Third-party aggression and emotion work among nurses: Testing a moderated mediation model.

Silvia Gilardi, Chiara Guglielmetti*, Daniela Converso, Roberta Fida, Sara Viotti

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Client aggression is increasingly a stressor in the workplace. This study aims to analyze how and why these experiences may trigger burnout. Focusing on health care workers, we tested a moderated mediation model of the relationship between exposure to third-party (patients and/or relatives) verbal aggression and burnout with the goal of assessing the mediation effects of emotion work and the moderating effects of personal resources (i.e., perceived self-efficacy in communication with patients) and job resources (job control, role clarity, social support by colleagues and by supervisors) on this relationship. A purposive sample of 356 nurses was recruited from four hospitals in northern Italy. A structured, self-report questionnaire was used to collect data. Mediated and moderated mediation regression models with PROCESS were used to test the hypotheses. As postulated, emotion work mediated the relationship between patient third-party aggression and nurses’ burnout. Role clarity and supervisors’ support were found to reduce the harmful effects of emotion work triggered by third-party aggression. Unexpectedly, perceived self-efficacy in communication did not have a buffering effect in the tested model. These results offer a novel approach to designing preventive actions aimed at cultivating resources to counter the impact of perceived exposure to client aggression on well-being.

Original languageEnglish
Pages (from-to)146-159
Number of pages14
JournalInternational Journal of Stress Management
Issue number2
Early online date19 Jun 2019
Publication statusPublished - May 2020


  • burnout
  • emotion work
  • job resources
  • self-efficacy
  • workplace aggression


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