Citizenship Fatigue as a Mediator Between Compulsory Citizenship Behavior and Work–Life Balance Among Nurses

ABSTRACT

Introduction

Nurses' compulsory citizenship behaviors can negatively impact work–life balance over time, both directly and through citizenship fatigue.

Design

It is a cross‐sectional descriptive study.

Aim

This study aimed to examine the relationships between compulsory citizenship behavior, citizenship fatigue, and work–life balance among nurses.

Methods

Data were collected from 499 nurses working in a public hospital in a provincial setting in İstanbul (Türkiye) between August 1, 2025, and September 20, 2025. Data were collected using the Citizenship Fatigue Scale, the Compulsory Citizenship Behavior Scale, and the Work–Life Balance Scale. Analyses included descriptive statistics, Pearson correlations, and mediation analyses using the PROCESS macro for SPSS. The STROBE reporting method, which is one of the EQUATOR guidelines, was followed.

Results

Nurses reported moderate levels of compulsory citizenship behavior, citizenship fatigue, and work–life balance. Compulsory citizenship behavior was positively associated with citizenship fatigue and negatively associated with work–life balance, while citizenship fatigue was negatively associated with work–life balance (p < 0.05). Mediation analysis indicated that citizenship fatigue partially mediated the relationship between compulsory citizenship behavior and work–life balance (p < 0.05).

Conclusion

Compulsory citizenship behavior and citizenship fatigue are key organizational factors that undermine nurses' ability to maintain a healthy work–life balance by accelerating resource loss processes.

Clinical Relevance

This study aims to guide the development of strategies that reduce citizenship fatigue and improve work–life balance by examining the relationship between nurses' workloads and their voluntary behaviors in the clinic.

1. Introduction

Nurses are a core component of the global health workforce and play a central role in maintaining health system functioning and ensuring high‐quality patient care. In the post‐COVID‐19 era, however, the profession continues to experience substantial strain due to persistent workforce shortages and high workloads worldwide (WHO ²⁰²⁵). Reflecting these challenges, the 2025 theme of the International Council of Nurses (ICN), “Our Nurses. Our Future. Caring for nurses strengthens economies,” emphasizes that protecting nurses' well‐being and ensuring safe working conditions are urgent priorities for health systems and global policy. Excessive workloads and hidden extra demands have been highlighted as key contributors to burnout and disturbances in nurses' work–life balance (ICN ²⁰²⁵).

Work–life balance (WLB) refers to a state of harmony between professional and personal domains, encompassing how time is allocated, roles are fulfilled, and overall satisfaction is experienced. It reflects a condition in which occupational responsibilities do not interfere with family or private life and personal roles do not prevent the fulfillment of work obligations (Bocean et al. 2023). Among nurses, work–life balance is shaped by multiple determinants. Individual factors include age, perceived income adequacy, role ambiguity, role conflict, and psychological resilience, whereas interpersonal factors such as family support and community resources, and system‐level conditions such as total working hours, organizational culture, and work‐related physical strain also play important roles (Widayana et al. 2025).

The consequences of WLB are wide‐ranging. At the individual level, it is associated with well‐being, life and family satisfaction, emotional exhaustion, mental and physical health, anxiety, depressive symptoms, motivation, and stress‐related indicators. At the organizational level, WLB is linked to job satisfaction, job performance, turnover intention, job stress, affective commitment, organizational citizenship behavior, and employee engagement (Zahra et al. 2024). Maintaining WLB among nurses is therefore essential not only for nurses and their families, but also for patient safety and quality of care (Li et al. 2025; Widayana et al. ²⁰²⁵; Yang et al. ²⁰²⁵). Nevertheless, the literature indicates that the full range of factors influencing nurses' WLB has not been comprehensively examined, and investigating both individual and organizational determinants remains an important research priority (Hujová et al. 2025; Widayana et al. ²⁰²⁵).

In recent years, growing attention has focused on a specific organizational factor that may threaten nurses' WLB: citizenship behaviors that are formally voluntary but, in practice, are perceived as compulsory due to organizational pressure (Chen et al. 2023; Neves and Andrade ²⁰²¹; Sajuyigbe et al. ²⁰²²). The negative effects of such compulsory citizenship behavior (CCB), and the resulting citizenship fatigue (CF), on psychological well‐being and WLB have attracted increasing scholarly interest. Extra‐role behaviors expected from nurses under implicit organizational demands may constitute a notable psychosocial risk, contributing to higher CF and undermining WLB.

1.1. Background

This study is grounded in Conservation of Resources (COR) theory. COR theory posits that individuals possess finite resources such as time, energy, and psychological capacity and are motivated to acquire, protect, and accumulate these resources. Actual or threatened loss of resources generates stress, contributes to burnout, and can damage long‐term well‐being. When resources are progressively depleted under ongoing demands, a “resource loss spiral” may occur, leading individuals to adopt defensive strategies such as withdrawal, reduced role engagement, or limiting voluntary effort to protect remaining resources. In nursing, demands for compulsory extra‐role activities not only deplete tangible resources such as time and energy, but may also trigger this loss spiral by undermining autonomy, perceived fairness, and a sense of control (Hobfoll 1989, 2002).

1.2. Compulsory Citizenship Behavior

CCB refers to performing extra‐role activities beyond formal job descriptions not out of personal willingness, but in response to direct or implicit pressure or coercive social and organizational expectations from managers or influential colleagues. It has been described as a darker form of organizational behavior that gradually depletes employees' energy in favor of organizational demands, at the cost of personal well‐being (Vigoda‐Gadot ²⁰⁰⁶, ²⁰⁰⁷). Meta‐analytic findings suggest that although compulsory citizenship behavior may appear as a short‐term “extra contribution,” over time it is harmful, negatively affecting employee well‐being and organizational effectiveness (Yildiz et al. 2023).

Research has demonstrated that CCB is positively associated with a range of adverse outcomes both for employees and organizations, including unproductive work behaviors, burnout, work‐related stress, resentment toward the organization, organizational cynicism, disengagement, turnover intention, social loafing, moral disengagement, and work–family conflict (Ahmed 2022; Chaudhary et al. ²⁰²³; Chen et al. ²⁰²³; Neves and Andrade ²⁰²¹; Sajuyigbe et al. ²⁰²²; Yildiz et al. ²⁰²³). In contrast, it has been found to be negatively associated with work–life balance (Sajuyigbe et al. 2022), contextual performance (Hung et al. 2022), well‐being (He et al. 2022), and job performance (Song et al. 2023). CCB has been shown to reduce nurses' subjective vitality (Elibol et al. 2025) and to increase silence behaviors (Guo et al. 2026; Li et al. ²⁰²⁵), social loafing (Yildiz and Elibol 2021), job stress (Unaldi Baydin et al. 2020), turnover intention (Selçuk and Harmancı‐Seren ²⁰²⁴; Yildiz and Elibol ²⁰²¹), citizenship fatigue (Nisar et al. 2024), and anger toward the organization and moral disengagement (Yildiz et al. 2022). To the best of current knowledge, no studies have directly examined the effect of CCB on work‐family balance within the nursing literature. From a COR perspective, such behaviors deplete nurses' key resources, including time and emotional and physical energy, and may further disrupt work–life balance by reducing autonomy, perceived fairness, and a sense of control.

1.3. Citizenship Fatigue

CF is defined as a condition with both affective and cognitive dimensions, arising when individuals feel exhausted, strained, or tense and attribute these feelings to extra responsibilities or discretionary behaviors beyond their formal job roles (Bolino et al. 2015). Employees experiencing CF often report frustration and a sense of being undervalued, perceiving that their additional efforts are not adequately recognized (Bolino et al. 2015). Empirical evidence suggests that such fatigue can negatively influence psychological well‐being, opportunities for self‐development, organizational commitment, and voluntary behaviors, while increasing turnover intentions (Karadeniz 2025; Karadeniz et al. ²⁰²³; Zugay ²⁰²¹). There is also evidence that CF is associated with greater work–family conflict and disturbances in work–life balance (Neves and Andrade 2021; Suhail et al. ²⁰²⁴). For instance, Fuller (2024) found that in contexts with high citizenship pressure, fatigue increased among employees attempting to manage both challenge and hindrance stressors, while Neves and Andrade (2021) showed that CCB significantly increases fatigue, with employees experiencing mental and physical exhaustion as they assume additional tasks under pressure. Although both voluntary and CCB may contribute to fatigue, research indicates that compulsory behaviors are more potent triggers (Haldorai et al. 2025). To date, only one study has examined the relationship between CCB and citizenship fatigue within the nursing literature (Nisar et al. 2024).

From a COR perspective, CF emerges when resource loss due to CCB exceeds any potential replenishment. Under these circumstances, extra‐role behaviors are no longer perceived as investments but as efforts that yield minimal return. The additional time and energy devoted to work diminish resources that could otherwise be allocated to family and personal life, intensifying tension between work and home roles and fostering a persistent perception that work dominates life.

The body of research on CCB in nursing remains limited. Few studies have explicitly examined its impact on work–family conflict or WLB among nurses; most investigations have been conducted in non‐nursing populations such as police officers, teachers, and private‐sector employees (Chaudhary et al. 2023; He et al. ²⁰²²; Sajuyigbe et al. ²⁰²²). Moreover, to date, no studies in nursing have simultaneously examined CCB, CF, and WLB within a single conceptual model grounded in COR theory. Although studies in other sectors have explored the relationship between CCB and CF and the mediating role of CT in work–family or work–life outcomes, their findings are not entirely consistent.

In nursing contexts, examining these three variables together is essential for understanding nurses' psychological well‐being, their WLB, and the sustainability of the nursing workforce. Accordingly, this study aims to examine the effect of CCB on WLB and to evaluate the mediating role of CF within a COR‐based conceptual framework. The conceptual model (Figure 1) proposes that as nurses assume additional tasks under pressure, their time, energy, and autonomy resources are gradually depleted, leading to higher CF, which in turn negatively affects WLB.

FIGURE 1.

The conceptual model of the study.

2. Methods

2.1. Aim

This study aimed to examine the relationships between compulsory citizenship behavior, citizenship fatigue, and work–life balance among nurses.

2.2. Design and Research Hypotheses

This study used a cross‐sectional correlational design to examine relationships between CCB, CF, and WLB among nurses. The STROBE reporting method, which is one of the EQUATOR guidelines, was followed.

Research Questions:

Is there a negative relationship between compulsory citizenship behavior (CCB) and work–life balance among nurses?

Is there a positive relationship between CCB and citizenship fatigue (CF) among nurses?

Is there a negative relationship between CF and work–life balance among nurses?

Does citizenship fatigue mediate the relationship between CCB and work–life balance among nurses?

2.3. Setting and Sample

Eligible participants were (1) employed at the study hospital, (2) had at least 1 year of experience in the same institution, and (3) provided voluntary consent. The target population consisted of 860 nurses. All eligible nurses were invited to participate, and participation was voluntary, yielding a convenience sample. Of the 518 questionnaires returned, 19 were excluded due to uniform response patterns or substantial missing data, resulting in 499 usable questionnaires. The response rate was 60.23%, and the final sample represented 58.02% of the target population. The final sample of 499 nurses was considered sufficient to test the study hypotheses. Post hoc sensitivity power analysis, assuming a two‐tailed test with a significance level of α = 0.05 and the observed correlations, indicated that the study had over 95% power to detect effects of approximately medium magnitude (around d = 0.30), suggesting that the sample size was adequate for identifying medium and large relationships.

2.4. Data Collection Tools

Data were gathered using a structured questionnaire comprising four sections: a Nurse Information Form, the Compulsory Citizenship Behavior Scale, the Citizenship Fatigue Scale, and the Work–Life Balance Scale.

2.4.1. Nurse Information Form

The Nurse Information Form included items on socio‐demographic characteristics (age, gender, marital status, education level) and work‐related variables (unit, position, work schedule, years of professional experience).

2.4.2. Compulsory Citizenship Behavior Scale

CCB was assessed with a five‐item, single‐factor scale originally developed by Vigoda‐Gadot (2007) and adapted into Turkish by Harmancı‐Seren and Unaldi Baydin (2017). Items are rated on a five‐point Likert scale ranging from “strongly disagree” (1) to “strongly agree” (5), with higher scores reflecting higher perceived compulsory citizenship behavior. The Turkish version previously showed good internal consistency (Cronbach's α = 0.88); in the present study, Cronbach's α was 0.90.

2.4.3. Citizenship Fatigue Scale

CF was measured using the seven‐item scale developed by Bolino et al. (2015) and translated and validated in Turkish by Şen et al. (2025). Items are scored on a five‐point Likert scale from “strongly disagree” (1) to “strongly agree” (5), and mean scores (range 1–5) indicate the level of citizenship fatigue, with higher values representing greater fatigue. Cronbach's α was 0.92 in the original study and 0.93 in the current sample.

2.4.4. Work–Life Balance Scale

WLB was evaluated with the 17‐item Work–Life Balance Scale developed by Fisher et al. (2009) and adapted into Turkish by Ekinci and Sabancı (2021). The scale comprises four subdimensions: negative effect of life on work, negative effect of work on life, positive effect of life on work, and positive effect of work on life. Items are rated on a five‐point Likert scale from “strongly disagree” (1) to “strongly agree” (5). Higher mean scores indicate a more favorable perception of WLB. In the Turkish validation study, Cronbach's α for the total scale was 0.70, whereas in the present study, internal consistency for the total score was 0.83.

For all scales, mean scores were calculated by summing item scores and dividing by the number of items, yielding values between 1 and 5. Higher scores indicated higher levels of compulsory citizenship behavior, higher citizenship fatigue, and better work–life balance, respectively.

2.5. Validity, Reliability, and Rigor

Construct validity for all three instruments was re‐examined in the present sample using confirmatory factor analysis (CFA), in addition to the internal consistency coefficients reported above. Composite reliability (CR) and average variance extracted (AVE) were calculated for each construct, and discriminant validity was assessed using the Fornell–Larcker criterion. A Harman single‐factor test was also conducted to evaluate common method bias (see Section 2.7).

The Compulsory Citizenship Behavior Scale (Vigoda‐Gadot ²⁰⁰⁷; Harmancı‐Seren and Unaldi Baydin ²⁰¹⁷) is a one‐dimensional, five‐item measure. The original development study reported a Cronbach's α of 0.83 (Vigoda‐Gadot ²⁰⁰⁷); the Turkish adaptation study, conducted with 233 nurses, reported α = 0.88, with item–total correlations ranging from 0.61 to 0.77 and a confirmatory factor analysis supporting the single‐factor structure (χ²/df = 1.40, RMSEA = 0.042, GFI = 0.99, AGFI = 0.96, CFI = 0.99). Confirmatory factor analysis in the present sample (n = 499) supported the one‐factor structure of the scale. Modification indices indicated two theoretically interpretable residual covariances—between the two items referring to being required to perform unrewarded, out‐of‐role duties, and between the two items referring to perceived pressure to help a colleague or supervisor without adequate time or energy—which were allowed in the model. With these covariances specified, model fit reached good levels (χ²/df = 2.71, CFI = 0.997, TLI = 0.990, RMSEA = 0.059), with standardized factor loadings ranging from 0.62 to 0.90. Composite reliability was 0.88 and AVE was 0.60, both exceeding the recommended thresholds (CR ≥ 0.70; AVE ≥ 0.50) and supporting convergent validity. Internal consistency in the present sample was α = 0.90, consistent with the Turkish adaptation study.

The Citizenship Fatigue Scale (Bolino et al. 2015; Şen et al. ²⁰²⁵) is a one‐dimensional, seven‐item measure. The Turkish validation study (Şen et al. 2025), conducted with 320–348 nurses, reported a single‐factor structure explaining 68.4% of the variance, factor loadings of 0.62–0.88, and a Cronbach's α of 0.929; the CFA in that study showed good fit (χ²/df = 2.05, CFI = 0.99, RMSEA = 0.076). In the present sample, the single‐factor CFA likewise showed good fit (χ²/df = 6.80, CFI = 0.970, TLI = 0.956, GFI = 0.966, AGFI = 0.948, RMSEA = 0.108), with standardized factor loadings ranging from 0.64 to 0.90. Composite reliability was 0.93 and AVE was 0.67, supporting convergent validity. Internal consistency was α = 0.93, matching the value reported in Section 2.4.3.

The Work–Life Balance Scale (Fisher et al. 2009; Ekinci and Sabancı ²⁰²¹) comprises 17 items across four correlated subdimensions: negative effect of work on life (IYOSE, 5 items), negative effect of life on work (YIOSE, 6 items), positive effect of work on life (IYOLE, 3 items), and positive effect of life on work (YIOLE, 3 items). The Turkish adaptation study (n = 203 teachers) supported this four‐factor structure via exploratory and confirmatory factor analysis (CFA: χ²/df = 1.57, RMSEA = 0.053, CFI = 0.98, GFI = 0.91, AGFI = 0.87) and reported subdimension reliabilities of 0.70–0.87. In the present sample, the four‐factor CFA showed acceptable fit (χ²/df = 3.79, CFI = 0.942, TLI = 0.931, GFI = 0.924, AGFI = 0.908, RMSEA = 0.075), with standardized loadings ranging from 0.57 to 0.91 across the four subdimensions. Composite reliability ranged from 0.81 (IYOLE) to 0.91 (YIOSE), and AVE ranged from 0.60 (IYOLE) to 0.70 (YIOLE), all exceeding recommended thresholds. Discriminant validity was supported using the Fornell–Larcker criterion: the square root of AVE for each subdimension (0.77–0.84) exceeded its correlation with every other subdimension (≤ 0.53), indicating that the four dimensions were empirically distinct. Internal consistency for the total scale was α = 0.83 (Section 2.4.4); subdimension alphas ranged from 0.81 to 0.91. Detailed CFA fit indices, internal consistency, composite reliability, and average variance extracted for all three instruments are presented in Table 1.

TABLE 1.

Confirmatory factor analysis fit indices, standardized factor loading ranges, internal consistency (Cronbach's α), composite reliability (CR), and average variance extracted (AVE) for the study instruments (n = 499).

Construct	k	Loading range	χ2/df	RMSEA	CFI	TLI	GFI	AGFI	α	CR	AVE
CCB (1‐factor)	5	0.62–0.90	2.71	0.059	0.997	0.990	0.995	0.984	0.90	0.88	0.60
CF (1‐factor)	7	0.64–0.90	6.80	0.108	0.970	0.956	0.966	0.948	0.93	0.93	0.67
WLB – IYOSE	5	0.67–0.88	—	—	—	—	—	—	0.91	0.91	0.66
WLB – YIOSE	6	0.57–0.91	—	—	—	—	—	—	0.91	0.91	0.64
WLB – IYOLE	3	0.64–0.85	—	—	—	—	—	—	0.81	0.81	0.60
WLB – YIOLE	3	0.81–0.88	—	—	—	—	—	—	0.88	0.88	0.70
WLB (4‐factor model, overall)	17	—	3.79	0.075	0.942	0.931	0.924	0.908	0.83	—	—

Note: The CCB model includes two theoretically interpretable residual covariances (see Section 2.5). CR and AVE were computed from standardized factor loadings of each one‐factor (CCB, CF) or four‐factor (WLB) confirmatory model. The four WLB subdimensions were estimated jointly within a single correlated four‐factor model; the overall fit indices reported in the last row pertain to this combined model. Discriminant validity among the four WLB subdimensions was supported by the Fornell–Larcker criterion (the square root of AVE for each subdimension, 0.77–0.84, exceeded its correlation with every other subdimension, ≤ 0.53).

Abbreviations: CCB, compulsory citizenship behavior scale; CF, citizenship fatigue scale; IYOLE, positive effect of work on life; IYOSE, negative effect of work on life; k, number of items; WLB, work–life balance scale; YIOLE, positive effect of life on work; YIOSE, negative effect of life on work.

Taken together, these findings confirm the psychometric adequacy of the Compulsory Citizenship Behavior Scale, the Citizenship Fatigue Scale, and the Work–Life Balance Scale in the present sample, supporting their use in the subsequent correlational, regression, and mediation analyses.

2.6. Data Collection

Data were collected from nurses working in a public hospital in İstanbul (Türkiye) between August 1, 2025, and September 20, 2025. After approval from nursing administration, unit charge nurses were informed about the study, and questionnaires were distributed in sealed envelopes during periods of relatively lower workload. Nurses completed the questionnaires independently and returned them in sealed envelopes; no identifying data (e.g., names, email addresses) were collected. Because the study was conducted in a single institution over a defined time period, generalizability to other settings may be limited. To enhance representativeness, data collection was extended across different shifts and post leave returns, and repeated visits were made to each unit.

2.7. Common Method Bias

Several procedural safeguards were implemented to minimize common method bias. The questionnaire provided clear instructions, avoided overly complex or ambiguous wording, and emphasized anonymity, confidentiality, and the absence of right or wrong answers to encourage honest responses.

Potential common method bias was also examined statistically. Harman's single‐factor test was conducted by entering all items into an exploratory factor analysis with a single‐factor solution using principal axis factoring. The first factor accounted for 31.69% of the total variance, which is below the commonly cited 50% threshold for concern about substantial common method bias. These findings suggest that the measures were not dominated by a single common factor and that the constructs under study were empirically distinct.

2.8. Generative Artificial Intelligence and AI‐Assisted Technologies

Artificial intelligence–based tools were used to support language refinement and structural editing of the manuscript. The authors verified all AI‐assisted outputs, take full responsibility for the content, and confirm that no AI tools were used to generate or manipulate the study data or results.

2.9. Data Analysis

Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were computed as means and standard deviations for continuous variables and as frequencies (n) and percentages (%) for categorical variables. The distributional properties of continuous variables were assessed with skewness–kurtosis indices and visual inspection of histograms and normality plots.

Bivariate relationships between continuous variables were examined using Pearson correlation coefficients. Group differences were analyzed using independent samples t‐tests for comparisons between two groups and one‐way analysis of variance (ANOVA) for comparisons across three or more groups. Effect sizes were calculated as Cohen's d for t‐tests and eta‐squared (η ²) for ANOVA.

Hierarchical linear regression analyses were conducted to investigate multivariate associations between compulsory citizenship behavior, citizenship fatigue, and work–life balance. Age, gender, marital status, education level, and years of professional experience were entered as control variables in all models. Regression models were estimated using the enter method; model fit was assessed using R ² and F statistics. Multicollinearity was evaluated via variance inflation factors (VIF), and the independence of residuals was checked using the Durbin–Watson statistic.

The mediating role of citizenship fatigue in the relationship between compulsory citizenship behavior and work–life balance was tested using Model 4 of the PROCESS macro for SPSS (Version 4.2). Indirect effects were estimated with 5000 bootstrap resamples, and mediation was considered statistically significant if the 95% confidence interval for the indirect effect did not include zero. All mediation models controlled for age, gender, marital status, education level, and years of professional experience. All tests were two‐tailed, and p values < 0.05 were taken as statistically significant.

2.10. Ethical Considerations

The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the University of Health Sciences Türkiye, Hamidiye Non‐Interventional Scientific Research Ethics Committee (Meeting date: July 17, 2025; Decision No. 2025/15; Resolution No. 15/20). Permission to use the Turkish versions of the measurement scales was obtained from the authors of the adaptation studies. Participants were informed on the first page of the questionnaire about the purpose of the study, the voluntary nature of participation, and the confidentiality and anonymity of their responses, and written informed consent was obtained from all nurses who agreed to participate.

3. Results

3.1. Participant Characteristics

A total of 499 nurses were included in the analysis. Mean professional experience was 6.61 years (SD = 7.5). The mean age was 29.2 years (SD = 7.2). Most participants were female (84.0%) and single (67.3%). The majority held a bachelor's degree (77.4%), and 9.2% had completed postgraduate education. In terms of work schedules, 68.5% worked shifts and 31.5% worked regular daytime hours. Most respondents were clinical nurses (88.4%), whereas 11.6% occupied managerial positions (Table 2).

TABLE 2.

Socio‐demographic characteristics of the nurses (n = 499).

Variables	n (%)	Mean (SD)
Age		29.21 (7.20)
Professional experience		6.61 (7.5)
Sex
Female	419 (84.0)
Male	80 (16.0)
Marital status
Married	336 (67.3)
Single	163 (32.7)
Education
High school	37 (7.4)
Associate degree	30 (69.0)
Bachelor's degree	386 (77.4)
Master's degree	46 (9.2)
Work schedule
Day	157 (31.5)
Shifts	342 (68.5)
Work position
Clinical nurse	441 (88.4)
Nurse manager	58 (11.6)

Abbreviation: SD, standard deviation.

3.2. Descriptive Statistics and Correlations

Mean scores on the Compulsory Citizenship Behavior Scale, the Citizenship Fatigue Scale, and the Work–Life Balance Scale, together with standard deviations and Cronbach's alpha coefficients, are presented in Table 3. Internal consistency was acceptable for all measures. Age was not significantly associated with CCB, CF, or WLB (all p > 0.05). CF showed a strong positive correlation with compulsory citizenship behavior (r = 0.645, p < 0.001). WLB was negatively and significantly correlated with both citizenship fatigue (r = −0.497, p < 0.001) and compulsory citizenship behavior (r = −0.442, p < 0.001) (Table 3).

TABLE 3.

Score statistics for the scales used in the study (n = 499).

Variables	Mean (SD)	Range scores	Skewness	Kurtosis	Cronbach's alpha	Age	CF	CCB
Age	29.21 (7.20)	20–62	—	—	—	—
CF	3.10 (0.97)	1–5	−0.05	−0.38	0.93	0.019
CCB	3.35 (0.97)	1–5	−0.19	−0.56	0.90	0.041	0.645***
WLB	3.03 (0.58)	1–5	−0.11	0.78	0.83	0.058	−0.497*	−0.442***

Note: Values below the diagonal represent Pearson correlation coefficients. *p < 0.05. ***p < 0.001.

Abbreviations: CCB, compulsory citizenship behavior; CF, citizenship fatigue; SD, standard deviation; WLB, work–life balance.

3.3. Differences in Study Variables by Participant Characteristics

Gender‐based comparisons showed no statistically significant differences between female and male nurses in CF (t = 0.81, p = 0.421, d = 0.11), CCB (t = 0.32, p = 0.750, d = 0.04), or work–life balance (t = 1.42, p = 0.158, d = 0.21) (Table 4).

TABLE 4.

Comparison of nurses' mean scores on compulsory citizenship behavior, organizational citizenship fatigue, and work–life balance by descriptive characteristics (n = 499).

Variables	CF	CCB	WLB
	Mean (SD)	Mean (SD)	Mean (SD)
Sex
Female	3.36 (0.93)	3.10 (0.93)	3.05 (0.54)
Male	3.25 (1.18)	3.06 (1.20)	2.93 (0.73)
t/p‐value	0.81/0.421	0.32/0.750	1.42/0.158
Cohen's d	0.11	0.04	0.21
Marital status
Single	3.28 (0.98)	3.03 (1.02)	3.04 (0.59)
Married	3.48 (0.94)	3.22 (0.87)	3.01 (0.55)
t/p‐value	−2.23/0.026*	−2.05/0.041*	0.55/0.580
Cohen's d	0.21	0.20	0.05
Education
High school	3.04 (0.96)	3.19 (1.00)	3.05 (0.53)
Associate degree	2.95 (1.05)	3.55 (1.10)	3.12 (0.60)
Baccalaureate degree	3.11 (0.98)	3.35 (0.95)	3.00 (0.57)
Master's degree	3.11 (0.95)	3.33 (1.06)	3.21 (0.62)
F/p‐value	0.77/0.510	0.31/0.818	2.09/0.101
η 2	0.005	0.002	0.013
Work schedule
Day	3.22 (0.91)	2.95 (0.86)	3.19 (0.49)
Shifts	3.40 (1.00)	3.16 (1.02)	2.96 (0.60)
t/p‐value	−1.96/0.050	−2.28/0.023*	4.68/< 0.001
Cohen's d	0.18	0.22	0.42
Work position
Clinical nurse	3.36 ± 0.97	3.11 ± 0.99	2.99 ± 0.58
Nurse manager	3.26 ± 1.01	3.00 ± 0.83	3.32 ± 0.46
t/p‐value	0.68/0.498	0.82/0.412	−4.90/< 0.001
Cohen's d	0.09	0.11	0.57

Note: *p < 0.05.

Abbreviations: CCB, compulsory citizenship behavior; CF, citizenship fatigue; F, one‐way ANOVA test; r, Pearson correlation test; SD, standard deviation; t, Student's t‐test; WLB, work–life balance.

Marital status analyses revealed that married nurses reported higher CF (t = −2.23, p = 0.026, d = 0.21) and higher compulsory citizenship behavior (t = −2.05, p = 0.041, d = 0.20) than single nurses. WLB did not differ significantly by marital status (t = 0.55, p = 0.580, d = 0.05) (Table 4).

One‐way ANOVA showed no significant differences by education level for CF (F = 0.77, p = 0.510, η ² = 0.005), CCB (F = 0.31, p = 0.818, η ² = 0.002), or WLB (F = 2.09, p = 0.101, η ² = 0.013), with Bayes factors close to 1, suggesting weak evidence for between‐group differences (Table 4).

Comparisons by work schedule indicated that nurses working shifts reported higher CF (t = −1.96, p = 0.050, d = 0.18) and higher CCB (t = −2.28, p = 0.023, d = 0.22) than nurses working regular daytime hours. In contrast, daytime workers had significantly higher WLB scores (t = 4.68, p < 0.001, d = 0.42) (Table 4).

Position‐based analyses showed that nurses in managerial roles reported higher CCB compared with clinical nurses (t = −4.90, p < 0.001, d = 0.57). No significant differences were observed between managers and clinical nurses in CF (p = 0.498, d = 0.09) or CCB (p = 0.412, d = 0.11). Detailed group comparisons are provided in Table 4.

3.4. Regression Analysis

Multivariate hierarchical linear regression was conducted to explore the relationships between CCB, CF, and WLB (Table 5). In Model 1 (path a), after adjusting for age, gender, marital status, education level, and years of professional experience, CCB was a positive and statistically significant predictor of CF (B = 0.641, SE = 0.034, p < 0.001), explaining 42.0% of the variance in CF (R ² = 0.420).

TABLE 5.

Hierarchical regression models examining the associations between compulsory citizenship behavior, organizational citizenship fatigue, and work–life balance (n = 499).

Variables	CF (a path)			WLB (c path)			WLB (b & c' paths)
	Model 1			Model 2			Model 3
	B	SE	p	B	SE	p	B	SE	p
Constant	3.298	0.345	< 0.001	4.016	0.196	< 0.001	4.304	0.190	< 0.001
Age	−0.007	0.011	0.531	−0.003	0.006	0.540	−0.003	0.005	0.547
Sex (2 vs. 1)	−0.101	0.119	0.398	−0.134	0.063	0.033*	−0.151	0.060	0.012*
Marital status (1 vs. 2)	0.229	0.104	0.027*	−0.037	0.055	0.502	−0.013	0.052	0.807
Educational background	0.012	0.066	0.855	0.023	0.035	0.521	0.020	0.033	0.543
Duration of professional experience	0.004	0.013	0.758	0.016	0.007	0.018*	0.014	0.006	0.026*
CCB	0.641	0.034	< 0.001	−0.267	0.024	< 0.001	−0.130	0.029	< 0.001
CF							−0.214	0.029	< 0.001
R 2	0.420			0.219			0.295
ΔR 2	—			0.219			0.076
F	59.41			22.98			29.31
p	< 0.001			< 0.001			< 0.001
Durbin Watson test	1.93			1.84			1.87

Note: Understanardized coefficients (B) are raported. All models adjusted for age, sex, marital status, education, and professional experience (N = 499). Sex: 1 = male, 2 = female; marital status: 1 = married, 2 = single. *p < 0.05.

Abbreviations: CCB, compulsory citizenship behavior; CF, organizational citizenship fatigue; WLB, work–life balance.

In Model 2 (path c), controlling for the same covariates, CCB was negatively and significantly associated with WLB (B = −0.267, SE = 0.024, p < 0.001). This model accounted for 21.9% of the variance in WLB (R ² = 0.219) (Table 5).

In Model 3 (paths b and c'), inclusion of CF increased the explained variance in WLB to 29.5% (R ² = 0.295). Within this model, CF was a negative and significant predictor of WLB (B = −0.214, SE = 0.029, p < 0.001), and the effect of CCB on WLB decreased in magnitude but remained significant (B = −0.130, SE = 0.029, p < 0.001). Assumptions regarding linearity, multicollinearity, and independence of residuals were met in all models (Table 5).

3.5. Mediation Analysis

The mediating role of CF in the relationship between CCB and WLB was further examined using Hayes' PROCESS macro (Model 4), with age, gender, marital status, education level, and years of professional experience entered as covariates. Figure 2 presents the path coefficients for the mediation model, and Table 5 presents the estimates for the total, direct, and indirect effects.

FIGURE 2.

The mediating effect of citizenship fatigue on the relationship between compulsory citizenship behavior among nurses and work–life balance.

In the first step, CCB exerted a strong positive effect on CF (path a: B = 0.64) (Table 6).

TABLE 6.

Results of the mediation model bootstrap analysis (n = 499).

Structural effects	Citizenship fatigue			p	Work–life Balance			p
	B	SE	LLCI–ULCI		B	SE	LLCI–ULCI
Compulsory citizenship behavior (c path, total effect)					−0.26	0.02	[−0.31; −0.20]	< 0.001
Compulsory citizenship behavior (a path)	0.64	0.03	[0.57;0.71]	< 0.001
Compulsory citizenship behavior (c' path, direct effect)					−0.12	0.03	[−0.19; −0.05]	0.001
Citizenship fatigue (b path)					−0.21	0.03	[−0.28; −0.14]	< 0.001
Indirect effect (a*b)					−0.13	0.02	[−0.18; −0.09]	< 0.001

Abbreviations: B, unstandardized effect; LLCI, lower limit confidence interval; SE, standard error; ULCI, upper limit confidence interval.

In the second step, CF was negatively associated with WLB when controlling for CCB (path b: B = −0.21). The total effect of CCB on WLB was negative (path c: B = −0.2669, 95% CI [−0.3216, −0.2121]). When CF was added to the model, the direct effect of CCB decreased but remained statistically significant (path c': B = −0.1296, 95% CI [−0.1978, −0.0613]) (Table 6).

The indirect effect of CCB on WLB through CF was statistically significant; the bootstrap 95% confidence interval for the indirect effect (a × b = −0.1373) did not include zero. Overall, these findings indicate that citizenship fatigue partially mediates the relationship between compulsory citizenship behavior and work–life balance among nurses (Table 6).

4. Discussion

This study examined the relationships among nurses' CCB, CF, and WLB and specifically explored the mediating role of CF in these relationships. The findings indicated that nurses reported moderate levels of CCB and CF, and that WLB was also at a moderate level. Increases in CCB and CF were associated with decreases in WLB, with CF partially mediating the relationship between CCB and WLB.

4.1. Levels of Compulsory Citizenship Behavior, Citizenship Fatigue, and Work–Life Balance

In this study, nurses' CCB levels were moderate, consistent with previous research among healthcare professionals and other occupational groups (Selçuk and Harmancı‐Seren ²⁰²⁴; Yildiz et al. ²⁰²²; Chen et al. ²⁰²³). These variations across studies suggest that CCB is a context‐sensitive construct shaped by organizational culture, management style, workload, and broader national or cultural factors. CF was likewise found to be at a moderate level. Although studies focusing specifically on nurses remain limited, research in other sectors has reported low (He et al. 2024; Qiu et al. ²⁰²⁰), moderate (Karadeniz 2025; Zugay et al. ²⁰²⁵), or high levels (De Clercq et al. 2021) of CF, indicating that CF is influenced both by contextual conditions and by the intensity and nature of citizenship pressure.

WLB in the present sample was also moderate. This aligns with earlier studies of nurses' WLB (e.g., Yadav ²⁰²⁵), whereas some research has reported lower levels (e.g., Widayana et al. ²⁰²⁵) and others higher levels (e.g., Matrafi et al. ²⁰²⁵). Taken together, these findings suggest that nurses' perceptions of WLB are closely linked to factors such as the work environment, shift patterns, organizational support policies, and cultural expectations surrounding family and caregiving roles.

4.2. Compulsory Citizenship Behavior and Work–Life Balance

A key finding of this study is that nurses' CCB has a significant negative effect on WLB. Higher levels of CCB were associated with a reduced ability to maintain a healthy balance between professional and personal life. Evidence from other occupational groups similarly shows that compulsory or coercive citizenship behaviors can increase work–family conflict, disrupt work–life balance, and impair employees' ability to fulfill family responsibilities (Ahmed 2022; Banwo and Du ²⁰²⁰; Chaudhary et al. ²⁰²³; Chen et al. ²⁰²³; Liang and Wang ²⁰²⁴; Neves and Andrade ²⁰²¹).

From a Conservation of Resources (COR) perspective, involuntary extra‐role tasks increase the time and energy devoted to work, gradually depleting resources such as time, energy, and psychological capacity that could otherwise be allocated to family, social life, or personal care (Liang and Wang 2024; Qin and Zhang ²⁰²⁴; Liu et al. ²⁰¹⁷). As a result, opportunities for rest and personal activities are reduced, and nurses' ability to invest in their private lives diminishes. Over time, this imbalance fosters a perception that work consistently dominates life, leading to a distorted sense of work–life balance.

4.3. Compulsory Citizenship Behavior and Citizenship Fatigue

The study also showed that higher levels of CCB were associated with a significant increase in CF. This is consistent with prior research in various sectors that has documented a positive relationship between CCB and CF (Nisar et al. 2024; Neves and Andrade ²⁰²¹; Suhail et al. ²⁰²⁴). CCB can deplete employees' energetic resources by increasing emotional burnout (Liang et al. 2022) and reducing subjective vitality (Elibol et al. 2025). For nurses, this means that both physical and emotional energy are heavily consumed when they face additional tasks beyond their formal job roles.

In the nursing context, this finding is particularly important. Care work is labor‐intensive, emotionally demanding, and often time‐pressured, placing considerable strain on already limited resources. Under these conditions, extra responsibilities beyond the formal role frequently feel mandatory, which may lead nurses to experience citizenship fatigue more rapidly and intensely than workers in many other sectors. Over time, this reduces their capacity to sustain organizational citizenship behaviors and poses a significant risk to their psychological well‐being.

Another key finding is that CF negatively affects WLB, highlighting its mediating role in the relationship between CCB and WLB. As CF increases, nurses' ability to maintain equilibrium between professional and personal life declines, suggesting that CF is not only an expression of work‐related burnout but also a source of tension that extends into other life domains. This result is supported by prior literature: Neves and Andrade (2021) reported that CF mediates the relationship between CCB and work–family conflict among elderly care professionals, while Netchaeva et al. (2023) found that CF negatively affects personal relationships and the quality of spousal interaction. Qiu et al. (2020) similarly showed that employees who engage in organizational citizenship behavior voluntarily and intrinsically experience less fatigue and fewer negative consequences than those who feel coerced. Suhail et al. (2024) also demonstrated that CCB affects work–family conflict through CF, resulting in energy and motivation loss that directly contributes to imbalance.

In the present study, multivariate modeling indicated that CF partially mediates the relationship between CCB and WLB. Including CF in the model reduced the direct effect of CCB on WLB, but the association remained statistically significant. Bootstrap analyses confirmed a significant indirect effect, showing that CCB negatively affects WLB both directly and indirectly through increased CF. While similar mediation pathways have been reported in non‐nursing samples, this study uniquely examines the CCB–CF–WLB mechanism in a nursing workforce within a single COR‐based framework. It underscores CF as a central mechanism: resource loss initiated by CCB is amplified through CF, further limiting the resources that nurses can devote to family, social life, and personal care, thereby contributing to work–life imbalance.

4.4. Limitations

This study has several limitations. First, it was conducted in a single public hospital, so the findings may not be generalizable to all nurses or to other healthcare settings. Second, the cross‐sectional design does not allow for firm conclusions regarding causality between the study variables. Third, because the number of nursing studies addressing these constructs is still limited, the discussion drew on work–family conflict research and evidence from non‐nursing populations, which may reduce the contextual specificity of some interpretations.

Future research could adopt multi‐center designs across diverse healthcare settings (e.g., public, private, and university hospitals) with larger and more heterogeneous samples to improve generalizability. Examining these relationships in different countries and cultural contexts would also help clarify the global relevance of the findings. Longitudinal studies and alternative methodological approaches could better capture the causal dynamics among CCB, CF, and WLB over time. Moreover, incorporating a wider range of individual and organizational variables could provide a more nuanced understanding of how different factors interact to shape CCB, CF, and WLB. Finally, reliance on self‐report data may introduce response biases, despite efforts to reduce common method variance.

5. Conclusion

The present study found that higher levels of compulsory citizenship behavior and citizenship fatigue were associated with significant decreases in nurses' perceived work–life balance. Citizenship fatigue partially mediated the relationship between compulsory citizenship behavior and work–life balance, suggesting that compulsory extra‐role demands undermine balance both directly and indirectly through fatigue. These findings indicate that CCB and CF play key roles in shaping nurses' ability to maintain a healthy work–life balance. Compulsory citizenship behaviors deplete core resources such as time and energy, leading to increased CF, which further reduces the resources available for family life, social activities, and self‐care, thereby contributing to work–life imbalance. Interventions aimed at limiting CCB and reducing CF may therefore support nurses in achieving a more sustainable balance between their professional responsibilities and personal lives.

The findings of this study indicate that CCB and CF significantly affect nurses' work–life balance and overall psychological well‐being. While organizational citizenship behaviors can be beneficial, they should remain voluntary; efforts should be made to prevent them from becoming perceived or enacted as mandatory duties. At the practical level, nurse managers should prioritize fair workload distribution, clear communication of organizational expectations, and the encouragement of genuinely voluntary participation in additional roles. Creating a supportive work environment in which extra‐role behaviors are viewed as a “valuable contribution” rather than an obligatory “task burden” may help maintain engagement and motivation while protecting well‐being.

Organizational support, empowerment initiatives, and strategies to enhance psychosocial well‐being should be systematically implemented to prevent or reduce CF. Interventions such as regular supervision or reflection meetings, training to raise awareness about citizenship pressure and fatigue, and constructive feedback mechanisms can strengthen nurses' emotional resilience and organizational commitment. Moreover, flexible shift scheduling, adequate opportunities for rest, and access to employee assistance programs may directly improve WLB and, in turn, the quality of patient care. Routine monitoring of workload, fatigue, and satisfaction at the unit level can further support evidence‐based leadership and informed decision‐making.

The relationship between CCB, CF, and WLB has important implications for nursing and health policy. High levels of CCB and their negative impact on WLB highlight the need for policies that encourage voluntary organizational citizenship behaviors while reducing the sense of obligation among nurses. At the institutional level, healthcare organizations should integrate flexible work models, fair workload management systems, and psychosocial risk assessment procedures into their policies. Units with a high risk of CF may benefit from early warning systems and regular monitoring of behavioral, emotional, and cognitive indicators of fatigue.

Human resources policies should be restructured to prioritize nurses' well‐being. Measures such as flexible scheduling, adequate rest facilities, social support, and access to counseling services can improve job satisfaction and enhance workforce sustainability. Finally, organizational cultures should promote voluntary citizenship behaviors and realistic role expectations to avoid excessive role overload. Policymakers should develop strategies that balance employee health and well‐being with service efficiency, thereby strengthening nurses' job satisfaction and contributing to the delivery of high‐quality, sustainable patient care.

6. Clinical Resources

• International Council of Nurses—International Nurses Day 2025: Our Nurses. Our Future. Caring for nurses strengthens economies. https://www.icn.ch/sites/default/files/2025‐04/ICN_IND2025_report_EN_A4_FINAL_0.pdf.

• International Council of Nurses—Assessing the Global Sustainability of the Nursing Workforce. https://www.icn.ch/sites/default/files/2025‐04/ICN_NNA‐Presidents‐Survey‐Report_EN_FINAL.pdf.

• Lippincott NursingCenter—Maintaining Work–Life Balance Infographic. https://www.nursingcenter.com/ncblog/february‐2016/maintaining‐work‐life‐balance‐infographic.

Funding

The authors have nothing to report.

Ethics Statement

The study was conducted in accordance with the principles of the Declaration of Helsinki. All procedures involving human participants were approved by the Hamidiye Non‐Interventional Scientific Research Ethics Committee of the University of Health Sciences (Meeting Date: July 17, 2025; Decision No. 2025/15; Resolution No. 15/20). Permissions to use the Turkish versions of the scales were obtained from the authors of the original adaptation studies via email. On the first page of the questionnaire, participants were informed about the study's purpose, the voluntary nature of participation, and the confidentiality and anonymity of their responses. Written informed consent was obtained from all nurses who agreed to participate.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.