Updating Factors Influencing Nurse Work Engagement in the Hospital Settings: A Systematic Review

Figures & data

Figure 1 Flow diagram of the systematic review. Adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int Surg J. 2021;88:105906. Creative Commons.¹⁸

Table 1 Summary of Quality Assessment (n = 61)

Quality Assessment	No	Yes
Design
1. “Was the study prospective?”	0	61
2. “Was probability sampling used?”	57	4
Sample
3. “Was the sample size justified?”	0	61
4. “Was the sample drawn from more than 1 site?”	0	61
5. “Was anonymity protected?”	0	61
6. “Response rate more than 60%”	6	55
Measurement: Factors associated with WE (IVs)
7. “Was the factor measured for reliability?”	6	55
8. “Was the factor measured using a valid instrument?”	1	60
Work engagement (DV)
9. “Are the effects observed rather than self‐reported?^a”	61	0
10. “Did the scale used for measuring WE as an outcome have an internal consistency ≥0.70?”	4	57
11. “Was a theoretical model/framework used for guidance?”	17	44
Statistical analysis
12. “If multiple factors were studied, are correlations analyzed?”	6	55
13. “Are outliers managed?”	0	61
Overall study validity rating: 10.41 (high) (0–4 = LOW; 5–9 = MED; 10–14 = High)

Notes: ^aThis item scored 2 points. All others scored 1 point.

Table 2 Socio-Demographic Characteristics

No	Factors	Findings	Sources
1	Age	Positive correlation between nurse’s age and work engagement. The older, the higher the engagement.	Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23 Pericak, Hogg, Skalsky, Bourdeanu^Citation24 Alharbi, Alrwaitey^Citation25 Alkorashy, Alanazi^Citation26 Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27
2	Gender (sex)	There is a significant difference in work engagement according to gender (between male and female). Self-compassion’s impact on work engagement is moderated by gender^Citation31	Zhang, Chen, Wang, Li, Li, Liu^Citation28 Allande-Cussó, García-Iglesias, Ruiz-Frutos, Domínguez-Salas, Rodríguez-Domínguez, Gómez-Salgado^Citation29 Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27 Tang, Zhang, Feng, Li, Zeng, Xie, Jin, Wang^Citation30 Bahrami Nejad Joneghani, Bahrami Nejad Joneghani, Dustmohammadloo, Bouzari, Ebrahimi, Fekete-Farkas^Citation31
3	Marital status (married)	There is a significant correlation between marital status, especially those who are married, and increased engagement.	Zhang, Zhang, Liu, Wang, Hu, Du^Citation32 Balay odao, Cruz, Alquwez, Al Otaibi, Al Thobaity, Alotaibi, Valencia, Danglipen^Citation33
4	Educational level (negative) and (positive)	Positive and negative relationships with work engagement. Yang, Hatanaka, Takahashi, Shimizu^Citation34 revealed that the group with a university degree or higher has significantly lower scores on work engagement than those with diplomas. Alharbi, Alrwaitey^Citation25 showed higher educational levels align with higher work engagement. Allande-Cussó, García-Iglesias, Ruiz-Frutos, Domínguez-Salas, Rodríguez-Domínguez, Gómez-Salgado^Citation29 and Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27 called the educational level equal to the academic training level. Nursing graduates and individuals with specialized university degrees demonstrate the highest levels of work engagement.	Yang, Hatanaka, Takahashi, Shimizu^Citation34 Alharbi, Alrwaitey^Citation25 Allande-Cussó, García-Iglesias, Ruiz-Frutos, Domínguez-Salas, Rodríguez-Domínguez, Gómez-Salgado^Citation29 Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27
5	Physical condition	Positively related to work engagement.	Zhang, Chen, Wang, Li, Li, Liu^Citation28
6	Monthly income	Positive correlation between monthly income and work engagement.	Tang, Zhang, Feng, Li, Zeng, Xie, Jin, Wang^Citation30
7	Number of children	Positive correlation with work engagement.	Fukuzaki, Iwata, Ooba, Takeda, Inoue^Citation35
8	Years of experience	Positive relationship between years of experience and work engagement. Alharbi, Alrwaitey^Citation25 pointed specifically to experience of more than 10 years. In contrast, Yang, Hatanaka, Takahashi, Shimizu^Citation34 revealed higher engagement for those with more than 6 years of nursing experience.	Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23 Alkorashy, Alanazi^Citation26 Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27 Yang, Hatanaka, Takahashi, Shimizu^Citation34 Alharbi, Alrwaitey^Citation25
9	Position at work / Staff role / Job title / Department position/ Employment status	Position at work positively is correlated with work engagement. Being a staff nurse contributes more to the dedication and absorption aspects of work engagement than being a managerial nurse. And being a rescue staff also affects engagement. Department position (ordinary nurse, team teacher, team leader, head nurse, and above) is also associated with engagement.	Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23 Zhang, Zhang, Liu, Wang, Hu, Du^Citation32 Zhang, Chen, Wang, Li, Li, Liu^Citation28 Balay odao, Cruz, Alquwez, Al Otaibi, Al Thobaity, Alotaibi, Valencia, Danglipen^Citation33
10	Type of employment contract / Employment status	Permanent and precarious (part-time) employment contracts significantly correlate with work engagement. Also, Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23 found that the nursing contract type showed a negative correlation with dedication and vigor.	Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27 Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23 Balay odao, Cruz, Alquwez, Al Otaibi, Al Thobaity, Alotaibi, Valencia, Danglipen^Citation33
13	Years in their present unit	Significant relationship to work engagement.	Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23
14	Nationality	Increased work engagement is correlated with a non-Saudi nationality. Additionally, there is a significant difference in work engagement between Portuguese and Spanish nurses.	Alharbi, Alrwaitey^Citation25 Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27

Table 3 Individual and Professional Traits, Skills, Values, and Attributes

Factors	Findings	Source
Individual-related Psychological Characteristics:
Psychological capital	Positive psychological state has multiple constructs: self-efficacy, optimism, hope, and resiliency. There is a significant correlation between PsyCap and work engagement. Mediated role: Psychological capital mediates between a healthy work environment and work engagement.	Pericak, Hogg, Skalsky, Bourdeanu^Citation24 Xue, Qiao, Li, Zhang, Wang, Wang, Xu^Citation36
Self-efficacy	Positive correlation with work engagement. Mediated role: Self-efficacy mediated the inter-correlations between resilience, stress, and work engagement.^Citation37 Also, self-efficacy partially mediates the correlation between ‘professional nursing practice environment and engagement’.^Citation37	Dan, Huang, Ren, Tian, He^Citation38 Cabrera-Aguilar, Zevallos-Francia, Morales-García, Ramírez-Coronel, Morales-García, Sairitupa-Sanchez, Morales-García^Citation37 Al Hamdan, Bani Issa^Citation39
Optimism	Positive correlation with work engagement. Optimism has a mediate role between autonomy and organizational citizenship behavior.	Zhang, Zhao, Zou, Liu, Lin, Ye, Tang, Shao, Chen^Citation40
Resilience	Positive relationship with work engagement. The correlation between organizational identity and work engagement is mediated by resilience.^Citation41	Okojie, Ismail, Begum, Ferdous Alam, Sadik-Zada^Citation42 Cabrera-Aguilar, Zevallos-Francia, Morales-García, Ramírez-Coronel, Morales-García, Sairitupa-Sanchez, Morales-García^Citation37 Lyu, Yao, Zhang, Liu^Citation41
Motivation	Motivation to succeed and avoid failure is significantly correlated with work engagement. Mediated role: The correlation between professional nursing practice environment and work engagement is partially mediated by achievement motivation.^Citation38 Also, the interrelationship between job resources, work engagement, and burnout is mediated by intrinsic motivation.^Citation43	Dan, Huang, Ren, Tian, He^Citation38 Kohnen, De Witte, Schaufeli, Dello, Bruyneel, Sermeus^Citation43
Core self-evaluation	Self and control abilities predict work engagement.	Pericak, Hogg, Skalsky, Bourdeanu^Citation24
Proactive personality	A proactive personality affects work engagement.	Hu, Zhao, Gao, Li, Yan, Yan, Shao, Su, Li^Citation44
Self-compassion	Self-compassion significantly affects work engagement.	Bahrami Nejad Joneghani, Bahrami Nejad Joneghani, Dustmohammadloo, Bouzari, Ebrahimi, Fekete-Farkas^Citation31
Personal resource (empathy)	Empathy is significantly correlated with work engagement. Also, more empathy is associated with providing more individualized care through more work engagement.	Scheepers, Vollmann, Cramm, Nieboer^Citation45
Job-related Psychological Characteristics
Emotional labor	Emotional labor includes “emotional control effort in the profession”, “patient-focused emotional suppression”, and emotional pretense by norms, which has a function relationship with work engagement.	Yao, Wei, Hu, Li, Zhang^Citation46
Conflict management styles	Conflict management styles are related to work engagement. Nurses are more likely to adopt integrating management styles—a win-win way of dealing with conflict.	Zhang, Bu, Liu^Citation47
Role conflict	Positively correlated with work engagement.	Giménez-Espert, Prado-Gascó, Soto-Rubio^Citation48
Autonomy	Positively related to work engagement.	Scheepers, Vollmann, Cramm, Nieboer^Citation45
Affective commitment	Significantly correlated with work engagement.	Fukuzaki, Iwata, Ooba, Takeda, Inoue^Citation35
Work ethics	Significantly related to work engagement. It includes hard work, morality, leisure, the centrality of work, wasted time, self-reliance, and delay of gratification.	Balay odao, Cruz, Alquwez, Al Otaibi, Al Thobaity, Alotaibi, Valencia, Danglipen^Citation33
Work values	Work values have a significant correlation with work engagement. After combining many variables, only extrinsic and prestige work values are correlated with work engagement moderated by negative work-to-family spillover.	Hara, Yamada, Takada, Sugiyama, Asakura^Citation49
Work meaningfulness	Positively related to work engagement. Work meaningfulness mediates and moderates the correlation between ethical leadership and work engagement.	Mostafa, Abed El-Motalib^Citation50
Job crafting	Seeking challenges (job crafting) has a positive relationship with work engagement. Job crafting mediates the correlation between learning goal orientation and work engagement.	Matsuo^Citation51
Learning goals	Positively correlated with work engagement. Learning goals are influenced by job crafting and reflection in relation to work engagement. Individuals with high learning goals are engaged in their work not only because they are intrinsically motivated to acquire knowledge or skills but also because they are eager to redesign their jobs toward more challenging ones and reassess their jobs when they have habits of reflecting on their work processes.	Matsuo^Citation51
Coping with organizational change	Positively significantly related to work engagement.	Pericak, Hogg, Skalsky, Bourdeanu^Citation24
Job-related Skills
Competency	Competency affects work engagement. Competency mediates the correlation between proactive personality and work engagement.	Hu, Zhao, Gao, Li, Yan, Yan, Shao, Su, Li^Citation44
Communication skills	The positive influence of communication skills and work engagement.	Huaman, Morales-García, Castillo-Blanco, Saintila, Huancahuire-Vega, Morales-García, Calizaya-Milla, Palacios-Fonseca^Citation52

Table 4 Organizational-Related Factors

Factors	Findings	Sources
Human resource and professional development
Job resources (autonomy, performance feedback, and opportunities for growth and development)	Positive significant correlation with work engagement.	Kohnen, De Witte, Schaufeli, Dello, Bruyneel, Sermeus^Citation43
Job resources (collegial support and autonomy)	Positively significantly correlated with work engagement.	Scheepers, Vollmann, Cramm, Nieboer^Citation45
Possibilities for professional development	Possibilities for professional development are positively related to work engagement. Possibilities for professional development mediate the relationship between supervisor support and work engagement and between college support and work engagement.	Contreras, Abid, Govers, Saman Elahi^Citation53
Talent management	Positively influences work engagement.	Sopiah, Kurniawan, Elfia, Narmaditya^Citation54
Promotion focus	Promotion focus increases the acceleration effects associated with work engagement.	Paustian-Underdahl, Halbesleben, Carlson, Hamadi^Citation20
Human capital development	Human capital development (training and skill building, local employment, motivation, knowledge, and technology transfer) directly impacts nursing work engagement.	Zyoud, Alolayyan, Alqahtani, Azzam, Shelash^Citation55
Personal and professional resources for nurses to work vigorously (PPR-N)	PPR-N has a positive (cross-lagged) effect on their subsequent (three months later) work engagement, and there is no direct effect of work engagement on PPR-N held for the early-career nurses’ population. Also, direct influence on engagement exists specifically for mid-career nurses and beyond.	Nagai, Ogata, Yamamoto, Fedyk, Bell^Citation22
Basic psychological needs	“Basic psychological needs” are positively associated with employee engagement, and it mediated the correlation between organizational support and engagement.	Ni, Wu, Bao, Li, You^Citation56
Structural empowerment	Structural empowerment (access to opportunity, resources, and informal power) influenced work engagement.	Balay odao, Cruz, Alquwez, Al Otaibi, Al Thobaity, Alotaibi, Valencia, Danglipen^Citation33
Leadership
Transformational leadership	Positive correlation with work engagement. The positive impact of transformational leadership is evident, yet its strength diminishes when faced with high-challenge demands.^Citation21 A moderate to strong relationship between “transformational leadership and employee engagement”.	Asiri, Mahran, Elseesy^Citation57 Ding, Cao^Citation21 Al-Dossary^Citation58
Transactional leadership	Positive correlation with work engagement. Compared to transformational leadership, transactional leadership strongly impacts employee engagement.58	Asiri, Mahran, Elseesy^Citation57 Al-Dossary^Citation58
Servant leadership	There is a strong positive effect of servant leadership on work engagement.	Qin, Li, Li^Citation59
Ethical leadership	Positive relationship with work engagement. Ethical leadership is mediated and moderated by work meaningfulness associated with work engagement.	Mostafa, Abed El-Motalib^Citation50
Humble leadership	Positively correlated with work engagement.	Yang, Zhou, Wang, Lin, Luo^Citation60
Laissez-faire leadership	Moderate relationship with work engagement.	Al-Dossary^Citation58
Organizational culture and behavior
Organizational justice	Organizational justice significantly directly affected work engagement.	Dong, Lu, Wang, Zhang, Chen, Li, Huang, Wan, Dong, Shang^Citation61
Perceived organizational support	Perceived organizational support affects engagement at work positively.	Al Hamdan, Bani Issa^Citation39
Organizational commitment	The correlation between the organization’s commitment and work engagement is significant and positive.	Tang, Zhang, Feng, Li, Zeng, Xie, Jin, Wang^Citation30 Al-Dossary^Citation58
Organizational culture	Organizational culture has an impact on work engagement directly.	Slåtten, Lien, Mutonyi^Citation62
Nursing culture	Positive linkage between nursing culture and work engagement.	Zhai, Cai, Chen, Zhao, Yu, Zhang^Citation63
Organizational identification	Positive impact on work engagement. Organizational identification is also mediated by psychological resilience in the relationship with work engagement.	Lyu, Yao, Zhang, Liu^Citation41
Organizational-retention commitment	Positively correlated with work engagement.	Tang, Zhang, Feng, Li, Zeng, Xie, Jin, Wang^Citation30
Social network degree centrality	“Social network degree centrality” (with colleagues and friendship) is positively associated with work engagement.	Liu, Chen, Cui, Hu^Citation64
Job and role factor
Nurse job fit	Significant relationship between nurse job fit and work engagement.	Khairuddin, Baputeyb^Citation65
Working schedule	Fixed working schedules and rotating shift work significantly affect work engagement.	Borges, Sequeira, Queirós, Mosteiro‐Díaz^Citation27
Job characteristic	Significant direct effect on work engagement. Job characteristics dimensions: Variety of skills, identity of tasks, significance of tasks, autonomy, and feedback in the job.	Dong, Lu, Wang, Zhang, Chen, Li, Huang, Wan, Dong, Shang^Citation61
Role overload	Role overload is negatively related to work engagement.	Zhang, Xu, Li, Xu^Citation66
Total night shifts per month	Negatively correlated with work engagement.	Zhang, Chen, Wang, Li, Li, Liu^Citation28
Workload (mental demand, performance, frustration)	Negative correlation with work engagement.	Zhang, Zhang, Liu, Wang, Hu, Du^Citation32
Workload	Workload (amount or quantity of work in a job) positively correlated with work engagement. Higher workload is linked to increased work engagement in this study, but it’s not the most significant predictor. The workload is based on pace and quantity, not the number of patients. “Volume” refers to extra tasks like research or administrative duties, not patient assignments.	Pericak, Hogg, Skalsky, Bourdeanu^Citation24
Flexibility idiosyncratic deals	Predictor of work engagement.	Ngobeni, Dhanpat^Citation67
Task idiosyncratic deals	Predictor of work engagement.	Ngobeni, Dhanpat^Citation67
Implementation of an electronic medical record	Electronic medical record implementation, closely followed by the SARS-CoV-2 pandemic, is linked to adverse alterations in work engagement.	Jedwab, Hutchinson, Manias, Calvo, Dobroff, Redley^Citation68

Table 5 Work-Life Balance

Factors	Findings	Sources
Work-to-family spillover (positive and negative)	Positive ‘work-to-family spillover’ to work positively correlated with work engagement. Additionally, negative spillover from family to work acted as a mediator between affective commitment and work engagement. Hara, Yamada, Takada, Sugiyama, Asakura^Citation49 discovered that ‘the impact of work-to-family spillover altered the connection between work values and engagement. Specifically, the combination of adverse work-to-family spillover with extrinsic and prestige work values has a notable effect on work engagement.’	Fukuzaki, Iwata, Ooba, Takeda, Inoue^Citation35 Hara, Yamada, Takada, Sugiyama, Asakura^Citation49
Work-to-family conflict	Increased conflict between work and family responsibilities resulted in reduced levels of work engagement. The negative relationship is also mediated by transformational leadership.	Labrague, Obeidat^Citation69
Family–work enrichment	Family–work enrichment predicts work engagement.	Rastogi, Saikia^Citation70

Table 6 Work Environment

Factors	Findings	Sources
Professional nursing practice environment	Direct effect with work engagement. The professional nursing practice environment is mediated by self-efficacy and achievement motivation.	Dan, Huang, Ren, Tian, He^Citation38
Healthy work environment	Positively correlated with work engagement. A healthy work environment is also mediated by psychological capital.	Xue, Qiao, Li, Zhang, Wang, Wang, Xu^Citation36
Supportive work environment (supervisor and colleague support)	Supervisor and colleague support have a positive correlation with work engagement.	Contreras, Abid, Govers, Saman Elahi^Citation53 Rastogi, Saikia^Citation70
Collaboration climate	The climate of collaboration has a direct correlation with work engagement.	Slåtten, Lien, Mutonyi^Citation62
Organizational climate	‘Organizational climate’ and work engagement are positively associated. It also indirectly affects work engagement, partially mediated by the adversity quotient.^Citation71 Organizational climate mediates the connection between psychological violence and work engagement.^Citation74	Li, Xu, Jing, Wei, Li, Guo^Citation71 Hu, Gong, Ma, Wu^Citation74
Hospital spiritual climate	A positive spiritual climate in the hospital is associated with improved nurse work engagement.	Cruz, Alquwez, Balay‐odao^Citation72
Quality of work-life	Work-life quality and work engagement are directly correlated.	Buckley, Berta, Cleverley, Widger^Citation73
Type of hospital	The type of hospital (private and public hospitals) influences work engagement.	Balay odao, Cruz, Alquwez, Al Otaibi, Al Thobaity, Alotaibi, Valencia, Danglipen^Citation33 Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23
Type of unit	The type of unit predicts work engagement.	Allande-Cussó, García-Iglesias, Ruiz-Frutos, Domínguez-Salas, Rodríguez-Domínguez, Gómez-Salgado^Citation29
Hospital capacity	Negative predictor of work engagement.	Falguera, Labrague, De Los Santos, Firmo, Tsaras^Citation23
Burnout (Emotional Exhaustion, Depersonalization, Personal Accomplishment)	Burnout has a negative correlation with work engagement. Emotional exhaustion has a strong inverse association, while depersonalization demonstrates a moderate inverse relationship with engagement. Personal accomplishment is strongly correlated with engagement. The connection between quality of work life and work engagement is mediated by burnout.^Citation75	Pericak, Hogg, Skalsky, Bourdeanu^Citation24 Buckley, Berta, Cleverley, Widger^Citation73 Sun, Fu, Yan, Wang, Fan^Citation75
Stress (infection control, PPE discomfort)	Stress (control of infection and discomfort related to personal protective equipment) is associated with work engagement negatively.	Zhang, Zhang, Liu, Wang, Hu, Du^Citation32
Emotional disorder/psychological distress	Emotional disorders (stress, anxiety, depression) have a negative correlation with work engagement. It also plays “a partial mediating role in the connections between conflict management styles and work engagement”.	Zhang, Bu, Liu^Citation47
Psychological violence	Psychological violence negatively influences work engagement, mediated by organizational climate.	Hu, Gong, Ma, Wu^Citation74

Figure 2 Factors influencing work engagement among nurses.

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