When caring hurts: The association between psychological well-being and retention among pediatric critical care nurses: The mediating role of sleep quality

BACKGROUND: Pediatric critical care nurses practicing in NICUs, PICUs, and ICUs are often faced with high-acuity work demands, emotionally demanding situations, and non-traditional work schedules. These work-related stressors may have a negative impact on sleep and psychological well-being. While psychological distress and poor sleep have been identified as antecedents of burnout and intent to leave, the mediating effect of sleep quality on the relationship between psychological well-being and turnover intention has not been adequately explored in the context of pediatric critical care nurses. AIM: This study aimed to assess the relationship between psychological well-being and turnover among critical care nurses, with sleep quality as a mediating factor. METHODS: A cross-sectional study was conducted among 385 nurses working in NICUs, PICUs, and ICUs in governmental hospitals. Standardized instruments were used to assess psychological well-being, sleep quality (PSQI), and turnover intention. Data were analyzed using correlation, regression, and structural equation modeling (SEM). RESULTS: = 0.461). CONCLUSION: The findings suggest that sleep quality represents a key mediating pathway in the association between psychological well-being and turnover intention among nurses. Reduced psychological well-being was associated with higher turnover intention both directly and indirectly through poorer sleep quality. These findings highlight the potential importance of recovery-related processes; however, given the cross-sectional design, the observed relationships should be interpreted as associative rather than causal. IMPACT STATEMENT: This study highlights the need for healthcare organizations and policymakers to prioritize interventions that improve the psychological well-being and sleep quality of critical care nurses. By integrating mental health support programs, optimizing shift schedules, and addressing workplace stressors, institutions can reduce turnover intentions and stabilize the nursing workforce. Policymakers should advocate for workplace standards that promote nurse recovery and resilience, ultimately enhancing patient care quality and organizational performance.