Factors influencing the thriving of emergency department nurses in China

The global population is still growing, exacerbating the severe nursing shortage. Emergency department (ED) nurses report a worse work experience and are more likely to leave than general department nurses due to a lack of human nursing resources, fast-paced nursing work, higher burnout, and frequent workplace violence [1], [2], [3]. The best indicator of nurses leaving their jobs is their intention to leave [2], [4]. Increased turnover rates among nurses worsen the lack of nursing personnel, increase negative work experiences for nurses, reduce the quality of care, and even threaten patient safety [5], [6]. Previous studies have shown that nurses' propensity to leave the profession is adversely correlated with thriving, which is a positive experience for them at work [7]. Nurses who experience thriving at work are less likely to be tempted to leave. Therefore, focusing on and improving the thriving of ED nurses at work can help reduce the willingness to leave and improve the quality of care.

Thriving is a positive psychological feeling experienced by employees at work, primarily consisting of vitality and learning [8]. Vitality is a positive feeling that employees have energy, and learning is the ability of employees to acquire knowledge and skills and be able to apply them [8]. Increased thriving encourages creative activity among staff members, lowers burnout and the intention to leave, and fosters personal development [9]. Because of understaffing and excessive workloads, nurses do not always feel they are thriving [10]. Şahin et al. [11] discovered that during the COVID-19 pandemic, family-supportive supervisory behaviors improved psychological well-being and decreased work-family conflict, which in turn enhanced thriving among Turkish and Nigerian nurses. Another study conducted in China [12] reported that nurses' thriving is influenced by both personal and environmental factors, including psychological capital and perceived organizational support, as well as workplace violence, authentic leadership, and organizational justice. As front-line personnel rescue patients with acute, severe, and critical illnesses, ED nurses still face heavy, busy, and urgent work tasks due to insufficient human resources in nursing. Their thriving may be lower than that of nurses in the general departments. According to a qualitative study [10] of Canadian critical care nurses, when nurses were pleased with their jobs, they were more engaged and eager to assist their colleagues; on the other hand, when they were not, their work just seemed like going through the motions. According to earlier research, thriving may encourage constructive behavior among nurses, boost their professional well-being and job satisfaction, and improve patient safety and nursing quality [13], [14]. To encourage ED nurses to perform well at work, it is essential to comprehend the elements that contribute to their thriving.

Unit contextual features and personal traits are essential antecedent variables determining employees' thriving [9], [15]. Unit contextual features are crucial environmental elements that employees need to thrive. They foster an environment of mutual respect and trust among coworkers, give employees decision-making autonomy, and encourage information sharing within the organization [8]. Stressors can be categorized as challenge and hindrance stressors based on their characteristics [16]. Nurses may experience stress from challenge stressors, but there may be benefits as well. It primarily consists of hefty workloads, time pressure, and a strong sense of responsibility [17]. Hindrance stressors, which include role ambiguity, role conflict, job insecurity, workplace relationship problems, and career bottlenecks, can hinder personal accomplishment and development [17]. Challenge stressors put more pressure on workers and offer them the freedom to make their own decisions so they can complete tasks efficiently. Additionally, staff members exchange ideas on handling difficult stress situations. Overcoming challenge stressors contributes to career advancement, which improves mutual trust and demonstrates management's recognition of the employee's abilities. Hindrance stressors inhibit employees from generating positive experiences and limit the stimulation of positive behaviors [18]. It does not support creating an environment outside of which people can thrive. Challenge stressors have been shown to boost employees' positive work attitudes and behaviors and raise levels of thriving in research involving corporate personnel, whereas hindrance stressors have the reverse effect on thriving [18], [19]. More research is necessary to determine whether challenge stressors, hindrance stressors, and thriving are associated in ED nurses.

Psychological detachment refers to the state in which employees not only physically leave the workplace but also refrain from work-related activities during their non-work time and cease thinking about work [20]. Resource conservation theory states that an individual has a certain amount of inherent resources [21]. When resources are depleted or threatened, individuals always try to recover their physical and mental resources by all means [21]. The person will attempt to mobilize his or her resources during the work period in an effort to meet the demands of the job and handle pressure, which will cause resources to be depleted. Psychological detachment, as a means of recovering the individual's physical and mental resources, is conducive to the individual's speedy recovery of emotional resources drained by work. In addition to lowering burnout and turnover intention, more psychological detachment raises nurses' satisfaction with life and job engagement [22], [23], [24], [25]. Nurses play a crucial role in maintaining patient safety in the healthcare sector. Because of promotions, frequent hospital exams, research tasks, and the need to enhance nursing practice, most nurses cannot detach themselves from their jobs, and they must forfeit their free time for continuous study after work. Additionally, nurses experience higher negative emotions due to excessive job pressure and unpleasant workplace occurrences (such as conflicts among nurses and patients, workplace tensions). These emotions may persist into non-working hours, during which they may consider acceptable solutions. The incapacity of nurses to completely unwind during their breaks could impact their work performance and feelings. According to a German study [26], psychological detachment among employees was a strong and favorable predictor of thriving at work. Employees with high psychological detachment also reported higher levels of vitality and learning experiences. Jackson [10] found that due to the busy schedules of critical care nurses, stressful emotions remain high at home at night, preventing them from relaxing and creating barriers to their thriving. More studies are needed on the connection between psychological detachment and thriving. Challenge-hindrance stressors are considered unit contextual features, and psychological detachment is a personal trait of nurses. It is unclear if they impact ED nurses' thriving and what potential mechanisms may be involved.

According to the stressor-detachment model [20], stressors at work reduce employees' psychological detachment, and a lack of psychological detachment causes stress reactions that impact an employee's well-being and performance. Furthermore, the link between stressors and stress reactions is mediated and moderated by psychological detachment. Both challenge-hindrance stressors enhanced entrepreneurs' nighttime job regurgitation and impeded their psychological detachment, according to a diary study by Wach et al. [27]. Furthermore, a meta-analysis revealed that employees' psychological detachment decreased with increasing challenge and hindrance stressors [28]. Challenge-hindrance stressors can be viewed as work-related stressors for ED nurses, and thriving might indicate responding to stress. Research is necessary to determine whether the challenge-hindrance stressors experienced by ED nurses can tangentially impact thriving by causing psychological detachment.

Therefore, to provide a foundation for creating strategies to enhance nurses' thriving, this study explored the factors that contribute to thriving among ED nurses as well as the processes of mediating and moderating effects between the elements.

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