Thriving at work as a mediator of the relationship between psychological resilience and the work performance of clinical nurses

The contingency theory of work and performance was chosen as the conceptual framework for guiding this study. This theory was proposed by Boyatzis in 1982 as a response to the failure of traditional management methods to maximise employee performance. The theory views effective performance as a dependent variable and points to three main foundations of effective performance, that is, individual, work-related and organisational environmental factors, and posits that consistency between two or more components can improve performance efficiency [15]. The psychological resilience explored in this study is a relevant correlational factor at the individual level that fully reflects the influence of individual subjective initiative on work performance. We developed a conceptual research model based on variables from the contingency theory of work and performance (Fig. 1).

Consistent with the conceptual framework that guides our study, the following hypotheses were empirically tested:

Hypothesis a: Nurses’ psychological resilience significantly predicts their ability to thrive at work.

Hypothesis b: Nurses thriving at work significantly predicts their work performance.

Hypothesis c: Nurses’ psychological resilience significantly predicts their ability to thrive at work.

Hypothesis d: Nurses’ thriving at work plays a partial mediating role between psychological resilience and work performance.

A convenience sampling method was used to select clinical front-line nurses from a tertiary A-level hospital in Changsha, Hunan Province, China, from February to April 2023 as the research participants for the survey. Inclusion criteria: (1) possession of a nurse practising certificate; (2) clinical working time ≥ 1 year. Exclusion criteria: (1) intern nurses, continuing education nurses; (2) executive grade nurses, nurses assigned full time for tasks other than general nursing care, such as at reception and information desk; (4) nurses who were not in the hospital during the survey due to sickness or personal long-term leave; (3) past or current sufferers of mental disorders.

This study obtained ethical approval from the hospital’s ethics committee (ethical approval no: [2023]-144) and informed consent from the research participants.

The sample size required for this study is based on the results calculated by G*Power 3.1™. Statistical power was 95%, α = 0.05 and the effect size was moderate (F2 = 0.15); two predictors were used as the statistical basis for calculating linear multiple regression analysis (fixed model, R² deviation 0). According to the calculation, the sample size should be 262. In addition to a 10% system bias and sample loss rate, the total sample size should be at least 289. Finally, 308 samples were confirmed for inclusion.

Survey research was conducted using an electronic questionnaire compiled through the Wenjuanxing platform (wjx.cn). The questionnaire included the research survey’s purpose, content and methods of completion. The researchers contacted the head nurses of each ward and issued the questionnaire QR code via WeChat, following a set of standardised instructions, for the clinical nurses to complete anonymously. To ensure the quality of the responses, all items were set as mandatory fields that required completion to submit the form. The data was exported from the user backend of Questionnaire Star, which is a practical app that can design questionnaires, distribute online and collect information. A total of 308 questionnaires were collected, 298 of which were valid, resulting in a valid recovery rate of 97%.

The SPSS 26.0 software was used for statistical analysis. An independent samples t-test or one-way analysis of variance was used for group comparisons. For normally distributed measurement data, mean ± standard deviation (\( \stackrel{-}{x}\pm s\)) was used and for count data, frequency and percentage were used. Pearson correlation analysis was used to explore the relationship between psychological resilience, thriving at work, and work performance. The ‘Process’ plugin in the SPSS software was used for mediation effect analysis. All statistical significance was set at P<0.05.

To test the hypotheses of this study, we adopted the method of Baron and Kenny [19], which proposes four steps of regression analysis to determine that independent variables influence dependent variables through mediating variables. This method first regresses the independent variable with the mediator, then the mediator with the dependent variable and then the independent variable with the dependent variable to confirm that there is a significant zero-order association between the variables [19]. When the significant zero-order correlation between variables was assumed, step 4 was carried out. As such, step 4 required simultaneous multiple linear regression, including predictors, mediators and dependent variables. When indirect effects were present but no direct effects, we inferred a complete mediation; conversely, when both direct and indirect effects were present, we confirmed partial mediation [20].

The total score for the work performance of clinical nurses was 44.72 ± 6.10. The mean scores for each dimension, ranked from high to low, were as follows: interpersonal facilitation, task performance and job dedication. The results of the one-way analysis showed statistically significant differences in the work performance scores of clinical nurses based on age, length of service, type of employment, job title, position, average number of night shifts per month and whether they enjoyed nursing work (P < 0.05). See Table 1 for details.

The Harman single-factor test was used to check for common method bias. The results showed that there were 6 factors with eigenvalues greater than 1, and the maximum factor variance explanation rate was 48.63%, which is lower than the critical value of 50%, suggesting that there was no serious common method bias.

The results showed a significant positive correlation between psychological resilience and thriving at work (r = 0.806, P < 0.01), between thriving at work and work performance (r = 0.571, P < 0.01) and between psychological resilience and work performance (r = 0.572, P < 0.01). See Table 2 for details.

To further analyse the impact of psychological resilience on work performance, the mediating effect of thriving at work on work performance was tested. Model 4 in the Process macro (a plug-in of SPSS software) was employed for the mediation effect analysis, with age, length of service, type of employment, job title, position, average number of night shifts per month, years of work, and whether they enjoyed nursing work as control variables. The bootstrap method was used for the confidence interval (CI) estimation test, with 5,000 resamples, to calculate the 95% CI. The results indicated that psychological resilience had a significant positive predictive effect on work performance (β = 0.558, t = 11.165, P < 0.01). Even after incorporating thriving at work as a mediating variable, the predictive effect of psychological resilience on work performance remained significant (β = 0.371, t = 4.772, P < 0.01). Psychological resilience had a significant positive predictive effect on thriving at work (β = 0.731, t = 20.779, P < 0.01), and thriving at work had a significant positive predictive effect on work performance (β = 0.256, t = 3.105, P < 0.05). The mediating effect of thriving at work between psychological resilience and work performance was 33.49%, and the direct effect of psychological resilience on work performance was 66.51%. The bootstrap 95% CI of the direct effect of psychological resilience on work performance and the mediating effect of thriving at work did not include 0 in the upper nor lower limits, indicating that the differences were statistically significant (P < 0.05). See Tables 3 and 4 for details and Fig. 2 for the validation diagram.

The results of this study indicated that the average work performance score of clinical nurses was 4.07 ± 0.56, indicating a high level of work performance. This result is consistent with the findings of Liu Lingyan et al. [21], suggesting that most clinical nurses feel good about their performance at work and believe they are competent in their clinical roles. Among these, the interpersonal facilitation dimension scored higher than the other two dimensions, indicating that clinical nurses feel good about their handling of interpersonal relationships. Moreover, this study found that the work performance of clinical nurses was slightly lower than that of general practitioners [22] and hospital infection control professionals [23], which may be related to the high intensity of clinical nursing work, high pressure, low income, irregular rest and lower social status of the role. In addition, clinical nurses, apart from fulfilling their own job responsibilities, also need to complete the nursing department’s regular three basics and three strict exams, which can easily lead to job burnout, which is unfavourable for clinical nursing work and learning. This suggests that medical and health institutions and nursing managers, based on local conditions, should improve the bonus distribution and appraisal systems, optimise incentive mechanisms and further promote the work enthusiasm of clinical nurses to enhance their work performance.

This study also found that age, length of service, type of employment, job title, position, average number of night shifts per month and whether they enjoyed nursing work were factors that influenced work performance, and this was consistent with previous research findings [24‐28]. The reasons for these findings are analysed as follows. (1) With an increase in age and length of service, nurses gain a deeper understanding of professional knowledge, accumulate more work experience and enhance their stress resilience and problem-solving abilities. This enables them to complete clinical nursing work at a higher quality in the shortest time, ultimately improving their work performance. (2) Officially employed nurses have higher work performance, which may be associated with the current welfare treatment in public institutions in China. (3) The higher the job title and position, the higher the income of clinical nurses. Additionally, clinical nurses with lower titles and no positions were typically less experienced, had been working for a lower number of years and were incapable of handling high-difficulty nursing tasks. They were often assigned to simple and trivial chores, which could easily reduce individual occupational identity and self-efficacy [29, 30], lead to lower work enthusiasm and further affect work performance. (4) Clinical nurses who frequently work night shifts may face problems concerning energy and time allocation conflicts. Coupled with the high stress of night shifts, even if they want to efficiently complete their work and studies, they often have the will but not the energy, leading to lower work performance. (5) Compared with clinical nurses who dislike nursing work, those who enjoy it tend to have a higher sense of professional identity. They can face nursing work with a positive attitude, tend to have a high level of work initiative and show a willingness to invest more enthusiasm and energy in their work, thereby improving work performance.

Psychological resilience for individual protection is an important mechanism through which one can demonstrate flourishing positive work behaviours [31]. This study found a positive correlation between psychological resilience and work performance, that is, the higher the level of psychological resilience, the better the work performance, consistent with the research results of Liu Ruihan et al. [32]. Due to the shortage of nursing staff and the complexity of their work, nurses are often overloaded. Good psychological resilience helps individuals generate positive emotions, which enables them to better complete nursing tasks, manage relationships with colleagues and easily pass periodic hospital assessments. Thus, it enhances work performance concerning three different levels: task performance, interpersonal promotion and work dedication. This study also found that psychological resilience correlates positively with thriving at work, that is, the higher the level of psychological resilience, the stronger the thriving at work, which is in line with previous research findings [10]. This suggests that it is necessary to emphasise the perspective of positive psychology and pay attention to the motivational aspects of the work when evaluating the work performance of clinical nurses. Research in organisational psychology describes thriving at work as a subjective state of consciousness in which an individual becomes so absorbed in something that they forget about time, fatigue and everything else [33]. When clinical nurses face external stressors and other stimuli, psychological resilience serves as a characteristic factor that helps them to overcome adversities and develop positively. It promotes individuals to be passionate and energetic about work and learning in terms of three aspects: optimism, strength and resilience, thereby increasing thriving at work. Additionally, this study reveals a positive correlation between thriving at work and work performance, that is, the stronger individuals thrive at work, the better the work performance, which echoes previous findings [34]. This implies that clinical nurses with strong thriving at work can devote more energy to learning the skills and methods needed for their tasks, adapt to dynamic changes in the work environment, and improve work efficiency, leading to better work performance.

The survey results revealed that thriving at work partially mediates the relationship between psychological resilience and work performance. Specifically, clinical nurses’ psychological resilience positively influences work performance. Furthermore, clinical nurses’ psychological resilience can also indirectly affect work performance through thriving at work, with the mediating effect accounting for 33.49% of the total effect. The Socially Embedded Model of Thriving at Work [35] postulates that stable organisational situational characteristics and resources generated in dynamic work will together trigger proactive individual behaviours, leading to the development of thriving at work. Flexible psychological adjustment is a powerful motivator for improving job engagement and has also been shown to have a beneficial effect on job satisfaction and is a strong predictor of job engagement [36]. Clinical nurses in good psychological health will possess psychological traits such as optimism, resilience and self-confidence, which will aid them in comfortably acquiring new professional knowledge and skills, effectively dealing with stressful events, maintaining amicable colleague relationships and navigating complex nurse–patient interactions. This enhances their professional skills and generates stable organisational situations, fostering a higher level of thriving at work. Their work and learning become more active, ultimately contributing to personal growth and career development.