Moonlighting intention and turnover intention among Chinese nurses: latent classes and associated factors

BACKGROUND: The rise of the gig economy has increased moonlighting among healthcare professionals. In China, nurse moonlighting and multi-site nursing practice remain emerging and context-dependent phenomena. Existing studies largely describe behaviors, with limited insight into subgroups and mechanisms underlying moonlighting intention among nurses. OBJECTIVE: This study aimed to identify latent classes based on Chinese nurses' moonlighting intention and turnover intention, and to examine factors associated with membership in these classes. DESIGN: A multicenter cross-sectional survey with item-level latent class analysis was conducted. SETTING(S): Nursing staff in medical institutions in seven geographic regions of China (northeast, north, central, east, south, northwest, southwest). PARTICIPANTS: Registered nurses (n = 1,879) from 21 hospitals in 7 cities across 7 provinces recruited via convenience sampling. METHODS: Data were collected June-October 2024. Measures included demographics (gender, age, years employed, professional title, marital status, education, income, etc.), the Occupational Identity Scale, the Perceived Organizational Support Scale, and a Moonlighting Intention Scale. Latent class analysis identified joint classes of moonlighting and turnover intention. Univariate analyses and multinomial logistic regression were used to identify factors associated with class membership. RESULTS: A four-class solution was selected as the preferred model for the joint patterns of moonlighting intention and turnover intention (Entropy = 0.89; LMR/BLRT p < 0.001). The four classes were labelled as the Low MI-Low TI class (21.13%), High MI-Low TI class (23.36%), High MI-Moderate/High TI class (39.49%), and Uncertain MI-Low/Uncertain TI class (16.02%). Using the Low MI-Low TI class as the reference, nurses whose spouses did not have stable employment, those aged 25.1-30 years, those working in primary hospitals, and those with higher occupational identity had higher odds of belonging to the High MI-Low TI class, whereas higher perceived organizational support was associated with lower odds of membership in this class. For the High MI-Moderate/High TI class, spouse's unstable employment, unmarried/divorced/widowed status, male gender, age 25.1-30 years, and working in a primary hospital were associated with higher odds of membership, while no children, more than 15 years of practice, formal establishment, higher income, higher occupational identity, and higher perceived organizational support were associated with lower odds of membership. For the Uncertain MI-Low/Uncertain TI class, age 25.1-30 years was associated with higher odds of membership, whereas monthly income of 7,001-12,500 RMB was associated with lower odds. CONCLUSION: The relationship between moonlighting intention and turnover intention among Chinese nurses is heterogeneous rather than uniformly positive. Moonlighting intention should not be interpreted simply as a sign of withdrawal or impending turnover. Profile-specific retention strategies are needed, particularly for nurses with both high moonlighting intention and elevated turnover intention. Strengthening occupational identity, perceived organizational support, employment security, income protection, and career development pathways may help reduce turnover-related risk while addressing nurses' diverse work and career needs.