Abstract
Background
Nurses, as core members of the healthcare team, play a crucial role in patient care. Their work engagement directly affects care quality and patient satisfaction. High work engagement not only elevates service quality and safeguards patient safety but also enhances nurses’ job satisfaction and overall well-being. However, empirical evidence on how professional calling influences nurses’ work engagement remains limited. This study examines the mediating role of work motivation in the relationship between professional calling and work engagement among clinical nurses.
Methods
In this cross-sectional study, stratified random sampling was used to survey 2,924 clinical nurses in Sichuan Province, China, from February to March 2024. Data were collected with demographic questionnaires, the Professional Calling Scale, the Work Motivation Scale, and the Work Engagement Scale. Analyses were performed with SPSS 26.0, comprising descriptive statistics, univariate analysis, correlation analysis, and hierarchical regression. Mediation was tested with Model 4 of PROCESS 4.1.
Results
The mean work engagement score was 33.63 ± 7.14. Correlation analysis showed that professional calling was positively correlated with work engagement (r = 0.863, P < 0.01) and work motivation (r = 0.877, P < 0.01), and work motivation was positively correlated with work engagement (r = 0.814, P < 0.01). Mediation analysis revealed that work motivation partially mediated the relationship between professional calling and work engagement, with an effect size of 0.199, accounting for 24.8% of the total effect.
Conclusion
The findings confirm that work motivation mediates the association between professional calling and work engagement among clinical nurses. Nursing managers should therefore foster nurses’ professional calling and strengthen their work motivation to enhance work engagement.
Clinical trial number
Not applicable.
Keywords: Nurses, Work engagement, Professional calling, Work motivation, Mediating effect
Introduction
In recent years, the growing demand for healthcare services has magnified the impact of nurses—core members of medical teams—whose work engagement directly shapes care quality and patient satisfaction [1]. Yet the high-intensity workload, chronic stress, and occupational burnout inherent to nursing can erode work motivation [2]. Consequently, enhancing nurses’ work engagement has become a pivotal challenge for healthcare management [3]. Work engagement denotes an individual’s vigor, dedication, and absorption in professional tasks; nurses displaying high engagement exhibit greater enthusiasm, lower turnover, and elevated patient satisfaction [4]. Prior research has established work engagement as a positive psychological state that not only improves nursing quality and patient safety but also heightens job satisfaction and overall well-being [5, 6]. According to Kato et al.’s review, strengthening both personal and job resources can effectively elevate nurses’ work engagement [7]. Personal resources encompass internal psychological assets such as self-efficacy, role clarity, authentic self-expression, and constructive coping strategies, whereas job resources comprise organizational supports—including team climate, leadership behaviors, performance feedback, and institutional backing [8]. Furthermore, studies indicate that nurses’ engagement levels vary under high-intensity conditions and stressful environments, potentially influenced by factors such as age, marital status, professional title, and position [9]. Investigating the key determinants and mechanisms underlying nurses’ work engagement is therefore essential for optimizing nursing workforce management and advancing healthcare quality.
In recent years, the sense of professional calling has garnered considerable attention from human resource managers as a pivotal element of organizational behavior and positive psychological capital [10]. Professional calling denotes an individual’s profound conviction that their chosen vocation endows life with meaning, thereby inspiring passionate and dedicated pursuit of work that fosters self-actualization and societal contribution. Its core dimensions encompass directional force—the felt responsibility to pursue a specific profession—altruistic contribution, an orientation toward helping others and positively impacting society while serving national interests, and meaning and value, the alignment between one’s occupation and personal life purpose, values, and interests [11]. Empirical evidence indicates that professional calling buffers the effects of work stress, attenuating its detrimental impact. Nurses who experience a stronger calling exhibit heightened psychological resilience and reduced burnout [12]. Consistent with the broaden-and-build theory of positive emotions, the affirmative affective experiences generated by a professional calling expand individuals’ thought–action repertoires, eliciting proactive behaviors that subsequently elevate work engagement [13]. Ziedelis et al. documented a robust positive association between nurses’ sense of calling and their work engagement [14]. A pronounced calling compels nurses to invest greater time and energy in clinical practice while simultaneously cultivating feelings of self-worth and professional fulfillment.
Work motivation constitutes a pivotal psychological determinant of individual work behavior, encompassing the internal and external forces that initiate performance behaviors while shaping their form, direction, intensity, and duration. The construct comprises two dimensions: autonomous motivation—arising from inherent work characteristics such as challenge and interest—and controlled motivation, which reflects external regulation through environmental contingencies [15]. Self-determination theory posits that satisfaction of the basic psychological needs for autonomy, competence, and relatedness markedly strengthens work motivation, thereby fostering positive work behaviors [16]. Consistent empirical evidence identifies work motivation as a central predictor of employee work engagement, modulating engagement levels and encouraging voluntary participation in work-related activities [17]. As a positive psychological resource, professional calling may cultivate autonomous work motivation among nurses who possess a strong sense of mission, subsequently enhancing their work engagement. The Job Demands–Resources Model further suggests that job resources and personal resources—including professional calling, work motivation, and psychological capital—can operate independently or synergistically to stimulate employee engagement, such as organizational commitment and work engagement [18]. Nevertheless, research examining the specific mediating mechanisms through which professional calling influences work engagement via work motivation within nursing populations remains conspicuously scarce. Most investigations are confined to theoretical speculation or simple correlational analyses, lacking rigorous empirical scrutiny. Accordingly, this study aims to comprehensively elucidate the relationships among professional calling, work motivation, and work engagement, thereby clarifying the mediating role of work motivation. Such inquiry will enrich empirical evidence within nursing contexts and provide a theoretical foundation for developing targeted interventions designed to enhance clinical nurses’ work engagement.
Building upon these theoretical considerations, we propose the following hypothesis: Work motivation mediates the relationship between professional calling and work engagement, serving as a psychological mechanism that bridges these constructs (see Fig. 1).
Fig. 1.
Mediational model and hypotheses
Methods
Study design
This study is a cross-sectional study. This study was standardized for reporting using the guidelines for reporting observational studies in cross-sectional research designs (STROBE list).
Participants
Between February and March 2024, we employed stratified random sampling to divide Sichuan Province, China into five geographic regions: Northern Sichuan, Eastern Sichuan, Western Sichuan, Southern Sichuan, and Chengdu Metropolitan Area. All tertiary and secondary hospitals in these regions were systematically numbered (1-N). Using a lottery method, we randomly selected three tertiary hospitals and two secondary hospitals from each region, resulting in a total of 25 surveyed hospitals. To ensure population representativeness, we recruited 20–30% of clinical nurses from each selected hospital. The inclusion criteria were: (1) holding a valid nursing license; (2) being a registered clinical nurse; (3) having over one year of clinical nursing experience; and (4) providing informed consent for voluntary participation. Exclusion criteria included: (1) interns, residents, or nurses in training programs; and (2) those on extended leave (sick leave, maternity leave, etc.). The sample size was calculated using the following parameters [19]: α = 0.05, standard deviation (SD) of nursing work engagement scores = 6.54 (based on preliminary survey results), and a maximum allowable error of 0.5. The initial calculation yielded n = 656. Accounting for a 20% anticipated invalid response rate, the final target sample size was determined to be 820. The study collected 3,287 questionnaires in total. After excluding 363 invalid responses (identified through: demographic inconsistencies, ≥ 6 consecutive identical responses, or completion times < 2 or > 30 min), we retained 2,924 valid questionnaires, achieving an 89.0% valid response rate. The research subject flowchart is shown in Fig. 2.
Fig. 2.
Participant flowchart
Measures
Demographic information questionnaire
The research team designed a demographic data survey form based on the research objectives, which included age, gender, marital and childbearing status, highest level of education, etc.
Professional calling scale
This scale was adapted and revised for Chinese use by Chinese scholar Zhang [20], following Brislin’s translation-back-translation standard procedure. It is primarily used to assess an individual’s sense of professional calling. The scale comprises three dimensions: directional force (4 items), altruistic contribution (3 items), and meaning and value (3 items), totaling 10 items. It employs a 5-point Likert scale, scoring from “strongly disagree” to “strongly agree” with values ranging from 1 to 5. The total score ranges from 10 to 50 points, with higher scores indicating a stronger professional calling. The scale and its dimensions demonstrate strong reliability and validity. Confirmatory factor analysis confirmed a well-fitted unidimensional structure, with a TLI of 0.965, RMSEA of 0.038, and Cronbach’s α coefficient of 0.840. In this study, the Cronbach’s α coefficient for the scale was 0.968.
Work motivation scale
The Work Motivation Scale developed by Moller et al. was employed [21]. This scale comprises two dimensions—intrinsic motivation (4 items) and extrinsic motivation (4 items)—totaling 8 items. A 5-point Likert scale was employed, with responses ranging from “strongly disagree” to “strongly agree” scored from 1 to 5 points, respectively. The total score ranged from 8 to 40 points, with higher scores indicating stronger work motivation. The scale and its dimensions demonstrated good reliability and validity. Confirmatory factor analysis indicated a well-fitted unidimensional structure. In this study, the Cronbach’s α coefficient for the scale was 0.939.
Work engagement scale
This scale was developed by Schaufeli et al. in 2006 [22] and translated into Chinese by Li et al. in 2013 [23]. The Chinese adaptation followed Brislin’s translation-back-translation standard procedure and is primarily used to assess individuals’ levels of work engagement. The scale comprises three dimensions: vigor (3 items), dedication (3 items), and focus (3 items), totaling 9 items. It employs a 7-point Likert scale ranging from “never” to “daily,” scored from 0 to 6 points, respectively. The total score ranges from 0 to 54 points, with higher scores indicating greater work engagement. The scale and its dimensions demonstrate good reliability and validity. Confirmatory factor analysis indicates a well-fitted unidimensional structure, with a Cronbach’s α coefficient of 0.930. In this study, the Cronbach’s α coefficient for the scale was 0.945.
Data collection
The data for this study were collected using “Wenjuanxing” for the creation and distribution of electronic questionnaires. First, after obtaining informed consent from the nursing department directors of all participating hospitals, one representative from each hospital was designated as the survey coordinator for this study. All survey coordinators received standardized training to clarify the purpose, significance, completion methods, and key considerations of the survey. The survey coordinators then distributed the electronic questionnaires to the WeChat groups of all nurses in their respective hospitals. The first page of the questionnaire included a standardized instruction statement explaining the purpose of the study, completion methods, and key points to note. Participants were required to provide informed consent and sign an electronic informed consent form before completing the questionnaire, which could only be submitted after all items were fully completed. All questionnaires were completed anonymously. Technical measures were implemented to restrict each IP address or device to a single submission, eliminating the collection of personal identifiers and duplicate responses at the source. Upon data collection completion, all de-identified raw data was exported from the “Wenjuanxing” platform. Access to this data on the server was restricted to the principal investigator and designated core data analysts via personal account credentials. In accordance with institutional policies and research ethics requirements, all raw data from this study will be retained for at least five years from the project’s completion date. During this period, the data will be accessible solely for potential audits or subsequent analysis. Upon expiration of the retention period, all electronic data will be permanently and securely deleted from storage devices.
Data analysis
Statistical analysis was performed using SPSS 26.0. The significance level was set at α = 0.05 (two-tailed). Between-group differences in work engagement were analyzed using either independent samples t-tests or one-way ANOVA, as appropriate. Pearson correlation analysis examined the bivariate relationships among professional calling, work motivation, and work engagement. A hierarchical regression analysis was used to examine the factors influencing nurses’ work and the mediating role of work motivation in the relationship between professional calling and work engagement. In the first step, meaningful variables related to sociodemographic characteristics were included as control variables in Model (1) In the second step, the independent variable professional calling was included in Model (2) In the third step, the mediating variable work motivation was included in Model 3.
The significance of the mediating effect was tested using the bias-corrected percentile bootstrap method, and the mediating effect of work motivation between professional calling and work engagement was tested using Model 4 in the PROCESS 4.1 plugin. Professional calling was the independent variable, work engagement was the dependent variable, and work motivation was the mediating variable. Before testing the model, the scores for professional calling, work motivation, and work engagement were standardized. The 95% confidence interval (95% CI) for the indirect effect was calculated to verify the presence of a mediating effect.
Ethical considerations
The study was reviewed and approved by the Ethics Committee of Deyang People’s Hospital (2024-04-016-K01), and the research process followed the Declaration of Helsinki.
Results
Demographic characteristics of participants
Of the 2924 nurses, the average age was (31.93 ± 6.96) years; 4.48% were male, and 95.52% were female. The highest percentage of married and childbearing was 59.40%; 67.96% had a bachelor’s degree, and 63.78% were in tertiary hospitals. The rest of the general information is shown in Table 1.
Table 1.
General information characteristics (n = 2924)
| Item | N (%) | Work engagement | |||
|---|---|---|---|---|---|
| Mean ± SD | t/F | P | |||
| Age | <30 | 1498 (51.23) | 32.34 ± 7.26 | 68.287 | <0.001 |
| 30~<40 | 1060 (36.25) | 34.39 ± 6.87 | |||
| ≥ 40 | 366 (12.52) | 36.74 ± 6.14 | |||
| Gender | Male | 131 (4.48) | 33.69 ± 8.11 | 0.087 | 0.930 |
| Female | 2793 (95.52) | 33.63 ± 7.10 | |||
| Marital and childbearing status | Unmarried | 787 (26.92) | 31.93 ± 7.27 | 27.113 | <0.001 |
| Married but not having children | 315 (10.77) | 32.71 ± 7.47 | |||
| Married and having children | 1737 (59.40) | 34.50 ± 6.85 | |||
| Divorced or other | 85 (2.91) | 35.14 ± 7.29 | |||
| Highest level of education | College and below | 912 (31.19) | 33.32 ± 7.42 | 1.826 | 0.161 |
| Undergraduate | 1987 (67.96) | 33.79 ± 7.01 | |||
| Master’s degree or above | 25 (0.85) | 32.24 ± 7.28 | |||
| Hospital level | Secondary | 1059 (36.22) | 33.29 ± 7.33 | 3.871 | 0.049 |
| Tertiary | 1865 (63.78) | 33.83 ± 7.03 | |||
| Work department | Internal medicine system | 739 (25.27) | 33.36 ± 7.02 | 4.744 | <0.001 |
| Surgical system | 667 (22.81) | 33.50 ± 7.39 | |||
| Maternal and child system | 414 (14.16) | 33.83 ± 7.23 | |||
| Critical care system | 172 (5.89) | 31.47 ± 6.84 | |||
| Operating room systems | 179 (6.12) | 34.10 ± 6.75 | |||
| Outpatient and emergency system | 310 (10.60) | 34.89 ± 6.90 | |||
| Other | 443 (15.15) | 33.88 ± 7.15 | |||
| Professional title | Nurse | 642 (21.96) | 32.60 ± 7.33 | 20.571 | <0.001 |
| Nurse practitioner | 1231 (42.10) | 33.04 ± 7.24 | |||
| Nurse supervisor | 908 (31.05) | 34.84 ± 6.88 | |||
|
Deputy chief nurse and above |
143 (4.89) | 35.76 ± 5.42 | |||
| Position | Clinical nurse | 2658 (90.90) | 33.43 ± 7.21 | 13.284 | <0.001 |
| Nursing team leader | 236 (8.07) | 35.39 ± 6.07 | |||
| Head nurse | 30 (1.03) | 37.73 ± 5.63 | |||
| Mode of employment | Labor contract | 2459 (84.10) | 33.48 ± 7.16 | 7.573 | 0.006 |
| Professional preparation | 465 (15.90) | 34.47 ± 7.21 | |||
| Years of work experience | <3 | 546 (18.67) | 32.62 ± 7.32 | 43.256 | <0.001 |
| 3~<10 | 1051 (35.95) | 32.33 ± 7.19 | |||
| 10~<15 | 796 (27.22) | 34.29 ± 6.87 | |||
| ≥ 15 | 531 (18.16) | 36.26 ± 6.42 | |||
| Average monthly personal income | <5000 | 1383 (47.30) | 32.87 ± 7.39 | 13.185 | <0.001 |
| 5000~<8000 | 1135 (38.82) | 34.02 ± 7.00 | |||
| 8000~<11,000 | 317 (10.84) | 34.94 ± 6.44 | |||
| ≥ 10,000 | 89 (3.04) | 35.94 ± 5.88 | |||
| Specialty nurse certification | No | 2373 (81.16) | 33.42 ± 7.14 | 6.132 | 0.002 |
| Provincial nurse Specialist | 483 (16.52) | 34.43 ± 6.83 | |||
| State-level specialized nurses | 68 (2.33) | 35.38 ± 7.44 | |||
| Whether on night shift | Yes | 1863 (63.71) | 32.77 ± 7.20 | 76.268 | <0.001 |
| No | 1061 (36.29) | 35.14 ± 6.77 | |||
| Self-assessment of work intensity | Low | 44 (1.50) | 37.41 ± 6.69 | 57.266 | <0.001 |
| General | 1811 (61.94) | 34.59 ± 6.86 | |||
| High | 1069 (36.56) | 31.86 ± 7.27 | |||
| Self-assessment of job satisfaction | Extremely satisfied | 655 (22.40) | 38.95 ± 6.16 | 339.385 | <0.001 |
| Satisfied | 1291 (44.15) | 34.23 ± 6.23 | |||
| General | 876 (29.96) | 29.66 ± 5.90 | |||
| Dissatisfied | 102 (3.49) | 26.06 ± 6.54 | |||
Univariate analysis of clinical nurses’ work engagement
The results of univariate analysis showed that age, marital and childbearing status, highest level of education, work department, professional title, position, mode of employment, years of work experience, average monthly personal income, specialty nurse certification, whether on night shift, self-assessed intensity of work, and self-assessed job satisfaction were the influencing factors of work engagement (all P < 0.05). See Table 1.
Descriptive analysis and correlation analysis of each scale
In this study, the clinical nurses’ scores for professional calling were (39.55 ± 7.62), work motivation were (31.57 ± 5.81), and work engagement were (33.63 ± 7.14). Pearson correlation analysis showed that professional calling was positively correlated with work engagement (r = 0.863, P < 0.01), professional calling was positively correlated with work motivation (r = 0.877, P < 0.01), and work motivation was positively correlated with work engagement (r = 0.814, P < 0.01). See Table 2.
Table 2.
Descriptive and correlational analysis of professional calling, work motivation, and work engagement
| Variables | Mean ± SD | 1 | 2 | 3 |
|---|---|---|---|---|
| 1 Professional calling | 39.55 ± 7.62 | 1 | ||
| 2 Work motivation | 31.57 ± 5.81 | 0.877* | 1 | |
| 3 Work engagement | 33.63 ± 7.14 | 0.863* | 0.814* | 1 |
*P<0.01
Multivariate stratified regression results
In the first step of the multilevel regression analysis, the variables from the single-factor analysis of work engagement that were found to be significant were included as control variables in the model. In the second step, after controlling for the effects of the aforementioned control variables, professional calling was found to be positively correlated with work engagement (β = 0.798, P < 0.001), indicating that professional calling has a significant impact on work engagement, explaining 47% of the variance. In the third step, work motivation was positively correlated with work engagement (β = 0.237, P < 0.001). Adding the mediating variable of work motivation to the model explained an additional 48.3% of the variance in work engagement. The regression coefficient for professional calling decreased from 0.798 in the second step to 0.596 in the third step, but remained statistically significant. Collinearity diagnostics showed that the tolerance values for each model ranged from 0.219 to 0.925, and the variance inflation factors ranged from 1.081 to 4.562, indicating no multicollinearity among the independent variables. Statistical analysis preliminarily indicated that work motivation partially mediated the relationship between professional calling and work engagement among nurses. See Table 3.
Table 3.
Multiple stratified regression analysis of work engagement
| Variables | Model 1 | Model 2 | Model 3 | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SE | β | t | P | 95%CI | SE | β | t | P | 95%CI | SE | β | t | P | 95%CI | |
| Control variables | |||||||||||||||
| ① | 0.233 | -0.028 | -1.090 | 0.276 | -0.681, 0.194 | -0.321 | -0.037 | -2.472 | 0.014 | -0.575, -0.066 | 0.126 | -0.044 | -2.990 | 0.003 | -0.625, -0.130 |
| ② | 0.375 | 0.036 | 2.051 | 0.040 | 0.034, 1.503 | 0.568 | 0.027 | 2.607 | 0.009 | 0.141, 0.995 | 0.212 | 0.029 | 2.908 | 0.004 | 0.201, 1.033 |
| ③ | 0.182 | 0.008 | 0.382 | 0.703 | -0.287, 0.426 | -0.188 | -0.021 | -1.779 | 0.075 | -0.396, 0.019 | 0.103 | -0.029 | -2.537 | 0.011 | -0.464, -0.059 |
| ④ | 0.235 | -0.067 | -4.019 | <0.001 | -1.403, -0.483 | -0.522 | -0.037 | -3.823 | <0.001 | -0.790, -0.254 | 0.133 | -0.035 | -3.730 | <0.001 | -0.756, -0.235 |
| ⑤ | 0.148 | -0.470 | -28.315 | <0.001 | -4.480, -3.900 | -0.977 | -0.110 | -10.178 | <0.001 | -1.165, -0.789 | 0.094 | -0.100 | -9.561 | <0.001 | -1.079, -0.711 |
| ⑥ | 0.798 | 75.520 | <0.001 | 0.596 | 31.665 | <0.001 | |||||||||
| ⑦ | 0.237 | 12.784 | <0.001 | ||||||||||||
|
F (P) |
92.678 (<0.001) |
662.065 (<0.001) |
663.325 (<0.001) |
||||||||||||
| R 2 | 0.293 | 0.761 | 0.774 | ||||||||||||
| R2 change | 0.290 | 0.760 | 0.773 | ||||||||||||
Note: Independent variable coding method: Professional title (Nurse = 1, Nurse practitioner = 2, Nurse supervisor = 3, Deputy chief nurse and above = 4), Position (Clinical nurse = 1, Nursing team leader = 2, Head nurse = 3), Average monthly personal income (<5000 = 1, 5000~<8000 = 2, 8000~<11,000 = 3, ≥ 10,000 = 4), Self-assessment of work intensity (Low = 1, General = 2, High = 3), Self-assessment of job satisfaction༈Extremely satisfied = 1, Satisfied = 2, General = 3, Dissatisfied = 4)
Mediation analysis of professional calling, work motivation and work engagement
Using Model 4 in the SPSS macro program PROCESS, with professional calling as the independent variable (X), work motivation as the mediating variable (M), and work engagement as the dependent variable (Y), professional title, position, average monthly personal income, self-assessment of work intensity, and self-assessment of job satisfaction serve as control variables, we tested the mediating effect of work motivation between professional calling and work engagement. Mediation analysis revealed that professional calling has a positive predictive effect on work motivation, with a = 0.850, SE = 0.010, P < 0.001; Both professional calling and work motivation entered the regression equation. Professional calling had a positive predictive effect on work engagement, c’=0.604, SE = 0.019, P < 0.001; work motivation had a positive predictive effect on work engagement, b = 0.234, SE = 0.019, P < 0.001. The Bootstrap method revealed that work motivation partially mediated the positive relationship between professional calling and work motivation, with ab = 0.199, BootSE = 0.018, 95% CI: [0.163, 0.234]. The fully standardized indirect effect value β_(indirect) = 0.15, with the mediating effect accounting for 24.8% of the total effect. According to the effect size assessment criteria, the indirect effect of β_(indirect) = 0.15 in this study can be regarded as a medium effect size. See Table 4; Fig. 3.
Table 4.
Results of mediation analysis
| Effects | Effect size | SE | 95% CI |
|---|---|---|---|
| Total effect | |||
| Professional Calling→Work Engagement | 0.803 | 0.011 | (0.782, 0.824) |
| Direct effect | |||
| Professional Calling→Work Engagement | 0.604 | 0.019 | (0.567, 0.641) |
| Indirect effect | |||
| Professional Calling→Work Motivation→Work Engagement | 0.199 | 0.018 | (0.163, 0.234) |
Fig. 3.
Model of the mediating role of work motivation between professional calling and work engagement
Discussion
Current status of clinical nurses’ work engagement
The results show that clinical nurses’ work engagement averaged 33.63 ± 7.14 points, with a mean item score of 3.74 ± 0.79. Both values exceed the theoretical median of 3, indicating an above-average level consistent with prior research [24] and suggesting that Chinese clinical nurses maintain relatively high work engagement. Possible contributors include a strong sense of professional calling, increased organizational support from hospitals, a positive team climate, and continuous professional development opportunities [25]. Moreover, work motivation was found to mediate the relationship between professional calling and work engagement, with elevated motivation amplifying the beneficial impact of calling on engagement. This finding aligns with numerous Western studies rooted in self-determination theory, which emphasize that intrinsic, meaning-driven motivation is essential for sustaining long-term engagement [16]. A distinctive feature of the Chinese context is that its professional culture—marked by collectivism and a spirit of dedication—imbues a sense of mission with significance that extends beyond the individual and is deeply intertwined with social responsibility [12]. These insights offer valuable guidance for nursing administrators aiming to further enhance nurses’ work engagement, improve clinical care quality, and safeguard patient safety.
This study identified professional title, position, average monthly personal income, self-assessed work intensity, and self-assessed job satisfaction as determinants of clinical nurses’ work engagement. The underlying mechanisms can be summarised as follows: (1) Professional title denotes expertise and seniority; nurses with advanced titles typically exhibit stronger professional identity, richer knowledge and skills, and greater autonomy, all of which elevate engagement [26]. (2) Nurses in administrative or managerial roles (e.g., head nurses) assume broader responsibilities, participate in decision-making, and enjoy increased autonomy, thereby cultivating a heightened sense of responsibility and intrinsic motivation that fosters engagement [27]. (3) Income serves as a critical motivator and security buffer; higher earnings directly affirm the value of nursing labour, enhance perceived fairness and satisfaction, and relieve financial pressure, enabling nurses to devote greater attention to their professional duties [9]. (4) Nurses who perceive their work as highly intensive display lower engagement; prolonged, high-intensity labour induces physical fatigue and depletes energy reserves, diminishing efficiency and eroding commitment [28]. (5) Job satisfaction constitutes the most immediate psychological precursor to engagement; nurses who are satisfied with their work content, environment, and interpersonal relationships form more positive emotional attachments and are therefore more willing to invest discretionary effort in their roles [9].
Correlation between clinical nurses’ professional calling, work motivation, and work engagement
The findings reveal a positive association between clinical nurses’ sense of professional calling and their work engagement: nurses who experience a stronger calling display markedly higher engagement, echoing prior results [14]. Professional calling can be construed as an intrinsic and enduring sense of identity and meaning that arises from an individual’s recognition of nursing’s value and an accompanying emotional dedication to the profession [10]. Nurses with a pronounced calling typically exhibit heightened intrinsic motivation; this internally anchored state, tied to professional identity and value pursuit, is manifested by proactive duty fulfillment, diligent efforts to meet clinical demands, and sustained commitment to patient care [9]. Additionally, a robust sense of calling is linked to lower burnout and greater psychological resilience [29]. Collectively, these elements form a vital psychological backdrop that fosters professional focus and persistent engagement.
The findings demonstrate that clinical nurses’ sense of professional calling is positively associated with work motivation: nurses who experience a stronger calling report higher motivational levels, aligning with previous evidence [30]. Grounded in self-determination theory, human behavior is linked to the satisfaction of three basic psychological needs—autonomy, competence, and relatedness [16]. As an intrinsic driver, a pronounced professional calling leads nurses to regard nursing not merely as a livelihood but as an essential avenue for self-actualisation. This internal identification fosters heightened workplace autonomy, enhanced professional competence, and a deep sense of team belonging, collectively constituting the psychological substrate for elevated work motivation [31]. Moreover, nurses with a stronger calling are more likely to maintain a positive outlook amid work stress and to construe challenges as growth opportunities; these cognitive and behavioral attributes are significantly associated with the sustained maintenance of work motivation [32].
The findings reveal a positive association between clinical nurses’ work motivation and work engagement: nurses with elevated motivation display heightened engagement, mirroring prior conclusions [33]. Highly motivated nurses typically articulate clearer career plans and goals, aligning personal professional development closely with daily practice. Consequently, they proactively exercise initiative, actively pursue growth opportunities, and continually refine nursing care—behavioral signatures consistently linked to superior engagement [3]. Moreover, when confronted with occupational stress, these nurses exhibit greater psychological resilience, reframing professional challenges as avenues for development; this constructive coping style underpins more sustained and profound engagement. Zeng et al. similarly observed that autonomy-driven engagement is accompanied by a robust sense of competence and an active-participation behavioral orientation [34].
The mediating role of work motivation in clinical nurses’ professional calling and work engagement
The results demonstrate that work motivation mediates the association between clinical nurses’ professional calling and work engagement. Calling exerts both a direct impact on engagement and an indirect effect via work motivation, with the mediated pathway accounting for 24.9% of the total effect. As a profound intrinsic driver and value orientation, professional calling encourages nurses to regard nursing as a noble avenue for self-actualization, thereby elevating their work motivation [35]. Within self-determination theory, work motivation satisfies the basic psychological needs for autonomy, competence, and relatedness, and subsequently shapes engagement through cognitive appraisal and behavioral choice [15]. Highly motivated nurses typically establish clear career goals, proactively confront professional challenges, and derive fulfilment from clinical achievements; these factors jointly raise engagement levels. Conversely, nurses with weaker motivation are more vulnerable to burnout and disengagement. The job demands–resources model positions both professional calling and work motivation as key psychological resources that buffer work stress and foster positive work behaviors [18]. In particular, nurses with a stronger calling display a heightened capacity to convert stress into developmental motivation; this adaptive mechanism reinforces work motivation and, through goal-directed actions and emotional commitment, promotes engagement [35]. Empirical evidence consistently shows that employees with a stronger professional calling maintain higher intrinsic motivation, which cultivates sustained work enthusiasm and proactive behaviors that enhance engagement and performance [36]. Nursing administrators should therefore prioritize the cultivation of clinical nurses’ professional calling through structured values education, role-model interventions, and systematic reinforcement of work meaning, thereby strengthening professional identity, deepening value commitment, boosting work motivation, and ultimately optimizing engagement across clinical practice.
Relevance of clinical practice
Nurses constitute the cornerstone of healthcare systems worldwide, fulfilling an indispensable role in protecting human health. Their multifaceted contributions span health education, disease prevention, patient self-management support, mental-health services, community health initiatives, research innovation, and interdisciplinary collaboration. Yet when confronted with excessive workloads, high-stress environments, and complex interpersonal dynamics, nurses frequently experience occupational burnout. This syndrome erodes health productivity, compromises nursing service quality, and may endanger patient safety; in severe cases it precipitates attrition from the profession. Amid an escalating global nursing shortage, enhancing clinical nurses’ work engagement has become paramount for safeguarding patient safety. Grounded in our empirical findings, we propose the following evidence-based recommendations to elevate engagement among clinical nurses:
First, nursing administrators should prioritize the cultivation of professional calling among clinical nurses. This can be achieved by engaging nurses in departmental governance and decision-making, coupled with the delegation of appropriate authority to expand workplace autonomy and thereby nurture intrinsic calling. Simultaneously, administrators should support the creation of individualized career roadmaps that delineate clear professional growth trajectories, utilizing employee-assistance programmes or group-counselling interventions to strengthen career-advancement competencies. In addition, the establishment of self-regulation frameworks and the development of psychological capital will enable nurses to embrace their professional responsibilities with heightened positivity and dedication.
Second, professional value and equitable remuneration are pivotal to work motivation, serving as key levers for reducing burnout and amplifying enthusiasm among clinical nurses. Managers should foreground nurses’ academic credentials and skill development by designing bespoke education and training programmes that furnish clear avenues for career advancement. Concurrently, a transparent compensation system must be instituted, grounding pay policies on objective appraisals of performance, clinical expertise, and contributory impact, thereby ensuring that nursing labour receives dignified and commensurate reward. Moreover, concerted support for early-career nurses—encompassing continuing education, skills enhancement, promotional pathways, social support, and competitive benefits—will fortify their sense of calling and motivation, ultimately elevating both work engagement and job satisfaction.
Finally, the National Nursing Education Steering Committee is advised to revise the core curriculum guidelines by designating “Nursing Professional Values and Mission Education” as a compulsory module, thereby enabling students to establish a robust professional identity before workforce entry. In parallel, health administrative departments should integrate key psychological and retention indicators—namely “nurse professional well-being,” “work engagement,” and “turnover rates”—into the performance appraisal framework for public hospitals and the annual salary assessment system for hospital directors. Such an institutional strategy will motivate hospital leadership to allocate resources toward cultivating nurses’ psychological capital.
Limitations
This study has several limitations that merit acknowledgement. First, the survey was confined to clinical nurses in 25 hospitals within Sichuan Province, China, yielding limited sample representativeness. Although Sichuan is populous and possesses a comparatively balanced healthcare system whose conditions may partially reflect those of central and western China, the findings cannot be directly extrapolated to regions with markedly different socioeconomic and cultural profiles—such as affluent coastal provinces or remote underdeveloped areas—where healthcare resources, work cultures, and management policies may moderate observed relationships. Multi-centre sampling across diverse geographic locales and healthcare settings is therefore warranted to validate the generalisability of the results. Second, data were collected exclusively through online self-administered questionnaires, introducing potential response bias attributable to inter-individual variability in item interpretation. Future studies should supplement questionnaires with face-to-face interviews or supervised administration to enhance data quality and validity. Third, most invalid questionnaires contained data of insufficient quality for reliable analysis, and no information could be obtained on nurses who did not participate; consequently, unmeasured or unobservable differences between the final sample and the target population cannot be fully excluded. Proactive follow-up designs—such as reminders for non-respondents or sampling interviews—should be adopted to assess and mitigate such biases. In addition, to examine clustering effects across hospitals and tiers, a two-way random model was used to compute intraclass correlation coefficients (ICC); values < 0.01 indicated negligible hospital-level clustering, so cluster analysis or mixed-effects adjustments were not applied. Future investigations could employ multilevel modelling to estimate individual- and hospital-level effects more precisely. Finally, although the study identified key determinants of clinical nurses’ work engagement and established work motivation as a mediator between professional calling and engagement, it did not incorporate other potentially influential variables such as organisational culture or leadership styles. Subsequent research should adopt a broader perspective, integrating familial, social, and policy factors and examining additional mediators and moderators to construct a more comprehensive model of how professional mission shapes work engagement.
Conclusion
In conclusion, this study offers a comprehensive analysis of clinical nurses’ work engagement in post-pandemic China, extending the theoretical framework by demonstrating that professional calling enhances engagement through the mediating role of work motivation. The findings underscore the pivotal influence of both professional calling and work motivation, providing evidence-based guidance for nursing management. By cultivating professional calling and reinforcing work motivation, nursing leaders can elevate nurses’ engagement, initiative, and proactivity, thereby improving clinical care quality and safeguarding patient safety.
Acknowledgements
We acknowledge the hospitals managers and all nurses who participated in this study.
Author contributions
WJJ and LYX contributed to interpreting the data, and participated in writing and revising the manuscript. ZXL, FYT, ZJQ and DP designed the study, collected the data. WJJ and LYX collected the data, and performed the statistical analysis. RX contributed to interpreting the data. RX and HL participated in revising the manuscript. WJJ and LYX designed the study, and participated in revising the manuscript. All authors have read and approved the manuscript.
Funding
This work was supported by the Sichuan Hospital Management and Development Center (approval number: SCYG2023-31).
Data availability
The dataset generated and analyzed during the current study are available from the corresponding authors on reasonable request.
Declarations
Ethics approval and consent to participate
This study followed the Declaration of Helsinki and was approved by the Ethics Committee of Deyang People’s Hospital (2024-04-016-K01). All participants gave informed consent and volunteered to participate in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Jijun Wu and Yuxin Li contributed equally to this work.
Contributor Information
Xian Rong, Email: 1165254226@qq.com.
Lin He, Email: 905956308@qq.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The dataset generated and analyzed during the current study are available from the corresponding authors on reasonable request.