Skip to main content
Download PDF
Download ePub

The influencing factors of turnover intention among pediatric healthcare workers: a moderated mediation model

Human Resources for Health volume 23, Article number: 22 (2025) Cite this article

Abstract

Background

Turnover intention (TI) is significant for stabilizing the pediatric healthcare workforce and ensuring sufficient pediatric healthcare human resources. This study focuses on the impact and potential mechanisms of person–organization fit (POF), hierarchical plateau (HP), and person–group fit (PGF) on TI.

Methods

The data set was collected from the Children’s Hospital of Hebei Province on the Wenjuanxing online platform using the convenience sampling method in September and October 2023. 546 questionnaires were collected, with 371 valid questionnaires (effective rate: 67.95%). Model 4 and Model 14 of the PROCESS macro (version 3.3) in SPSS were used to construct mediation and moderated mediation models, respectively, and the significance of mediation and moderation effects in the theoretical model was verified using the Bootstrap method (sample size = 5000).

Results

The results of Model 4 indicate that POF has a negative impact on the HP ( B = -0.1414, p < 0.01) and TI (B = − 0.3616, p < 0.001), while the HP has a positive impact on TI ( B = 0.2528, p < 0.001), and HP can mediate the relationship between POF and TI (B = − 0.0358, 95% CI [− 0.0678, − 0.0049]). The results of Model 14 show that the POF has a negative impact on the HP ( B = -0.1414, p < 0.01) and TI (B = − 0.2827, p < 0.001), while the HP has a positive impact on TI ( B = 0.2747, p < 0.001), and index of moderated mediation shows that the PGF can moderate the indirect effect of POF on TI (Index = 0.0305, 95% CI [0.0020, 0.0582]).

Conclusions

This study constructed a moderated mediation model and found that POF can negatively affect the TI of pediatric healthcare workers, the HP can mediate the relationship between POF and TI, and PGF can moderate the second part of this mediating process. This emphasizes the important role of employee fit with the organization and group, as well as the significant impact of employee career development on TI.

Peer Review reports

Introduction

To promote the healthy growth of children, the National Health Commission has issued the Implementation Plan for the Development of Women and Children in China from 2021 to 2030. It is pointed out that by 2030, the mortality rates of newborns, infants, and children under 5 years in China are expected to decrease to below 3.0 ‰, 5.0 ‰, and 6.0 ‰, respectively. At the same time, to ensure the achievement of this goal, a development goal of 1.12 pediatric practicing (assistant) doctors per thousand children has been proposed [1]. However, existing data indicates that although there has been an increase compared to 2020, the number of pediatric practicing (assistant) doctors per thousand children in China in 2021 was only 0.78 [2]. Compared with the set development goals, there is still great room for improvement in enriching pediatric health human resources. To ensure the total number of pediatric professionals, some medical colleges in China (such as Fudan University) have resumed undergraduate-level teaching in pediatrics to meet the increasing demand for children’s health care services [3]. In addition, the turnover intention (TI) of medical staff should be given more attention. The loss of medical personnel not only damages the quantity of human resources but also leads to potential resource waste [4], as hiring new personnel means generating new employment and training costs [5, 6]. Even worse, a higher turnover rate may lead to a “vicious cycle” of personnel turnover, further damaging health human resources [7].

Considering the adverse effects of TI [4, 7], researchers have focused on how to avoid the loss of existing pediatric health human resources and ensure a sufficient number of pediatric human resources. Some researchers have focused their attention on employees and found that job satisfaction is negatively correlated with employee TI [8, 9], while job burnout [10, 11] and perceived stress [12, 13] are positively correlated with employee TI. Some researchers have also focused on environmental factors. Relevant studies have shown that unsafe working environments [14, 15] and unfavorable working conditions [16] can positively predict employee TI. We attempt to explore the impact mechanism of TI in pediatric health human resources from the perspective of person–environment fit, by combining the joint influence of individuals and the environment. The person–environment fit is considered a match between the values, norms, and other attributes that people possess with the environment, and has been used to explain and study the specific attitudes and behaviors of employees [17]. The research in the field of person–environment fit includes many dimensions, such as person–organization fit (POF), person–job fit, and person–group fit (PGF), which are among them [18]. Currently, many studies focus on POF [19]. Researchers believe that POF is organization-centered and conceptually closer to resignation decision-making. Therefore, POF is included as an important antecedent in the conceptual model of resignation [20]. Some researchers have pointed out that job satisfaction mediates the effects of POF on TI [21], and hierarchical plateau (HP), as an important criterion affecting job satisfaction [22], we expect it to have the same effect. However, current researchers have paid less attention to PGF [19], and most medical practices are team-based, requiring coordination between healthcare providers from the same or different departments. Therefore, the important role of PGF cannot be ignored [18]. Based on this, this study constructs a moderated mediation model to explore the specific mechanisms of the relationship between POF, HP, PGF, and TI.

Theoretical background and hypothesis

Person–organization fit and turnover intention

The POF is evaluated by the consistency between the values that individuals adhere to and the content advocated by the organization [23]. Previous studies have shown that the degree of consistency between individuals and organizations can affect the attitudes and behaviors exhibited by individuals within the organization, as individuals exist in specific organizational environments [24]. When individuals are in an organization that aligns with their values, they prefer to exhibit more proactive work performance, such as higher levels of organizational identity and organizational citizenship behavior [20]. POF can also significantly affect employee TI [21, 25]. Liu et al.’s research shows that employees who align with organizational values are more satisfied with the working conditions provided by the organization and have a lower tendency to resign [26]. Similarly, research has found that healthcare workers have a negative association between their perception of POF and TI, and the inconsistency in values between individuals and organizations can lead to higher TI [27].

Based on the above research, hypothesis 1 is proposed: POF negatively predicts TI.

The mediating role of hierarchical plateau

The HP is considered “the point at which the possibility of obtaining additional promotion in the career is very low” [28, 29]. Many studies have found that a perceived HP positively correlates with poor work attitudes, states, and outcomes, such as decreased organizational commitment and job satisfaction, emotional exhaustion, and increased stress [22, 28, 30, 31]. Moreover, research has pointed out the positive correlation between HP and employee TI [22, 31,32,33], and the more stable the employee’s hierarchical plateau, the higher their willingness to resign [34, 35].

This is because HP means that there is a gap between employee resource investment in work and expected promotion benefits [28]. According to the Conservation of Resources theory, the pressure caused by insufficient expected resource returns is an important influencing factor of employee TI [12, 13, 36]. Previous studies have shown that employees feel higher organizational support in a suitable organization [37], and receive career guidance and challenging work tasks [38], which are important resources that can promote employee promotion [39]. Therefore, individuals who are more suitable for the organization are more likely to be promoted within the organization, thereby reducing the TI due to HP.

Based on the above research, hypothesis 2 is proposed: HP mediates the relationship between POF and TI.

The moderating role of person–group fit

We emphasize the crucial role of PGF, because most medical practices require coordination between medical service providers in the same or different departments [18]. Good compatibility between individuals and workgroups is often associated with more positive outcomes. The previous meta-analysis pointed out that job satisfaction and colleague satisfaction can be positively predicted by PGF, while TI can be negatively forecasted by PGF [40]. Similarly, in the medical context, it has been found that better teamwork among nursing staff means higher job satisfaction with their current position and profession [41].

PGF is a very important resource for employees, as a better fit with the group means more social support from the group can be obtained [42]. This important resource can bridge the gap between resource investment and promotion expectations brought about by HP [28, 36], thereby alleviating to some extent the adverse effects caused by insufficient resources [12, 13, 36]. Moreover, studies have found that individuals at an HP perceive less support from organizations and supervisors [43], and the lack of support from organizations and supervisors is significantly correlated with TI [44,45,46,47]. The substitution hypothesis suggests that when different resources meet common needs, they can replace each other [48]. Given that social support from organizations, supervisors, and groups can alleviate employee TI [46, 47, 49], we believe that when employees perceive insufficient organizational or managerial support at an HP, social support from colleagues can serve as a substitute, thereby regulating the association between the HP and TI.

This study proposes hypothesis 3, based on the above research and theory: PGF can significantly moderate the second part of the mediating process (the association between the HP and TI), specifically, the indirect impact of POF on TI through HP can be alleviated through PGF.

Research model

This study explores the influencing factors of TI in pediatric health human resources from the perspective of person–environment fit, combining the Conservation of Resources theory and substitution hypothesis. Specifically, by constructing a moderated mediation model (Fig. 1), the mediating role of HP in the association between POF and TI was examined, as well as the moderating role of PGF in this mediating process.

Fig. 1
figure 1

Moderated mediation model

Full size image

Materials and methods

Data collection

The data was collected from the online survey platform Wenjuanxing at the Children’s Hospital of Hebei Province in September and October 2023, and volunteers were recruited using a convenience sampling method. Specifically, the link to the survey questionnaire was distributed through our partners to the WeChat group so that potential respondents could participate in this study. The Medical Ethics Committee of Hebei Children’s Hospital approved this project. Moreover, during the questionnaire survey process, respondents need to express informed consent to this study and authorize the use of research data before answering formal items.

In this project, we collected a total of 546 questionnaires. Strict quality screening standards are used for the quality control of the collected questionnaires. Specifically, it includes the following steps. First, the IP address of the questionnaire is used for quality control. If two or more questionnaires are sourced from the same IP address, these questionnaires will be excluded from this study. Through this step, we had excluded 97 questionnaires. Second, we exclude questionnaires with potential quality defects by checking whether the options for the forward and reverse questions set in the scale are consistent. Specifically, we set up three scales in the questionnaire that included both forward and reverse questions. If the respondent’s answer is completely consistent on a scale that includes both forward and reverse questions, it will be marked. If all three scales that include both positive and negative questions are marked, the questionnaire data will be excluded from this study. Through this step, 78 questionnaire data were excluded from this study. Finally, after the quality control process, out of the 546 questionnaires collected, 175 were excluded, and the remaining 371 questionnaires in this study had an effective rate of 67.95%.

Sample characteristics

The 371 data included in this study were composed of doctors, nurses, pharmacists, and medical technicians. Among them, there were 108 doctors (29.11%), 164 nurses (44.20%), 43 pharmacists (11.59%), and 56 medical technicians (15.09%). Among the respondents, females accounted for the majority (n = 314, 84.64%), while there were 57 males, accounting for 15.36%; The educational background is concentrated at bachelor’s degree or below (n = 241, 64.96%), with a total of 130 people holding a master’s degree or above, accounting for 35.04%.

Research tools

Person–organization fit

The evaluation of POF is conducted using the POF scale formed by Cable and DeRue [20]. This scale consists of three positive questions that measure the degree of POF based on the consistency of values. A typical question is “My personal values match my organization’s values and culture”. In this study, the Likert-5 scoring system was used (1 = strongly disagree, 5 = strongly agree), with higher scores indicating higher fit between individuals and organizations. The Cronbach’s alpha of the original scale is 0.91. Cronbach’s alpha is 0.936 in this study, indicating high reliability.

Hierarchical plateau

The HP scale developed by Chinese scholars is used to measure the degree of career development limitations of respondents, which is widely used in Chinese research [50]. The measurement of the HP consists of three forward questions and one reverse question (“I get limited space to be promoted in my work unit”; “I can never get a higher position in my work unit”; “The possibility of getting promoted is little in my work unit” and “I still can get promoted from superiors”). In this study, the Likert-5 scoring system was used (1 = strongly disagree, 5 = strongly agree), where previously, higher scores usually meant higher HP (after manually assigning reverse scores to reverse questions). The Cronbach’s alpha of the original scale is 0.84. Cronbach’s alpha is 0.777 in this study, indicating acceptable reliability.

Person–group fit

The PGF scale formed by Vogel and Feldman was used to evaluate the degree of fit between people and groups [51]. The scale consists of four forward questions and one reverse question. This study used the Likert-5 scoring method (1 = strongly disagree, 5 = strongly agree), with higher scores indicating higher fit between individuals and groups (after manually assigning reverse scores to reverse questions). The Cronbach’s alpha of the original scale is 0.76. Cronbach’s alpha is 0.717 in this study, indicating acceptable reliability.

Turnover intention

This study used the TI scale formed by Farh et al. to evaluate the TI of respondents [52]. The scale consists of three forward questions and one reverse question. This study used the Likert-5 scoring method (1 = strongly disagree, 5 = strongly agree), with higher scores indicating higher TI (after manually assigning reverse scores to reverse questions). The Cronbach’s alpha of the original scale is 0.81. Cronbach’s alpha is 0.788 in this study, indicating acceptable reliability.

Control variables

Similar to previous studies, gender and education were selected as covariates [53,54,55]. We encoded education (0 = bachelor’s degree or below, 1 = master’s degree or above) and gender (0 = male, 1 = female) as dummy variables and placed them in the regression analysis model to control for their potential confounding effects.

Statistical analysis

All data analysis in this study was completed in SPSS 22.0. First, Harman’s single-factor test results indicated that there are four factors with eigenvalues greater than 1. The total variance explained by the first common factor is 36.437%, which is below the critical value of 40%, indicating no serious common method bias [56, 57]. In addition, kurtosis and skewness indicate that the continuity data in this study roughly follow a normal distribution [58, 59]. Use mean ± standard deviation (M ± SD) to statistically describe the continuity data involved in this study. In addition, use the Pearson correlation coefficient to evaluate the correlation between variables. Finally, the hypothesis model proposed in this study was validated using Model 4 and Model 14 of the PROCESS macro (version 3.3) in SPSS, with gender and education as control variables. Using the Bootstrap method (sample size = 5000) to test the mediating and moderating effects in theoretical hypotheses, the 95% confidence interval (CI) does not include zero, indicating statistical significance.

Results

Descriptive statistics and correlations for variables

The mean, standard deviation, and correlation matrix of the variables in this study are shown in Table 1. The results showed that the POF was negatively related to TI, the POF was negatively related to the HP, and the HP was positively related to TI. As a moderating variable, the PGF was negatively related to TI.

Table 1 Description statistics and correlation analysis
Full size table

Test of mediation

We used Model 4 from the PROCESS macro to validate the mediation hypothesis in this study. After controlling for gender and educational variables, evaluate the mediating role of the HP on the association between POF and TI. It was found that the POF can negatively predict HP ( B = -0.1414, p < 0.01) and TI (B = − 0.3616, p < 0.001). Moreover, the HP can positively predict TI ( B = 0.2528, p < 0.001). A mediation model that includes both predictor variables and covariates explained 24.38% of TI (R2 = 0.2438, p < 0.001). As shown in Table 2. The Bootstrap method (sample size = 5000) was used to verify the significance of the mediating effect. The results indicate that POF directly affects TI (B = − 0.3616, 95% CI [− 0.4660, − 0.2589]), while HP can mediate the association between POF and TI (B = − 0.0358, 95% CI [− 0.0678, − 0.0049]), and the mediating effect accounts for 9.01% of the total effect, which is a partial mediating effect. As shown in Table 3. Hypotheses 1 and 2 are supported.

Table 2 Regression analysis results of the mediating model
Full size table
Table 3 Results and bootstrap analysis of mediation effects
Full size table

Test of moderated mediation

In this study, we used Model 14 from the PROCESS macro to validate the moderate mediation hypothesis, and the Bootstrap method (sample size = 5000) was used for significance testing. After controlling for gender and educational variables, evaluate whether PGF moderates the second part of the process mediating by the HP. As shown in Table 4, POF negatively predicts TI (B = − 0.2827, p < 0.001), HP positively predicts TI ( B = 0.2747, p < 0.001), and PGF negatively predicts TI (B = − 0.2344, p < 0.001), and PGF can moderate the association between HP and TI (HP * PGF: B = -0.2155, p < 0.001). A moderated mediation model that includes both covariates and predictor variables explained 28.97% of TI (R2 = 0.2897, p < 0.001). Meanwhile, Table 5 show the indirect effect of POF on TI through the HP at different levels of PGF. In addition, the moderated mediation index is significant (index = 0.0305, 95% CI [0.0020, 0.0582]), as 95% CI does not include 0. Hypotheses 3 are supported.

Table 4 Regression analysis results of the moderated mediation model
Full size table
Table 5 Conditional direct and indirect effects of person–organization fit on turnover intention at different values of person–group fit
Full size table

Discussion

General discussion

In summary, considering the important impact of TI in stabilizing the pediatric healthcare workforce and ensuring sufficient pediatric healthcare human resources, a moderated mediation model was utilized in this study to explore the influencing factors of TI among pediatric healthcare staff.

Both Model 4 and Model 14 confirm a direct negative correlation between POF and TI of pediatric healthcare workers. This result supports Hypothesis 1 and is consistent with previous research results [25,26,27]. Although studies have confirmed that POF can negatively forecast TI, this study focuses on the special group of pediatric healthcare workers in the Chinese context, providing important literature references for research in this field.

Corresponding to hypothesis 2 of this study, we confirm that HP can play a mediating role between POF and TI. Interactive psychology believes that the specific behavior or performance of employees in an organization stems from the interaction between the employees and the organization [23]. Many subsequent researchers have also explored the association between POF and TI and proposed that factors such as career satisfaction, self-efficacy, resilience, work engagement, and burnout can mediate the association between POF and TI [60,61,62]. This study confirms that HP can play a mediating factor between POF and TI, providing another specific path for studying the association between person–environment fit and TI.

In addition, hypothesis 3 based on the Conservation of Resources theory and substitution hypothesis has been validated, providing further literature for the Conservation of Resources theory and substitution hypothesis, and providing a new perspective for exploring the comprehensive impact of the interaction between PGF and POF on specific behaviors or performance. Previously, Vogel and Feldman proposed that PGF is an accelerator for POF, but the results did not confirm that PGF can moderate the relationship between POF and TI. They attributed this result to perceived fit as only one of the ways to conceptualize fit, and the lack of “objective” fitting measurements can cause significant measurement confusion [19]. We suggest that the consistency between the values and culture advocated by a group and the content advocated by an organization may affect the moderating role of PGF on the association between POF and related work outcomes, as subcultures within an organization may not necessarily be completely consistent with the main culture and may even be opposite [63,64,65]. Future researchers can design further studies to validate.

Practical implications

This study explores the influencing mechanism of POF, HP, and PGF on the TI of pediatric medical workers. This has significant practical significance for pediatric medical workers and pediatric human resource management departments.

For pediatric healthcare workers, we provide the following specific recommendations: first, when seeking a job, it is important to carefully weigh the consistency between the values and culture advocated by the organization and one’s own beliefs, as better alignment with organizational values means less uncertainty and more opportunities to meet one’s own needs [66]. Second, we suggest that pediatric healthcare workers actively integrate into their group and leverage the potential power of the group to enhance their resources to deal with the adverse impact of work. When an individual actively integrates into their group, they can better receive social support from the group [42]. This social support from colleagues is an important resource that can help employees enrich their resource pool, thereby placing themselves in a position to minimize risk and maximize resources [36].

For the pediatric human resource management department, we provide the following specific suggestions: first, in the process of recruiting employees, attention should be paid to identifying and absorbing employees who are consistent with the organizational values, and accurately selecting employees who can contribute to the development of the organization. Studies have shown that employee behavior within an organization is influenced by the degree of consistency with organizational values [24]. Organizations that attract employees who are more in line with themselves can benefit from more positive work behaviors and attitudes [67], because when individuals coexist harmoniously with organizational values, employees experience belonging and identification with the organization, thereby promoting positive attitudes and behaviors towards the organization [68]. Second, pay attention to the potential hazards of HP, facilitate the development channels of employees within the organization, and take measures from multiple perspectives to decrease the occurrence and harm of HP. Career plateau can be alleviated by appropriately optimizing positions, and providing employees with more promotion and learning opportunities. For example, training nurses to become specialized nurses can help reduce employees’ perception of career stagnation [69]. On the other hand, the alternative rewards provided by organizations are also quite important. Providing employees with work challenges, coaching, and social support can buffer the adverse impact of HP and prevent employees from feeling less support when their self-perception is stagnant [28]. In addition, providing development opportunities for employees through special project work, additional training, and educational assistance can help offset the potential adverse consequences of stagnation. Employees can also cope with stagnation from a psychological perspective through stress management training and employee assistance programs [70]. Third, it is important to emphasize the guiding role of organizational values, identify and guide the consistency between the culture and values advocated by the group and the organization, and improve the cohesion of the organization. Previous studies have pointed out that the values pursued by different groups within an organization may not necessarily be completely consistent with organizational culture [64]. Therefore, a better fit between employees and the group may not necessarily help improve their alignment with the organization to achieve organizational goals and values, and may even have the opposite effect, as organizational goals may be abandoned due to group goals [71]. Managers should promote a consistent organizational culture and values by emphasizing organizational goals and values, thereby reducing differences between subunits within the organization, enhancing connections among organizational members, and improving task execution efficiency [71, 72].

Limitations

Some limitations have to be emphasized to remind future researchers of this study. We conducted a questionnaire survey in a single medical institution to collect the data required for this study using a convenience sampling method. We remind future researchers to pay attention to the representativeness of single-center samples and the potential limitations of cross-sectional data in causal inference. In addition, using convenience sampling methods cannot clearly determine how many people were actually covered in the study, so it is also impossible to calculate the response rate of the questionnaire. Finally, due to the use of questionnaire surveys, which collect data through self-reporting by respondents, possible common method bias also needs to be noted.

Research prospects

We suggest that future researchers in the field of person–environment fit should not only focus on the impact of a certain dimension on specific work outcomes but also consider the comprehensive impact of interactions between different dimensions. In addition, attention should also be paid to exploring the potential role of defining and measuring multiple ways of fit. Another concern is that we suggest future researchers when exploring the interaction between PGF and POF, can further evaluate the consistency between the values and culture advocated by the group and the mainstream of the organization, and explore the important role of this degree of consistency in specific work outcomes and performance.

Conclusion

In summary, this study comprehensively explores the impact of POF, HP, and PGF on the TI of pediatric medical workers by constructing a moderated mediation model. The research results found a direct negative association between POF and TI, and HP can play the mediating factor in the association between POF and TI, while PGF can regulate the second part of this mediating process. According to the research findings, we emphasize the important role of employee fit with the organization and group, as well as the significant impact on employee career development.

Availability of data and materials

Further data can be requested from the corresponding author through reasonable requests.

Abbreviations

POF:

Person–organization fit

HP:

Hierarchical plateau

PGF:

Person–group fit

TI:

Turnover intention

References

  1. National Health Commission. Notice of the National Health Commission on Issuing the Implementation Plan for the Development of Women and Children in China from 2021 to 2030. https://www.gov.cn/zhengce/zhengceku/2022-04/09/content_5684258.htm. Accessed 11 Jan 2024.

  2. National Bureau of Statistics. Statistical Monitoring Report on the Development Plan for Children in China (2021–2030) in 2021. https://www.stats.gov.cn/sj/zxfb/202304/t20230417_1938688.html. Accessed 8 Mar 2024.

  3. Hu Y, Xu J, Dong W, Yuan Z, Sun X. Strategies to correct the shortage of paediatricians in China. Lancet. 2018;392:385.

    Article  PubMed  Google Scholar 

  4. Ye X, Zhai M, Feng L, Xie A, Wang W, Wu H. Still want to be a doctor? Medical student dropout in the era of COVID-19. J Econ Behav Organ. 2022;195:122–39.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kuypers T, Guenter H, Van Emmerik H. Team turnover and task conflict: a longitudinal study on the moderating effects of collective experience. J Manag. 2018;44:1287–311.

    Google Scholar 

  6. Lim J, Moon K-K. Exploring the effect of emotional Labor on turnover intention and the moderating role of perceived organizational support: evidence from Korean firefighters. Int J Environ Res Public Health. 2023;20:4379.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rouleau D, Fournier P, Philibert A, Mbengue B, Dumont A. The effects of midwives’ job satisfaction on burnout, intention to quit and turnover: a longitudinal study in Senegal. Hum Resour Health. 2012;10:9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tziner A, Rabenu E, Radomski R, Belkin A. Work stress and turnover intentions among hospital physicians: the mediating role of burnout and work satisfaction. J Work Organ Psychol. 2015;31:207–13.

    Google Scholar 

  9. Ali Jadoo SA, Aljunid SM, Dastan I, Tawfeeq RS, Mustafa MA, Ganasegeran K, et al. Job satisfaction and turnover intention among Iraqi doctors—a descriptive cross-sectional multicentre study. Hum Resour Health. 2015;13:1–11.

    Article  Google Scholar 

  10. Ran L, Chen X, Peng S, Zheng F, Tan X, Duan R. Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction. BMJ Open. 2020;10: e036702.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang H, Jin Y, Wang D, Zhao S, Sang X, Yuan B. Job satisfaction, burnout, and turnover intention among primary care providers in rural China: results from structural equation modeling. BMC Fam Pract. 2020;21:1–10.

    Article  Google Scholar 

  12. Jiang N, Zhang H, Gong Y, Lv C, Yang F, Yin X. The relationship between occupational stress and turnover intention among emergency physicians: a mediation analysis. Front Public Health. 2022;10: 901251.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lu Y, Hu X-M, Huang X-L, Zhuang X-D, Guo P, Feng L-F, et al. The relationship between job satisfaction, work stress, work–family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study. BMJ Open. 2017;7: e014894.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Heponiemi T, Kouvonen A, Virtanen M, Vänskä J, Elovainio M. The prospective effects of workplace violence on physicians’ job satisfaction and turnover intentions: the buffering effect of job control. BMC Health Serv Res. 2014;14:1–8.

    Article  Google Scholar 

  15. Li N, Zhang L, Xiao G, Chen J, Lu Q. The relationship between workplace violence, job satisfaction and turnover intention in emergency nurses. Int Emerg Nurs. 2019;45:50–5.

    Article  PubMed  Google Scholar 

  16. Arnoux-Nicolas C, Sovet L, Lhotellier L, Di Fabio A. Perceived work conditions and turnover intentions: the mediating role of meaning of work. Front Psychol. 2016;7: 179726.

    Article  Google Scholar 

  17. Barrick MR, Parks-Leduc L. Selection for Fit. Annu Rev Organ Psychol Organ Behav. 2019;6:171–93.

    Article  Google Scholar 

  18. Xiao Y, Dong M, Shi C, Zeng W, Shao Z, Xie H, et al. Person–environment fit and medical professionals’ job satisfaction, turnover intention, and professional efficacy: a cross-sectional study in Shanghai. PLoS ONE. 2021;16: e0250693.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Vogel RM, Feldman DC. Integrating the levels of person-environment fit: the roles of vocational fit and group fit. J Vocat Behav. 2009;75:68–81.

    Article  Google Scholar 

  20. Cable DM, DeRue DS. The convergent and discriminant validity of subjective fit perceptions. J Appl Psychol. 2002;87:875–84.

    Article  PubMed  Google Scholar 

  21. Andela M, Van Der Doef M. A comprehensive assessment of the person-environment fit dimensions and their relationships with work-related outcomes. J Career Dev. 2019;46:567–82.

    Article  Google Scholar 

  22. Lentz E, Allen TD. The role of mentoring others in the career plateauing phenomenon. Group Org Manag. 2009;34:358–84.

    Article  Google Scholar 

  23. Chatman JA. Improving interactional organizational research: a model of person-organization fit. Acad Manag Rev. 1989;14:333.

    Article  Google Scholar 

  24. Afsar B, Badir YF. Person–organization fit, perceived organizational support, and organizational citizenship behavior: the role of job embeddedness. J Hum Resour Hosp Tour. 2016;15:252–78.

    Google Scholar 

  25. Chhabra B. Work role stressors and employee outcomes: investigating the moderating role of subjective person-organization and person-job fit perceptions in Indian organizations. IJOA. 2016;24:390–414.

    Article  Google Scholar 

  26. Liu B, Liu J, Hu J. Person-organization fit, job satisfaction, and turnover intention: an empirical study in the Chinese public sector. Soc Behav Pers. 2010;38:615–25.

    Article  CAS  Google Scholar 

  27. Abdalla A, Elsetouhi A, Negm A, Abdou H. Perceived person-organization fit and turnover intention in medical centers: the mediating roles of person-group fit and person-job fit perceptions. PR. 2018;47:863–81.

    Article  Google Scholar 

  28. Yang W-N, Niven K, Johnson S. Career plateau: a review of 40 years of research. J Vocat Behav. 2019;110:286–302.

    Article  Google Scholar 

  29. Ference TP, Stoner JAF, Warren EK. Managing the career plateau. AMR. 1977;2:602–12.

    Article  Google Scholar 

  30. Hurst CS, Kungu K, Flott P. Stress, organizational citizenship behaviors, and coping: comparisons among plateaued and non-plateaued employees. BMR. 2012;1:17.

    Article  Google Scholar 

  31. Wang Y-H, Hu C, Hurst CS, Yang C-C. Antecedents and outcomes of career plateaus: the roles of mentoring others and proactive personality. J Vocat Behav. 2014;85:319–28.

    Article  Google Scholar 

  32. Xie B, Lu X, Zhou W. Does double plateau always lead to turnover intention? Evidence from china with indigenous career plateau scale. J Career Dev. 2015;42:540–53.

    Article  Google Scholar 

  33. Xie B, Xin X, Bai G. Hierarchical plateau and turnover intention of employees at the career establishment stage: Examining mediation and moderation effects. CDI. 2016;21:518–33.

    Article  Google Scholar 

  34. Chang Boon Lee P. Going beyond career plateau: using professional plateau to account for work outcomes. J Manag Dev. 2003;22:538–51.

  35. Tremblay M, Roger A, Toulouse J-M. Career plateau and work attitudes: an empirical study of managers. Human Relat. 1995;48:221–37.

    Article  Google Scholar 

  36. Hobfoll SE. The influence of culture, community, and the nested-self in the stress process: advancing conservation of resources theory. Appl Psychol. 2001;50:337–421.

    Article  Google Scholar 

  37. Sun M, Alam F, Ma C. How Nurses’ person-organization fit influences organizational loyalty. RMHP. 2023;16:2019–36.

    Article  Google Scholar 

  38. Greenhaus JH, Parasuraman S, Wormley WM. Effects of race on organizational experience, job performance evaluations, and career outcomes. Acad Manag J. 1990;33:64–86.

    Article  Google Scholar 

  39. Gorman EH, Kmec JA. Hierarchical rank and women’s organizational mobility: glass ceilings in corporate law firms. Am J Sociol. 2009;114:1428–74.

    Article  Google Scholar 

  40. Kristof-Brown AL, Zimmerman RD, Johnson EC. Consequences of individuals’ fit at work: a meta-analysis of person–job, person–organization, person–group, and person–supervisor fit. Pers Psychol. 2005;58:281–342.

    Article  Google Scholar 

  41. Kalisch BJ, Lee H, Rochman M. Nursing staff teamwork and job satisfaction. J Nurs Manag. 2010;18:938.

    Article  PubMed  Google Scholar 

  42. Pauksztat B, Grech MR. Building social support: the impact of workgroup characteristics, the COVID-19 pandemic and informal interactions. Work. 2022;72:1175–89.

    PubMed  PubMed Central  Google Scholar 

  43. Lapalme M-È, Tremblay M, Simard G. The relationship between career plateauing, employee commitment and psychological distress: the role of organizational and supervisor support. Int J Human Resour Manag. 2009;20:1132–45.

    Article  Google Scholar 

  44. Newman A, Thanacoody R, Hui W. The effects of perceived organizational support, perceived supervisor support and intra-organizational network resources on turnover intentions: a study of Chinese employees in multinational enterprises. Pers Rev. 2011;41:56–72.

    Article  Google Scholar 

  45. Akgunduz Y, Sanli SC. The effect of employee advocacy and perceived organizational support on job embeddedness and turnover intention in hotels. J Hosp Tour Manag. 2017;31:118–25.

    Article  Google Scholar 

  46. Dawley D, Houghton JD, Bucklew NS. Perceived organizational support and turnover intention: the mediating effects of personal sacrifice and job fit. J Soc Psychol. 2010;150:238–57.

    Article  PubMed  Google Scholar 

  47. Van Knippenberg D, Van Dick R, Tavares S. Social identity and social exchange: identification, support, and withdrawal from the job. J Appl Soc Psychol. 2007;37:457–77.

    Article  Google Scholar 

  48. Hobfoll SE, Freedy J, Lane C, Geller P. Conservation of social resources: social support resource theory. J Soc Pers Relat. 1990;7:465–78.

    Article  Google Scholar 

  49. Park J, Min H (Kelly). Turnover intention in the hospitality industry: a meta-analysis. Int J Hosp Manag. 2020;90:102599.

  50. Liu D, Yang X, Li Q, Shi L, Tang Q. Prevalence and associated factors of the career plateau of primary care providers in Heilongjiang, China: a cross-sectional study. BMC Fam Pract. 2021;22:1–9.

    Article  Google Scholar 

  51. Vogel RM, Feldman DC. Integrating the levels of person-environment fit: the roles of vocational fit and group fit. J Vocat Behav. 2009;75:14.

    Article  Google Scholar 

  52. Farh J-L, Tsui AS, Xin K, Cheng B-S. The influence of relational demography and Guanxi: the Chinese case. Organ Sci. 1998;9:471–88.

    Article  Google Scholar 

  53. Zhou L, Tetgoum Kachie AD, Xu X, Quansah PE, Epalle TM, Ampon-Wireko S, et al. COVID-19: the effects of perceived organizational justice, job engagement, and perceived job alternatives on turnover intention among frontline nurses. Front Psychol. 2022;13: 920274.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Tang Y, Dias Martins LM, Wang S, He Q, Huang H. The impact of nurses’ sense of security on turnover intention during the normalization of COVID-19 epidemic: the mediating role of work engagement. Front Public Health. 2022;10:1051895.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Yan H, Sang L, Liu H, Li C, Wang Z, Chen R, et al. Mediation role of perceived social support and burnout on financial satisfaction and turnover intention in primary care providers: a cross-sectional study. BMC Health Serv Res. 2021;21:1–9.

    Article  Google Scholar 

  56. Wang M, Chen M, Chen Z. The effect of relative deprivation on aggressive behavior of college students: a moderated mediation model of belief in a just world and moral disengagement. BMC Psychol. 2023;11:272.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Qiu R, Gong Y, Cao Y, You X, Zhu X. Influence of self-efficacy on male military pilots’ capability to handle special situations: a moderated mediation model. Sci Rep. 2023;13:10794.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Kim H-Y. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod. 2013;38:52.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychol Methods. 1996;1:16–29.

    Article  Google Scholar 

  60. Wongsuwan N, Na-Nan K. Mediating effects of self-efficacy, resilience and job satisfaction on the relationship between person-organisation fit and employee work adjustment. Sustainability. 2022;14:11787.

    Article  Google Scholar 

  61. Peng J-C, Lee Y-L, Tseng M-M. Person-organization fit and turnover intention: exploring the mediating effect of work engagement and the moderating effect of demand-ability fit. J Nurs Res. 2014;22:1–11.

    Article  PubMed  Google Scholar 

  62. Bao Y, Vedina R, Moodie S, Dolan S. The relationship between value incongruence and individual and organizational well-being outcomes: an exploratory study among Catalan nurses. J Adv Nurs. 2013;69:631–41.

    Article  PubMed  Google Scholar 

  63. Brown AD. Organisational culture. London Pitman; 1998.

  64. Bellou V. Identifying organizational culture and subcultures within Greek public hospitals. J Health Org Mgt. 2008;22:496–509.

    Article  Google Scholar 

  65. Identifying HG, Subcultures O. Identifying organizational subcultures: an empirical approach. J Manag Stud. 1998;35:1–12.

    Article  Google Scholar 

  66. Xu Y, Liu K, Chen K, Feng M. How does person-environment fit relate to career calling? the role of psychological contracts and organizational career management. Psychol Res Behav Manag. 2023;16:1597.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Gould-Williams JS, Mostafa AMS, Bottomley P. Public service motivation and employee outcomes in the Egyptian public sector: testing the mediating effect of person-organization fit. J Publ Adm Res Theory. 2015;25:597–622.

    Article  Google Scholar 

  68. Saks AM, Ashforth BE. A longitudinal investigation of the relationships between job information sources, applicant perceptions of fit, and work outcomes. Pers Psychol. 1997;50:395–426.

    Article  Google Scholar 

  69. Zhu H, Li M. Developing a prediction model of career plateau for nurses: a cross-sectional study. Nurs Open. 2023;10:7631–8.

    Article  PubMed  PubMed Central  Google Scholar 

  70. McCleese CS, Eby LT, Scharlau EA, Hoffman BH. Hierarchical, job content, and double plateaus: a mixed-method study of stress, depression and coping responses. J Vocat Behav. 2007;71:282–99.

    Article  Google Scholar 

  71. Kristof AL. Person-organization fit: an integrative review of its conceptualizations, measurement, and implications. Pers Psychol. 1996;49:1–49.

    Article  Google Scholar 

  72. Soda G, Zaheer A. A network perspective on organizational architecture: performance effects of the interplay of formal and informal organization. Strateg Manag J. 2012;33:751–71.

    Article  Google Scholar 

Download references

Acknowledgements

We sincerely express our gratitude to the participants of this study.

Funding

This project has received support from the Hebei Provincial Department of Human Resources and Social Security.

Author information

Authors and Affiliations

  1. Organization and Personnel Department, Children’s Hospital of Hebei Province, Shijiazhuang, China

    Qingwen Jia & Hao Yuan

  2. Graduate School, Hebei Medical University, Shijiazhuang, China

    Wenkang Shi

Authors
  1. Qingwen Jia
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Wenkang Shi
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Hao Yuan
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Q. J drafted the manuscript, conducted statistical analysis, and made revisions to the manuscript. W.S participated in the drafting and statistical analysis of the manuscript. H.Y participated in the manuscript revision and conducted a critical review of the knowledge content.

Corresponding author

Correspondence to Hao Yuan.

Ethics declarations

Ethics approval and consent to participate

The Medical Ethics Committee of Hebei Children’s Hospital approved the project, and the respondents expressed informed consent when participating in this survey.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jia, Q., Shi, W. & Yuan, H. The influencing factors of turnover intention among pediatric healthcare workers: a moderated mediation model. Hum Resour Health 23, 22 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12960-025-00989-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12960-025-00989-2

Keywords

Human Resources for Health

ISSN: 1478-4491