The intermediary effect of emotional exhaustion on the relationship between moral dilemmas and turnover intention among psychiatric nurses

Psychiatric nurses frequently encounter moral dilemmas and emotional exhaustion, both of which significantly influence job satisfaction and turnover intentions. Studies highlight that these factors are key drivers of nurse attrition. Given the high turnover rates in this field, understanding the mechanisms connecting these factors is essential.The aim of this study was to investigate the current status of moral dilemmas, emotional exhaustion, and turnover intentions among psychiatric nurses, and to explore the mediating effect of emotional exhaustion in the relationship between moral dilemmas and turnover intentions.A convenience sampling method was used to select psychiatric nurses from four secondary and tertiary hospitals in Guangdong Province as the study subjects in February 2025. Data were collected using a descriptive information form, the Moral Dilemmas Scale for Psychiatric Nurses, the Emotional Exhaustion Scale, and the Turnover Intention Scale. Path analysis was conducted using structural equation modeling with AMOS 24.0, and the mediating effect was tested.A total of 403 nurses participated in the study. The mean score for moral dilemmas was (30.10 ± 32.20), for emotional exhaustion was (12.45 ± 6.68), and for turnover intention was (2.37 ± 0.94). The total score of moral dilemmas was positively correlated with the total score of emotional exhaustion ( r = 0.400, p < 0.01), the total score of emotional exhaustion was positively correlated with the total score of turnover intention ( r = 0.389, p < 0.01), and the total score of moral dilemmas was positively correlated with the total score of turnover intention ( r = 0.514, p < 0.01). Emotional exhaustion partially mediated the relationship between moral dilemmas and turnover intention, with a mediating effect value of 0.172, accounting for 42.86% of the total effect. Emotional exhaustion can be considered as a key mediator in the relationship between moral dilemmas and turnover intentions in psychiatric nursing.Moral dilemmas and turnover intentions were at a moderate to low level, and emotional exhaustion was at a moderate level for this group of nurses. Emotional exhaustion has an effect on the relationship between moral dilemmas and turnover intentions among psychiatric nurses.