The impact of work pressure on nurses' work engagement: A moderated mediation model

Against the backdrop of medical tax reform and escalating doctor-patient conflicts, the workload of nurses in China has surged, with resignation rates rising year after year. Based on this context, this study draws on resource conservation, social cognition, and ecosystem theories to construct an intermediary model of ‘work pressure → self-efficacy → work engagement,’ and introduces social support as a moderating variable to establish a moderated intermediary model. In terms of sampling methods, stratified cluster sampling was employed to select 765 clinical nurses from first- to third-level hospitals in Province S, China, for a cross-sectional questionnaire survey. The study results revealed: first, work stress significantly negatively impacts work engagement (β = –0.170, p < 0.001); Second, self-efficacy partially mediated this relationship, with work stress reducing work engagement by lowering self-efficacy, accounting for 10.88% of the total effect; Third, social support significantly moderated the effect of work stress on work engagement, with social support significantly alleviating the negative impact of work stress on work engagement; Finally, the moderated mediation model holds true, with social support significantly moderating the first half of the mediation chain ‘work pressure—self-efficacy—work engagement.’ Specifically, when nurses receive higher levels of social support, the negative chain of work pressure reducing work engagement by weakening self-efficacy is significantly buffered; conversely, in low-support situations, this negative transmission is more pronounced. The findings of this study suggest that hospitals can effectively break the vicious cycle of ‘high stress—low self-efficacy—low work engagement’ by strengthening self-efficacy training and establishing blended online and offline support networks. This approach provides feasible strategies for stabilising the nursing workforce and enhancing patient experience under the DRG reform framework.