Associations of workload, work satisfaction, change fatigue, and presenteeism with quiet quitting among healthcare professionals: a structural equation modeling study
5 affiliations
- 1Department of Health Care Management, Faculty of Health Sciences, Mus Alparslan University
- 2Department of Health Care Management, Faculty of Economics and Administrative Sciences, Erzincan Binali Yıldırım University
- 3Çivril Atasay Kamer Vocational School, Health Institutions Management, Pamukkale University
- 4Department of Healthcare Management, Faculty of Health Sciences, Acıbadem Mehmet Ali Aydınlar University
- 5Department of Healthcare Management, Graduate School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University
Abstract
Background: Quiet quitting is an increasingly relevant concern in healthcare settings, where high workload, repeated organizational change, and presenteeism may be associated with reduced motivation, engagement, and service quality. This study examined the direct and indirect associations of workload, work satisfaction, change fatigue, and presenteeism with quiet quitting among healthcare professionals.
Methods: A cross-sectional study was conducted between July and September 2025 among healthcare professionals employed for at least 1 year at a single public hospital in Denizli, Türkiye. The sample included 329 participants: 146 physicians, 117 nurses, and 66 other healthcare professionals. Data were collected using a personal information form and validated scales measuring workload, work satisfaction, change fatigue, presenteeism, and quiet quitting. Descriptive statistics, correlation analysis, confirmatory factor analysis, structural equation modeling, and mediation analysis were performed.
Results: The structural model showed mixed fit and explained 55.6% of the variance in quiet quitting. Workload showed the strongest association with quiet quitting (β = 0.589, p < 0.001), and work satisfaction was negatively associated with quiet quitting (β = −0.097, p = 0.001). The direct association between presenteeism and quiet quitting was positive but marginal and did not meet strict significance criteria, as the bootstrap confidence interval included zero (B = 0.353, 95% CI [−0.008, 0.680]; β = 0.233, p = 0.039) and was not robust in sensitivity analyses. Change fatigue was positively associated with workload (β = 0.185, p = 0.011) and presenteeism (β = 0.539, p < 0.001), but was not directly associated with quiet quitting. Change fatigue showed significant indirect associations with quiet quitting through workload, through presenteeism, and through the sequential pathway of workload and work satisfaction (total effect β = 0.383, p < 0.001).
Conclusion: Workload was positively associated with quiet quitting, whereas greater work satisfaction was associated with lower quiet quitting. The association between presenteeism and quiet quitting was positive but marginal and requires replication before firm conclusions can be drawn. Workload was the association that remained stable across all model specifications and professional groups, suggesting that manageable workload distribution and organizational support during periods of change are the most promising targets for further study. Given the cross-sectional design, the temporal direction of these relationships cannot be determined. Longitudinal and multicenter studies are needed to clarify the observed relationships.
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BibTeX
@article{yetim2026associations,
title = {{Associations of workload, work satisfaction, change fatigue, and presenteeism with quiet quitting among healthcare professionals: a structural equation modeling study}},
author = {Birol Yetim and Seval Selvi Sarıgül and İsmail Biçer and Yusuf Çelik},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1936291},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1936291/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations of workload, work satisfaction, change fatigue, and presenteeism with quiet quitting among healthcare professionals: a structural equation modeling study
AU - Birol Yetim
AU - Seval Selvi Sarıgül
AU - İsmail Biçer
AU - Yusuf Çelik
PY - 2026
DA - 2026/10/21
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1936291
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1936291/full
AB - Background: Quiet quitting is an increasingly relevant concern in healthcare settings, where high workload, repeated organizational change, and presenteeism may be associated with reduced motivation, engagement, and service quality. This study examined the direct and indirect associations of workload, work satisfaction, change fatigue, and presenteeism with quiet quitting among healthcare professionals. Methods: A cross-sectional study was conducted between July and September 2025 among healthcare professionals employed for at least 1 year at a single public hospital in Denizli, Türkiye. The sample included 329 participants: 146 physicians, 117 nurses, and 66 other healthcare professionals. Data were collected using a personal information form and validated scales measuring workload, work satisfaction, change fatigue, presenteeism, and quiet quitting. Descriptive statistics, correlation analysis, confirmatory factor analysis, structural equation modeling, and mediation analysis were performed. Results: The structural model showed mixed fit and explained 55.6% of the variance in quiet quitting. Workload showed the strongest association with quiet quitting (β = 0.589, p < 0.001), and work satisfaction was negatively associated with quiet quitting (β = −0.097, p = 0.001). The direct association between presenteeism and quiet quitting was positive but marginal and did not meet strict significance criteria, as the bootstrap confidence interval included zero (B = 0.353, 95% CI [−0.008, 0.680]; β = 0.233, p = 0.039) and was not robust in sensitivity analyses. Change fatigue was positively associated with workload (β = 0.185, p = 0.011) and presenteeism (β = 0.539, p < 0.001), but was not directly associated with quiet quitting. Change fatigue showed significant indirect associations with quiet quitting through workload, through presenteeism, and through the sequential pathway of workload and work satisfaction (total effect β = 0.383, p < 0.001). Conclusion: Workload was positively associated with quiet quitting, whereas greater work satisfaction was associated with lower quiet quitting. The association between presenteeism and quiet quitting was positive but marginal and requires replication before firm conclusions can be drawn. Workload was the association that remained stable across all model specifications and professional groups, suggesting that manageable workload distribution and organizational support during periods of change are the most promising targets for further study. Given the cross-sectional design, the temporal direction of these relationships cannot be determined. Longitudinal and multicenter studies are needed to clarify the observed relationships.
SN - 2296-2565
ER -