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. 2025 Jul 7;24(1):863.
doi: 10.1186/s12912-025-03533-8.

The impact of perceived workload on nurse presenteeism and missed nursing care: the mediating role of emotional intelligence and occupational stress

Lina Wang  1 , Qian Huang  2 , Yiqiu Zhang  3 , Jie Liu  4 , Chaoran Chen  5   6
Affiliations

The impact of perceived workload on nurse presenteeism and missed nursing care: the mediating role of emotional intelligence and occupational stress

Lina Wang et al. BMC Nurs. .

Abstract

Background: Nurses are the core workforce responsible for coordinating and delivering patient care, playing a critical role in ensuring patient safety and enhancing healthcare quality. However, when confronted with multiple patient demands, scarce medical resources, and heavy workloads, nurses' subjective perceptions of workload may trigger specific psychological response mechanisms, which in turn negatively affect their work status and nursing behavior.

Aim: This study aimed to explore the impact of nurses' perceived workload on missed nursing care and presenteeism, and to examine the mediating roles of occupational stress and emotional intelligence in these relationships.

Methods: A cross-sectional study design was employed. Between May and October 2024, 730 questionnaires were distributed, with 706 valid responses collected, resulting in an effective response rate of 96.7%. Descriptive statistics and Pearson correlation analyses were conducted using SPSS 27.0. Structural equation modeling was performed using AMOS 25.0, and mediation effects were tested via the bootstrap method.

Results: The results showed that nurses' perceived workload was not directly associated with missed nursing care(β = 0.04, P>0.05) or presenteeismββ = 0.13, P>0.05). However, occupational stress played a significant mediating role in the relationship between perceived workload and missed nursing care (PW → OS, β = 0.96, P < 0.001; OS → MNC, β = 0.59, P < 0.001), as well as in the relationship between perceived workload and presenteeism (PW → OS, β = 0.96, P < 0.001; OS → PRE, β = 0.55, P < 0.001). Similarly, emotional intelligence served as a significant mediator in the relationship between perceived workload and missed nursing care (PW → EI, β = -0.56, P < 0.001; EI → MNC, β = -0.25, P < 0.001), and also in the relationship between perceived workload and presenteeism (PW → EI, β = -0.56, P < 0.001; EI → PRE, β = -0.13, P < 0.001).

Conclusions: Nurses' perceived workload does not directly lead to missed nursing care or presenteeism; rather, it mainly influences their work status and nursing behavior indirectly through either occupational stress or emotional intelligence.

Implications for nursing management: When optimizing the work environment and human resource allocation, nursing managers should not only focus on the distribution of objective workload but also pay close attention to nurses' perceived workload and the development of their psychological coping mechanisms.

Keywords: Emotional intelligence; Missed nursing care; Nurse; Nurse presenteeism; Occupational stress; Perceived workload.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the Biomedical Ethics Committee of Henan University (Approval No. HUSOM2024-532). The research strictly adhered to the ethical principles outlined in the Declaration of Helsinki. Prior to distributing the questionnaires, informed consent was obtained from the nursing management departments of the participating hospitals. The purpose and significance of the study were fully explained to all participants to ensure their clear understanding. Subsequently, written informed consent was obtained from all participants. All consent forms were approved by the institutional review board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Theoretical framework
Fig. 2
Fig. 2
The mediating role of emotional intelligence and occupational stress between perceived workload and presenteeism, as well as between perceived workload and missed nursing care. Note: Perceived workload did not directly affect missed nursing care or presenteeism (Hypotheses 1 and 2 not supported). However, significant mediating effects of occupational stress and emotional intelligence were found, supporting Hypotheses 3 through 6. Abbreviations: MNC, Missed Nursing Care. ***P < 0.001, **P < 0.01, *P < 0.05
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