From stress to exit: occupational stress, work engagement, and turnover intentions among nurses in an emerging economy

In emerging economies in Sub-Saharan Africa, persistent nurse shortages and system pressures heighten concerns about stress, engagement, and retention. Understanding how occupational stress influences work engagement and turnover intention is essential for strengthening workforce stability and advancing Sustainable Development Goal 3, which emphasizes a resilient and effective health workforce. This study examines the effect of occupational stress on nurses’ work engagement and the mediating role of turnover intention. A cross-sectional descriptive survey design was employed. Data were collected from 417 nurses working in public hospitals within the Accra Metropolitan Area, Ghana. Standardized questionnaires measured occupational stress, work engagement, and turnover intention. Regression and mediation analyses were conducted to test direct and indirect effects. Occupational stress had a significant negative effect on work engagement. Occupational stress showed a positive but non-significant relationship with turnover intention. Turnover intention significantly predicted work engagement. However, the indirect effect of occupational stress on work engagement through turnover intention was not significant, indicating no mediation effect. Unexpectedly, turnover intention positively predicted work engagement. Occupational stress directly reduces nurses’ work engagement in Ghanaian public hospitals, but turnover intention does not mediate this relationship. The weak association between stress and turnover intention may reflect limited job mobility and contextual labour market conditions. Interventions aimed at reducing job demands and strengthening institutional support systems are necessary to sustain engagement.