The Protective Ceiling: A Mixed Methods Study of Work Meaning, Resilience, and Burnout Among Chinese Nurses
##plugins.pubIds.doi.readerDisplayName##:
https://doi.org/10.67148/fahss-2026-211关键词:
Nurse burnout; work meaning; psychological resilience; protective ceiling; mixed methods; China摘要
Background. The global nursing workforce crisis is intensified in China by collective cultural values, steep organizational hierarchies, and persistently high workloads. While the Job Demands-Resources (JD-R) model posits that personal resources such as work meaning and psychological resilience buffer job demands, this protective effect appears limited in rigid, resource-constrained healthcare systems. Most prior research has been conducted in Western settings, leaving unexplained the paradox of high personal resources coexisting with severe burnout among nurses in East Asian institutional contexts.
Objectives. This study aimed to examine the "protective ceiling"—a boundary condition of the JD-R model under which structural constraints redirect personal resources from protective buffering to performance maintenance. Specifically, it sought to identify the structural and psychological mechanisms that limit resource efficacy, clarify how hierarchy and failed recovery systems erode protective function, and generate evidence for context-specific interventions that move beyond individual resilience training toward structural reform.
Methods. An exploratory sequential mixed-methods design was employed. In the quantitative phase, 70 registered nurses from a primary-level private hospital in southwestern China completed the Meaning in Work Scale (MIW), the Maslach Burnout Inventory—Human Services Survey (MBI-HSS), and the Connor-Davidson Resilience Scale (CD-RISC). Data were analyzed using descriptive statistics and Pearson product-moment correlation. In the qualitative phase, seven nurses were purposively selected using extreme-case sampling to represent distinct positions on the meaning-burnout and resilience-burnout continua. Semi-structured interviews were analyzed using thematic analysis following Braun and Clarke's six-phase framework to explain the quantitative paradox.
Results. Nurses reported high work meaning (M = 3.64, SD = 1.08) and high psychological resilience (M = 3.55, SD = 1.03), yet also high overall burnout (M = 3.69) marked by severe emotional exhaustion (M = 4.10). Work meaning and resilience were negatively correlated with burnout (r = −0.694 and r = −0.666, p < 0.001), yet absolute scores indicated paradoxical coexistence. Qualitative analysis revealed three mechanisms forming the protective ceiling: (1) structural constraints and professional identity conflicts, including hierarchical friction, educational stratification, and cultural-economic tension; (2) psychological depletion masked by continued functioning, encompassing existential exhaustion, moral trauma, and physiological manifestations; and (3) failure of recovery mechanisms, characterized by career-stage inequity, pseudo-recovery behaviors, and gendered barriers to genuine restoration.
Conclusion. and Impact. The protective ceiling advances JD-R theory by specifying structural boundary conditions where personal resources are structurally captured for institutional performance maintenance rather than individual health protection. For nursing management and health policy, this implies that sustainable practice requires a three-tier intervention framework: Tier 1 structural deconstruction (reducing non-clinical administrative burden, establishing shared governance, enforcing protected nurse-to-patient ratios); Tier 2 institutional recovery mechanisms (mandatory digital disconnection protocols, trauma-informed supervision, narrative documentation systems); and Tier 3 mutual support systems (interdisciplinary peer networks, cross-hierarchical mentorship). Interventions focused solely on strengthening individual resilience risk intensifying the protective ceiling by enhancing performance capacity without dismantling the structural barriers that convert such capacity into additional unrewarded labor.
参考
[1] World Health Organization. State of the world’s nursing 2020: investing in education, jobs and leadership[R]. Geneva: World Health Organization, 2020. https://www.who.int/publications/i/item/9789240003279
[2] Garmy P. Why is it important how the nursing profession is perceived[J]. J Res Nurs, 2025.
[3] Saparniene D, Strukcinskiene B, Mineviciute G, et al. Working environment of health care professionals: focus on occupational stress[J]. Ann Agric Environ Med, 2023, 30(4): 721-728.
[4] Demerouti E, Bakker A B, Nachreiner F, et al. The job demands-resources model of burnout[J]. J Appl Psychol, 2001, 86(3): 499-512.
[5] Bakker A B, Demerouti E. Job demands-resources theory: taking stock and looking forward[J]. J Occup Health Psychol, 2017, 22(3): 273-285.
[6] Steger M F, Dik B J, Duffy R D. Measuring meaningful work: the work and meaning inventory (WAMI)[J]. J Career Assess, 2012, 20(3): 322-337.
[7] Creswell J W, Creswell J D. Research design: qualitative, quantitative, and mixed methods approaches[M]. 6th ed. Thousand Oaks: SAGE Publications, 2023.
[8] von Elm E, Altman D G, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies[J]. Ann Intern Med, 2007, 147(8): 573-577.
[9] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups[J]. Int J Qual Health Care, 2007, 19(6): 349-357.
[10] Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses[J]. Behav Res Methods, 2009, 41(4): 1149-1160.
[11] Cohen J. Statistical power analysis for the behavioral sciences[M]. 2nd ed. Hillsdale: Lawrence Erlbaum Associates, 1988.
[12] Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability[J]. Field Methods, 2006, 18(1): 59-82.
[13] Maslach C, Jackson S E. The measurement of experienced burnout[J]. J Organ Behav, 1981, 2(2): 99-113.
[14] Maslach C, Jackson S E, Leiter M P. Maslach burnout inventory[M]. 3rd ed. Palo Alto: Scarecrow Education, 1997.
[15] Connor K M, Davidson J R. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC)[J]. Depress Anxiety, 2003, 18(2): 76-82.
[16] Braun V, Clarke V. Using thematic analysis in psychology[J]. Qual Res Psychol, 2006, 3(2): 77-101.
[17] Wang X, Fu F, Gan A, et al. Psychological status of healthcare workers in the post-COVID 19 period in China: a retrospective multicentric cross-sectional study[J]. Front Psychiatry, 2025, 16: 1520361.
[18] Zhao Y, Zhang X, Zheng Z, et al. Burnout among junior nurses: the roles of demographic and workplace relationship factors, psychological flexibility, and perceived stress[J]. J Nurs Manag, 2023, 2023: 9475220.
[19] Nunnally J C, Bernstein I H. Psychometric theory[M]. 3rd ed. New York: McGraw-Hill, 1994.
[20] Xia W, Defang W, Xiaoli G, et al. Compassion satisfaction and compassion fatigue in frontline nurses during the COVID-19 pandemic in Wuhan, China[J]. J Nurs Manag, 2022, 30(7): 2537-2548.
[21] Cohen J. Statistical power analysis for the behavioral sciences[M]. 3rd ed. New York: Routledge, 2013.
[22] Bakker A B, Demerouti E, Sanz-Vergel A. Job demands-resources theory: ten years later[J]. Annu Rev Organ Psychol Organ Behav, 2023, 10(1): 25-53.
[23] Hobfoll S E. Social and psychological resources and adaptation[J]. Rev Gen Psychol, 2002, 6(4): 307-324.
[24] Akoo C, McMillan K, Price S, et al. “I feel broken”: chronicling burnout, mental health, and the limits of individual resilience in nursing[J]. Nurs Inq, 2024, 31(2): e12609.
[25] Long Z, Marshall-McKelvey K, Matter M M. Material precarity, performative imperative, and burnout from resilience: surfacing the dark side of resilience laboring in women’s entrepreneurial stories[J]. J Appl Commun Res, 2024, 52(2): 179-198.
[26] Kennedy L, Brom H, Lasater K B, et al. Advanced Practice Registered Nurse burnout in Magnet hospitals: opportunities for organizational intervention[J]. J Nurs Adm, 2025, 55(4): 230-236.
[27] Huang Z P, Huang F, Liang Q, et al. Socioeconomic factors, perceived stress, and social support effect on neonatal nurse burnout in China: a cross-sectional study[J]. BMC Nurs, 2023, 22(1): 218.
[28] Hanh L N D, Borromeo A R, Palaganas E C. Exploring the lived experiences of working female nursing students in a private university in Ho Chi Minh, Vietnam: a phenomenological study[J]. Philipp J Nurs, 2025, 95(1).
[29] Elshikh M. Mitigating burnout: identifying risk factors and effective strategies for enhancing nurses’ well-being[D]. Vaasa: Vaasa University of Applied Sciences, 2024.
##submission.downloads##
已出版
##submission.howToCite##
期
栏目
##submission.license##
##submission.license.cc.by4.footer##For all articles published in Axon Academic Publishing Institute journals, copyright is retained by the authors. Articles are licensed under an open-access Creative Commons CC BY 4.0 license, meaning that anyone may download, read, reuse, and quote the paper for free, provided that the original published version is cited. This ensures that the work receives maximum use and exposure, while giving proper credit to the authors.
In exceptional circumstances, articles may be licensed differently. If you have specific conditions (such as those related to funding) that prevent using this license, please notify the journal’s editorial office during submission. Exceptions will be considered at the publisher's discretion.
