Thriving at Work Among Clinical Nurses: A Systematic Review and Meta-Analysis

This systematic review aimed to synthesize the available evidence on the level of thriving at work among clinical nurses, assess its overall level, and provide an evidence-based reference for improving nurses' occupational psychological well-being and optimizing nursing management practices.

The global nursing shortage and high turnover rates necessitate a deeper understanding of factors that support nurse retention. Thriving at work is a positive psychological state linked to greater occupational well-being and lower turnover intention, yet a comprehensive synthesis of the level of thriving at work among clinical nurses is lacking.

A systematic literature search was conducted in eight databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and Chinese Biomedical Literature Database (CBM), from database inception to September 23, 2026. Two reviewers independently screened records, extracted data, and assessed methodological quality using the quality assessment tool for cross-sectional studies recommended by the Agency for Healthcare Research and Quality (AHRQ). Meta-analyses were performed using Stata 17.0. The percent of maximum possible (POMP) scores were used to standardize scores across different Likert scale versions of the instrument, with POMP-standardized means and 95% confidence intervals (CIs) as the effect size. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity, along with sensitivity analyses and publication bias tests.

A total of 64 cross-sectional studies were included. Meta-analysis showed that the pooled POMP score for overall thriving at work among clinical nurses was 0.66 (95% CI: 0.64-0.69), with a 95% prediction interval of 0.45-0.87. The pooled scores for the vitality and learning dimensions were 0.65 (95% CI: 0.62-0.67) and 0.69 (95% CI: 0.65-0.72), respectively. High heterogeneity was observed across studies (I² = 99.7%). Subgroup analyses showed some numerical differences in pooled estimates among subgroups, such as lower values for the central region, other specialized departments, and critical care departments, and slightly higher values for studies using a 5-point Likert scale and those published in 2025-2026. However, none of these differences were statistically significant (all p > 0.05). Univariate meta-regression showed that geographical region was a significant source of heterogeneity (p = 0.017). These subgroup and meta-regression findings should be considered exploratory.

Meta-analysis showed that the pooled POMP score for thriving at work among clinical nurses was 0.66, corresponding to 66% of the maximum possible score, indicating room for improvement. The learning dimension scored higher than the vitality dimension, suggesting strong professional growth motivation but relatively insufficient work vitality. Exploratory findings from some subgroup analyses may inform future research. Given the extremely high heterogeneity among included studies, the pooled estimate should be interpreted with caution.

These findings suggest that nursing managers should prioritize the level of thriving at work among clinical nurses, with particular emphasis on restoring work vitality and maintaining learning motivation. Nursing managers are encouraged to build a supportive organizational work environment across structural, cultural, resource-related, and relational dimensions to promote nurses' thriving at work. This may help enhance nurses' positive occupational psychological state and strengthen nursing workforce stability.