002; 25: 176-188
        • Baek JB
        • Kang SJ
        The effect of violence experience on turnover intention among nurses.
        Jour of Ko Con.a. 2018; 18: 570-578
        • McGuire S.S.
        • Gazley B.
        • Majerus A.C.
        • Mullan A.F.
        • Clements C.M.
        Impact of the COVID-19 pandemic on workplace violence at an academic emergency department.
        Am J Emerg Med. 2022; 53: 285.e1-285.e5
        • Hsieh H.F.
        • Hung Y.T.
        • Wang H.H.
        • Ma S.C.
        • Chang S.C.
        Factor of resilience in emergency department nurses who have experienced workplace violence in Taiwan.
        J Nurs Scholarsh. 2016; 48: 23-30
        • Foster A.
        • Wood E.
        • Clowes M.
        Identifying the evidence base of interventions supporting mental health nurses to cope with stressful working environments: a scoping review.
        J Nurs Manag. 2021; 29: 1639-1652
        • Ayasreh I.R.
        • Hayajneh F.A.
        Workplace violence against emergency nurses: a literature review.
        Crit Care Nurs Q. 2021; 44: 187-202


      Ji Eun Park is a Registerd Nurse, Emergency Department, The Catholic University, Incheon St. Mary’s Hospital, Bupyeong-gu, Incheon, South Korea.


      Mi Ryeong Song is a Professor, College of Nursing, Gachon University, Yeonsu-gu, Incheon, South Korea. ORCID identifier: