Work Stress in Chinese Hospitals: Evidence Across Doctors, Nurses, and Administrative Staff with Regional Patterns and International Comparisons
DOI:
https://doi.org/10.63808/jmh.v2i1.421Keywords:
Work stress, Burnout, Chinese hospitals, Physicians, Nurses, Administrative staff, Regional differences, International comparisonAbstract
Work stress among doctors, nurses, and administrative staff is an important hospital-management concern because it is associated with workforce stability, service quality, and patient safety. This structured narrative review synthesizes 20 core sources published between 2000 and August 2026, including empirical studies, reviews, and three foundational theoretical articles. Evidence was identified through targeted searches of PubMed, Web of Science, and Scopus, supplemented by backward citation searching, and was organized using the Job Demands–Resources model, the Effort–Reward Imbalance model, and organizational support theory. The synthesis distinguishes four linked dimensions: workload and process demands, psychosocial and safety risks, effort–reward conditions, and organizational or system resources. Evidence is strongest for doctors and nurses; findings for administrative staff and regional differences remain more limited and should be interpreted cautiously. International evidence from Europe and North America is used as a bounded comparison because the included cross-national studies provide directly comparable evidence on staffing, working hours, and organizational support. The review contributes an evidence-to-management framework that links observed stressors to proportionate organizational responses while avoiding causal claims from predominantly cross-sectional evidence.
References
[1] Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987–1993. https://doi.org/10.1001/jama.288.16.1987
[2] Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., Bruyneel, L., Rafferty, A. M., Griffiths, P., Moreno-Casbas, M. T., Tishelman, C., Scott, A., Brzostek, T., Kinnunen, J., Schwendimann, R., Heinen, M., Zikos, D., Sjetne, I. S., Smith, H. L., & Kutney-Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717. https://doi.org/10.1136/bmj.e1717
[3] Bai, M., Jing, T., Li, S., & Zhang, Z. (2025). Unravelling critical burnout syndrome in Chinese hospitals: A network analysis of the Maslach Burnout Inventory–Human Services Survey. Scientific Reports, 15, 9870. https://doi.org/10.1038/s41598-025-93627-9
[4] Bakker, A. B., & Demerouti, E. (2007). The Job Demands–Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. https://doi.org/10.1108/02683940710733115
[5] Chen, W., Shi, J., Xu, J., Wang, Y., & Wu, Y. (2024). Workplace violence against Chinese licensed doctors: A cross-sectional study. Frontiers in Public Health, 12, 1235576. https://doi.org/10.3389/fpubh.2024.1235576
[6] Dall’Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. H. (2015). Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: Findings from a cross-sectional study of 12 European countries. BMJ Open, 5(9), e008331. https://doi.org/10.1136/bmjopen-2015-008331
[7] Eisenberger, R., Huntington, R., Hutchison, S., & Sowa, D. (1986). Perceived organizational support. Journal of Applied Psychology, 71(3), 500–507. https://doi.org/10.1037/0021-9010.71.3.500
[8] Lin, K. H., Hsu, C. C., & Lin, K. Y. (2025). Job stress and burnout among hospital administrative staff: A cross-sectional study. Scientific Reports, 15, 31064. https://doi.org/10.1038/s41598-025-17209-5
[9] Liu, L., Wu, D., Wang, L., Qu, Y., & Wu, H. (2020). Effort–reward imbalance, resilience and perceived organizational support: A moderated mediation model of fatigue in Chinese nurses. Risk Management and Healthcare Policy, 13, 893–901. https://doi.org/10.2147/RMHP.S259339
[10] Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International Journal of Health Policy and Management, 3(2), 77–89. https://doi.org/10.15171/ijhpm.2014.65
[11] Rossi, M. F., Beccia, F., Cittadini, F., Amantea, C., Aulino, G., Santoro, P. E., Borrelli, I., Oliva, A., Ricciardi, W., Moscato, U., & Gualano, M. R. (2023). Workplace violence against healthcare workers: An umbrella review of systematic reviews and meta-analyses. Public Health, 221, 50–59. https://doi.org/10.1016/j.puhe.2023.05.021
[12] Rotenstein, L. S., Torre, M., Ramos, M. A., Rosales, R. C., Guille, C., Sen, S., & Mata, D. A. (2018). Prevalence of physician burnout: A systematic review. JAMA, 320(11), 1131–1150. https://doi.org/10.1001/jama.2018.12777
[13] Shanafelt, T. D., West, C. P., Dyrbye, L. N., Trockel, M., Tutty, M., Wang, H., Carlasare, L. E., & Sinsky, C. (2022). Changes in burnout and satisfaction with work–life integration in physicians and the general US working population between 2011 and 2020. Mayo Clinic Proceedings, 97(3), 491–506. https://doi.org/10.1016/j.mayocp.2021.11.021
[14] Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27–41. https://doi.org/10.1037/1076-8998.1.1.27
[15] Wang, Q., Ding, J., Dai, Y., Yang, S., & Zhou, Z. (2025). Occupational stress, burnout, and fatigue among healthcare workers in Shanghai, China: A questionnaire-based cross-sectional survey. Healthcare, 13(13), 1600. https://doi.org/10.3390/healthcare13131600
[16] Wu, H., Liu, L., Wang, Y., Gao, F., Zhao, X., & Wang, L. (2013). Factors associated with burnout among Chinese hospital doctors: A cross-sectional study. BMC Public Health, 13, 786. https://doi.org/10.1186/1471-2458-13-786
[17] Xiao, Y., Dong, D., Zhang, H., Chen, P. P., Li, X. Y., Tian, Z., Jing, Z. C., & Zhang, S. Y. (2022). Burnout and well-being among medical professionals in China: A national cross-sectional study. Frontiers in Public Health, 9, 761706. https://doi.org/10.3389/fpubh.2021.761706
[18] Zhang, X. C., Huang, D. S., Guan, P., & SUBLIN Study Team. (2014). Job burnout among critical care nurses from 14 adult intensive care units in northeastern China: A cross-sectional survey. BMJ Open, 4(6), e004813. https://doi.org/10.1136/bmjopen-2014-004813
[19] Zheng, Q., Yang, K., Zhao, R.-J., Wang, X., Ping, P., Ou, Z.-H., Su, X.-P., Zhang, J., & Qu, M. (2022). Burnout among doctors in China through 2020: A systematic review and meta-analysis. Heliyon, 8(7), e09821. https://doi.org/10.1016/j.heliyon.2022.e09821
[20] Zhu, H., Liu, X., Yao, L., Zhou, L., Qin, J., Zhu, C., & Zhang, J. (2022). Workplace violence in primary hospitals and associated influencing factors: A cross-sectional study. Nursing Open, 9(1), 513–518. https://doi.org/10.1002/nop2.1090
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Copyright (c) 2026 Shuai Wang, Linzhong Zhou, Peilin Li, Sai-Keong Chan, Dongmei Li, Qian Li
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