Gender Differences in Nursing Work Environment and Perceived Nursing Quality: A Mixed‐Methods Study With Emerging Ethical Insights

ABSTRACT

Aim

To examine how gender differences in the nursing work environment shape nurses' perceived quality of care and to identify gender-specific predictors and evaluative mechanisms.

Design

A mixed-methods design was employed, integrating quantitative data analysis with qualitative in-depth individual interviews.

Methods

This study was conducted in two phases: The first phase was a quantitative analysis, based on a large national dataset from the 2017 Chinese Nursing Work Environment Survey (N = 16,382), in which secondary analysis was performed using hierarchical linear regression, relative importance analysis, and network analysis to identify key predictors. The second phase was a qualitative study, in which in-depth individual interviews were conducted with 30 clinical nurses (15 male and 15 female), and thematic analysis was applied to explore gender-differentiated experiences.

Findings

The core finding of this study is that gender-differentiated factors within the work environment significantly shape nurses' perception of care quality. Quantitative results showed that the strongest predictor for female nurses was professional development, whereas recognition of value was most salient for male nurses. Qualitative results corroborated these findings: female nurses emphasised continuing education and emotional support, while male nurses emphasised fair evaluation and professional identity. Both groups reported that high-intensity workloads hindered the delivery of ideal humanistic care, inducing moral distress and emotional suppression and exposing ethical gaps in organisational support.

Conclusion

Gender differences in the nursing work environment shape pathways to perceived care quality and expose deeper managerial and ethical challenges. A gender-sensitive, ethics-oriented management approach can enhance nurse satisfaction and care quality, providing empirical support for optimising workforce allocation and sustaining healthcare systems.

Impact

Findings direct nurse leaders to tailor improvement strategies—enhancing professional-development infrastructure for women and strengthening recognition mechanisms for men—while embedding explicit ethical support to reduce moral distress and improve both workforce well-being and patient outcomes.

Patient or Public Contribution

No patient or public contribution.