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This study aims to explore occupational burnout among Chinese nurses from two perspectives: first, by comparing changes in emotional exhaustion, depersonalisation and personal accomplishment before and after the COVID-19 pandemic; and second, by identifying long-term work-related stressors and structural factors contributing to burnout.
A mixed-methods approach was adopted, combining a systematic review with qualitative interviews. The qualitative component involved semi-structured interviews with 53 hospital-employed nurses from various departments and regions across China, focusing on the three core dimensions of occupational burnout.
The systematic review included both Chinese and English-language studies published between 2016 and 2023 that used the Maslach Burnout Inventory to assess burnout among nurses. A total of 22 studies met the inclusion criteria, selected independently by two researchers using the JBI critical appraisal tool. In parallel, the qualitative interviews explored nurses' subjective experiences and coping strategies related to work stress, emotional fatigue and professional identity.
Bayesian factor analysis indicated no significant differences in emotional exhaustion (BF01 = 2.202), depersonalisation (BF01 = 2.761) or personal accomplishment (BF01 = 2.747) before and after the pandemic. Qualitative findings revealed that burnout was primarily driven by long-standing systemic stressors, including promotion pressure, clinical workload, organisational demands and work–family conflict. Although many nurses relied on self-regulation strategies to maintain psychological stability, they continued to experience ongoing physical and emotional exhaustion. Some reported emotional numbness, but most retained empathy and a strong sense of responsibility. Their sense of personal accomplishment often stemmed from patient recovery and recognition of professional value.
Occupational burnout among Chinese nurses remained largely stable before and after the COVID-19 pandemic. Its root causes stem from persistent work-related stressors and systemic issues, rather than the pandemic itself. Effective mitigation requires institutional strategies, including better staffing, clear career pathways and sustained emotional support.
Short-term crisis responses alone are insufficient to address enduring burnout. Nursing leadership should prioritise systemic reforms—such as optimising shift schedules, defining promotion channels and integrating regular psychological support—to enhance nurse well-being and care quality.
No patient or public contribution.
To identify predictors of nurses' perceived care quality, explore their understanding of high-quality care and propose improvement strategies to inform clinical practice.
A mixed-methods design, integrating quantitative data analysis and qualitative in-depth individual interviews.
Quantitative analysis used cross-sectional data from the 2017 Chinese Nursing Work Environment Survey (C-NWES). Chi-square tests and logistic regression were used to examine how demographic characteristics, work environment and occupational burnout predicted perceptions of care quality at hospital and unit levels. Qualitatively, 42 frontline nurses were interviewed in 2024 to explore their perceptions of care quality, predicting factors and improvement strategies in a post-pandemic context. Thematic analysis was applied to code and synthesise the interview data.
Quantitative analysis revealed that gender, education, workload, experience, work environment and burnout had differing impacts on nurses' care quality perceptions at hospital and unit levels. In-depth individual interviews revealed that nurses perceive high-quality care as patient-centred, predicted by factors such as human resources, occupational burnout, patient and family cooperation at the unit level and environmental and policies factors at the hospital level. Unit-level strategies included improving communication, team collaboration and leadership support, while hospital-level recommendations focused on welfare benefits, continuing education, flexible scheduling and resource optimisation. Through the mutual validation of quantitative analysis and in-depth interviews, this study revealed the multidimensional understanding and key predictors of care quality among frontline clinical nurses in China.
Work environment, occupational burnout and demographic factors significantly impact nurses' perceived care quality, highlighting the need for targeted organisational improvements at both unit and hospital levels to enhance care quality.
The findings highlight the importance of organisational interventions. Nursing managers should promote a positive work environment and mitigate burnout. Future research should develop testing models to explore the relationship between work environment and perceived care quality and validate their effectiveness.
No patient or public contribution.
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.
A mixed-methods design was employed, integrating quantitative data analysis with qualitative in-depth individual interviews.
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.
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.
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.
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.
No patient or public contribution.
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