Decent Work Among Hospital Nurses: Associations with Work Engagement, Burnout, and Job Crafting in a Cross-Sectional Study

Background/Objectives: Decent Work (DW) has emerged as a comprehensive framework for understanding the quality of working conditions. However, evidence regarding DW among hospital nurses remains limited, particularly in Japanese hospitals with 200–399 beds. This study aimed to describe DW among hospital nurses working in hospitals with 200–399 beds in Japan and to examine its associations with work engagement, burnout, and job crafting. The five-factor structure of the Decent Work Scale for Hospital Nurses (DWS-N) was also re-examined in an independent sample. Methods: A cross-sectional, web-based survey was conducted among hospital nurses working in Japanese hospitals with 200–399 beds between 7 July and 2 August 2026. Of 348 responses received, 342 were included in the analysis. Participants completed the DWS-N, the Utrecht Work Engagement Scale, the Copenhagen Burnout Inventory, and the Job Crafting Scale. Descriptive statistics, confirmatory factor analysis (CFA), correlation analyses, and hierarchical multiple regression analyses were performed. The regression analyses examined associations between the five DWS-N dimensions and the study outcomes after adjustment for age and sex. Results: The mean DW score was 72.64 (SD = 13.97). The previously established five-factor DWS-N model showed acceptable approximate fit (CFI = 0.939, TLI = 0.929, RMSEA = 0.063). Total DW was positively correlated with work engagement (r = 0.550, p < 0.001) and all four job crafting dimensions (rs = 0.218–0.294, all p < 0.001), and negatively correlated with all three burnout dimensions (rs = −0.476 to −0.528, all p < 0.001). In adjusted regression analyses, Meaningful and Fulfilling Work was positively associated with work engagement and with three of the four job crafting dimensions and negatively associated with all three burnout dimensions. Supportive and Safe Working Environment was positively associated with work engagement and selected job crafting dimensions and negatively associated with client-related burnout. Appropriate Working Time and Work–Life Balance was negatively associated with personal and work-related burnout and positively associated with decreasing hindering job demands. Protection of Workers’ Rights showed negative adjusted associations with three job crafting dimensions. Conclusions: DW was associated with work engagement, burnout, and job crafting among hospital nurses working in Japanese hospitals with 200–399 beds. The dimension-specific findings suggest that different aspects of DW may show distinct associations with nurses’ psychological and proactive work-related outcomes. Given the cross-sectional design, these findings should be interpreted as associations rather than temporal or causal relationships. Longitudinal research is needed to examine the direction and temporal ordering of these relationships.