{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:05:01Z","timestamp":1793829901003,"version":"4.6.1"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Effort-reward imbalance (ERI) is a prevalent issue in the healthcare sector, particularly in the high-intensity, high-risk, and high-stress environment of the emergency department. This results in emergency department nurses bearing heavier workloads, responsibilities, and time commitments compared to their counterparts in other departments. ERI poses significant risks to their physical, psychological, and sleep quality. Therefore, it is essential to explore the mechanisms through which ERI influences the health of emergency department nurses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this investigation is to analyze if work\u2013family conflict moderates the mediating influence emotional exhaustion has on the association between ERI and somatic symptoms and sleep disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>\n                      The emergency nurses (\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f1,540) were included from 30 tertiary hospitals in 20 provinces or autonomous regions (Northeast, North, East, Central, South, Southwest, and Northwest China) of mainland China between December 26, 2023, and January 18, 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants were recruited using stratified cluster sampling, obtaining data through web-based questionnaires. The study investigated the mediating and moderating effects using the\n                      <jats:italic>PROCESS<\/jats:italic>\n                      macro for SPSS. The mediation effect is tested by the bias correction\n                      <jats:italic>Bootstrap<\/jats:italic>\n                      sample size was set to 5,000.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      Considering emotional exhaustion as a mediating variable, the direct predictive influence of ERI on somatic symptoms and sleep disorders continues to be statistically significant (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.271, 0.137,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Compared to the high-level work\u2013family conflict group, the positive moderating effect of low-level work\u2013family conflict on the relationship between ERI and emotional exhaustion was more pronounced (\n                      <jats:italic>simple slope<\/jats:italic>\n                      \u202f=\u202f0.479, 0.757,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). The moderated mediation effects of emotional exhaustion on somatic symptoms and sleep disorders are \u22120.063 (95%CI: \u22120.077\u202f~\u202f\u22120.050) and \u22120.044 (95%CI: \u22120.056\u202f~\u202f\u22120.033) respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study findings indicate that ERI was correlated with heightened emotional exhaustion, somatic symptoms, and sleep disorders among emergency department nurses. As a result, interventions should be implemented to improve ERI, alleviate emotional exhaustion among nurses, monitor work\u2013family conflict levels, and mitigate the effects of these factors on nurses\u2019 overall well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1580501","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T01:17:37Z","timestamp":1748222257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Effects of effort-reward imbalance on emergency nurses\u2019 health: a mediating and moderating role of emotional exhaustion and work-family conflict"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuanyuan","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luying","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongli","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1037\/1076-8998.1.1.27","article-title":"Adverse health effects of high-effort\/low-reward conditions","volume":"1","author":"Siegrist","year":"1996","journal-title":"J Occup Health Psychol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1136\/emermed-2023-213189","article-title":"Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study","volume":"41","author":"Daniels","year":"2024","journal-title":"Emerg Med J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"100814","DOI":"10.1016\/j.ienj.2019.100814","article-title":"Top ten: a model of dominating factors influencing job satisfaction of emergency nurses","volume":"49","author":"Staempfli","year":"2020","journal-title":"Int Emerg Nurs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13017-019-0236-3","article-title":"Challenges faced by acute care surgeons in China","volume":"14","author":"Xu","year":"2019","journal-title":"World J Emerg Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1136\/emermed-2016-205886","article-title":"Satisfaction, burnout and intention to stay of emergency nurses in Shanghai","volume":"34","author":"Jiang","year":"2017","journal-title":"Emerg Med J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1604912","DOI":"10.3389\/ijph.2022.1604912","article-title":"Prevalence and risk factors of workplace violence against emergency department nurses in China","volume":"67","author":"Lei","year":"2022","journal-title":"Int J Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e674","DOI":"10.1002\/hpm.2541","article-title":"A systematic review of effort-reward imbalance among health workers","volume":"33","author":"Nguyen","year":"2018","journal-title":"Int J Health Plann Manag"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"3363","DOI":"10.1111\/jocn.15367","article-title":"The relationship between effort-reward imbalance and empathy among clinical nurses: a cross-sectional online survey","volume":"29","author":"Kong","year":"2020","journal-title":"J Clin Nurs"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1186\/s12888-021-03344-6","article-title":"Evaluating effort-reward imbalance among nurses in emergency departments: a cross-sectional study in China","volume":"21","author":"Tian","year":"2021","journal-title":"BMC Psychiatry"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3243","DOI":"10.3390\/ijerph16183243","article-title":"A cross-sectional study evaluating psychosocial job stress and health risk in emergency department nurses","volume":"16","author":"Bardhan","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1111\/j.1471-6712.2006.00376.x","article-title":"Psychosocial work stress is associated with poor self-rated health in Danish nurses: a test of the effort-reward imbalance model","volume":"20","author":"Weyers","year":"2006","journal-title":"Scand J Caring Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1186\/s12913-021-06526-w","article-title":"Evaluation of the correlation between effort-reward imbalance and sleep quality among community health workers","volume":"21","author":"Deng","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"165","DOI":"10.13075\/ijomeh.1896.02223","article-title":"Evaluating the association between effort-reward imbalance and suboptimal health status among hospital nurses: a cross-sectional study","volume":"37","author":"Yu","year":"2024","journal-title":"Int J Occup Med Environ Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1002\/job.4030020205","article-title":"The measurement of experienced burnout","volume":"2","author":"Maslach","year":"1981","journal-title":"J Organ Behav"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1111\/j.1365-2850.2008.01355.x","article-title":"Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings","volume":"16","author":"Schulz","year":"2009","journal-title":"J Psychiatr Ment Health Nurs"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/S1479-3555(02)02007-3","article-title":"Effort-reward imbalance at work and health","volume":"2","author":"Siegrist","year":"2002","journal-title":"Res Occup Stress Well-being"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1146\/annurev.psych.52.1.397","article-title":"Job burnout. Annual","volume":"52","author":"Maslach","year":"2001","journal-title":"Rev Psychol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.ienj.2017.12.005","article-title":"Quantification of burnout in emergency nurses: a systematic review and meta-analysis","volume":"39","author":"Li","year":"2018","journal-title":"Int Emerg Nurs"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0195039","DOI":"10.1371\/journal.pone.0195039","article-title":"Prevalence of burnout in paediatric nurses: a systematic review and meta-analysis","volume":"13","author":"Pradas","year":"2018","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","article-title":"The job demands-resources model of burnout","volume":"86","author":"Demerouti","year":"2001","journal-title":"J Appl Psychol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"760570","DOI":"10.3389\/fpsyg.2021.760570","article-title":"The effort-reward model and its effect on burnout among nurses in Ecuador","volume":"12","author":"Alvarado","year":"2021","journal-title":"Front Psychol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2272","DOI":"10.1016\/S0140-6736(16)31279-X","article-title":"Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis","volume":"388","author":"West","year":"2016","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"736625","DOI":"10.3389\/fpubh.2021.736625","article-title":"Work-family conflict of emergency nurses and its related factors: a National Cross-Sectional Survey in China","volume":"9","author":"Wu","year":"2021","journal-title":"Front Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1108\/02683940810861365","article-title":"Effort-reward imbalance, over-commitment and work-life conflict: testing an expanded mode","volume":"23","author":"Kinman","year":"2008","journal-title":"J Manag Psychol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1111\/j.1559-1816.2011.00763.x","article-title":"Personality as a moderator of the relationship between role conflict, role ambiguity, and burnout","volume":"41","author":"Ghorpade","year":"2011","journal-title":"J Appl Soc Psychol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02678370801975842","article-title":"Positive and negative work-family interaction and burnout: a longitudinal study of reciprocal relations","volume":"22","author":"Innstrand","year":"2008","journal-title":"Work Stress"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"4859","DOI":"10.2147\/PRBM.S429283","article-title":"Exploring the relationship between work-family conflict, family-work conflict and job embeddedness: examining the mediating role of emotional exhaustion","volume":"16","author":"Dukhayk","year":"2023","journal-title":"Psychol Res Behav Manag"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1186\/1471-2458-12-915","article-title":"Work-family conflict and burnout among Chinese female nurses: the mediating effect of psychological capital","volume":"12","author":"Wang","year":"2012","journal-title":"BMC Public Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"432","DOI":"10.3390\/ijerph13040432","article-title":"Associations of extrinsic and intrinsic components of work stress with health: a systematic review of evidence on the effort-reward imbalance model","volume":"13","author":"Siegrist","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1492662","DOI":"10.3389\/fpubh.2024.1492662","article-title":"Sex differences in burnout and work-family conflict among Chinese emergency nurses: a cross-sectional study","volume":"12","author":"Diao","year":"2024","journal-title":"Front Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e70008","DOI":"10.1111\/nicc.70008","article-title":"Relationship between workplace violence and occupational health in emergency nurses: the mediating role of dyssomnia","volume":"30","author":"Zhang","year":"2025","journal-title":"Nurs Crit Care"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3760\/cma.j.issn.1001-9391.2004.06.008","article-title":"Measurement of psychosocial factors in work environment:application of two models of occupational stress","volume":"6","author":"Yang","year":"2004","journal-title":"China J Indust Hyg Occup Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"321","DOI":"10.13213\/j.cnki.jeom.2013.05.018","article-title":"The association between burnout and impaired health productivity among medical professionals","volume":"30","author":"Huang","year":"2013","journal-title":"Environ. Occup. Med."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1016\/j.socscimed.2004.02.002","article-title":"Job stress, social support, and prevalence of insomnia in a population of Japanese daytime workers","volume":"59","author":"Nakata","year":"2004","journal-title":"Soc Sci Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e024290","DOI":"10.1136\/bmjopen-2018-024290","article-title":"Identifying and measuring the severity of somatic symptom disorder using the self-reported somatic symptom scale-China (SSS-CN): a research protocol for a diagnostic study","volume":"9","author":"Jiang","year":"2019","journal-title":"BMJ Open"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s10869-017-9529-2","article-title":"Work-family behavioral role conflict: scale development and validation","volume":"34","author":"Clark","year":"2019","journal-title":"J Bus Psychol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.16821\/j.cnki.hsjx.2024.05.015","article-title":"Chinese version of the Work-Family Role Conflict Scale and its reliability and validity testing","volume":"58","author":"Sun","year":"2023","journal-title":"Chinese Journal of Nursing."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.brat.2016.11.001","article-title":"Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation","volume":"98","author":"Hayes","year":"2017","journal-title":"Behav Res Ther."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1425445","DOI":"10.3389\/fpsyg.2024.1425445","article-title":"Incidence of effort-reward imbalance among nurses: a systematic review and meta-analysis","volume":"15","author":"Zhang","year":"2024","journal-title":"Front Psychol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12955-020-01374-4","article-title":"Sleep quality of nurses in the emergency department of public hospitals in China and its influencing factors: a cross-sectional study","volume":"18","author":"Dong","year":"2020","journal-title":"Health Qual Life Outcomes"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1111\/nhs.12626","article-title":"Sleep disturbances and related factors among nurses","volume":"21","author":"Chaiard","year":"2019","journal-title":"Nurs Health Sci"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/1043659619881491","article-title":"Psychological distress and sleep disturbance among female nurses: anxiety or depression?","volume":"32","author":"Chueh","year":"2021","journal-title":"J Transcult Nurs"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"579","DOI":"10.3390\/healthcare12050579","article-title":"The occurrence of anxiety, depression, and distress among professionals working in emergency care","volume":"12","author":"Ferkai","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"4762","DOI":"10.1111\/jocn.16518","article-title":"The effects of effort-reward imbalance on emergency nurses\u2019 turnover intention: The mediating role of depressive symptoms","volume":"32","author":"Fei","year":"2023","journal-title":"J Clin Nurs."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"599831","DOI":"10.3389\/ijph.2021.599831","article-title":"Burnout of healthcare workers based on the effort-reward imbalance model: a cross-sectional study in China","volume":"66","author":"Yuan","year":"2021","journal-title":"Int J Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e107130","DOI":"10.1371\/journal.pone.0107130","article-title":"The mediating effects of burnout on the relationship between anxiety symptoms and occupational stress among community healthcare workers in China: a cross-sectional study","volume":"9","author":"Ding","year":"2014","journal-title":"PLoS One"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1111\/jnu.12666","article-title":"Effort-Reward Imbalance and Its Effects on Satisfaction With Working Conditions and Sleep-Related Problems: Comparison of Nurses and Other Occupations","volume":"53","author":"Hong","year":"2021","journal-title":"J Nurs Scholarsh."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"296","DOI":"10.4103\/jehp.jehp_1809_21","article-title":"Relationship between burnout, effort-reward imbalance, and insomnia among informational technology professionals","volume":"11","author":"Raju","year":"2022","journal-title":"J Educ Health Promot"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1111\/jan.14208","article-title":"Mediating effects of self-efficacy, coping, burnout, and social support between job stress and mental health among young Chinese nurses","volume":"76","author":"Chen","year":"2020","journal-title":"J Adv Nurs"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1111\/jan.15524","article-title":"Psychosocial factors associated with career success among nurses: A latent profile analysis","volume":"79","author":"Zhang","year":"2023","journal-title":"J Adv Nurs."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/disa.12288","article-title":"Effort-reward imbalance and burnout among humanitarian aid workers","volume":"43","author":"Jachens","year":"2019","journal-title":"Disasters"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1001\/jama.288.12.1447","article-title":"Mid-careerburnout in generalist and specialist physicians","volume":"288","author":"Spickard","year":"2002","journal-title":"JAMA"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1097\/NNR.0000000000000239","article-title":"Effort-reward imbalance and burnout among ICU nursing staff: a cross-sectional study","volume":"66","author":"Padilla","year":"2017","journal-title":"Nurs Res"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3389\/fpsyg.2019.00284","article-title":"The relationship between burnout, depression, and anxiety: a systematic review and Meta-analysis","volume":"10","author":"Koutsimani","year":"2019","journal-title":"Front Psychol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"779","DOI":"10.2147\/NDT.S127053","article-title":"Work-family conflict as a mediator between occupational stress and psychological health among mental health nurses in Japan","volume":"13","author":"Sugawara","year":"2017","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1177\/01939459211005712","article-title":"Job characteristics, emotional exhaustion, and work-family conflict in nurses","volume":"44","author":"Rh\u00e9aume","year":"2022","journal-title":"West J Nurs Res"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1111\/sjop.12328","article-title":"A two-wave cross-lagged study of work-role conflict, work-family conflict and emotional exhaustion","volume":"57","author":"Jensen","year":"2016","journal-title":"Scand J Psychol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1186\/s12888-020-02673-2","article-title":"The role of social support and emotional exhaustion in the association between work-family conflict and anxiety symptoms among female medical staff: a moderated mediation model","volume":"20","author":"Zhang","year":"2020","journal-title":"BMC Psychiatry"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12912-019-0329-z","article-title":"The role of collective affective commitment in the relationship between work-family conflict and emotional exhaustion among nurses: a multilevel modeling approach","volume":"18","author":"Galletta","year":"2019","journal-title":"BMC Nurs"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"195","DOI":"10.2486\/indhealth.2021-0280","article-title":"The association between burnout and multiple roles at work and in the family among female Japanese nurses: a cross-sectional study","volume":"61","author":"Kida","year":"2023","journal-title":"Ind Health"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1056\/NEJMra2302878","article-title":"Burnout, depression, and diminished well-being among physicians","volume":"391","author":"Guille","year":"2024","journal-title":"N Engl J Med"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1186\/s12912-023-01355-0","article-title":"The relationships among overcommitment, effort-reward imbalance, safety climate, emotional labour and quality of working life for hospital nurses: a structural equation modeling","volume":"22","author":"Liang","year":"2023","journal-title":"BMC Nurs"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12995-023-00376-4","article-title":"Managers perception of hospital employees\u2019 effort-reward imbalance","volume":"18","author":"Heming","year":"2023","journal-title":"J Occup Med Toxicol."},{"key":"ref64","doi-asserted-by":"publisher","first-page":"1515593","DOI":"10.3389\/fpubh.2024.1515593","article-title":"Effort-reward imbalance and health outcomes in emergency nurses: the mediating role of work-family conflict and intrinsic effort","volume":"12","author":"Tong","year":"2025","journal-title":"Front Public Health."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1580501\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T01:17:40Z","timestamp":1748222260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1580501\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":64,"alternative-id":["10.3389\/fpubh.2025.1580501"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1580501","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]},"article-number":"1580501"}}