Publication date: Sep 01, 2025

The COVID-19 pandemic significantly disrupted the healthcare sector, exacerbating nurse turnover intentions globally. Turnover intention is influenced by organizational justice and effort-reward imbalance (ERI). However, the specific mechanisms underlying these relationships, particularly the intermediary function of psychological distress, remain inadequately investigated. This study investigated the relationships among organizational justice (procedural and interactional), ERI, psychological distress, and turnover intention among hospital nurses in Japan during the COVID-19 crisis. A cross-sectional study with 773 nurses was conducted. Structural equation modeling helped analyze the total, direct, and indirect effects of organizational justice and ERI on turnover intentions, with psychological distress as a mediating variable. The results show that interactional justice was negatively associated, mediated by psychological distress. ERI was positively associated with turnover intention, with job promotion and salary imbalance being the most influential components. Psychological distress emerged as a significant mediator in the associations between interactional justice, ERI, and turnover intentions. Enhancing interactional justice and addressing ERI are critical strategies for reducing turnover intentions. Alleviating psychological distress supports nurse retention.

Semantics

Original Article