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PR
49,5 Work–family conflict
and turnover intentions
among Chinese nurses
1140 The combined role of job and life satisfaction
Received 13 January 2019 and perceived supervisor support
Revised 14 August 2019
Accepted 22 September 2019 Yue Zhang
School of Economics and Management,
China University of Petroleum (Huadong), Qingdao, China
Muhammad Imran Rasheed
School of Management,
University of Science and Technology of China, Hefei, China and
Department of Management Sciences,
The Islamia University of Bahawalpur, Bahawalpur, Pakistan, and
Adeel Luqman
Department of Commerce,
Fatima Jinnah Women University, Rawalpindi, Pakistan

Abstract
Purpose – As the shortage of nurses is a major problem being faced by the world health-care system, it is
essential to investigate the factors that influence nurses’ turnover. Drawing on the conservation of resources
theory, the purpose of this paper is to explore how work–family conflict (WFC) influences nurses’ turnover
intentions in the Peoples’ Republic of China.
Design/methodology/approach – For empirically testing the theoretical model, the authors conducted a
three-wave longitudinal research survey and collected data from 236 nurses’ sample in China.
Findings – The findings show that job satisfaction and life satisfaction are the underlying psychological
reasons in the positive relationship between WFC and nurses’ turnover intentions. Moreover, perceived
supervisor support was found to be a boundary condition on the direct and indirect relationships between
WFC and its negative outcomes such that the relationships are weak at the high levels of supervisory support.
Originality/value – This study is important to the management of health-care systems as it carries
significant implications for theory and practice toward understanding job retention problems of nurses.
Keywords Quantitative, Turnover intention, Work–family conflict, Job satisfaction
Paper type Research paper

Introduction
Nursing is considered as a critical job in the health-care system around the world (Ekici et al.,
2017). However, the world health-care system is confronted with a huge shortage of nurses
(Kovner et al., 2016; Leineweber et al., 2016). China is the world’s most populous country, still it
is badly affected with the nurses’ shortage (Feng et al., 2017). According to the National Health
Commission of China, the ratio of registered nurses per thousand population was only 2.74 at
the end of the year 2017. The shortage of nurses puts negative impact on the overall quality
and productivity of the health-care system; therefore, maintaining a sufficient nursing
workforce has become an international priority (WHO, 2013).
Personnel Review Nurses shortage may cause patient medication errors (Kouatly et al., 2018), patient
Vol. 49 No. 5, 2020
pp. 1140-1156
dissatisfaction (Stimpfel et al., 2012), decrease incivility (Smith et al., 2018) and reduce work
© Emerald Publishing Limited
0048-3486
efficiency (Rosseter, 2014). It is, therefore, important to understand factors that influence
DOI 10.1108/PR-01-2019-0017 nurses’ turnover in the health-care system. To study the factors that influence employee
turnover in organizations, a significant amount of research has focused on the relationship Work–family
between work and family over the past decades (Liu et al., 2015). Research has found that the conflict and
conflict between work and family does not only cause negative consequences in the family turnover
domain, but it also puts a harmful impact on work domain (Odle-Dusseau et al., 2012; Wayne
et al., 2017). According to the gender role perspective, women are considered more responsible intentions
for family and home maintenance (Gutek et al., 1991). Nurses are, therefore, likely to experience
the high level of work–family conflict (WFC) as nursing is a female-dominated occupation 1141
(Shen-Miller and Smiler, 2015). Some recent scholars have identified WFC as an important issue
in nursing jobs (Anafarta, 2011; Yildirim and Aycan, 2008). For instance, Grzywacz et al. (2006)
reported that 50 percent of nurses experienced WFC. It is, therefore, highly relevant to examine
the role of WFC in the nursing profession (Yildirim and Aycan, 2008).
Drawing on the cross-national differences in WFC, Spector et al. (2007) argue that the role of
culture is important in understanding the impact of WFC in organizations. They found WFC as
a more significant issue in individualistic cultures as compared with collectivistic cultures. They
believe that exploring the role of WFC in Asia where work demands and high workloads are
perceived differently (a job contributing to family rather than competing with it) is important as
most of the studies in this context belong to individualistic cultures. Similarly, the theory of
contextualization ( Johns, 2006) argues that context is significant in research in organizational
behavior. Contextualization theory suggests that the context has an important impact on
organizational behavior; therefore, research in the field of OB can be better explained by
contextualizing. John (2006) further discussed that organizational characteristics and culture
provide a good context for individual members. Drawing on the assumptions of the theory of
contextualization, we argue that the relationship between WFC and job and life satisfaction have
been previously studied in OB, but the context of nursing profession is important to explore in
Asia where industry is currently facing a major issue of high turnover of the nursing staff.
We draw our assumptions on the conservation of resources (COR) theory (Hobfoll, 1989)
and believe that WFC may lead to nurses’ turnover intentions in the Chinese health-care
system. As such, WFC is negatively related with job satisfaction and life satisfaction of
nurses. For instance, when nurses experience WFC, they are likely to attribute it to their jobs
and working conditions and feel less satisfied at work (Spector et al., 2007; Yildirim and
Aycan, 2008). In addition, WFC arises when work interferes with family domain which
further contributes to life satisfaction ( Judge et al., 1994). Less satisfaction with job and life
is likely to result in high turnover intentions among nurses (Demerouti et al., 2000; Lu et al.,
2016). We assume that although WFC may have a less harmful impact on employees in
collectivistic cultures (Spector et al., 2007), still the nature of nursing job that includes longer
working hours, night duties and less salary may cause work interfering family, which leads
to several negative consequences such as quitting the current job.
We further take supervisor support as a moderator on the relationships between WFC
and its negative outcomes, and we assume that the relationships between WFC and its
negative outcomes are weaker when the nurses getting high support from their supervisors.
Our assumption regarding the boundary condition role of supervisor support is consistent
with COR theory (Hobfoll, 1989), which presumes that the resource gain from another
domain is likely to make up for the resource loss in one domain. We believe that when
individuals are encountered with loss of recourse in terms of conflict in their work and
family, the support from the supervisors would work as a resource gain that has the
potential to offset the negative impact of WFC. This assumption is also consistent with the
buffering model of social support (Cohen and Wills, 1985) that assumes that social support
buffers the negative impact of work stressors in organizations.
The purpose of the current research was three-fold: to examine whether WFC influences
nurses’ turnover intentions in Chinese health-care system, to investigate job satisfaction and life
satisfaction as the underlying psychological mechanisms in the relationship between WFC and
PR nurses’ turnover intentions and to examine the moderating role of perceived supervisor support
49,5 (PSS) on the relationship between WFC and its negative outcomes. The current study extends
the literature on WFC and turnover intentions among nursing industry in China, which is
recently facing a major issue of high turnover among nurses. Investigating a unique sample
from the nursing profession in Asia is, therefore, a major contribution this study makes to realize
the role of context in OB. Second, we explain the underlying psychological mechanisms in the
1142 form of life satisfaction and job satisfaction between WFC and turnover intention. Given that
previous studies have explored the link between work–family and turnover intentions, however,
few studies have investigate the underlying process that explains how WFC is related to nurses’
turnover intentions. Third, we identify supervisor support as a critical boundary condition on
the relationships between nurses’ WFC and its negative outcomes. Finally, an important
contribution of this study is related to our methodology. In contrast with the majority of
previous research studies, we adopted a time-lag research design and conducted a three-wave
research survey to comprehensively explore the mechanism.

Theory and hypotheses development

WFC and turnover intentions among Chinese nurses
Work and family are the two important life domains for most adults to juggle with (Clark,
2000). A conflict arises when individuals cannot balance the demands of functioning in these
two domains (Greenhaus and Beutell, 1985). With the changes in gender-roles and working
conditions, the conflicts between work and family are increasing (Ghislieri et al., 2017). The
issue of WFC is especially important for the nursing profession (Cortese et al., 2010), where
scholars have suggested that work interfering with family may have a significant impact on
performance and turnover intentions, as well as the health and well-being of nurses
(Chen et al., 2015; Wang and Tsai, 2014).
We believe that WFC is a source of stress among nurses which may affect their mental
capacity in serving the organizations (Hon et al., 2013). COR theory (Hobfoll, 1989) explains
that loss of resources causes stress among individuals which further leads to negative
outcomes. We believe that WFC as a major stressor for nurses reduces their psychological
resources leading them to quit their jobs. When facing WFC at work, nurses may believe
that leaving the current job is a better solution in dealing with the conflict.
Person-environment fit theories (Holland, 1973) further help us to explain the relationship
between WFC and nurses’ turnover intentions. According to P-E fit theories (Holland, 1973),
WFC may cause nurses to leave hospitals and find a new job, which may be viewed as a way
to cope with their mismatched situation. Anderson and Berdahl (2002) has discussed that
when individuals experience ongoing and unresolved WFC, they may believe that finding
another job may be a better solution to the problem. Turnover intention is described as a
conscious and deliberate willfulness to leave the organization and is supposed to be the
immediate precursor to actual turnover (Van Dam et al., 2013). Scholars have investigated the
positive relationship between WFC and turnover intentions in other contexts and professions
(Battistelli et al., 2013; Chen et al., 2015). Based on the above theoretical insights and past
empirical research in other contexts, therefore, we assume that in the nursing profession, WFC
may be positively related to turnover intentions. Here, we hypothesized that:
H1. WFC is positively related to turnover intentions among Chinese nurses.

Mediating role of job and life satisfaction

Job satisfaction is defined as “a pleasurable or positive emotional state resulting from the
appraisal of one’s job” (Locke, 1976, p. 1304). Spector (1997) described job satisfaction as an
extent to which people like or dislike the job. He further elaborated that job satisfaction is an
attitude that is based on employees’ work that should be taken as an extent to which
individuals feel about the extrinsic and intrinsic characteristics of their jobs. Individuals
who have a high level of job satisfaction are more likely to show high commitment to the Work–family
organization (Yousef, 1998). Researchers have found that employees having high job conflict and
satisfaction have less tendency to search for a new job (Babin and Boles, 1996). turnover
When nurses experience WFC, they are likely to attribute it to their working conditions
and feel less satisfied with their jobs (Spector et al., 2007; Yildirim and Aycan, 2008). We intentions
argue that WFC is negatively related to job satisfaction of nurses, which is subsequently
associated with their turnover intentions in the Chinese health-care system. Our assumption 1143
is consistent with COR theory (Hobfoll, 1989) that presumes stress arising from a loss of
resources leads to further negative outcomes at jobs. We believe that individuals face a loss
of psychological resources in terms of high WFC and less job satisfaction leading them with
the intention of leaving their jobs. Coomber and Barriball (2007) has also suggested a
negative relationship between job satisfaction and nurses’ turnover intentions. Empirical
research has found a relationship between job satisfaction and turnover intentions in other
professions, such as salesperson (Pettijohn et al., 2008), doctors and policeman (Brunetto
et al., 2012). Drawing on these arguments, we hypothesized that:
H2a. WFC is negatively related to nurses’ job satisfaction.
H2b. Job satisfaction is negatively related to nurses’ turnover intentions.
H2c. Job satisfaction mediates the positive relationship between nurses’ WFC and
turnover intention.
A situation in which an individual faces work interfering family indicates that the person has a
difficulty in meeting the demands of family due to his work role, either a longer time spent at
work or the stress which he brings to home from the work (Spector et al., 2007). Such a situation
causes a depletion of resources that may further lead to a negative state such as low level of life
satisfaction (Goh et al., 2015). Past research has shown that high WFC is related to a number of
negative physical and psychological outcomes from both work and non-work domains such as
low job satisfaction (Bruck et al., 2002), low job performance (Van Steenbergen and Ellemers,
2009), negative emotions ( Judge et al., 2006) and less marital and family satisfaction (Aryee et al.,
1999; Rupert et al., 2012). When individuals feel less satisfied with life because of work, they may
perceive that the changing of their job is instrumental to a better life. Given that turnover may be
a way to manage a less satisfied life, the higher the degree to which a job is the reason why
individuals have low life satisfaction, the more possibly individuals will leave the job (Erdogan
et al., 2012). However, the empirical studies have shown mixed results ranging from a non-
significant (Harris and Cameron, 2005) to significant relationships of life satisfaction with
employee turnover intentions (De Cuyper et al., 2009).
Perrewé et al. (1999) suggested that “the extent to which a job helps a worker to attain life
values” explains the relationship between WFC and workers’ life satisfaction. In this study,
we, however, argue that WFC is the reason why nurses have less life satisfaction and this
less satisfaction with life may lead to a higher turnover intention among them. Our
assumption is consistent with COR (Hobfoll, 1989) theory which implies that workplace
stressors create strain that lead to negative “state of being” like less satisfaction, and this
may further lead to more negative outcomes for individuals in organizations. Here we can
explain that WFC is a kind of stressor that may lead an individual into a negative state of
being, such as a low level of life satisfaction, and this less satisfaction with life will further
result in turnover intentions for nurses. Considering life satisfaction as the underlying
psychological mechanism in the relationship between nurses’ works family conflict and
turnover intentions, we intend to answer the question of how WFC inserts impact on
employee turnover intentions in organizations. Here, we hypothesized as:
H3a. WFC is negatively related to nurses’ life satisfaction.
PR H3b. Life satisfaction is negatively related to nurses’ turnover intentions.
49,5 H3c. Life satisfaction mediates the positive relationship between nurses’ WFC and
turnover intention.

Moderating role of perceived supervisor support

1144 WFC is a situation where meeting the job demands deplete resources (e.g. time, energy and
emotions) required to participate in a family role (Kossek et al., 2011). We propose that PSS,
defined as perceptions that one’s supervisor values his/her contributions and shows care for
his/her well-being (Eisenberger et al., 2002), can provide new resources that may help them
to deal with their work and family demands. When individuals feel supported by their
supervisors at work, they perceive that they have access to get help in verse situations
(Kossek et al., 2011). Researchers argue that people seek social support from the individuals
around them, which gives them the feeling of being a group member, feelings of value and
belongingness (Sarafino and Smith, 2014).
Research has described different types of social support, for example, emotional support
that is sympathy, affirmative support which is in the form of idea recognition and tangible
support, for example, money, information and advice, etc. (Antonucci and Jackson, 1990).
Cohen and Wills (1985) proposed a buffering hypothesis of social support and argued that
social support helps people in dealing with the negative impact of stressors. For instance,
some studies (Ng and Sorensen, 2008; Shakespeare-Finch and Obst, 2011) have suggested
several sources of social support including family, friends, co-workers and supervisor.
However, when an employee is confronted with WFC in the work-domain, a supervisor
should be considered as the primary source of social support and has the potential to
instrumentally help his/her subordinates maintaining satisfaction and retaining the
current job.
On the contrary, Seiger and Wiese (2009) believe that social support is more like an
antecedent of WFC than being a moderator. We, however, argue that perceived supervisor
support increases individuals’ psychological resources, which help them in coping with
stressors, and thus individuals having high support from their supervisors may better deal
with the problems arises from WFC. An instrumental support from the supervisor in the
workplace may help individuals to better deal with the work demands, especially
considering that supervisor is directly responsible for his/her subordinates’ work in
organizations (Hammer et al., 2009). To summarize, when individuals have more PSS, they
will have more resources to deal with the problems of WFC, maintaining his/her job and life
satisfaction and retaining their current jobs. Our assumption is consistent with the famous
buffering hypothesis of social support (Cohen and Wills, 1985) as well as COR (Hobfoll,
1989) theory. Buffering model of social support that has been empirical tested in several past
studies assumes that social support buffers the negative impact of stressors, for instance,
WFC. On the other hand, COR theory (Hobfoll, 1989) assumes that individuals gain and
protect their resources and psychological stress happens when these resources are lost or
are threatened, individuals try to replenish their stress of lost or threatened resources with a
resource gain from another source. Therefore, COR theory implies that resource gain can
help individuals buffer to against stress.
As noted earlier, PSS is a type of resource that can help individuals to deal with the
problems of WFC. As a resource gain from PSS will offset the negative impact of resource
loss caused by WFC, and thus individual’s job satisfaction and life satisfaction may be less
influenced by WFC if they have more supervisor support. Especially, since China is
characterized as a collectivistic culture, supervisor support may be more instrumental in
weakening the negative impact of WFC for nurses. Empirical research has also confirmed
the moderating effects of other sources of support (e.g. coworkers, community, financial and
organization) on the relationship between WFC and it consequence (Martins et al., 2002; Work–family
O’Driscoll et al., 2003). Therefore, we hypothesized that: conflict and
H4a. PSS moderates the relationship between WFC and job satisfaction such that the turnover
relationship between WFC and job satisfaction is weaker at the higher level of PSS. intentions
H4b. PSS moderates the relationship between WFC and life satisfaction such that the
relationship between WFC and life satisfaction is weaker at the higher level of PSS. 1145
Till this point, we have developed theoretical explanations for the mediating role of job
satisfaction and life satisfaction and the moderating role of PSS. That is, job satisfaction and
life satisfaction mediate the relationship between nurses’ WFC and turnover intentions in
health care system, and PSS moderates the relationships between occupational stress in the
form of WFC and its negative impact on nurses’ job and life satisfaction and turnover
intentions such that the relationships are weak at the higher levels of supervisor support.
The theoretical reasoning behind these hypotheses, as well as above discussion on the
buffering role of PSS, further suggests an integrated moderated mediation model.
Specifically, PSS may moderate the indirect relationships between WFC and nurses’
turnover intentions through job satisfaction and life satisfaction. Both indirect relationships
will be weak for the nurses perceiving high supervisor support in the health care system,
consequently, we suggest integrated moderated mediation hypotheses such as:
H5a. PSS moderates the relationship between WFC and turnover intentions through
job satisfaction such that the mediated relationship is weaker at the higher level
of PSS.
H5b. PSS moderates the relationship between WFC and turnover intentions through life
satisfaction such that the mediated relationship is weaker at the higher level of PSS.

Method
Study design and participants
An online survey was conducted in three waves in Anhui province of China from January
2017 to June 2017. During the first phase of our survey, with the help of China association
for science and technology, we distributed 2,450 self-report electronic questionnaires
through e-mails to the nurses working in seven tertiary hospitals in the Anhui province of
China. The participants were required to rate the measures on WFC, PSS and demographics,
including age, gender, marital status, and tenure in the current organization. We received
353 responses indicating a 14.4 percent response rate (which is considered a reasonable
response rate in such kind of survey methods, Hofmann and Stokburger-Sauer, 2017). After
three months, these 353 nurses were contacted for the second phase of our survey to provide
us the ratings of job satisfaction and life satisfaction and we received response during this
second wave from 288 participants who were contacted again after three months for the
third time to obtain the measure of their turnover intentions and here we received 236 final
usable responses. Of the 236 nurses 231 were females, 55.93 percent were married, and 28.39
percent were in the age group of 30–35 years, while their average working duration in the
same hospital was 14.97 months (Table I).
At the beginning of the survey, respondents were ensured about confidentiality and
about the purpose of research as academic only. In order to enhance the response rate, a
cash prize reward of RMB1,500 was also announced to be given through a lottery
to the winning participant who will participate in all three phases of our survey. We believe
that this cash prize announcement helped us in getting a good response rate in this
online survey.
PR Variable Frequency Percentage
49,5
Age
Less than 25 49 20.76
25–30 43 18.22
30–35 67 28.39
35–40 54 22.88
1146 40–45 17 7.20
More than 45 06 2.54
Gender
Male 05 2.12
Female 231 97.88
Marital status
Table I. Single 124 52.54
Characteristics of Married 132 55.93
participants Note: n ¼ 236

Measures
Surveys were administered in the Chinese language after translating all scales from the
English language by following the back-translation procedure as recommended by Brislin
(1980). All the scale items were rated on a five-point response ranging from “1 ¼ strongly
disagree to 5 ¼ strongly agree.”

Work–family conflict (WFC)

WFC was measured with nine items developed by Carlson et al. (2000), including time-based,
strain-based, and behavior-based WFC. A sample item is “the time I must devote to my job
keeps me from participating equally in household responsibilities and activities.”
Cronbach’s α for this scale in our study was found as 0.94.

Job satisfaction
Job satisfaction was assessed with the three items from Cammann et al. (1979). A sample
item is “All in all, I am satisfied with my job.” Cronbach’s α for this scale in the current study
was found as 0.87.

Life satisfaction
Life satisfaction was measured by the six items scale from Diener et al. (1985). Items were
adapted to reflect an overall assessment, for example, “In most ways my life is close to my
ideal” and “I am satisfied with my life.” Reliability of α for this scale in our study was found
as 0.87.

Turnover intention
The turnover intention was measured with three items developed by Mitchell et al. (2001). A
sample item is “do you intend to leave the hospital in the next 12 months?” Cronbach’s α for
this scale in the current study was found as 0.92.

Perceived supervisor support

Consistent with previous efforts to measure PSS (Eisenberger et al., 2002), we adapted five
items from Survey of Perceived Organizational Support scale to assess employees’ perceived
value and care for by their supervisor by the way of replacing the word organization with
the supervisor. A sample item is “my supervisor is willing to listen to my job-related Work–family
problems.” Cronbach’s α for this scale in our study was found as 0.95. conflict and
turnover
Demographic variables intentions
We also measure the demographic characteristics of the participants, such as age, gender,
marital status, and the tenure of current job. Age was coded as 1 ¼ “under 30 years old,”
2 ¼ “between 30 and 50 years old” and 3 ¼ “over 50 years old.” Gender as 1 ¼ “male” and 1147
2 ¼ “female.” Tenure in terms of working in the current hospital was required in actual
numbers of months.

Analysis and results

Before proceeding with hypotheses testing, we conducted a series of confirmatory factor
analyses to examine the distinctiveness of WFC, PSS, job satisfaction, life satisfaction and
turnover intentions. The hypothesized five-factor model fits the data satisfactorily
(w2 (199) ¼ 655.94, CFI ¼ 0.96, TLI ¼ 0.95, RMSEA ¼ 0.06). All factor loadings were
statistically significant ( p o0.001). Standardized factor loadings for WFC were ranging
from 0.82 to 0.94, for job satisfaction ranging from 0.76 to 0.85, for life satisfaction ranging
from 0.76 to 0.85, for PSS ranging from 0.83 to 0.93 and for turnover intentions ranging from
0.87 to 0.92. Hence, results indicate that our measures capture adequate reliability standard.
Table II shows means, standard deviations and correlations of all study variables. As
expected T1 WFC was significantly correlated with T2 job satisfaction (r ¼ −0.27, p o0.01),
T2 life satisfaction (r ¼ −0.29, p o0.01) and T3 turnover intention (r ¼ 0.15, p o0.01), while
T2 job satisfaction (r ¼ −0.38, p o 0.01) and T2 life satisfaction (r ¼ −0.30, p o0.01) were
significantly correlated with T3 turnover intentions.
We tested our H1–H3 with hierarchical multiple regression and H4–H5 with hierarchical
moderated regressions. In all analyses, we entered age and tenure as the control variables as
in our preliminary analysis we found a significant relationship between these demographics
and the main constructs of our study. The regression results are reported in Table III.
H1 proposed that WFC is positively related to turnover intentions among Chinese
nurses. Results of Model 6 show that, T1 WFC (β ¼ 0.20, po 0.01) was positively related to
T3 turnover intentions. Thus, H1 is supported. Model 2 in Table III shows that, T1 WFC
was negatively related to T2 job satisfaction (β ¼ −0.32, p o0.001), which provided support
for H2a. Model 4 in Table III reports that T1 WFC was negatively related to T2 life
satisfaction (β ¼ −0.32, p o0.001), thus providing a support for our H3a. In Model 6 in
Table III, T2 job satisfaction (β ¼ −0.35, p o0.01) and T2 life satisfaction (β ¼ −0.10,
p o0.01) were negatively related to T3 turnover intentions, supporting our H2b and H3b.

Variable M SD 1 2 3 4 5 6 7 8

1. Gender na na
2. Age 4.15 1.87 0.04
3. Tenure 14.97 9.63 −0.01 0.79**
4. Marital status na na 0.11** −0.11** −0.10**
5. T1WFC 3.95 1.02 −0.02 0.10 −0.07 0.02
6. T2 job satisfaction 3.57 0.73 −0.03 0.08* 0.03 0.01 −0.27**
7. T2 life satisfaction 3.88 0.95 −0.04 0.14** 0.12** 0.02 −0.29** 0.61**
8. T1 PSS 3.63 0.89 0.07 −0.03 −0.02 0.01 −0.28** 0.62** 0.39**
9. T3 turnover 2.05 0.89 −0.05 −0.17** −0.11** −0.03 0.15** −0.38** −0.30** −0.29** Table II.
intention Means, standard
Notes: n ¼ 236. PSS, perceived supervisor support. Tenure in actual number of months. *p o0.05; **p o 0.01 deviations,
(two-tailed) correlations
PR T2 job satisfaction T2 life satisfaction T3 turnover intention
49,5 Variable Model 1 Model 2 Model 3 Model 4 Model 5 Model 6

Age 0.17* 0.21** 0.13* 0.18** −0.23** −0.14**

Tenure −0.11 −0.17* 0.03 −0.04 0.11 0.05
T1 WFC −0.32*** −0.32*** 0.20** 0.06
T2 job satisfaction −0.35**
1148 T2 life satisfaction −0.10*
R2 0.01 0.11 0.02 0.13 0.08 0.26
Table III. R2 change 0.10 0.11 0.18
Regression results F-value 3.22 23.94*** 7.06 29.37*** 16.15*** 40.59***
for mediation Notes: n ¼ 236. *p o0.05; **p o0.01; ***p o0.001

Furthermore, results of Model 6 in Table III show that after T2 job satisfaction and T2 life
satisfaction were taken into account, the effects of T1 WFC (β ¼ −0.06, ns) become
insignificant, which suggests full a mediation of job satisfaction and life satisfaction in the
relationships between T1 WFC and T3 turnover intentions.
To further assess the significance of the mediation, we estimated the direct effect,
indirect effect and total effect, and their confidence intervals through bootstrapping with
5,000 iterations, which is considered as a more powerful way than the causal step procedure
(Preacher and Hayes, 2008). Results indicated that the indirect effect of T1 WFC on T3
turnover intention was significant through T2 job satisfaction (γ ¼ 0.09, 95% CI ¼ [0.05,
0.13]), and the indirect effect of T1 WFC on T3 turnover intention through T2 life
satisfaction was also significant (γ ¼ 0.03, 95% CI ¼ [0.01, 0.06]). The total effect of T1 WFC
(γ ¼ 0.14, 95% CI ¼ [0.07, 0.22]) on T3 turnover intention was also significant. Taken
together, H2c and H3c that job satisfaction (H2c) and life satisfaction (H3c) would mediate
the relationship between T1 WFC and T3 turnover intention were supported.
H4 proposed that PSS moderates the relationship between T1 WFC and T2 job
satisfaction (H4a), as well as T2 life satisfaction (H4b). Table IV shows that the interaction
term for WFC with PSS (β ¼ −0.07, p o0.001, Model 2, Table IV ) was significant in
predicting job satisfaction. Thus, H4a was supported. In contrast, the interaction term for
WFC with PSS (β ¼ −0.06, ns Model 4, Table IV ) on life satisfaction was not significant,
which means H4b was not supported.
We further plotted simple slopes to examine the form of the interaction using the
Johnson–Neyman technique developed by Bauer and Curran (2005). The plot is presented in
Figure 1 which illustrates that WFC is only negatively related to job satisfaction at high
levels of PSS (β ¼ −0.21, p o0.01), but not at low levels (β ¼ −0.02, ns).
H5 predicted that the indirect effects of T2 job satisfaction (H5a) and T2 life satisfaction
(H5b) for WFC to turnover intentions relationship would be weakened with the higher levels

Job satisfaction Life satisfaction

Variable Model 1 Model 2 Model 3 Model 4

Age 0.21** 0.21** 0.17** 0.17*

Tenure −0.14* −0.13* −0.02 −0.02
T1WFC −0.15*** −0.14*** −0.22*** −0.21***
T1 PSS 0.59*** 0.60*** 0.35*** 0.36***
WFC×PSS −0.07* −0.06
2
R 0.42 0.43 0.25 0.25
Table IV. R2 change 0.01 0.01
Moderated multiple F-value 102.46*** 83.52*** 46.13*** 37.55***
regression analyses Note: *,**,***Significant at 0.05, 0.01 and 0.001, respectively
 4.5 Work–family
4 conflict and
turnover
3.5
intentions
3
Job satisfaction

2.5 1149
2

1.5

1 Figure 1.
Low PSS
Interaction of WFC
0.5 High PSS and perceived social
support on
0 job satisfaction
Low WFC High WFC

of PSS. However, H4b was not supported, thus, H5b also did not get a support. To assess
moderated mediation we examined the different conditional indirect effects of WFC on
turnover intentions, via job satisfaction, across low and high levels of PSS. Following
Preacher et al.’s (2007) recommendation, we operationalized high and low levels of PSS as
one standard deviation above and below the mean score of PSS variable. Results show that
the conditional indirect effects of WFC were stronger and significant in high PSS (γ ¼ 0.05,
p o0.01) but were weaker and not significant in low PSS (γ ¼ 0.01, ns). Thus, we get support
for our H5a.

Discussion
Drawing on COR (Hobfoll, 1989) theory, we investigated the relationship between WFC and
turnover intentions through job satisfaction and life satisfaction, and the role which PSS
plays in moderating relationships in a sample of Chinese nurses. Our results have shown
that the relationship between WFC and turnover intention was fully mediated by job
satisfaction and life satisfaction. Our results also indicated that PSS has a moderating
impact on the relationships between WFC and its negative outcomes, such as job
satisfaction and turnover intentions. However, the moderating effect of PSS on the
relationship between WFC and life satisfaction was not found.
Our study helps to understand better how WFC is positively related to individuals’
turnover intentions in Chinese culture. The results have confirmed that WFC is a potential
predictor of job satisfaction, life satisfaction and turnover intentions, which is in line with
other studies on this subject (Chen et al., 2015; Yildirim and Aycan, 2008). Moreover, this
study explored important mediating mechanisms that the job and life satisfaction in the
relationship between WFC and nurses’ turnover intentions. Our findings imply that when
heavy work demands (i.e. high work overload and tough work schedules) interfere with the
performance of the family role, nurses may less satisfied, which, in turn, leads to nurses
intend to quit their current jobs. As we conceptualized WFC as a stressor, our results are
consistent with the findings of previous studies (Lo et al., 2018; Yousaf et al., 2019) that
stress leads to turnover intentions through job satisfaction.
Another interesting finding of our study is that life satisfaction is negatively related to
nurses’ turnover intentions. Although some past research has suggested that the turnover
intention of nurses is less likely to be influenced by their life satisfaction (Erdogan et al., 2012),
PR our study has found different result where life satisfaction is significantly and negatively
49,5 associated with nurses’ turnover intentions. This finding may be taken in line with the studies
such as Lai et al. (2008) who found that happiness is significantly associated with an intention
to leave, while a conceptual and empirical similarity has been found between happiness and
life satisfaction (Cohn et al., 2009). We introduced a new path from nurses’ WFC to turnover
intentions through their life satisfaction and got supporting results from our empirical survey.
1150 It indicated that when nurses perceived the work demands as a threat to their life satisfaction,
they may take actions, including leaving the current job for getting rid of WFC and regaining
their life satisfaction. Combining with the mediation effect of job satisfaction and life
satisfaction, the direct effects between WFC and turnover intentions become insignificant.
Therefore, we can confirm that the two variables (i.e. job satisfaction and life satisfaction)
play an important mediation role, answering our question of how WFC may lead toward
turnover intentions.
Additionally, our results confirmed that PSS has a significant effect on WFC and job
satisfaction. This finding is consistent with the previous research findings that supervisory
support had a direct effect on employee outcomes (Anderson and Berdahl, 2002). The
correlation between PSS and WFC, as well as job satisfaction, is stronger than what was
explicitly found about work–family support in previous studies by Cortese et al. (2010) and
Yildirim and Aycan (2008). It is not surprising that PSS plays an important role in the
relationship between WFC and job satisfaction of nurses working in China, where a culture
that interpersonal harmony and the guanxi with one’s supervisor are strong social values
(Bond and Hwang, 1986). We found the moderating role of PSS on the relationship between
WFC and job satisfaction is consistent with the assumptions of buffering hypothesis of
social support (Cohen and Wills, 1985), which suggests that social support may buffer the
negative impact of stress. Moreover, this finding can also be explained through the lens of
COR theory (Hobfoll, 1989), which presumes that the resource gain can offset the negative
impact of resource loss. In our study, we can explain that resource gain in the form of
supervisor support can offset the negative impact of resource loss for nurses when they are
facing WFC. We, however, did not get support for the moderation of PSS on the
relationships between WFC and life satisfaction. A potential explanation to this result may
be that as supervisors belong to an employee’s work domain their support also helps them
in the same domain and the effect of a support form supervisor is not very strong on an
employee’s family-related issues. Therefore, in order to offset the negative impact of WFC
on employees’ life satisfaction, they may need support from family and friends. In the WFC
literature, there is an ongoing debate about the role of social support whether it is antecedent
of WFC or a moderating variable on the relationship between WFC and its negative
outcomes (Seiger and Wiese, 2009). Our study found the moderating role of PSS on the
relationship between WFC and job satisfaction such that the relationship is weak at the
higher levels of supervisor support. Therefore, we recommend social support, in the form of
supervisors’ support, as a good moderator that weakens the relationship between WFC and
its negative outcomes. As explained earlier, our finding is consistent with COR theory
(Hobfoll, 1989) as well as the buffering hypothesis of social support (Cohen and Wills, 1985).
The finding regarding the moderating role of supervisor support is also in line with the
findings of recent empirical studies. For instance, Li et al. (2015) found that supervisor
support can moderate the relationship between FWC and job satisfaction, as well as life
satisfaction. Wang and Tsai (2014) found that social support moderates the relationship
between WFC and performance of employees.
This finding has more relevance with Asian context, as our study investigated a sample
from China which is characterized as collectivistic culture, so we can understand how
supervisor support as a moderator that weakens the negative impact of WFC on turnover
intentions. We believe that supervisor support is influential in weakening the negative
impact of WFC in a collectivistic culture. Investigating a unique sample from a collectivistic Work–family
culture has made a major contribution in understanding the role of context as suggested by conflict and
the theory of contextualization ( Johns, 2006). Integrating COR theory (Hobfoll, 1989) and turnover
buffering hypothesis of social support (Cohen and Wills, 1985), our research is an extension
to a different population in a collectivistic culture. The Chinese sample is also important for intentions
this study as past research has shown high turnover as a major issue for the nursing
profession in China. 1151
Practical implications
This study does not only carry theoretical contribution to the nursing literature, but it also
helps the human resource managers to improve HR management strategies in reducing
nurses’ turnover, which specifically in China and generally in any country that is facing
similar issues. The health-care managers and the direct supervisors of nurses should
understand the severity of the negative impacts associated with nurses’ WFC. They should
realize how WFC may result in high turnover intentions among nurses by negatively
affecting their life and job satisfaction. Past studies have indicated turnover intentions as a
major issue related to the nursing workforce in China (Feng et al., 2017). Our findings,
therefore, carry valuable lessons for managers in health-care systems who want to
understand the antecedents of nurses’ turnover. The mediating roles of job and life
satisfaction in the relationship between WFC and turnover intentions found in our research
help us understand how WFC exerts its impact on nurses’ turnover intentions. This is an
important finding in a way that health-care managers should not only devise a strategy for
reducing WFC, but they should also pay good attention to develop strategies that can
strengthen the nurses’ job satisfaction and life satisfaction, which is influential in reducing
their turnover intentions.
The moderating role of PSS identified in this study is highly important for the
management of the health-care system who deal with the job retention issue of nurses. Our
study has shown that supervisors can buffer the negative impact of WFC on nurses’
retention. Similarly, supervisors and health-care organizations should try to develop the
supporting work environment in hospitals where direct supervisors should help nurses in
dealing with their WFC issues. This finding also implies that health-care systems should
reward supporting supervisors. The hospitals should, therefore, reward their supporting
managers with financial and non-financial recognition in order to enhance support from
supervisors toward their nursing staff. This study also carries an important finding for
nurses who are facing issues of WFC and satisfaction with their job and life. Nurses in the
health-care system who are facing such an issue may strive for gaining support from their
supervisors in order to eliminate the negative impact of WFC on their jobs. Another way for
enhancing supervisor support in the health-care system is by providing training to the
supervisors, as well as to the nurses for enhancing social networking in hospitals that aims
to provide and seek more social support.

Limitations of the study and future directions

A three-wave longitudinal research design strengthens this study, but still, it has some
limitations. The first limitation is about generalizing the findings of our study to other
countries and cultures as the entire sample of our study belongs to one country that is
China. We believe that these findings could be similar in other countries characterized with a
collectivistic culture, but it could be different in an individualistic culture. Some cross-
culture comparative research will also be of great value. Second, identification of job and life
satisfaction as mediators in the relationship between WFC and turnover intentions of nurses
merits the investigation of more outcomes of job and life satisfaction of nurses other than
turnover intentions. Third, this study has explored PSS as a moderator on the relationship
PR between WFC and its negative outcomes. However, other types of social support, such as
49,5 spousal support, family support and coworkers’ support, may also be investigated.
Especially, as we did not find a significant moderating role of supervisor support on the
relationship between WFC and life satisfaction, future research could find the significant
moderator of social support on the relationship between WFC and life satisfaction.
Moreover, although the turnover intention is considered as a predictor of actual turnover in
1152 organizations (Han et al., 2015), an individual having turnover intention may still not leave
the organization due to several factors such as non-availability of good external
opportunities. Therefore, a research study measuring the actual turnover of nurses would
carry good value.
As we have already pointed out the ongoing debate on social support as an antecedent of
WFC or a moderator on the relationship between WFC and its outcomes, future research can
theorize and test social support as an antecedent of WFC or work–family facilitation for
nurses. We did not collect information on participants’ number of children and their ages,
however, we believe that WFC may increase with the number of children and may decrease
with their ages, future research considering these points is highly recommended.

Conclusion
Relationship between WFC and turnover intentions is essential to understand the shortage of
nurses in the health-care system. The combined role of job and life satisfaction and PSS
strengthens our understanding of this relationship. This paper highlights the role of PSS as an
important boundary condition on the relationship between WFC and its negative impact on
outcomes for nursing staff. On the bases of the findings of this study, we recommend supervisor
support, as an important factor which may reduce the negative effects of WFC in nurses.

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Muhammad Imran Rasheed can be contacted at: emranrsheed@[Link]

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