BowenXue et al.

BMC Nursing (2024) 23:31 BMC Nursing

[Link]

RESEARCH Open Access

Decent work, work engagement,

and turnover intention among registered
nurses: a cross‑sectional study
BowenXue1†, Yaping Feng3†, Yihui Zhao2, Xin Li2, Yang Yang2, Jingxuan Zhang2, Yu Zhang2, Zhiguo Hu3* and
Hong Luo1*   

Abstract
Background Nurses face substantial career challenges arising from global pandemics, economic crises, and their
roles in conflict-ridden areas. In this context, the rights of nurses pertaining to decent work, such as freedom, fairness,
safety, and dignity, are not adequately safeguarded. This study examines decent work status among Chinese nurses
and its links to demographics, work engagement, and turnover intention.
Methods A cross-sectional study design was used following STROBE guidelines. Through a convenient sampling
method, a total of 476 nurses were surveyed. These participants were drawn from three esteemed tertiary Grade
A hospitals in Hangzhou, with data collection spanning from June to August in 2023. We used a comprehensive set
of assessment instruments, encompassing an evaluation of demographic characteristics, the Decent Work Percep-
tions Scale (DWPS), the Utrecht Work Engagement Scale (UEWS), and turnover intention questionnaire. Bootstrapping
procedures were used to ensure the robustness and reliability of the model.
Results The study revealed that nurses’ perceptions of decent work significantly impacted work engagement
(β = 0.603, p < 0.001) and turnover intention (β = -0.275, p < 0.001). Work engagement operated as a mediator
between decent work and turnover intention, decreasing the likelihood of nurses leaving their positions (β = -0.062,
p < 0.001). Factors such as age, years of working experience, professional title, job category, and attendance at profes-
sional conferences significantly influenced nurses’ perceptions of decent work (all p < 0.05).
Conclusions This study examines factors affecting decent work among nurses and explores its connection with work
engagement and the intention to leave. Despite limitations (sample, social desirability bias), the study offers valuable
insights for nursing practice. This suggests managers improve decent work for young nurses through rational shift
schedules and continuous education. Policymakers should consider adjusting nursing policies for better employment
conditions.
Keywords Decent work, Work engagement, Turnover intention, Nurses, Mediation analysis

†
Bowen Xue and Yaping Feng contributed equally to this work and share first
authorship.
*Correspondence:
Zhiguo Hu
huzg@[Link]
Hong Luo
luohong@[Link]
Full list of author information is available at the end of the article

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BowenXue et al. BMC Nursing (2024) 23:31 Page 2 of 11

Introduction on both individuals and organizations. However, previ-

In recent years, the global COVID-19 pandemic and ous research has indicated that nurses often perceive the
localized economic and wartime crises have placed many concept of decent work slightly below the average level,
nurses in a precarious position. They confront inadequa- and their perception is influenced by characteristics spe-
cies in welfare protection, a decline in social status, and cific to the nursing work environment [13]. Within this
challenging working conditions. Notably, there is a dis- complex interplay, it becomes evident that the concept of
cernible shift in the professional landscape for nurses decent work affects work engagement among nurses [14].
both preceding and following the pandemic. The average Work engagement refers to a state characterized by
score reflecting nurses’ likelihood to leave increased from a positive and fulfilling state of mind related to work,
13.24 to 15.54 [1], suggesting a heightened inclination marked by vitality, dedication, and absorption [15].
toward professional disengagement. What is even more Vitality represents a sense of professional psychologi-
concerning is the inadequate protection of nurses’ work- cal resilience and energy levels during work. Dedication
ing conditions [2], including extended working hours [3], denotes a strong commitment to work, where individu-
high job-related stress levels [4], and workplace violence als experience the meaning, challenge, inspiration, pride,
[5]. It is evident that traditional research perspectives and enthusiasm in what they do. Absorption refers to
often confine themselves to specific manifestations of the feeling of being focused and completely engrossed
professional challenges faced by nurses, overlooking con- in their work. When individuals perceive that they have
siderations related to dignity, rights, fairness, and overall decent work conditions, including fair compensation, job
development in the workplace. The United Nations Sus- security, and opportunities for personal growth, they are
tainable Development Goal (SDG) 8 is explicitly focused more likely to feel satisfied and secure in their work envi-
on labor and is titled "Decent Work and Economic ronment [16]. Previous research has demonstrated that
Growth." It highlights the importance of promoting nurses’ work engagement is a key driver of nursing qual-
sustained, inclusive, and sustainable economic growth ity and can predict nurses’ job satisfaction [17], nurse‒
and providing full and productive employment along patient relationships [18], and turnover intention [19, 20].
with decent work for all [6]. However, existing research When an individual’s level of work engagement is low,
indicates a limited focus on the concept of decent work they are more likely to disengage from their work roles,
among nurses, particularly in exploring the relation- consequently affecting job performance and even leading
ships of associated variables and understanding influ- to turnover intention.
encing factors. Therefore, prioritizing the concept of Turnover intention refers to an individual’s inclination
’decent work’ and its associated variables among nurses, to leave their current job and seek other employment
alongside an examination of the influencing factors, is an opportunities [21], often serving as a strong predictor
essential imperative for advancing the sustainable devel- of actual turnover behavior [22]. While nurses with high
opment of health. turnover intentions may not necessarily act upon these
intentions, research has shown associations between
Background high turnover intentions, absenteeism, and missed
Within the context of the rapidly evolving landscape nursing care [20]. Additionally, studies have found that
of the nursing profession, the concept of ’decent work’ "decent work," which includes factors such as equitable
emerges as a crucial notion. encompassing equitable compensation, favorable working conditions, opportuni-
income, social security, safe working conditions, oppor- ties for leisure, access to medical benefits, and alignment
tunities for personal development and social integra- with personal values, constitutes a more comprehensive
tion, as well as the freedom to express opinions and raise construct that effectively predicts employees’ turnover
concerns in the workplace [7, 8]. In accordance with the intentions [16]. Therefore, gaining insights into this pro-
International Labor Organization (ILO), it is evident cess is essential for addressing high turnover intentions
that decent work embodies a fusion of four fundamen- among nurses and, consequently, patient safety concerns.
tal values: freedom, fairness, safety, and human dignity, The psychology of working theory (PWT) provides a
encompassing a range of broader principles related to framework for understanding the relationships between
equitable and dignified employment [9]. Numerous sur- decent work, work engagement, and turnover intention
veys and studies focusing on nurses and other profes- [23]. According to the PWT, decent work is subject to the
sional groups across various regions consistently indicate influence of environmental variables, such as economic
that decent work correlates with individual professional constraints and marginalization. Moreover, there are psy-
resilience, teamwork, job satisfaction, work engage- chological variables, such as decision-making autonomy
ment, and occupational burnout [10–12]. These findings and career adaptability, which act as mediating variables.
underscore the comprehensive impact of decent work Concurrently, personality traits, such as proactivity,
BowenXue et al. BMC Nursing (2024) 23:31 Page 3 of 11

function as moderating mechanisms. This comprehensive II errors. The study involved 23 variables, comprising 12
framework has been substantiated by multiple research sociodemographic characteristics and 11 scale-associ-
studies [24, 25]. On the other hand, previous research has ated dimensions. The calculated minimum sample size
identified key elements of decent work, including a safe was 234 nurses. Factoring a potential 10% rate of invalid
working environment, income, leisure time, and values. questionnaires, a minimum of 257 nurses were deemed
These factors have been found to positively predict indi- necessary for participation in this study.
viduals’ job satisfaction while negatively predicting turn-
over intentions [26].
While there has been some attention directed toward Inclusion and non‑entry criteria determination
the concept of decent work among nurses, it is notewor- The inclusion and non-entry criteria for this study were
thy that the field of nursing research currently lacks com- meticulously developed through collaborative discus-
prehensive investigations into the concept of decent work sions within the research team. The comprehensive
among registered nurses, as well as the influential fac- details are as follows:
tors that contribute to it. Moreover, there has been lim- The inclusion criteria for this study were as follows: (a)
ited attention to the relationships between decent work, nurses with a minimum of one year of clinical experience,
work engagement, and turnover intention. Therefore, (b) registered nurses, and (c) voluntary participation in
this study focuses on clinically registered nurses as the the study.
study population. The primary objectives of this research The non-entry criteria were as follows: (a) nursing
are to assess the current status of decent work within interns or trainees, (b) nurses who were not on duty
this specific group, conduct a comprehensive analysis of during the survey period, (c) nonclinical nurses, such as
the multifaceted factors influencing decent work, and those working in medication distribution centers, and (d)
investigate the relationships between decent work, work nurses who declined to participate in the study.
engagement, and turnover intention. Ultimately, our Ultimately, the research encompassed 500 nurses out of
overarching goal is to promote the positive and sustain- a target population of 1640 nurses. A set of 500 question-
able development of clinical nursing. naires was distributed, and all 500 were successfully col-
lected. Following the exclusion of 27 questionnaires due
to abnormal responses (e.g., 12121212, 11111111), 476
Methods
questionnaires were deemed valid, resulting in an effec-
Design
tive response rate of 95.2%.
This research was conducted as a cross-sectional study,
adhering to the guidelines provided by the Strengthening
the Reporting of Observational Studies in Epidemiology Data collection
(STROBE) checklist (see Appendix S1). The data collection process for this study employed a
combination of online and offline methods. First, project
Participants team members contacted the heads of nursing depart-
In this study, considering the limitations of time and ments in various hospitals via phone, email, and other
resources, a convenience sampling method was employed means to extend invitations to participate in the research.
to survey nurses from three tertiary Grade A hospitals in Upon receiving approval from the nursing department
Hangzhou, Zhejiang Province, China. The selection of heads, the research team distributed both paper-based
these hospitals was based on their similar scale and work- questionnaires and electronic questionnaire links to the
ing environments. The objective of this decision was to nurses.
ensure research validity while maximizing internal valid- Subsequently, the principal investigator conducted
ity. Data collection took place between June 2023 and uniform training for all data collectors to ensure a clear
August 2023. The sample size calculation was performed understanding of the research objectives and content.
using the G*Power program (version 3.1). Using the lin- Particular emphasis was placed on respecting the rights
ear multiple regression approach, the study incorporated of participating nurses and underscoring the signifi-
a moderate effect size of 0.15 [27]. This decision aimed cance of obtaining informed consent. During the data
to balance statistical power and the necessary sample collection phase, researchers provided detailed explana-
size, avoiding overly optimistic expectations while ensur- tions to participating nurses regarding the study’s pur-
ing the ability to detect meaningful results. In setting the pose, expected outcomes, and the importance of their
parameters for the study, we defined the α level as 0.05 involvement. It was explicitly highlighted that participa-
to control the acceptable Type I error rate. Simultane- tion in this study was entirely voluntary, and participants
ously, we aimed for a desired power (1-β error probabil- had the option to withdraw at any point without facing
ity) of 0.95, highlighting our emphasis on reducing Type any negative consequences. Additionally, the research’s
BowenXue et al. BMC Nursing (2024) 23:31 Page 4 of 11

confidentiality and data protection measures were clearly total score on the scale falls within the range of 0 to 90. In
articulated, ensuring full respect for participants’ privacy. this study, the Cronbach’s α coefficient for the scale was
All participating nurses willingly agreed to participate calculated to be 0.930.
in the study, with the freedom to choose their preferred
method of responding to the questionnaires. The ques- Turnover intention
tionnaires incorporated standardized instructions to The Chinese version of the turnover intention scale(TIS)
introduce the data collection requirements and guide- is based on the instrument originally developed and vali-
lines to the participants. Upon completion of the ques- dated by Michaels and Spector [31]. It has been subse-
tionnaires, they were immediately reviewed on-site to quently translated, adapted, and validated by Chinese
ensure data validity and completeness. Finally, data entry researchers for the purpose of assessing nurses’ turnover
was carried out by two individuals, cross-verified for intentions [32, 33]. The questionnaire comprises three
accuracy to ensure precise data recording. dimensions, each consisting of two items: Turnover
Intention I, representing the inclination to resign from
Instruments the current job; Turnover Intention II, indicating the
Demographic characteristics desire to seek alternative job opportunities; and Turnover
The demographic characteristics included gender, age, Intention III, reflecting the readiness for a new job. Par-
education background, marital status, number of chil- ticipants employ a 4-point scale to rate each item, with
dren, years of working, professional title, department, 1 indicating "Never" and 4 indicating "Always." The total
leadership roles, type of employment, monthly night shift score ranges from 6 to 24 points. The severity of turnover
frequency, and annual participation in external educa- intention is categorized into four levels: 0-6, 7-12, 13-18,
tional activities. and 19-24, corresponding to low, moderate, moderate to
high and high degrees of intention to leave, respectively,
Decent work perceptions with higher scores indicating a stronger intention to leave
The Decent Work Perceptions Scale (DWPS), initially [34, 35]. The reliability of this scale has been consist-
developed by Chinese scholars, has undergone meticu- ently demonstrated in multiple studies, with Cronbach’s
lous assessments of its reliability and validity [28]. It con- α coefficients ranging from 0.75 to 0.81 [36]. The Cron-
sists of five distinct dimensions, encompassing a total bach’s α coefficient for this study’s questionnaire is 0.907.
of 16 items. These dimensions include Work Rewards
(comprising 4 items), Work Position (containing 3 items), Data analysis
Work Atmosphere (including 3 items), Work Develop- The statistical analysis was conducted using IBM SPSS
ment (consisting of 3 items), and Work Recognition Statistics, version 26.0. Categorical variables were
(comprising 3 items). Respondents utilize a 5-point Lik- described in terms of frequencies and percentages.
ert scoring system, with response options ranging from For univariate analysis, the appropriate statistical test
"Strongly Disagree" to "Strongly Agree," correspond- was selected based on the data type. Specifically, we
ingly scored from 1 to 5. The cumulative score on this employed the t test for comparing two groups of data
scale falls within the range of 16 to 80 points, with higher and utilized one-way analysis of variance (ANOVA) for
scores denoting a more robust perception of decent comparing multiple groups of data. Within the variables,
work. It is noteworthy that the DWPS exhibited a Cron- because "department" and "marital status," among oth-
bach’s α coefficient of 0.939 in this study. ers, were considered unordered categorical variables, we
included them in the model after creating dummy vari-
Work engagement ables. To explore the relationships between decent work,
The Work Engagement Scale used in this study was work engagement, and turnover intention, Spearman’s
adapted from the Utrecht Work Engagement Scale correlation analysis was used. Variables with p values less
(UEWS) developed by Schaufeli et al. [29]. The Chinese than.05 in both univariate and correlation analyses were
version of the scale, which was translated and revised by subsequently included in the multiple linear regression
Zhang Yi-wen [30], was used to assess the work engage- analysis. A significance level of p <.05 was deemed sta-
ment status of nurses. The UEWS comprises three tistically significant. We conducted mediation analysis
dimensions: vigor, dedication, and absorption, totaling using Hayes’ PROCESS Macro [37].
15 items. Specifically, the ’vigor’ dimension consists of
six items, the ’dedication’ dimension includes four items, Results
and the ’absorption’ dimension comprises five items. Table 1 provides an overview of the demographic and
Each item is rated on a 7-point Likert scale, ranging from employment characteristics of the nursing staff in the
’never’ to ’always’, with scores ranging from 0 to 6. The study. The majority of participants were female (95.6%),
BowenXue et al. BMC Nursing (2024) 23:31 Page 5 of 11

Table 1 Sociodemographic characteristics of the sample (N = 476)

Demographics n(%) Decent Work Work Engagement Burnout
M ± SD F/t p M ± SD F/t p M ± SD F/t p

Gender -1.889 0.059 -1.897 0.058 1.556 0.120

Male 21(4.4) 49.10±10.76 44.81±17.25 15.33±3.45
Female 455(95.6) 53.56±10.57 51.64±16.08 14.01±3.83
Age 6.187 <0.001 5.777 <0.001 33.693 <0.001
≤25 40(8.4) 47.73±14.66 44.83±21.54 16.30±3.80
26-30 99(20.8) 53.07±8.47 49.30±14.91 15.71±3.42
31-35 153(32.1) 52.01±9.19 49.87±15.24 14.75±3.10
≥36 184(38.7) 55.86±11.08 55.07±15.50 12.14±3.73
Educational Background 1.086 0.338 0.734 0.480 2.563 0.078
Short-cycle Courses 16(3.4) 52.56±8.34 48.63±9.67 12.06±4.22
Bachelor’s degree 456(95.8) 53.32±10.70 51.36±16.33 14.15±3.80
Master’s degree or above 4(0.8) 61.00±3.37 59.50±18.88 12.75±2.22
Marital status 0.618 0.539 1.850 0.158 13.088 <0.001
Married 338(71.0) 53.02±10.82 52.13±15.77 13.58±3.85
Unmarried 122(25.6) 54.11±10.03 48.93±17.34 15.55±3.37
Others 16(3.4) 54.75±10.64 52.94±14.25 13.13±3.70
Number of children -0.089 0.928 -2.717 0.007 5.725 <0.001
0 158(33.2) 53.30±10.29 48.50±16.08 15.39±3.41
1-3 318(66.8) 53.39±10.78 52.75±16.06 13.41±3.85
Years of Working 5.180 0.002 4.032 0.008 35.374 <0.001
<5 42(8.8) 54.74±10.31 48.60±17.51 15.29±3.04
5~15 275(57.8) 51.76±9.84 49.69±15.80 15.04±3.48
16~25 100(21.0) 55.55±12.51 54.62±16.67 13.12±3.84
>25 59(12.4) 56.10±9.64 55.39±14.80 10.25±2.93
Professional title 5.766 <0.001 4.753 0.003 34.842 <0.001
Registered nurses 15(3.2) 55.93±9.60 45.87±16.91 14.40±5.19
Senior nurse 248(52.1) 51.85±10.09 49.63±16.12 15.41±3.27
Supervisor nurses 178(37.4) 54.12±11.34 52.62±16.27 12.98±3.68
Cochief nurses or above 35(7.4) 59.03±8.40 59.23±12.84 9.94±2.75
Department -1.126 0.261 0.475 0.635 1.839 0.067
Medicine or surgery 289(62.6) 52.94±10.75 51.61±15.84 14.32±3.77
Special departments 178(37.4) 54.07±10.35 50.88±16.76 13.65±3.88
Leadership roles 6.413 <0.001 4.261 <0.001 -7.715 <0.001
Yes 43(9.0) 62.86±9.42 61.19±14.53 10.02±3.04
No 433(91.0) 52.42±10.26 50.36±16.01 14.47±3.66
Job category 3.729 <0.001 2.381 0.018 -6.338 <0.001
Permanently employed 315(66.2) 54.64±10.68 52.59±16.03 13.30±3.74
Temporarily employed 161(33.8) 50.86±10.03 48.88±16.23 15.56±3.54
Monthly night shift frequency 14.830 <0.001 13.845 <0.001 55.522 <0.001
<5 179(37.6) 56.33±10.73 56.21±15.76 11.96±3.48
5~7 135(28.4) 53.16±9.92 48.94±14.98 14.95±3.61
>7 162(34.0) 50.25±10.16 47.96±16.36 15.67±3.25
Annual conference -6.475 <0.001 -4.383 <0.001 6.928 <0.001
2< 389(81.7) 51.93±10.16 49.83±15.93 14.61±3.62
≥2 87(18.3) 59.75±10.27 58.08±15.60 11.62±3.76
Special departments: Including emergency, operating room, ICU Interventional center, hemodialysis, and other departments
BowenXue et al. BMC Nursing (2024) 23:31 Page 6 of 11

with a small representation of males (4.4%). Age cat- Table 3 Correlation of decent work, work engagement and
egories showed a distribution across the four groups, turnover intention (N = 476)
with the largest proportion falling in the ≥36 age range Variables 1 2 3
(38.7%). Educational backgrounds predominantly
included individuals with bachelor’s degrees (95.8%), Decent work 1
while marital status indicated that a substantial portion Work engagement 0.603** 1
of participants were married (71.0%). Concerning the Turnover intention -0.446** -0.449** 1
number of children, approximately one-third had none **
p<0.001; 1= Decent work; 2= Work engagement; 3= Turnover intention
(33.2%), and two-thirds had 1-3 children (66.8%). Work
experience varied, with a significant number having annual conference (2< vs. ≥ 2) emerged as significant
5-15 years of experience (57.8%). Senior nurses were the influencing factors affecting decent work.
most common professional title (52.1%), and the major-
ity worked in Medicine or Surgery departments (62.6%). Correlations among decent work, work engagement
Leadership roles were held by 9.0% of participants, while and turnover intention
the majority did not (91.0%). Permanently employed The findings of Pearson’s correlation analysis examining
nurses constituted 66.2%, and monthly night shift fre- the associations among decent work, work engagement,
quencies were diverse. The majority attended fewer than and turnover intention are presented in Table 4. It was
two annual conferences (81.7%). observed that work engagement demonstrates a positive
correlation with decent work, while turnover intention
exhibits a negative correlation with decent work.
The scores of decent work, work engagement and turnover
intention
The mediating role of work engagement in the relationship
The study participants reported an average score of 53.36
between decent work and turnover intention
± 10.61 for decent work, 51.34 ± 16.17 for work engage-
The PROCESS macro analysis revealed several signifi-
ment, and 14.07±3.82 for turnover intention. The specific
cant associations among the variables in our study. Spe-
scores for each dimension can be found in Table 2.
cifically, we found that decent work significantly predicts
turnover intention (β = -0.275, p < 0.001), explaining
Influencing factors of decent work approximately 19.9% of the total variance in turnover
The results of a multiple regression analysis concerning intention. Furthermore, decent work significantly pre-
the concept of decent work are presented in Table 3. The dicts work engagement (β = 0.603, p < 0.001), accounting
variables accounted for 14.6% of the variance in decent for approximately 36.3% of the variance in work engage-
work. Notably, age (≤25 vs. ≥36), years of working (<5 ment. Work engagement, in turn, significantly predicts
vs. 5~15), monthly night shift frequency (<5 vs. >7), and turnover intention (β = -0.283, p < 0.001), serving as a
mediator in the relationship between decent work and
turnover intention (β = -0.062, p < 0.001) and explaining
Table 2 Descriptive statistics for the decent work, work approximately 25.0% of the variance in turnover inten-
engagement, and turnover intention
tion. These results are supported by a 95% bootstrap con-
Variables Minimum Maximum Scores (Mean ± SD) fidence interval of -0.086 to 0.036 (refer to Table 5).
Work Rewards 4 20 12.24 ± 3.20
Work Position 3 15 9.71 ± 2.32
Discussion
In this study, through a survey of clinical registered
Work Atmosphere 3 15 11.49 ± 2.39
nurses, it was found that the average score for decent
Work Development 3 15 10.51 ± 2.42
work among registered nurses was 53.36 ± 10.61. This
Work Recognition 3 15 9.41 ± 2.40
finding is similar to previous investigations into the con-
Decent work 16 80 53.36 ± 10.61
cept of decent work among Chinese registered nurses
Vigor 0 36 21.47 ±6.65
[38]. Sociodemographic factors (age, years of working,
Dedication 0 24 13.01 ±4.59
professional title, job category, and annual conference)
Absorption 0 30 16.85 ±5.65
were identified as the primary factors influencing nurses’
Work engagement 0 90 51.34 ±16.17
perception of decent work. Work engagement serves as
Turnover intention I 2 8 4.42 ± 1.49
a mediator between decent work and turnover intention
Turnover intention II 2 8 4.49±1.44
among nurses.
Turnover intention III 2 8 5.16±1.36
In this study, the results indicate that nurses aged
Turnover intention 6 24 14.07±3.82
25 or younger, those with less than 5 years of working
BowenXue et al. BMC Nursing (2024) 23:31 Page 7 of 11

Table 4 Regression analysis results

Variables β SE t p

Age (≤25 vs. ≥36) -12.030 2.724 -4.416 <0.001

Age (26~30 vs. ≥36) -1.733 2.049 -0.845 0.398
Age (31~35 vs. ≥36) -1.846 1.747 -1.057 0.291
Years of Working (<5 vs.5~15) 7.995 2.192 3.647 <0.001
Years of Working (16~25 vs.5~15) 0.068 1.715 0.040 0.968
Years of Working (≥25 vs.5~15) -0.713 2.215 -0.322 0.748
Professional title (registered nurses vs. senior nurse) 4.908 2.834 1.732 0.084
Professional title (supervisor nurses vs. senior nurse) -2.328 1.459 -1.596 0.111
Professional title (cochief nurses or above vs. senior nurse) -1.064 2.622 -0.406 0.685
Job category (permanently employed vs. temporarily employed) -2.100 1.158 -1.813 0.070
Monthly night shift frequency (<5 vs.5~7) -1.128 1.420 -0.794 0.427
Monthly night shift frequency (<5 vs. >7) -3.140 1.412 -2.223 0.027
Annual conference (2<vs. ≥ 2) 6.126 1.353 4.527 <0.001
R2 0.169
Adjusted R2 0.146

Table 5 The mediating role of work engagement in decent work and turnover intention
Effect Variable Adjusted R2 Coefficient SE p LLCI ULCI

Direct effect Decent Work → UEWS 0.363 0.603 0.056 <0.001 0.810 1.029
Decent Work → TIQ 0.199 -0.275 0.018 <0.001 -0.134 -0.064
UEWS→TIQ -0.283 0.012 <0.001 -0.090 -0.044
Indirect Effect (UEWS) Decent Work →UEWS→TIQ 0.250 -0.062 0.013 <0.001 -0.086 -0.036
Total Effect -0.160 0.015 <0.001 -0.190 -0.131

experience, and registered nurses tend to score lower may perceive their work as lacking in decency due to the
on measures of decent work. On one hand, this obser- potential instability associated with their career [44]. This
vation may be linked to the distinct work values and observation aligns with the tenets of the PWT, empha-
employment preferences of the millennial generation, sizing the importance of survival needs [23]. In light of
highlighting a shift in priorities beyond merely seek- these findings, healthcare organizations are urged to
ing high income [39]. Millennials often prioritize fac- take proactive measures to alleviate concerns about
tors such as having sufficient free time and aligning the future career prospects of temporary nurses. For
with their personal life values in their work [40]. On the instance, implementing comprehensive career develop-
other hand, these trends may be attributed to the rela- ment plans or offering pathways to transition into more
tively lower remuneration [41], lack self-confidence, suf- stable positions could be beneficial. Furthermore, nurses
ficient work experience and problem-solving skills [42], who actively participate in professional academic con-
and the young nurses’ lack of firmly established profes- ferences may experience enhanced professional recog-
sional identity [43], which are commonly associated with nition, knowledge enrichment, expanded interpersonal
younger nurses and may compromise their perception networks, and heightened professional self-esteem and
of work decency. Consequently, healthcare institutions self-confidence [45]. Recognizing the positive impact of
should not only assist young nurses in finding fulfillment conference participation, healthcare organizations can
in their work but also provide them with adequate time leverage this enthusiasm for continuous learning. Facili-
to enjoy their personal lives [40]. tating ongoing opportunities for continuing education
The results of regression analyses revealed that the and skills development not only aligns with the nurses’
perception of decent work among nurses is influenced pursuit of knowledge but also fosters a heightened sense
not only by demographic factors such as age and pro- of job decency.
fessional title but also by job category and attendance Additionally, our study reveals that there is a strong
at annual conferences. Temporary nurses, in particular, association between work engagement and turnover
BowenXue et al. BMC Nursing (2024) 23:31 Page 8 of 11

intention. This suggests that when nurses are fully Finally, our research emphasizes the correlation between
engaged in their work, they are less likely to contem- decent work, work engagement, and turnover intention,
plate leaving their current positions. This is consistent highlighting the mediating role of work engagement in the
with the findings of several previous studies [16, 40]. association between decent work and turnover intention.
High levels of work engagement manifest in nurses dis- This implies that decent work contributes, at least partially,
playing a strong sense of responsibility and professional to reducing turnover intention by impacting work engage-
commitment [46], extending beyond a mere employ- ment. This aligns with prior research results [14]. In prior
ment relationship. They view their work as a mission, research, it was established that equitable remuneration,
leading them to address professional challenges with a secure working conditions, chances for personal growth,
proactive attitude and diligent work rather than resort- and the presence of decent labor conditions, including
ing to avoidance or seeking new positions [46]. Moreo- freedom of expression, have a direct impact on individual
ver, the passion and commitment exhibited by nurses in job satisfaction and their perception of work [16]. When
their professional roles enhance their personal job satis- individuals perceive their work as decent, it signifies that
faction and alleviate their inclination to seek alternative their work environment meets their fundamental needs,
employment [47]. Given these outcomes, healthcare including fair treatment, respect, and safety assurances
institutions should cultivate a positive work environ- [52]. In a contented work environment, individuals are
ment that fosters nurses’ work engagement and dimin- motivated, gain recognition for their work, and develop
ishes turnover intentions. Additionally, it is crucial to emotional commitment to the organization [53]. This
establish suitable incentive mechanisms that guarantee positive relationship further emphasizes the crucial role of
acknowledgment of nurses’ efforts. Implementation work engagement in diminishing turnover intention [54].
of flexible work arrangements is equally important to This suggests that healthcare institutions can proactively
address their work-life needs [48]. These measures con- nurture and sustain employees’ work engagement by pro-
tribute not only to the improvement of healthcare ser- viding ongoing training, establishing effective communi-
vice quality and efficiency but also to the formation of cation channels, and implementing reward systems, thus
a resilient and effective nursing team within healthcare effectively reducing turnover intentions and enhancing
organizations. work efficiency and service quality.
The findings of this study reveal a positive correlation
between decent work and work engagement, and the per- Implication
ception of decent work among nurses significantly pre- In conclusion, nursing management should take into
dicts their level of work engagement. Nurses who view account various factors such as age, experience, job cat-
their work as decent are more inclined to invest time and egory, and career development when establishing a work
effort in their professional roles. This finding aligns with environment that promotes decency. Particularly for
prior research within the academic personnel context [9]. younger nurses, it is essential to implement structured
On the one hand, when individuals perceive their work guidance programs, providing them with ample support
as decent, they are more likely to experience a sense of and a systematic career development pathway. Addition-
safety, satisfaction, and achievement in their work [16]. ally, tailored career development plans, including person-
On the other hand, there is also evidence suggesting alized training programs and mentorship systems, should
that elements of decent work, such as favorable working be designed for nurses at different career stages to ensure
conditions and job security, are related to work engage- promising career prospects [55]. Moreover, ensuring
ment [49]. When working conditions are conducive and competitive salary packages and job security is crucial for
fulfill fundamental needs for survival, social connec- reducing nursing turnover and safeguarding the key ele-
tions, and societal determinants, individuals are more ments of decent work, especially for temporary nursing
inclined to invest in their tasks and responsibilities [50]. staff [56]. Such strategies not only address their concerns
This underscores the importance for managers to pri- about future career prospects but also effectively enhance
oritize and implement measures to ensure nurses have their perception of work decency. Therefore, manage-
a decent working environment. For example, providing ment institutions should prioritize the formulation of
fair and equitable compensation, a safe working envi- specific benefits and incentive mechanisms for tempo-
ronment, good career development opportunities, and rary nurses. Simultaneously, nursing managers should
ample social security [51]. Additionally, efforts should be recognize the value of continuous education and profes-
made to enhance the image and recognition of the nurs- sional networking, actively encouraging nurses of all age
ing profession, boosting nurses’ professional identity and groups to participate in professional conferences for skill
self-esteem consequently improving their perception of enhancement, staying informed about industry trends,
decent work. and strengthening professional identity [57]. Finally, by
BowenXue et al. BMC Nursing (2024) 23:31 Page 9 of 11

focusing on measures such as supporting nurses’ work Supplementary Information

engagement, providing resources, creating a positive The online version contains supplementary material available at [Link]
work environment, offering motivation and recognition, org/​10.​1186/​s12912-​023-​01662-6.
promoting work-life balance, and fostering a sense of par-
Additional file 1.
ticipation, nursing turnover rates can be reduced, leading
to improved nursing quality and patient satisfaction [58].
Acknowledgments
We would like to thank all nurses who participated in this study.
Limitations
This study has several limitations that should be Authors’ contributions
BX and HL was the primary investigator of the study. BX, ZH, YF did a statistical
acknowledged. First, the survey was conducted in three analysis and wrote this paper. ZH and HL helped conduct the study and revised
public hospitals in the Hangzhou region, which may the manuscript; YZ, XL, YY, JZ, and YZ helped supervised the survey and checked
limit the generalizability of the findings to nurses in dif- the data. All authors contributed to and approved the final manuscript.
ferent healthcare settings, such as those in private hos- Author information
pitals or other regions. Therefore, future research could BX and YF contributed equally to this work and share first authorship.
benefit from conducting surveys in multiple centers with
Funding
larger samples to enhance the representativeness and This work was supported by the Entrepreneurship and Innovation Project in
generalizability of the results. Second, the adoption of Hangzhou for High-Level Returned Overseas Scholars (to ZH).
a cross-sectional design in this study offers a snapshot
Availability of data and materials
of the relationships investigated. However, it impedes The data that support the findings of this study are available from the cor-
the establishment of causal relationships between vari- responding author on reasonable request.
ables, and future research can use longitudinal studies to
explore dynamic changes in nurses’ careers, investigating Declarations
the lasting effects of decent working conditions on work
Ethics approval and consent to participate
engagement and turnover intention. Last, the study rec- In accordance with the principles outlined in the Helsinki Declaration, this
ognizes the potential influence of social desirability bias study was approved by the Ethics Committee of Affiliated Hospital of Hang-
on nurses’ responses. Given the nature of the topic, there zhou Normal University (No. 2023(E2)-KS-121). Participants were informed
about the study’s goals and had the freedom to withdraw at any time. All data
is a possibility that nurses may have provided responses collected were anonymized and treated with strict confidentiality, following
they deemed socially acceptable, leading to an overes- ethical guidelines. Informed consent was obtained from all participants.
timation of decent work perceptions. To address this in
Consent for publication
future research, careful consideration of survey design No applicable.
and the implementation of techniques to minimize social
desirability bias, such as indirect questioning, could be Competing interests
The authors declare no competing interests.
explored.
Author details
1
Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital,
Conclusion Zhejiang University School of Medicine, Hangzhou 310007, Zhejiang, China.
In conclusion, our study delves into decent work among 2
Hangzhou Normal University, Hangzhou 310007, Zhejiang, China. 3 Affiliated
Chinese registered nurses, revealing key influences on Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang, China.
their work engagement and turnover intention. Empha- Received: 21 October 2023 Accepted: 13 December 2023
sizing the significance of decent work, especially for
younger nurses, and highlighting work engagement as a
crucial mediator, our findings contribute to nursing man-
agement. For administrators, our research offers a road- References
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