With the reform of the nursing mode and the rapid development of medical technology, significant medical problems are being faced in today’s society with the new era of nursing staff having higher requirements. As the core force and key factor affecting the reform of the nursing mode, the work engagement of nurses has become the focus of society’s attention. However, while the work life of nurses has received considerable attention, their family life and mental health have been neglected. Owing to the particularity of their work, nurses are more likely to face work-family conflicts than other professionals because of the heavy work pressure that leads to their constricted psychological space. Thus, balancing the relationship between work and family is a key factor in improving the work engagement of nurses.
With the advancement of positive psychology, psychological researchers have begun to focus on people’s positive psychological abilities in contrast to the traditional focus on negative emotions and negative behaviors . Based on the research and development of job burnout, work engagement is proposed under the influence of positive psychology and positive organizational behavior. As a positive individual state, work engagement has gradually entered the perspective of research and has become a hot spot of researchers’ attention in recent years. The concept of work engagement was first proposed by Kahn, an American scholar, in 1990, who defined the term as “the perfect combination of employees and their work roles through effective self-control” . At present, research on work engagement has been conducted in nursing, psychology, human resource management, and many other fields, and an increasing number of researchers have begun to pay attention to research on nurse job involvement [3-7]. Nurses are the providers of patient care services and play a vital role in medical services: when their work input is at a high level, they tend to be more willing to devote more time and energy to work, realize the perfect combination of self and work, and perform better in terms of physiology, cognition, and emotion, and present themselves well; in contrast, when their work engagement level is low, they tend to pull themselves out of their work role, which affects their occupational health status, resulting in a reduction in work performance and nursing quality, and a high dismissal rate[8-10]. In Europe, 43% of nurses consider leaving within three years . In China, 20.2–56.1% of nurses have a high turnover tendency . The problem of nurse shortage and loss has become one of the major concerns of medical institutions at all levels worldwide, thus affecting the development of global health. This is also one of the challenges faced by the nursing industry in China. Since the outbreak of the novel coronavirus disease 2019 (COVID-19), medical staff, particularly nursing staff, have been subjected to significant psychological and physical pressure in the face of the sudden epidemic, with heavy workloads, in addition to the responsibility of caring for their loved ones. Consequently, their work vitality, dedication, and concentration have been directly affected, thereby influencing the quality of nursing work. Nurses are the backbone of the healthcare system, and their work runs throughout the field of healthcare. The efficiency and high-quality work of nurses determines the service quality and nursing quality of hospitals and health units to a large extent, and affects the development of nursing careers. Therefore, improving the work engagement of nursing staff is an important task for managers of health organizations.
Based on the continuous research on work engagement, factors affecting work engagement can be classified into three categories, namely individual, organizational, and family factors. Individual factors include anxiety , emotional intelligence , and self-efficacy ; organizational factors include organizational support , organizational behavior , organizational commitment ; and family factors include family support , work-family conflict , and family mastery . However, at present, most studies on work engagement at home and abroad involve bivariate studies, while the potential relationship between these factors has rarely been reported. Therefore, this study used clinical nurses as the research object to explore the interaction mechanism among the four variables of work-family conflict, anxiety, emotional intelligence and work engagement, so as to provide some references for intervention research to improve the level of work engagement of nurses.
The influence of work-family conflict on work engagement
The concept of work-family conflict was first proposed by Kahn and Wolfe et al. (1964). Work-family conflict refers to the role interaction conflict when the work and family pressures are irreconcilable in certain respects . Work-family conflict is bidirectional, including work-family conflict and family-work conflict . The study of the relationship between work and family has become a hot topic in the field of contemporary Western organizational behavior, as well as the focus of psychology, sociology, and human resource management in recent years. Work-family conflict among nurses has been attracting increasing attention from researchers at home and abroad. It is challenging for nurses to balance their work and family life, because they not only have to assume the role of staff, undertake heavy workloads, high pressure, and high-risk nursing work, but also face the requirements of family life. Therefore, work-family conflict is an inevitable problem for nurses, and research has shown that work-family conflict is an important predictor of their work engagement . Work-family conflicts for nurses tend to affect their physical and mental health; cause job burnout; reduce work enthusiasm, job satisfaction, and level of work engagement; increase turnover tendency; and affect the stability of the entire nursing team. Therefore, we hypothesize the following:
Hypothesis 1: Work-family conflict will significantly predict work engagement (emotional intelligence →work engagement).
The mediating effect of anxiety between work-family conflict and work engagement
Anxiety is a psychological and physical state combined with cognitive, somatic, emotional, and behavioral aspects, often associated with annoyance, tension, fear, or worry, and a negative emotional experience that is often felt by individuals . Numerous studies have shown that nurses are more susceptible to anxiety [26-30]. In China, the incidence of nurse anxiety is 18–43% [31-35]. As a negative emotion, anxiety has a certain influence on the thoughts, cognition, behavior, and physical health of nurses. Against the background of current social development, nurses, as medical workers working in the frontline of medical care for a long time, are prone to work-family conflicts owing to the particularity of their work. When nurses are in a predicament that they cannot cope with or when they cannot cope with pressure effectively, they experience further anxiety. If their anxiety is not addressed in time, it can lead to burnout, low work efficiency, dull or unstable mood, and other adverse reactions, thus imposing a long-term serious impact on the physical and mental health of clinical nurses, which in turn affects nursing quality. Only nurses with good psychological quality and a stable mood can exhibit their best skills and the best nursing level, and fully engage in their nursing work. Therefore, we hypothesize the following:
Hypothesis 2: Work-family conflict will influence work engagement through the mediating effect of anxiety (work-family conflict→ anxiety →work engagement).
The mediating effect of emotional intelligence between work-family conflict and work engagement
The concept of emotional intelligence was first proposed by Mayer and Salovey (1990). Emotional intelligence refers to the ability of individuals to control their own and others’ emotions and recognize and use this information to guide their own thoughts and actions . The professional particularity of nurses shows that they are highly emotional workers, and their emotional intelligence not only affects their own mental health and work engagement, but also has a certain impact on work-family conflict. Emotional intelligence is closely related to work-family conflict and work engagement [37-39]. When faced with work-family conflicts, nurses with high emotional intelligence can regulate their emotions effectively, implement self-motivation effectively, generate more neutral feelings toward work, and in the face of setbacks exhibit a stronger psychology to bear other responsibilities, and encourage themselves to do better work, thus improving the adaptability and enthusiasm toward work, and becoming fully involved in their nursing work. Therefore, we hypothesize the following:
Hypothesis 3: Work-family conflict will influence work engagement through the mediating effect of emotional intelligence (Work-family conflict→emotional intelligence →work engagement).
The chain mediating effect of emotional intelligence and anxiety on work-family conflict and work engagement
Emotional intelligence can alleviate work-family conflicts, negative emotions, and negative impacts on work engagement. Nurses with a high emotional intelligence, when faced with a low work-family conflict, can devote sufficient psychological resources to work. In contrast, when faced with a high work-family conflict, they can effectively regulate their emotions and behavior, significantly alleviate work-family conflicts caused by stress, reduce the production of negative emotions, and maintain a high level of work engagement. Therefore, we hypothesize the following:
Hypothesis 4: Anxiety and emotional intelligence will jointly play an intermediary role in the relationship between work-family conflict and, work engagement (work-family conflict→ anxiety →emotional intelligence→work engagement).