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Testing the relationship between patient-related stressor, psychological distress, work engagement, job satisfaction and recovery attitude among psychiatric nurses in Japan.

AIMS
To test the relationship between patient-related stressor, psychological distress, work engagement and outcomes (job satisfaction and recovery attitude) among psychiatric nurses in Japan. Specifically, we tested the following hypotheses: psychological distress mediates the relationship between patient-related stressor and outcomes and work engagement moderates the direct and indirect effects of patient-related stressor on outcomes.


DESIGN
Cross-sectional study.


METHODS
In total, 446 psychiatric nurses in Japan responded to a self-reported questionnaire between August and October 2018. Data on demographics, patient-related stressor, job satisfaction, recovery attitude, psychological distress and work engagement were collected, followed by a moderated mediation analysis using hierarchical regression and structural equation modeling (SEM).


RESULTS
Regression analysis indicated that psychological distress mediated the negative relationship between patient-related stressor and job satisfaction and that work engagement moderated the direct and indirect effects of patient-related stressor on job satisfaction. In particular, the higher the work engagement, the higher the indirect effect, but the lower the direct effect. Additionally, no mediation of psychological distress and moderation of work engagement was observed in the relationship between patient-related stressor and recovery attitude; however, work engagement directly increased recovery attitude. Results of the SEM test showed a satisfactory fit of the final model.


CONCLUSIONS
Work engagement facilitates recovery attitude and increases the indirect effect of patient-related stressor on job satisfaction through psychological distress. However, work engagement decreases the direct effect not mediated by psychological distress.


IMPACT
This study addresses an essential topic, that is, psychiatric nurse job outcomes (job satisfaction and recovery attitude) are negatively influenced by patient-related stressor. Work engagement has multiple beneficial effects on outcomes as both a facilitator and moderator; thus, programs that improve work engagement are useful for psychiatric nurses. Furthermore, programs may be enhanced considering that work engagement decreases the direct effect of patient-related stressor on job satisfaction.