This study investigated the relationship between nurse stress and professional commitment among clinical nurses and tested whether resilience and coping act as serial mediators in that relationship. The authors framed the research within stress and coping theory and prior evidence that resilience and coping buffer the effects of workplace stress. The primary hypothesis posited that resilience and coping would each mediate the stress–commitment link and would operate sequentially as serial mediators.
A cross-sectional, descriptive correlational design was used. Data were collected via self-administered questionnaires at a single medical center in central Taiwan. Recruitment took place from May 1 to July 31, 2024. A convenience sampling approach invited all eligible inpatient nurses during the study period. Exclusion criteria included nurse practitioners, outpatient nurses, administrative nurses, case managers, and nurses with less than one year of experience in their current unit.
A total of 355 nurses consented to participate; 345 valid questionnaires were included in the final analyses, yielding a valid response rate of 97.2%. Participants worked in internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units, providing a consistent inpatient clinical context across departments. Institutional Review Board approval was obtained (Approval Number: CS2–23171).
Nurse work stress was measured using the Nurse Stress Checklist, which contains 47 items across four dimensions: personal response, work concern, competency, and incompletion of personal arrangement. Items were scored on a 9-point Likert scale (0–8), with higher scores indicating greater stress. The Chinese version of the checklist was used; internal consistency in this sample was high (Cronbach’s alpha = 0.95).
Personal resilience was assessed with the Resilience Scale (RS) developed by Wagnild and Young, which includes 25 items spanning purpose, equanimity, self-reliance, perseverance, and existential aloneness. Coping was measured using established coping instruments (details about specific coping scale items and scoring beyond the general description were reported in the source). Professional commitment was operationalized according to established definitions capturing belief in professional values, commitment to professional goals, and intention to maintain career development.
All participants completed the questionnaire packet after providing informed consent; completion required approximately 20–25 minutes.
Descriptive statistics, univariate analyses, and Pearson correlation analyses were performed to describe variable distributions and bivariate relationships. The authors tested mediation using PROCESS Model 6 to evaluate serial multiple mediation, with resilience entered as the first mediator and coping as the second mediator in the pathway linking nurse stress to professional commitment.
Sample size planning used G*Power for linear multiple regression with a medium effect size (0.15), alpha = 0.05, and power = 0.95; the calculated minimum sample size was 130, adjusted to a target of 156 to allow for potential data loss. The final analytic sample of 345 substantially exceeded these requirements, supporting adequate power for mediation analyses.
In bivariate and multivariate mediation analyses, higher nurse stress was significantly associated with lower professional commitment. The total association was reported as c = −0.0808 (p < 0.001). When resilience and coping were modeled as serial mediators, the direct effect of nurse stress on professional commitment remained statistically significant (c′ = −0.0382, p = 0.0011), indicating partial mediation through the proposed psychological pathway.
The findings indicate that both resilience and coping are significantly associated with the relationship between stress and commitment and that they function as sequential mediators in the tested model. Exact indirect effect sizes, confidence intervals, and additional model coefficients were reported in the source tables and figures.
Interpretation The authors interpret their results as evidence that greater workplace stress is linked to reduced professional commitment among clinical nurses and that this relationship is partially explained by lower resilience and maladaptive coping in a serial fashion. Given the cross-sectional design, the directionality of effects cannot be established; the results should be read as associations rather than causal inferences.
Limitations Key limitations reported by the authors include the single-center convenience sample, which may limit generalizability to other settings or healthcare systems; the cross-sectional one-time sampling that precludes causal claims and temporal ordering; and ethical restrictions that prevent public sharing of raw data to protect confidentiality. The source also notes that nurse subgroups excluded from study participation (e.g., outpatient or administrative nurses) limit the scope of inference to inpatient clinical nurses with at least one year in their unit.
Implications for practice The study suggests that organizational and educational interventions aimed at strengthening resilience and promoting adaptive coping strategies could mitigate the negative association between nurse stress and professional commitment. Practical approaches may include resilience training, peer and supervisory support, structured stress-management programs, and workplace policies that address known stressors such as workload, recognition, and work–family conflict. Because the results reflect associations, pilot intervention studies or longitudinal research are recommended to evaluate whether enhancing resilience and coping produces sustained improvements in professional commitment and retention.
This research documents a significant negative association between nurse stress and professional commitment in a sample of 345 inpatient clinical nurses and identifies resilience and coping as partial serial mediators of that relationship. The authors recommend interpreting findings as associative due to the cross-sectional design and highlight the potential value of programs that bolster resilience and foster adaptive coping to support nurses’ professional commitment. Future research using longitudinal designs, multi-center samples, and intervention trials is necessary to establish causal pathways and to test the effectiveness of resilience- and coping-focused interventions in improving professional commitment and workforce stability.