Organizational and Psychological Determinants of Nursing Performance: A PLS-SEM Analysis Among Registered Nurses in Saudi Arabia

Abstract* Background Maintaining high nursing performance is increasingly challenging in modern healthcare systems due to heavy workloads, workforce shortages, and growing psychological demands. Although work-life balance has been recognized as an important organizational resource, limited evidence has examined how it influences nursing performance through employee well-being and stress reduction, particularly in Saudi Arabian healthcare settings. This study investigated the relationships among work-life balance, employee well-being, stress reduction, and nursing performance among registered nurses. Methods A cross-sectional study was conducted among 427 registered nurses employed at The Medical City of Medina, Saudi Arabia. Participants were selected using proportionate stratified random sampling. Data were collected using validated self-administered questionnaires and analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Direct and indirect relationships were evaluated using a bootstrapping procedure with 5,000 resamples. Results Work-life balance demonstrated significant positive effects on employee well-being (β = 0.885, p < 0.001), stress reduction (β = 0.888, p < 0.001), and nursing performance (β = 0.219, p < 0.001). Stress reduction emerged as the strongest predictor of nursing performance (β = 0.417, p < 0.001), followed by employee well-being (β = 0.320, p < 0.001). Both employee well-being (β = 0.283, p < 0.001) and stress reduction (β = 0.371, p < 0.001) significantly mediated the relationship between work-life balance and nursing performance. Conclusions Work-life balance contributes to nursing performance both directly and indirectly by improving employee well-being and reducing occupational stress. These findings highlight the importance of organizational strategies that promote healthy work environments, flexible work arrangements, and psychological support programmes to strengthen nursing performance and workforce sustainability in tertiary healthcare settings.