Abstract
BACKGROUND: A robust psychosocial safety climate (PSC) can enhance nurses' work engagement. Conversely, presenteeism-the behaviour of working while ill-reduces nurses' productivity and negatively impacts their work engagement. However, research is scarce on the interplay between PSC, presenteeism, and work engagement among nurses. OBJECTIVE: This study examined the mediation of presenteeism in the relationship between PSC and nurses' work engagement. METHODS: This cross-sectional descriptive study was performed among 2982 full-time registered nurses from tertiary hospitals in 38 cities across 15 provinces in China. An online questionnaire survey was conducted from 2 December 2024 to 31 January 2025. The measurement tools included the 12-item Psychosocial Safety Climate Scale, the Chinese version of the Stanford Presenteeism Scale, and the Utrecht Work Engagement Scale. The collected data were analyzed using descriptive statistics, independent samples t-tests, one-way ANOVA, multiple stepwise linear regression analysis, and PROCESS v3.5 macro analysis. RESULTS: The average scores for PSC, presenteeism, and work engagement were 49.10 (±10.37), 15.23 (±4.67), and 86.28 (±24.49), respectively. Marital status, only-child status, nurse specialist qualification, PSC score, and presenteeism score significantly influenced nurses' work engagement, accounting for 43.9% of the variance. PSC boosted work engagement and lowered presenteeism, while presenteeism decreased work engagement. Furthermore, presenteeism partially mediated the relationship between PSC and work engagement. CONCLUSION: Nurses report a relatively strong PSC and moderate levels of presenteeism and work engagement. Demographic and work-related characteristics, along with PSC and presenteeism scores, determine nurses' work engagement. Furthermore, PSC exerts both a direct and an indirect influence on nurses' work engagement, with presenteeism serving as a partial mediator. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should prioritize fostering a supportive PSC, minimizing presenteeism, and enhancing work engagement. Such measures can ultimately improve care quality and patient safety.