Predictors of work engagement and burnout among rural nurses in Japan during COVID-19: a cross-sectional study

BACKGROUND: Work engagement and burnout are distinct psychological constructs, yet their coexistence under prolonged crisis conditions remains insufficiently examined, particularly in rural healthcare settings. This study investigated predictors of both work engagement and burnout among nurses in rural Japan during the later phase of the COVID-19 pandemic (July 2022). METHODS: A cross-sectional paper-based survey was administered to all 560 nurses and midwives working at a rural university hospital. Missing data were minimal and handled using listwise deletion, resulting in a final analytical sample of 195 participants for regression analyses. Validated instruments assessed work engagement (UWES-3), burnout (BAT-J), job crafting (JCS-J), resilience (RS-14), and mental health (S-WHO-5-J). Hierarchical multiple linear regression analyses were conducted, with demographic variables entered first, followed by psychological variables and interaction terms to examine conditional associations with the COVID-19 care experience. Statistical significance was set at p < 0.05. RESULTS: Work engagement was positively associated with job crafting (β = 0.31, p < 0.001) and resilience (β = 0.29, p < 0.001). The COVID-19 care experience moderated these relationships, weakening the association between job crafting and work engagement (β = −0.20, p = 0.003) while strengthening the association between mental health and work engagement (β = 0.21, p = 0.002), indicating indirect and conditional pathways rather than direct effects. Burnout was negatively associated with mental health (β = −0.46, p < 0.001) and resilience (β = −0.18, p = 0.014) and was higher among unmarried nurses (β = 0.13, p =0.047). No interaction effects were observed for burnout. Work engagement and burnout showed a weak inverse correlation (r = − 0.28). CONCLUSIONS: The psychological impact of COVID-19 varied by pandemic phase. In the later stage, the COVID-19 care experience was not directly associated with work engagement or burnout; however, it reconfigured how job and personal resources were linked to work engagement. Burnout was primarily linked to psychosocial factors rather than to the COVID-19 care experience. Sustaining nurse well-being during prolonged crises requires long-term organizational strategies that support job crafting, resilience, and accessible mental health care, with attention to regional and structural contexts, such as rural healthcare settings. CLINICAL TRIAL NUMBER: Not applicable.