Abstract
Orientation: Workplace bullying remains a problem that has a significant impact on the well-being and professional outcomes of doctors.
Research purpose: This study is conducted to evaluate how workplace bullying can affect job burnout and turnover intention (TI) in the health sector, especially for resident doctors, by considering their perception of meaningful work.
Motivation for the study: While extensive research has examined workplace bullying, studies exploring its impact on doctors or examining how meaningful work can mitigate the negative impact is still limited.
Research approach/design and method: A total of 230 resident doctors in Medan, North Sumatra, were selected as respondents using a purposive sampling method (response rate: 76.67%). Data were collected by distributing online questionnaires using Google Forms, whereafter they were processed using conditional process analysis via SPSS macro-PROCESS.
Main findings: TI in resident doctors can be influenced by workplace bullying and job burnout, and job burnout mediates the influence of workplace bullying on TI. The negative influence of workplace bullying on TI through job burnout can be weaker when resident doctors feel that their work is meaningful.
Practical/managerial implications: These findings underscore the importance of addressing workplace bullying and fostering a sense of meaningful work to improve the well-being and retention of doctors working in the health sector.
Contribution/value-add: This study contributes to the literature by highlighting the role of meaningful work in mitigating the detrimental impact of bullying and burnout on Tis in the healthcare sector.
Keywords: job burnout; meaningful work; turnover intention; workplace bullying; mediated moderation; resident doctors.
Introduction
Bullying in the workplace is a disturbing phenomenon and can provide negative outcomes for the organisation. Until now, cases of verbal and physical violence in the work environment are increasing (Fan et al., 2023; Nimmi et al., 2023), and this is a concern that needs serious attention. Shafaei et al. (2024) and Feijó et al. (2019) stated that bullying can have a negative impact on employee welfare. As stated by Xia et al. (2023), employees’ intention to leave often increases because of bullying in the workplace. If left untreated and not handled seriously, this can result in an unhealthy work environment and reduce employee satisfaction and loyalty to the organisation (Liang & Yeh, 2020; Nauman et al., 2019).
Workplace bullying (WB) itself can involve assigning excessive workloads and unrealistic tasks, which causes high stress levels and increases turnover intention (TI) (Einarsen et al., 2020; Islam & Chaudhary, 2024). In fact, the occurrence of TI needs to be limited by organisations because this can affect stability, productivity and operational sustainability, as well as being an important indicator for measuring job satisfaction and potential workforce retention (Salleh et al., 2020; Wen et al., 2022).
A number of studies have examined the relationship between bullying and various aspects, such as burnout (Ribeiro et al., 2022), work stress (Salama et al., 2022) and decreased employee well-being (Farley et al., 2023). These negative outcomes indicate the adverse effects of bullying when it continues to be allowed in an organisation. In the health industry sector, WB is a significant challenge for organisations (Escartín et al., 2017). Ribeiro et al. (2024). stated that an unhealthy environment is often the main trigger that can encourage TI, which ultimately causes high employee turnover rates. According to Xia et al. (2023), the turnover rate in the health sector often occurs in the first year, especially in the workforce of nurses and resident doctors. This problem is also exacerbated by a lack of staff, which forces health workers to work harder, thereby increasing burnout and decisions to leave their current employment.
In Indonesia, the issue of bullying towards health workers, especially among resident doctors, has been in the spotlight in recent months. The case of the death of a resident doctor because of bullying from his seniors has increasingly brought this issue to the surface (Rahmadania, 2024). The Ministry of Health of the Republic of Indonesia reported that this act of bullying did not only occur at one university, but also at a number of hospitals under the auspices of the Ministry. As of early August 2024, there were 1540 reports of suspected bullying among resident doctors, with 540 cases identified as bullying cases, of which 221 occurred in the Ministry of Health’s vertical hospitals (Rahmadania, 2024; Rizki, 2024). Cases of bullying most often occur in internal medicine, surgery and anaesthesia specialists, which shows that there are serious problems in the work environment of resident doctors (Kautsar, 2024).
In the context of WB and its impact on TI, the concept of meaningful work can be seen as a significant factor. Meaningful work itself is characterised by the presence of purpose and satisfaction obtained from one’s work, which can act as a protector against the negative impacts of bullying in the workplace (Steger et al., 2012). For doctors, their profession is often seen as meaningful because of its commitment to patient care and the opportunity to have a positive impact on individual lives. Research shows that when individuals perceive their work as meaningful, they are more likely to develop resilience and maintain job satisfaction, even in challenging environments (Allan et al., 2020). In this research, meaningful work is positioned as a moderating variable that is able to weaken the negative impact of WB on TI, which is still less explored in the literature.
Based on this background, this study aims to fill the gap in the existing literature regarding WB in the health sector, which generally focuses more attention on nurses rather than doctors, including resident doctors (Fan et al., 2023; Kim et al., 2019; Xia et al., 2023). Specifically, this research will explore the experiences of resident doctors, who are particularly vulnerable to bullying from senior residents. In addition, this research will examine the role of meaningful work as a potential moderator in the relationship between workplace bullying, job burnout and TI. By using a moderated mediation model, this research aims to understand how and in what situations the negative influence of bullying can be reduced, answering suggestions from previous studies (Chowdhury et al., 2023; Srivastava & Agarwal, 2020), which state that this mechanism is still under-researched. Thus, it is hoped that this research can provide deeper insight into the influence of WB as well as the contribution of factors that can mitigate its negative effects.
Literature review
Workplace bullying, job burnout and turnover intention
According to Ribeiro et al. (2024), WB refers to all types of bullying experienced by someone in the work environment, whether verbal, physical or psychological. It is a negative action that occurs over time, thereby placing individuals in a lower position by undermining their confidence, authority or professional standing within the workplace (Einarsen et al., 2009). Bullying can occur when a gap in power is exploited by individuals or groups to pressure, degrade or intimidate other parties who are in weaker positions, both hierarchically and socially, thereby creating an unhealthy work environment (Hershcovis, 2011). In this study, WB is defined as persistent negative behaviours directed towards an individual by colleagues or superiors, which can lead to a hostile work environment and significantly impact the victim’s well-being. Bullying in the workplace can affect and harm an individual’s condition in terms of physical, emotional and mental exhaustion (Chowdhury et al., 2023; Ribeiro et al., 2022).
Burnout, as defined by Ribeiro et al. (2022), refers to a state of physical, emotional and mental exhaustion resulting from prolonged exposure to stressors at work. This condition often manifests as emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment (Salama et al., 2022). In the context of this study, burnout is viewed as the result of sustained workplace bullying, where the victim’s emotional and physical resources are drained over time.
Previous research found that burnout or physical and emotional exhaustion occurs because of bullying in the workplace (Kim et al., 2019; Livne & Goussinsky, 2018). Thus, the following hypothesis is formulated:
H1: Workplace bullying positively influences burnout.
Considering that skilled employees are an important asset, organisations need to create a work environment that supports and ensures employee welfare (Farley et al., 2023; Hussein et al., 2020). High employee turnover rates can be a serious problem for organisations, because this has the potential to increase recruitment and training costs, disrupt team stability and reduce productivity (Wen et al., 2022). Previous studies have reported that employees’ intention to leave the organisation is influenced by many factors (Asim et al., 2023; Hussain et al., 2020). Among these factors, abusive supervision (Arif & Ahmed, 2023; Asim et al., 2023; Lyu et al., 2019), work environment (Kurniawaty et al., 2019) and WB (Al Muharraq et al., 2022; Coetzee & Van Dyk, 2018) have been identified as the main causes. Workplace bullying can occur in various forms, including verbal or non-verbal aggression, giving excessive work or giving disproportionate criticism (Coetzee & Van Dyk, 2018). Individuals who experience bullying can feel uncomfortable in their workplace, thereby reducing satisfaction and leading them to want to leave the organisation (Al Muharraq et al., 2022; Chowdhury et al., 2023). Therefore, the hypothesis proposed is as follows:
H2: Workplace bullying significantly influences turnover intention.
Job burnout, which is characterised by physical, emotional and mental exhaustion because of prolonged stress and challenges at work, has been widely recognised as a significant predictor of TI. Research consistently shows that employees who experience high levels of burnout are more likely to consider leaving their organisations (Fan et al., 2023; Scanlan & Still, 2019). Kim et al. (2019) and Livne and Goussinsky (2018) highlight that job burnout not only reduces job satisfaction but also erodes commitment, thereby encouraging employees to look for alternative work opportunities. Likewise, Marshall and Stephenson (2020) and Ribeiro et al. (2024), showed that the negative impact of job burnout extends to various sectors, thus reinforcing the notion that employees in environments with high levels of stress are particularly vulnerable to turnover. Furthermore, Salama et al. (2022) emphasise the need for organisations to address job burnout proactively, because this has a direct impact on employee retention and TI. Based on this explanation, the following hypothesis is proposed:
H3: Job burnout significantly influences turnover intention.
Job burnout as mediating variable
As stated by Ribeiro et al. (2024), job burnout experienced by employees is often associated with experiences of bullying in the workplace. When employees experience bullying, they will tend to consider the burnout they feel as one of the main predictors of TI (Scanlan & Still, 2019). In this context, the role of burnout is a significant mediating factor, which influences the relationship between WB and TI. Xia et al. (2023) suggested that WB does not only have a direct effect on TI but also causes increased burnout. Bullying, both verbal and non-verbal, can result in prolonged emotional stress, thereby damaging employees’ mental well-being (Farley et al., 2023). Employees who experience bullying tend to feel depressed, which ultimately leads to physical and emotional exhaustion. This situation creates a cycle in which high burnout exacerbates the tendency to change jobs, because employees who feel tired and helpless are more likely to look for a better work environment (Marshall & Stephenson, 2020; Salama et al., 2022). Prolonged fatigue, both physical and emotional, can result in employees feeling helpless and less motivated to stay in their jobs (Ribeiro et al., 2024). In this situation, burnout becomes a factor that worsens the impact of bullying, thereby increasing employees’ intentions to look for other work opportunities. In this context, the following hypothesis is proposed:
H4: Job burnout mediates the influence of workplace bullying on turnover intention.
Meaningful work as moderating variable
In understanding which factors contribute to meaningfulness in the workplace, Lysova et al. (2019) identified that an individual’s view of work is one of the factors that can create meaningful work. According to Rosso et al. (2010), meaningfulness refers to a person’s perception of the elements in the environment and the work they do. Meaningful work provides positive value and has significance for individuals, in order to improve their psychological well-being. In the context of WB, an individual’s perception of work can have a significant impact on the negative experiences they experience. As has been explained by Al Muharraq et al. (2022) and Chowdhury et al. (2023), WB creates emotional pressure, which can make employees feel depressed and tend to want to leave their jobs. Steger et al. (2012) show that individuals who feel their work makes a positive contribution to their personal goals and values are better able to withstand pressure and negative behaviour such as bullying. In other words, when employees feel that their work is meaningful, the negative impact of bullying can be minimised. Conversely, when employees feel that their work has no meaning or does not contribute to things they consider important, the impact of bullying on TI will be stronger. This indicates that meaningful work can function as a buffer that reduces the negative influence of WB. In this context, research by Allan et al. (2020) and Han et al. (2020) emphasised that individuals who experience meaningful work tend to be more resilient and able to handle stress caused by bullying. Thus, the hypotheses proposed are as follows:
H5: Meaningful work significantly moderates the relationship between workplace bullying and job burnout, that more meaningful work can weaken the influence of workplace bullying on job burnout.
H6: Meaningful work significantly moderates the relationship between job burnout and turnover intention, that more meaningful work can weaken the influence of job burnout on turnover intention.
Figure 1 presents the conceptual framework proposed in the study.
H7: Meaningful work significantly moderates the indirect influence of workplace bullying on turnover intention through job burnout, that more meaningful work can weaken the indirect influence.
Research method
A quantitative, cross-sectional research design was chosen in this study, by utilising self-administered surveys as the primary method of data collection (Sekaran & Bougie, 2013). The research targeted resident doctors or medical doctors currently enrolled in a specialist medical education programme at various hospitals in Medan City, North Sumatra province, Indonesia.
Given the nature of the research that specifically focuses on individuals who have experienced workplace bullying, a purposive sampling strategy was employed. This approach was selected because the study sought to gather insights from a specific subgroup of the population, which is resident doctors in their first to third year of training who had experienced bullying during their residency. The total number of resident doctors in the region is not officially published, and therefore, a probability sampling method could not be applied. Instead, purposive sampling ensured the selection of participants who met the study’s key inclusion criteria and could provide relevant information for testing the research model.
A total of 300 resident doctors were invited to participate, based on estimated accessibility, resource limitations and expected response rate. Of these, 230 completed the questionnaire, yielding a response rate of 76.67%. Data were collected via an online questionnaire distributed through Google Forms platform.
To identify eligible participants, the survey link was distributed through professional and academic networks, including residency group chats, emails and informal peer-to-peer referrals among resident doctors. Participants were informed about the study’s purpose and were asked to self-identify whether they had experienced bullying during their specialist training. Bullying experience was determined based on a screening question at the beginning of the survey, where respondents were asked: ‘Have you experienced any form of bullying (e.g., verbal, physical, psychological) during your residency?’ Only those who answered ‘yes’ were allowed to proceed with the full questionnaire.
Although the response rate reached 76.67%, the study acknowledges the potential for non-response bias. To minimise this, reminders were sent one week after the initial invitation, and participation was encouraged through follow-up messages. However, as participation remained voluntary and anonymous, the characteristics of non-respondents could not be compared directly.
Ethical clearance for this study was obtained from the Committee of Ethics of Universitas Pembangunan Masyarakat Indonesia. Informed consent was collected digitally before respondents could access the questionnaire. All participants were assured of the confidentiality and anonymity of their responses. No identifying information was collected, and data were stored securely for academic use only.
The study was processed using conditional process analysis techniques with the Hayes’ PROCESS macro for SPSS model (Model 58 and Model 4). Model 4 is used to test the mediation effect of job burnout between workplace bullying and TI. It assesses the indirect effect of workplace bullying on TI through burnout, aligning with Hypotheses H1 to H4. Model 58, on the other hand, was used to examine the moderating role of meaningful work in both the direct and indirect pathways, consistent with Hypotheses H5 to H7. The use of these models allows for simultaneous testing of complex interactions and mediation effects, making them well-suited for the research framework, which includes both mediating and moderating variables.
The results of respondent characteristics (Table 1) show that of the total respondents, 54.8% were women and 45.2% were men, reflecting a balanced gender distribution. Based on age, the majority of respondents were in the 26-35 year range (43.5%), followed by respondents aged over 36 years (42.2%) and 14.3% aged under 25 years. Regarding specialty programmes, anaesthesiology had the most respondents (81), followed by general and neurosurgery (72), obstetrician-gynaecologist (45) and internist (32). The majority of respondents who filled out the questionnaire were in their second year of residency (42%), followed by respondents in their first year (37%) and residents in their third year (21%).
Variable measurement
This study used a Likert scale response of 1 to 5 where 1 indicates ‘strongly disagree’ and 5 ‘strongly agree’. The questionnaires used in this study were not newly developed but adapted from previously validated instruments (see Appendix 1). The workplace bullying variable is measured by seven items, which include personal bullying and work-related bullying, which were adopted from Einarsen et al. (2009). Burnout was measured by nine items adopted from Ribeiro et al. (2024) and Salama et al. (2022). Meaningful work was measured by three items adopted from research performed by Han et al. (2020). Finally, TI was measured by three items adopted from Marshall and Stephenson (2020). All items were translated into Bahasa Indonesia using a forward–backward translation procedure to ensure linguistic equivalence and cultural relevance.
To ensure content validity, the adapted questionnaires were reviewed by two academic experts in organisational psychology and one medical education practitioner to assess item clarity, relevance and appropriateness for the context of resident doctors. Based on their feedback, minor adjustments in wording were made to increase clarity without altering the meaning of the items.
To assess the construct validity and internal consistency of the instrument prior to full data collection, a pilot study was conducted with 30 resident doctors who met the same sampling criteria but were not included in the final sample. The results of the pilot test confirmed the internal consistency of the scales, with all variables showing Cronbach’s alpha (α) values above 0.70. Furthermore, exploratory factor analysis (EFA) was performed, and all items loaded onto their intended constructs with factor loadings exceeding 0.60, supporting the dimensional structure of the adapted instruments.
Based on the results of the descriptive statistics test, the Cronbach’s alpha (α) value for all variables exceeds the cut off value (0.6), meaning that the variables involved are declared reliable (Hair et al., 2019). The WB variable has an average value of 29.49 with a standard deviation (SD) of 4.135, indicating a relatively high level of WB on a scale range of 15–35, skewness value of −1.119 and kurtosis of 1.764. The job burnout (JB) variable has a mean of 37.94 and a SD of 5.277, with skewness value of −0.750 and kurtosis of 1.577. The meaningful work (MW) variable has an average of 12.14 and a SD of 2.075, as well as a skewness value of −0.584 and kurtosis of 0.945. Meanwhile, the TI variable has an average of 10.86 and a SD of 3.215, with skewness value of −0.462 and kurtosis of −0.415.
The skewness and kurtosis values confirm that the data are distributed normally because these numbers are in the range −2 to 2 (Ghozali, 2016). Furthermore, the correlation between variables presented in Table 2 shows a significant relationship. Workplace bullying is strongly correlated with JB (r = 0.739), which is in accordance with the theory that WB significantly increases work fatigue or burnout (Daus, 2004). In addition, JB has a positive correlation with TI (r = 0.417), supporting the theory that JB contributes to intentions to leave (Fernet et al., 2016). The result also indicate that MW was also negatively correlated with TI (r = 0.667), which is consistent with the literature suggesting that MW can reduce TIs (Steger et al., 2012).
Table 3 presents the item-level validity and reliability results for all variables used in this study. Each item was evaluated through item-total correlation analysis to determine its contribution to the overall scale. All items showed correlation coefficients exceeding the recommended threshold of 0.50 (Hair et al., 2019), indicating strong construct validity. The factor loadings obtained through EFA in the pilot test also ranged from 0.615 to 0.947, further confirming that each item adequately represented its respective construct. The Cronbach’s alpha values for all variables exceeded 0.60, confirming internal consistency and reliability of the measurement instruments.
Normality test
The results of the Kolmogorov-Smirnov normality test (Figure 2 and Table 4) show that the test statistical value is 0.116 with Asymptotic Significance (2-tailed) of 0.123. Because the significance value (p-value) is greater than 0.05, namely 0.123, the residual can be considered normally distributed. Thus, the normality assumption in the regression analysis is met, and the model can be regarded as acceptable related to the normal distribution of residuals.
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FIGURE 2: Results of normality test of P-P plot. |
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| TABLE 4: Results of normality test with Kolmogorov-Smirnov (N = 230). |
Ethical considerations
Ethical approval to conduct this study was obtained from the Universitas Pembinaan Masyarakat Indonesia (No. 112/J.15/KE-UPMI/V/2024).
Results of hypothesis test
The results of hypothesis testing with the dependent variable JB (Table 5) show that the overall regression model is significant. This model also has an R2 value = 0.5685, which means 56.85% of the variation in JB can be explained by the variables in the model. The WB variable has a significant positive influence on JB (b = 1.2355, p = 0.0003) (H1 is supported). This suggests that higher levels of perceived WB – such as experiencing persistent personal or work-related mistreatment—are associated with greater levels of burnout. The interaction between WB and MW has a significant negative effect on JB (b = −1.0328, p < 0.0001) (H5 is supported), which means MW can reduce the negative effect of WB on JB. In other words, when someone feels that their work is meaningful, the negative influence of bullying on burnout is reduced.
| TABLE 5: Results of hypothesis test on job burnout: Outcome variable: JB. |
Based on Table 6, hypothesis testing with the dependent variable TI shows that this regression model is overall significant. This model has an R2 value = 0.4583, which means 45.83% of the variation in TI can be explained by the variables in the model. The WB variable has a positive and significant influence on TI (b = 0.2619, p < 0.0001) (H2 is supported). This shows that the higher the level of WB, the greater the employee’s tendency to have TI. The JB has a positive and significant influence on TI (b = 0.2711, p < 0.0001) (H3 is supported). This indicates that the higher the level of JB, the greater the employees’ tendency to have TI. The interaction between JB and MW has a negative and significant influence on TI (b = −0.5281, p < 0.0001) (H6 is supported). This illustrates that MW can reduce the negative influence of JB on TI. This means that when someone feels that their work is meaningful, the influence of burnout on the intention to leave work will decrease.
| TABLE 6: Results of hypothesis test on turnover intention: Outcome variable: TI. |
Based on the results of the mediation test in Table 7 for the path WB → JB → TI, JB functions as a significant mediator in the relationship between WB and TI (H4 is supported). Job burnout mediates the influence of WB on TI with an effect of 0.1633. This means that WB increases JB, which in turn increases TI.
The results of the mediated-moderation test (Table 8) illustrate that WB has an indirect effect on TI through JB at three different levels of MW: 10.0646, 12.1391 and 14.2137 (H7 supported). At all MW levels, the mediation effect is significant because the BootLLCI (lower limit confidence interval) and BootULCI (upper limit confidence interval) values do not include zero, with effects of 0.1102, 0.1082, and 0.0983, respectively. This indicates that job burnout mediates the relationship between WB and TI. However, the strength of this mediation weakens as perceived MW increases. In other words, higher perceptions of meaningful work reduce the strength of the indirect effect of WB on TI via JB.
| TABLE 8: Result of mediated-moderation test. |
Discussion
The study focuses on the influence of WB in the workplace on JB and TI in resident doctors who are taking part in a specialist education programme at a private hospital in Medan City, West Sumatra province. Specifically, this study analyses the mediating role of JB and the moderating role of MW to fully understand how WB influences an individual’s TI. Based on research findings, WB has now become a factor that is receiving attention, especially in the health industry sector. The results show that when resident doctors who are taking part in educational programmes experience bullying, they experience JB and hide their feelings. As stated by Fernet et al. (2016), emotional exhaustion is a psychological response that occurs as a result of bullying, which causes high levels of burnout. The results of this study are consistent with those of Anasori et al. (2020), Kim et al. (2020) and Ribeiro et al. (2022) that WB can drain a person’s resources, resulting in JB.
Apart from physical and emotional fatigue, WB can affect individuals and increase their TI. As stated by Van Schalkwyk et al. (2011) and Ahmad and Kaleem (2020) that WB, whether verbal, psychological or physical, can cause emotional stress, which results in individuals or employees, being trapped in an unsupportive work environment, thus increasing their TI. Likewise, several previous studies have stated that exposure to bullying and other forms of mistreatment in the workplace, whether harassment, excessive work assignments or incivility, significantly influences individuals’ intentions to leave their jobs (Nielsen & Einarsen, 2018; Ribeiro et al., 2022).
Apart from having an impact on emotional well-being, burnout has also been shown to increase individuals’ intentions to leave the organisation. This finding is in line with previous research, which states that emotional and physical fatigue can make employees lose motivation and work commitment, thereby increasing TI (Fernet et al., 2016; Kim et al., 2019). Burnout in stressful work environments, such as the healthcare sector, makes individuals more susceptible to considering leaving their job as a way to cope with burnout (Chowdhury et al., 2023; Fan et al., 2023). Especially among resident doctors, high levels of burnout exacerbate the risk of turnover because of ongoing job demands and emotional burden (Ribeiro et al., 2024). Thus, these results emphasise the need for more attention to burnout management to reduce high turnover in the healthcare industry.
The results of this study also support the hypothesis that burnout mediates the relationship between WB and TI. These findings suggest that WB not only affects individuals’ intentions to leave directly but also indirectly through increased burnout. Bullying triggers emotional and mental exhaustion, which ultimately strengthens the tendency to leave their organisation (Livne & Goussinsky, 2018; Xia et al., 2023). Burnout acts as an important mechanism in explaining why victims of WB are more likely to have the intention to leave. This finding is consistent with previous studies highlighting that a stressful work environment exacerbates burnout, which then influences TI (Kim et al., 2019; Scanlan & Still, 2019). In resident doctors, who face high demands and a hierarchical environment, burnout is a crucial factor that bridges the influence of bullying on TI.
The findings of this research also support the moderating role of MW in the relationship between WB, burnout and TI. Meaningful work can act as a buffer against the negative influence of bullying, both on burnout and TI. In the relationship between WB and burnout, MW plays an important role in weakening the influence of bullying. Workplace bullying, which often causes emotional, physical and psychological distress, usually increases the risk of burnout. However, when individuals feel that their work is meaningful, they are more resilient to the negative effects of bullying (Allan et al., 2020; Han et al., 2020). In resident doctors, this occurs when they feel capable of contributing to public health or having a positive social impact. Conversely, if work is felt to be meaningless, bullying will more easily cause burnout, thereby worsening their emotional condition (Xia et al., 2023).
Meaningful work also moderates the relationship between burnout and TI. In burnout conditions, individuals who feel that their work is meaningful tend to be more motivated to persist, because they feel connected to the goals and contributions of their work (Steger et al., 2012). However, if this meaning is absent, burnout will encourage them to leave the organisation and look for work elsewhere that is more aligned with their personal values and goals (Kim et al., 2019; Ribeiro et al., 2024). In the context of resident doctors who face high workloads and hierarchical environments, MW can strengthen their resilience to continue working despite experiencing burnout.
These findings also support mediated-moderation, where MW weakens the indirect impact of bullying on TI through burnout. For resident doctors who feel that their work is meaningful, the effect of burnout on TI is weaker. In contrast, without the perception of meaning in work, burnout strengthens the relationship between bullying and TI, thereby increasing the likelihood of leaving the organisation. Overall, MW plays an important role in strengthening employee resilience to negative behaviour and reducing the impact of burnout on TI. Meaningful work not only helps individuals survive difficult conditions but also reduces their tendency to leave work despite facing challenges.
Conclusions and limitations
This study aims to examine the relationship between WB and TI, with a focus on the mediating role of JB and the moderating role of MW. The findings reveal that high levels of JB significantly increase TI, and WB is identified as a major factor that exacerbates JB and encourages individuals to leave their organisations. These results highlight the importance of preventing WB and managing burnout to maintain employee well-being and reduce employee turnover. Although previous research has explored these topics, this study offers new insights by focusing on resident doctors undergoing a specialist medical education programme in Medan, Indonesia.
These findings have practical implications for organisations. Creating an inclusive work environment that fosters mutual respect and respect for diversity can help prevent WB. Monitoring employee well-being through regular assessments allows organisations to detect early signs of burnout and provide timely intervention. In addition, encouraging MW by helping employees find purpose in their roles can increase their resilience, making them better equipped to handle workplace stress. These steps are particularly relevant in healthcare settings, where hierarchical structures and heavy workloads are common.
This research has several limitations that must be addressed in future research. The study was conducted at a specific location and time, which may limit the generalisability of the findings. Future research could explore different regions and contexts to validate the results. In addition, although the sample provides valuable insight, future research with a larger sample size could increase the representativeness and generalisability of the findings to a broader population. A longitudinal approach would also be useful to capture the dynamic impact of WB and burnout over time.
Acknowledgements
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Authors’ contributions
B.A.S. was responsible for conceptualisation, methodology, formal analysis, investigation, writing the original draft, project administration, software and funding acquisition. D.S. was responsible for conceptualisation, visualisation, validation, data curation, resources, writing (review and editing) and supervision.
Funding information
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data availability
The data that support the findings of this study are available from the corresponding author, B.A.S., upon reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder or agency, or that of the publisher. The authors are responsible for this article’s results, findings and content.
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Appendix 1
Questionnaire items
Workplace bullying (Einarsen, 2009)
Work-related bullying
I was exposed to an unmanageable workload with unreasonable deadlines. I received pressure not to claim something to which I was entitled (e.g., sick leave, holiday entitlement, travel expenses). My opinions were ignored.
Person-related bullying
4. I was persistently criticised for my errors or mistakes. 5. I was ignored or faced a hostile reaction when I approached others. 6. I was humiliated or ridiculed in connection with my work. 7. I received insulting or offensive remarks about my personality, attitude or private life.
Job burnout (Maslach et al., 2001; Ribeiro et al., 2024)
Emotional exhaustion
I feel emotionally drained from my work. I feel used up at the end of the workday. I feel burned out from my work. I feel frustrated by my job. Working with people all day is really a strain for me.
Depersonalisation
I have started to feel more emotionally distant from patients since I began this job. I worry that this job is making me emotionally numb. I find myself feeling less emotionally involved in what happens to my patients at times. I feel that patients or their families often blame me for their problems.
Work meaningfulness (Han et al., 2020; Spreitzer, 1995)
The work I do is very important to me. My job activities are personally meaningful to me. The work I do is meaningful to me.
Turnover intention (Marshall & Stephenson, 2020; Netemeyer et al., 2004)
I intend to leave my position during the next 12 months. I hope to be able to resign within the next 12 months. I hope to quit my current organisation within the next 12 months.
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