Effort-reward imbalance and health outcomes in emergency nurses: the mediating role of work-family conflict and intrinsic effort.

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.