Abstract
This paper aims to understand the status quo of structural empowerment of clinical nurses and analyze its influencing factors to provide references for optimizing nursing management. A cross-sectional survey of 333 clinical nurses was conducted using the Chinese version of the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II) for Medical Staff and the Psychological Capital Scale. The total score of clinical nurses’ structural empowerment was (57.45 ± 9.28), and the average score of structural empowerment was (3.02 ± 0.49). Multiple linear regression analysis showed that marital status, highest educational background, position, employment method, and mental health training experience were the main influencing factors of nurses’ structural empowerment level (P < .05). Correlation analysis showed that the total score of structural empowerment was significantly positively correlated with the total score of psychological capital (r = 0.449, P < .001). The level of structural empowerment of clinical nurses is at a moderate level and is affected by many factors. Medical institutions and nursing managers should take effective improvement measures according to its influencing factors to improve the level of structural empowerment of clinical nurses, optimize nursing management, and help the development of the nursing career.
Keywords: clinical nurses, current Status, influencing factors, nursing management, psychological capital, structural empowerment
1. Introduction
The State of the World’s Nursing Report 2025 highlights that nurses are an indispensable workforce for advancing health-related Sustainable Development Goals worldwide.[1] Nevertheless, clinical nurses are plagued by heavy workloads, complicated professional environments, and prolonged working hours, resulting in prevalent occupational burnout and turnover intention among nursing staff.[2] Severe loss of nursing human resources not only hinders the improvement of medical service quality but also poses hidden risks to patient safety.[3] Accordingly, exploring organizational management resources and individual psychological resources that can mitigate occupational depletion and stimulate nurses’ intrinsic work motivation, as well as formulating targeted management interventions to improve nurses’ occupational well-being and reduce turnover rates, has become a critical research priority in the field of nursing management.
Structural empowerment, a core organizational management variable derived from Kanter’s empowerment theory and further refined by Laschinger et al, refers to the information channels, organizational support, accessible working resources, career development opportunities, and favorable practice environments provided by nursing managers for nurses.[4] It encompasses 6 dimensions: opportunity, information, support, resources, formal power, and informal power. As an organizational antecedent that optimizes nurses’working conditions and grants nurses autonomous decision-making rights, structural empowerment has been verified by domestic and international studies to exert positive effects on nurses’ proactive work behaviors, clinical nursing environments, team collaboration efficiency and hospital operational performance.[5] It serves as a vital driver to improve nurses’ occupational experience and stabilize the nursing workforce.[6] However, most existing domestic studies on structural empowerment are conducted in medical institutions in central and eastern China, while systematic empirical investigations targeting clinical nurses in tertiary hospitals in Inner Mongolia border areas remain scarce.
Psychological capital describes a positive psychological state formed by individuals through personal growth and career development, consisting of 4 subdimensions: self-efficacy, hope, resilience, and optimism.[7] As core intrinsic psychological resources of nurses, it facilitates nurses’ personal and professional growth and strengthens their comprehensive clinical competence to cope with various workplace stressors.[7] Existing literature has confirmed a positive correlation between structural empowerment and nurses’ positive psychological states: structural empowerment supplies sufficient external organizational resources to nurses and helps them accumulate psychological capital. In turn, nurses with high psychological capital possess stronger emotion regulation and communication capabilities, enabling them to fully utilize organizational resources and authority in clinical practice, forming a mutually reinforcing relationship between the 2 variables.[8] Although the correlation between structural empowerment and psychological capital has been supported by partial research, relevant empirical data lack local samples from ethnic minority regions in Inner Mongolia, and stratified analyses integrated with local nurses’ employment structures, ethnic working contexts and management modes remain largely unexplored.
The Conservation of Resources (COR) theory proposed by Hobfoll provides the fundamental theoretical framework for this study.[9] This theory holds that individuals will take proactive actions to acquire, protect, and sustain valued resources to adapt to changes in external environments, and the gain or loss of resources directly reshapes individuals’ work behaviors and psychological status.[10] From the perspective of COR theory, structural empowerment delivers external organizational resources (information, materials, development opportunities, management authority, etc) to nurses and effectively alleviates resource depletion. Psychological capital represents nurses’ internal psychological resources, and the 2 jointly constitute a dual resource system for nurses to cope with occupational stress. When nurses obtain abundant resources via structural empowerment, their intrinsic psychological resources can be continuously nurtured. Similarly, sufficient psychological capital allows nurses to make better use of resources brought by organizational empowerment.[11] Based on this theory, 2 core hypotheses are proposed in this study: firstly, nurses’ demographic characteristics exert significant impacts on the level of structural empowerment. Secondly, there is a significant positive correlation between clinical nurses’ structural empowerment and psychological capital.
Domestic research on nurses’ structural empowerment is still in the developmental stage, with insufficient integrated exploration of its multidimensional influencing factors, and comprehensive surveys covering demographic characteristics, organizational contexts, and individual psychological variables are relatively limited. Foreign studies mainly focus on the antecedents and outcome variables of structural empowerment, lacking stratified analysis of influencing factors tailored to nursing groups in border ethnic minority areas. Inner Mongolia Autonomous Region has unique organizational and regional healthcare characteristics, including uneven nursing workforce allocation, a predominance of temporary contract staff, and ethnic cultural differences that increase communication complexity – all of which may confound nurses’ subjective perceptions of structural empowerment, making existing research conclusions difficult to directly adapt to local nursing management scenarios. Local empirical data are urgently needed to supplement relevant research. Clarifying the current status of structural empowerment among local clinical nurses, identifying its key influencing factors, and verifying its correlation mechanism with psychological capital can provide theoretical evidence for nursing administrators to formulate context-specific management strategies.
In summary, grounded in COR theory, this cross-sectional study selects clinical nurses from a tertiary general hospital in Inner Mongolia as research subjects. It aims to systematically investigate the current level of structural empowerment among clinical nurses, screen its independent influencing factors, and analyze the correlation between structural empowerment and psychological capital. The findings fill the gap in local research on nurses’ structural empowerment in Inner Mongolia and expand the application scope of COR theory in organizational nursing management. Practically, this study provides empirical references for nursing managers to build a hierarchical and differentiated empowerment management system and simultaneously promote nurses’ psychological development. It can further stimulate nurses’ work initiative, stabilize the nursing talent pool, continuously improve the quality of clinical nursing services, safeguard patient safety, and support the high-quality development of the nursing profession.
2. Materials and methods
2.1. Study design
This study adopted a cross-sectional design and adhered to the checklist of the guidelines for reporting observational descriptive research results (STROBE statement).
2.2. Setting and sample
This study adopted the convenience sampling method. From April to July 2025, convenience sampling was used to select clinical nurses from grade III level A general hospitals in the Inner Mongolia Autonomous Region as the research objects. In China, grade III level A general hospitals represent the highest-tier medical institutions, characterized by comprehensive clinical departments, advanced medical equipment, and a significant responsibility for clinical teaching and research. They are often considered benchmarks for regional healthcare. A total of 1 tertiary A general hospital in the Inner Mongolia Autonomous Region was invited and participated in formal questionnaire distribution. Included clinical departments covered emergency, internal medicine, surgery, gynecology and obstetrics, pediatrics, intensive care units, operating rooms, and outpatient nursing units. This survey did not establish additional exclusion criteria for departmental classification. Inclusion criteria: Possessed a valid Chinese nursing practice license and had a minimum of 1 year of full-time clinical nursing experience. Exclusion criteria: Nurses absent from duty during the survey period (maternity leave, sick leave, personal leave, off-site training), nursing interns, and visiting nurses. All participants provided written informed consent prior to enrollment. Sample size calculation was performed based on the standard that the sample size should be 10 to 20 times the total number of analytical variables (17 demographic variables, 6 CWEQ-II dimensions, 4 psychological capital dimensions).[12] After accounting for a 10% to 20% potential nonresponse rate, the preliminary required sample size ranged from 297 to 648. This study was approved by the Medical Ethics Committee of Inner Mongolia Medical University Affiliated Hospital (Approval No. KY2025126).
2.3. Measures
2.3.1. General information questionnaire
This self-designed questionnaire covered 17 items: gender, age, ethnic groups, marital status, number of children, highest educational background, professional title, position, employment method, work experience, average monthly income, mental health training experience, sleep status, self-rated health status, experience of article publication or patent application, academic conference participation experience, and research project participation experience.
2.3.2. The Chinese version of the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II)
It was originally developed by Lachinger et al[4] and translated into Chinese by Jia.[13] This scale has been widely used to evaluate the level of structural empowerment of nurses in clinical work in China. The scale consists of a total of 19 items, covering 6 dimensions: opportunity, information, support, resources, formal power, and informal power. A higher score indicates a higher level of structural empowerment that nurses receive in the clinical work environment. The content validity of the Chinese version of CWEQ-II is 0.980, and Cronbach coefficient is 0.904, demonstrating excellent reliability and validity. In this study, the Cronbach α of the total CWEQ-II scale was 0.880, which was consistent with previous domestic validation results. The Cronbach α values of each dimension were listed as follows: opportunity (α = 0.709), information (α = 0.796), support (α = 0.753), resources (α = 0.742), formal Power (α = 0.700), and informal Power (α = 0.703). All dimensions achieved acceptable internal consistency; these values met the widely accepted internal consistency standard for nursing research scales.
2.3.3. Chinese Nurses’ Psychological Capital Scale (Chinese version of Nurse Psychological Capital Scale)
It was compiled by Luthans et al,[14] Luo[15] translated and revised it into the Chinese version in 2010. The Chinese version of the Nurse Psychological Capital Scale included 4 dimensions and 20 items, which were self-efficacy, hope, resilience, and optimism. The higher the score, the higher the level of nurses’ psychological capital. The scale exhibited robust reliability and validity. The Cronbach α coefficient of the scale is 0.923, and the test–retest reliability is 0.510 to 0.874. In this study, Cronbach α of the total psychological capital scale was 0.946, which was consistent with previous domestic validation results. The Cronbach α values of each dimension were listed as follows:self-efficacy (α = 0.869), hope (α = 0.872), resilience (α = 0.867), Optimism (α = 0.916). All dimensions of this scale attained favorable internal consistency; these values met the widely accepted internal consistency standard for nursing research scales.
2.4. Data collection
Data were collected via paper-based questionnaires. Prior to the survey, standardized instructions were provided to all participants to explain the purpose and significance of the study. The principles of voluntariness, anonymity, confidentiality, and informed consent were strictly adhered to, and participants were assured that there were no right or wrong answers. To ensure data quality, we implemented the following quality control measures: all items were required to be completed; each participant was permitted to submit only 1 questionnaire; and the completion time was recorded. Any questionnaire with a completion time of less than 3 minutes, or with identical responses across all items (regardless of whether the answers were consistently positive or negative), was excluded from the final analysis. A total of 350 questionnaires were distributed and 333 valid questionnaires were returned, with an effective recovery rate of 95.14%.
2.5. Data analysis
Excel software was used for data entry, and SPSS 27.0 (IBM Corporation) statistical software was used for data analysis. The presence of common method bias was further evaluated using Harman’s single-factor test. Univariate t tests and 1-way analysis of variance (ANOVA) were used to screen demographic variables. Variables with P < .05 were selected as candidate independent predictors. All variables with statistically significant univariate results were simultaneously entered into the regression model via the enter method. Interaction terms were not incorporated into the primary model, as this cross-sectional study primarily aimed to identify independent influencing factors of structural empowerment. Between-group comparisons were conducted via t tests or ANOVA; multiple linear regression analysis was used to identify influencing factors. Pearson correlation analysis was applied to test correlations between continuous variables. The 2-sided significance level was set at α = 0.05.
2.6. Bias control
To minimize potential biases, the following measures were implemented. First, to reduce social desirability bias, all questionnaires were completed anonymously, and participants were explicitly informed in the instructions that there were no right or wrong answers and that they should respond based on their true feelings. Second, to control for self‑selection bias, questionnaires were distributed at different time points and across various work shifts to ensure adequate coverage of nurses in different positions. Third, given that all data were collected through single-time-point self‑report questionnaires, a common method bias test was conducted in the statistical analysis. Throughout the entire survey process, standardized instructions were used, and no leading explanations regarding the questionnaire content were provided by the investigators.
3. Results
Harman’s single-factor test conducted on the combined item pool extracted a first unrotated factor accounting for 31.67% of the total variance, below the 40% threshold conventionally used to indicate substantive common method bias. This indicated that common method bias was not a serious issue in this study.
3.1. Differences in empowerment scores of clinical nurses with different demographic characteristics
To test the hypothesis that “the demographic characteristics of nurses have a significant impact on structural empowerment,” this study initially conducted a 1-way ANOVA of demographic variables. Independent sample t tests and 1-way ANOVA indicated that marital status, highest educational background, position, employment method, average monthly income, mental health training experience, sleep status, self-rated health status, and academic conference participation experience had a significant impact on the level of structural empowerment of clinical nurses (P < .05). Details are shown in Table 1.
Table 1.
Differences in empowerment scores among different demographic characteristics of clinical nurses.
| Variables | Classify | Frequency (%) | Score (M ± SD) | t/F | P-value |
|---|---|---|---|---|---|
| Gender | Male | 44 (13.2) | 55.16 ± 8.63 | −1.766 | .078 |
| Female | 289 (86.8) | 57.80 ± 9.34 | |||
| Age (yr) | ≤25 | 87 (26.1) | 57.07 ± 9.11 | 0.302 | .824 |
| 26–35 | 171 (51.4) | 57.64 ± 9.58 | |||
| 36–45 | 60 (18.0) | 57.03 ± 9.09 | |||
| > 45 | 15 (4.5) | 59.27 ± 8.05 | |||
| Ethnic group | Han | 269 (80.8) | 57.67 ± 9.65 | 0.377 | .686 |
| Mongolian | 56 (16.8) | 56.54 ± 7.35 | |||
| Others | 8 (2.4) | 56.63 ± 9.18 | |||
| Marital status | Unmarried | 129 (38.7) | 55.74 ± 9.22 | 3.954 | .020 |
| Married | 198 (59.5) | 58.45 ± 9.26 | |||
| Divorced or widowed | 6 (1.8) | 61.33 ± 5.79 | |||
| Number of children | 0 | 144 (43.2) | 56.34 ± 9.19 | 2.382 | .094 |
| 1 | 142 (42.6) | 58.70 ± 9.45 | |||
| ≥2 | 47 (14.1) | 57.09 ± 8.76 | |||
| Highest educational background | College or below | 64 (19.2) | 55.02 ± 8.29 | 3.158 | .044 |
| Bachelor’s degree | 252 (75.7) | 57.90 ± 9.39 | |||
| Master’s degree or above | 17 (5.1) | 59.94 ± 9.97 | |||
| Professional title | Nurse | 135 (40.5) | 56.59 ± 8.81 | 2.160 | .093 |
| Nurse practitioner | 78 (23.4) | 56.86 ± 8.54 | |||
| Nurse in charge | 102 (30.6) | 58.27 ± 10.56 | |||
| Associate chief nurse and above | 18 (5.4) | 61.89 ± 6.63 | |||
| Position | Nurse | 320 (96.1) | 57.15 ± 9.26 | −3.028 | .003 |
| Nursing manager | 13 (3.9) | 65.00 ± 6.31 | |||
| Employment method | Contract | 245 (73.6) | 58.26 ± 9.26 | 4.150 | .017 |
| Staff establishment | 78 (23.4) | 55.60 ± 9.13 | |||
| Others | 10 (3.0) | 52.20 ± 7.80 | |||
| Work experience (yr) | ≤5 | 105 (31.5) | 56.84 ± 9.46 | 0.479 | .751 |
| 6–10 | 99 (29.7) | 57.80 ± 7.88 | |||
| 11–15 | 91 (27.3) | 57.18 ± 10.76 | |||
| 16–20 | 24 (7.2) | 58.29 ± 9.49 | |||
| > 20 | 14 (4.2) | 60.00 ± 6.55 | |||
| Average monthly income (yuan) | ≤3999 | 58 (17.4) | 53.95 ± 9.74 | 3.663 | .013 |
| 4000–5999 | 131 (39.3) | 57.83 ± 7.72 | |||
| 6000–7999 | 117 (35.1) | 58.74 ± 10.37 | |||
| ≥8000 | 27 (8.1) | 57.59 ± 8.85 | |||
| Mental health training experience | No | 165 (49.5) | 54.34 ± 8.32 | −6.426 | .000 |
| Yes | 168 (50.5) | 60.51 ± 9.18 | |||
| Sleep status | Normal | 260 (78.1) | 58.27 ± 9.07 | 4.690 | .010 |
| Insomnia | 38 (11.4) | 54.24 ± 11.43 | |||
| Other conditions | 35 (10.5) | 54.91 ± 7.01 | |||
| Self-rated health status | Good | 225 (67.6) | 58.48 ± 9.47 | 4.956 | .008 |
| General | 91 (27.3) | 55.76 ± 8.90 | |||
| Poor | 17 (5.1) | 53.00 ± 5.82 | |||
| Experience of article publication or patent application | No | 257 (77.2) | 57.07 ± 9.41 | −1.403 | .162 |
| Yes | 76 (22.8) | 58.76 ± 8.76 | |||
| Academic conference participation experience | No | 164 (49.2) | 56.02 ± 8.69 | −2.809 | .005 |
| Yes | 169 (50.8) | 58.85 ± 9.64 | |||
| Research project participation experience | No | 283 (85.0) | 57.10 ± 9.20 | −1.663 | .097 |
| Yes | 50 (15.0) | 59.46 ± 9.56 |
M = mean, SD = standard deviation.
3.2. Score of structural empowerment of clinical nurses
The total score of structural empowerment of clinical nurses was (57.45 ± 9.28), and the average score of items was (3.02 ± 0.49), which was at a moderate level compared to the theoretical mean (3.00). The average scores of the 6 dimensions in descending order are as follows: opportunity dimension, formal power dimension, support dimension, resources dimension, informal power dimension, and information dimension. The scores of each dimension are shown in Table 2.
Table 2.
Clinical nurses’ structural empowerment and scores of each dimension (N = 333).
| Variables | Items | Score (M ± SD) | Item average score (M ± SD) |
|---|---|---|---|
| Structural empowerment | 19 | 57.45 ± 9.28 | 3.02 ± 0.49 |
| Opportunity | 3 | 9.83 ± 2.05 | 3.28 ± 0.68 |
| Information | 3 | 8.71 ± 2.24 | 2.90 ± 0.75 |
| Support | 3 | 9.15 ± 2.03 | 3.05 ± 0.68 |
| Resources | 3 | 8.78 ± 2.14 | 2.93 ± 0.71 |
| Formal power | 3 | 9.27 ± 1.96 | 3.09 ± 0.65 |
| Informal power | 4 | 11.71 ± 2.65 | 2.93 ± 0.66 |
M = mean, SD = standard deviation.
3.3. Multiple linear regression analysis of influencing factors of structural empowerment of clinical nurses
To further verify the hypothesis that nurses’ demographic characteristics significantly affect structural empowerment and identify its influencing factors, multiple linear regression was performed. Clinical nurses’ structural empowerment scores served as the dependent variable, and 9 statistically significant variables derived from univariate analyses were entered into the regression model as independent variables. The assignment of these independent variables is detailed in Table 3. Multiple linear regression revealed 5 independent predictors of structural empowerment total scores (P < .05). The overall regression model was statistically significant (F = 16.065, P < .001), with R = 0.444, R2 = 0.197, and adjusted R2 = 0.185, indicating these predictors collectively explained 18.5% of the variance in structural empowerment. Predictors were ranked by standardized effect size (absolute β): mental health training experience (β = 0.285), employment method (β = −0.213), marital status (β = 0.159), position (β = 0.150), and highest educational background (β = 0.120). The collinearity analysis revealed that all tolerance values were <1, and all variance inflation factor values were below 10, indicating no multicollinearity among the variables and demonstrating robust model stability. The details are shown in Table 4.
Table 3.
Method of variable assignment.
| Independent variable | Assignment |
|---|---|
| Marital status | Unmarried = 1, married = 2, divorced or widowed = 3 |
| Highest educational background | College or below = 1, bachelor’s degree = 2, master’s degree or above = 3 |
| Position | Nurse = 1, nursing manager = 2 |
| Employment method | Contract = 1, staff establishment = 2, others = 3 |
| Average monthly income (yuan) | ≤3999 = 1, 4000–5999 = 2, 6000–7999 = 3, ≥8000 = 4 |
| Mental health training experience | No = 1, yes = 2 |
| Sleep status | Normal = 1, insomnia = 2, other conditions = 3 |
| Self-rated health status | Good = 1, general = 2, poor = 3 |
| Academic conference participation experience | No = 1, yes = 2 |
Table 4.
Multiple linear regression analysis of influencing factors of structural empowerment of clinical nurses.
| Independent variables | B | SE | 95% CI for B | Beta | t-value | P-value | Collinearity statistics | |
|---|---|---|---|---|---|---|---|---|
| Tolerance | VIF | |||||||
| (constant) | 41.920 | 4.289 | 33.483, 50.357 | – | 9.775 | <.001 | ||
| Marital status: | 2.845 | 1.112 | 0.657, 5.032 | 0.159 | 2.558 | .011 | 0.915 | 1.093 |
| Highest educational background: | 2.353 | 1.060 | 0.268, 4.437 | 0.120 | 2.220 | .027 | 0.899 | 1.113 |
| Position: | 7.163 | 2.497 | 2.251, 12.075 | 0.150 | 2.869 | .004 | 0.915 | 1.093 |
| Employment method: | −3.819 | 0.932 | −5.654, −1.985 | −0.213 | −4.097 | <.001 | 0.918 | 1.089 |
| Mental health training experience | 5.285 | 0.996 | 3.326, 7.244 | 0.285 | 5.308 | <.001 | 0.954 | 1.048 |
R = 0.444, R2 = 0.197, adjusted R2 = 0.185, F = 16.065, P < .001.
CI = confidence interval, VIF = variance inflation factor.
3.4. Correlation analysis of structural empowerment and psychological capital of clinical nurses
To further test the hypothesis of a positive correlation between structural empowerment and psychological capital, Pearson correlation analyses were performed for the total psychological capital score, overall structural empowerment score, and its 6 dimensions of clinical nurses. Pearson correlation analysis revealed a significant positive correlation between overall structural empowerment and psychological capital (r = 0.449, 95% CI [0.361, 0.529], P < .001), supporting the hypothesis. See Table 5 for details.
Table 5.
Correlation analysis of structural empowerment and psychological capital in clinical nurses.
| Structural empowerment | Opportunities | Information | Support | Resources | Formal power | Informal power | |
|---|---|---|---|---|---|---|---|
| Psychological capital (r) | 0.449 |
0.058 |
0.279 |
0.357 |
0.419 |
0.323 |
0.442 |
| P | <.001 | .294 | <.001 | <.001 | <.001 | <.001 | <.001 |
4. Discussion
4.1. Analysis of the current status of structural empowerment of clinical nurses
The results of this study showed that the total score of structural empowerment of clinical nurses was (57.45 ± 9.28), and the average score of structural empowerment was (3.02 ± 0.49), which was at a moderate level.[16] In this study, we adopted the conventional categorization for the CWEQ‑II item‑mean score (range 1–5), where scores ≥ 3.5 indicate a high level, 2.5 to 3.4 a moderate level, and <2.5 a low level, consistent with prior Chinese nursing studies.[17] Accordingly, the observed mean of 3.02 suggests that the current state of structural empowerment in this sample is at a moderate level. This was consistent with the research results of Fu et al,[18] Tan et al,[19] Shen et al[20] but lower than those of Wang et al,[21] which was consistent with the reality of current nursing work with high pressure and relatively tight resources.
Each dimension score: the informal power dimension obtained the highest score (11.71 ± 2.65). This was consistent with the research results of Bao et al[22] and Meng et al.[23] Informal power primarily refers to the interpersonal relationships between nurses and other healthcare workers. A higher score in this dimension indicates that nurses have relatively good interpersonal relationships with their colleagues, which may be associated with close collaboration and communication among nurses. The information dimension scored the lowest (8.71 ± 2.24), which is consistent with the research findings of Liu et al[24] and Dong et al.[25] This indicates a relative deficiency in information acquisition, potentially associated with the lack of transparency in the hospital management system and impeded information transmission among organizational members.[26] Enhancing information transparency and accessibility serves as a crucial entry-point for optimizing structural empowerment.
4.2. Analysis of influencing factors of structural empowerment of clinical nurses
Ranked by standardized regression coefficients (β), the 5 independent predictors contributed to the total structural empowerment score in the following order: mental health training experience (β = 0.285), employment method (β = −0.213), marital status (β = 0.159), position (β = 0.150), and highest educational background (β = 0.120). Combined with subgroup Cohen d effect size analyses, mental health training (d = −0.70) and employment method (d = −0.56) should serve as primary intervention targets. Position (d = 0.45) and marital status (d = 0.32) should be prioritized for targeted interventions (|d| ≈ 0.30–0.50). Highest educational background (d = −0.32, |d| < 0.40), although demonstrating a smaller effect size, was statistically significant and also warrants due attention. Detailed analyses are presented below.
4.2.1. Marital status
The results showed that marital status was an independent influencing factor for structural empowerment among clinical nurses. Unmarried nurses had significantly lower total structural empowerment scores than married nurses (β = 0.159, d = 0.32, P < .05), suggesting that unmarried nurses represent a group with relatively weak perceptions of structural empowerment. Most unmarried nurses are in the early stages of their careers and have limited clinical experience, which places them at a disadvantage in terms of organizational integration within their departments, access to organizational support, and availability of work resources, ultimately contributing to lower levels of structural empowerment.[27] It is recommended that nursing administrators implement stratified support strategies with a specific focus on young unmarried nurses. These strategies may include one‑on‑one preceptorship, regular counseling sessions to actively listen to their work‑related concerns, provision of dedicated participation opportunities for young nurses in departmental quality improvement initiatives and nursing care discussions, and gradual delegation of work autonomy based on individual competence. Such measures can help build organizational trust and continuously enhance their ability to access resources, thereby narrowing the gap in empowerment perceptions between nurses of different marital statuses. Longitudinal multicenter intervention studies are needed to quantify the magnitude of improvements in structural empowerment after implementing targeted support for unmarried nurses.
4.2.2. Highest educational background
The results demonstrated that the highest educational background was an independent predictor of structural empowerment. Nurses with a bachelor’s degree or higher scored significantly higher on structural empowerment than those with a junior college degree or below (β = 0.120, d = −0.32, P < .05). Nurses with higher education have received more systematic and standardized professional training,[28] possess more comprehensive knowledge reserves and stronger critical thinking skills, and are therefore more likely to gain recognition from managers and receive greater work autonomy. Healthcare institutions should continuously support nursing staff in pursuing continuing education and introduce long‑term incentive policies.[29] Specific measures include providing special subsidies for degree advancement, offering tuition reimbursement and reasonable shift adjustments to accommodate study time for nurses pursuing higher degrees on the job, and establishing regular academic exchange platforms to support less‑educated nurses in accessing specialized training and academic conferences. It should be noted, however, that empirical evidence is currently lacking regarding whether educational incentive policies can effectively improve nurses’ perceptions of structural empowerment. Future quasi‑experimental studies are warranted to further verify the actual effects of such interventions.
4.2.3. Position
The results indicated that position was an independent influencing factor for structural empowerment. Nurses holding managerial positions had significantly higher structural empowerment scores than those without such positions (β = 0.150, d = 0.45, P < .05). There are marked differences in resource access channels and work autonomy across different job positions. Zang[30] proposed that appropriate job promotion can enhance nurses’ perceptions of structural empowerment and facilitate the implementation of empowerment systems. It is advisable for healthcare institutions to develop diversified career development pathways for nursing professionals, rather than relying solely on administrative positions to achieve empowerment. A competency‑based tiered empowerment system should be established, for clinical nurses without administrative roles but with outstanding clinical expertise, specific work authorities – such as specialized nursing, quality control, and new staff preceptorship – should be granted.[31] Additionally, non‑administrative positions such as specialist nurses and team leaders can be created, allowing excellent clinical nurses to obtain corresponding autonomy and resource support without holding formal managerial posts.
4.2.4. Employment method
The results showed that employment method was an independent predictor of structural empowerment. Contract‑based nurses scored significantly lower on structural empowerment than their permanently employed counterparts (β = −0.213, d = −0.56, P < .05). The unequal distribution of resources and unequal development opportunities resulting from different employment statuses contribute to weaker organizational belonging among contract nurses and hinder their equal access to organizational resources. Healthcare institutions should break down employment‑status barriers and establish a fair and unified empowerment evaluation mechanism that uses professional competence and work performance as the primary criteria for granting authority.[32] All nurses, regardless of employment type, should have equal access to continuing education quotas, research grant applications, and internal promotion channels. Moreover, the eligibility criteria for participation in departmental management and nursing innovation projects should be standardized across different employment categories, thereby enhancing contract nurses’ sense of organizational belonging.
4.2.5. Mental health training experience
The results revealed that mental health training experience was an independent influencing factor for structural empowerment. Nurses who had participated in mental health training reported higher levels of structural empowerment (β = 0.285, d = −0.70, P < .05). Mental health training helps nurses acquire communication skills, facilitates the establishment of trust with colleagues, patients, and families, and effectively resolves nurse‑patient conflicts and team communication issues, thereby enabling them to better utilize the various authorities granted by the organization in their daily work.[33] Nursing administrators should regularly implement tiered mental health training programs that cover communication techniques and emotion regulation for all nursing staff. Hospitals may incorporate such training into departmental routine learning plans and include training participation in comprehensive departmental performance evaluations. In addition, integrated online and offline psychological support channels should be established to provide ongoing counseling and mental health support for nurses. By improving nurses’ psychological well‑being and communication competence, the positive effects of structural empowerment can be fully realized.[34]
4.3. Correlation between structural empowerment and psychological capital of clinical nurses
This study identified a moderate positive correlation between structural empowerment and psychological capital (r = 0.449, 95% CI [0.361, 0.529], P < .001), consistent with international and domestic published literature. According to Cohen widely recognized effect size criteria, correlation coefficients ranging from 0.3 to 0.5 represent moderate associations, which is consistent with the research findings of Dwyer[35] and Wang et al.[36] Structural empowerment provides nurses with organizational resources, including information, support, development opportunities, and material resources. Adequate organizational resources help nurses cope with workplace stress, alleviate occupational strain, cultivate positive psychological resources, and promote the accumulation of psychological capital.[35] Conversely, nurses with higher levels of psychological capital possess stronger emotion‑regulation and communication skills, enabling them to better utilize the authority and resources granted by the organization in their clinical work.[36] This positive reciprocal relationship suggests that nursing administrators should not enhance structural empowerment or psychological capital in isolation, but rather develop an integrated and comprehensive intervention strategy.[37] On the one hand, efforts should be made to continuously optimize the nursing practice environment, improve intra‑hospital information‑sharing mechanisms, and ensure that nurses receive adequate organizational support, clinical resources, and decision‑making autonomy, thereby comprehensively enhancing their perceptions of structural empowerment.[38] On the other hand, routine mental health training, emotional counseling, and psychological support services should be implemented to foster positive psychological qualities among nurses.[39] Nursing administrators may combine one‑on‑one career guidance, tiered empowerment management, and routine psychological support to simultaneously improve nurses’ ability to access organizational resources and their psychological resilience. Future longitudinal intervention studies are warranted to verify whether combined interventions targeting both structural empowerment and psychological capital can yield sustained positive effects for clinical nurses.
5. Conclusion
Clinical nurses in this single-center sample demonstrated a moderate level of structural empowerment. Marital status, highest educational background, position, employment method, and mental health training experience were identified as significant independent predictors of structural empowerment. In addition, structural empowerment was positively correlated with psychological capital, indicating that nurses who perceived higher levels of structural empowerment tended to possess more abundant positive psychological resources. These findings offer practical reference points for nursing administrators and healthcare institutions. Differentiated management strategies should be developed for those with lower perceived structural empowerment, including balanced resource allocation, equitable distribution of authority, active promotion of continuing education and academic support, improved transparent internal information-sharing mechanisms, and the cultivation of a supportive team climate grounded in mutual trust and recognition. Such measures not only facilitate nurses’ individual career development, stabilize the nursing workforce, and advance high‑quality nursing practice, but also hold significant implications for ensuring patient safety and enhancing the overall quality of medical services. Elevating the level of structural empowerment among nurses contributes to nursing system reform, improves nurses’ work‑related well‑being and job satisfaction, reduces turnover rates, and is also of great importance for improving clinical nursing quality, promoting patient recovery, and optimizing patient outcomes.
6. Limitations
This study has several limitations. First, the cross-sectional design can only confirm a correlational relationship between structural empowerment and psychological capital, and cannot establish causal pathways between them. Second, potential sampling bias cannot be fully quantified in this research. We did not record subgroup response rates stratified by department, shift type, and employment status. Accordingly, we cannot verify whether nurses working night shifts, staff from specific departments, or contract nurses demonstrated lower participation rates and were underrepresented within the sample, which constitutes a notable limitation of this study. Third, convenience sampling was adopted, and the sample consisted solely of nurses from a single tertiary general hospital in Inner Mongolia, which limits the generalizability of the findings. Future research could employ multicenter longitudinal designs combined with in-depth qualitative interviews to further elucidate the mechanisms and underlying pathways through which structural empowerment affects clinical nurses.
Acknowledgments
The researchers thank all the participants for their valuable time in this study. We are also grateful to the hospital and nursing administrators for their support and assistance during the study.
Author contributions
Conceptualization: Wei Zhao, Fei Guo, Wen-Nv Hao.
Data curation: Wei Zhao, Wen-Nv Hao.
Formal analysis: Wei Zhao, Wen-Nv Hao.
Investigation: Wei Zhao, Fei Guo, Wen-Nv Hao.
Methodology: Wei Zhao, Fei Guo, Wen-Nv Hao.
Project administration: Wen-Nv Hao.
Resources: Wei Zhao, Wen-Nv Hao.
Software: Wei Zhao, Wen-Nv Hao.
Validation: Wei Zhao, Wen-Nv Hao.
Writing – original draft: Wei Zhao.
Writing – review & editing: Wei Zhao, Fei Guo, Wen-Nv Hao.
Abbreviations:
- ANOVA
- analysis of variance
- COR
- Conservation of Resources Theory
- CWEQ-II
- the Chinese version of Conditions for Work Effectiveness Questionnaire-II
- M =
- mean
- SD
- standard deviation
- SE
- standard error
- STROBE
- strengthening the reporting of observational studies in epidemiology
- VIF
- variance inflation factor.
In this study, we were performed in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Hospital of Inner Mongolia Medical University (Number: KY2025126). All participants adhered to ethical principles and voluntarily participated in this study. This was done through an anonymous survey, and the survey data were used for academic research purposes only, and not for other commercial purposes.
The authors have no funding and conflicts of interest to declare.
The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.
How to cite this article: Zhao W, Guo F, Hao W-N. Analysis of the current status and influencing factors of structural empowerment among clinical nurses: A cross-sectional study. Medicine 2026;105:36(e50504).
Contributor Information
Wei Zhao, Email: 1784955812@qq.com.
Fei Guo, Email: 2781723579@qq.com.
References
- [1].World Health Organization. State of the world’s nursing 2025: investing in education, jobs, leadership and service delivery. World Health Organization; 2025. Available from: https://iris.who.int/handle/10665/381329. Accessed April 8, 2026. [Google Scholar]
- [2].Alruwaili MM. Workplace violence as an occupational hazard in psychiatric nursing: burnout, quality of life, and turnover intentions in Saudi Arabia. Healthcare (Basel). 2026;14:2190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Mossadeghrad MA, Dargahi H, Rashidi QAN, et al. Nurse turnover intention in university hospitals in Iran. BMC Nurs. 2026;25:745. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Laschinger HK, Finegan J, Shamian J, Wilk P. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter’s model. J Nurs Adm. 2001;31:260–72. [DOI] [PubMed] [Google Scholar]
- [5].Garcia-Sierra R, Fernandez-Castro J. Relationships between leadership, structural empowerment, and engagement in nurses. J Adv Nurs. 2018;74:2809–19. [DOI] [PubMed] [Google Scholar]
- [6].Yuan Z, Zhang X, Wang F, et al. Levels of psychological capital among nurses: a systematic review and meta-analysis. Int Nurs Rev. 2023;70:89–96. [DOI] [PubMed] [Google Scholar]
- [7].Wang X, Qin Y, Mao Q, Wang J. Psychological contract, psychological capital, career plateau, and job embeddedness among early-career nurses: a serial mediation model. Front Psychol. 2026;17:1822548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Silén M, Skytt B, Engström M. Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff. Geriatr Nurs. 2019;40:67–71. [DOI] [PubMed] [Google Scholar]
- [9].Hobfoll SE. Conservation of resources. A new attempt at conceptualizing stress. Am Psychol. 1989;44:513–24. [DOI] [PubMed] [Google Scholar]
- [10].Egozi Farkash H, Lahad M, Hobfoll SE, Leykin D, Aharonson-Daniel L. Conservation of resources, psychological distress, and resilience during the COVID-19 pandemic. Int J Public Health. 2022;67:1604567. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [11].Baek EB, Bae SH. Relationship between a university hospital nurses’ structural empowerment and quality of nursing work life: mediating effect of psychological empowerment. J Health Info Stat. 2022;47:159–66. [Google Scholar]
- [12].Huang ML, Li C, Ge W, et al. A comparative study on evaluation methods of sample representativeness for clinical research. Chin J Health Stat. 2024;41:167–74. [Google Scholar]
- [13].Jia T. Investigation of clinical nurses’ work empowerment, self-efficacy and job control[D]. Chengdu: Sichuan University; 2007. [Google Scholar]
- [14].Luthans F, Youssef CM. Emerging positive organizational behavior. J Manage. 2007;33:321–49. [Google Scholar]
- [15].Luo H, He ZH. Reliability and validity analysis of the psychological capital questionnaire in the nurse population. Chin J Behav Med Brain Sci. 2010;19:853–54. [Google Scholar]
- [16].Alanazi KA, Traynor M, McFetridge L, et al. Linking transformational leadership to patient care quality: the role of structural empowerment and registered nurses’ clinical leadership. J Nurs Manag. 2026:e7518764. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Kadosh E, Rozani V. Impact of leadership style and structural empowerment on nursing group power in ICU settings: a cross-sectional study. Nurs Crit Care. 2025;30:e70140. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Fu LL. Study on adversity quotient, structural empowerment and innovative behavior of nurses in traditional Chinese medicine hospitals based on structural equation and latent class[D]. Anhui: Anhui University of Chinese Medicine; 2024. [Google Scholar]
- [19].Tan L, Lu Y, Tian T, et al. Mediating effect of perceived career benefit between structural authorization and innovative behavior in infusion nurses. J Nurs. 2021;28:58–62. [Google Scholar]
- [20].Shen X, Bu H, Zhang J, et al. The dual roles of empathy in mediating structural empowerment and compassion fatigue among Chinese nurses. BMC Nurs. 2024;23:837. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Wang YY, Zheng XY, Dong X, et al. Structural equation model of the impact of transformational leadership style and structural empowerment on nurse-physician collaboration. J Nurs Adm. 2022;22:77–82. [Google Scholar]
- [22].Bao L, Zhang YQ, Wu JM, et al. Correlation study on nurses’ structural empowerment and psychological empowerment. Nurs J Chin PLA. 2012;29:1–4. [Google Scholar]
- [23].Meng XL, Zhang PL, Gao HY. An investigation into structural and psychological empowerment among EICU nurses. Today Nurse. 2019;26:58. [Google Scholar]
- [24].Liu ZH, Zhu YH, Li X, et al. The mediating effect of structural empowerment on the relationship between nurse leadership and work engagement. J Nurs Adm. 2024;24:206–10. [Google Scholar]
- [25].Dong N, Zhang L, Gan YJ, et al. Impact of psychological empowerment and structural empowerment on nurses’ organizational commitment. Nurs J Chin PLA. 2014;31:15–8. [Google Scholar]
- [26].Tian Q. Influence of structural and psychological empowerment on job crafting of community nurses. J Nurs Sci. 2020;35:95–97 + 109. [Google Scholar]
- [27].Sarikose S, Celik SS. Structural and psychological empowerment among newly graduated nurses and related factors: a mixed methods study. J Adv Nurs. 2024;80:2917–28. [DOI] [PubMed] [Google Scholar]
- [28].Abdullatif I. Influences of structural empowerment and demographic factors on nurses’ psychological empowerment. J Nurs Manag. 2023:8827968. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [29].Li F, Feng Y, Lou J, et al. Mediating effect of organizational silence on the relationship between structural empowerment and occupational gain sense among emergency nurses. Psych Month. 2026;21:43–6. [Google Scholar]
- [30].Zang M. The Relationship between Structural Empowerment and Work Engagement among Nurses[D]. Shenyang: Liaoning University Of Traditional Chinese Medicine; 2024. [Google Scholar]
- [31].Li B, Chen J, Howard N. Organizational position and structural empowerment in Chinese community nursing: an interpretive case study. J Nurs Manag. 2025;3611018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [32].Mustafa C, Harun S. Relationship between authentic leadership, service quality, organizational commitment and work engagement: testing a moderated mediation model. Leadersh Organ Dev J. 2025;46:185–98. [Google Scholar]
- [33].Huang L, Zeng D, Huang Y. Application research of health education based on empowerment theory in self-management of patients with traumatic brain injury. JCMP. 2026;8:269–74. [Google Scholar]
- [34].Wang LJZ, Li P, Dang X. Mediating effect of psychological empowerment between structural empowerment and moral distress of nurses in infection department. Occup Health. 2023;39:1522–28. [Google Scholar]
- [35].Dwyer AP, Revell HMS, Sethares AK, et al. The influence of psychological capital, authentic leadership in preceptors, and structural empowerment on new graduate nurse burnout and turnover intent. Appl Nurs Res. 2019;48:37–44. [DOI] [PubMed] [Google Scholar]
- [36].Wang L, Wang XX, Jin XL, et al. Relationship between structural empowerment, innovative behavior, self-efficacy and career success among cardiology nurses from six grade-A tertiary hospitals in Sichuan Province. Occup Health. 2023;39:1929–34. [Google Scholar]
- [37].Zhang YN, Ye ZH. Verification for the best model of the influence path of structural empowerment and psychological capital on nurses’ work engagement. Chin J Nurs Res. 2021;35:2900–3. [Google Scholar]
- [38].Liao R, Liu Y. The impact of structural empowerment and psychological capital on competence among Chinese baccalaureate nursing students: a questionnaire survey. Nurse Educ Today. 2016;36:31–6. [DOI] [PubMed] [Google Scholar]
- [39].Yang D, Pan HY, Xu YH, et al. Mediating effect of psychological capital between structural empowerment and work engagement for diabetes specialist nurses. J Nurs Rehabil. 2023;22:11–5. [Google Scholar]