Tong Le, Zhu Ling, Zhang Hao, Zhong Luying, Diao Dongmei, Chen Xiaoli, Zhang Jianna
Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China.
Disaster Medical Center, Sichuan University, Chengdu, China.
Front Public Health. 2025 Jan 3;12:1515593. doi: 10.3389/fpubh.2024.1515593. eCollection 2024.
Emergency nurses experience high stress, but the mechanisms linking effort-reward imbalance to health outcomes are unclear. Work-family conflict might mediate this relationship, and intrinsic effort could moderate it. This study aimed to explore these interactions and their impact on nurse health.
A prospective cross-sectional survey was conducted from 30 tertiary hospitals across 19 provinces in mainland China. Participants completed validated scales to measure effort-reward imbalance, work-family conflict, somatic symptoms, and mental health symptoms. Statistical analyses, including mediation and moderation, were performed using the PROCESS macro to evaluate the relationships between the variables.
In this study, 1,540 emergency nurses were finally included. The analysis revealed that 80.5% of participants reported experiencing effort-reward imbalance, which was significantly associated with increased somatic symptoms and mental symptoms. Work-family conflict was identified as a significant mediator in the relationship between effort-reward imbalance and health outcomes, with a direct effect of effort-reward imbalance on overall symptoms ( = 0.554, < 0.001). Additionally, intrinsic effort moderated the impact of effort-reward imbalance on work-family conflict; moderate levels of emotional investment provided protection against burnout, while excessive intrinsic effort heightened the risk of mental health deterioration ( = -0.104, < 0.001).
These findings underscored the urgent need for targeted interventions that address both effort-reward imbalance and work-family conflict in healthcare settings. Enhancing workplace conditions and supporting emotional engagement among emergency nurses are essential strategies for improving their well-being and reducing burnout risk. Future research should focus on longitudinal studies to assess the effectiveness of these interventions over time.
急诊护士面临着较高的压力，但努力-回报失衡与健康结果之间的关联机制尚不清楚。工作-家庭冲突可能在这种关系中起中介作用，而内在努力可能起到调节作用。本研究旨在探讨这些相互作用及其对护士健康的影响。
在中国大陆19个省份的30家三级医院进行了一项前瞻性横断面调查。参与者完成了经过验证的量表，以测量努力-回报失衡、工作-家庭冲突、躯体症状和心理健康症状。使用PROCESS宏进行统计分析，包括中介和调节分析，以评估变量之间的关系。
本研究最终纳入了1540名急诊护士。分析显示，80.5%的参与者报告经历了努力-回报失衡，这与躯体症状和精神症状的增加显著相关。工作-家庭冲突被确定为努力-回报失衡与健康结果之间关系的重要中介因素，努力-回报失衡对总体症状有直接影响（β = 0.554，p < 0.001）。此外，内在努力调节了努力-回报失衡对工作-家庭冲突的影响；适度的情感投入可预防职业倦怠，而过度的内在努力则会增加心理健康恶化的风险（β = -0.104，p < 0.001）。
这些发现强调了在医疗环境中针对努力-回报失衡和工作-家庭冲突进行有针对性干预的迫切需求。改善工作场所条件并支持急诊护士的情感投入是改善他们的幸福感和降低职业倦怠风险的重要策略。未来的研究应侧重于纵向研究，以评估这些干预措施随时间的有效性。
