Perceived decent work and work engagement among nurses: a multicenter cross-sectional mediation analysis of...

A stable and engaged nursing workforce is important for continuity of care and health-system preparedness. Perceived decent work may be associated with nurses' work engagement, and self-esteem may account statistically for part of this association; however, cross-sectional data cannot establish temporal or causal pathways.

To assess perceived decent work among nurses in tertiary Grade-A hospitals in Sichuan Province, examine its association with work engagement, and estimate the statistical indirect association through self-esteem.

We conducted a multicenter cross-sectional survey between November 2022 and May 2023 among 323 registered clinical nurses recruited by convenience sampling from five hospitals with different administrative affiliations in Sichuan Province. Spearman correlations described unadjusted monotonic associations. Multiple linear regression estimated adjusted associations after simultaneous control for gender, age, household registration, education, and professional title. A bias-corrected bootstrap mediation analysis with 5,000 resamples estimated total, direct, and indirect associations; a sensitivity model adjusted for gender, age, education, and professional title.

Mean scores for perceived decent work, self-esteem, and work engagement were 39.27 ± 7.62, 32.52 ± 5.00, and 27.27 ± 6.53, respectively. The variables were positively correlated (r = 0.336-0.637, all p < 0.01). The total, direct, and indirect estimates were 0.637 (95% CI 0.552-0.721), 0.566 (95% CI 0.468-0.664), and 0.071 (95% CI 0.029-0.121), respectively; the indirect estimate represented 11.1% of the total and remained statistically significant after covariate adjustment (0.065, 95% CI 0.024-0.115). In adjusted regressions, male nurses had lower perceived decent work (B = -3.447, 95% CI -5.606 to -1.288), self-esteem (B = -2.020, 95% CI -3.446 to -0.594), and work engagement (B = -2.656, 95% CI -4.524 to -0.789) scores than female nurses.

In this regional convenience sample, perceived decent work was positively associated with work engagement, with a modest statistical indirect association through self-esteem. The cross-sectional design precludes conclusions about temporal ordering, causality, intervention effects, or population-level policy effectiveness. The findings support prospective evaluation of organizational and workforce hypotheses in more representative samples.