Support Utilization, Not Availability, Is Associated With Lower Burnout and Presenteeism Among Haemodialysis Nurses:...

To investigate the distinct pathways of social support and safety attitudes on presenteeism mediated by burnout in haemodialysis nurses and to identify the most potent protective resources within the JD-R model.

A multicentre, cross-sectional survey.

Data from 583 haemodialysis nurses across multiple provinces were analysed using validated scales (SSRS, SAQ, MBI-HSS and SPS-6) and mediation analyses (PROCESS macro).

Burnout fully mediated the relationship between job stress and presenteeism. Support utilization (rather than mere availability) was associated with the largest protective indirect effect. Management perceptions had a unique direct association with presenteeism. Clinically significant presenteeism was observed in 47.2% of the nurses. Low income combined with overtime was associated with higher burnout.

In clinical practice, activating support utilization (e.g., help-seeking behaviours) appears more critical than merely providing resources. Trust in leadership may directly safeguard organizational performance. Nursing managers should implement structural interventions (overtime caps, specialty premiums) to reduce the effort-reward imbalance.

Creating help-seeking cultures and trustworthy leadership, alongside correcting systemic inequities, can break the burnout-presenteeism cycle and improve patient safety. Nursing managers should implement structured interventions such as overtime caps and specialty premiums to reduce effort-reward imbalance and develop resource navigation systems to activate support utilization at the unit level.

This study suggests that support utilization may be a key protective factor against burnout and presenteeism in high-reliability nursing settings, offering a targeted, tiered intervention framework for managers and policymakers.

The STROBE guidelines for cross-sectional studies.

None.