Organizational Support and Job Satisfaction of Nurses in Contemporary Clinical Practice: Indirect Associations Through Distributive Justice and Emotional Exhaustion

Background/Objectives: Nurses’ job satisfaction is influenced by organizational conditions and psychological responses to demanding work. Although perceived organizational support, organizational justice, and burnout are established correlates of nurses’ work outcomes, less is known about how distributive justice and emotional exhaustion may operate simultaneously within the association between organizational support and job satisfaction. This study examined these two theoretically distinct indirect pathways. Methods: A cross-sectional study was conducted among 157 nurses employed at General County Hospital Požega, Croatia, between November 2023 and January 2025. Perceived organizational support, distributive justice, emotional exhaustion, and job satisfaction were assessed using standardized questionnaires. Structural equation modeling used robust maximum likelihood estimation with full information maximum likelihood for partially missing data; indirect associations were evaluated in a separate maximum-likelihood model using 5000 bootstrap samples. Results: Greater perceived organizational support was associated with more favorable perceptions of distributive justice and lower emotional exhaustion. Greater distributive justice was associated with higher job satisfaction, whereas emotional exhaustion was associated with lower job satisfaction. The remaining direct association between organizational support and job satisfaction was not statistically significant after both pathways were included. Bootstrap analyses supported indirect associations through both distributive justice and emotional exhaustion. A sensitivity analysis showed that reversing the ordering of distributive justice and organizational support yielded identical global fit indices. Conclusions: Organizational support, perceived fairness, and emotional exhaustion appear to be closely interconnected aspects of nurses’ work experience. The findings integrate organizational and psychological perspectives and identify supportive management, fair resource allocation, and the prevention of emotional exhaustion as complementary organizational targets. Because of the cross-sectional design, the pathways should be interpreted as statistical indirect associations rather than causal mechanisms.