A study of the impact of obstetric nurses' job insecurity on work engagement in the context of low fertility: a cross-sectional study

A study of the impact of obstetric nurses' job insecurity on work engagement in the context of low fertility: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A study of the impact of obstetric nurses' job insecurity on work engagement in the context of low fertility: a cross-sectional study Dengmei Chen¹, Jun Ma¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8560523/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Against the backdrop of declining global fertility, obstetric nurses are encountering increasingly stressful professional environments. This study aimed to examine the impact of job insecurity among obstetric nurses on their work engagement levels. Additionally, it sought to validate the chain-mediated effects of perceived organizational support and challenging assessment in the relationship between job insecurity and work engagement. The findings aim to inform the development of targeted management strategies for nurses within healthcare organizations. Methods From April to May 2025,researchers conducted a cross-sectional study, recruiting 406 obstetric nurses from secondary and tertiary medical institutions in Chongqing.Data collection involved the use of a demographic questionnaire, the Job Insecurity Scale, the Specialist Nurse Work Engagement Scale, the Perceived Organizational Support Scale, and the Challenge Assessment Scale. Data analysis employed Pearson correlation analysis, hierarchical linear regression, and structural equation modeling. Results Obstetric nurses scored 105.97±41.84 on work engagement, falling into the medium-to-upper range. Hierarchical regression showed that nurses in secondary hospitals had significantly lower work engagement than those in tertiary hospitals (β = -37.123, p < 0.001); contract nurses also scored markedly lower than permanent staff (β = -21.876, p < 0.001). Job insecurity, perceived organizational support, and challenge assessment were key influencing factors, explaining 58.9% of the variance in work engagement (R²=0.589). Structural equation modeling verified the chain mediating effect: perceived organizational support and challenge assessment separately mediated 21.18% and 20.73% of the total effect, while their combined chain mediation accounted for 28.47%. Conclusions The nursing management department can implement a combined strategy of organizational support empowerment and positive cognitive cultivation to effectively assist obstetric nurses in reducing job insecurity and improving work engagement. The findings of this research are instrumental in guiding managers to develop supportive strategies, stabilize the nursing team, and ensure the safety of mothers and infants. Low fertility rate Obstetric nurses Job insecurity Work engagement Structural equation modeling Figures Figure 1 Figure 2 1 Introduction The world is confronting a significant challenge posed by declining fertility rates. Current data indicate that the global total fertility rate is projected to decrease from 1.83 in 2050 (predicted range: 1.59–2.08) to 1.59 by 2100 (predicted range: 1.25–1.96). Notably, more than half of the countries are expected to experience fertility rates falling below the population replacement level before 2100 [ 1 ]. This trend is particularly pronounced in China. According to the National Bureau of Statistics of China, the country's population has experienced negative growth for three consecutive years, from 2022 to 2024, with growth rates of -0.06%, -0.148%, and − 0.099%, respectively. In response to the domestic challenge of low fertility rates, the Chinese government has continuously refined its fertility policies, transitioning from the one-child policy to a two-child policy for couples in which one partner is an only child, then to a universal two-child policy, and ultimately to the current universal three-child policy. Nevertheless, these policy adjustments have not resulted in a significant increase in China's birth rate or fertility rate [ 2 ].Various factors such as high work pressure, costly child-rearing, and low happiness levels are identified in the literature as key contributors to declining fertility rates [ 3 ]. Notably, recent shifts in China's employment landscape, particularly the rise in overtime work, have adversely influenced fertility intentions [ 4 ]. Moreover, trends such as increased educational attainment (reflected in the proportion of non-student women), delayed marriage (indicated by the proportion of married women), and fluctuations in marital fertility rates collectively impact overall fertility rates [ 5 ]. The conflict that urban women encounter balancing family obligations with career advancement also significantly influences their desire for a second child [ 6 ]. Considering these factors, scholars project a continued decrease in birth rates in China [ 2 ]. Job insecurity, the persistent concern about career continuity and stability, is a significant stressor for individuals [ 7 ]. Amid a persistent decline in the fertility rate, the demand for obstetric services has markedly decreased, prompting structural adjustments within the obstetric service system, including the reduction of hospital beds and the integration of medical resources [ 8 ]. This trend mirrors the experience in South Korea, where the number of obstetric hospitals fell sharply from 1,371 in 2003 to 541 in 2019, representing a decrease of 60.5% [ 9 ]. Nurses, pivotal in obstetric care, face evolving job roles and paces due to reduced workloads. This shift not only reduces income and career advancement opportunities but also intensifies industry competition. In extreme cases, nurses may confront unemployment, leading to psychological challenges like job insecurity [ 10 ]. However, nurses' mental well-being directly impacts their ability to deliver safe patient care [ 11 ]. Work engagement refers to the positive psychological state characterized by profound cognitive focus, intense emotional energy, and wholehearted commitment to tasks demonstrated by professionals during work [ 12 ]. Amid the global trend of declining fertility rates, the obstetrics sector faces escalating competition, resource limitations, and mounting work pressures, necessitating obstetric nurses to exhibit enhanced work attitudes and proactive behaviors. Research has shown that nurses' favorable work attitudes can notably enhance their clinical effectiveness [ 13 ]. Based on this, obstetric nurses need to respond to the competition and practice challenges of the industry with a higher level of work engagement, which in turn guarantees a steady improvement in the quality of nursing services. Previous research, both domestic and international, has extensively examined the determinants of work engagement. Various crucial factors have been identified: nurses exhibit different levels of work engagement based on their age, educational background, and monthly income [ 14 ]. Job insecurity directly reduces work engagement [ 15 ]. Perceived organizational support can mitigate the adverse effects of job insecurity on work engagement [ 16 ]. Moreover, challenge assessment may act as a mediator between job insecurity and work engagement, whereby job insecurity indirectly enhances work engagement by fostering employees' perception of challenges, such as viewing stress as an opportunity for growth [ 17 ]. However, there is still room for further expansion of the existing research. The current literature predominantly explores the buffering effect of organizational support and the mediating role of challenge assessment separately. The combined mechanism of these two factors in the impact of job insecurity on work engagement remains largely unexplored. Moreover, while existing studies mainly concentrate on corporate employees in general, there is a need to delve into the experiences of maternity nurses. These professionals operate in the context of a declining birthrate and encounter distinct occupational pressures that warrant additional investigation. Specifically, research should shift its focus to obstetric nurses who face unique challenges within the backdrop of a low fertility rate. A comprehensive analysis of the interplay among job insecurity, perceived organizational support, challenging assessment and work engagement within this specific group is essential for further advancement in this area. 2 Theoretical Framework and Research Hypotheses Grounded in Cognitive Appraisal Theory (CAT) and Conservation of Resources Theory (COR), this study seeks to investigate the influence of job insecurity among obstetric nurses on their work engagement. Additionally, it aims to assess the combined mediating effects of perceived organizational support and challenge assessment in this context. According to Cognitive Appraisal Theory, an individual's evaluation of stressors serves as a crucial variable affecting work engagement [ 18 ]. This study specifically identifies "low fertility rate" as the primary stressor for obstetric nurses and posits that nurses' cognitive appraisal of this stressor significantly influences their level of work engagement. Conservation of Resources Theory categorizes the resources accessible to individuals into four types: conditional resources, object resources, energy resources, and personal resources [ 19 ].This study focused on the psychological mechanism of action and the adaptability of cross-sectional studies to subjective perception variables. It selected organizational support perception (energy resources) and challenge assessment (personal resources) as core mediating variables, excluding conditional resources and object resources with lower correlation to psychological mechanisms. The study aimed to analyze the joint mediating role of these variables in the path of "job insecurity - work engagement." A theoretical framework (Fig. 1 ) was developed based on this research, along with the formulation of the following research hypotheses: H1: There is a significant correlation among job insecurity, perceived organizational support, challenge assessment and work engagement of obstetric nurses. H2: Perceived organizational support and challenge assessment respectively mediate the relationship between job insecurity and work engagement. H3: Perceived organizational support and challenge assessment have a chain mediating effect on the relationship between job insecurity and work engagement. 3 Research Objects and Methods 3.1 Research Subjects As the only municipality directly governed by the Central Government in southwest China and a key city in the western region, Chongqing had a permanent resident population of 31.9047 million by the end of 2024. The city is home to 410 midwifery medical institutions, which include 142 secondary and 79 tertiary facilities; however, its birth rate stands at only 5.99 per thousand, below the national average. This demographic profile renders Chongqing a pertinent location for this study. The research employed a cross-sectional design alongside a two-stage sampling method. Initially, secondary and tertiary institutions were randomly selected in a stratified ratio of approximately 4:1. Subsequently, obstetric nurses were recruited from the selected institutions through convenience sampling. Anonymous online self-administered questionnaires were utilized via the Wenjuanxing platform. Prior to the survey, respondents were informed about the research objectives to obtain informed consent, and a data confidentiality agreement was explicitly outlined. The mediating effect was assessed using structural equation modeling (SEM). The sample size was determined according to widely accepted empirical guidelines, which recommend that the number of participants should be 10 to 15 times the number of observed variables [ 20 ] to ensure adequate statistical power. The study encompassed 13 variables: five dimensions from the Job Insecurity Scale, five dimensions from the work engagement Scale, two dimensions from the Perceived Organizational Support Scale, and one dimension from the Challenge Assessment Scale. Based on established guidelines, the necessary sample size was determined to be between 130 and 195 participants. To account for anticipated invalid responses, estimated at 20%, the adjusted sample size ranged from 156 to 234 participants. Ultimately, 418 questionnaires were distributed, yielding 406 valid responses and an effective response rate of 97%. Inclusion criteria : Nurses who hold a nursing practice qualification certificate and have been engaged in obstetric nursing for at least one year. Exclusion criteria : Obstetric nurses who are currently undergoing further studies or training in hospitals; Obstetric nurses who were on leave or off duty during the investigation period. 3.2 Measures 3.2.1 Basic Sociodemographic Questionnaire A self-designed sociodemographic questionnaire was employed, encompassing variables such as gender, age, whether the participant was an only child, marital status, institution type, institution level, highest education, professional title, job position, employment status, years of service, and monthly income. 3.2.2 Job Insecurity Scale This study utilized the "Chinese Employee Job Insecurity Scale," developed by Hu Sanman and Li Zhongbin [ 21 ]. This scale is based on pertinent foreign research, while also integrating the social and cultural context of China and the characteristics of contemporary society, consisting of 25 items distributed across five dimensions: Job Loss Insecurity (9 items), Interpersonal Insecurity (4 items), Work Execution Insecurity (4 items), Excessive Competition Insecurity (4 items), and Compensation and Promotion Insecurity (4 items). A 5-point Likert scale was employed for scoring, ranging from 1 (strongly disagree) to 5 (strongly agree). The total score varies from 25 to 125, with higher scores indicating greater job insecurity. The Cronbach's alpha coefficient for the Chinese version of this scale is 0.922. 3.2.3 Work Engagement Scale This study utilized the "Work Engagement Scale for Chinese Specialized Nurses," developed by Qin Hui et al. [ 22 ]. This scale was revised from the UWES scale, taking into account the occupational characteristics of specialized nursing in China as well as the psychological traits of specialized nurses,which consists of 32 items and 5 dimensions: work attitude (8 items), work values (6 items), work recognition(4 items), work initiative (9 items), and work enthusiasm and concentration (5 items) .This scale employs a 5-point Likert scoring system (ranging from 1 = never to 5 = always), with higher scores indicating greater work commitment. The Cronbach's alpha coefficient for the Chinese version of this scale is 0.958. 3.2.4 Challenge Assessment Scale The "Challenge-Threat Assessment Scale" [ 23 ], developed by Lepine et al., was utilized in this study. This scale has been optimized and expanded based on previously validated instruments, including the MLQ Leadership Questionnaire and the PANAS Affective Scale,which consists of two dimensions: challenge assessment and threat assessment. The challenge assessment subscale includes three items and utilizes a 7-point Likert scoring system (from 1 = strongly disagree to 7 = strongly agree), with a Cronbach's alpha coefficient of 0.929 for this subscale. 3.2.5 Perceived Organizational Support Scale This study utilized the "Perceived Organizational Support Scale for Chinese Nurses" [ 24 ], developed by Zuo Hongmei. The scale was revised from the original perceived organizational support scale created by Professor Chen Zhixia, incorporating the specific characteristics of the nursing profession, insights from nurse interviews, and expert opinions, which consists of 13 items and 2 dimensions: emotional support (10 items) and instrumental support (3 items). The scale adopts the Likert 5-point scoring method (from 1 = very inconsistent to 5 = very consistent), with all items scored positively. The total score ranges from 13 to 65 points, and the higher the score, the stronger the perceived organizational support. The Cronbach's alpha coefficient of this scale is 0.92. 3.3 Statistical Analysis Statistical analyses were performed using SPSS 26.0 and Amos 26.0 software. The normality of the measurement data was assessed using a Quantile-Quantile (Q-Q) plot. Normal distribution characteristics were statistically described as mean ± standard deviation (M ± SD), and an independent sample t-test was employed for comparisons between two groups. One-way analysis of variance (ANOVA) was utilized for comparisons among three or more groups. Pearson correlation analysis was conducted to investigate the relationships among various variables. Discontinuous categorical variables were encoded as dummy variables and subsequently included in hierarchical multiple linear regression analysis to identify factors influencing work input. Structural equation modeling (SEM) was developed using Amos 26.0, with job insecurity as the independent variable, work engagement as the dependent variable, and perceived organizational support and challenge assessment as mediating variables. The model's effectiveness was verified through model fit indices, and effect sizes and confidence intervals were calculated using 5,000 bootstrap samples. The significance level was set at α = 0.05. 4 Results The normality of the measurement data was assessed using Quantile-Quantile (Q-Q) plots. The results indicated that the Q-Q plots for the four variables—job insecurity, work engagement, perceived organizational support, and challenge assessment—displayed observed points that were generally aligned with the theoretical normal distribution reference line. There was no evident systematic deviation, such as extreme value deviation or nonlinear offset, suggesting that the data distribution approximately conforms to a normal distribution. 4.1 The differences in work engagement among obstetric nurses with different demographic characteristics Among the 406 obstetric nurses with varying demographic characteristics, 98.8% were female. Nurses aged 25 to 34 comprised 61.8% of the sample. Notably, 139 participants were only children, and 338 were married. Additionally, 60.1% of the nurses were employed in general hospitals, while 64.5% worked in secondary institutions. A total of 358 individuals held a bachelor's degree or higher. The cohort included 206 senior nurses and 304 general nurses, with 98 classified as regular staff members and 235 as contract workers. Furthermore, 63.8% of the nurses had between 6 and 15 years of work experience. Monthly income for 63.1% of the nurses ranged from 4,001 to 8,000 yuan. Statistical analyses revealed significant differences in work engagement scores among obstetric nurses based on institution type, institution level, professional title, job position, employment status, and monthly income (P < 0.05; see Table 1 ). Table 1 Work engagement of obstetric nurses under different demographic characteristics (N = 406) Variable Category Frequency Total Score t/F Variable Category Frequency Total Score t/F (%) (M ± SD) (%) (M ± SD) Gender Male 5 (1.2%) 127.6 ± 33.24 1.16 Professional Title Nurse 40 (9.9%) 108.7 ± 39.32 3.62* Female 401 (98.8%) 105.7 ± 41.9 Nurse Practitioner 134 (33%) 96.99 ± 43.04 Age Under 24 71 (17.5%) 98.31 ± 39.71 2 Senior Nurse 206 (50.7%) 109.54 ± 41.25 25–34 years 251 (61.8%) 105.5 ± 42.96 Associate Chief Nurse and above 26 (6.4%) 119.77 ± 37.32 35–44 years 71 (17.5%) 112.39 ± 40.37 Job Position Staff Nurse 304 (74.9%) 102.13 ± 42.53 3.81** Over 45 13 (3.2%) 121.85 ± 32.77 Charge Nurse 46 (11.3%) 114.07 ± 40.46 Only Child Yes 139 (34.2%) 105.97 ± 41.84 0.54 Head Nurse 47 (11.6%) 121.83 ± 34.01 No 267 (65.8%) 105.16 ± 42.18 Department Head Nurse and above 9 (2.2%) 111.56 ± 42.65 Marital Status Unmarried 54 (13.3%) 100.7 ± 41.7 1.58 Employment Status Staff Nurse 98 (24.1%) 128.69 ± 25.73 40.73*** Married 338 (83.3%) 106.11 ± 42.06 Contract Nurse 235 (57.9%) 88.79 ± 43.83 Divorced 14 (3.4%) 122.93 ± 34.18 Agency Nurse 70 (17.2%) 131.29 ± 20.59 Widowed 0 (0%) 0 Others 3 (0.7%) 118.67 ± 19.73 Institution Type General Hospital 244 (60.1%) 110.52 ± 41.76 6.4*** Years of Service ≤ 5 years 74 (18.2%) 102.47 ± 36.80 1.79 6–10 years 133 (32.8%) 104.07 ± 44.91 Specialized Hospital 79 (19.5%) 107.54 ± 39.85 11–15 years 126 (31%) 106.58 ± 41.56 Traditional Chinese Medicine Hospital 14 (3.4%) 68.29 ± 40.38 16–20 years 39 (9.6%) 101.92 ± 42.98 Women’s and Children’s Hospital 69 (17%) 95.74 ± 39.85 > 20 years 34 (8.4%) 123.41 ± 37.17 Institution Level Secondary 262 (64.5%) 87.15 ± 38.6 -17.81*** Monthly Income ≤ 4000 CNY 54 (13.3%) 83.26 ± 38.14 21.58*** Tertiary 144 (35.5%) 139.87 ± 20.97 4001–6000 CNY 168 (41.4%) 95.14 ± 42.60 Highest Education Junior College and below 41 (10.1%) 97.85 ± 38.56 1.03 6001–8000 CNY 88 (21.7%) 121 ± 35.89 Bachelor’s Degree 358 (88.2%) 107.06 ± 42.03 ≥ 8000 CNY 96 (23.6%) 123.92 ± 35.32 Master’s Degree and above 7 (1.7%) 97.71 ± 50.67 Notes:*P < 0.05; ** P < 0.01; *** P < 0.001. 4.2 The current situation of job insecurity, work engagement, perceived organizational support and challenge assessment among obstetric nurses The average score of job insecurity of obstetric nurses was 76.07 ± 22.80 points (out of 125), the average score of work engagement was 105.97 ± 41.84 points (out of 160), and the average score of perceived organizational support was 43.46 ± 13.59 points (out of 65). The average score of the challenge assessment was 14.25 ± 5.66 points (out of a total of 21 points). It can be seen that, against the backdrop of a low fertility rate, obstetric nurses are all at an above-average level in the above four indicators (see Table 2 ). Table 2 Total & Subscale Scores of Four Variables (N = 406) Project Minimum Maximum Total Score (M ± SD) Item Average Score (M ± SD) Job Insecurity 25 125 76.07 ± 22.80 4.00 ± 1.18 Job Loss Insecurity 9 45 28.02 ± 9.14 3.11 ± 1.02 Interpersonal Insecurity 4 20 11.96 ± 4.84 2.99 ± 1.21 Work Execution Insecurity 4 20 11.22 ± 4.51 2.80 ± 1.13 Excessive Competition Insecurity 4 20 12.14 ± 4.43 3.04 ± 1.11 Compensation and Promotion Insecurity 4 20 12.73 ± 4.10 3.18 ± 1.03 Job Involvement 32 160 105.97 ± 41.84 5.42 ± 2.15 Work Attitude 8 40 24.68 ± 12.76 3.09 ± 1.59 Work Value 6 30 20.64 ± 8.28 3.44 ± 1.38 Work Recognition 4 20 13.56 ± 5.39 3.39 ± 1.35 Work Initiative 9 45 30.42 ± 12.23 3.38 ± 1.36 Work Enthusiasm and Concentration 5 25 16.67 ± 6.74 3.33 ± 1.35 Challenge Evaluation 3 21 14.25 ± 5.66 4.75 ± 1.89 Perceived Organizational Support 13 65 43.46 ± 13.59 5.43 ± 1.77 Emotional Support 10 50 32.52 ± 11.18 3.25 ± 1.12 Instrumental Support 3 15 10.93 ± 2.69 3.64 ± 0.90 4.3 Correlation of Job Insecurity, Perceived Organizational Support, Challenge Assessment, and Work Engagement among Obstetric Nurses Pearson correlation analysis revealed significant correlations among job insecurity, work engagement, perceived organizational support and challenge assessment (all P < 0.01). Specifically, job insecurity exhibited a negative correlation with work engagement (r=-0.415), challenge assessment (r=-0.385), and perceived organizational support (r = -0.358). Conversely, work engagement demonstrated a positive correlation with challenge assessment (r = 0.735) and perceived organizational support (r = 0.607). Additionally, challenge assessment was positively correlated with perceived organizational support (r = 0.618) (all P < 0.01; see Table 3 ). Building on these correlation findings, structural equation modeling (SEM) was employed to verify the causal pathways among the variables and to investigate the mediating roles of challenge assessment and perceived organizational support in the relationship between job insecurity and work engagement. Table 3 Results of Pearson correlation analysis (r) Variable Job Insecurity Job Involvement Challenge Evaluation Perceived Organizational Support Job Insecurity 1 Job Involvement − .415** 1 Challenge Evaluation − .385** .735** 1 Perceived Organizational Support − .385** .607** .618** 1 Notes:** indicates P < 0.01 (statistically significant at the 0.01 level). 4.4 Common Method Bias Test Given that the data for this study were obtained through a self-report method, the potential for common method bias exists. To mitigate this risk, the study implemented ex-ante controls, which included anonymous completion of the survey and both forward and backward scoring of the scale. Additionally, AMOS software was employed to perform a single-factor confirmatory factor analysis on all self-assessment items to evaluate common method deviation. The results indicated a poor model fit, with χ²/df = 11.168, CFI = 0.488, GFI = 0.181, AGFI = 0.134, NFI = 0.466, and RMSEA = 0.158. Consequently, it can be concluded that there is no significant issue with common method bias in this study[ 25 ]. 4.5 Stratified multiple linear regression analysis of work engagement of obstetric nurses This study investigates the predictive influence of core variables on work engagement and the moderating effects of background factors using hierarchical multiple linear regression. Model 1 includes only job insecurity, challenge assessment, and perceived organizational support. In contrast, Model 2 builds upon Model 1 by incorporating background variables that are significantly correlated with work engagement, as identified through univariate analysis. These background variables include institution type, institution level, professional title, job position, Employment Status, and monthly income. The first five variables are categorical and are represented as dummy variables in the regression model. The coefficient of determination (R²) for Model 1 is 0.589, while Model 2 shows an increase to 0.746. The change in explanatory power (△R²) is 0.157, with a corresponding △F(14, 388) of 17.1 (P < 0.001), indicating that the addition of background variables significantly enhances the model's explanatory power regarding work engagement.Among the core variables, challenge assessment and perceived organizational support remained significant predictors in both models (P < 0.001), with challenge assessment exerting the strongest influence on work engagement. In contrast, job insecurity was significant only in Model 1, which did not control for background variables (P = 0.001); its effect diminished upon controlling for these variables, indicating that its direct impact on work engagement was confounded by background factors rather than being an independent effect. The results of Model 2 further demonstrate that hospital grade and personnel status significantly negatively affect the work engagement of obstetric nurses. Specifically, the work engagement level of obstetric nurses in secondary medical institutions is significantly lower than that in tertiary medical institutions (β = -37.123, p < 0.001). Additionally, contract-based obstetric nurses exhibit significantly lower work engagement levels compared to their permanent counterparts (β = -21.876, p < 0.001) (see Table 4 ). Consequently, a structural equation model will be constructed, incorporating independent variables such as job insecurity, perceived organizational support, and challenge assessment, alongside the dependent variable of work engagement, to systematically elucidate the mechanisms by which core variables influence work engagement. Table 4 Multiple Linear Regression: Effects on Work Engagement (N = 406) Variable B SE t VIF R² △R² F △F D-W Block1 (Constant) 34.518*** 8.319 4.149 0.589 192.236*** Job Insecurity -0.215** 0.065 -3.312 1.224 Challenge Evaluation 4.095*** 0.307 13.335 1.688 Perceived Organizational Support 0.677*** 0.128 5.299 1.688 Block2 (Constant) 87.149*** 9.217 9.455 0.746 0.157 67.109*** 17.1 1.689 Job Insecurity -0.029 0.056 -0.511 1.431 Challenge Evaluation 2.518*** 0.276 9.14 2.122 Perceived Organizational Support 0.351** 0.106 3.314 1.812 Specialized Hospital 3.504 2.899 1.209 1.153 Traditional Chinese Medicine Hospital -6.908 6.086 -1.135 1.079 Maternal and Child Health Hospital 1.077 3.053 0.353 1.151 Level 2 -37.123*** 2.741 -13.546 1.509 Staff Nurse -0.559 4.04 -0.138 3.16 Senior Nurse 0.098 4.167 0.023 3.799 Associate Chief Nurse and Above 1.308 6.941 0.188 2.528 Team Leader -1.432 3.78 -0.379 1.256 Head Nurse -1.592 4.227 -0.377 1.601 Nurse Supervisor -6.161 8.446 -0.729 1.354 Contract-employed Nurse -21.876*** 3.401 -6.432 2.468 Labor Dispatch 7.37 3.967 1.858 1.966 Service Outsourcing -2.695 13.377 -0.201 1.149 Monthly Income 1.967 1.321 1.49 1.505 Notes:** P < 0.01; *** P < 0.001. VIF < 10 is acceptable. The constants set for institution type,level, professional title, job position and employment status are respectively general hospital, tertiary hospital, junior nurse, nurse and staff nurse. 4.6 Structural Equation Model(SEM)and path coefficient evaluation The results indicate that the factor loadings for the latent variables—job insecurity, challenge assessment, work engagement, and perceived organizational support—exceed 0.5 (ranging from 0.56 to 0.97, p < 0.001). Additionally, the average variance extracted (AVE) is greater than 0.5 (ranging from 0.6 to 0.96), and the composite reliability (CR) surpasses 0.8 (ranging from 0.87 to 0.99). The standardized factor loadings, CR, and AVE for each variable meet the established criteria, demonstrating that all four measurement models exhibit strong convergent validity [ 26 ]. A structural equation model (SEM) was developed, positioning job insecurity as the independent variable and work engagement as the dependent variable, with perceived organizational support and challenge assessment as mediating variables. To enhance model fit and adaptability to the data, this study established a covariation relationship between the residual terms of compensation and promotion insecurity and excessive competition insecurity, guided by the Modification Index (MI) and theoretical rationale. Theoretically, common sources of measurement error may exist between the two, such as individual cognitive biases regarding workplace risks and systematic errors in questionnaire responses. From a data perspective, incorporating this residual correlation effectively alleviates model constraints and significantly improves the fit indices.The final fitting index is: χ²=150.805, DF = 59, p < 0.001, χ²/df = 2.556, GFI = 0.985, NFI = 0.976, TLI = 0.98, CFI = 0.985, SRMR = 0.024, RMSEA = 0.062[ 27 ]. The standardized coefficients of each path are shown in Fig. 2 , which reveals several key paths: job insecurity, perceived organizational support, and challenge assessment all have a significant impact on work engagement (β values are − 0.13, 0.23, and 0.55 respectively, all p < 0.001). Job insecurity has a significant negative impact on perceived organizational support and challenge assessment (β values are − 0.41, -0.17 respectively, both p < 0.001); perceived organizational support has a significant positive impact on challenge assessment (β = 0.56, p < 0.001 4.7 Test of Mediating Effects To further investigate the mediating roles of perceived organizational support and challenge assessment in the relationship between job insecurity and work engagement, the bias-corrected percentile Bootstrap method was employed. This study utilized AMOS software and performed Bootstrap resampling 5,000 times to estimate the mediating effects of perceived organizational support and challenge assessment, along with their 95% confidence intervals. A confidence interval that excludes zero signifies a statistically significant mediation effect, while an interval that includes zero indicates nonsignificance.The results show that: the direct effect of job insecurity on work engagement is − 0.13, the total indirect effect is − 0.309, and the total effect is − 0.439. Among them, the independent mediating effect of perceived organizational support accounted for 21.18% of the total effect, the independent mediating effect of challenge assessment accounted for 20.73% of the total effect, and the chain mediation effect of the two accounted for 28.47% of the total effect. All confidence intervals do not include 0, indicating that the mediation model is valid (see Table 5 ). This shows that job insecurity not only directly has a negative impact on work engagement, but also indirectly has a negative impact on work engagement through the separate mediating path of perceived organizational support and challenge assessment and the chain mediating path of the two. There are significant multiple mediating effects. Table 5 Mediating Effect Analysis Pathway β SE 95%CI Effect propor-tion(%) LLCI ULCI Total Effect -0.439 0.046 -0.528 -0.347 100% Total Direct Effect -0.13 0.039 -0.205 -0.052 29.61% Total Indirect Effect -0.309 0.036 -0.38 -0.241 70.39% Mediating Effect (A→B→D) -0.093 0.023 -0.145 -0.054 21.18% Mediating Effect (A→C→D) -0.091 0.026 -0.144 -0.042 20.73% Chain Mediating Effect (A→B→C→D) -0.125 0.022 -0.176 -0.089 28.47% Notes: β is unstandardized path coefficient; SE is standard error;A is Job Insecurity;B is Perceived Organizational Support;C is Challenge Assessment;D is Work Engagement. 5 Discussion The ongoing decline in global fertility rates has significantly influenced population structure and social development. Existing research predominantly examines the functioning of obstetric institutions and the transformation of physicians, while neglecting the mental health of the obstetric nursing workforce. Given that the mental health of nurses is a critical concern in global health, and that the quality of obstetric care directly impacts the safety of mothers and infants, it is essential to investigate the job insecurity and work engagement of obstetric nurses. This study focused on obstetric nurses in Chongqing, China, employing structural equation modeling (SEM) and chain mediation model analysis. The findings reveal that perceived organizational support and challenge assessment partially mediate the relationship between job insecurity and work engagement. The robustness of the model was confirmed through 5,000 Bootstrap sampling tests. These results offer a novel perspective on the application of occupational psychology within the medical field and provide a scientific foundation for the management of obstetric nursing teams. 5.1 Analysis on the current situation of obstetric nurses’ work engagement The findings of this study indicate that the work engagement score of obstetric nurses is 105.97 ± 41.84 points. This result aligns with previous research on the work engagement of specialist nurses, suggesting that their engagement level is categorized as upper-medium [ 28 , 29 ]. This characteristic may be closely linked to the unique occupational demands of obstetrics, which include “high nursing skill requirements, high service standards, and high environmental risks” [ 30 ]. The dual attributes of elevated professionalism and significant risk necessitate that obstetric nurses consistently maintain a high level of investment in their work. An analysis of various dimensions of work input reveals that the dimensions of work motivation and work attitude yield higher scores. The declining fertility rate and the transformation of the obstetric service model exert pressure on nurses to enhance their professional competitiveness. Consequently, obstetric nurses have broadened their service scope from solely providing delivery care to encompassing full-cycle health management. They are now required to adopt diverse roles throughout the prenatal, intrapartum, and postpartum stages, including pre-pregnancy file manager, pregnancy health educator, postpartum depression counseling specialist, and lactation care guide [ 8 ]. This expansion of roles inevitably demands that nurses exhibit a high degree of work initiative.Conversely, in alignment with findings from pertinent Korean studies, low fertility rates have markedly heightened maternal demand for natural delivery and personalized care [ 31 ]. Nurses must dedicate increased time and effort to comprehensive care, which includes individualized pregnancy health guidance, continuous support during delivery, and dynamic follow-up for postpartum recovery. This care model fosters a serious work ethic among nurses. However, scores reflecting work recognition, enthusiasm, focus, and professional value remain relatively low. The primary influencing factors may stem from adjustments in obstetric services due to declining fertility rates. First, a decrease in business volume may result in lower income levels for nurses; research indicates that salary reductions directly diminish job satisfaction among nursing professionals [ 32 ]. Second, the contraction of departmental development can obscure career advancement pathways, thereby diminishing nurses' perceived opportunities for professional growth and weakening their job recognition and sense of professional value [ 33 , 34 ]. Third, a relative decline in organizational resource investment can lead to reduced perceived organizational support, and this decrease is a significant contributor to diminished work enthusiasm [ 35 ]. 5.2 There are differences in work engagement levels among obstetric nurses with different institution levels and employment status This study employed both single-factor and hierarchical multiple linear regression analyses to systematically investigate the influence of demographic and occupational characteristics on nurses' work engagement. The results from the single-factor analysis indicated that six factors—institution type, institution level, professional title, job position, employment status, and monthly income—were statistically significant predictors of nurses' work engagement scores (p < 0.05). Based on this foundation, the study employed hierarchical multiple linear regression analysis. The findings indicated significant differences in work engagement levels among obstetric nurses across various institution grades and employment situations. Specifically, obstetric nurses in secondary medical institutions exhibited lower work engagement compared to their counterparts in tertiary medical institutions. Additionally, contract-appointed obstetric nurses demonstrated lower work engagement than those in permanent positions. Based on extant research, the formation mechanism of the aforementioned outcomes is primarily manifested in three key aspects. Firstly, tertiary medical institutions typically boast more abundant diagnostic and treatment resources and staffing compared to secondary medical institutions. They also offer clear career advancement pathways and enjoy high social esteem[ 36 , 37 ]. This setting effectively enhances nurses' professional identity and job performance, facilitating the maintenance of a high level of commitment. Secondly, permanent nurses benefit from greater job stability, experiencing markedly higher occupational security than their contracted counterparts [ 38 ]. In contrast, contract-based nurses often perceive lower organizational belongingness due to disparities in rights protection, consequently impacting their level of work engagement.Based on the aforementioned research findings, enhancing nurses' work input levels can be achieved by facilitating the sharing of equipment configurations and training resources among primary medical institutions. For instance, in Chengdu, China, 146 medical alliances, urban medical groups, and two-way referral platforms have been established[ 39 ]; enabling nurses both within and outside these establishments to benefit equally. This includes access to union benefits, improved working conditions through the extension of more open-term contracts, and the implementation of a salary system based on job value rather than employee status[ 40 , 41 ]. An example of this approach is the "equal pay for work of equal value" evaluation plan implemented by the British NHS, ensuring that identical positions with the same workload receive equitable compensation[ 42 ]. 5.3 Obstetric nurses' job insecurity, work engagement, perceived organizational support and challenge assessment are significantly related to each other This study confirms that the four variables are interconnected rather than existing independently. It provides evidence for the impact of job insecurity on work engagement, with a direct effect size of 29.61% and an indirect effect size of 70.39%, thereby verifying Hypothesis 1. Consistent with prior literature [ 43 ], job insecurity is found to directly decrease employees' work engagement, while perceived organizational support is shown to influence work engagement across various professions such as nurses, teachers, and police [ 44 – 46 ]. Furthermore, this study establishes a significant positive correlation between challenge assessment and work engagement. Unlike previous research that focused on the binary analysis framework of challenge assessment and threat assessment [ 47 ], this study emphasizes the positive cognitive evaluation aspect of challenge assessment. 5.4 Perceived organizational support and challenge assessment each mediate the relationship between job insecurity and work engagement The findings of this study indicate that job insecurity influences work engagement through the partial mediating roles of perceived organizational support and challenge assessment, resulting in two independent mediation pathways: job insecurity → perceived organizational support → work engagement and job insecurity → challenge assessment → work engagement. The mediating effects of these two pathways accounted for 21.18% and 20.73% of the total effect, respectively. Hypothesis 2 was confirmed and aligns with prior research, elucidating the roles of perceived organizational support and challenge assessment in the relationship between work stress and employee attitudes and behaviors [ 43 , 48 ]. According to resource conservation theory, declining fertility rates result in a contraction of obstetric services, leading nurses to experience concerns regarding resource loss. Perceived organizational support can mitigate the gap in developmental resources through instrumental assistance. Relevant studies suggest that enhancing skills training, providing competitive salaries and benefits, and establishing clear career development plans can effectively foster employee work engagement [ 49 – 51 ]. Literature indicates that occupational anxiety can be mitigated through emotional support, including psychological counseling and team care [ 52 , 53 ]. Together, these resources serve as external energy sources to address job insecurity, thereby counteracting the resource depletion associated with it. Additionally, enhancing challenge assessment as an internal personal resource can help individuals navigate the difficulties and challenges posed by low fertility. Relevant studies suggest that cultivating psychological resilience, aligning work demands with appropriate resources, and fostering transparent internal communication can improve employees' challenge assessment of stress [ 54 – 56 ]. From the perspective of cognitive appraisal theory, when stress is perceived as a challenge, individuals are more likely to actively acquire skills—such as prenatal consultation, mid-partum health education, and postpartum rehabilitation—to adapt to changes in obstetric services, ultimately translating these efforts into increased work engagement [ 57 ]. 5.5 Perceived organizational support and challenge assessment have chain-mediating effects on the relationship between job insecurity and work engagement This study confirmed the existence of a mediating chain effect between perceived organizational support and challenge evaluation regarding the work engagement of obstetric nurses (path: job insecurity → perceived organizational support → challenge assessment → work engagement). This effect constituted 28.47% of the total effect. Hypothesis H3 was validated. This finding transcends the limitations of single-variable research [ 58 ] and delineates the chain of effects from “organizational environment → individual psychology → work behavior,” thereby affirming the guiding significance of organizational support on individual cognition and behavior. Under conditions of low fertility rates, obstetric nurses often experience unease stemming from job uncertainty. The provision of instrumental support, such as training and welfare, alongside emotional support, including psychological counseling and team care, can facilitate the transformation of this unease into manageable challenges. This aligns with the findings of the "Supportive Environment Optimization Stress Assessment" [ 59 ]. With this positive cognitive framework, nurses are likely to proactively enhance their skills in response to service changes, thereby increasing their work engagement. This research offers clear implications for management practice: a singular intervention yields limited results, whereas a collaborative strategy that combines "organizational support and empowerment with positive cognitive cultivation" can more effectively mitigate nurses' anxiety, enhance work input, and provide a novel approach to the stable management of obstetric nursing teams. 6 Research Significance and Contributions In the context of China's "low fertility rate" era, this study integrates cognitive evaluation theory with conservation of resources theory (COR theory), transcending the traditional single-causality research paradigm to elucidate the intrinsic mechanisms by which job insecurity impacts obstetric nurses' work engagement. Specifically, perceived organizational support and challenge assessment serve as chain mediators in this relationship, effectively mitigating nurses' job insecurity and enhancing their levels of work engagement. The results of the mediation effect analysis, conducted using structural equation modeling (SEM), are consistent and provide a novel theoretical perspective along with practical guidance for managers in formulating organizational support strategies. These strategies aim to stabilize the nursing talent pool and optimize working conditions for nurses. Furthermore, this study contributes positively to the development of a scientific and efficient nursing management system. 7 Research Limitations and Future Prospects First, while the cross-sectional design can illustrate the co-variation relationship between variables, data collected at a single time point restricts the ability to establish causal relationships. Future research should employ longitudinal follow-up designs to conduct a comprehensive analysis of causal pathways and mechanisms by examining the dynamic changes in variables over time. Second, although the mediation effect model elucidates the influence pathways of two key variables, accounting for 70.39% of the variation, the complexity of social phenomena suggests the existence of potential variables or mechanisms that may not have been considered. Subsequent research should integrate theoretical frameworks with empirical investigations, utilize multi-source data, and apply complex statistical models to explore additional influencing factors and their interactions. 8 Conclusion In the context of China's "low fertility rate," this study elucidates the specific pathway through which obstetric nurses' job insecurity influences work engagement. It demonstrates that perceived organizational support and challenge assessment serve as mediators in the relationship between these two factors. By alleviating job insecurity and enhancing nurses' organizational support and challenge assessment skills, work engagement can be significantly improved. The findings offer a novel perspective for managers in developing supportive strategies, stabilizing the nursing workforce, and optimizing working conditions, while also serving as a reference for establishing a scientific nursing management system. Declarations Authors' contributions D. C. was responsible for conceptualization, data curation, formal analysis, investigation, methodology, software, validation, visualization, writing – original draft, and writing – review & editing. J.M. contributed to conceptualization, project administration, resources, supervision, and writing – review & editing. E. Competing interests The authors declare no competing interests Ethics approval and consent to participate This study was approved by the Ethics Committee of the School of Public Health, Chongqing Medical University (Ethics Approval No: 2025010), and all methods were performed in accordance with relevant guidelines and regulations. This study complies with the ethical standards set forth in Declaration of Helsinki. All participants gave informed consent before data collection. Participants were promised that the information provided would remain anonymous. Consent for publication Not applicable. Availability of data and materials The data supporting the findings of this study are limited in availability as they were used under a specific license and are not publicly accessible. Funding No funding was obtained for this study. Acknowledgements We thank the members of the research as well as all participants for their contribution. References Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024, 403(10440):2057–2099.http://dor.org/10.1016/s0140-6736(24)00550-6. Wang W, Mo Y, Kuang Y: Effect evaluation, prediction and response strategy analysis of China's birth policy adjustment. 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Gillman JC, Turner MJ, Slater MJ: The role of social support and social identification on challenge and threat cognitive appraisals, perceived stress, and life satisfaction in workplace employees. PLoS One 2023, 18(7):e0288563.http://dor.org/10.1371/journal.pone.0288563. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 05 Feb, 2026 Editor invited by journal 12 Jan, 2026 Editor assigned by journal 10 Jan, 2026 Submission checks completed at journal 10 Jan, 2026 First submitted to journal 09 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8560523","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":586153365,"identity":"78a1a9c4-2f04-427a-8a35-c170c914e11d","order_by":0,"name":"Dengmei Chen¹","email":"","orcid":"","institution":"First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dengmei","middleName":"","lastName":"Chen¹","suffix":""},{"id":586153366,"identity":"bfc32079-42d9-454f-aae3-f337256f3fcd","order_by":1,"name":"Jun Ma¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYHCCBAaGCiiTh3gtZ0jUwsDA2EaKFt32A8+kC+fZya6dkcD44G0bg7w5IS1mZxLSpGduSzbediOB2XBuG4PhzgZCWg4AtfBuO5AI1MImzdvGkGBwgJCW8w+AWuaAtbD/Jk7LDZAtDRBbmInU8iDZmucY0C9nHjZLzjknYbiBsMNyEm/z1NjJbjuefPDDmzIbeYK2AOMiAUQyNoAQA4MEQfVAwH4AqmUUjIJRMApGAQ4AAKpzQi5Va5oUAAAAAElFTkSuQmCC","orcid":"","institution":"Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"","lastName":"Ma¹","suffix":""}],"badges":[],"createdAt":"2026-01-09 11:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8560523/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8560523/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102214380,"identity":"8043f595-5276-4954-8f81-6cc5ee003a5c","added_by":"auto","created_at":"2026-02-09 12:43:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":223619,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTheoretical Framework.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8560523/v1/6f843e9a7680cd9a3cf53efe.png"},{"id":102214391,"identity":"951b1d82-79ce-4ac1-af43-5fac963d9626","added_by":"auto","created_at":"2026-02-09 12:43:41","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":105903,"visible":true,"origin":"","legend":"\u003cp\u003eChain Mediation Model.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8560523/v1/43c682a27d4189c2d104cc8c.jpeg"},{"id":102214594,"identity":"bbcf8737-7685-4a12-bdb9-2fe48d28b80e","added_by":"auto","created_at":"2026-02-09 12:44:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2179712,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8560523/v1/d80401e3-832f-4d8e-950f-b08f7a31758d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A study of the impact of obstetric nurses' job insecurity on work engagement in the context of low fertility: a cross-sectional study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eThe world is confronting a significant challenge posed by declining fertility rates. Current data indicate that the global total fertility rate is projected to decrease from 1.83 in 2050 (predicted range: 1.59\u0026ndash;2.08) to 1.59 by 2100 (predicted range: 1.25\u0026ndash;1.96). Notably, more than half of the countries are expected to experience fertility rates falling below the population replacement level before 2100 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This trend is particularly pronounced in China. According to the National Bureau of Statistics of China, the country's population has experienced negative growth for three consecutive years, from 2022 to 2024, with growth rates of -0.06%, -0.148%, and \u0026minus;\u0026thinsp;0.099%, respectively. In response to the domestic challenge of low fertility rates, the Chinese government has continuously refined its fertility policies, transitioning from the one-child policy to a two-child policy for couples in which one partner is an only child, then to a universal two-child policy, and ultimately to the current universal three-child policy. Nevertheless, these policy adjustments have not resulted in a significant increase in China's birth rate or fertility rate [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].Various factors such as high work pressure, costly child-rearing, and low happiness levels are identified in the literature as key contributors to declining fertility rates [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Notably, recent shifts in China's employment landscape, particularly the rise in overtime work, have adversely influenced fertility intentions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Moreover, trends such as increased educational attainment (reflected in the proportion of non-student women), delayed marriage (indicated by the proportion of married women), and fluctuations in marital fertility rates collectively impact overall fertility rates [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The conflict that urban women encounter balancing family obligations with career advancement also significantly influences their desire for a second child [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Considering these factors, scholars project a continued decrease in birth rates in China [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eJob insecurity, the persistent concern about career continuity and stability, is a significant stressor for individuals [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Amid a persistent decline in the fertility rate, the demand for obstetric services has markedly decreased, prompting structural adjustments within the obstetric service system, including the reduction of hospital beds and the integration of medical resources [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This trend mirrors the experience in South Korea, where the number of obstetric hospitals fell sharply from 1,371 in 2003 to 541 in 2019, representing a decrease of 60.5% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nurses, pivotal in obstetric care, face evolving job roles and paces due to reduced workloads. This shift not only reduces income and career advancement opportunities but also intensifies industry competition. In extreme cases, nurses may confront unemployment, leading to psychological challenges like job insecurity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, nurses' mental well-being directly impacts their ability to deliver safe patient care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWork engagement refers to the positive psychological state characterized by profound cognitive focus, intense emotional energy, and wholehearted commitment to tasks demonstrated by professionals during work [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Amid the global trend of declining fertility rates, the obstetrics sector faces escalating competition, resource limitations, and mounting work pressures, necessitating obstetric nurses to exhibit enhanced work attitudes and proactive behaviors. Research has shown that nurses' favorable work attitudes can notably enhance their clinical effectiveness [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Based on this, obstetric nurses need to respond to the competition and practice challenges of the industry with a higher level of work engagement, which in turn guarantees a steady improvement in the quality of nursing services.\u003c/p\u003e \u003cp\u003ePrevious research, both domestic and international, has extensively examined the determinants of work engagement. Various crucial factors have been identified: nurses exhibit different levels of work engagement based on their age, educational background, and monthly income [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Job insecurity directly reduces work engagement [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Perceived organizational support can mitigate the adverse effects of job insecurity on work engagement [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moreover, challenge assessment may act as a mediator between job insecurity and work engagement, whereby job insecurity indirectly enhances work engagement by fostering employees' perception of challenges, such as viewing stress as an opportunity for growth [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, there is still room for further expansion of the existing research. The current literature predominantly explores the buffering effect of organizational support and the mediating role of challenge assessment separately. The combined mechanism of these two factors in the impact of job insecurity on work engagement remains largely unexplored. Moreover, while existing studies mainly concentrate on corporate employees in general, there is a need to delve into the experiences of maternity nurses. These professionals operate in the context of a declining birthrate and encounter distinct occupational pressures that warrant additional investigation. Specifically, research should shift its focus to obstetric nurses who face unique challenges within the backdrop of a low fertility rate. A comprehensive analysis of the interplay among job insecurity, perceived organizational support, challenging assessment and work engagement within this specific group is essential for further advancement in this area.\u003c/p\u003e"},{"header":"2 Theoretical Framework and Research Hypotheses","content":"\u003cp\u003eGrounded in Cognitive Appraisal Theory (CAT) and Conservation of Resources Theory (COR), this study seeks to investigate the influence of job insecurity among obstetric nurses on their work engagement. Additionally, it aims to assess the combined mediating effects of perceived organizational support and challenge assessment in this context. According to Cognitive Appraisal Theory, an individual's evaluation of stressors serves as a crucial variable affecting work engagement [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This study specifically identifies \"low fertility rate\" as the primary stressor for obstetric nurses and posits that nurses' cognitive appraisal of this stressor significantly influences their level of work engagement. Conservation of Resources Theory categorizes the resources accessible to individuals into four types: conditional resources, object resources, energy resources, and personal resources [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].This study focused on the psychological mechanism of action and the adaptability of cross-sectional studies to subjective perception variables. It selected organizational support perception (energy resources) and challenge assessment (personal resources) as core mediating variables, excluding conditional resources and object resources with lower correlation to psychological mechanisms. The study aimed to analyze the joint mediating role of these variables in the path of \"job insecurity - work engagement.\" A theoretical framework (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was developed based on this research, along with the formulation of the following research hypotheses:\u003c/p\u003e \u003cp\u003eH1: There is a significant correlation among job insecurity, perceived organizational support, challenge assessment and work engagement of obstetric nurses.\u003c/p\u003e \u003cp\u003eH2: Perceived organizational support and challenge assessment respectively mediate the relationship between job insecurity and work engagement.\u003c/p\u003e \u003cp\u003eH3: Perceived organizational support and challenge assessment have a chain mediating effect on the relationship between job insecurity and work engagement.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"3 Research Objects and Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Research Subjects\u003c/h2\u003e \u003cp\u003eAs the only municipality directly governed by the Central Government in southwest China and a key city in the western region, Chongqing had a permanent resident population of 31.9047\u0026nbsp;million by the end of 2024. The city is home to 410 midwifery medical institutions, which include 142 secondary and 79 tertiary facilities; however, its birth rate stands at only 5.99 per thousand, below the national average. This demographic profile renders Chongqing a pertinent location for this study.\u003c/p\u003e \u003cp\u003eThe research employed a cross-sectional design alongside a two-stage sampling method. Initially, secondary and tertiary institutions were randomly selected in a stratified ratio of approximately 4:1. Subsequently, obstetric nurses were recruited from the selected institutions through convenience sampling. Anonymous online self-administered questionnaires were utilized via the Wenjuanxing platform. Prior to the survey, respondents were informed about the research objectives to obtain informed consent, and a data confidentiality agreement was explicitly outlined. The mediating effect was assessed using structural equation modeling (SEM). The sample size was determined according to widely accepted empirical guidelines, which recommend that the number of participants should be 10 to 15 times the number of observed variables [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] to ensure adequate statistical power.\u003c/p\u003e \u003cp\u003eThe study encompassed 13 variables: five dimensions from the Job Insecurity Scale, five dimensions from the work engagement Scale, two dimensions from the Perceived Organizational Support Scale, and one dimension from the Challenge Assessment Scale. Based on established guidelines, the necessary sample size was determined to be between 130 and 195 participants. To account for anticipated invalid responses, estimated at 20%, the adjusted sample size ranged from 156 to 234 participants. Ultimately, 418 questionnaires were distributed, yielding 406 valid responses and an effective response rate of 97%.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e: Nurses who hold a nursing practice qualification certificate and have been engaged in obstetric nursing for at least one year.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e: Obstetric nurses who are currently undergoing further studies or training in hospitals; Obstetric nurses who were on leave or off duty during the investigation period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Measures\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Basic Sociodemographic Questionnaire\u003c/h2\u003e \u003cp\u003eA self-designed sociodemographic questionnaire was employed, encompassing variables such as gender, age, whether the participant was an only child, marital status, institution type, institution level, highest education, professional title, job position, employment status, years of service, and monthly income.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Job Insecurity Scale\u003c/h2\u003e \u003cp\u003eThis study utilized the \"Chinese Employee Job Insecurity Scale,\" developed by Hu Sanman and Li Zhongbin [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This scale is based on pertinent foreign research, while also integrating the social and cultural context of China and the characteristics of contemporary society, consisting of 25 items distributed across five dimensions: Job Loss Insecurity (9 items), Interpersonal Insecurity (4 items), Work Execution Insecurity (4 items), Excessive Competition Insecurity (4 items), and Compensation and Promotion Insecurity (4 items). A 5-point Likert scale was employed for scoring, ranging from 1 (strongly disagree) to 5 (strongly agree). The total score varies from 25 to 125, with higher scores indicating greater job insecurity. The Cronbach's alpha coefficient for the Chinese version of this scale is 0.922.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Work Engagement Scale\u003c/h2\u003e \u003cp\u003eThis study utilized the \"Work Engagement Scale for Chinese Specialized Nurses,\" developed by Qin Hui et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This scale was revised from the UWES scale, taking into account the occupational characteristics of specialized nursing in China as well as the psychological traits of specialized nurses,which consists of 32 items and 5 dimensions: work attitude (8 items), work values (6 items), work recognition(4 items), work initiative (9 items), and work enthusiasm and concentration (5 items) .This scale employs a 5-point Likert scoring system (ranging from 1\u0026thinsp;=\u0026thinsp;never to 5\u0026thinsp;=\u0026thinsp;always), with higher scores indicating greater work commitment. The Cronbach's alpha coefficient for the Chinese version of this scale is 0.958.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 Challenge Assessment Scale\u003c/h2\u003e \u003cp\u003eThe \"Challenge-Threat Assessment Scale\" [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], developed by Lepine et al., was utilized in this study. This scale has been optimized and expanded based on previously validated instruments, including the MLQ Leadership Questionnaire and the PANAS Affective Scale,which consists of two dimensions: challenge assessment and threat assessment. The challenge assessment subscale includes three items and utilizes a 7-point Likert scoring system (from 1\u0026thinsp;=\u0026thinsp;strongly disagree to 7\u0026thinsp;=\u0026thinsp;strongly agree), with a Cronbach's alpha coefficient of 0.929 for this subscale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.2.5 Perceived Organizational Support Scale\u003c/h2\u003e \u003cp\u003eThis study utilized the \"Perceived Organizational Support Scale for Chinese Nurses\" [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], developed by Zuo Hongmei. The scale was revised from the original perceived organizational support scale created by Professor Chen Zhixia, incorporating the specific characteristics of the nursing profession, insights from nurse interviews, and expert opinions, which consists of 13 items and 2 dimensions: emotional support (10 items) and instrumental support (3 items). The scale adopts the Likert 5-point scoring method (from 1\u0026thinsp;=\u0026thinsp;very inconsistent to 5\u0026thinsp;=\u0026thinsp;very consistent), with all items scored positively. The total score ranges from 13 to 65 points, and the higher the score, the stronger the perceived organizational support. The Cronbach's alpha coefficient of this scale is 0.92.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 26.0 and Amos 26.0 software. The normality of the measurement data was assessed using a Quantile-Quantile (Q-Q) plot. Normal distribution characteristics were statistically described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), and an independent sample t-test was employed for comparisons between two groups. One-way analysis of variance (ANOVA) was utilized for comparisons among three or more groups. Pearson correlation analysis was conducted to investigate the relationships among various variables. Discontinuous categorical variables were encoded as dummy variables and subsequently included in hierarchical multiple linear regression analysis to identify factors influencing work input. Structural equation modeling (SEM) was developed using Amos 26.0, with job insecurity as the independent variable, work engagement as the dependent variable, and perceived organizational support and challenge assessment as mediating variables. The model's effectiveness was verified through model fit indices, and effect sizes and confidence intervals were calculated using 5,000 bootstrap samples. The significance level was set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Results","content":"\u003cp\u003eThe normality of the measurement data was assessed using Quantile-Quantile (Q-Q) plots. The results indicated that the Q-Q plots for the four variables\u0026mdash;job insecurity, work engagement, perceived organizational support, and challenge assessment\u0026mdash;displayed observed points that were generally aligned with the theoretical normal distribution reference line. There was no evident systematic deviation, such as extreme value deviation or nonlinear offset, suggesting that the data distribution approximately conforms to a normal distribution.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 The differences in work engagement among obstetric nurses with different demographic characteristics\u003c/h2\u003e \u003cp\u003eAmong the 406 obstetric nurses with varying demographic characteristics, 98.8% were female. Nurses aged 25 to 34 comprised 61.8% of the sample. Notably, 139 participants were only children, and 338 were married. Additionally, 60.1% of the nurses were employed in general hospitals, while 64.5% worked in secondary institutions. A total of 358 individuals held a bachelor's degree or higher. The cohort included 206 senior nurses and 304 general nurses, with 98 classified as regular staff members and 235 as contract workers. Furthermore, 63.8% of the nurses had between 6 and 15 years of work experience. Monthly income for 63.1% of the nurses ranged from 4,001 to 8,000 yuan. Statistical analyses revealed significant differences in work engagement scores among obstetric nurses based on institution type, institution level, professional title, job position, employment status, and monthly income (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWork engagement of obstetric nurses under different demographic characteristics (N\u0026thinsp;=\u0026thinsp;406)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et/F\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127.6\u0026thinsp;\u0026plusmn;\u0026thinsp;33.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProfessional Title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e108.7\u0026thinsp;\u0026plusmn;\u0026thinsp;39.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e3.62*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e401 (98.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105.7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNurse Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e134 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e96.99\u0026thinsp;\u0026plusmn;\u0026thinsp;43.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.31\u0026thinsp;\u0026plusmn;\u0026thinsp;39.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e206 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e109.54\u0026thinsp;\u0026plusmn;\u0026thinsp;41.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e251 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105.5\u0026thinsp;\u0026plusmn;\u0026thinsp;42.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAssociate Chief Nurse and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e119.77\u0026thinsp;\u0026plusmn;\u0026thinsp;37.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112.39\u0026thinsp;\u0026plusmn;\u0026thinsp;40.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJob Position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e304 (74.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e102.13\u0026thinsp;\u0026plusmn;\u0026thinsp;42.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e3.81**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOver 45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121.85\u0026thinsp;\u0026plusmn;\u0026thinsp;32.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCharge Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46 (11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e114.07\u0026thinsp;\u0026plusmn;\u0026thinsp;40.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly Child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105.97\u0026thinsp;\u0026plusmn;\u0026thinsp;41.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e121.83\u0026thinsp;\u0026plusmn;\u0026thinsp;34.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (65.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105.16\u0026thinsp;\u0026plusmn;\u0026thinsp;42.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDepartment Head Nurse and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e111.56\u0026thinsp;\u0026plusmn;\u0026thinsp;42.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e98 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e128.69\u0026thinsp;\u0026plusmn;\u0026thinsp;25.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e40.73***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106.11\u0026thinsp;\u0026plusmn;\u0026thinsp;42.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eContract Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e235 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e88.79\u0026thinsp;\u0026plusmn;\u0026thinsp;43.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122.93\u0026thinsp;\u0026plusmn;\u0026thinsp;34.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAgency Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e131.29\u0026thinsp;\u0026plusmn;\u0026thinsp;20.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e118.67\u0026thinsp;\u0026plusmn;\u0026thinsp;19.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInstitution Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeneral Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e244 (60.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e110.52\u0026thinsp;\u0026plusmn;\u0026thinsp;41.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e6.4***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYears of Service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e74 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e102.47\u0026thinsp;\u0026plusmn;\u0026thinsp;36.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e133 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e104.07\u0026thinsp;\u0026plusmn;\u0026thinsp;44.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (19.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107.54\u0026thinsp;\u0026plusmn;\u0026thinsp;39.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e126 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e106.58\u0026thinsp;\u0026plusmn;\u0026thinsp;41.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional Chinese Medicine Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.29\u0026thinsp;\u0026plusmn;\u0026thinsp;40.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e101.92\u0026thinsp;\u0026plusmn;\u0026thinsp;42.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWomen\u0026rsquo;s and Children\u0026rsquo;s Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.74\u0026thinsp;\u0026plusmn;\u0026thinsp;39.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e123.41\u0026thinsp;\u0026plusmn;\u0026thinsp;37.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstitution Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.15\u0026thinsp;\u0026plusmn;\u0026thinsp;38.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e-17.81***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4000 CNY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e54 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e83.26\u0026thinsp;\u0026plusmn;\u0026thinsp;38.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e21.58***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139.87\u0026thinsp;\u0026plusmn;\u0026thinsp;20.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4001\u0026ndash;6000 CNY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e168 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e95.14\u0026thinsp;\u0026plusmn;\u0026thinsp;42.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior College and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.85\u0026thinsp;\u0026plusmn;\u0026thinsp;38.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6001\u0026ndash;8000 CNY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e88 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e121\u0026thinsp;\u0026plusmn;\u0026thinsp;35.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e358 (88.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107.06\u0026thinsp;\u0026plusmn;\u0026thinsp;42.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8000 CNY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e96 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e123.92\u0026thinsp;\u0026plusmn;\u0026thinsp;35.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s Degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.71\u0026thinsp;\u0026plusmn;\u0026thinsp;50.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eNotes:*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ** P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; *** P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2 The current situation of job insecurity, work engagement, perceived organizational support and challenge assessment among obstetric nurses\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe average score of job insecurity of obstetric nurses was 76.07\u0026thinsp;\u0026plusmn;\u0026thinsp;22.80 points (out of 125), the average score of work engagement was 105.97\u0026thinsp;\u0026plusmn;\u0026thinsp;41.84 points (out of 160), and the average score of perceived organizational support was 43.46\u0026thinsp;\u0026plusmn;\u0026thinsp;13.59 points (out of 65). The average score of the challenge assessment was 14.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66 points (out of a total of 21 points). It can be seen that, against the backdrop of a low fertility rate, obstetric nurses are all at an above-average level in the above four indicators (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTotal \u0026amp; Subscale Scores of Four Variables (N\u0026thinsp;=\u0026thinsp;406)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eItem Average Score\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob Insecurity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e76.07\u0026thinsp;\u0026plusmn;\u0026thinsp;22.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Loss Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e28.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Execution Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcessive Competition Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompensation and Promotion Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob Involvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e105.97\u0026thinsp;\u0026plusmn;\u0026thinsp;41.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.68\u0026thinsp;\u0026plusmn;\u0026thinsp;12.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e20.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Recognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Initiative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e30.42\u0026thinsp;\u0026plusmn;\u0026thinsp;12.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Enthusiasm and Concentration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChallenge Evaluation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived Organizational Support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e43.46\u0026thinsp;\u0026plusmn;\u0026thinsp;13.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e32.52\u0026thinsp;\u0026plusmn;\u0026thinsp;11.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Correlation of Job Insecurity, Perceived Organizational Support, Challenge Assessment, and Work Engagement among Obstetric Nurses\u003c/h2\u003e \u003cp\u003ePearson correlation analysis revealed significant correlations among job insecurity, work engagement, perceived organizational support and challenge assessment (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Specifically, job insecurity exhibited a negative correlation with work engagement (r=-0.415), challenge assessment (r=-0.385), and perceived organizational support (r = -0.358). Conversely, work engagement demonstrated a positive correlation with challenge assessment (r\u0026thinsp;=\u0026thinsp;0.735) and perceived organizational support (r\u0026thinsp;=\u0026thinsp;0.607). Additionally, challenge assessment was positively correlated with perceived organizational support (r\u0026thinsp;=\u0026thinsp;0.618) (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Building on these correlation findings, structural equation modeling (SEM) was employed to verify the causal pathways among the variables and to investigate the mediating roles of challenge assessment and perceived organizational support in the relationship between job insecurity and work engagement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of Pearson correlation analysis (r)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJob Insecurity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJob Involvement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge Evaluation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePerceived Organizational Support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.415**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChallenge Evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.385**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.735**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived Organizational Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.385**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.607**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.618**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNotes:** indicates P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (statistically significant at the 0.01 level).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Common Method Bias Test\u003c/h2\u003e \u003cp\u003eGiven that the data for this study were obtained through a self-report method, the potential for common method bias exists. To mitigate this risk, the study implemented ex-ante controls, which included anonymous completion of the survey and both forward and backward scoring of the scale. Additionally, AMOS software was employed to perform a single-factor confirmatory factor analysis on all self-assessment items to evaluate common method deviation. The results indicated a poor model fit, with χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;11.168, CFI\u0026thinsp;=\u0026thinsp;0.488, GFI\u0026thinsp;=\u0026thinsp;0.181, AGFI\u0026thinsp;=\u0026thinsp;0.134, NFI\u0026thinsp;=\u0026thinsp;0.466, and RMSEA\u0026thinsp;=\u0026thinsp;0.158. Consequently, it can be concluded that there is no significant issue with common method bias in this study[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Stratified multiple linear regression analysis of work engagement of obstetric nurses\u003c/h2\u003e \u003cp\u003eThis study investigates the predictive influence of core variables on work engagement and the moderating effects of background factors using hierarchical multiple linear regression. Model 1 includes only job insecurity, challenge assessment, and perceived organizational support. In contrast, Model 2 builds upon Model 1 by incorporating background variables that are significantly correlated with work engagement, as identified through univariate analysis. These background variables include institution type, institution level, professional title, job position, Employment Status, and monthly income. The first five variables are categorical and are represented as dummy variables in the regression model. The coefficient of determination (R\u0026sup2;) for Model 1 is 0.589, while Model 2 shows an increase to 0.746. The change in explanatory power (△R\u0026sup2;) is 0.157, with a corresponding △F(14, 388) of 17.1 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that the addition of background variables significantly enhances the model's explanatory power regarding work engagement.Among the core variables, challenge assessment and perceived organizational support remained significant predictors in both models (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with challenge assessment exerting the strongest influence on work engagement. In contrast, job insecurity was significant only in Model 1, which did not control for background variables (P\u0026thinsp;=\u0026thinsp;0.001); its effect diminished upon controlling for these variables, indicating that its direct impact on work engagement was confounded by background factors rather than being an independent effect. The results of Model 2 further demonstrate that hospital grade and personnel status significantly negatively affect the work engagement of obstetric nurses. Specifically, the work engagement level of obstetric nurses in secondary medical institutions is significantly lower than that in tertiary medical institutions (β = -37.123, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, contract-based obstetric nurses exhibit significantly lower work engagement levels compared to their permanent counterparts (β = -21.876, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Consequently, a structural equation model will be constructed, incorporating independent variables such as job insecurity, perceived organizational support, and challenge assessment, alongside the dependent variable of work engagement, to systematically elucidate the mechanisms by which core variables influence work engagement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Linear Regression: Effects on Work Engagement (N\u0026thinsp;=\u0026thinsp;406)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVIF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e△R\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e△F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eD-W\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBlock1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.518***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e192.236***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJob Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.215**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-3.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChallenge Evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.095***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived Organizational Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.677***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"17\" rowspan=\"18\"\u003e \u003cp\u003e\u003cb\u003eBlock2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.149***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e67.109***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJob Insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChallenge Evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.518***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived Organizational Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.351**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional Chinese Medicine Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-6.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal\u003c/p\u003e \u003cp\u003eand Child Health Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-37.123***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-13.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate Chief Nurse and Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam Leader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse Supervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-6.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eContract-employed Nurse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-21.876***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-6.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLabor Dispatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService Outsourcing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-2.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eNotes:** P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; *** P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. VIF\u0026thinsp;\u0026lt;\u0026thinsp;10 is acceptable. The constants set for institution type,level, professional title, job position and employment status are respectively general hospital, tertiary hospital, junior nurse, nurse and staff nurse.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Structural Equation Model(SEM)and path coefficient evaluation\u003c/h2\u003e \u003cp\u003eThe results indicate that the factor loadings for the latent variables\u0026mdash;job insecurity, challenge assessment, work engagement, and perceived organizational support\u0026mdash;exceed 0.5 (ranging from 0.56 to 0.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the average variance extracted (AVE) is greater than 0.5 (ranging from 0.6 to 0.96), and the composite reliability (CR) surpasses 0.8 (ranging from 0.87 to 0.99). The standardized factor loadings, CR, and AVE for each variable meet the established criteria, demonstrating that all four measurement models exhibit strong convergent validity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A structural equation model (SEM) was developed, positioning job insecurity as the independent variable and work engagement as the dependent variable, with perceived organizational support and challenge assessment as mediating variables. To enhance model fit and adaptability to the data, this study established a covariation relationship between the residual terms of compensation and promotion insecurity and excessive competition insecurity, guided by the Modification Index (MI) and theoretical rationale. Theoretically, common sources of measurement error may exist between the two, such as individual cognitive biases regarding workplace risks and systematic errors in questionnaire responses. From a data perspective, incorporating this residual correlation effectively alleviates model constraints and significantly improves the fit indices.The final fitting index is: χ\u0026sup2;=150.805, DF\u0026thinsp;=\u0026thinsp;59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;2.556, GFI\u0026thinsp;=\u0026thinsp;0.985, NFI\u0026thinsp;=\u0026thinsp;0.976, TLI\u0026thinsp;=\u0026thinsp;0.98, CFI\u0026thinsp;=\u0026thinsp;0.985, SRMR\u0026thinsp;=\u0026thinsp;0.024, RMSEA\u0026thinsp;=\u0026thinsp;0.062[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The standardized coefficients of each path are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which reveals several key paths: job insecurity, perceived organizational support, and challenge assessment all have a significant impact on work engagement (β values are \u0026minus;\u0026thinsp;0.13, 0.23, and 0.55 respectively, all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Job insecurity has a significant negative impact on perceived organizational support and challenge assessment (β values are \u0026minus;\u0026thinsp;0.41, -0.17 respectively, both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); perceived organizational support has a significant positive impact on challenge assessment (β\u0026thinsp;=\u0026thinsp;0.56, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Test of Mediating Effects\u003c/h2\u003e \u003cp\u003eTo further investigate the mediating roles of perceived organizational support and challenge assessment in the relationship between job insecurity and work engagement, the bias-corrected percentile Bootstrap method was employed. This study utilized AMOS software and performed Bootstrap resampling 5,000 times to estimate the mediating effects of perceived organizational support and challenge assessment, along with their 95% confidence intervals. A confidence interval that excludes zero signifies a statistically significant mediation effect, while an interval that includes zero indicates nonsignificance.The results show that: the direct effect of job insecurity on work engagement is \u0026minus;\u0026thinsp;0.13, the total indirect effect is \u0026minus;\u0026thinsp;0.309, and the total effect is \u0026minus;\u0026thinsp;0.439. Among them, the independent mediating effect of perceived organizational support accounted for 21.18% of the total effect, the independent mediating effect of challenge assessment accounted for 20.73% of the total effect, and the chain mediation effect of the two accounted for 28.47% of the total effect. All confidence intervals do not include 0, indicating that the mediation model is valid (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This shows that job insecurity not only directly has a negative impact on work engagement, but also indirectly has a negative impact on work engagement through the separate mediating path of perceived organizational support and challenge assessment and the chain mediating path of the two. There are significant multiple mediating effects.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMediating Effect Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePathway\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEffect propor-tion(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eULCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Direct Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.61%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Indirect Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.39%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMediating Effect (A\u0026rarr;B\u0026rarr;D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMediating Effect (A\u0026rarr;C\u0026rarr;D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.73%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChain Mediating Effect (A\u0026rarr;B\u0026rarr;C\u0026rarr;D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNotes: β is unstandardized path coefficient; SE is standard error;A is Job Insecurity;B is Perceived Organizational Support;C is Challenge Assessment;D is Work Engagement.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5 Discussion","content":"\u003cp\u003eThe ongoing decline in global fertility rates has significantly influenced population structure and social development. Existing research predominantly examines the functioning of obstetric institutions and the transformation of physicians, while neglecting the mental health of the obstetric nursing workforce. Given that the mental health of nurses is a critical concern in global health, and that the quality of obstetric care directly impacts the safety of mothers and infants, it is essential to investigate the job insecurity and work engagement of obstetric nurses. This study focused on obstetric nurses in Chongqing, China, employing structural equation modeling (SEM) and chain mediation model analysis. The findings reveal that perceived organizational support and challenge assessment partially mediate the relationship between job insecurity and work engagement. The robustness of the model was confirmed through 5,000 Bootstrap sampling tests. These results offer a novel perspective on the application of occupational psychology within the medical field and provide a scientific foundation for the management of obstetric nursing teams.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Analysis on the current situation of obstetric nurses\u0026rsquo; work engagement\u003c/h2\u003e \u003cp\u003eThe findings of this study indicate that the work engagement score of obstetric nurses is 105.97\u0026thinsp;\u0026plusmn;\u0026thinsp;41.84 points. This result aligns with previous research on the work engagement of specialist nurses, suggesting that their engagement level is categorized as upper-medium [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This characteristic may be closely linked to the unique occupational demands of obstetrics, which include \u0026ldquo;high nursing skill requirements, high service standards, and high environmental risks\u0026rdquo; [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The dual attributes of elevated professionalism and significant risk necessitate that obstetric nurses consistently maintain a high level of investment in their work. An analysis of various dimensions of work input reveals that the dimensions of work motivation and work attitude yield higher scores. The declining fertility rate and the transformation of the obstetric service model exert pressure on nurses to enhance their professional competitiveness. Consequently, obstetric nurses have broadened their service scope from solely providing delivery care to encompassing full-cycle health management. They are now required to adopt diverse roles throughout the prenatal, intrapartum, and postpartum stages, including pre-pregnancy file manager, pregnancy health educator, postpartum depression counseling specialist, and lactation care guide [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This expansion of roles inevitably demands that nurses exhibit a high degree of work initiative.Conversely, in alignment with findings from pertinent Korean studies, low fertility rates have markedly heightened maternal demand for natural delivery and personalized care [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Nurses must dedicate increased time and effort to comprehensive care, which includes individualized pregnancy health guidance, continuous support during delivery, and dynamic follow-up for postpartum recovery. This care model fosters a serious work ethic among nurses. However, scores reflecting work recognition, enthusiasm, focus, and professional value remain relatively low. The primary influencing factors may stem from adjustments in obstetric services due to declining fertility rates. First, a decrease in business volume may result in lower income levels for nurses; research indicates that salary reductions directly diminish job satisfaction among nursing professionals [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Second, the contraction of departmental development can obscure career advancement pathways, thereby diminishing nurses' perceived opportunities for professional growth and weakening their job recognition and sense of professional value [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Third, a relative decline in organizational resource investment can lead to reduced perceived organizational support, and this decrease is a significant contributor to diminished work enthusiasm [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003e5.2 There are differences in work engagement levels among obstetric nurses with different institution levels and employment status\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study employed both single-factor and hierarchical multiple linear regression analyses to systematically investigate the influence of demographic and occupational characteristics on nurses' work engagement. The results from the single-factor analysis indicated that six factors\u0026mdash;institution type, institution level, professional title, job position, employment status, and monthly income\u0026mdash;were statistically significant predictors of nurses' work engagement scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Based on this foundation, the study employed hierarchical multiple linear regression analysis. The findings indicated significant differences in work engagement levels among obstetric nurses across various institution grades and employment situations. Specifically, obstetric nurses in secondary medical institutions exhibited lower work engagement compared to their counterparts in tertiary medical institutions. Additionally, contract-appointed obstetric nurses demonstrated lower work engagement than those in permanent positions.\u003c/p\u003e \u003cp\u003eBased on extant research, the formation mechanism of the aforementioned outcomes is primarily manifested in three key aspects. Firstly, tertiary medical institutions typically boast more abundant diagnostic and treatment resources and staffing compared to secondary medical institutions. They also offer clear career advancement pathways and enjoy high social esteem[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This setting effectively enhances nurses' professional identity and job performance, facilitating the maintenance of a high level of commitment. Secondly, permanent nurses benefit from greater job stability, experiencing markedly higher occupational security than their contracted counterparts [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In contrast, contract-based nurses often perceive lower organizational belongingness due to disparities in rights protection, consequently impacting their level of work engagement.Based on the aforementioned research findings, enhancing nurses' work input levels can be achieved by facilitating the sharing of equipment configurations and training resources among primary medical institutions. For instance, in Chengdu, China, 146 medical alliances, urban medical groups, and two-way referral platforms have been established[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]; enabling nurses both within and outside these establishments to benefit equally. This includes access to union benefits, improved working conditions through the extension of more open-term contracts, and the implementation of a salary system based on job value rather than employee status[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. An example of this approach is the \"equal pay for work of equal value\" evaluation plan implemented by the British NHS, ensuring that identical positions with the same workload receive equitable compensation[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003e5.3 Obstetric nurses' job insecurity, work engagement, perceived organizational support and challenge assessment are significantly related to each other\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study confirms that the four variables are interconnected rather than existing independently. It provides evidence for the impact of job insecurity on work engagement, with a direct effect size of 29.61% and an indirect effect size of 70.39%, thereby verifying Hypothesis 1. Consistent with prior literature [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], job insecurity is found to directly decrease employees' work engagement, while perceived organizational support is shown to influence work engagement across various professions such as nurses, teachers, and police [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Furthermore, this study establishes a significant positive correlation between challenge assessment and work engagement. Unlike previous research that focused on the binary analysis framework of challenge assessment and threat assessment [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], this study emphasizes the positive cognitive evaluation aspect of challenge assessment.\u003c/p\u003e \u003cp\u003e \u003cb\u003e5.4 Perceived organizational support and challenge assessment each mediate the relationship between job insecurity and work engagement\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe findings of this study indicate that job insecurity influences work engagement through the partial mediating roles of perceived organizational support and challenge assessment, resulting in two independent mediation pathways: job insecurity \u0026rarr; perceived organizational support \u0026rarr; work engagement and job insecurity \u0026rarr; challenge assessment \u0026rarr; work engagement. The mediating effects of these two pathways accounted for 21.18% and 20.73% of the total effect, respectively. Hypothesis 2 was confirmed and aligns with prior research, elucidating the roles of perceived organizational support and challenge assessment in the relationship between work stress and employee attitudes and behaviors [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. According to resource conservation theory, declining fertility rates result in a contraction of obstetric services, leading nurses to experience concerns regarding resource loss. Perceived organizational support can mitigate the gap in developmental resources through instrumental assistance. Relevant studies suggest that enhancing skills training, providing competitive salaries and benefits, and establishing clear career development plans can effectively foster employee work engagement [\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLiterature indicates that occupational anxiety can be mitigated through emotional support, including psychological counseling and team care [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Together, these resources serve as external energy sources to address job insecurity, thereby counteracting the resource depletion associated with it. Additionally, enhancing challenge assessment as an internal personal resource can help individuals navigate the difficulties and challenges posed by low fertility. Relevant studies suggest that cultivating psychological resilience, aligning work demands with appropriate resources, and fostering transparent internal communication can improve employees' challenge assessment of stress [\u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. From the perspective of cognitive appraisal theory, when stress is perceived as a challenge, individuals are more likely to actively acquire skills\u0026mdash;such as prenatal consultation, mid-partum health education, and postpartum rehabilitation\u0026mdash;to adapt to changes in obstetric services, ultimately translating these efforts into increased work engagement [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003e5.5 Perceived organizational support and challenge assessment have chain-mediating effects on the relationship between job insecurity and work engagement\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study confirmed the existence of a mediating chain effect between perceived organizational support and challenge evaluation regarding the work engagement of obstetric nurses (path: job insecurity \u0026rarr; perceived organizational support \u0026rarr; challenge assessment \u0026rarr; work engagement). This effect constituted 28.47% of the total effect. Hypothesis H3 was validated. This finding transcends the limitations of single-variable research [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and delineates the chain of effects from \u0026ldquo;organizational environment \u0026rarr; individual psychology \u0026rarr; work behavior,\u0026rdquo; thereby affirming the guiding significance of organizational support on individual cognition and behavior.\u003c/p\u003e \u003cp\u003eUnder conditions of low fertility rates, obstetric nurses often experience unease stemming from job uncertainty. The provision of instrumental support, such as training and welfare, alongside emotional support, including psychological counseling and team care, can facilitate the transformation of this unease into manageable challenges. This aligns with the findings of the \"Supportive Environment Optimization Stress Assessment\" [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. With this positive cognitive framework, nurses are likely to proactively enhance their skills in response to service changes, thereby increasing their work engagement. This research offers clear implications for management practice: a singular intervention yields limited results, whereas a collaborative strategy that combines \"organizational support and empowerment with positive cognitive cultivation\" can more effectively mitigate nurses' anxiety, enhance work input, and provide a novel approach to the stable management of obstetric nursing teams.\u003c/p\u003e \u003c/div\u003e"},{"header":"6 Research Significance and Contributions","content":"\u003cp\u003eIn the context of China's \"low fertility rate\" era, this study integrates cognitive evaluation theory with conservation of resources theory (COR theory), transcending the traditional single-causality research paradigm to elucidate the intrinsic mechanisms by which job insecurity impacts obstetric nurses' work engagement. Specifically, perceived organizational support and challenge assessment serve as chain mediators in this relationship, effectively mitigating nurses' job insecurity and enhancing their levels of work engagement. The results of the mediation effect analysis, conducted using structural equation modeling (SEM), are consistent and provide a novel theoretical perspective along with practical guidance for managers in formulating organizational support strategies. These strategies aim to stabilize the nursing talent pool and optimize working conditions for nurses. Furthermore, this study contributes positively to the development of a scientific and efficient nursing management system.\u003c/p\u003e"},{"header":"7 Research Limitations and Future Prospects","content":"\u003cp\u003eFirst, while the cross-sectional design can illustrate the co-variation relationship between variables, data collected at a single time point restricts the ability to establish causal relationships. Future research should employ longitudinal follow-up designs to conduct a comprehensive analysis of causal pathways and mechanisms by examining the dynamic changes in variables over time. Second, although the mediation effect model elucidates the influence pathways of two key variables, accounting for 70.39% of the variation, the complexity of social phenomena suggests the existence of potential variables or mechanisms that may not have been considered. Subsequent research should integrate theoretical frameworks with empirical investigations, utilize multi-source data, and apply complex statistical models to explore additional influencing factors and their interactions.\u003c/p\u003e"},{"header":"8 Conclusion","content":"\u003cp\u003eIn the context of China's \"low fertility rate,\" this study elucidates the specific pathway through which obstetric nurses' job insecurity influences work engagement. It demonstrates that perceived organizational support and challenge assessment serve as mediators in the relationship between these two factors. By alleviating job insecurity and enhancing nurses' organizational support and challenge assessment skills, work engagement can be significantly improved. The findings offer a novel perspective for managers in developing supportive strategies, stabilizing the nursing workforce, and optimizing working conditions, while also serving as a reference for establishing a scientific nursing management system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD. C. was responsible for conceptualization, data curation, formal analysis, investigation, methodology, software, validation, visualization, writing \u0026ndash; original draft, and writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eJ.M. contributed to conceptualization, project administration, resources, supervision, and writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE. Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the School of Public Health, Chongqing Medical University (Ethics Approval No: 2025010), and all methods were performed in accordance with relevant guidelines and regulations. This study complies with the ethical standards set forth in Declaration of Helsinki. All participants gave informed consent before data collection. Participants were promised that the information provided would remain anonymous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are limited in availability as they were used under a specific license and are not publicly accessible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the members of the research as well as all participants for their contribution.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGlobal fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. \u003cem\u003eLancet\u0026nbsp;\u003c/em\u003e2024, 403(10440):2057\u0026ndash;2099.http://dor.org/10.1016/s0140-6736(24)00550-6.\u003c/li\u003e\n \u003cli\u003eWang W, Mo Y, Kuang Y: Effect evaluation, prediction and response strategy analysis of China\u0026apos;s birth policy adjustment. \u003cem\u003ePLoS One\u0026nbsp;\u003c/em\u003e2025, 20(9):e0330308.http://dor.org/10.1371/journal.pone.0330308.\u003c/li\u003e\n \u003cli\u003eLan X, Liang Y, Wu G, Ye H: Relationships Among Job Burnout, Generativity Concern, and Subjective Well-Being: A Moderated Mediation Model. \u003cem\u003eFront Psychol\u0026nbsp;\u003c/em\u003e2021, 12:613767.http://dor.org/10.3389/fpsyg.2021.613767.\u003c/li\u003e\n \u003cli\u003eZhao J, Li Y, Li W: Reasons for the continued decline in fertility intentions: explanations from overtime work. \u003cem\u003eBiodemography Soc Biol\u0026nbsp;\u003c/em\u003e2024, 69(4):231\u0026ndash;253.http://dor.org/10.1080/19485565.2024.2422850.\u003c/li\u003e\n \u003cli\u003eChen C, Xiong X, Tang G: A decomposition study on the factors influencing China\u0026apos;s total fertility rate changes between 1990 and 2020. \u003cem\u003eSci Rep\u0026nbsp;\u003c/em\u003e2024, 14(1):28176.http://dor.org/10.1038/s41598-024-79999-4.\u003c/li\u003e\n \u003cli\u003eYang Y, He R, Zhang N, Li L: Second-Child Fertility Intentions among Urban Women in China: A Systematic Review and Meta-Analysis. \u003cem\u003eInt J Environ Res Public Health\u0026nbsp;\u003c/em\u003e2023, 20(4).http://dor.org/10.3390/ijerph20043744.\u003c/li\u003e\n \u003cli\u003eShoss MK: Job Insecurity: An Integrative Review and Agenda for Future Research. \u003cem\u003eJournal of Management\u0026nbsp;\u003c/em\u003e2017, 43(6):1911\u0026ndash;1939.http://dor.org/10.1177/0149206317691574.\u003c/li\u003e\n \u003cli\u003eMingming X, Youdi X: Role transformation of Chinese obstetricians and improvement of obstetric service systems amid declining birth rates: Challenges and strategies. \u003cem\u003eHeliyon\u0026nbsp;\u003c/em\u003e2024, 10(23):e40011.http://dor.org/10.1016/j.heliyon.2024.e40011.\u003c/li\u003e\n \u003cli\u003eLee SJ, Li L, Hwang JY: After 20 years of low fertility, where are the obstetrician-gynecologists? \u003cem\u003eObstet Gynecol Sci\u0026nbsp;\u003c/em\u003e2021, 64(5):407\u0026ndash;418.http://dor.org/10.5468/ogs.21138.\u003c/li\u003e\n \u003cli\u003eZhong X, Zeng Y, Peng L, Li X, Jia Y, Pan C, Wang B: Levels and related factors of occupational stress among nurses: hospital-based evidence from China, 2023. \u003cem\u003eFront Psychol\u0026nbsp;\u003c/em\u003e2024, 15:1471640.http://dor.org/10.3389/fpsyg.2024.1471640.\u003c/li\u003e\n \u003cli\u003eLin HR, Lee YK, Chang CL, Kuo CH, Ho HY, Wu CJ, Chen YQ, Wu CC, Ho YC, Chu TH\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: Assessment of psychological health effects of nurses during 2022-2023 of the COVID-19 pandemic: a descriptive study in Southern Taiwan. \u003cem\u003eAnn Med\u0026nbsp;\u003c/em\u003e2025, 57(1):2447405.http://dor.org/10.1080/07853890.2024.2447405.\u003c/li\u003e\n \u003cli\u003eSchaufeli WB, Salanova M, Gonz\u0026aacute;lez-Rom\u0026aacute; 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This study aimed to examine the impact of job insecurity among obstetric nurses on their work engagement levels. Additionally, it sought to validate the chain-mediated effects of perceived organizational support and challenging assessment in the relationship between job insecurity and work engagement. The findings aim to inform the development of targeted management strategies for nurses within healthcare organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eFrom April to May 2025,researchers conducted a cross-sectional study, recruiting 406 obstetric nurses from secondary and tertiary medical institutions in Chongqing.Data collection involved the use of a demographic questionnaire, the Job Insecurity Scale, the Specialist Nurse Work Engagement Scale, the Perceived Organizational Support Scale, and the Challenge Assessment Scale. Data analysis employed Pearson correlation analysis, hierarchical linear regression, and structural equation modeling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eObstetric nurses scored 105.97±41.84 on work engagement, falling into the medium-to-upper range. Hierarchical regression showed that nurses in secondary hospitals had significantly lower work engagement than those in tertiary hospitals (β = -37.123, p \u0026lt; 0.001); contract nurses also scored markedly lower than permanent staff (β = -21.876, p \u0026lt; 0.001). Job insecurity, perceived organizational support, and challenge assessment were key influencing factors, explaining 58.9% of the variance in work engagement (R²=0.589). Structural equation modeling verified the chain mediating effect: perceived organizational support and challenge assessment separately mediated 21.18% and 20.73% of the total effect, while their combined chain mediation accounted for 28.47%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eThe nursing management department can implement a combined strategy of organizational support empowerment and positive cognitive cultivation to effectively assist obstetric nurses in reducing job insecurity and improving work engagement. The findings of this research are instrumental in guiding managers to develop supportive strategies, stabilize the nursing team, and ensure the safety of mothers and infants.\u003c/p\u003e","manuscriptTitle":"A study of the impact of obstetric nurses' job insecurity on work engagement in the context of low fertility: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:41:03","doi":"10.21203/rs.3.rs-8560523/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-05T05:04:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-12T11:12:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-10T08:47:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-10T08:45:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-01-09T11:14:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33dde9b4-59db-4488-be7e-204baada56a5","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T12:41:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:41:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8560523","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8560523","identity":"rs-8560523","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}