High-Performance Work Systems and Nurse Role Stress: Serial Indirect Associations of Psychological Capital and Professional Identity

Background: Role stress is common among frontline nurses and is associated with demanding work conditions and organizational contexts. High-performance work systems (HPWSs) represent bundled human resource management practices that may be relevant to nurse role stress. This study examined the association between perceived HPWSs and role stress and further evaluated the possible roles of psychological capital and professional identity in this relationship. Methods: A multicenter cross-sectional survey was conducted from May to October 2024 in 10 tertiary public hospitals across four Chinese cities. Frontline registered nurses were recruited using cluster sampling and completed an anonymous questionnaire assessing perceived HPWSs, role stress, psychological capital, and professional identity. Descriptive statistics, univariate analyses, and Pearson correlation analyses were performed. Indirect associations were tested using PROCESS with 5000 bootstrap resamples. Sensitivity analyses were conducted with additional covariate adjustment and after excluding the role clarity items from the HPWS measure. Results: A total of 2824 valid questionnaires were included. The mean role stress score was 2.88 ± 0.69. Perceived HPWS was negatively associated with role stress (B = −0.143, p < 0.001) and positively associated with psychological capital (B = 0.217, p < 0.001) and professional identity (B = 0.044, p = 0.028). Psychological capital was positively associated with professional identity (B = 0.191, p < 0.001). Bootstrap analyses showed significant indirect associations through psychological capital (effect = −0.075, 95% CI [−0.094, −0.056]), professional identity (effect = −0.008, 95% CI [−0.015, −0.001]), and their serial linkage (effect = −0.007, 95% CI [−0.011, −0.005]). The overall pattern remained broadly similar in the sensitivity analyses. Conclusions: Perceived HPWS was associated with lower nurse role stress, with significant indirect association patterns involving psychological capital and professional identity. These findings highlight the potential relevance of both individual psychological resources and organizational human resource practices in understanding nurse role stress.