Perceived stress partly links job strain to fatigue in operating room nurses

Operating room nurses in China report a moderate but persistent burden of occupational fatigue, and a new multi-center cross-sectional study suggests that how much stress they perceive may be one thread connecting their working conditions to that exhaustion. The research, published in Frontiers in Public Health, surveyed 1,122 operating room nurses across nine tertiary Grade-A hospitals and tested whether perceived stress mediates the relationship between the three dimensions of the Job Demand-Control-Support model—job demand, job control, and social support—and three distinct fatigue outcomes: acute fatigue, chronic fatigue, and inter-shift recovery.

The study was conducted between August and September 2026. Researchers purposively selected three provincial-level administrative units from each of eastern, central, and western China, then chose one tertiary Grade-A hospital in each, producing sites in Shanghai, Beijing, Zhejiang, Hubei, Jiangxi, Henan, Sichuan, Guangxi, and Shaanxi. Within each hospital, uniformly trained investigators distributed questionnaires by convenience sampling to all operating room nurses who had worked in the operating room for at least one year. Of 1,216 questionnaires distributed, 1,122 valid responses remained after excluding patterned, garbled, or implausibly fast completions, an effective recovery rate of 92.27 percent. Participants had a mean age of 31.41 years, and just over half worked rotating shifts that included mid-shift and night-shift duties.

Three validated instruments anchored the measurement. The Chinese version of the Occupational Fatigue Exhaustion Recovery Scale captured acute fatigue, chronic fatigue, and inter-shift recovery, each on converted percentage scales where higher scores mean more severe fatigue or better recovery. The 10-item Perceived Stress Scale measured global perceived stress over the past month, and the Chinese Job Content Questionnaire assessed job demand, job control, and social support. Internal consistency was strong across all scales, with Cronbach’s alpha coefficients between 0.874 and 0.912, and confirmatory factor analysis of the overall measurement model showed acceptable fit, with standardized item loadings ranging from 0.711 to 0.930.

The headline numbers describe a workforce under sustained strain. Acute fatigue scored 45.55 on average, chronic fatigue 44.13, and inter-shift recovery 56.27, which the authors characterize as an overall moderate level of occupational fatigue with recovery between shifts still leaving room for improvement. The perceived stress score averaged 21.01 out of a possible 40, a level the researchers describe as moderate to high. Job demand averaged 36.44, job control 71.54, and social support 24.02. Compared with earlier studies, the authors note that chronic fatigue among these operating room nurses was significantly higher than in American anesthesia and pediatric nurse populations, while inter-shift recovery was lower than that reported for American anesthesia nurses.

Hierarchical multiple regression, controlling for demographic and work characteristics, showed that all three JDCS dimensions remained independent correlates of all three outcomes. The full models explained 46.0 percent of the variance in acute fatigue, 30.5 percent in chronic fatigue, and 35.3 percent in inter-shift recovery. In the acute fatigue model, job demand was positively associated with fatigue while job control and social support were negatively associated. The same directional pattern held for chronic fatigue, and for inter-shift recovery the associations reversed: higher job demand predicted poorer recovery, while higher control and support predicted better recovery, with social support showing the strongest predictive effect in that model.

The structural equation model, estimated with maximum likelihood in AMOS, added the mediating pathway. Job demand positively predicted perceived stress, while job control and social support negatively predicted it. Perceived stress in turn positively predicted acute fatigue and chronic fatigue and negatively predicted inter-shift recovery. Bias-corrected bootstrap tests with 5,000 resamples found statistically significant partial mediation for all nine antecedent-outcome combinations, with 95 percent confidence intervals excluding zero in every case. Yet the authors are explicit that these indirect effects were small in magnitude, ranging from 0.023 to 0.084 in absolute value, with the proportion of the total effect mediated spanning 3.41 percent for the job control pathway to inter-shift recovery up to 17.35 percent for job demand to chronic fatigue. Most of the association between working conditions and fatigue ran directly, not through stress appraisal.

The pattern of direct effects was itself differentiated. Job demand exerted its largest effect on acute fatigue, consistent with the idea that immediate workload overload is the main trigger of short-term exhaustion, while its effect on chronic fatigue was roughly half as large. Job control showed larger effects on chronic fatigue and inter-shift recovery than on acute fatigue, suggesting that autonomy and decision latitude matter most for long-term cumulative fatigue and for restoring energy between shifts. Social support, by contrast, had a larger effect on acute fatigue than on chronic fatigue, pointing to the immediate value of help from supervisors and colleagues in defusing day-to-day exhaustion.

The study also documented striking demographic and scheduling contrasts. Regional differences were the most prominent: nurses in eastern China reported the highest fatigue scores and the worst inter-shift recovery, while those in the west fared best, a pattern the authors attribute plausibly to the concentration of medical resources, large surgical volumes, and fast work pace in eastern hospitals. Non-permanent contract nurses reported higher fatigue and worse recovery than permanent staff, and lower-income nurses reported the highest acute fatigue. In a counterintuitive finding, nurses averaging seven or more hours of daily sleep reported the highest fatigue scores, while those sleeping five hours or less reported the lowest; the authors suggest this may reflect increased sleep demand caused by fatigue, poor sleep quality, or the bidirectional relationship between fatigue and sleep, and they caution that the cross-sectional design cannot disentangle these possibilities.

Night-shift scheduling produced a nuanced picture. Nurses on regular rotating shifts—defined in this study as fixed night-shift assignments—had the highest fatigue scores, while those with irregular or flexible schedules fared better. Nurses with intervals of thirteen days or more between night shifts had the highest acute fatigue, which the authors interpret as a circadian

Subject of Research: The mediating role of perceived stress between the job demand-control-support model and occupational fatigue among operating room nurses: a multi-Center cross-sectional study

Article Title: The mediating role of perceived stress between the job demand-control-support model and occupational fatigue among operating room nurses: a multi-Center cross-sectional study

Article References: Qian, W., Wu, L., & Wang, X. (2026). The mediating role of perceived stress between the job demand-control-support model and occupational fatigue among operating room nurses: a multi-Center cross-sectional study. Frontiers in Public Health, 14, 1947875. https://doi.org/10.3389/fpubh.2026.1947875

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1947875

Keywords: mediating, role, perceived, stress, between, demand-control-support, model, occupational, fatigue, operating, room, nurses