Exploring psychological pathways between workplace violence and burnout among nurses in Chinese Tertiary Hospitals

Nurse burnout is an escalating global concern and is often intensified by exposure to workplace violence (WPV). However, the psychological and behavioral pathways linking WPV and burnout remain insufficiently characterized. This study aimed to develop and test a model to examine the associations between WPV and nurse burnout; we tested statistical indirect paths via resilience and emotional labor and a conditional role of perceived organizational support. A cross-sectional survey was conducted from March to May 2025 among 549 clinical nurses from eight tertiary hospitals in Sichuan Province, China. Data were collected using structured questionnaires distributed via the Wenjuanxing online platform, covering demographic characteristics, WPV, resilience, emotional labor, burnout, and perceived organizational support. All statistical analyses were conducted in IBM SPSS Statistics 26.0. Indirect and moderation analyses were estimated in PROCESS v4.1 (Models 6 and 86) with 5,000 bootstrap resamples to obtain bias-corrected 95% confidence intervals; estimates are interpreted as associations. For the 549 participants, the MBI-HSS burnout score was 55.45 ± 21.31. Hierarchical regression showed that WPV was positively associated with burnout (β = 0.269, p < 0.001). Analyses indicated statistical indirect associations via resilience (β = 0.092, 95%CI 0.064-0.123) and via emotional labor (β = 0.031, 95%CI 0.012-0.053), and a significant sequential indirect pathway (β = 0.024, 95%CI 0.014-0.036). The interaction between emotional labor and perceived organizational support (POS) was significantly and negatively associated with burnout (β=-0.114, 95%CI - 0.185 to - 0.042), and POS conditioned the strength of the indirect associations. WPV was associated with higher burnout among nurses, with statistical indirect paths via lower resilience and higher emotional labor demands. A sequential indirect pathway was observed.Higher perceived organizational support was associated with attenuation of the positive association between emotional labor and burnout.Hospital managers are encouraged to implement comprehensive interventions focused on violence prevention, emotional labor training, and the development of organizational support systems.