Workplace exclusion linked to quiet quitting among hospital staff, with anxiety amplifying the pathway

Healthcare workers who feel ignored, sidelined, or deliberately excluded by colleagues and managers appear more likely to quietly withdraw from their jobs, and a new study from Turkey suggests that this link runs partly through rule-breaking behaviour on the job and is strongest among employees who are anxious. The research, published in the journal Discover Health Systems, surveyed 459 staff at a medium-sized public hospital in the Marmara region and tested a statistical model that ties together four constructs: organisational ostracism, organisational deviance, anxiety, and quiet quitting.

Quiet quitting describes employees who stop going beyond the minimum requirements of their job descriptions, performing only the tasks formally assigned to them while quietly asserting their rights in the workplace. The authors frame it as a form of psychological withdrawal in which workers ask themselves questions such as “What am I doing?” and “Is it worth it?” and respond by disengaging from the organisation. The phenomenon gained wide attention after the COVID-19 pandemic, particularly among younger employees, and the researchers treat it as a coping strategy in which people conserve their remaining emotional and cognitive resources rather than resign outright.

The theoretical backbone of the study is conservation of resources theory, which holds that employees are motivated to protect and acquire valued resources such as social belonging, support, and recognition. According to this framework, workplace ostracism depletes social and psychological resources, and workers respond by reducing discretionary effort to prevent further loss. The authors argue that exclusion may first erode adherence to organisational norms, producing deviant behaviours such as arriving late, leaving early, taking unnecessary sick leave, withholding information, or worse, and that these behaviours then feed into quiet quitting as a further stage of withdrawal.

Data were collected between 1 and 25 June 2024 using questionnaires distributed to all hospital units. Of 520 forms handed out, 487 were returned and 459 were complete and correct enough to analyse, a response rate of 53.2 percent. Participants had to have worked actively in the institution for at least one year and hold a valid professional licence; trainees, students, and staff on leave were excluded. All four study variables were measured with validated scales rated on five-point Likert formats: an eleven-item exclusion at work scale, an eight-item quiet resignation scale, a fifteen-item organisational deviance scale, and a twelve-item shortened social anxiety scale. Ethical approval came from Erzincan Binali Yıldırım University, and the study followed STROBE reporting guidelines.

The descriptive results were striking on their own. Among respondents, 73.4 percent reported feeling excluded in their organisation, 62.5 percent admitted engaging in unethical behaviour at work such as lying, cheating, slowing down work, sabotage, or stealing, 76.6 percent said they were unwilling to take on new tasks or responsibilities, and 73.8 percent reported recently feeling tense, anxious, or restless. The sample was 63.8 percent female, 68.8 percent married, and 40.3 percent aged between 26 and 33, with 37.7 percent reporting six to ten years of work experience.

Statistically, all four constructs were strongly and positively correlated. Organisational exclusion correlated with quiet quitting at r = 0.78, with deviance at r = 0.87, and with anxiety at r = 0.88, while anxiety and quiet quitting correlated at r = 0.76. A confirmatory factor analysis supported a four-factor measurement model with acceptable fit indices (χ2/df = 3.24; RMSEA = 0.07; CFI = 0.94; TLI = 0.93; SRMR = 0.03), and Cronbach’s alpha values ranged from 0.891 to 0.975. Harman’s single-factor test suggested that common method bias, a concern whenever all data come from self-reports at one point in time, was not a serious threat, with the first unrotated factor accounting for 23 percent of variance, well below the 50 percent threshold.

The hypothesis tests used regression and bootstrap analyses in the SPSS PROCESS macro. Organisational exclusion significantly and positively predicted quiet quitting (β = 0.307) and deviance (β = 0.844), and deviance in turn predicted quiet quitting (β = 0.307). Mediation analysis with 5,000 bootstrap resamples showed that organisational deviance partially mediated the exclusion-to-quiet-quitting link (indirect effect β = 0.254, confidence interval 0.179 to 0.285), meaning the direct path from ostracism to quiet quitting remained significant even with the mediator in the model. Anxiety moderated the second stage: the interaction between deviance and quiet quitting was significant and positive (β = 0.121, 95 percent CI 0.073 to 0.171), and the index of moderated mediation was significant (β = 0.103, 95 percent CI 0.048 to 0.157).

The conditional indirect effect followed a clear pattern. When anxiety was low, the indirect association through deviance was not statistically significant (β = 0.079, 95 percent CI −0.038 to 0.195, an interval that includes zero). At moderate anxiety the indirect effect was significant (β = 0.229, CI 0.153 to 0.306), and at high anxiety it was stronger still (β = 0.379, CI 0.275 to 0.481). In other words, the pathway from feeling excluded, through deviant behaviour, to quiet withdrawal appears to operate mainly among employees carrying higher levels of anxiety, consistent with the idea that anxious workers have fewer psychological resources available to cope with workplace stressors.

The authors are careful to stress what the design cannot show. Because the study is descriptive, correlational, and cross-sectional, and because every measure came from the same respondents at a single point in time, the results describe patterns of association rather than causal effects. The data do not demonstrate that exclusion produces anxiety, or that anxiety then produces deviance or quiet quitting; anxiety was measured as a moderator at one moment, and the temporal ordering implied by a causal reading was never tested. Reverse pathways, such as quiet quitting increasing perceptions of exclusion, remain equally consistent with the data. The authors also note that the very high correlations among exclusion, deviance, and anxiety raise the possibility of conceptual overlap between the constructs, that the anxiety instrument measured social anxiety rather than generalised or work-specific anxiety, and that demographic and occupational characteristics were not entered as covariates, leaving the reported associations unadjusted.

Generalisability is a further constraint. The sample came from a single public hospital, recruited by convenience sampling, which may have introduced self-selection bias if employees with stronger perceptions of workplace experiences were more likely to respond. The authors explicitly state that the conclusions apply to the study setting and design and should not be generalised to healthcare workers more broadly, nor interpreted causally, until replicated with longitudinal and multi-site data. Within those limits, they suggest that the findings offer a preliminary account of how ostracism may be linked to quiet quitting among healthcare workers, and they flag organisational deviance and anxiety as constructs worth attention in future work, with any practical recommendations regarded as tentative until confirmed by stronger research designs.

Subject of Research: The association between workplace ostracism, organisational deviance, anxiety, and quiet quitting among healthcare workers in a Turkish public hospital

Article Title: Organizational ostracism and quiet quitting in healthcare a mediated moderated model of deviance and anxiety

Article References: Küçükali, A., Bas, M., & Tarsuslu, S. (2026). Organizational ostracism and quiet quitting in healthcare a mediated moderated model of deviance and anxiety. Discover Health Systems, 5(1), Article 77. https://doi.org/10.1007/s44250-026-00417-9

Image Credits: AI Generated

DOI: 10.1007/s44250-026-00417-9

Keywords: quiet quitting, organizational ostracism, organizational deviance, anxiety, healthcare workers, cross-sectional study, conservation of resources theory, moderated mediation, hospital staff, Turkey, employee withdrawal, occupational psychology