The Association Between Healthy Work Environment and Work Engagement Among Intensive Care Unit Nurses: The Mediating...

Nurse work engagement is a persistent issue in healthcare. Low engagement reduces professional dedication and sense of belonging, increases the likelihood of turnover, impedes collaboration and treatment continuity, and, ultimately, has a negative impact on care quality and patient safety. The issue warrants particular attention in the demanding context of intensive care. Therefore, maintaining higher levels of work engagement among ICU nurses is important for workforce retention and high-quality patient care.

To assess the association between a healthy work environment and work engagement among ICU nurses and to test the hypothesized mediating roles of self-efficacy and compassion fatigue.

A cross-sectional survey involving ICU nurses was conducted at four general hospitals in China from November 2025 to January 2026. The Healthy Work Environment Assessment Tool (HWEAT), Utrecht Work Engagement Scale (UWES), General Self-Efficacy Scale (GSES), and Compassion Fatigue Short Scale (CF-Short Scale) were used. Statistical analyses were conducted in SPSS 25.0 and structural equation modeling in AMOS 26.0.

Significant indirect associations were identified through self-efficacy and compassion fatigue, which together accounted for part of the association between a healthy work environment and work engagement. The results indicated that a healthy work environment was positively associated with self-efficacy (β = 0.67, p < 0.001) and work engagement (β = 0.46, p < 0.001) and negatively associated with compassion fatigue (β = -0.51, p < 0.001). Additionally, self-efficacy was positively associated with work engagement (β = 0.33, p < 0.001) and negatively associated with compassion fatigue (β = -0.36, p < 0.001). Compassion fatigue was negatively associated with work engagement (β = -0.22, p < 0.001). The hypothesized model demonstrated acceptable fit: χ²/df = 3.240, CFI = 0.983, RMSEA = 0.079, and GFI = 0.933.

This study assessed the association between a healthy work environment and work engagement among ICU nurses and examined the indirect roles of self-efficacy and compassion fatigue. Hospital administrators may consider prioritizing healthy work environments and implementing initiatives that support nurses' self-efficacy and address compassion fatigue, given their associations with work engagement. Notably, the cross-sectional nature of the data precludes causal interpretation; the findings should, therefore, be interpreted as associations rather than causal effects.

The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational research.

The findings indicate that a healthy work environment, self-efficacy, compassion fatigue, and work engagement are closely interrelated among ICU nurses. Nursing managers may adopt an integrated strategy that combines environmental support with efforts to promote self-efficacy and address compassion fatigue, thereby potentially supporting work engagement among ICU nurses. Meanwhile, greater attention to the healthy work environment and nurses' self-efficacy may help support workforce resilience, care quality, and staff retention.