Effort-Reward Imbalance, Resilience and Perceived Organizational Support: A Moderated Mediation Model of Fatigue in Chinese Nurses.

PURPOSE: Fatigue undermines nurses' well-being and work performance worldwide. Work stress is a critical factor that causes nurses' fatigue, but the solutions are not well known. This study aimed to identify the moderated mediation model of fatigue involving effort-reward imbalance (ERI), resilience and perceived organizational support (POS) in Chinese nurses. METHODS: In a cross-sectional investigation conducted in Liaoning Province of China, 996 nurses completed the self-administered measurements of fatigue, ERI, resilience and POS. Moderated mediation was tested using the PROCESS procedure. The "pick-a-point" method was adopted to assess conditional effect on fatigue. RESULTS: The indirect effect of ERI on fatigue through resilience was significant (a×b = 0.119, BCa 95% CI: 0.094 to 0.146), indicating a partial mediation of resilience. POS moderated the association of resilience with fatigue (ß = -0.056, p = 0.006). The higher the level of POS was, the stronger the resilience-fatigue association became. Thus, the mediating role of resilience in the ERI-fatigue association was gradually increased with the increase of POS level (low POS: 0.073; moderate POS: 0.095; high POS: 0.116). CONCLUSION: Resilience could partially mediate the ERI-fatigue association. POS could act as a moderator that enhanced the association of resilience with fatigue. A moderated mediation model of fatigue was demonstrated in Chinese nurses. Managers should establish a balanced social reciprocity, and improve nurses' resilience and POS in order to decrease nurses' fatigue.