Association between perceived overqualification, work engagement, job satisfaction among nurses: a cross-sectional study

Abstract

Objectives

This cross-sectional correlational study aimed to understand nurses’ perceived overqualification and work engagement, explore their effects on job satisfaction and provide a theoretical basis for hospital management policies in a public comprehensive tertiary hospital in China.

Design

Cross-sectional correlational study.

Setting

The study was conducted in a public comprehensive tertiary hospital in China. The specific location is not disclosed.

Participants

584 nurses participated in the study, with a completion rate of 97.3%. The average age of participants was 34.8±6.7 years, with 96.4% being women. 67.8% held a bachelor’s degree or higher, and 71.6% had over 5 years of work experience.

Primary and secondary outcome measures

The Scale of Perceived Overqualification was used to assess nurses’ perceptions of their qualifications, demonstrating a high level of reliability with a Cronbach’s alpha coefficient of 0.832. Utrecht Work Engagement Scale was used to assess nurses’ work engagement, showing internal consistency coefficients (Cronbach’s alpha) of 0.683 for the vigour dimension, 0.693 for the dedication dimension and 0.834 for the absorption dimension. Minnesota Satisfaction Questionnaire was used to evaluate nurses’ job satisfaction, with internal consistency coefficients (Cronbach’s alpha) of 0.765 for the intrinsic satisfaction scale and 0.734 for the extrinsic satisfaction scale. The primary outcome measures included perceived overqualification, work engagement and job satisfaction.

Results

The average scores for perceived overqualification, work engagement and job satisfaction were 26.38±3.44, 65.36±14.92 and 74.29±15.04, respectively. Perceived overqualification showed negative correlations with work engagement (r=−0.562, p<0.05) and job satisfaction (r=−0.674, p<0.05). However, work engagement was positively correlated with job satisfaction (r=0.519, p<0.05). Path analysis indicated that perceived overqualification had both a direct (β=−0.06, p<0.001) and an indirect effect (β=−0.35, p=0.015) on job satisfaction, with work engagement partially mediating this relationship.

Conclusion

The perception of overqualification among nurses shows a significant correlation with both their work engagement and job satisfaction. This finding suggests that hospital administrators should pay attention to nurses’ perceptions of their qualifications and take measures to enhance their job satisfaction. Furthermore, work engagement acts as a mediator between the perception of overqualification and job satisfaction, emphasising the importance of increasing work engagement. Overall, hospitals can improve nurses’ work engagement and job satisfaction by providing career development opportunities, establishing feedback mechanisms and fostering work-life balance. Comprehensive management measures focusing on nurses’ career development opportunities and levels of work engagement are necessary. Future research could expand the sample size, employ more diverse research designs and integrate qualitative research methods to further explore the factors influencing nurses’ job satisfaction and happiness.

Strengths and limitations of this study.

• High participation rate: The response rate of the questionnaire in this study reached as high as 97.3%, making the sample highly representative and capable of comprehensively reflecting the actual situation of the nursing population.

• Sample diversity: The participants had a wide range of distributions in terms of age, education level and work experience, covering nurses from different career stages and backgrounds, which enhanced the statistical validity of the research results.

• Rigorous data collection: Strict control measures were implemented in data collection to ensure the quality and reliability of the data.

• Scientific analysis using structural equation modelling (SEM): The use of the AMOS software to build an SEM analysis enhanced the scientific rigour and explanatory power of the study results. SEM not only explores complex relationships between variables but also controls confounding variables, ensuring the robustness of the results.

• Generalisability of results: The survey questionnaires were sourced from a comprehensive tertiary hospital, encompassing nurses of various age groups, education levels and work experiences. Therefore, the research results are highly applicable to nurse populations in similar work environments and with similar demographic characteristics.

Introduction

Nurses play a crucial role in the medical field, being the first point of contact for patients and engaging in long-term communication with them. On the medical stage, nurses play a role in saving lives and providing care, making them indispensable pillars in hospitals. However, do we truly understand the challenges and contradictions faced by the nurses who silently dedicate themselves to their daily work? Their behaviours and emotions are responses to job satisfaction, which is a key indicator of hospital quality and reflects their perceptions of job performance, work environment and life.¹ The nurses’ satisfaction with their role helps improve hospital performance and provide high-quality care to patients.^{2 3} On the contrary, their dissatisfaction can have adverse effects on hospitals and patients,⁴ such as high staff turnover and absenteeism^{5 6} and patients may experience undertreatment, nurse neglect and prescription errors.7,9 In summary, job satisfaction of nurses is critical to improving the quality of patient care and benefitting hospitals.

Job satisfaction is a key organisational behaviour variable that can improve the functioning of an organisation and is a powerful management indicator due to its possible impact on performance.¹⁰ Job satisfaction reflects work-related happiness and also includes contentment and peace.¹¹ Job satisfaction is directly related to mental health, higher satisfaction can reduce the incidence of fatigue, thereby improving the quality of nursing.¹² It is estimated that over 50% of emergency department nursing staff are dissatisfied with their work, especially millennial nurses, whose dedication and job satisfaction are lower.^{13 14} Factors affecting the job satisfaction of nursing staff are divided into personal, organisational, managerial, academic, professional and income levels.¹⁵ The work environment has a greater impact on nurses’ job satisfaction than personal characteristics, hospital and department type.¹⁶ According to previous research, nurses are often dissatisfied with the clinical work environment, such as pay, promotion, supervision and relationships with clinicians.^{6 15 16} In addition, Yu et al found that employees who perceive overqualification are often dissatisfied with job expectations and may be depressed or pessimistic.¹⁷ However, other studies have found that overqualification can help produce better work results.¹⁸ Given the conflicting results on the effect of overqualification on nurses’ job satisfaction, further research is needed to explore whether nurses’ qualifications affect their job satisfaction.

Perceived overqualification is defined as an employee’s awareness that their education, experience, skills and other qualifications exceed the requirements of their current job.19,21 A large number of studies have proven that perceived overqualification affects individual attitudes (such as work attitude, job satisfaction,22,24 occupational satisfaction, self-efficacy, organisational commitment), individual behaviours (resignation,²⁵ innovation, deviant behaviour, work engagement, etc), performance, physical and mental health, sense of well-being,^{26 27} career success, etc. Although perceiving overqualification may lead to nurses’ job dissatisfaction and low morale, the mediating role of work engagement in alleviating or strengthening the relationship between perceived overqualification and job satisfaction has not been established.

Work engagement is a favourable and satisfying mental state related to work,²⁸ presented in three dimensions:¹ Vigour refers to being energetic, willing to exert more effort at work and daring to overcome difficulties²; dedication is defined as being proud, enthusiastic and optimistic while engaging in work³; absorption is manifested as being completely interested in work, immersed in it, to the point that time seems to fly by.^{29 30} Research shows that work engagement can enhance individual and organisational performance by increasing employees’ positive emotions, thereby fully mobilising productivity resources and improving team performance.^{28 31 32} Furthermore, due to nursing shortages and the continued decline in healthcare costs, work engagement is of utmost consideration in the nursing field. Many studies have demonstrated the link between work engagement and increased organisational revenue.³³ However, little is known about whether work engagement mediates the relationship between perceived overqualification and job satisfaction. Li et al found that work engagement, organisational support and job satisfaction significantly affect nurses’ work intention, among which job satisfaction plays a mediating role. Through a multicentre cross-sectional study, Guo et al found that perceived overqualification significantly reduced nurses’ harmonious passion and increased their obsessive passion, while high organisational commitment significantly promoted their harmonious and obsessive passions.³⁴ However, to our knowledge, there have been no reports on the relationships among perceived overqualification, work engagement and job satisfaction, which need to be deciphered.

Based on the person-job fit theory and existing empirical knowledge, we have established a hypothesised model outlining the relationships among perceived overqualification, work engagement and job satisfaction, as depicted in figure 1. The model includes three primary hypotheses:

Figure 1. Conceptual framework of this study. M, mediating variable; X, independent variable; Y, dependent variable.

Hypothesis 1 (Regarding the Relationship Between Perceived Overqualification and Work Engagement):

H1: Nurses’ perception of being overqualified for their job is negatively correlated with their work engagement.

Hypothesis 2 (Regarding the Relationship Between Work Engagement and Job Satisfaction):

H2: Nurses’ work engagement is positively correlated with their job satisfaction.

Hypothesis 3 (Regarding the Overall Relationship Among Perceived Overqualification, Work Engagement and Job Satisfaction):

H3: Nurses’ perception of being overqualified negatively affects their job satisfaction by reducing their work engagement.

Additionally, this study considers other confounding factors such as age, marital status, work experience and position. These variables may influence nurses’ work engagement and job satisfaction. For instance, marital status could impact work-life balance and emotional state, thereby affecting job satisfaction; age, education level and position may reflect career development stages and accumulated experience, which in turn can influence work perception and engagement.35,38 Based on these three hypotheses, this research aims to validate these relationships to provide robust theoretical support and practical guidance for improving nurse job satisfaction and enhancing the quality of nursing care.

Methods

Research design

This is a cross-sectional study based on survey questionnaires. By constructing a path model and ensuring fit, the direct and indirect effects of perceived overqualification and work engagement on nurses’ job satisfaction were explored and the mediating effects were tested.

Data collection and sample size calculation

This study conducted relevant research on 600 nurses in clinical departments of a public comprehensive tertiary hospital in October 2021 using convenience sampling. Inclusion criteria: (1) licensed and registered practicing nurses; (2) employed for at least 1 year; (3) voluntary participation in the research. Exclusion criteria: (1) interns or personnel on external training; (2) nurses returning to work after more than 1 month off duty. Well-trained researchers distributed survey questionnaires to potential participants who met the inclusion criteria, informing them of the purpose, procedures and completion instructions of the study before obtaining their informed consent.

Researchers visited hospital nursing departments, explained the purpose and significance of the study, emphasised the confidentiality and anonymity of the survey questionnaire and obtained permission from the nurses. Subsequently, eligible nurses were contacted through nursing supervisors, distributed electronically questionnaires to consenting nurses and completed the survey. All options were mandatory, each device could only answer once, and the survey respondents independently filled out the questionnaire and submitted it. The questionnaire was filled out anonymously, and the introductory part of the questionnaire clearly stated the precautions. There was no right or wrong answer, and the information provided was for academic research purposes only. Survey respondents were required to complete the questionnaire within 1-week according to the requirements of the questionnaire. Quality control was conducted on the collected questionnaires, and questionnaires with the same answers or regular patterns of answers were excluded. In order to enhance the confidentiality of the collected data, only two investigators were involved in the data entry process.

The sample size was estimated based on 10 times the number of variables. In this study, there are a total of 52 independent variables, including 6 general demographic variables, 9 variables from the Scale of Perceived Overqualification (SPOQ), 17 variables from the Utrecht Work Engagement Scale (UWES) and 20 variables from the Minnesota Satisfaction Questionnaire (MSQ). Therefore, the sample size for this study should be 520 individuals. Considering a 15% non-response rate, the sample size should be at least 600 nurses.³⁹ A total of 600 survey questionnaires were distributed in this study. After excluding questionnaires with a completion time of less than a minute, 584 valid questionnaires were collected, with a completion rate of 97.3%.

Patient and public involvement

Participants were informed that participation was completely voluntary and anonymous. Our research was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. This work has been approved by the hospital nursing department (NO: 0178/2021) and obtained informed consent from the participants.

Research tools

Socio-demographic characteristics

Social demographic characteristics included gender, age, marital status, education level, work experience and position.

Scales and tests

Cronbach’s alpha value is a statistical method used to evaluate the reliability or internal consistency of a scale or questionnaire.⁴⁰ It was proposed by American psychologist Lee Cronbach in 1951.⁴¹ Cronbach’s alpha coefficient ranges from 0 to 1 and is commonly used to assess the consistency or correlation between items on a scale. A Cronbach’s alpha coefficient greater than 0.7 is considered to indicate good consistency between items with high reliability. Higher alpha values generally indicate greater consistency among items within the scale, with greater reliability.

Perceived overqualification

The 9-item SPOQ was developed by Maynard et al.⁴² Its validity and reliability have been confirmed by Chinese scholars.⁴³ The nine items of SPOQ reflect people’s feelings about their education, training, abilities, skills and work experience exceeding job requirements. Using the Likert 5-point rating scale, 1–5 points, respectively, represent ‘completely inconsistent’, ‘slightly inconsistent’, ‘uncertain’, ‘slightly consistent’ and ‘completely consistent’. The score was positively correlated with the perceived level of overqualification. The internal consistency coefficient Cronbach’s alpha value of this scale in this study was 0.832, indicating high reliability.

Work engagement

The Chinese version of the UWES was translated by Zhang and Gan,⁴⁴ and its validity and reliability have been confirmed in China. This scale is widely used in domestic and international research on nurses’ work engagement, consisting of three dimensions: vigour with 6 items, dedication with 5 items and absorption with 6 items, totalling 17 items. The scale uses a Likert 7-point rating scale, with scores ranging from 0 to 6 indicating ‘never’, ‘almost never’, ‘rarely’, ‘sometimes’, ‘often’, ‘very often’ and ‘always’, respectively. The total score of the scale ranges from 0 to 90, with higher scores indicating higher levels of work engagement. The results showed that the internal consistency coefficients (Cronbach’s alpha) for vigour, dedication and absorption scales were 0.683, 0.693 and 0.834, respectively.

Job satisfaction

The MSQ was used to assess the job satisfaction of nurses. Its validity and reliability have been confirmed in China.⁴⁵ The scale includes 20 items such as welfare benefits, scheduling, balance between family and work and relationships among colleagues. It consists of 12 items on the intrinsic satisfaction scale and 8 items on the extrinsic satisfaction scale.⁴⁶ Using the Likert 5-point rating scale, the importance is divided into 1–5 points, namely: ‘Very Dissatisfied’, ‘Dissatisfied’, ‘Uncertain’, ‘Satisfied’ and ‘Very Satisfied’. The results showed that the internal consistency coefficients Cronbach’s alpha values of the intrinsic satisfaction and extrinsic satisfaction scales were 0.765 and 0.734, respectively.

Statistical analysis

Statistical analysis of the data was conducted using SPSS V.26.0 software. Categorical data were presented as frequency counts and percentages, while continuous data were presented as means and SD. Correlation analysis was conducted on perceived overqualification, work engagement and job satisfaction. If the bivariate data met normal distribution, Pearson correlation analysis was used; if not, Spearman correlation analysis was used. AMOS V.24.0 software was used to establish a structural equation modelling (SEM) to evaluate the predictive effect of nurses’ perceived overqualification and work engagement on job satisfaction and conduct a mediating effect test. The Root Mean Square Error of Approximation (RMSEA), Goodness of Fit Index (GFI), Comparative Fit Index (CFI), Incremental Fit Index (IFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI) and χ² Divided by df (CMIN/DF) were applied to the fitness index of the measurement model. The closer the RMSEA value is to 0, the better the fit of the model.⁴⁷ For GFI, CFI, IFI, TLI and NFI, the closer the value is to 1, the better the fit of the model.⁴⁸ A smaller value of CMIN/DF indicates a better fit between the model and the observed data. Typically, a value <5 indicates a good fit.

Bias control

1. Controlling potential sources of bias:

   1. Measurement bias: All participants used the same standardised questionnaire for data collection. The questionnaire underwent a rigorous validation process during its design to ensure reliability and validity. We also trained the investigators to maintain consistency in the data collection process.

   2. Information bias: To minimise information bias, we employed anonymous questionnaires during data collection, encouraging participants to respond truthfully.

   3. Confounding bias: In our data analysis, we used multivariate regression analysis to control for confounding variables such as age, marital status, work experience and education level. This helps to reduce the impact of confounding factors on the study results.

2. Statistical analysis control:

   1. Reliability and validity assessment: Construct reliability (CR) and average variance extracted (AVE) were used to assess the reliability and validity of the model. CR was used to assess the reliability of latent variables, ranging from 0 to 1. A higher value indicates higher reliability, with values above 0.70 considered good. AVE was used to assess the validity of latent variables, also ranging from 0 to 1. A higher value indicates higher validity, with values above 0.50 considered good.

   2. Significance level: Bonferroni correction was used to adjust p values and control the increased risk of errors associated with multiple comparisons. The significance level was set at α=0.05. At the same time, a 95% bias-corrected CI was used to test the significance of the indirect effect.

Results

Demographic data of the study participants

In this study, a total of 600 survey questionnaires were distributed. After excluding surveys with completion times of less than 1 min, 584 valid questionnaires were collected, resulting in a completion rate of 97.3%. Among these, 6 questionnaires were excluded due to completion times of less than 1 min and 10 questionnaires were not returned. The primary reasons for non-return included being too busy with work to complete the questionnaire, lack of interest in the research objectives or concerns about information disclosure (despite anonymous handling measures being implemented). Among the surveyed nurses, 96.4% were women and 3.6% were men. 66.4% of the nurses were aged between 25 and 40 years, with an average age of 34.8±6.7 years. The interviewed nurses had a high level of education, with 67.8% of them having a bachelor’s degree or higher; 60.1% of the nurses were married, and 71.6% of nurses had more than 5 years of work experience, as shown in table 1.

Table 1. Socio-demographic characteristics of the sample (N=584).

Variables	Categories	N	%
Age (years)	<25	137	23.5
	25–40	388	66.4
	>40	59	10.1
Gender	Female	563	96.4
	Male	21	3.6
Marital status	Married	351	60.1
	Single	208	35.6
	Others	25	4.3
Education level	Vocational education	41	7.0
	Advanced diploma	147	25.2
	Bachelor or higher	396	67.8
Work experience (years)	<5	166	28.4
	5–15	348	59.6
	>15	70	12.0
Position	Head nurse	31	5.3
	Nurse	553	94.7

The relationships among nurses’ perceived overqualification, work engagement and job satisfaction

The average score of perceived overqualification was 26.38±3.44, the average score of work engagement was 65.36±14.92 and the average score of job satisfaction was 74.29±15.04 (table 2). The Cronbach’s alpha values of perceived overqualification, work engagement and job satisfaction were 0.832, 0.794 and 0.832, respectively, indicating good internal consistency among the items in the scale with high scale reliability.

Table 2. Descriptive statistics for the perceived overqualification, work engagement, job satisfaction.

Variables	Categories	Items	Mean	SD	Cronbach’s alpha
Perceived over qualification		9	26.38	3.44	0.832
Work engagement		17	65.36	14.92	0.794
	Vigour	6	19.72	3.43	0.683
	Dedication	5	18.87	3.42	0.693
	Absorption	6	21.74	3.38	0.834
Job satisfaction		20	74.29	15.04	0.832
	Intrinsic	12	46.83	8.27	0.765
	Extrinsic	8	20.35	5.49	0.734

The correlation analysis results showed that perceived overqualification was moderately negatively correlated with work engagement (r=−0.562) and job satisfaction (r=−0.674), while work engagement was positively correlated with job satisfaction (r=0.519) (table 3).

Table 3. Correlations among variables.

Variables	Perceived overqualification	Work engagement
Work engagement	r=−0.562 (p<0.05)	r=1
Job satisfaction	r=−0.674 (p<0.05)	r=0.519 (p<0.05)

Factors for nurses’ job satisfaction

Linear regression analysis in SEM was used to explore the factors for nurses’ job satisfaction and determine the causal relationships and paths between variables. The results are shown in online supplemental table 1. In model 1, perceived overqualification was the independent variable, work engagement was the dependent variable and age and marital status were the control variables. Model 1 accounted for 47.5% of the variance in work engagement, indicating that perceived overqualification significantly predicted work engagement (β=−0.512, p<0.001). In model 2, work engagement was the independent variable, accounting for 31.8% of the variance in job satisfaction (dependent variable), with age, marital status, education level (bachelor’s degree or higher) and head nurse as control variables. The results showed that work engagement significantly predicted job satisfaction (β=0.628, p<0.001).

Testing the hypothesis models

The final model and standardised model paths of the SEM are shown in figure 2 and online supplemental table 2. The results showed that perceived overqualification exerted a direct effect on job satisfaction (β=−0.06, p<0.001). The direct effect of perceived overqualification on work engagement was (β=−0.57). While the direct effect of work engagement on job satisfaction was (β=0.61). Work engagement played a partial mediating role in the relationship between perceived overqualification and job satisfaction (β=−0.35, p=0.015). The model had good fit indices: RMSEA=0.085, CFI=0.926, GFI=0.910, IFI=0.934, TLI=0.921, NFI=0.943, CMIN/DF=3.267, all fit indices met the fitness standards proposed in previous studies.⁴⁹ In this study, the CR values of each variable were all greater than 0.70 and the AVE values of each variable were all greater than 0.50, indicating a high level of convergent validity for the model.

Figure 2. Final model and standardised model paths. JS, job satisfaction; PQ, perceived overqualification; WE, work engagement; WE1, vigour; WE2, dedication; WE3, absorption.

Discussion

Nurse job satisfaction has a significant impact on the quality of medical services and hospital performance. To the best of our knowledge, this study is the first to explore the relationships among nurses’ perceived overqualification, work engagement and job satisfaction and to analyse the mediating role of work engagement between perceived overqualification and job satisfaction. The results showed that perceived overqualification was negatively correlated with work engagement and job satisfaction, work engagement was positively correlated with job satisfaction and work engagement mediated the relationship between perceived overqualification and job satisfaction.

Nurses with higher job satisfaction can enhance their recognition of their own work. Nurses with low job satisfaction tend to have higher turnover intentions and lower levels of engagement and dedication at work.^{7 45} A study found that work engagement mediates the relationship between perceived overqualification and turnover intentions, with a mediation effect coefficient of 0.13. Both the direct and indirect effects of perceived overqualification on turnover intentions are significantly negative (p<0.05),⁵⁰ consistent with our results. Studies by Arvan et al²¹ and Alfes et al²³ found that employees in the USA and the Netherlands both have a moderate level of perceived overqualification. A recent multicentre study conducted in China also showed similar findings,³⁴ where nurses’ enthusiasm for work is reduced by high perceived overqualification, while being promoted by high organisational commitment. Existing research indicates that perceived overqualification is a double-edged sword, as it can bring harm to employees (low satisfaction and high turnover intentions) as well as benefits (higher work engagement).⁵¹ Therefore, nurse managers should be aware of the significant impact of perceived overqualification on nurses’ clinical performance and create appropriate conditions for nurses to expend additional energy and time on meaningful activities. In our study, high work engagement had a positive impact on nurses’ job satisfaction. High job satisfaction can motivate employees to perform better at work and increase employee work engagement.⁵² In summary, as shown above, appropriately reducing nurses’ perceived overqualification can increase work engagement. There is a mutually reinforcing relationship between high work engagement and positive job satisfaction, forming a virtuous circle, which contributes to nurses’ work performance and organisational performance. We suggest management adopt a strategy of customising work tasks for individuals. By understanding the skills and experience of each nurse, work tasks can be arranged more accurately, thereby alleviating the problem of perceived overqualification. In addition, increasing salary levels and implementing reward mechanisms can reduce nurses’ work pressure, establish a positive work atmosphere and provide challenging and developmental work tasks.

The average score for job satisfaction in this investigation is 74.29 points, with a job satisfaction rate of 62%. Related studies have reported job satisfaction rates of 61% in the UK, 44% in Greece, 58% in Ireland and 49% in Poland,^{53 54} indicating that job satisfaction among nurses is generally low in other countries as well. The average score of nurses’ work engagement in this study is 65.36, indicating that nurses’ dedication to work is generally low, similar to the results reported by Wan et al.⁵⁵ However, the average score of work engagement in this study is lower than the research results of other countries such as Australia, the USA, Portugal and Saudi Arabia.55,57 The level of job satisfaction reported in this study is higher than in previous research, while the level of work engagement is lower. The reason for this may be that this work was conducted in Chinese public tertiary hospitals, which are well-equipped and nurses usually have high nursing knowledge and skills. The rapid recovery of patients makes nurses feel highly self-satisfied, receive more salary rewards and praise from managers, thus leading to higher job satisfaction.⁵⁸ However, nurses often encounter work overload and conflicts with patients, nursing staff or medical colleagues during their work process.^{59 60} In addition, Chinese tertiary hospitals have higher educational requirements for nurses,⁶¹ and nurses with higher education have higher recognition and value for their work, but the results do not match expectations, leading to work indifference. Another reason is the large number of patients in China, the heavy workload easily leads to nurses’ attention diversion and high burden pressure, resulting in lower dedication of nurses to their work. This study was conducted during the COVID-19 pandemic and due to the uncertainty of the hospital environment and the increase in additional tasks such as nursing, sample collection and external support, nurses are facing greater work pressure, which has led to the emergence of professional burnout.

Currently, multiple studies suggest that marital status is closely related to work engagement. Unmarried nurses have higher work engagement than married nurses.⁶² According to the conservation of resources theory, the energy and time of each person are limited. If organisational members invest too much in one role, it will lead to a decrease in investment in another role. When demands arise simultaneously in both family and work, organisational members face the choice of work-family conflict⁶³ and married nurses need to take on more family responsibilities, which takes up a lot of their time and energy, leading to a decrease in work engagement. However, married nurses, due to marital stability, invest more time and experience in their work, increasing their work dedication.³⁵ Therefore, we included marital status in the model, and the results showed that marital status was significantly related to work engagement and job satisfaction.

This study found that nurses’ perceived overqualification can directly or indirectly (through work engagement) predict job satisfaction, with work engagement acting as a moderating factor between perceived overqualification and job satisfaction. To improve nurses’ job satisfaction, nurse managers can enhance nurses’ knowledge and skills to realise their value. Furthermore, nurses’ job satisfaction can also be increased by creating a positive hospital atmosphere and appropriate workload, enhancing nurses’ autonomy, decision-making authority, social support and team cohesion.⁶⁴ After experiencing the global COVID-19 pandemic, the high-intensity clinical nursing tasks, high-pressure nursing environment and fast-paced emergency support have brought new challenges to hospital nursing management. This suggests that hospitals can actively explore the nursing concepts, career planning, welfare benefits and other bottlenecks of nursing staff from the traditional medical management system to improve nurses’ job satisfaction and effectively respond to large-scale public health emergencies.

Strengths

First, this study was conducted in clinical departments of a public tertiary general hospital, where nurses showed a high level of cooperation, resulting in a questionnaire response rate of 97.3%. Second, the nurses surveyed varied widely in age, education level and years of experience, covering different career stages and backgrounds. This diversity indicates that the collected sample is highly representative, providing a comprehensive reflection of the nursing population. Third, we implemented stringent control measures during data collection, such as excluding questionnaires that were completed too quickly or were of poor quality, ensuring the data’s quality and reliability. Fourth, we used SEM analysis via AMSO software, enhancing the scientific rigour and interpretive power of the research findings. Lastly, since the survey questionnaires were sourced from a comprehensive tertiary hospital and included nurses of various ages, educational levels and years of experience, the results are highly applicable to nurse populations in similar work environments and with similar demographic characteristics.

Limitations

First, we acknowledge that the results of this study may only be applicable to the specific context of public tertiary hospitals in China, as there are structural and policy differences in different medical environments, regions and countries. To our knowledge, the relationships among perceived overqualification, work engagement and job satisfaction are reported for the first time, so we are not sure if other countries or regions have similar results. To better understand this relationship comprehensively, further study needs to include nurses from multicentre hospitals across regions for larger-scale research exploration and to comprehensively analyse the relationships among perceived overqualification, work engagement and job satisfaction. Furthermore, the cross-sectional design used in this study provides observations of relationships at a single point in time, limiting our understanding of causal relationships. Future research should consider the time dimension and explore the impact of time changes on the relationships among these three variables at a longitudinal level. Third, although work engagement has been identified as an intermediate factor between perceived overqualification and job satisfaction, it may also be influenced by other factors such as job characteristics, organisational identification and career development opportunities. Therefore, future investigation needs to comprehensively consider these potential factors to better understand nurses’ job satisfaction.

Conclusion

In this study, there was a significant negative correlation between perceived overqualification and job satisfaction among nurses, while work engagement was positively correlated with job satisfaction. More importantly, work engagement plays a partial mediating role between perceived overqualification and job satisfaction, highlighting the importance of work engagement in enhancing nurse satisfaction. Therefore, management should implement specific measures to alleviate the impact of nurses’ perceived overqualification, promote work engagement and strengthen teamwork and support.

Implication for nursing management

Through in-depth research on nurses’ job satisfaction, we can identify a series of issues and propose practical solutions. This provides valuable insights for nursing management, helping to improve nurses’ job satisfaction and overall performance.

First, in addressing the issue of perceived overqualification, we suggest that management adopt a strategy of customising job tasks. Giving more importance to the match between nurses’ job roles and personal skills and experience can help nurses better adapt to their roles and reduce issues related to perceived overqualification by adjusting job assignments and providing training and development opportunities. Furthermore, providing career development opportunities is crucial. By establishing support systems, providing mental health support and career development guidance for nurses, we can ignite their professional passion and increase satisfaction. Encouraging teamwork and providing continuing education opportunities are key to enhancing work engagement. Creating a supportive team environment, strengthening collaboration among nurses through training and team-building activities, is essential to improving overall work engagement. At the same time, providing more career development opportunities, including promotion pathways, training courses and participation in research projects, can help nurses achieve their personal career goals, enhance their commitment and satisfaction toward work. Third, we recommend conducting in-depth and qualitative research. By incorporating study design into a longitudinal time dimension, a more comprehensive understanding of the long-term trends in nurses’ job satisfaction can be obtained, thus better addressing the changing needs of nurses. Using qualitative research methods can provide a deeper understanding of nurses’ feelings towards job satisfaction, offering management with more detailed information and decision-makers with more strategies. Finally, we emphasise the importance of developing a comprehensive nursing management plan, integrating qualitative and quantitative data, formulating a comprehensive nursing management plan, regularly assessing nurses’ job satisfaction and well-being and adjusting management strategies based on the assessment. Through timely feedback and improvement measures, the working environment of the nursing team can be continuously optimised, the happiness and job satisfaction of nurses can be improved, a more comprehensive understanding of the factors for nurses’ job satisfaction can be obtained and practical management strategies can be provided. This helps enhance the overall team performance, create a more dynamic and positive work environment and lay a solid foundation for providing high-quality nursing services.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.