Emergency room (ER) nurses play a crucial role as they need to make appropriate judgments and provide immediate care to patients with various symptoms and degrees of severity [1]. However, due to the unique characteristics and diverse situations in the ER, the burden on nurses is high, leading to a higher turnover rate compared to nurses in other departments [2]. A 2023 report highlights that the national average turnover rate for registered nurses (RNs) is 18.4%, while turnover rates in emergency services and similar high-stress units exceed 29.0%, significantly higher than the rates observed in pediatrics or general wards [3]. The increased turnover rate among ER nurses results in a shortage of nursing staff who need to provide care on-site, and particularly, the absence of experienced nurses negatively impacts the quality of emergency care [2]. To improve the quality of emergency nursing, it is essential not only to increase the retention of ER nurses and reduce their turnover intentions but also to ensure the retention of experienced nurses. Job embeddedness, a concept developed by Mitchell et al. to understand why people stay in their organizations, is relevant here [4]. Most studies related to job embeddedness among clinical nurses focus on its relationships with turnover intention, retention intention, and other organizational factors. But there is an insufficiency of analytical research on the psychological or emotional factors influencing job embeddedness [5].

Positive psychological capital refers to the psychological resources that individuals utilize for personal development, encompassing physical and mental health, and contributing to improved group performance [6]. According to previous studies, Positive Psychological Capital positively affects job embeddedness and individual job-related behaviors, bringing positive changes to the nursing organization [7]. ER nurses experience job stress and emotional labor due to the coexistence of emergency and nonemergency patients and workload, and Positive Psychological Capital can reduce psychological stress and increase job satisfaction, thus being a key factor in enhancing job embeddedness [8].

Gratitude is defined as recognizing the value and meaning of events, people, actions, or objects and feeling a positive connection to them, helping individuals recover and overcome negative situations [9]. ER nurses are exposed to negative factors such as emotional labor, incivility, and violence, which cause them to experience stress, burnout, and anxiety while providing nursing care [10]. Recent studies suggest that gratitude in the workplace enhances job satisfaction, which serves as a crucial factor in reducing turnover intention. Research indicates that gratitude improves job satisfaction and fosters positive work attitudes, thereby increasing job involvement and decreasing the likelihood of leaving an organization [11,12].

ER nurses often face situations where maintaining a cooperative relationship with patients and guardians is challenging, and they frequently experience anger due to assaults by patients or intoxicated individuals [10]. However, due to the nature of their profession, nurses lack the skills to manage and express anger appropriately [13]. This inappropriate anger expression reduces work concentration and efficiency, negatively affecting organizational retention and commitment [14]. This implies that anger increases turnover intentions and indirectly negatively impacts job embeddedness [13]. However, since there is limited research directly linking levels of anger expression to job embeddedness, it is necessary to study the relationship between anger expression and job embeddedness.

Based on the three variables-positive psychological capital, gratitude, and anger expression -that hold significant meaning for the job embeddedness of emergency room nurses, this study aims to examine how these variables influence job embeddedness. It will evaluate the levels of these variables among participants, analyze how they differ based on general characteristics, explore their interrelationships, and identify key factors influencing job embeddedness in ER nurses.

The level of job embeddedness among emergency room nurses in this study was found to be lower compared to nurses in general wards or long-term care facilities, as indicated by previous research [21,22]. This difference may be attributed to the higher psychological stress experienced by emergency room nurses, which can negatively affect their sense of job attachment and engagement. Recent studies indicate that stress among nurses significantly impacts their job embeddedness, with high stress levels often leading to reduced organizational commitment and weaker interpersonal connections within the workplace [23]. ER nurses maintain a constant state of tension due to interactions with other departments based on the urgency of emergency patients and the pressure to administer quick treatment [24]. This excessive psychological stress likely results in relatively low job embeddedness scores among ER nurses.

Among the subdomains, organizational fit scored the highest. This suggests that job embeddedness is positively influenced when individuals feel that their colleagues and work environment align with their personal goals rather than the benefits obtained from the organization [7]. Particularly in the ER, where frequent cooperation and interaction with various departments are essential [24], high scores in fit and linkage can be understood. However, in the sacrifice domain, which refers to the benefits of staying, lower scores were observed compared to fit and linkage. Previous studies have also found low scores in the sacrifice domain [7,22], suggesting that ER nurses, due to frequent exposure to sudden emergencies, verbal abuse, and physical conflicts, experience higher frustration and desire to escape [24], negatively impacting the sacrifice domain.

The level of positive psychological capital in this study was relatively high compared to studies [7]. The high scores in the “hope” dimension of positive psychological capital among emergency nurses likely reflect their belief in the potential for improvement in patient conditions, which motivates them to create effective nursing plans, even in complex situations. A recent study supports this idea, emphasizing that positive psychological capital, including hope, is crucial for maintaining performance under stressful conditions and mediates the impact of burnout on nursing outcomes [25]. The level of gratitude was found to be lower compared to studies conducted on general nurses [26], and the expression subdomain scoring the highest. The high score in the expression subdomain may be because ER nurses frequently interact with other departments and various people, creating many situations where they need to express gratitude.

The anger expression subdimension showed the highest level among the subdimensions of anger. This suggests that individuals make significant efforts to control their anger expression [19]. ER nurses encounter many situations that provoke anger due to interactions with various departments and patients. Instead of expressing or suppressing their anger, they make considerable efforts to control it. Additionally, controlling and managing anger to provide high-quality nursing services [14] explains their high score in anger control.

Job embeddedness varied by demographic characteristics, being higher among older, married nurses with higher positions and clinical experience. This finding aligns with previous research [27]. As age and experience increase, so does job proficiency, which can lead to promotions and increased organizational benefits, resulting in higher job embeddedness. However, job embeddedness was lowest among nurses aged 26~35. This age group often experiences career stagnation, repeating familiar tasks rather than taking on new ones, leading to uncertainty about their position and future. This uncertainty can increase interest in new fields or organizations, raising turnover intentions [4]. Strategies to improve job embeddedness for this age group are necessary. Married nurses showed higher job embeddedness, possibly due to the responsibility and stability family life provides [7].

Positive psychological capital was higher among older, more educated, higher-ranking, experienced, and non-religious nurses. Increased age, experience, and education may lead to greater confidence in handling emergencies and higher job satisfaction, enhancing positive psychological capital. The achievement and willingness to learn gained through professional knowledge acquisition positively impact nursing performance [14], suggesting the need for programs that motivate learning and apply acquired knowledge in clinical practice to enhance positive psychological capital.

Gratitude was higher among older, more educated, higher-ranking, experienced, religious, and married nurses. Gratitude can develop through training and learning [28], and higher age, education, position, and experience contribute to its enhancement over time. Implementing gratitude expression training programs could improve nurses' levels of gratitude.

No significant differences in anger expression were found based on demographic characteristics. This result is similar to studies on ER nurses [14]. The frequent interactions with various job types, patients, and guardians in the ER lead to many situations provoking dissatisfaction, verbal abuse, and violence [24]. Therefore, efforts are made to control and resolve anger rather than expressing it based on demographic characteristics [14]. Due to the frequent anger-inducing situations in the ER, interventions such as emotional control and appropriate communication training are necessary [14].

Correlation analysis showed significant positive correlations between job embeddedness and positive psychological capital and gratitude. Positive psychological capital had the strongest positive correlation, consistent with studies on clinical nurses [25]. This suggests that ER nurses seek positive strategies and work attitudes in various situations, overcoming challenges and achieving higher satisfaction, which enhances job embeddedness. Although direct comparisons are difficult due to a lack of studies on gratitude and job embeddedness, gratitude also showed a positive correlation. Gratitude helps regulate emotions and recover in difficult situations, fostering a proactive attitude toward problem-solving [9]. This positive impact of gratitude helps ER nurses find meaning in stressful situations [24], positively influencing job embeddedness.

Although no significant correlation between anger expression and job embeddedness was found, studies on ER and general hospital nurses suggest that appropriate anger expression and control are related to job performance and organizational commitment [13,14]. This indirectly indicates a correlation between appropriate anger expression and job embeddedness. The lack of correlation in this study may be due to ER nurses’ need to control emotions and provide quick judgment and care rather than react to anger-inducing situations.

Multiple linear regression analysis identified positive psychological capital as the most significant factor influencing job embeddedness. This finding supports research on trauma center nurses [7], which also highlighted the importance of developing and enhancing positive psychological capital. Positive psychological capital helps individuals cope with complex and diverse environments, developing their abilities [6]. In the ER, with its dynamic work characteristics, positive psychological capital enhances ER nurses’ coping abilities and potential [7]. Implementing simulation or stress management programs for handling emergencies could improve coping abilities and hope [24]. Further research is needed to verify the impact of such programs on positive psychological capital.

Other factors influencing job embeddedness included age and marital status, supporting findings from studies on trauma center and long-term care hospital nurses [7]. Increased age correlates with accumulated experience and proficiency, enhancing understanding and response to emergencies, positively impacting job embeddedness. Marital status suggests a tendency to settle in one place, also positively influencing job embeddedness [7].

The last factor influencing job embeddedness was gratitude, indicating that higher levels of gratitude among emergency room (ER) nurses correlate with higher job embeddedness. A study on clinical nurses confirmed that higher gratitude levels positively affect happiness and psychological well-being [29]. This suggests that when gratitude levels are high, emotional stability improves, positively impacting job embeddedness. ER nurses experience high psychological instability due to heavy workloads and emotional labor [24], necessitating the provision of emotional management programs to increase gratitude levels. Individually, it is essential to incorporate meditation, prayer, and contemplation, providing time for self-reflection and expressing gratitude in life. Previous studies have developed and applied programs to increase gratitude levels, proving that gratitude can be enhanced through education and training [28]. Based on this, follow-up research is needed to understand ER nurses' psychological states and apply programs to increase their gratitude levels, confirming the improvement post-application. A limitation of this study is that data were collected only from emergency room nurses at university hospitals in three regions, so caution should be exercised when generalizing the findings.

The nursing implications of this study are as follows:

First, this study academically highlights the significance of emotional and psychological factors, such as positive psychological capital, gratitude, and anger expression, as influential variables on job embeddedness, which have been overlooked in previous research. This contributes to a deeper understanding of job embeddedness and highlights the need for a multidimensional approach in nursing research. Furthermore, by analyzing the unique impacts of job embeddedness in high-risk, high-stress environments such as emergency rooms, this study expands the scope of research on job embeddedness across diverse nursing settings. Notably, exploring negative emotions such as anger as a key variable of job embeddedness provides a differentiated academic contribution compared to previous studies.

Second, in terms of practical implications, the findings of this study provide a basis for developing practical intervention programs aimed at enhancing positive psychological capital and gratitude among emergency room nurses. Additionally, based on the study results, nursing managers can establish nurse retention strategies, such as stress reduction programs, emotional support systems, and professional development initiatives, which will contribute to improving the quality of emergency medical services.

This study found significant positive correlations between positive psychological capital, gratitude, and job embeddedness. The main factors influencing job embeddedness among ER nurses were identified as positive psychological capital, gratitude, and marital status. Based on these findings, exploring ways to enhance positive psychological capital and gratitude levels is essential to improve ER nurses’ job embeddedness. There were significant differences in clinical experience and job position regarding positive psychological capital and gratitude, which influence job embeddedness. Therefore, when providing programs to enhance job embeddedness among ER nurses, education should be tailored according to their experience and position. Moreover, when developing educational programs, positive psychological capital and gratitude are emotional aspects, so practical applications should be included

This study provides nursing significance by examining the relationship between positive psychological capital, gratitude, anger expression, and job embeddedness among ER nurses and can serve as foundational data for improving job embeddedness among ER nurses. However, further research is needed due to the lack of studies examining the relationship between gratitude, anger expression, and job embeddedness. Additionally, research on the positive effects of anger expression, often viewed negatively, and the tools to measure anger expression among nurses is insufficient, necessitating repetitive studies. Based on these results, developing programs to enhance positive psychological capital and appropriate gratitute methods, and exploring and verifying their effects, is needed to improve job embeddedness among ER nurses.