Background <p>This study examines the relationships among job satisfaction, work-family conflict, psychological distress, and turnover intention among nursing assistants in China, with a particular focus on the mediating role of psychological distress.</p> Methods <p>A cross-sectional survey was conducted among 240 nursing assistants from Jiangsu and Fujian provinces between December 2023 and March 2024. Standardized instruments measured job satisfaction, work-family conflict, psychological distress (K10), and turnover intention. Pearson correlation and mediation analyses were performed using PROCESS Macro (Model 4) to assess relationships and mediating effects.</p> Results <p>Job satisfaction was negatively associated with turnover intention (<i>r</i>=-0.30, <i>p</i> &lt; 0.01) and psychological distress (<i>r</i>=-0.23, <i>p</i> &lt; 0.01). Work-family conflict was positively correlated with psychological distress (<i>r</i> = 0.52, <i>p</i> &lt; 0.01) and turnover intention (<i>r</i> = 0.48, <i>p</i> &lt; 0.01). Mediation analyses indicated that psychological distress partially explained the associations of job satisfaction and work-family conflict with turnover intention, accounting for 17.64% and 27.22% of the total effects, respectively.</p> Conclusion <p>Job satisfaction and work-family conflict demonstrate both direct associations with turnover intention and indirect associations through psychological distress. These findings suggest that integrating psychological health protection into workforce management strategies, alongside reducing work-family conflict and strengthening organizational resources, may represent a viable approach to improving retention in China’s long-term care sector.</p> Clinical trial number <p>Not applicable.</p>