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Can patient gratitude compensate Gratitude

compensates
for depletion from family-to-work for depletion
from FWC
conflict in nurses? An experience
sampling study 2153
Xiaojun Zhan Received 18 December 2020
Revised 21 June 2021
Research Center of Cluster and Enterprise Development, 21 November 2021
Jiangxi University of Finance and Economics, Nanchang, China 28 March 2022
15 June 2022
Wei Yang Accepted 14 July 2022
School of Business Administration, Jiangxi University of Finance and Economics,
Nanchang, China
Yirong Guo
Center for Higher Education Development of Xiamen University,
Institute of Education, Xiamen University, Xiamen, China, and
Wenhao Luo
School of Economics and Management, North China University of Technology,
Beijing, China
Abstract
Purpose – Nurses’ work engagement is critical for the service quality of the hospital. Thus, investigation on
the influencing factors of nurses’ work engagement has become an important issue. This study addresses this
issue by exploring the effect of daily family-to-work conflict (FWC) on next-day work engagement among
Chinese nurses.
Design/methodology/approach – The theoretical model was tested using 555 experience sampling data
from 61 nurses collected for 10 workdays in China.
Findings – Nurses’ daily FWC is associated with their next-day ego depletion. Moreover, increased ego
depletion ultimately reduces their next-day work engagement. In addition, a between-individual factor of
frequency of perceived patient gratitude mitigates the effect of FWC on ego depletion and the indirect effect on
work engagement via ego depletion.
Originality/value – This study is important to the management of health-care organizations as it carries
significant implications for theory and practice toward understanding the influence of FWC among nurses. On
the one hand, the authors apply the job demands-resources (JD-R) model as the overarching theoretical
framework, which contributes to the authors’ understanding of how FWC impairs work engagement. On the
other hand, the authors extend extant theoretical models of FWC by identifying the frequency of perceived
patient gratitude as an important contextual factor that counteracts the negative effects of FWC among nurses.
Moreover, organizations could encourage patients to express their gratitude to nurses by providing more
channels, such as thank-you notes, to offer nurses some support for overcoming the destructive effect of FWC.
Keywords Job demands-resources model, Family-to-work conflict, Work engagement, Frequency of perceived
patient gratitude
Paper type Research paper

The authors would like to acknowledge and thank all the nurses who participated in the study.
Research fund: This study was supported by National Natural Science Foundation of China (Project
Numbers: 72002113; 72072002; 71662013).
Conflict of interest statement: All authors declare no conflict of interest.
Authors’ Note: All authors contributed equally to this paper. Personnel Review
Vol. 52 No. 9, 2023
The authors would like to acknowledge the funding support by the National Natural Science pp. 2153-2171
Foundation of China (72002113, 72072002), Fundamental Research Funds for the Central Universities © Emerald Publishing Limited
0048-3486
(ZK1023) and Ministry of Education of Humanities and Social Science Project (21YJA630112). DOI 10.1108/PR-12-2020-0891
PR Introduction
52,9 Nursing work is demanding and arduous, and nurses’ physical health is more vulnerable to
damage, nurses already face higher work pressure (Starkey et al., 2019). This is because nurses
tend to face high job demands including long and irregular work hours, challenging work
conditions and job stress (Yildirim and Aycan, 2008). Increasing job demand not only leads to
lower job satisfaction, reduced organizational commitment, increased absenteeism and
turnover among nurses (Lee and Akhtar, 2011), but also to decreases in quality of care, greater
2154 likelihood of therapeutic failure and even higher mortality rates among patients (Aiken et al.,
2002; Garcıa-Sierra et al., 2015). Therefore, it is important to examine the influencing factors of
work engagement among nurses to develop feasible ways to motivate engagement at work.
One important factor that might shape nurses’ work engagement stems from their family
domain. Juggling dual roles brings higher demands and stress, which may result in conflict
between work and family (Ten Brummelhuis et al., 2010). In particular, family-to-work
conflict (FWC), which refers to family obligations negatively interfering with work (De Clercq
et al., 2019), arises as an important antecedent that may influence nurses’ work engagement.
A recent study suggests that 93% of nurses have experienced moderate or high levels of
work-family conflict (Zandian et al., 2020). However, few studies have deciphered the
mechanisms and boundary conditions underlying this relationship, and even fewer have
specifically studied the nursing profession. Limited knowledge of how and when FWC
impairs nurses’ work engagement hinders us from developing measures to enhance nurse
engagement. Therefore, this study intends to uncover the “black box” of the relationship
between nurses’ FWC and their work engagement.
Job demands-resources (JD-R) model posits that high job demands consume the
employees’ mental and physical resources leading to energy consumption and health
problems (Demerouti et al., 2001), which subsequently impair their work behaviors, such as
low work engagement, low work performance and low organizational commitment
(Demerouti et al., 2001; Schaufeli et al., 2002). Individuals are easily falling into the state of
ego depletion in organizations due to numerous job demands (Hobfoll, 1989). Ego depletion is
defined as a cognitive state of diminished self-control resources (Baumeister et al., 1998).
When nurses face FWC, such cross-domain resource competition and role conflicts consume
their resources, which subject them to ego depletion and then impair their work engagement.
Accordingly, based on the JD-R model, we propose that ego depletion serves as a key
mechanism linking nurses’ FWC with work engagement.
Furthermore, the JD-R model implies that job resources can buffer the loss of high work
requirements on employees, that is, the job resources can reduce the negative impact of work
requirements on employees (Bakker et al., 2008; Trougakos et al., 2015). In the nursing
situation, in addition to coworkers and supervisors, patients are also one of the main sources
of resource replenishment for nurses at work. The specific characteristics of the nursing
profession have determined that nurses communicate with the beneficiaries of their work
more frequently than many people in other professions (Grant, 2007, 2012). Moreover,
patients’ gratitude (i.e. expressing appreciation to nurses and their work) could provide
nurses with positive regard, effectively reduce the psychological burden on nurses and can
maintain and replenish nurses’ resources. Therefore, we argue that frequency of perceived
patient gratitude, a more stable replenishment of resources during their work (Sheridan and
Ambrose, 2022), can mitigate the negative impact of FWC on ego depletion and subsequent
work engagement. As such, we propose a boundary role for the frequency of perceived
patient gratitude in the relationship between nurses’ family-to-work and work engagement.
The theoretical model of this study is shown in Figure 1.
Based on a sample of nurses in China, the current study utilizes the experience sampling
method to examine the within-person linkages between nurses’ daily FWC and their next-day
work engagement over multiple days from a JD-R perspective. As well, we test nurses’
frequency of perceived patient gratitude as a between-person moderator on the relationship Gratitude
between FWC and ego depletion. As such, this study aims to contribute to extant research on compensates
FWC and work engagement in at least four ways. First, we apply the JD-R model as our
overarching theoretical framework and uncover the mediating role of ego depletion in the
for depletion
relationship between nurses’ FWC and their work engagement, which contributes to our from FWC
understanding of how FWC impairs work engagement. Second, we enrich the existing
resource supplement path of the JD-R model by finding that gratitude from employees’ work
beneficiaries, who are outside the organization, can also effectively improve employees’ work 2155
engagement. Third, our paper also confirms the role of receiving gratitude in interpersonal
relationships, responding to the call for research on gratitude reception in the workplace
(Sheridan and Ambrose, 2022). By using an experience sampling design that measures
different constructs at multiple time points, this study complements the existing between-
person approach and captures more dynamic effects of FWC.

Theoretical framework and hypotheses

JD-R model focuses on describing the relationship between work characteristics and well-
being. According to the JD-R model, any work characteristics can be classified into two
categories (i.e. job demands and job resources). Demerouti et al. (2001, p. 501) defined job
demands as “requirements of individual’s physical, psychological and social abilities, which
require the individual to make corresponding efforts or costs to complete the work”. In
contrast, job resources are “positive factors” in work, which have a significant function on the
realization of work goals, reduction of job demands associated physiological and
psychological costs. The JD-R model is developed based on the conservation of resource
theory (Hobfoll, 1989). Hobfoll (1989) distinguishes four different types of resources, namely
material, conditional, individual characteristic and energy resources that can help individuals
resist stress and acquire other resources they need. In this paper, we focus on nurse energy
resources that can be depleted by FWC and replenished by patients’ gratitude.
The JD-R model developed the “dual processes” (i.e. impairment process and motivational
process) to explain how demands and resources work among individuals. The first
impairment process corresponds to the depletion of resources, in the process, numerous and
chronic job demands will drain the individual’s energy, which in turn leads to job burnout
(Demerouti et al., 2001). The second process by the JD-R model is assumed that job resources
play a motivational role because they foster individuals’ growth, learning and development.
Furthermore, the JD-R model implies that job resources can not only stimulate the
achievement of work goals but also can buffer the negative effect on employees due to high
work demands (Bakker and Demerouti, 2017).
From the perspective of integrating the main effect (job demand mechanisms) and the
moderation effect (job resource mechanisms), we think the JD-R framework is capable to

Between-person Level

Frequency of Perceived Patient Gratitude

Within-person Level

Family-to-work Conflict Ego Depletion Work Engagement

Figure 1.
Theoretical model
Daily Survey/ Day t Daily Survey/ Day t+1 Daily Survey/Day t+1
PR organize our overall research model. Therefore, drawing on the JD-R model as our
52,9 overarching theoretical framework, this study focuses on examining how daily work
engagement is depleted by FWC. Furthermore, in line with the JD-R model, we suspect that
the frequency of perceived patient gratitude as an energy resource from the job, will mitigate
the negative effect of FWC and lead to work engagement (Bakker and Demerouti, 2017).

2156 Family-to-work conflict and ego depletion

The conflict between work and family includes two directions, one is from work to family, and
the other is from family to work (Carlson et al., 2000; Greenhaus and Beutell, 1985).
Considering the high proportion of females in the nurse group (World Health Organization,
2020), they are more influenced by family roles (Yu et al., 2020). Thus, we mainly explore the
FWC in this paper. FWC refers to a situation in which individuals’ responsibilities and role
pressures from the family domain interfere with their work and hinder their optimal
functioning at work (Greenhaus and Beutell, 1985; Ten Brummelhuis et al., 2014). Previous
research has found that FWC has harmful effects on individuals, such as emotional
exhaustion, depression, job dissatisfaction, absenteeism and intention to leave (e.g. Allen
et al., 2020; Amstad et al., 2011).
Although most previous studies have examined FWC as a general and stable state with a
between-person approach, some recent research has demonstrated substantial within-person
variations in FWC (e.g. Courtright et al., 2016; Liu et al., 2015). The findings highlight the
necessity to establish a within-person framework to examine the effects of FWC on a temporal
basis. Therefore, utilizing an experience sampling design, the current study focuses on daily
FWC, which manifests as episodic interference of family issues with work on a given day.
According to the JD-R model, FWC is regarded as a job demand, constantly trying to deal
with conflicts during work may wear out employees and cause ego depletion later on (Bakker
and Demerouti, 2017; Breevaart and Bakker, 2018). First, FWC occurs on days when
individuals face too many responsibilities or stress from their families (Ten Brummelhuis et al.,
2010; Bakker et al., 2008). Under these circumstances, individuals’ thoughts are occupied by
family matters and are often distracted from their work during these days (Carlson et al., 2000).
Such effort is at the cost of individuals’ resources and thereby will increase their ego depletion.
Second, daily FWC infuses individuals with negative emotions that will impede their work
processes on that day. On the one hand, nurses’ engagement with negative family issues makes
them feel exhausted and agitated. On the other hand, failure to throw themselves into their work
and effectively complete their tasks, which signifies inconsistency between individuals’ actual
behaviors and work norms, will lead to individuals’ guilt or feelings of inadequacy (Judge et al.,
2006). As such, negative emotions accumulate throughout the day because of FWC consuming
resources in restraining these negative emotions and thus increasing their ego depletion.
Third, when individuals experience heightened FWC one day, they might even have to
spend their work time addressing family issues (Peeters et al., 2005), such as sending
messages to their family members, purchasing necessities for their family and solving family
problems. While dealing with conflicts, they must also complete work tasks, which makes
employees overwhelmed and adds to their ego depletion. To sum up, FWC as a job demand
will cost employees’ energy resources, which in turn cause ego depletion in individuals. Thus,
we hypothesize that
H1. Daily family-to-work conflict is positively related to nurses’ next-day ego depletion.

Family-to-work conflict, ego depletion and work engagement

Previous studies have shown that work engagement reflects a within-person phenomenon
that fluctuates over time and requires individuals to put in resources (Lanaj et al., 2014;
Sonnentag, 2003). Accordingly, we propose that FWC on one day will increase individuals’ Gratitude
ego depletion and then decrease their work engagement on the next day. Work engagement compensates
refers to a positive and satisfying state of mind at work that manifests as vigor, dedication
and absorption (Schaufeli et al., 2002). More specifically, vigor refers to a high level of energy,
for depletion
willingness to put in the effort at work and resilience when faced with difficulties; dedication from FWC
manifests as a feeling of meaningfulness, enthusiasm, inspiration, pride and challenge;
absorption describes a state of full concentration (Schaufeli et al., 2002; Owens et al., 2016).
Therefore, to be engaged at work for one day, individuals need to invest their regulatory 2157
resources into the work role to be energetic, resilient, enthusiastic and engrossed in work
(Lanaj et al., 2014; Schaufeli, 2017). However, due to limited resources, when individuals
experience high FWC, individuals with ego depletion will decrease their willingness and
ability to invest in their work role (Breevaart and Bakker, 2018), further resulting in less work
engagement. In fact, Uy et al. (2017) have also shown that end-of-day emotional exhaustion is
negatively related to next-day work engagement among customer service representatives.
Therefore, consistent with the aforementioned arguments, we hypothesize that
H2. Daily family-to-work conflict is negatively related to nurses’ next-day work
engagement through the mediating role of ego depletion.

The moderating role of frequency of perceived patient gratitude

Gratitude has a long history in psychological research and has received much attention in
management research in recent years. There are three forms of gratitude: state, trait and
expression behaviors (Locklear et al., 2022). From a state perspective, gratitude refers to an
emotional feeling for experiences that are beneficial to rather than attributable to the self
(Fehr et al., 2017; Locklear et al., 2022). From a trait perspective, McCullough and his
collaborators defined gratitude as a general tendency to acknowledge and respond to others’
behavior of kindness with gratitude (McCullough et al., 2002). Wood et al. (2010) regard
gratitude as a trait that tends to appreciate the positive aspects of life. Fehr et al. (2017)
defined gratitude as a stable tendency in a particular situation. From a behavioral
perspective, gratitude refers to the display and expression of appreciation, representing a
form of felt positive regard (Sheridan and Ambrose, 2022; Locklear et al., 2022).
Existing research has documented that gratitude plays an important role in personal
health, moral behavior and social relationships (Locklear et al., 2022). Studies have shown that
gratitude could effectively promote individual well-being (Nezlek et al., 2017; Watkins et al.,
2003; Wood et al., 2008), enhance psychological capital and obtain support from social
networks (Lambert et al., 2010; Wood et al., 2010). In addition, scholars have found that
gratitude could enhance prosocial or pro-organizational behaviors (Ford et al., 2018;
McCullough et al., 2001; Spence et al., 2014; Sun et al., 2019), as well as maintain and promote
existing interpersonal interactions (Algoe, 2012; Williams and Bartlett, 2015).
Although there are few studies on gratitude in interpersonal relationships (Sheridan and
Ambrose, 2022; Locklear et al., 2022), the importance of gratitude in interpersonal relationship
have attracted increasing attention from academia (Fehr et al., 2017; Locklear et al., 2022).
Based on COR theory, Sheridan and Ambrose (2022) have found that if supervisors feel
appreciated by their subordinates, it gives them energy and resources and then has a positive
impact on their job attitudes and behaviors.
Following this line of research, this study defines patient gratitude as a behavior,
representing an expression of positive regard to the nurse who cares for them. Gratitude from
patients is, in a sense, a return on nurses’ investment. Gratitude from patients enables nurses
to realize that their efforts are not in vain and to feel valued and valuable to others (Grant and
Gino, 2010), which in turn supplements energy resources. Energy is a resource that can be
both consumed and replenished (Hobfoll and Shirom, 2001). Studies have shown that positive
PR interactions and good relationships between employees and clients in service occupations
52,9 (such as nurses and patients) can generate energy resources to supplement energy
expenditure (Dutton and Heaphy, 2003; Tang et al., 2022). Gratitude is the patient’s
recognition of the nurse’s work, indicating a good relationship between the nurse and the
patient. Studies have found that gratitude is positively correlated with energy resources (Reis
et al., 2000; Sheridan and Ambrose, 2022). Gratitude can not only make nurses feel at ease but
also generate motivation and bring positive energy to nurses (Hobfoll and Shirom, 2001;
2158 Sheridan and Ambrose, 2022). We believe that patient gratitude can effectively reduce the
psychological burden of nurses, improve nurses’ job well-being and can be seen as important
replenishing energy to promote work engagement.
However, due to the differences in individual characteristics, working teams and
interpersonal sensitivity, different nurses have different perceptions of patient gratitude. For
those nurses who perceived high frequency of patient gratitude, they could have an
important resource replenishment due to enhanced prosocial impact and positive emotions.
On the one hand, patient gratitude increases nurses’ perception of their prosocial impact (Lee
et al., 2019), namely the subjective judgment that one’s actions benefit others, which serves as
an energy resource to help replenish their resource pool (Grant and Campbell, 2007). Thus,
even though faced with FWC, nurses may not be affected by this and consume fewer
resources in this process, which will then buffer the negative effect of ego depletion and help
them to be engaged in work. On the other hand, nurses will experience positive emotions (e.g.
happiness, pride, etc.) due to the favorable appraisals about them resulting from patient
gratitude (Johnson et al., 2014). Experiencing gratitude as well as other positive emotions
helps nurses build enduring resources (Fredrickson, 2001) and thus helps increase their
ability for dealing with conflict (Tice et al., 2007), leading to less ego depletion and less decline
in work engagement when facing FWC.
For those nurses who perceived low frequency of patient gratitude, they are less likely to
have resource replenishment that could be used to cope with FWCs. JD-R model implies that
the replenishment of job resources will contribute to alleviating the loss due to job demands,
which thus endows individuals with less ego depletion (Demerouti et al., 2001; Trougakos
et al., 2015). Thus, when nurses need to deal with FWC but perceive low frequency of patient
gratitude, they would be more likely to be ego depletion and disengagement in their work due
to the consumption of resources and lack of resource replenishing.
Extrapolating from these arguments, we propose that the frequency of perceived patient
gratitude will infuse more job resources into the nurses’ pool of resources and increase their
capacity to efficiently regulate and handle FWC, which thereby mitigates the effect of FWC
on ego depletion and subsequent work engagement. Therefore, we propose:
H3. Frequency of perceived patient gratitude will moderate the relationship between
daily family-to-work conflict and next-day ego depletion such that the relationship
will be weaker when nurses perceive more gratitude.
H4. Frequency of perceived patient gratitude will moderate the indirect effect of daily
family-to-work conflict on next-day work engagement through next-day ego
depletion, such that the indirect effect will be weaker when nurses perceive more
gratitude.

Method
Participants and procedures
A total of 66 nurses at a general hospital located in China were contacted by the authors and
invited to participate in our research [1]. With strong support from top managers and the
human resources department of the hospital, we were provided a list of participants’ names
and timetables before administering the questionnaires. When conducting the survey, Gratitude
members of our research team explained our research purpose and promised to keep all compensates
responses confidential. Of the 66 nurses who expressed an interest in participating, 61
completed sufficient surveys (we excluded 5 participants who completed less than three daily
for depletion
surveys). The final sample was 86.9% women with an average age of 27.90 years (SD 5 6.61), from FWC
1.55 (SD 5 0.76) children and a tenure of 6.57 years (SD 5 6.66).
Data collection was implemented in two phases. First, all focal participants filled out a
questionnaire on frequency of perceived patient gratitude and demographics. One week later, 2159
they started completing daily questionnaires hosted by [Link], a Chinese website similar to
[Link]. For two consecutive weeks, focal nurses responded to one daily survey within
two hours of finishing work. The daily survey mainly contains three variables of FWC, ego
depletion and work engagement. We obtained a total of 555 valid surveys out of a possible
660, yielding a response rate of 84.1%. Thus, our final sample consisted of 555 observations at
Level 1 and 61 observations at Level 2.

Measurement
All measures were initially compiled in English. Once the list of measures was complete, the
items were translated into Mandarin by a bilingual research assistant, and then translated
back into English by a separate bilingual research assistant (Brislin, 1970).
Family-to-work conflict. Nurses rated FWC using Carlson et al.’s (2000) 9-item measure.
Three items were selected according to the characteristics of the nursing profession. Nurses
reported the extent to which they experienced FWC on that workday (from 1 5 strongly
disagree to 5 5 strongly agree). A sample item is “Today, due to stress at home, I am often
preoccupied with family matters at work” (α 5 0.89).
Ego depletion. For ego depletion, the 5-item scale developed by Lanaj et al. (2014) was
utilized. Participants indicated the extent to which they felt ego depletion during that day’s
work (from 1 5 not at all to 5 5 a great deal). A sample item is “Today, I felt like my willpower
was gone” (α 5 0.90).
Work engagement. Work engagement was measured in this survey with the 9-item scale
developed by Schaufeli (2017). Three items were selected according to the highest factor
loading. Nurses were asked to rate the level of work engagement in their work (from
1 5 strongly disagree to 5 5 strongly agree). One sample item is ‘‘Today, I felt strong and
vigorous at my job” (α 5 0.94).
Frequency of perceived patient gratitude. Frequency of perceived patient gratitude was
measured via 3 items from Lee et al. (2019). All three items were modified to fit the purpose of this
study. Participants indicated how often they received gratitude from patients during the last
month using a scale ranging from 1 (Never) to 5 (Very often). The sample item includes “During
the last month, after I provided help, the recipients expressed gratitude toward me.” (α 5 0.93).
Control variables. Nurses’ individual difference variables may account for variance in an
individual’s work engagement, such as age, gender or tenure. Therefore, we controlled for
age, gender, tenure and the number of children in our analysis. Sonnentag et al. (2010) suggest
that work shift affects employees’ emotions at a daily level, so we also took the daily work
shift (0 5 day; 1 5 night shift) as a within-individual control variable. Also, we controlled for
ego depletion and work engagement from the previous day, which enabled us to examine the
change in these variables (Johnson et al., 2014).

Analytic strategy
Data analysis consists of two parts. We firstly conducted the preliminary analyses, including
confirmatory factor analyses, the amount of within-individual variance, reliability test and
correlation analysis. Following that, we then conducted hypothesis testing.
PR Given the hierarchical structure of our data (i.e. daily observations nested within
52,9 individuals), we utilized a multilevel path analysis for our data analysis (Preacher et al., 2016).
At the within-person level (Level 1) were the repeated daily observations of FWC, ego
depletion and work engagement. At the between-person level (Level 2) were the one-time
assessments of frequency of perceived patient gratitude. Hypotheses analyses were explicitly
conducted with the Mplus version 7.4 using maximum likelihood estimation with robust
standard errors. We centered the Level 2 moderator at its grand mean to test the interaction
2160 effect. Simple-slopes analysis (Aiken et al., 1991) was used to probe the interaction effect.
Mediation hypotheses and moderated mediation hypotheses were tested via Monte Carlo
simulation procedures using the RMediation add-on package for the R statistical software
environment (Tofighi and MacKinnon, 2016).

Results
Preliminary analyses
We conducted a series of multilevel confirmatory factor analyses (MCFAs) to examine the
convergent validity of the study variables (Dyer et al., 2005; please see Page 160). The fit
indices reveal that the proposed four-factor model fits the data well: χ 2 5 105.03, df 5 41,
p < 0.001, CFI 5 0.97, TLI 5 0.96, SRMR(within) 5 0.03, RMSEA 5 0.05. Moreover, the baseline
model yields the best results when compared to a two-factor model in which ego depletion and
work engagement are set to one latent variable, χ 2 5 702.77, df 5 43, p < 0.001, CFI 5 0.73,
TLI 5 0.63, SRMR(within) 5 0.16, RMSEA 5 0.16 and a one-factor model, in which all Level 1
variables are set to one latent variable, χ 2 5 1621.13, df 5 44, p < 0.001, CFI 5 0.35,
TLI 5 0.41, SRMR(within) 5 0.20, RMSEA 5 0.24. The factor loading of all research items can
be found in the Appendix.
To establish the appropriateness of using multilevel analysis, we first inspected the
amount of within-person variance of all Level 1 variables. As shown in Table 1, the results
indicate that a considerable proportion of the total variance in the variables (ranging from
36% to 60%) was within the individual. This evidence of within-individual variance
supported proceeding with multilevel path analysis, as there was both within- and between-
individual variance to explain.
Means, standard deviations, reliabilities and correlations between study variables are
presented in Table 2. At the within-individual level, FWC (day t) is positively related to ego
depletion (day tþ1) (r 5 0.39, p < 0.01). Ego depletion (day tþ1) is positively related to work
engagement (day tþ1) (r 5 0.20, p < 0.01). These results provide preliminary support for
some of the hypothesized relations.

Percentage of
within-i
Within-individual Between-individual ndividual variance
Construct variance (e 2) variance (r 2) (%)

Ego depletion (day t) 0.78 1.05 43

Work engagement (day t) 0.32 0.22 59
Table 1. Family-to-work conflict (day t) 0.33 0.58 36
Percentage of within- Ego depletion (day tþ1) 0.77 1.09 41
individual variance Work engagement (day tþ1) 0.33 0.22 60
among daily variables Note(s): The percentage of variance within-individuals is calculated as e2/(e2þ r 2)
Variable M SD-w SD-b 1 2 3 4 5 6 7 8 9 10 11 12

Within-individual level
1. Work shifta 1.24 0.57 0.31 0.01 0.05 0.06 0.10* 0.03 0.08
2. Weekdayb 0.30 0.46 0.11 0.11 0.03 0.01 0.06 0.04 0.03
3. Ego depletion (day t) 3.07 1.35 1.08 0.10 0.14 (0.93) 0.19** 0.52** 0.64** 0.01
4. Work engagement (day t) 3.42 0.73 0.53 0.02 0.14 0.01 (0.89) 0.05 0.04 0.46**
5. Family-to-work conflict (day t) 2.31 0.95 0.80 0.24 0.28* 0.63** 0.15 (0.94) 0.39** 0.14**
6. Ego depletion (day tþ1) 3.07 1.37 1.10 0.11 0.15 0.99** 0.04 0.62** (0.93) 0.20**
7. Work engagement (day tþ1) 3.41 0.74 0.55 0.01 0.16 0.01 0.99** 0.15 0.02 (0.89)
Between-individual level
8. Age 27.90 6.61 0.06 0.12 0.10 0.43** 0.03 0.10 0.43**
9. Sexc 0.12 0.32 0.07 0.07 0.03 0.15 0.07 0.05 0.15 0.10
10. Tenured 6.57 6.66 0.08 0.11 0.14 0.40** 0.07 0.14 0.40** 0.89** 0.12
11. Children 1.55 0.76 0.04 0.00 0.16 0.39** 0.08 0.16 0.38** 0.55** 0.06 0.53**
12. Frequency of perceived patient gratitude 3.39 0.65 0.29* 0.08 0.16 0.18 0.16 0.16 0.16 0.13 0.16 0.07 0.09 (0.89)
Note(s): Level 1 N 5 555; Level 2 N 5 61. Correlations above the diagonal represent group-mean centered relationships between the daily variables at the within-
individual level of analysis. Correlations below the diagonal are person-level aggregations of the daily variables and represent relationships at the between-individual level
of analysis. Mean values of Cronbach’s alpha coefficients are presented in parentheses along the diagonal
a
Work shift is coded as 0 5 day shift, 1 5 night shift
b
Weekday is coded as 0 5 weekday; 1 5 weekend
c
Sex is coded as 0 5 man, 1 5 woman
d
Tenure is measured by month
þ
p < 0.1, two tailed. *p < 0.05, two tailed. **p < 0.01, two tailed
for depletion
Gratitude

from FWC

2161
compensates

Means, standard
Table 2.

deviations, reliabilities,

among study variables

and correlations
PR Hypothesis testing
52,9 Hypothesis 1 suggests that within individuals, the FWC has a positive relationship with next-
day ego depletion. After controlling for a work shift and weekday at Level 1 and age, sex,
tenure and children at Level 2, daily FWC is indeed positively associated with next-day ego
depletion at work (γ 5 0.14, p < 0.05). Importantly, by controlling ego depletion on the
previous day, this relationship can be interpreted as representing a change in the employee’s
ego depletion as a result of FWC. Thus, Hypothesis 1 is statistically supported.
2162 Hypothesis 2 posits that, within individuals, FWC may have an indirect effect on next-day
work engagement via ego depletion. We estimated the indirect effect and conducted a Monte
Carlo simulation with 20,000 replications to obtain a confidence interval around the indirect
effect. As shown in Table 3 and consistent with Hypothesis 2, the estimate for the indirect
effect is 0.038, and the biased corrected 95% confidence interval does not include zero
[0.055, 0.003]. Thus, Hypothesis 2 was supported as ego depletion mediates the effect of
FWC on next-day work engagement.
Hypothesis 3 concerns the moderating effect of frequency of perceived patient gratitude
on the within-person relation of FWC and next-day ego depletion. Table 4 presents the
significant moderating effect of the interaction on ego depletion (γ 5 0.26, p < 0.05). Simple
slope analyses indicate that the positive relationship between FWC and next-day ego
depletion is significantly stronger among nurses who perceived low frequency of patient
gratitude (one standard deviation below the mean) during work, simple slope 5 0.31, p < 0.05,
than among those who perceived high frequency of patient gratitude (one standard deviation
above the mean) simple slope 5 0.02, n.s. The interaction pattern, as shown in Figure 2, is
consistent with Hypothesis 3. These results, therefore, support Hypothesis 3 showing that
frequency of perceived patient gratitude moderates the positive relationship between FWC
and next-day ego depletion.
Turning to our moderation mediation hypothesis, for Hypothesis 4 we predicted that
frequency of perceived patient gratitude would moderate the conditional indirect effect of
FWC on next-day work engagement through ego depletion. As previously mentioned, a
Monte Carlo method was applied to obtain the bias-corrected 95% confidence intervals for
these conditional indirect effects and ascertain the difference between them (MacKinnon et al.,
2007). Results suggest that the indirect effect of FWC on next-day work engagement is not
significant among individuals who perceived high frequency of patient gratitude
(Indirect effect 5 0.006; 95% CI 5 [0.054, 0.065]), but is significant among individuals
who perceived low frequency of patient gratitude during work (Indirect effect 5 0.077; 95%
CI 5 [0.149, 0.018]). Moreover, the difference between these two indirect effects is
significant (Indirect effect 5 0.083; 95% CI 5 [0.006, 0.173]), thereby demonstrating support
for Hypothesis 4.

95% CI
FWC → work engagement Effect LLCI UCLI

Indirect effect via ego depletion 0.038 *

0.055 0.003
Conditional indirect effect via ego depletion at:
High frequency of perceived patient gratitude (þ1 SD) 0.006 0.054 0.065
Low frequency of perceived patient gratitude (1 SD) 0.077* 0.149 0.018
Difference 0.083* 0.006 0.173
Note(s): N 5 555. The 95% confidence intervals for the indirect effect, the conditional indirect effects, and the
difference in the conditional indirect effects are calculated using Monte Carlo bootstrapping with 20,000
Table 3. repetitions
*
Results from Monte The 95% bias corrected bootstrapped confidence interval does not include zero; p < 0.05 (two-tailed)
Carlo analysis LLCI 5 lower level of the 95% confidence interval; UCLI 5 upper level of the 95% confidence interval
 Ego depletion day tþ1 Work engagement day tþ1
Gratitude
B SEB B SEB compensates
for depletion
Intercept 3.07*** 0.14 3.40*** 0.06
from FWC
Between-individual level
Age 0.02 0.04 0.02 0.02
Sex 0.15 0.34 0.13 0.19 2163
Tenure 0.03 0.03 0.00 0.01
Children 0.12 0.23 0.17 0.09
Frequency of perceived patient gratitude 0.29 0.24
Residual variances 1.03*** 0.21 0.16*** 0.04
Within-individual level
Work shift 0.13 0.08 0.03 0.03
Weekday 0.01 0.08 0.06 0.05
Ego depletion (day t) 0.04 0.07 0.06 0.03
Work engagement (day t) 0.01 0.09 0.01 0.04
Family-to-work conflict (day t) 0.14* 0.09 0.10 0.05
Ego depletion (day tþ1) 0.25*** 0.05
Residual variances 0.70*** 0.09 0.28*** 0.04
Cross level predictors
Frequency of perceived patient gratitude 0.26* 0.12
X Family-to-work conflict (day t)
Pseudo R Square 0.06 0.22 Table 4.
Note(s): Level 1 N 5 555; Level 2 N 5 61 Results from multilevel
*
p < 0.05, two tailed. **p < 0.01, two tailed. ***p < 0.001, two tailed path analysis

Discussion
This study examined the daily relationship between nurses’ FWC and their work engagement.
Utilizing an experience sampling design, we found that on days when nurses experienced more
FWC, they reported higher levels of ego depletion and lower levels of work engagement the next
day. In addition, we found that frequency of perceived patient gratitude mitigates the negative
effect of FWC. More specifically, for nurses who perceived higher frequency of patient
gratitude, the effect of family-to-work on their ego depletion and subsequent work engagement
was weaker. These findings generate several theoretical and managerial implications.

Theoretical implications
This study contributed to research on managing human resources in at least three ways.
First, we elaborated on the resource loss mechanism between FWC and job engagement
based on the JD-R model. Although previous researchers have found that FWC could
decrease employees’ work engagement (e.g. Ten Brummelhuis et al., 2010; Yucel, 2018), few
studies unpacked the underlying influence process whereby FWC decreases work
engagement. This study unraveled the mechanism from the JD-R perspective and
indicated that FWC could deplete employees’ energy resources, that is, increase their ego
depletion and then impair their engagement at work. This contributed to our understanding
of how FWC influences work engagement.
Second, few studies have focused on the moderating effect of patient gratitude on the resource
replenishment process. This paper considers the frequency of patient gratitude as a moderator of
the direct effect of FWC on ego depletion as well as the indirect effect on work engagement
through ego depletion. This finding implied that individuals would not always experience high
ego depletion when facing stressful and demanding encounters if their work is affirmed and
PR 4
52,9 3.8

3.6

3.4
Ego depletion

2164 Low frequency of

3.2 perceived patient
gratitude
3 High frequency of
perceived patient
2.8 gratitude

2.6

2.4

2.2
Low family-to-work High family-to-work
Figure 2. conflict conflict
Cross-level moderating
effect of frequency of Note(s): Level 1 N = 555; Level 2 N = 61. Simple slope test (Bauer and
perceived patient Curran, 2005; Preacher et al., 2006) confirm that the relationship between
gratitude on the within-
individual. FWC and next day ego depletion is stronger for employees experienced low
Relationship between frequency of perceived patient gratitude (r = 0 .31, p < 0 .05) but not for
family-to-work conflict employees experienced high frequency of perceived patient gratitude
(FWC) and ego
depletion
(r = –0.02, n.s.), and the difference between high and low frequency of
perceived patient gratitude is –0.33 (p < 0.05)

appreciated, which will replenish their resource pool. More importantly, energy supplement
comes from employees’ work beneficiaries, who are outside the organization, can also effectively
improve employees’ work engagement. The study incorporates gratitude into the JD-R model and
enriches as well as develops the resource supplement process in the JD-R model. Future research
might also consider the possibility of supplementing employees’ resources from gratitude.
Third, this paper also contributes to gratitude research by responding to the call for
research on gratitude reception in the workplace (Grant and Gino, 2010; Lee et al., 2019; Chen
et al., 2021; Sheridan and Ambrose, 2022). Previous literature primarily focused on the
benefits of expressing gratitude (e.g. Fehr et al., 2017; Williams and Bartlett, 2015), whereas
ignored the important function of receiving gratitude. Feeling appreciated is as important as
expressing it, perceived gratitude from others can increase caregivers’ life satisfaction and
quality of life (Sheridan and Ambrose, 2022). Our research found that receiving gratitude
from patients can successfully help nurses supplement their energy resources, deal with
FWCs and then improve work engagement. At the same time, it is also an important
expansion of work engagement literature. The decremented work engagement affected by
FWC would be restored by receiving gratitude, which helps employees realize the
significance and meaningfulness of work (Lee et al., 2019; Han et al., 2021; Meng et al., 2020).

Practical implications
The findings of this study also offered some useful insights to nurse professionals and
hospital managers. On the one hand, our study showed that when facing FWC, nurses needed
to consume their resources, which makes them prone to ego depletion and further impairs
their work engagement. Therefore, to fully engage nurses with their work, organizations Gratitude
must assist nurses in reducing their FWC. For instance, family-friendly policies such as compensates
flexible work arrangements, on-site childcare and parental or family leave were beneficial to
help nurses balance work and family (Masterson et al., 2021). Also, training programs or
for depletion
communications for improving nurses’ skills in juggling family and work demands, such as from FWC
time management skills, contribute to decreasing work-family conflict.
On the other hand, our study found a buffering role for frequency of perceived patient
gratitude in the relationship between FWC, ego depletion and work engagement, which was 2165
an important finding for organizations to reverse the negative effects of FWC and motivate
nurses to be engaged with their work. For example, organizations could encourage patients to
express their gratitude to nurses by providing more channels, such as small meetings,
message boards and thank-you notes while patients and families should also nurture
gratitude and caring for nurses. This not only contributed to the expression of gratitude but
also helped enhance more positive interactions and facilitates mutual understanding between
patients and nurses, which then was conducive to eliciting nurses’ positive emotions,
replenishing energy and motivation and then enhancing their engagement at work.

Limitations and directions for future research

Despite the above contributions, some limitations of the current study should be noted, which
can also suggest meaningful directions for future research. First, all measures in this study
were self-reported, which inevitably enhances the possibility of common method bias in our
findings (Podsakoff et al., 2003). In addition, ego depletion and work engagement were
measured at the same time, which makes it difficult to ensure the causal direction of the
relationships between these two constructs. However, we controlled the prior value of these
two constructs when testing our model, which helps to alleviate concerns regarding causality.
In addition, the positive effect of the previous day, as well as the number of total dependents
or marital status may affect the ego depletion on the next day. Therefore, future research
could consider this and utilize a more rigorous research design, such as the experiment
method, to claim causality.
Second, taking into account the particularity of the nursing profession, participants were
allowed ample time to fill out the questionnaire (two hours after work); thus, some emotions or
feelings at work may not be measured in time. As well, given that we used the same survey
during a 10-day investigation, participants probably remembered the content of the
questionnaire or the order of the questions, which renders the answers prone to inertia that
might affect our findings. Therefore, future research could add in other objective measures of
the key constructs and combine modern advanced technology (e.g. an electronic bracelet) for
more accurate investigations. For example, future studies could use some electronic
wristbands to monitor the subjects’ heartbeat, heart rate or blood pressure, to reflect
employees’ degree of ego depletion (Li et al., 2022). In addition, considering that work
engagement could help improve job performance, so work engagement could be reflected by
service speed, the number of patients served, etc.
Third, since work and family are two interrelated and interactive domains, the gratitude
for work may spill over to the family domain (Algoe et al., 2010). For example, the work-home
source model showed that the resources (e.g. time, energy and emotion) of an individual in the
work field are related to the family field, and the consumption of resources would induce
work-family conflict, while the accumulation of resources would produce work-family
enrichment (Ten Brummelhuis and Bakker, 2012). Gratitude as a positive emotional resource
could have a positive impact on employees’ families; in turn, gratitude built-in employees’
families could also be used as a positive job resource and have a positive impact on the work
area. Therefore, future research could discuss the relationship between gratitude and work-
family enrichment.
PR Note
52,9 1. Data were collected before the outbreak of COVID-19.

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Appendix Gratitude
compensates
for depletion
Variable Items Factor1 Factor2 Factor3 Factor4 from FWC
Family-to- In today’ work, due to stress at home, I am often 0.261 0.880 0.075 0.033
work preoccupied with family matters at work 2171
conflict In today’ work, because I am often stressed from 0.261 0.924 0.001 0.047
family responsibilities, I have a hard time
concentrating on my work
In today’ work, tension and anxiety from my 0.293 0.903 0.013 0.010
family life often weakens my ability to do my job
Ego In today’ work, I felt like my willpower was gone 0.869 0.178 0.095 0.001
depletion In today’ work, I felt drained 0.876 0.113 0.100 0.053
In today’ work, my mind felt unfocused 0.852 0.258 0.146 0.043
In today’ work, it would have taken a lot of effort 0.859 0.252 0.053 0.068
for me to concentrate on something
In today’ work, I could not absorb any information 0.788 0.215 0.042 0.121
Work In today’ work, I felt strong and vigorous at my job 0.147 0.018 0.904 0.045
engagement In today’ work, my job inspired me 0.130 0.030 0.901 0.080
I got carried away when I was working 0.035 0.025 0.880 0.081
Frequency During the last month, after I provided help, the 0.079 0.013 0.028 0.944
of perceived recipients expressed gratitude toward me
patient During the last month, after I provided help, the 0.097 0.003 0.037 0.916
gratitude recipients showed appreciation toward me
During the last month, after I provided help, the 0.027 0.096 0.140 0.835
recipients expressed positive emotions toward me Table A1.
Note(s): Italics indicate that measurement items of different variables are loading on different factors, The factor loading of
indicating that the discrimination validity between variables is high all research items

Corresponding author
Yirong Guo can be contacted at: guoyr@[Link]; Wenhao Luo can be contacted at: whluo1988@
[Link]

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