The mediating effect of job burnout on the relationship between practice environment and workplace deviance behavior of nurses in China: a cross-sectional study

The aging population and the growing prevalence of chronic disease are driving a significant increasing in the need for nursing services [1]. However, with only 3.7 registered nurses per 1,000 people as of 2022, this figure falls short of the World Health Organization’s recommended minimum of 4.45 per 1,000 people, leading to a nursing shortage that negatively affects patient care and healthcare efficiency [2, 3]. Clinical nurses deal with a great deal of strain, including long hours, night shifts, unpredictable workplace violence, and other occupational stressors [4, 5]. These factors have a detrimental impact on nurses’ mental health, the standard of care they provide, and the rate at which they leave their jobs [6].

Workplace Deviance Behavior(WDB) refers to the voluntary behavior of employees in violation of important organizational norms, considered as a deliberate behavior of inappropriate behavior by employees [7], which lead to a negative effect on the organization and its member [8], and may cause great potential harm to the organization. With the development of the economy and technology and the prevalence of individualism, workplace deviance behavior has become a common workplace problem. Previous empirical studies showed bad behaviors and professional deviations can lead to many potential problems, such as low efficiency, job burnout, interpersonal conflicts, and damage to the collective public image [7]. The workplace deviance behavior of nurses is considered an important behavior in clinical practice, which will bring negative effects and affect the development of nurse team, and considered to be one of the important indicators for evaluating team cohesion, stability, and development potential [9].The governance of workplace deviance behavior has gradually become more important and has become a focus of study in many fields [10‐12].

The practice environment is an organizational characteristic of the work setting that affects professional nursing practice [13]. It encompasses the physical, social, and psychological aspects of the workplace that are perceived by those who work there [14]. A positive practice environment fosters strong cooperation between doctors and nurses, ensures positive nurse-patient relationships, provides adequate support and staffing, and contributes to the psychological well-being of nurses [15]. Research has demonstrated that an improved practice environment is associated with lower intentions to leave [16]. Accordingly, the practice environment may be directly associated with work deviance behavior, and indirectly associated with work deviance behavior through job burnout. Nevertheless, these hypothetical pathways have not been tested [17].

Job burnout is a state of physical, mental, emotional, and social exhaustion resulting from unmanaged work stress and inadequate support from managers and colleagues, which reduces motivation for work [13, 14]. Studies have shown that high work pressure can lead to anxiety, depression, dissatisfaction, and reduced loyalty among clinical nurses, making them more likely to leave [15], and job burnout is directly associated with job satisfaction and the intention to leave [16‐18]. This negatively impacts the well-being and health of nurses and can lead to workplace deviance behavior, affecting the quality of nursing services and team stability in the long term [19].

Previous research has demonstrated the significant impact of job burnout and the practice environment on nurses’ work, including their job dissatisfaction, mental well-being, and intention to leave [20‐22], the significant impact of job burnout and the practice environment on nurses’ work, including their job dissatisfaction, mental well-being, and intention to leave [23]. This knowledge gap presents a barrier to developing targeted interventions to address workplace deviance behavior among nurses [14, 16, 24‐26]. Therefore, this study aims to explore the influence of the practice environment on nurses’ workplace deviance behavior, validate the mediating role of job burnout, and provide valuable insights for developing interventions to reduce workplace deviance behavior, stabilize the nursing workforce, improve nurses’ well-being, and decrease turnover rates.

Social Cognitive Theory (SCT), developed by Albert Bandura [27], emphasises that individual behavior is influenced by environmental and personal factors. This theory provides this study with theories that can be used to understand how the work environment(independent variable) influences work deviant behavior(dependent variable) through job burnout(mediating variable). A supportive practice environment has the power to enhance nurses’ confidence and lower job burnout. This, in turn, allows them to meet job requirements with ease and recognize the intrinsic value of their tasks. Additionally, it can reduce work deviation behavior among nurses [28]. As a result, we propose that job burnout may mediate the relationship between the practice environment and work deviation behavior of nurses. Based on the literature review, this survey aims to assess the work deviation behavior of nurses and explore potential mediating mechanism. Three hypotheses are presented in this study, as shown in Fig. 1.

This study described the current status of work deviance behavior of nurses in China, and explored the associations of practice environment, job burnout and work deviation behavior as well as confirmed the mediating role of job burnout in this relationship. The research uncovered three significant findings. Firstly, work deviance behavior among nurses in China was found to be at a lower level. Secondly, the practice environment was observed to have a negative association with work deviation behavior, while job burnout was positively linked to it. Finally, the study revealed that the practice environment could negatively predict work deviance behavior and the relationship between them was partly mediated by job burnout.

The issue of nurses’ workplace deviance behavior cannot be overlooked in today’s medical environment [23]. Positive working behavior among nurses is crucial for enhancing patient medical service experience and strengthening the cohesion of medical and nursing groups [30]. The results of our study show that workplace deviance behavior of nurses in China was at a lower level, which indicates that nurses are less likely to exhibit deviant workplace behaviours in China, which is consistent with the work deviation level of Egyptian nurses studied by Hashish et al. [23]. This may be related to the continuous improvement of the staff structure and management level of the nurse team in recent years. The dimension with the highest score of WDB was the behavioral deviation at the interpersonal level, which indicated that the behavior of nurses in interpersonal relationships needs to be improved. The higher score in this aspect may be due to the heavy workload of nurses and the increase in nurse-patient conflicts, which affects the physical and mental health of nurses [24, 43]. As a result, the risk of interpersonal conflicts between patients, family members and even colleagues is greater, and the possibility of behavioral deviations at the interpersonal level is higher [44]. Nurse managers should actively work towards establishing a supportive and respectful team relationship for nurses. By providing efficient access to information and resources, as well as appropriate support and autonomy to complete professional tasks, nurses will feel valued and more emotionally and physically connected to their work [45]. Additionally, considering the individual needs of nurses and resolving the conflict between work and personal life will help minimize workplace deviant behavior among nurses.

In this study, we found a significant negative correlation between nurses’ workplace deviance behavior and practice environment, indicating that the better the practice environment, the fewer occurrences of workplace deviance behavior. The possible reason is that the practice environment refers to the sum of various elements that directly or indirectly affect the nursing system. Improving the nursing working environment is the basic way to improve the job satisfaction of nurses, reduce the work deviance behavior and the turnover rate of nurses [21], consistent with previous studies [46] showed that practice environment factors, such as nurse-physician relationships, nursing management, nursing-patient relationship and workload are considered predictors of work deviance of nurses [47]. According to Alsadaan et al. (2023), a positive and supportive leadership environment fosters a sense of value and motivation among nurses, affecting their overall mindset and job satisfaction [25]. Leaders exemplifying ethical conduct and cultivating a culture of respect and collaboration markedly diminish the likelihood of disruptive behaviors among nursing staff, fostering a positive and industrious work environment [48]. A positive environmental atmosphere plays a crucial role in overseeing nurses’ development, and a harmonious department environment is conducive to stimulating nurses’ enthusiasm for work and enhancing their ability to assess and solve problems. This, in turn, helps reduce work deviation behavior among nurses.

There was a significant positive correlation between the total score of nurses’ workplace deviance behavior and the MBI-GS score, indicating that the higher the score of job burnout, the higher the nurses’ work deviance behavior score. Job burnout can result in emotional exhaustion [34], decreased work motivation, and reduced job satisfaction [49], all of which can lead to increased workplace deviance behavior among nurses. Studies have indicated that implementing a reward mechanism significantly impacts the value of accrediting nurses, reducing emotional exhaustion, and improving satisfaction [50, 51]. By combining rewards and encouragement, utilizing intelligent stimulation and contingency rewards, nurses’ sense of belonging and identity in the team can be enhanced, work enthusiasm can be mobilized, and the effective development of nurses’ standardized professional behavior can be ensured. Nurse managers need to establish detailed job responsibilities and division of labor, schedule flexible shifts based on workload, and implement a job rotation system to promptly rotate nursing staff with different levels of expertise to reduce job burnout and workplace deviance behavior.

In addition, this study found that the practice environment has a negative impact on job burnout, this suggests that positive practice environment reduce the incidence of job burnout and, conversely, negative work environments increase job burnout. It emphasizes the importance of supportive practice environments in reducing nurses’ job burnout, as evidenced by previous studies [52]. When nurses have efficient access to resources, support, and autonomy, they feel more valued and connected to their work [45]. Additionally, our findings underscore the correlation between job burnout, interpersonal relationships, leadership affinity, group efficacy, and group value [53]. Furthermore, the study confirms the close relationship between job burnout and nurses’ work deviance behavior [13, 16, 45]. The presence of internal negativity can significantly impact the behavior of nurses in a detrimental way. Research shows that positive emotions such as happiness and trust are associated with favorable behavior, whereas passive emotions like nervousness and anxiety are linked to unprofessional conduct [54]. It is vital for nurse managers to not only focus on clinical care but also prioritize the physical and mental well-being of nurses. They should proactively organize team-building activities, provide a platform for nurses to relax and alleviate stress, foster team unity, and enhance the management of nurses’ psychological well-being. This approach will lead to improved communication and understanding among colleagues, foster stronger relationships, and ultimately reduce instances of workplace deviant behavior among nurses.

Our findings suggest that the practice environment had a direct negative effect on workplace deviance behavior and could have an indirect influence through job burnout. Job burnout partially mediates the relationship between practice environment and nurses’ deviance workplace behaviours. This means that interventions can be made to provide better practice environment that are conducive to the reduction of nurses’ job burnout, and in turn the reduction of workplace deviant behaviours among nurses. Many researchers validated job burnout as a mediator of work engagement, quality of care, career satisfaction and propensity to leave [17, 55]. However, limited studies have explored the interplay between job burnout, practice environment and work deviance behavior in nurses. It is crucial to recognize that external factors can significantly shape an individual’s internal motivation [56]. In light of our findings, we posit that a positive work environment, characterized by transformational leadership, organizational support, collaborative relationships, and adequate staffing, can effectively nurture nurses’ intrinsic motivation [52], leading to reduced work deviance behavior. These results emphasize the importance of enhancing the practice environment to directly mitigate clinical work deviance and indirectly lower work deviance behavior by addressing job burnout. Future research should prioritize investigating the impact of interventions targeting the work environment and job burnout on work deviance behavior among nurses.

This study has some value in exploring the relationship between practice environment, job burnout and nurses’ deviance behaviours in the workplace, but there are still some limitations. Firstly, this study utilized self-reported data to investigate nurses’ workplace deviance behavior. It was noted that nurses might be concerned about potential criticism, leading to underreporting of their workplace deviant behavior. Therefore, the actual extent of workplace deviance behavior may be higher than what was reflected in the survey results. Secondly, this study encountered an unbalanced gender distribution during data collection, which may be due to the fact that in China the nursing profession is predominantly female and less male. Therefore, caution should be taken with the findings of this study, which may reflect more of the views and experiences of the female nurse population. Thirdly, We used questionnaire star for data collection, which has great convenience, but the security of collecting data online and may lead to misunderstanding of the research questions, care should be taken to protect the privacy of the participants during the research process and timely clarification should be done. Fourthly, our study used convenience sampling and did not analyse nurses’ workplace deviant behaviours in different departments and different levels of hospitals. It is suggested that future studies involve a larger, more diverse sample, possibly including multi-center studies to explore nurses’ deviance behavior across different departments and hospitals at different levels.

This comprehensive study delved into the workplace deviant behavior of nurses in China, revealing a medium overall score and a pressing need for improvement in nurses’ interpersonal relationships. Notably, the study identified the adverse impact of the practice environment on job burnout and work deviance behavior among nurses, with job burnout serving as a mediator in this relationship. Consequently, it is imperative for hospital managers to proactively enhance the practice environment for nurses by fostering a supportive, fair, and just workplace, ensuring effective communication, facilitating career development, and demonstrating genuine care for their well-being. Moreover, by bolstering the positive practice environment and mitigating job burnout through increased autonomy and improved work impact, managers can effectively curb nurses’ work deviance behavior. Understanding these intricate pathways among the environment, job burnout, and work deviance behavior will empower hospital management and nurse managers to implement targeted interventions, standardize nurse behavior, fortify the nursing team, and elevate the quality of nursing services. In light of these findings, nursing managers are urged to vigilantly address workplace deviance behavior and implement measures such as nurturing a positive practice environment, fostering camaraderie among colleagues, alleviating job burnout, and providing incentives to bolster nurses’ zeal, thus ensuring the stability of the nursing team.