Practice Environment and Mental Well-Being Among Hospital Nurses: The Mediating Role of Work Engagement
DOI:
https://doi.org/10.5708/EJMH.21.2026.0062Keywords:
mediation analysis, nurses, practice environment, mental well-being, work engagementAbstract
Introduction: Supporting the mental well-being (MWB) of healthcare professionals has become a critical priority in the context of global nursing shortages and increasing psychosocial demands. While previous research has established links between work environment, engagement, and MWB, empirical evidence from Hungary remains limited.
Aim: This study examined the relationships between the nursing practice environment (NPE), work engagement (WE), and MWB among Hungarian hospital nurses.
Methods: A cross-sectional online survey was conducted among 232 hospital nurses using the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Utrecht Work Engagement Scale (UWES-9), and the WHO-5 Well-Being Index. Pearson correlations and mediation analysis were applied to explore associations between variables while controlling for gender and work-related characteristics.
Results: A favorable NPE was significantly associated with higher levels of WE (r = .37, p < .001) and MWB (r = .46, p < .001). WE showed a strong positive relationship with MWB (r = .74, p < .001). Mediation analysis indicated that the total effect of the NPE on MWB was significant (B = 15.00, p < .001), and WE partially mediated the relationship between NPE and MWB (indirect effect: B = 7.89, 95% bootstrap CI [5.27, 10.43]).
Conclusions: The findings underscore the importance of the workplace environment as a key organizational resource that is positively associated with nurses’ WE and MWB. Although the cross-sectional design precludes causal inferences, these findings provide support for considering organizational strategies aimed at strengthening the NPE as a potential target for supporting nurse engagement and MWB.
References
Alharbi, M. S., Albughuli, M. B., Aljohani, S. S., Alraddadi, Y. A., Alalawi, N. B., Alawfi, H. M., Al Harbi, S. M., Alharbi, R. H., & Alreshidi, O. A. (2025). Nurses’ well-being and its relationship with quality of nursing work life at Alsalam and Al Haram hospitals, Saudi Arabia. Frontiers in Public Health, 13, Article 1678358.
https://doi.org/10.3389/fpubh.2025.1678358
Al Maqbali, M. (2026). Job satisfaction, work engagement and psychological distress among nurses: A mediated moderation model. Journal of Workplace Behavioral Health, 41(1), 60–75.
https://doi.org/10.1080/15555240.2024.2391891
Bakker, A. B., & Demerouti, E. (2007). The Job Demands‐Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328.
https://doi.org/10.1108/02683940710733115
Bakker, A. B., & Demerouti, E. (2017). Job demands–resources theory: Taking stock and looking forward. Journal of Occupational Health Psychology, 22(3), 273–285.
https://doi.org/10.1037/ocp0000056
Batz-Barbarich, C., Tay, L., Kuykendall, L., & Cheung, H. K. (2018). A meta-analysis of gender differences in subjective well-being: Estimating effect sizes and associations with gender inequality. Psychological Science, 29(9), 1491–1503.
https://doi.org/10.1177/0956797618774796
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191.
https://doi.org/10.1097/00007632-200012150-00014
Chiminelli-Tomás, V., Tutte-Vallarino, V., Ferreira-Umpiérrez, A., Hernández-Morante, J. J., & Reche-García, C. (2025). Impact of nursing practice environments in work engagement and burnout: A systematic review. Healthcare, 13(7), Article 779.
https://doi.org/10.3390/healthcare13070779
Cseh, S., Zorga, B., Sipos, D., Fináncz, J., & Csima, M. (2021). Professional well-being of nurses in Southwest Hungarian hospitals. Kontakt, 23(2), 76–82.
http://doi.org/10.32725/kont.2021.016
Delgado, C., Upton, D., Ranse, K., Furness, T., & Foster, K. (2017). Nurses’ resilience and the emotional labour of nursing work: An integrative review of empirical literature. International Journal of Nursing Studies, 70, 71–88.
https://doi.org/10.1016/j.ijnurstu.2017.02.008
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499–512.
https://doi.org/10.1037/0021-9010.86.3.499
Gao, X. L., Zhao, T., Du, M. X., Hao, R., & Wang, L. N. (2024). Relationship between emotional intelligence, occupational well-being, and work engagement among Chinese clinical nurses. Asian Nursing Research, 18(3), 253–259.
https://doi.org/10.1016/j.anr.2024.07.003
Han, S. (2023). Nurses’ job crafting, work engagement, and well-being: A path analysis. BMC Nursing, 22, Article 405.
https://doi.org/10.1186/s12912-023-01573-6
Kamppila, H., Czabanowska, K., Kämäräinen, P., Younas, A., & Kvist, T. (2026). Leadership of nurses’ interprofessional collaboration: A mixed-methods systematic review. Journal of Advanced Nursing, 1–23.
https://doi.org/10.1111/jan.70543
Keyko, K., Cummings, G. G., Yonge, O., & Wong, C. A. (2016). Work engagement in professional nursing practice: A systematic review. International Journal of Nursing Studies, 61, 142–164.
https://doi.org/10.1016/j.ijnurstu.2016.06.003
Kohnen, D., De Witte, H., Schaufeli, W. B., Dello, S., Bruyneel, L., & Sermeus, W. (2023). What makes nurses flourish at work? How the perceived clinical work environment relates to nurse motivation and well-being: A cross-sectional study. International Journal of Nursing Studies, 148, Article 104567.
https://doi.org/10.1016/j.ijnurstu.2023.104567
van Kraaij, J., de Vries, N., Wessel, H., Vermeulen, H., van Oostveen, C., & RN2Blend Consortium (2025). Enhancing work environments and reducing turnover intention: A multicenter longitudinal cohort study on differentiated nursing practices in Dutch hospitals. BMC Nursing, 24, Article 39.
https://doi.org/10.1186/s12912-024-02681-7
Labrague, L. J., Al Sabei, S., Al Rawajfah, O., AbuAlRub, R., & Burney, I. (2022). Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses. Journal of Nursing Management, 30(1), 268–278.
https://doi.org/10.1111/jonm.13491
Lake, E. T. (2002). Development of the practice environment scale of the nursing work index. Research in Nursing & Health, 25(3), 176–188.
https://doi.org/10.1002/nur.10032
Lake, E. T., Gil, J., Moronski, L., McHugh, M. D., Aiken, L. H., & Lasater, K. B. (2024). Validation of a short form of the practice environment scale of the nursing work index: The PES-5. Research in Nursing & Health, 47(4), 450–459.
https://doi.org/10.1002/nur.22388
Morales-García, W. C., Vallejos, M., Sairitupa-Sanchez, L. Z., Morales-García, S. B., Rivera-Lozada, O., & Morales-García, M. (2024). Depression, professional self-efficacy, and job performance as predictors of life satisfaction: The mediating role of work engagement in nurses. Frontiers in Public Health, 12, Article 1268336.
https://doi.org/10.3389/fpubh.2024.1268336
Ni, Y.-X., Wen, Y., Xu, Y., He, L., & You, G.-Y. (2023). The relationship between work practice environment and work engagement among nurses: The multiple mediation of basic psychological needs and organizational commitment: A cross-sectional survey. Frontiers in Public Health, 11, Article 1123580.
https://doi.org/10.3389/fpubh.2023.1123580
Othman, N., Ghazali, Z., & Nasurdin, A. M. (2017). Nurse engagement: Examining the role of resilience. International Journal of Economic Research, 14(15), 171–179.
Rozmann, N., Fusz, K., Macharia, J. M., Sipos, D., Kivés, Z., Kövesdi, O., & Raposa, B. (2025). Occupational stress and sleep quality among Hungarian nurses in the post-COVID era: A cross-sectional study. Healthcare, 13(16), Article 2029.
https://doi.org/10.3390/healthcare13162029
Salamon, J., Tóth-Király, I., Bõthe, B., Nagy, T., & Orosz, G. (2021). Having the cake and eating it too: First-order, second-order and bifactor representations of work engagement. Frontiers in Psychology, 12, Article 615581.
https://doi.org/10.3389/fpsyg.2021.615581
Sarıköse, S., & Göktepe, N. (2022). Effects of nurses’ individual, professional and work environment characteristics on job performance. Journal of Clinical Nursing, 31(5–6), 633–641.
https://doi.org/10.1111/jocn.15921
Schaufeli, W. B. & Bakker, A. B. (2004), Job demands, job resources, and their relationship with burnout and engagement: A multi-sample study. Journal Organizational Behavior, 25(3), 293–315.
https://doi.org/10.1002/job.248
Schaufeli, W. B., Bakker, A. B., & Salanova, M. (2006). The measurement of work engagement with a short questionnaire: A cross-national study. Educational and Psychological Measurement, 66(4), 701–716.
https://doi.org/10.1177/0013164405282471
Schaufeli, W. B., Salanova, M., González-Romá, V., & Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3, 71–92.
https://doi.org/10.1023/A:1015630930326
Siket Ujváriné, A., Gál, M., Harcsa Jakabné, E., Sárváry, A., Zrínyi, M., Fullér, N., & Oláh, A. (2020). Staying with nursing: The impact of conflictual communication, stress and organizational problem-solving. International Nursing Review, 67(4), 495–500.
https://doi.org/10.1111/inr.12619
Soósné Kiss, Z., Vitrai, J., Dió, M., Lipienné Krémer, I., & Ádám, S. (2024). High prevalence of burnout among midwives in Hungary: High job demands and low resources as potential persistent stressors, a focus on prevention. Heliyon, 10(2), Article e24495.
https://doi.org/10.1016/j.heliyon.2024.e24495
Susánszky, É., Konkolÿ Thege, B., Stauder, A., & Kopp, M. (2006). A WHO jól-lét kérdőív rövidített (WBI-5) magyar változatának validálása a Hungarostudy 2002 országos lakossági egészségfelmérés alapján [Validation of the short (5-item) version of the WHO Well-Being Scale based on a Hungarian representative health survey (Hungarostudy 2002)]. Mentálhigiéné és Pszichoszomatika, 7(3), 247–255.
https://doi.org/10.1556/Mental.7.2006.3.8
Swiger, P. A., Patrician, P. A., Miltner, R. S., Raju, D., Breckenridge-Sproat, S., & Loan, L. A. (2017). The practice environment scale of the nursing work index: An updated review and recommendations for use. International Journal of Nursing Studies, 74, 76–84.
https://doi.org/10.1016/j.ijnurstu.2017.06.003
Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 well-being index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167–176.
https://doi.org/10.1159/000376585
Wang, S., & Liu, Y. (2015). Impact of professional nursing practice environment and psychological empowerment on nurses' work engagement: test of structural equation modelling. Journal of Nursing Management, 23, 287–296.
https://doi.org/10.1111/jonm.12124
Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., & Erikson, P. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2), 94–104.
https://doi.org/10.1111/j.1524-4733.2005.04054.x
World Health Organization. (1998). Wellbeing measures in primary health care: The DepCare Project. WHO Regional Office for Europe. https://iris.who.int/server/api/core/bitstreams/8af98105-30ec-4da4-9fe9-097f7459e6da/content
World Health Organization. (2022). World mental health report: Transforming mental health for all. https://iris.who.int/server/api/core/bitstreams/40e5a13a-fe50-4efa-b56d-6e8cf00d5bfa/content
World Health Organization. (2025). State of the world's nursing 2025.
https://iris.who.int/server/api/core/bitstreams/a4173924-a18f-49b6-8bd1-9c2a4a098980/content
Xue, X., Qiao, J., Li, Y., Zhang, Q., Wang, Y., Wang, J., & Xu, C. (2023). Relationship between work engagement and healthy work environment among Chinese ICU nurses: The mediating role of psychological capital. Nursing Open, 10(9), 6248–6257.
https://doi.org/10.1002/nop2.1866
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Published 2026-09-29
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