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

Abstract

Background

Understanding the factors influencing work engagement among nurses is crucial for ensuring high-quality care and positive patient outcomes. Despite numerous factors associated with nurse work engagement, many were explored before the pandemic, potentially overlooking aspects relevant to the current context.

Aim

To explore and update factors related to nurse work engagement in the new normal era.

Design

Systematic review.

Data Sources

The search was restricted to articles published from 2019 to 2024 in CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest, with full English text. The search was conducted from September 13th to 15th, 2023. Quantitative research articles that examined factors related to work engagement were included.

Review Methods

Data extraction, quality appraisal, and data analysis were performed in all included studies. Manual content analysis method was used to classify and group the factors.

Results

Sixty-one research articles were included in the final review. Five key groups of factors were generated from content analysis, including 1) individual-related factors, 2) organizational-related factors, 3) job and role-related factors, 4) work-life balance, and 5) work environment.

Conclusion

Understanding and addressing these multifaceted factors holistically is essential to develop strategies to sustain optimal engagement levels among nursing staff and improve overall patient care outcomes. Further studies are needed to confirm the findings.

Keywords:

• work engagement
• nurse
• hospital
• pandemic
• new normal

Background

Over the past couple of years, the nursing profession has faced various challenges and uncertainties due to the COVID-19 pandemic. These difficulties range from insufficient protective equipment to massive and heightened infection risks to strained healthcare resources and adverse impacts on health.¹ Nurses found themselves grappling with stress, anxiety, depression, and insomnia due to the ethically challenging decisions they faced, the isolation of patients in their care, and the witnessing of patient deaths.² Their physical well-being has also taken a hit, enduring exhaustion and pressure injuries due to prolonged hours in protective equipment.

Despite these challenges, nurses have had remarkable resilience and adaptability to what is now called the “new normal”—an adaptation to altered lifestyles and work patterns, recognizing that the pre-pandemic state will not recur.^3,4 Nonetheless, interventions are crucial to foster a psychologically safe workplace, prevent burnout, and bolster mental health. Effective leadership, prioritizing staff well-being, and fostering supportive teamwork are essential protective measures.⁵ Additionally, there is a need to enhance work engagement to ensure quality, particularly given that Penturij-Kloks, de Gans, van Liempt, de Vries, Scheele, Keijsers¹ found a significant decrease in work engagement compared to pre-pandemic levels.

Work engagement has three components—vigor, dedication, and absorption—reflecting a positive and rewarding work attitude.⁶ Increased work engagement correlates with enhanced performance, positive emotions, and improved health and productivity among employees.⁷ Various research has established a positive correlation between heightened work engagement and better nurse performance across diverse healthcare settings.^8–11

Previous studies have identified various factors influencing nurse work engagement, such as recognition, social support, job control, and nurse-physician collaboration, all positively impacting work engagement.^7,12,13 Moreover, previous systematic reviews addressing the same research topic have highlighted collective factors influencing nurse work engagement. Keyko, Cummings, Yonge, Wong¹⁴ categorized 77 influencing factors into six categories: organizational climate, job resources, professional resources, personal resources, job demands, and demographic variables. García-Sierra, Fernández-Castro, Martínez-Zaragoza¹⁵ identified three groups of influencing factors: organizational, individual, and nurse managers’ characteristics. However, most of these studies were conducted before the pandemic, potentially missing factors relevant to the “new normal” context.

A recent systematic review by Midje, Nyborg, Nordsteien, Øvergård, Brembo, Torp¹⁶ analyzed work engagement antecedents deductively using the Job Demands–Resources (JD–R) model, identifying thirty-six unique antecedents categorized into job resources, personal resources, and job demands. Nevertheless, this review predominantly focused on long-term care facilities, which may not adequately represent factors in the general hospital setting. This is similar to Kato, Chiba, Shimazu,¹⁷ who also used the JD-R model but specifically focused on the Japanese context. Therefore, updating a comprehensive systematic review is crucial to establish robust evidence regarding the current factors impacting nurse work engagement.

This study aims to synthesize findings from various research efforts exploring these factors and aims to offer future research recommendations. This review is guided by the research question: “What factors contribute to nurse work engagement?”

Methods

Design

A systematic review design was employed, and it has been registered to PROSPERO (CRD42023468654). The PRISMA 2020 Statement was used to guide and report this systematic review.¹⁸

Search Methods

Multiple databases were used, including CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest. The search terms were limited to articles written in English, with quantitative study designs, and focused on determinants of nurse work engagement in hospitals. The search was limited to articles published from 2019 to 2024, which were done from the 13th to September 15th, 2023. The range from 2019 to 2024 was considered due to the pandemic and new normal era focus for this study. The keywords used include “work engagement”, “nurse”, and “hospital”. The details of the search strategy can be seen in the Table S1.

Inclusion and Exclusion Criteria

Articles must have met certain criteria to be included in this study, such as correlational or predictive studies that investigate the correlation between independent variables and nurse work engagement, articles written in English, and available in full text. Studies that involve work engagement acting as a mediator between factors and another outcome were also included. These studies can provide valuable insights into how certain factors impact nurse work engagement indirectly through a mediating variable. Experimental studies, qualitative studies, study protocols, and review articles were not considered. Studies that included a combination of other healthcare professionals without subgroup analysis were also excluded.

Screening

The third author (IGJ) searched and first screened the articles’ titles and abstracts in all databases. The other authors examined all full texts and assessed all the included articles manually to verify they met the criteria for inclusion. Studies were considered if they pertained to nurses working in clinical hospital settings such as inpatient, outpatient, intensive care, emergency, or specialty. While the definitions of nurse work engagement may not always be explicitly stated, we included studies that employed the same measurement instrument, typically the “Utrecht Work Engagement Scale”,⁶ to evaluate the identical construct and minimize bias and heterogeneity. All authors reached an agreement on whether these studies fulfilled the inclusion criteria.

Data Extraction

A table was utilized for data extraction purposes. The table included author names, country, publication year, research design, methods, measures, and results.

Quality Appraisal

A quality appraisal tool was used, specifically designed for correlational studies, to evaluate the quality of each article. The tool has been adapted from an instrument used in a previous systematic review.¹⁴ Thirteen criteria were examined, and each criterion was given a possible total of one point, resulting in a maximum possible score of 14. Each study was classified as low, moderate, or high quality based on the assigned total points.

Data Analysis

Content analysis was employed to consolidate the findings. The content analysis includes organizing content and variables into thematic categories, as described by Grove, Burns, Gray.¹⁹ Performing a meta-analysis was not viable because of the vast array of study designs, predictors, outcome variables, and the complex correlations between positive and negative, direct and indirect, and moderate and mediated variables.

Results

Search Results

Through the search strategy, 915 articles were initially found in the databases spanning 2019 to 2024. Following a title screening based on inclusion criteria, 365 articles were retained. These were further evaluated based on abstracts, resulting in 187 articles for a comprehensive review of full texts. Studies without full texts and those that were outside the criteria were excluded at this stage. After a thorough review, 61 articles were selected for inclusion (see Figure 1). The included studies were carried out in China (n = 22), Saudi Arabia (n = 8), Japan (n = 6), Peru (n = 2), Philippines (n = 2), Netherlands (n = 2), United States (n = 2), Jordan (n = 2), Spain (n = 2), Belgium (n = 1), Colombia (n = 1), Egypt (n = 1), Indonesia (n = 1), Iran (n = 1), Lagos, Nigeria (n = 1), Malaysia (n = 1), North Eastern Region (NER) of India (n = 1), Norway (n = 1), Portugal & Spain (n = 1), South Africa (n = 1), Toronto, Canada (n = 1), Victoria, and Australia (n = 1). All studies used a cross-sectional design, except for Penturij-Kloks, de Gans, van Liempt, de Vries, Scheele, Keijsers,¹ who used a single-center prospective cohort study; Paustian-Underdahl, Halbesleben, Carlson, Hamadi²⁰ used an online survey with six-time points spanning over two years; Ding, Cao²¹ with two-wave design; Nagai, Ogata, Yamamoto, Fedyk, Bell²² with longitudinal research design.

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

Quality Assessment Results

The overall rate for quality assessment was 10.41, which indicates high quality on average for all included studies. Of all studies, only four used probability sampling, and six had response rates that were less than 60%. Forty-four studies used a theoretical model, and all studies managed outliers during statistical analysis (Table 1). The details of quality assessment and data extraction in each study can be seen in Table S2 and S3.

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.

Analytical Findings

Individual-Related Factors

Socio-Demographic Characteristics

Socio-demographic characteristics are the inherent personal attributes of nurses that describe their social and demographic characteristics. These characteristics are not easily changed and include 14 factors from our review based on 13 studies, such as age,^23–27 gender,^27–31 marital status,^32,33 educational level,^25,34 physical condition,²⁸ monthly income,³⁰ number of children,³⁵ years of experience,^{23,25–27,34} position at work,^23,28,32,33 employment status,^23,27,33 years in the present unit,²³ and nationality^25,27 (Table 2). Socio-demographic characteristics can provide insights into broad trends or disparities within a group.

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

Individual and Professional Traits, Skills, Values, and Attributes

Three dimensions emerged from this variable: Individual-related psychological characteristics, Job-related psychological characteristics, and Job-related skills, which influence nurse work engagement (Table 3). The details of each can be seen in the following:

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

Individual-Related Psychological Characteristics

Individual-related psychological characteristics refer to inherent and distinctive aspects of a nurse’s mental and emotional makeup that influence their thoughts, feelings, and behaviors in various contexts. These characteristics often shape how individuals perceive, respond to, and interact with their environment. From 12 studies, the individual-related psychological characteristics include nine distinct factors, each drawn from specific studies.

Positive psychological capital, including “self-efficacy, optimism, hope, and resiliency”, strongly correlates to engagement.^24,36 Psychological capital is a mediator, connecting a healthy work environment to increased engagement.³⁶ Self-efficacy is positively associated with work engagement^37–39 and mediates relationships between resilience, stress, and work engagement,³⁷ as well as partially mediating the correlation between the “professional nursing practice environment” and work engagement.³⁸

Optimism⁴⁰ and resilience^37,41,42 are positively related to work engagement and play mediating roles. Optimism mediates autonomy and “organizational citizenship behavior”,⁴⁰ while resilience mediates the relationship between organizational identity and work engagement.⁴¹ Motivation, specifically the motivation to succeed and avoid failure, significantly correlates with work engagement,³⁸ with achievement motivation partially mediating the correlation between the “professional nursing practice environment” and work engagement,³⁸ and intrinsic motivation mediating the connection of job resources with work engagement and burnout.⁴³ Core self-evaluation predicts work engagement,²⁴ and proactive personality positively influences work engagement.⁴⁴ Self-compassion significantly affects work engagement,³¹ while empathy is correlated with work engagement, with higher levels associated with more individualized care provision.⁴⁵

Job-Related Psychological Characteristics

Job-related psychological characteristics refer to the various aspects of the mental and emotional state of nurses associated with their work or profession. These characteristics include a wide range of significant factors positively related to work engagement identified from 10 studies. The factors include emotional labor (the effort invested in managing emotions at work),⁴⁶ conflict management styles,⁴⁷ role conflict,⁴⁸ autonomy,⁴⁵ affective commitment to one’s job,³⁵ work ethics,³³ work values,⁴⁹ work meaningfulness,⁵⁰ job crafting,⁵¹ learning goals,⁵¹ and the ability to cope with organizational change.²⁴ Among these factors, only two have mediated roles which job crafting mediated the correlation between “learning goal orientation” and work engagement,⁵¹ and work meaningfulness mediated and moderated the correlation between “ethical leadership” and work engagement.⁵⁰

Job-Related Skills

Job-related skills refer to the specific abilities, competencies, and proficiencies that individuals acquire and apply in the context of their professional roles and responsibilities. Two studies revealed this job-related skills factor. Hu, Zhao, Gao, Li, Yan, Yan, Shao, Su, Li⁴⁴ indicated that competency directly affects work engagement and mediates the correlation between proactive personality and work engagement. On the other hand, effective communication skills independently positively influence work engagement.⁵²

Organizational-Related Factors

Three dimensions emerged from this category, including human resource and professional development, leadership, and organizational culture and behavior (Table 4). The details of each is described as follows:

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

Human Resource and Professional Development

Human resource and professional development is the systematic process of enhancing individuals’ skills, knowledge, and capabilities within an organizational framework. Our findings, based on nine studies, identified various factors associated to work engagement, such as “job resources (autonomy, performance feedback, and opportunities for growth and development)”,⁴³ job resources (collegial support and autonomy),⁴⁵ “possibilities for professional development”,⁵³ talent management,⁵⁴ promotion focus,²⁰ human capital development,⁵⁵ personal and “professional resources for nurses to work vigorously (PPR-N)”,²² basic psychological needs,⁵⁶ and structural empowerment.³³ Only one factor has a mediated role, namely “basic psychological needs”, which mediates between “perceived organizational support” and work engagement.

Leadership

Leadership is the dynamic process of guiding individuals or groups toward shared goals. Findings from six studies reveal diverse leadership styles influencing work engagement, including Transformational leadership,^21,57,58 Transactional leadership,^57,58 Servant leadership,⁵⁹ Ethical leadership,⁵⁰ Humble leadership,⁶⁰ and Laissez-faire leadership.⁵⁸ Notably, the positive influence of Transformational leadership may vary in high-challenge contexts,²¹ and Ethical leadership is intricately associated with work engagement through mediation and moderation by work meaningfulness.⁵⁰ These insights highlight the nuanced and contextual nature of effective leadership in fostering work engagement.

Organizational Culture and Behavior

Organizational culture and behavior refer to the shared values, beliefs, and practices within a workplace that significantly influence work engagement. Based on eight studies, a comprehensive set of factors plays pivotal roles in shaping engagement. These factors include organizational justice,⁶¹ perceived organizational support,³⁹ organizational commitment,^30,58 organizational culture,⁶² nursing culture,⁶³ organizational identification,⁴¹ organizational-retention commitment,³⁰ and social networks in shaping engagement.⁶⁴

Job and Role Factors

Job and role factors consist of the unique attributes, features, and expectations associated with a specific position or role within an organization. Drawing from nine studies, ten identified factors that influence work engagement. These factors include nurse job fit,⁶⁵ working schedule,²⁷ job characteristics,⁶¹ role overload,⁶⁶ total night shifts per month,²⁸ workload (mental demand, performance, frustration),³² Workload (volume within a job),²⁴ Flexibility idiosyncratic deals,⁶⁷ Task idiosyncratic deals,⁶⁷ and Implementation of an electronic medical record.⁶⁸ It is noteworthy that workload is a multifaceted concept with both positive²⁴ and negative³² dimensions. This duality in the direction of workload may be attributed to variations in the measured constructs.

Work-Life Balance

Work-life balance pertains to the equilibrium individuals strive for between their professional responsibilities and personal lives. In the context of factors influencing work engagement based on four studies, the findings reveal that positive spillover from family life correlates positively with work engagement.^35,49 Conversely, increased “work-to-family conflict” is associated with decreased work engagement, a relationship moderated by transformational leadership.⁶⁹ Family–work enrichment, indicative of positive experiences in the family domain, predicts higher work engagement.⁷⁰ Additionally, work-to-family spillover plays a nuanced role, with “family-to-work positive spillover” and specific interactions moderating the correlation between work values and work engagement^35,49 (Table 5).

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

Work Environment

Derived from 16 studies, the work environment variable includes 14 factors influencing work engagement (Table 6). The positive work environment factors include the professional nursing practice environment,³⁸ healthy work environment,³⁶ supportive work environment,^53,70 collaboration climate,⁶² “organizational climate”,⁷¹ hospital spiritual climate,⁷² and quality of work-life.⁷³ Notably, the “professional nursing practice environment” is mediated by self-efficacy and achievement motivation,³⁸ while a healthy work environment is influenced through mediation by psychological capital.³⁶ Organizational climate, positively related to work engagement, is indirectly mediated by the adversity quotient.⁷¹ Moreover, organizational climate mediated the linkage between psychological violence and work engagement.⁷⁴

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

In contrast, hospital capacity,²³ burnout,^24,73,75 stress,³² emotional disorders such as anxiety and depression,⁴⁷ and exposure to psychological violence⁷⁴ have an adverse effect on work engagement. Sun, Fu, Yan, Wang, Fan⁷⁵ contribute to understanding this relationship by highlighting the mediating role of burnout in the connection between the quality of work life and work engagement. Additionally, emotional disorders are identified as partial mediators between conflict management styles and work engagement.⁴⁷ Lastly, the negative correlation observed between “psychological violence and work engagement” is revealed to be mediated by organizational climate.⁷⁴ Type of hospital^23,33 and type of unit²⁹ are also positive predicting factors of work engagement.

Discussion

Summary of the Findings

Our research aimed to comprehensively explore the factors influencing nurses’ work engagement in the new normal context, as reflected in articles published from 2019 to 2024. The primary objective was to offer updated evidence that could contribute to retaining nurses in the hospital settings.

The systematic review identified multiple factors categorized into five groups: 1) individual-related factors, 2) organizational-related factors, 3) job and role factors, 4) work-life balance, and 5) work environment. It is noteworthy that these categories may overlap because of the multiple constructs of each factor (Figure 2). However, efforts were made to distinguish each category for clarity. Individual-related factors focus on the nurses themselves, organizational-related factors on the organization independent of individual nurses, job and role factors on the jobs and roles, work-life balance as a cross-cutting component between individual factors and organizational/job factors, and work environment as the overall context influencing all variables.

Figure 2 Factors influencing work engagement among nurses.

Individual-Related Factors

The “individual-related factors” comprised 1) socio-demographic characteristics and 2) individual and professional traits, skills, values, and attributes, each with multiple constructs. Among the socio-demographic characteristics (age, gender, marital status, educational level, physical condition, monthly income, number of children, years of experience, position at work, employment status, years in the present unit, and nationality) positively correlated with work engagement, only the education variable showed an inconsistent relationship; higher education of nurses did not guarantee higher engagement. Marital status highlighted that married nurses tended to be more engaged than their single counterparts. Additionally, the variable of years of experience, ranging from more than six years³⁴ to more than ten years,²⁶ had a positive association with engagement. Gender mediated the connection between self-compassion and work engagement.³¹ The nationality variable may make differences in work engagement,²⁷ but further exploration is needed.

Among individual-related psychological characteristics, all variables correlate positively and linearly with work engagement, with several mediating roles. Understanding the mediating roles of factors such as psychological capital,³⁶ self-efficacy,³⁷ optimism,⁴⁰ resilience,⁴¹ achievement motivation,³⁸ and intrinsic motivation⁴³ holds immense potential for interventions targeting enhanced workplace engagement and overall well-being.

Within the job-related psychological characteristics, various factors have consistently emerged as positively associated contributors to increased work engagement. These factors include emotional labor, conflict management styles, role conflict, autonomy, affective commitment to one’s job, work ethics, work values, work meaningfulness, job crafting, learning goals, and the ability to cope with organizational change. Empirical evidence highlights the mediating influence of job crafting in establishing a significant connection between a nurse’s learning goal orientation and their level of work engagement.⁵¹ Furthermore, work meaningfulness assumes a dual role as both “mediator and moderator” in the correlation between ethical leadership and work engagement.⁵⁰ Understanding these psychological characteristics offers insights into how nurses interact with their work environment, confront challenges, and engage in professional roles.

Furthermore, competency and effective communication skills positively correlate with work engagement.^44,52 Competent nurses can more adeptly navigate challenges and problem-solving situations, leading to better outcomes.⁴⁴ In addition, communication skills facilitate effective teamwork and collaboration. Clear communication fosters understanding among team members, reducing errors and enhancing productivity.⁵²

Organizational-Related Factors

The “organizational-related factors” consist of three aspects: human resource and professional development, leadership, and organizational culture and behavior. The critical points of human resource and professional development collectively emphasize the importance of creating an organization that not only supports nurses with necessary resources but also encourages their growth,⁵³ supports their basic needs and well-being,⁵⁶ and empowers them within the organizational framework.³³ Regarding leadership, various studies have revealed a spectrum of leadership styles—Transformational, Transactional, Servant, Ethical, Humble, and Laissez-faire—each uniquely impacting work engagement. While Transformational leadership often inspires, its effectiveness might vary in challenging contexts, necessitating adaptability.²¹ Ethical, servant, and humble leadership are kind of new approaches in which ethical leadership prioritizes moral values,^50,76 servant leadership focuses on serving others’ needs,⁵⁹ and humble leadership embraces humility, collaboration, and openness to foster inclusive and innovative environments within teams.⁶⁰ However, this mosaic of leadership styles highlights its dynamic, context-sensitive nature, urging nurse leaders and managers to embrace versatility and tailor their styles and competencies to their teams’ ever-evolving needs.⁴

The roles of organizational culture and behavior are also emphasized, including organizational justice, perceived support, commitment, culture, identification, and social networks.^{30,39,41,61,62} Recognizing unique subcultures, such as nursing culture,⁶³ highlights the need for tailored approaches. Meanwhile, acknowledging the impact of social networks emphasizes the importance of interpersonal connections.⁶⁴ These factors might seem simple, but providing genuine justice, commitment to retention, and full support to nurse employees is challenging.

Job and Role Factors

The “job and role factors” include job fit, schedules, characteristics, workload complexities, and the integration of electronic records.^27,32,65,67 Workload emerges as pivotal, demonstrating positive²⁴ and negative³² directions based on how it is measured. This duality emphasizes the multifaceted nature of workload, encompassing mental demand, performance, and frustration. Varied findings on workload’s impact suggest the need for standardized measurement approaches. Understanding these factors is crucial for organizations that enhance work engagement and employee well-being. By addressing these elements—such as workload distribution, task agreements, flexibility, and job fit—organizations can create environments that foster higher levels of engagement and satisfaction among employees. The evolving nature of work dynamics, especially in fields like healthcare, suggests the need for ongoing research and adaptation. Implementing electronic medical records, for instance, can significantly impact workload⁶⁸ and, subsequently, work engagement, requiring continuous evaluation and adjustment strategies.

Work-Life Balance

The “work-life balance” serves as a cross-cutting component between individual factors and organizational and job factors. However, the correlation between personal life and work engagement is complex. Positive family experiences can enhance engagement,⁷⁰ while work-family conflict, when mitigated by supportive leadership, may decrease it.^35,49,69 A fulfilling personal life correlates with higher work engagement, highlighting its significance. Understanding how work and family interactions influence values and engagement is crucial for nurse leaders and organizations aiming to create workplaces that promote better productivity and engagement.

Work Environment

The “work environment” includes the entire context and the nature of the system that influences all variables (individual-related factors, organizational-related factors, job and role factors, and work-life balance). This work environment has been significantly emphasized both pre and post-pandemic, indirectly suggesting that time plays a significant role in work engagement.¹

Positive work environments, which include elements like professional nursing practices, supportive climates, collaboration, and quality of work-life, directly influence engagement. This influence is mediated by self-efficacy, psychological capital, and organizational climate.^36,38,71 Conversely, negative elements such as burnout, stress, emotional disorders, and exposure to psychological violence decrease work engagement.^{24,32,73–75} The type of hospital or unit also indicated a positive correlation with engagement levels.^23,29,33 However, hospital capacity negatively affects work engagement.²³ Understanding these factors comprehensively is essential for hospital and nurse managers to grasp the dynamics of the work environment.

Implications for Nursing Practice and Hospital Management and Policy

This study has several implications: First, as individual-related factors impact work engagement, an individualized support program is necessary based on nurses’ diverse needs, considering socio-demographic characteristics, individual traits, values, and attributes.

Second, nurses’ work engagement should be promoted by prioritizing their professional development, emphasizing skill enhancement, resilience building, cultivating psychological capital, and fostering competencies, effective communication, and coping mechanisms. Third, nurse managers should encourage nurses to engage in job crafting, enabling them to reshape their roles to prioritize meaningfulness, autonomy, and ethical values, aligning job characteristics with their strengths to foster a heightened sense of purpose and engagement.

Fourth, to enhance work engagement, there is a need to acknowledge the impact of diverse leadership styles, like Transformational, Transactional, Servant, Ethical, Humble, and Laissez-faire. While each style has unique benefits, the dynamic nature of nursing environments requires adaptable leadership. Prioritizing moral values, meeting others’ needs, fostering inclusivity, task orientation, autonomy, and collaboration are all essential elements.

Fifth, hospitals must prioritize cultivating a supportive organizational culture by emphasizing human resource and professional development, providing resources, addressing basic needs, empowering nurses within the organizational structure, acknowledging subcultures like nursing culture, and highlighting the significance of social networks in the workplace.

Sixth, hospital and nurse managers should recognize the multiple aspects of workload complexities, establish standardized measurement methodologies to comprehend and address workload effectively, prioritize equitable workload distribution, define task agreements, and foster flexibility to create an environment conducive to elevated engagement and satisfaction among staff. Seventh, hospital and nurse managers ought to recognize the interrelationship between work-life balance and work engagement, utilizing supportive leadership to alleviate work-family conflicts, stressing the significance of positive family experiences in bolstering engagement, and implementing strategies to aid nurses in fulfilling personal lives.

Last, hospital and nurse managers need to establish positive work environments by cultivating professional nursing practices, supportive climates, and collaboration while addressing negative aspects like burnout, stress, and emotional disorders, conducting regular assessments and adapting to evolving work dynamics, considering hospital capacity and unit-specific variations to sustain optimal engagement levels among staff.

Strengths and Limitations

The strength of this study lies in its comprehensive exploration of factors influencing nurse work engagement. We have highlighted the additional antecedents that may not be addressed in the previous systematic reviews.^14–17 These include 1) a wide-ranging examination of leadership styles (transactional, servant, ethical, humble, and Laissez-faire), 2) a broader scope covering organizational commitment, organizational and nursing culture, social network degree centrality, organizational climate (collaboration and spiritual climate), and hospital type and capacity; 3) detailed consideration of individual socio-demographic characteristics (marital status-married, physical condition, monthly income, number of children, and status and type of employment); 4) examination of individual-psychological characteristics (proactive personality, empathy, and self-compassion); 5) exploration of job-related psychological characteristics (emotional labor, role conflict, psychological violence, work ethics, values, meaningfulness, learning goals, and coping with organizational changes); 6) assessment of job-related skills (communication skills); 7) inclusion of human resource management factors (talent management, promotion focus, basic psychological needs, and Personal and professional resources for nurses to work vigorously - PPR-N); 8) consideration of job-related factors (Flexibility and Task idiosyncratic deals and Implementation of an electronic medical record); and 9) a detailed evaluation of work-life balance (work-family spillover, conflict, enrichment, and quality of work-life).

Importantly, our study goes beyond identification by discussing the moderating and mediating factors associated with each variable, both directly and indirectly affecting nurse work engagement in the new normal context.

This systematic review exclusively incorporated studies utilizing the same instrument, specifically the “Utrecht Work Engagement Scale”, to ensure consistency in measuring the construct of work engagement. However, this approach may be a limitation since it narrows the scope of factors related to work engagement. Numerous other factors could have been identified if different measures of work engagement had been employed. Additionally, this review did not prioritize determining which factors have a larger effect size. Instead, it focused solely on exploring factors that demonstrated statistical significance in relation to work engagement. Further studies are necessary to address these limitations and validate the findings.

Conclusion

This systematic review of factors influencing nurses’ work engagement in the new normal era highlighted the multidimensional nature of this phenomenon. The comprehensive analysis identified five key groups of factors—individual-related, organizational-related, job and role-related, work-life balance, and work environment—each influencing nurses’ engagement levels. The study has highlighted the critical role of tailored support programs, adaptable leadership styles, workload management strategies, and initiatives promoting work-life balance in enhancing nurse engagement. Creating positive work environments, allocating resources for professional development, and fostering inclusivity emerge as pivotal strategies for hospitals seeking to optimize nurse engagement, ultimately leading to improved patient care, better outcomes, and sustained well-being within healthcare settings. Continual evaluation and adaptation of policies remain imperative in navigating the ever-evolving healthcare landscape.

Data Sharing Statement

The data generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Disclosure

The authors declare that there is no conflict of interest in this work.

Acknowledgment

The authors acknowledge Chulalongkorn University for supporting this study. Also, the authors thank Dr. Rapin Polsook for helping in enhancing this manuscript and finalizing the report.

Additional information

Funding

This research was (partially) supported by the Ratchadapisek Sompoch Endowment Fund (2023), Chulalongkorn University (Sys_66_010_3600_001).