Job satisfaction and organisational determinants among medical nursing assistants under hospital-based care reforms: a large cross-sectional study in China

Aim Population ageing and increasing care demands have led to a growing reliance on nursing support personnel in hospital care systems. This study aimed to examine the working conditions, sources of stress, and job satisfaction of medical nursing assistants (MNAs), defined as non-registered nursing support personnel providing basic care and daily living assistance under the supervision of registered nurses, in China, and to identify organisational factors associated with job satisfaction. Design Cross-sectional survey. Methods A cross-sectional survey using a self-developed questionnaire was conducted among 6,974 MNAs working in secondary and tertiary hospitals across Guangxi Province, China, using a multi-stage sampling approach. Data collected included demographics, training experiences, work conditions, sources of stress, and job satisfaction. Job satisfaction was measured using a 5-point Likert scale (1 = very dissatisfied to 5 = very satisfied) and dichotomized as satisfied (very satisfied or satisfied) versus dissatisfied (neutral, dissatisfied, or very dissatisfied). Independent variables, such as workload, training frequency, income satisfaction, and communication quality, were operationalized as categorical variables based on self-reported responses. Chi-square tests and multivariable logistic regression were performed,with odds ratios (ORs) and 95% confidence intervals (CIs) reported to estimate the associations between independent variables and job satisfaction. Results Most MNAs were female (92.11%) and aged 40–50 years (36.15%). Over half (53.38%) cared for ≥6 patients daily, and 39.02% frequently worked night shifts. While 61.13% perceived workload as appropriate, 20.76% reported excessive workload. Income levels were low: 48.00% earned <RMB 3,000 per month, and only 44.40% were satisfied with income. Major stressors included heavy workload (69.37%), complex interpersonal relationships (47.76%), and high care complexity (47.10%). Overall job satisfaction was 76.50%. Older age (OR = 1.179) and higher shift frequency (OR = 1.111) were associated with higher odds of job satisfaction, whereas income dissatisfaction (OR = 0.333), lack of regular training (OR = 0.618), unclear job roles (OR = 0.516), higher patient load (OR = 0.877), excessive workload (OR = 0.518), and poor communication (OR = 0.478) were associated with lower odds of job satisfaction, Nagelkerke R 2 = 0.281, indicating moderate explanatory power(all p < 0.05), with income dissatisfaction showing the strongest association. Conclusion Job satisfaction among MNAs is primarily shaped by organisational and work environment factors. Strengthening role clarity, structured training, staffing optimisation, income fairness, and communication support may enhance workforce stability and support sustainable inpatient care.