Relationships between psychological capital, quality of work life and career success among nurse managers in tertiary general hospitals: a cross-sectional study

Abstract

Background

Nurse managers’ career success is crucial for healthcare quality, nursing workforce stability, and field advancement. While demographic and organizational factors are well-documented predictors, the impact of psychological mechanisms, specifically psychological capital mediated through quality of work life, remains insufficiently researched. This research aims to investigate the current state of career success among nurse managers and to explore the mediating effect of quality of work life between psychological capital and career success.

Methods

A national cross-sectional study was conducted in 2023 with 2,085 Chinese nurse managers recruited from 51 tertiary general hospitals through multi-stage stratified proportional sampling. The participants completed an online questionnaire assessing their psychological capital, quality of work life, and career success. The Statistical Package for the Social Sciences version 26 was used for descriptive analysis, Pearson correlation analysis, hierarchical multiple linear regression, and structural equation modeling to analyze the data and confirm the relationships between the variables using Mplus version 7.0 software.

Results

The career success score was 37.09 ± 8.02. There was a positive correlation between psychological capital, quality of work life, and career success, with coefficients ranging from 0.573 to 0.673. Psychological capital and quality of work life explained 38.0% and 14.0% of the variance in career success, respectively. The structural equation modeling results showed that psychological capital positively and directly predicted career success (β = 0.371, P < 0.001), and indirectly affected career success via quality of work life (β = 0.346, P < 0.001). The final model explained 72.3% of the variance in career success.

Conclusion

Psychological capital was positively correlated with career success among nurse managers, and the quality of work life partially mediated this relationship. Thus, interventions emphasizing these two factors may be beneficial in improving the career success of nurse managers. Hospital administrators should cultivate positive personalities in nurse managers to enhance their psychological capital, improve their quality of work life, help them grow within the organization, achieve career success, and ensure the quality of nursing and its effectiveness.

Clinical trial number

Not applicable.

Background

The World Health Organization’s (WHO) [1] State of the World’s Nursing Report indicates that nurses constitute approximately 59% of healthcare professionals and are essential for attaining universal health coverage and the Sustainable Development Goals. In 2018, there was a shortage of 5.9 million nurses, with the majority of the deficit in low-income and middle-income countries. If no action is taken, there will be 5.7 million fewer nurses than anticipated by 2030 [1]. The global healthcare sector is confronting a major challenge due to the high rate of staff turnover and lack of nurses [2]. Despite the fact that the quality of nursing and hygiene in China has increased in recent years, problems remain such as inadequate career progression opportunities for nurses, a high turnover rate, and uneven development [3, 4]. An upsurge in the turnover rate of nurses can place a burden on nurse managers, resulting in job burnout and an increased turnover rate of nurse managers [5]. Nurse managers form the backbone of the nursing team; their high turnover rate not only leads to the loss of valuable resources and an increase in hiring costs, but also has a detrimental influence on the stability and long-term growth of nursing teams, as well as the quality and safety of nursing care [6].

Nurse managers are vital to the healthcare industry because they are expected to handle intricate work duties, direct diverse teams, resolve difficulties, and adapt to change [7]. Career success is the positive psychological feelings and achievements that an individual accumulates and acquires at work gradually, and is a universally recognized evaluation index of career development [8, 9]. Nurses who view their work as a calling are more inclined to utilize their strengths and address their deficits, resulting in a heightened sense of career success [10]. A strong sense of career success is beneficial for job satisfaction, improving the quality of nursing services, and reducing staff turnover [11, 12]. Conversely, decreased career success can lead to emotional exhaustion, apathy, and a higher incidence of job burnout [13]. Previous studies have shown that the professional achievements of nursing staff in China are unsatisfactory, which adversely affects the competency and quality of nursing teams [8, 14]. For nurse managers, low career success will not only affect their personal work motivation and engagement as well as career satisfaction, but also the organizational climate and team dynamics, which can impact the quality of nursing care and patient safety. Therefore, it is crucial to promote the career success of nurse managers, and a potential first step would be to identify modifiable factors.

With the advancement of positive psychology, scholars have started to explore nurses’ career development from a novel perspective, focusing on individual potential and psychological resources that can assist nurses in dealing with occupational stress [15]. Psychological capital is considered a positive psychological state during individual growth and encompasses four essential elements: self-efficacy, resilience, hope, and optimism [16]. Psychological capital, as a developable psychological resource, exhibits differentiated mechanisms in driving individuals’ career success. Individuals with heightened self-efficacy demonstrate superior ability to synthesize diverse perspectives in complex decision-making and enhance team execution through goal alignment [16]. Resilience enables rapid strategy adaptation under resource constraints [17], while elevated hope facilitates proactive management of psychological distress and work-related adversities, sustaining professional development pursuits [18]. Optimism, as an adaptive psychological asset, further reinforces career attainment [19]. Studies have confirmed psychological capital as a robust predictor of career success among nurses, showing consistent positive correlations [18, 20]. However, research on the association between psychological capital and career success in nurse managers remains limited. Hence, the link between psychological capital and career success in nurse managers and the underlying mechanisms through which psychological capital influences career success are notable research gaps, a population facing distinct leadership demands and systemic pressures, necessitating targeted investigations into mediation mechanisms.

Quality of work life (QWL) is regarded as the degree to which an individual’s important needs are met while achieving organizational goals [21]. Nurses’ self-efficacy is a predictor of QWL [6], which is a major factor in the recruitment and retention of talented staff as well as in sustaining superior performance [22]. In addition, QWL is a critical element of occupational health [23]. Nurses’ QWL can predict turnover intention [21, 24]. With good QWL, nurses can achieve both their individual and organizational objectives [25]. When nurse managers strike a balance between their professional and personal lives and have better QWL, they are more likely to remain motivated, show a positive attitude, improve their work performance, and promote their career development [6]. Thus, we speculate that QWL influences nurse managers’ career success.

This study was guided by conservation of resources (COR) theory [26] and the career resource model [27] to explore the factors related to career success. Career success is regarded as a valuable state [28]. The basic principle of COR theory, which affects one’s sense of professional success, is that “individuals make efforts to acquire, sustain, foster, and safeguard the things that are of great value to them” [26]. Resources are defined as anything that helps an individual achieve a goal and exist in both the individual and environmental domains [29]. Additionally, the career resource model shows that human capital, social resources, and psychological resources contribute to career success [27]. Psychological capital, categorized as a personal resource within the COR theory, enables individuals to mitigate stress and enhance adaptive capacity [30]. Individuals with high psychological capital are more likely to enter a “resource gain spiral” state - their optimistic disposition and self-efficacy foster proactive career planning and drive career advancement through resource investments (e.g., acquiring new skills, building supportive networks) [8, 19]. Career success, in turn, reinforces psychological capital, establishing a positive feedback loop. QWL, encompassing work environment, benefits, and stress management, directly influences material resources (e.g., income) and social resources (e.g., team support) [6]. Aligned with COR theory’s emphasis on buffering stress-induced resource depletion, a high level of QWL reduces resource loss (e.g., energy exhaustion) and sustains resource equilibrium by providing replenishment mechanisms (e.g., flexible work arrangements, training opportunities), thereby facilitating career success [22, 31]. As an internal positive psychological resource, psychological capital can supplement one’s energy consumption during the process of work and affect the strategy of utilizing other resources [32]. QWL is affected by individual and external environmental factors, so it can be regarded as an integration of psychological and social resources [21]. Based on COR theory, psychological capital could help individuals access and maintain other resources (such as job satisfaction, work-life balance), thereby improving QWL and promoting career success. As a work resource, QWL can buffer the negative impact of work demands on career success, while indirectly contributing to career success by enhancing job satisfaction and work-life balance. Therefore, we hypothesize that QWL acts as a mediator in the link between psychological capital and career success in nurse managers.

During the period of the National Nursing Development Plan (2021–2025), China aims to build nursing teams, foster high-quality growth in the field, and bolster the nursing management system by strengthening hierarchical management and organizational leadership [33]. Nurse managers are playing an increasingly prominent role on nursing teams. With the performance appraisal reform of tertiary public hospitals in China, higher requirements have been put forward for nursing management in the face of high-quality development of these public hospitals. Tertiary general hospitals are state-designated medical institutions for difficult, serious cases in general hospitals that provide high-level medical and health services as well as opportunities for teaching and research [34]. The high expectations of patients and the high demand for clinical services place greater work pressure on nurse managers than on those in lower-level hospitals [35]. Moreover, nurse managers face a shortage of human resources, difficulties in emergency and disaster response, and inadequate team collaboration [36, 37]. All of the above can pose challenges to nurse managers’ career development in tertiary general hospitals. Surprisingly, few empirical studies have simultaneously explored the relationship between nurse managers’ psychological capital, QWL, and career success in tertiary general hospitals, especially in China. Understanding the relationship among these three factors is crucial for designing effective ways to optimize nurse managers’ career progression. Therefore, in this study, we aim to explore the relationship between nurse managers’ psychological capital, QWL, and career success and whether QWL plays an intermediary role in the relationship between the psychological capital and career success in tertiary general hospitals. Our findings can help healthcare policymakers and hospital administrators worldwide implement effective interventions to improve nurse managers’ career success, thereby reducing turnover intention and nursing staff attrition. This has profound significance for advancing the nursing profession and enhancing patient safety and care quality.

Based on the above content, this study proposes the following research hypotheses:

Hypothesis 1

Psychological capital has a positive and direct effect on the career success of nurse managers.

Hypothesis 2

QWL has a positive and direct effect on the career success of nurse managers.

Hypothesis 3

QWL serves as a mediator linking psychological capital and career success in nurse managers.

Methods

Study design, participants, and setting

We conducted a descriptive cross-sectional survey in China between January and April of 2023. We followed the STROBE checklist to improve the quality of reporting in observational studies. China is geographically divided into seven regions, comprising a total of 34 provinces. These include five provinces in the north, three in the northeast, eight in the east, three in the central region, five in the south, five in the southwest, and five in the northwest. The official website of the National Health Commission of the People’s Republic of China provided information on the hospitals in each region. We used a proportional stratified cluster sampling method to select the participants. At the initial stage, we randomly selected 20 provinces, proportionate to 50% of all provinces in each region, including three provinces out of the five in the north, two out of the three in the northeast, four out of the eight in the east, two out of the three in the central region, three out of the five in the south, three out of the five in the southwest, and three out of the five in the northwest. Second, we used a computer-generated random number method to select 51 tertiary general hospitals from 20 provinces with a sampling rate of 10%. We utilized an empirical method of sample estimation for our analytical studies to calculate the sample size, which should be no less than 10 to 20 times the number of scale items [38]. We designed a total of 77 items for the questionnaire and considered 20% of potential invalid responses. Therefore, the calculation formula for the sample size is N = 77 * 10 + 77 * 10 * 20% ~ 77 * 20 + 77 * 20 * 20%. This means we needed a sample size of 924 to 1848 participants. Finally, all nurse managers from the 51 selected hospitals were chosen to participate.

In China, nurse managers are selected in accordance with the rules and requirements of each hospital, considering factors such as an individual’s experience, qualifications, clinical expertise, and leadership skills. The inclusion criteria of this study were as follows: (1) registered nurse, (2) > 1 year of management experience, and (3) informed consent and voluntary participation. The criteria excluded nurse managers who had retired or who had been rehired, because they no longer hold positions as nurse managers.

Measurements

General information questionnaire

We gathered general sociodemographic data on the participants’ (1) general situation (sex, age, marital status, fertility status, and education level), and (2) general work information (work ranking, position, specialist nurse qualifications, employment status, weekly hours worked, monthly income, years of work experience, and years of management experience).

Career success scale

The Career Success Scale (CSS) was initially developed by Eby et al. in 2003 [39]. In 2008, the Chinese version was translated and refined to add the dimension of career satisfaction developed by Yan et al. [40]. The version for medical staff has been revised, verified, and has been widely used in Chinese research, demonstrating high reliability and validity [41]. The CSS consists of three dimensions and 11 items: career satisfaction, perceived within-organization competitiveness, and perceived external organizational competitiveness. The Likert 5-point rating method is used, ranging from 1 (totally disagree) to 5 (totally agree). The score ranges from 11 to 55 points, with higher scores reflecting greater levels of career success. In this study, the Cronbach’s alpha coefficient of this scale was 0.913, and the Cronbach’s alpha coefficients of the three dimensions ranged from 0.861 to 0.930. In a confirmatory factor analysis (CFA), we found that our scale model exhibited good fit: RMSEA = 0.07, NFI = 0.97, CFI = 0.97, and TLI = 0.96.

Psychological capital questionnaire

The Psychological Capital Questionnaire (PCQ) was originally developed by Luthans et al. in 2005 [16]. This study employed the Chinese version of the PCQ, which was adapted, validated, and specifically designed for nurses by Luo et al. [42]. This scale includes 20 items, each rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree), and is divided into four dimensions: self-efficacy, resilience, optimism, and hope. The score was calculated by combining all items, ranging from 20 to 120 points, with a higher score demonstrating higher psychological capital. The Cronbach’s alpha of the scale in this study was 0.909, with a range of alpha for each dimension from 0.858 to 0.909. CFA revealed an acceptable fit of the scale model: RMSEA = 0.07, NFI = 0.93, CFI = 0.93, and TLI = 0.92.

Work-related quality of life scale-2

The Chinese version of Work-related Quality of Life Scale-2 (WRQoL-2) translated and revised by Shao et al. in 2014 [43] was used to assess the QWL in this study. It is composed of 33 items that are rated on a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree), and covers seven dimensions: stress at work, working conditions, control at work, work evaluation, the home-work interface, general well-being, and career satisfaction. The dimension of work pressure had negative items to which we applied reverse scoring. The final score of the scale is the average score of all items, ranging from 1 to 5. A higher score suggests a better QWL. The Cronbach’s alpha coefficient for this survey was 0.876, with subscales ranging from 0.828 to 0.937. CFA showed that the scale model exhibited good fit: RMSEA = 0.07, NFI = 0.98, CFI = 0.91, and TLI = 0.90.

Data collection

Prior to the distribution of the questionnaire, 60 nurse managers were invited to pre-test the questionnaire to evaluate the clarity and time required to finish it. We used the Star platform to distribute and collect the responses to the questionnaire online. The questionnaire platform remains accessible throughout the survey. First, we approached the nursing directors of the target hospitals to obtain approval to administer the online investigation to nurse managers in their hospitals. Subsequently, we sent a link to the electronic questionnaire via the WeChat application. WeChat is a mobile phone-based social networking application; its daily active users exceeded 1 billion at the end of 2018 [44]. WeChat-based questionnaire surveys have been increasingly applied in various research domains, including social sciences, medicine and nursing, and are welcomed by respondents. Finally, the nursing directors of each target hospital forwarded the link to the nurse managers, inviting them to take part in the study. The initial page of the questionnaire utilized consistent guideline language to explain the study’s purpose, methodology, and filling requirements of the survey, alongside mandatory ethical disclosures. Participants were systematically required to acknowledge informed consent through an explicit opt-in mechanism prior to accessing subsequent survey sections. Participants had two weeks to submit the online questionnaire, with only one submission per Internet protocol (IP) address. Each link required login via a unique WeChat ID, preventing multiple submissions from the same user. Submitting the questionnaire was not allowed until all questions had been answered by the participants. Considering the geographical location and economic situation of different regions in China, this study further analyzed and adjusted the samples after the completion of sample recruitment to ensure that the distribution of samples in the region was consistent with the overall distribution. In the process of questionnaire collection, the questionnaire recovery rate was low in some cities, so the researchers carried out another reminder and a second round of questionnaire distribution. During data collection, some cities exhibited low questionnaire recovery rates. To address this, researchers implemented reminder notifications and conducted a second round of questionnaire distribution. These strategies were employed to mitigate potential selection bias and enhance sample representativeness. In order to ensure the accuracy and validity of the data, after the participants completed the questionnaire, the two researchers jointly checked. According to the data results of the pre-survey and the questionnaire filling instructions, if the questionnaire filling time for this study is less than 5 min or all items are selected the same, the survey results will be invalid. We collected a total of 2,171 questionnaire responses, 86 of which were excluded as invalid, resulting in 2,085 valid questionnaires with an effective response rate of 96.04%.

Ethical considerations

This study adhered to the guidelines outlined in the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of Zigong First People’s Hospital (approval no. 2022-79). All participants were informed that they had the right to opt out of the research for any reason at any time without affecting their employment or personal life, and that their participation was entirely voluntary. The study was conducted anonymously to ensure the participants’ privacy. Since there was no way to identify the participants, participant response bias and pressure to participate in the study were diminished. Data were stored in encrypted documents to restrict access to authorized personnel only. Data confidentiality was strictly maintained, solely for research purposes and not shared with unauthorized parties. Furthermore, participants have the right to understand the collection, storage, usage, and sharing of their data, and to request access, correction, or deletion of their data, as well as to be informed of research findings. The research team meticulously followed both national and international ethical standards throughout the study.

Data analysis

This study used IBM SPSS v 26.0 to analyze the data. Normal distributions for nurse managers’ psychological capital, quality of work life, and career success were examined using quantile-quantile plotting. We employed descriptive statistics to identify the general characteristics. The common method factor method was used to test the common method deviation. We utilized independent t-tests and analysis of variance (ANOVA) to explore the differences in the career success of nurse managers among different demographic groups. To ensure the reliability of the scale items, we performed validation factor analysis and established the Cronbach’s alpha. We used Pearson correlation analysis to evaluate the correlations among psychological capital, QWL, and career success. We employed hierarchical multiple linear regression to validate the factors affecting the career success of nurse managers. We utilized structural equation modelling (SEM) to examine the factors affecting career success, and Mplus software (version 7.0) to calculate and develop the structural model. P < 0.05 was regarded as significant in all two-tailed tests.

Results

Testing of common method deviations

To address potential common method bias, we employed the latent method factor approach within structural equation modeling [45]. Two models were compared: a baseline model (Model 1) reflecting the hypothesized theoretical relationships, and an extended model (Model 2) incorporating an additional latent method factor with all observed indicators loading on both their respective constructs and the method factor. The baseline model exhibited acceptable fit indices (χ²/df = 16.334, RMSEA = 0.086, CFI = 0.955, TLI = 0.944, IFI = 0.955, RMR = 0.030). After introducing the method factor, the model fit improved marginally (χ²/df = 14.378, RMSEA = 0.080, CFI = 0.968, TLI = 0.951, IFI = 0.968, RMR = 0.024), with changes in fit indices falling below established thresholds for substantive improvement (ΔCFI = 0.013, ΔRMSEA = 0.006). Although the ΔCFI slightly exceeded the conservative 0.01 cutoff, the trivial magnitude of improvement across other indices (e.g., ΔTLI = 0.007, ΔRMR = 0.006) and weak method factor loadings (range: -0.10 to 0.22; all < 0.30) collectively suggest minimal influence of common method variance. Furthermore, standardized path coefficients between theoretical constructs remained stable (maximum Δβ < 0.05), reinforcing the robustness of our findings.

Sociodemographic characteristics and univariate analysis

The 2085 nurse managers surveyed in this study had a mean age of 40.89 years (SD = 6.20); 98.13% were female, and 93.72% were married. Table 1 presents their sociodemographic and work-related characteristics, as well as the results of the single factor analysis. The results showed that there were significant differences in position, specialist nurse qualifications, weekly hours worked, and monthly income (P < 0.05).

Table 1.

The univariate analysis of sociodemographic information and career success (n = 2085)

Variables	N (%)	Career success mean (SD)	t/F	P value
Sex			1.096	0.273
Male	39 (1.87)	38.49 (8.11)
Female	2046 (98.13)	37.07 (8.02)
Age (years)			0.922	0.429
< 30	39 (1.87)	37.33 (7.94)
30–39	854 (40.96)	37.23 (8.25)
40–49	992 (47.58)	36.83 (7.83)
≧ 50	200 (9.59)	37.77 (7.95)
Years of work experience			1.170	0.320
< 10	130 (6.24)	37.01 (7.69)
10–19	891 (42.73)	37.22 (8.29)
20–29	826 (39.62)	36.76 (7.76)
≧ 30	238 (11.41)	37.80 (8.02)
Work ranking			0.738	0.478
Junior	157 (7.53)	37.28 (9.44)
Intermediate	1065 (51.08)	36.88 (8.15)
Senior	863 (41.39)	37.09 (8.02)
Position			3.155	0.043
Head nurse in ward	1868 (89.59)	36.99 (7.98)
Head nurse of division	79 (3.79)	39.30 (7.68)
Nursing director	138 (6.62)	37.16 (8.54)
Education level			2.666	0.070
Junior college	17 (0.81)	36.94 (9.90)
Undergraduate	1890 (90.65)	37.22 (7.97)
Master’s degree or above	178 (8.54)	35.77 (8.21)
Specialist nurse qualifications			2.841	0.005
Yes	865 (41.49)	37.68 (7.92)
No	1220 (58.51)	36.67 (8.06)
Years of management experience			1.133	0.322
< 10	1327 (63.65)	36.95 (8.13)
10–19	654 (31.37)	37.23 (7.71)
≧ 20	104 (4.98)	38.10 (8.43)
Marital status			1.479	0.228
Single	46 (2.20)	36.17 (8.17)
Married	1954 (93.72)	37.17 (8.01)
Widowed or separated	85 (4.08)	35.81 (8.00)
Number of children			1.024	0.359
0	81 (3.88)	35.86 (7.70)
1	1351 (64.80)	37.11 (7.88)
≧ 2	653 (31.32)	37.21 (8.34)
Employment status			0.849	0.396
Permanent	1445 (69.30)	36.99 (7.87)
Contract	640 (30.70)	37.32 (8.33)
Weekly hours worked			4.975	0.000
≦ 40 h	862 (41.34)	38.13 (7.89)
> 40 h	1223 (58.66)	36.36 (8.03)
Monthly income			6.746	0.000
¥3000–5000	300 (14.39)	36.71(9.48)
¥5001–8000	871(41.78)	36.45(7.80)
¥8001-10,000	631(30.26)	37.41(7.61)
¥>10,000	283(13.57)	38.80(7.62)

Correlation analysis

As presented in Table 2, career success was positively correlated with psychological capital (r = 0.629, P < 0.01) and QWL (r = 0.673, P < 0.01). QWL was positively correlated with the level of psychological capital (r = 0.573, P < 0.01). Notably, the stress at work dimension within the QWL demonstrated no significant correlations with other variables in the analysis.

Table 2.

Means, SDs and correlations of psychological capital, quality of work life, and career success among nurse managers (n = 2085)

Scales and dimensions	Mean(SD)	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16
1. Quality of work life	3.47(0.65)	1
2. Working conditions	3.56(0.82)	0.878**	1
3. Stress at work	3.06(0.83)	0.217**	0.029	1
4. Control at work	3.53(0.75)	0.855**	0.768**	-0.101**	1
5. Home-work interface	3.46(0.88)	0.865**	0.748**	0.052*	0.782**	1
6. Employment evaluation of nurse	3.60(0.81)	0.915**	0.781**	0.016	0.808**	0.818**	1
7. General well-being	3.48(0.87)	0.908**	0.742**	0.109**	0.744**	0.768**	0.832**	1
8. Job and career satisfaction	3.57(0.83)	0.878**	0.733**	0.006	0.777**	0.756**	0.824**	0.794**	1
9. Career success	37.09(8.02)	0.673**	0.667**	-0.069**	0.661**	0.607**	0.621**	0.637**	0.592**	1
10. Career satisfaction	18.14(3.90)	0.654**	0.636**	-0.007	0.621**	0.576**	0.603**	0.617**	0.558**	0.888**	1
11. Intra-organizational career competitiveness	9.88(2.63)	0.662**	0.654**	-0.018	0.630**	0.592**	0.608**	0.598**	0.594**	0.877**	0.699**	1
12. Extra-organizational career competitiveness	9.06(2.86)	0.384**	0.401**	-0.169**	0.427**	0.370**	0.358**	0.395**	0.352**	0.784**	0.483**	0.585**	1
13. Psychological Capital	98.03(12.58)	0.573**	0.530**	0.051*	0.556**	0.478**	0.523**	0.542**	0.464**	0.629**	0.626**	0.527**	0.424**	1
14. Self-efficacy	30.47(3.81)	0.453**	0.426**	0.002	0.463**	0.374**	0.429**	0.423**	0.375**	0.499**	0.520**	0.393**	0.329**	0.886**	1
15. Optimism	14.83(2.40)	0.571**	0.519**	0.133**	0.503**	0.468**	0.505**	0.542**	0.455**	0.556**	0.572**	0.492**	0.326**	0.844**	0.637**	1
16. Resilience	24.02(3.53)	0.523**	0.483**	0.035	0.517**	0.446**	0.475**	0.496**	0.426**	0.590**	0.572**	0.495**	0.418**	0.915**	0.718**	0.753**	1
17. Hope	28.71(4.19)	0.540**	0.500**	0.046*	0.768**	0.748**	0.781**	0.742**	0.733**	0.618**	0.596**	0.527**	0.435**	0.942**	0.781**	0.747**	0.819**

**P<0.05; **P<0.01 (two-tailed)

The results of hierarchical multiple linear regression

Table 3 shows that career success was computed as the dependent variable, and the variables that were statistically significant in the results of the demographic characteristics of career success and correlation analysis were tested as independent variables. The findings demonstrate that psychological capital and QWL contributed to 38.0% and 14.0% of the variance in career success, respectively. Psychological capital and QWL were positively correlated with career success (β = 0.396, P < 0.01; β = 0.175, P < 0.01). Adding psychological capital to the model in step 2 showed that the absolute value of the psychological capital regression coefficient on career success was 0.396. After adding QWL in step 3, the absolute value of the regression coefficient of psychological capital on career success decreased to 0.230. However, the effect of psychological capital on career success remained significant (P < 0.01). The hierarchical regression results suggest that QWL may mediate the relationship between psychological capital and career success. A multicollinearity test was carried out on Block 3, and the VIF range for each variable was 1.018–1.540, indicating no multicollinearity among the variables in the model.

Table 3.

The analysis results of hierarchical multiple linear regression (n = 2085)

Variable	Career success
	Step 1 (β)	Step 2 (β)	Step3(β)
Block 1
Dummy_i1	-0.322	-0.973**	-1.611**
Dummy_i2	0.556	0.060	-1.166**
Dummy_i3	1.918**	0.506	-0.827
Dummy_p1	-0.081	0.223	-0.254
Dummy_p2	1.885	1.233	1.025
Weekly hours worked	-1.809**	-1.000**	-0.373
Specialist nurse qualifications	-1.088**	-0.808*	-0.469
Block 2
Psychological Capital		0.396**	0.230**
Block 3
QWL			0.175**
R2	0.028	0.408	0.548
∆R2 (change in R2)	0.028	0.380	0.140

Note. Dummy_i1, monthly income ¥3000–5000 versus ¥5001–8000; Dummy_i2, monthly income ¥3000–5000 versus ¥8001–10,000; Dummy_i3, monthly income ¥3000–5000 versus ¥>10,000. Dummy_p1: head nurse inward versus head nurse of division; Dummy_p2: head nurse inward versus nursing director

^*P < 0.05. ^**P < 0.01 (two-tailed)

SEM for factors affecting career success

Based on the above correlation and multiple linear regression analysis, we used Mplus 7.0 to build a structural model to verify the hypothesis. Bootstrap was used to conduct the significance test for mediating effects. As depicted in Table 4, the results of confirmatory factor analysis were as follows: χ²/df = 16.342, P < 0.001; RMSEA = 0.086, 95%CI = 0.082–0.090; CFI = 0.955, TLI = 0.944; SRMR = 0.041. The larger data of χ²/df was caused by the large sample size [46], yet the other indicators almost met the criteria and the model was a good fit.

Table 4.

Confirmatory factor analysis fits for the factors affecting career success

Index	Fit index in the current study	Reference value
χ2 (df), p value	1209.302(74), P < 0.001
Normed chi-square (χ2/df)	16.342	<5
RMSEA (CI)	0.086(0.082–0.090)	<0.08
CFI	0.955	>0.9
TLI	0.944	>0.9
SRMR	0.041	<0.08

Figure 1 depicts the mediating effect model. Psychological capital had a direct and positive influence on career success (β = 0.371, P < 0.001), thereby supporting Hypothesis 1. Moreover, QWL had a direct and positive effect on career success (β = 0.573, P < 0.001), thus supporting Hypothesis 2. Psychological capital had an indirect effect on career success through QWL (β = 0.346, P < 0.001), thereby supporting Hypothesis 3. Table 5 presents the direct, indirect, and total effects of the model variables in Fig. 1. The results show that the path from psychological capital to career success through QWL is significant. The confidence intervals are 95% (0.303, 0.387), which did not contain 0, indicating that the mediating effect was significant. The overall influence of psychological capital on career success was 0.717 (P < 0.001), and the 95% CI (0.683, 0.748) did not contain 0, indicating that the total effect was significant. The mediating effect accounted for 48.3% of the total effect. In total, 72.3% of the variance in career success of nurse managers can be explained by psychological capital and QWL (R² = 0.723).

Fig. 1.

Model of the mediating role of quality of work life (QWL) between psychological capital (PC) and career success (CS). Abbreviations: pc1: Self-efficacy; pc2: Optimism; pc3: Resilience; pc4: Hope; qwl1: Working conditions; qwl2: Stress at work; qwl3: Control at work; qwl4: Home-work interface; qwl5: Employment evaluation of nurse; qwl6: General well-being; qwl7: Job and career satisfaction; cs1: career satisfaction; cs2: Intra-organizational career competitiveness; cs3: Extra-organizational career competitiveness

Table 5.

The variables’ direct, indirect, and total effects in the final model. (n = 2085)

Effects	Structural paths	Point estimate	Product of coefficients		Bootstrap				P value	Explained variance
					BC 95% CI		Percentile 95% CI
			S.E.	Z	Lower	Upper	Lower	Upper
Total effects	PC→CS	0.717	0.016	43.780	0.683	0.748	0.683	0.748	< 0.001	0.723
Direct effects	PC→CS	0.371	0.028	13.324	0.320	0.428	0.318	0.426	< 0.001
Indirect effects	PC→QWL→CS	0.346	0.021	16.209	0.303	0.387	0.303	0.387	< 0.001

Note. PC = psychological capital, CS = career success, QWL = quality of work life

Discussion

This nationwide cross-sectional study, based on SEM, further explored the association between psychological capital, QWL, and career success among Chinese nurse managers in tertiary general hospitals. This focus provides novel insights into their career development, work challenges, and management strategies. In sum, the career success of nurse managers was at a medium-high level. Specialist nurse qualifications, weekly hours worked, monthly income, psychological capital, and QWL were identified as independent factors influencing career success. Furthermore, QWL had a partially mediating effect on the relationship between psychological capital and career success.

This study revealed that the career success of Chinese nurse managers was at a medium to high level, surpassing the survey results of nurses in prior studies [10, 47, 48] and higher than the survey outcomes of nurses with a master’s or doctoral degree in tertiary hospitals, as reported by Wang et al. [9]. This is also consistent with previous studies, as administrative nurses have higher career success scores than general nurses [8, 12]. One possible explanation is that nurse managers in China are typically sourced from the clinical frontlines of backbone nurses who possess greater clinical practice experience, communication skills, organization and coordination abilities than other nurses. This enables them to handle complex interpersonal relationships more adeptly, gain more autonomy at work, and realize their professional value [6], thus resulting in a higher perception of career success. In addition, nurse managers may hold a higher status within the hospital, affording them the chance to engage in policy development. Additionally, nurses in administrative roles often possess more time and resources to dedicate to ongoing education and professional development, thereby enhancing their career prospects [12, 49]. The career success scores of nurse managers in this study were slightly lower than those of the surveys conducted by Li et al. [50] and He et al. [51] on head nurses of tertiary hospitals in Hunan and Sichuan provinces, indicating that there may be differences in the career success scores of nurse managers in different regions; this could be related to differences in the levels of economic growth, cultural education backgrounds, healthcare systems, medical diagnosis and treatment levels, and performance appraisal systems in China’s different provinces. Due to the imbalance of economic development between different regions in China and the overall flow of nursing human resources to economically developed and resource-rich regions [52], it may lead to differences in the income level, welfare benefits, and workload of nurse managers in different regions, and ultimately affect their career success.

In our study, specialist nurse qualifications were independent predictors of nurse managers’ career success. A study of wound, ostomy and incontinence nurses in China showed that their career success and core competence were above average, and enhancing their core competitiveness can boost their career success [53]. This may be because nurse managers with specialist nurse training experience can master in-depth professional knowledge and skills. Nurse managers with expertise in specific fields are more likely to be successful in relevant positions [54]. They have a deeper understanding of the norms, best practices, and challenges in the field; they can also independently deal with difficult problems in their specialty and continue to innovate for personal and professional long-term development, thereby realizing self-worth and promoting professional success [53]. Moreover, nurse managers with specialist nurse qualifications can benefit from additional career and promotional opportunities. We also found that the more hours nurse managers worked per week, the lower their career success scores. A higher degree of work satisfaction and engagement is correlated with career success [47]. A moderate number of hours worked implies that nurse managers tend to utilize their time efficiently to maximize performance [46], which helps them maintain a work-life balance and better work engagement and satisfaction. Conversely, excessively long working hours may lead to increased work stress, a decreased sense of control at work, reduced work engagement and satisfaction, and even job burnout [55, 56]. Nurse managers should flexibly arrange working hours according to individual abilities, adaptability, and job requirements to ensure a work-life balance to promote career success. In this study, monthly income was an influential factor in career success; indeed, salaries are an objective indicator of career success [57]. Higher salaries for nurse managers can increase work motivation and job satisfaction, which in turn can contribute to career success [8, 58]. Additionally, high salaries are often seen as recognition of nurse managers’ abilities and contributions; this professional reputation and recognition can have a positive impact on the careers of nurse managers, attracting more opportunities and challenges and further boosting their career success.

A literature review revealed that Asian nurses exhibited the lowest psychological capital scores [59]. This may have something to do with the fact that Asian nurses face more difficult jobs [60]. Many studies of nurses’ negative work experiences from Asia report higher levels of compassion fatigue, workplace violence and burnout among nurses [61, 62]. In this study, nurse managers exhibited higher psychological capital scores than clinical nurses [63]. This difference may be attributed to their leadership roles in clinical nursing, which require strong organizational and managerial competencies, as well as the development of distinct leadership styles [64, 65]. Additionally, nurse managers frequently handle workplace emergencies, and through such experiences, they cultivate greater psychological resilience, contributing to their elevated psychological capital levels. Furthermore, the QWL of nurse managers in this study was basically consistent with the previous survey results of nurses in tertiary hospitals [66, 67]. On one hand, it may be related to the job responsibility requirements of nurse managers in tertiary hospitals. Beyond high professional competence, nurse managers require robust management skills, demanding significant time and energy investment [6]. On the other hand, with the promotion of public hospital reform and hospital grade evaluation, various medical units have carried out a series of management innovations in order to enhance the overall strength of hospitals and improve their comprehensive competitiveness. Nurse managers, as policy implementers, are inevitably impacted by the change.

Correlation analysis showed that the psychological capital of nurse managers was positively correlated with career success. The results of multiple linear regression further demonstrate the predictive effect of psychological capital on career success. Psychological capital is a fundamental psychological element that surpasses human and social capital and is displayed by individuals in the process of growth and development. It is a psychological resource that promotes career progression and enhances performance, thus creating a positive impetus for the organization [68]. Nurse managers with greater psychological capital can adjust to difficulties, gain knowledge from experience, and set their own career plans, which are usually reflected in better management abilities and the pursuit of higher-value goals. This finding is consistent with the outcomes of past studies on nurses [14]. Possessing a high level of psychological capital allows nurse managers to better fulfil their management duties, improve patient safety and nursing quality, and gain recognition from medical teams and higher-level leaders. This, in turn, prompts them to approach their work with a more positive attitude, thereby increasing their perceived professional benefits and consequently their sense of career success [69]. In the long run, maintaining a high level of psychological capital will lead to a gradual rise in job satisfaction and career success as well as a decline in the turnover rate. Furthermore, we noted a positive correlation between QWL and career success. QWL is important for promoting effective care teams, improving the quality and safety of clinical care, and enhancing hospital performance. The higher the QWL, the better the work engagement [70], which is positively correlated with career success [71]. Hence, positive work involvement helps nurse managers obtain positive feedback, boost their work performance, and eventually achieve job satisfaction and career success [72, 73]. Nurse managers are usually confronted with a busy workload and a high-pressure work environment, and having a high QWL can effectively help them balance their personal and professional lives, making it easier to maintain a healthy lifestyle and mental well-being, thus helping to improve work efficiency and creativity. However, there was no significant correlation between the work stress dimension and other variables, which may be related to the greater internal and external environmental pressure faced by nurse managers in tertiary public hospitals [35].

Based on the COR Theory and the career resource model [26, 27], this study verified the mediating role of QWL between nurse managers’ psychological capital and career success, with 51.74% of the direct effect of psychological capital on career success and 48.25% of the indirect effect through QWL. This finding has important implications for understanding the mechanisms of career development for nurse managers. Psychological capital exerts a significant positive influence on QWL. Specifically, individuals with high self-efficacy demonstrate enhanced capability in managing work challenges, potentially leading to increased job satisfaction. Similarly, resilient individuals exhibit greater proficiency in navigating workplace setbacks and maintaining work-life balance. These findings align closely with the concept of a person-job match within the work-life areas [74]. In addition, psychological capital could also drive managers to actively strive for environmental resources (e.g., training opportunities, decision-making empowerment) in order to achieve career success, forming a spiral path of “psychological capital - QWL - career success”. However, in China’s “high power distance” [75] and “high collectivism” cultures [76], nurse managers need to rely on organizational empowerment rather than solely on individual breakthroughs, and therefore, QWL showed a strong mediating effect in this study. And a positive feedback loop exists between QWL and psychological capital, with an improved work environment and a supportive organizational culture contributing to individual psychological capital. This interaction ultimately contributes to career success by increasing job engagement, reducing burnout, and enhancing professional commitment. Most nurse managers have better educational backgrounds and work achievements and therefore possess more psychological capital. High psychological capital can encourage innovative behaviors [77, 78], which are essential for nurse managers to fulfil their duties, overcome challenges, and accomplish work-related goals [73]. Additionally, high psychological capital can help nurse managers protect existing resources (e.g., time, energy) and invest in new resource acquisition (e.g., skill enhancement, social network expansion) in high-pressure environments, helping to achieve career success. In addition, Seligman [79] found that positive mental energy can help individuals tap into their own inherent or potential resources to build positive psychological qualities. Nurse managers with high psychological capital are likely to demonstrate greater enthusiasm, greater work involvement, and greater problem-solving ability at work, as well as positive emotion transfer (e.g., improved team climate) and emotion regulation, which can help to reduce work-family conflict and thus improve their QWL [6, 80]. A high-quality work environment further reduces resource depletion and provides career development providing sustainable support.

According to COR Theory and the career resources model, this study proposes an integrated intervention framework to enhance career success among nurse managers by synergistically developing psychological capital, optimizing QWL, and facilitating resource conversion. Key strategies include targeted psychological capital training (e.g., resilience-building workshops, Balint groups, SMART goal-setting programs) to strengthen self-efficacy and stress resilience [81, 82], organizational reforms such as humanized scheduling and multidimensional performance evaluations to improve QWL dimensions (e.g., job autonomy, work-family balance) [83], and dual-path career development initiatives that bridge internal leadership competencies (e.g., mentorship programs) [84, 85] with external professional influence (e.g., cross-institutional collaborations) [86]. The findings highlight QWL’s pivotal mediating role as a “resource conversion hub”, translating psychological resources into career satisfaction and competitiveness through enhanced job control and reduced occupational stress. These interventions emphasize individual-organization co-created strategies to disrupt resource depletion cycles, offering actionable pathways to transform nurse managers into resource-integrated leaders.

Implications for nursing management

Career success is closely associated with the productivity, quality, safety, and progress of the nursing discipline, and contributes to the stability of the nursing team and the growth of the organization. The results of this study provide new insights for hospital administrators and healthcare policymakers to take relevant measures to improve nurse managers’ career success, considering that psychological capital and QWL have beneficial effects on nurse managers’ career success. Hospital administrators should foster positive personalities in nurse managers to enhance their psychological capital from a positive psychology perspective, as well as focus on QWL to boost their growth within the organization and encourage career advancement, which can contribute to managers’ career success and improve the quality of care and optimize the efficiency of nursing management. Suggested measures include that hospital managers should regularly arrange career planning and mental health training for nurse managers, clarify the direction of career development, foster psychological resources, provide opportunities for professional development and organizational support, conduct job satisfaction surveys, and deliver targeted interventions. Moreover, policymakers can promote the career success of nurse managers by strengthening the development of leadership and management capabilities through providing high-quality leadership training; optimizing the work environment and offering mental health support programs; building communication and influence platforms to enhance professional discourse power and strategic participation.

Limitations of the study

Although we confirmed our hypotheses based on our findings, this study has some limitations. Firstly, this study was cross-sectional, meaning it may not demonstrate the causal connection between the variables. Secondly, we collected the data through a web-based self-report questionnaire, which is somewhat subjective and may lead to potential bias in terms of reporting. Thirdly, Chinese culture, with its unique history, values, and social structure, may influence the behavior and responses of the research subjects. Furthermore, recruiting nurse managers from China’s tertiary general hospitals may have affected the representation and generalizability of the results. The sample of this study is dominated by Chinese female nurse managers, which requires consideration of cultural particularity in generalizing the research results. In China, the nursing industry has been dominated by women for a long time, which is closely related to traditional culture, social role division, and career choice tendency. For example, female nurse managers may face greater stress from work-family conflict, while at the same time, they may face more gender bias and career ceilings in their career progression. These factors may influence the relationship between psychological capital, QWL, and career success. Future studies should attempt to include more influential variables (such as working environment, organizational culture, and organizational support) and different countries or levels of hospitals to extensively explore the factors influencing the career success of nurse managers, and to execute longitudinal researches to further validate them.

Conclusions

This nationwide cross-sectional study identified specific sociodemographic characteristics associated with nurse managers’ career success. The findings confirmed that psychological capital and QWL are positively correlated with career success, with QWL partially mediating the relationship between psychological capital and career success. This highlights that psychological capital and QWL are crucial determinants of nurse managers’ career success, suggesting that interventions targeting these two factors could effectively enhance their career development. Notably, the current level of career success among Chinese nurse managers indicates room for improvement. The insights from this study contribute to the theoretical understanding of the complex relationships among these variables and provide practical strategies for medical institutions and health administrative departments to develop targeted interventions. These findings establish a solid groundwork for future research and practical applications in this field.

Abbreviations

CSS

Career Success Scale

PCQ

Psychological Capital Questionnaire

WRQoL-2

Work-related Quality of Life Scale-2

QWL

Quality of Work Life

COR

Conservation of Resource Theory

SD

Standard deviation

ANOVA

Analysis of variance

SEM

Structural equation modelling

STROBE

Strengthening the Reporting of Observational Studies in Epidemiology

Author contributions

Z.C.C., X.W.J., and L.C.J. were responsible for developing the research proposal and thesis design. Z.C.C. was responsible for manuscript writing; Z.C.C. and X.W.J. were responsible for data collection, analysis, and interpretation; Z.L.L. and L.C.J. were accountable for quality control and critical review of the paper.

Funding

This study was supported by the Zigong Municipal Health Commission Funding (grant number 22yb011).

Data availability

The results generated during the study are not publicly available due to ethical considerations but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval for this research was obtained from the Clinical Research Ethics Committee of Zigong First People’s Hospital (Approval Number: 2022-79). All participants have gained informed consent before their participation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.