Network of job demands-resources and depressive symptoms in critical care nurses: a nationwide cross-sectional study

Critical care nurses are vulnerable to depression, which not only lead to poor well-being and increased turnover intention, but also affect their working performances and organizational productivity as well. Work related factors are important drivers of depressive symptoms. However, the non-liner and multi-directional relationships between job demands-resources and depressive symptoms in critical care nurses has not been adequately analyzed. Understanding these relationships would be helpful for reducing depression, increasing nurses’ well-being and retain healthcare forces. This was a cross-sectional study using baseline data from the Nurses’ mental health study (NMHS), a prospective cohort study on nurses from 67 tertiary hospitals in 31 province-level administrative regions in China. Only clinical nurses working in the ICU were included (n = 13,745). Data were collected using online questionnaires, and analyzed using network analysis and structural equation model. Job demands (average working hours per week, average number of night shifts per month, paperwork burden and work-life balance), job resources (supervisor support, co-worker support, leader justice, organizational climate satisfaction, work meaning, and career prospect), personal resource (resilience) and depressive symptoms were main variables in the networks, while demographic data and social health (social-emotional support and loneliness) were covariates. The prevalence of severe, moderately severe, moderate, mild, and none or minimum depressive symptoms in critical care nurses of this study were 1.21, 3.42, 9.76, 42.88, and 42.07% respectively. In the final network, 132 of 210 possible edges (62.8%) were not zero. “Fatigue” had the highest expected influence, followed by “Motor”, and “Appetite”. Meanwhile, in terms of job demands-resources and personal resources, the node with the highest expected influence was “Supervisor support”, followed by “Work meaning” and “Co-worker support”. Three bridge variables were identified: “Resilience-adaptation”, “Average working hours per week”, and “Co-worker support”. The final structural equation model basically supported the results of network analysis with an acceptable model-fit (GFI = 0.918, AGFI = 0.896, PCFI = 0.789, PNFI = 0.788, NFI = 0.909, IFI = 0.911, CFI = 0.911, SRMR = 0.040, and RMSEA = 0.064). There was a rather strong interconnectedness between depressive symptoms and job demands-resources. Fatigue, motor, and appetite were core depressive symptoms of critical care nurses. Close attention to those symptoms could help recognize depression in critical care nurses. Supervisor support, work meaning, and co-worker support played vital roles as job resources in reducing depression, while negative impact of long average working hours per week were more contagious. Resilience, as personal resources, could help mediate the associations between job demands-resources and depression. In clinical practice, it’s recommended for nursing managers to (1) encourage critical care nurses to find their “meaning in work”, (2) implement resilience enhancing programs for nurse, (3) build and maintain meaningful relationships with nurses and support them in daily work, and (4) create a harmonious and dedicated working environment where co-workers are willing to help and support each other. Improvements in those modifiable aspects could help reduce risk and prevent exacerbations of depressive symptoms in critical care nurses.