This study examined latent subtypes of the nursing work environment and the mediating role of job stress in the association between environment type and decision fatigue among clinical nurses. A total of 812 clinical nurses were included from the four public tertiary hospitals between May 2023 and July 2023. A latent profile analysis was conducted to identify heterogeneity in the nursing work environment. Decision fatigue was predicted by frequent night shifts, extended overtime, and heavy patient load. Job stress partially mediated the link between exhausting-straining environment and decision fatigue and significantly mediated the stagnant-buffered environment decision fatigue association. Findings highlight that enhancing work conditions and reducing stress may mitigate decision fatigue and promote nurses’ effectiveness and occupational health.
AlharbiAAlkubatiSAAlbaqawiH, et al. (2025) Relationship between nursing work environment and clinical decision-making among Saudi nurses: psychological empowerment as mediator. BMC Nursing24(1): 682.
2.
AlkhawaldehJMSohKLMukhtarF, et al. (2020) Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. 76(11): 3123–3135.
3.
AllanJLJohnstonDWPowellDJH, et al. (2019) Clinical decisions and time since rest break: An analysis of decision fatigue in nurses. Health Psychology38(4): 318–324.
4.
Al SabeiSDLabragueLJMiner RossA, et al. (2020) Nursing work environment, turnover intention, job burnout, and quality of care: The moderating role of job satisfaction. Journal of Nursing Scholarship52(1): 95–104.
5.
AnXXueYXiaY, et al. (2023) Current situation and influencing factors of 126 head nurses’ decision fatigue. Journal of Nursing30(3): 74–78.
6.
ArashAMahmoodi-ShanGMehravarF, et al. (2024) Clinical decision making and moral distress among intensive care units nurses in Iran. BMC Psychology12(1): 692.
7.
AyresPLeeJYPaasF, et al. (2021) The validity of physiological measures to identify differences in intrinsic cognitive load. Frontiers in Psychology12: 702538.
8.
BakkerABDemeroutiE (2007) The job Demands-Resources model: State of the art. Journal of Managerial Psychology22(3): 309–328.
9.
BeasleyTM (2014) Tests of mediation: Paradoxical decline in statistical power as a function of mediator collinearity. Journal of Experiential Education82(3): 283–306.
10.
BeeckmanDClaysEVan HeckeA, et al. (2013) A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: A two-armed randomized controlled trial. International Journal of Nursing Studies50(4): 475–486.
11.
BlissettSRodriguezSQasimA, et al. (2021) Learning echocardiography in the workplace: A cognitive load perspective. Journal Association of American Medical Colleges96(3): 441–448.
12.
ChanMYCohenHSpiegelBMR (2009) Fewer polyps detected by colonoscopy as the day progresses at a veteran’s administration teaching hospital. Clinical Gastroenterology and Hepatology7(11): 1217–1223.
13.
ChoHHanK (2018) Associations among nursing work environment and health-promoting behaviors of nurses and nursing performance quality: A multilevel modeling approach. Journal of Nursing Scholarship50(4): 403–410.
14.
ChoiAYNylund-GibsonKIsraelT, et al. (2019) A latent profile analysis of bisexual identity: Evidence of within-group diversity. Archives of Sexual Behavior48(1): 113–130.
15.
CyrMArtenieDZAl BikaiiA, et al. (2023) An evening light intervention reduces fatigue and errors during night shifts: A randomized controlled trial. Sleep Health9(3): 373–380.
16.
DemeroutiEBakkerAB (2011) The job demands–resources model: Challenges for future research. SA Journal of Industrial Psychology37(2): 1–9.
17.
DemeroutiEBakkerABNachreinerF, et al. (2001) The job demands-resources model of burnout. Journal of Applied Psychology86(3): 499–512.
18.
DongSSWangKZhangKQ, et al. (2024) Decision fatigue experience of front-line nurses in the context of public health emergency: An interpretative phenomenological analysis. BMC Nursing23(1): 553.
19.
DuarteITeixeiraACastroL, et al. (2020) Burnout among Portuguese healthcare workers during the COVID-19 pandemic. BMC Public Health20(1): 1885.
20.
EzenwajiIOEseadiCOkideCC, et al. (2019) Work-related stress, burnout, and related sociodemographic factors among nurses: Implications for administrators, research, and policy. Medicine98(3): e13889.
21.
FalgueraCCDe Los SantosJAAGalabayJR, et al. (2021) Relationship between nurse practice environment and work outcomes: A survey study in the Philippines. International Journal of Nursing Practice27(1): e12873.
22.
Fernández-MirandaGUrriago-RayoJAkleV, et al. (2023) Compassion and decision fatigue among healthcare workers during COVID-19 pandemic in a Colombian sample. PLoS One18(3): e0282949.
23.
GanLZhangHShangW, et al. (2020) Nursing turnover rate and its influencing factors. Chinese Journal of Nursing55(2): 198–203.
24.
HayesAF (2018) Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs85(1): 4–40.
25.
HeBZhangYQianS, et al. (2025) Fatigue and coping strategies among Chinese night-shift nurses: A cross-sectional study. BMC Nursing24(1): 500.
26.
HickmanRLJrPignatielloGATahirS (2018) Evaluation of the decisional fatigue scale among surrogate decision makers of the critically ill. Western Journal of Nursing Research40(2): 191–208.
27.
HollowayKBhullarNSchutteNS (2017) A latent profile analysis of dispositional hope and defense styles. Personality and Individual Differences114: 151–154.
28.
IgartuaJJHayesAF (2021) Mediation, moderation, and conditional process analysis: Concepts, computations, and some common confusions. Spanish Journal of Psychology24: e49.
29.
JacksonJAndersonJEMabenJ (2021) What is nursing work? A meta-narrative review and integrated framework. International Journal of Nursing Studies122: 103944.
30.
JunWH (2025) The mediating effects of nurses‘ professional values on the relationship between work environment and organizational commitment among long-term care hospital nurses. BMC Nursing24(1): 285.
31.
KhamisaNOldenburgBPeltzerK, et al. (2015) Work related stress, burnout, job satisfaction and general health of nurses. International Journal of Environmental Research and Public Health12(1): 652–666.
32.
LakeETSandersJDuanR, et al. (2019) A meta-analysis of the associations between the nurse work environment in hospitals and 4 sets of outcomes. Medical Care57(5): 353–361.
33.
LarsmanPPousetteASkyvell NilssonM, et al. (2024) Ethical value conflicts in healthcare and their effects on nurses’ health, turnover intent, team effectiveness, and patient safety: A longitudinal questionnaire study. Scandinavian Journal of Work Environment & Health50(2): 113–121.
34.
LiuYWangXWangZ, et al. (2023) Ethical conflict in nursing: A concept analysis. Journal of Clinical Nursing32(15–16): 4408–4418.
35.
LiXLiuY (2000) Job stressors and burnout among staff nurses. Chinese Journal of Nursing35(11): 645–649.
36.
LubkeGMuthénBO (2007) Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters. Structural Equation Modeling A Multidisciplinary Journal14(1): 26–47.
37.
LabragueLJAl SabeiSAl RawajfahO, et al. (2022) Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses. Journal of Nursing Management30(1): 268–278.
38.
MaierMPowellDMurchieP, et al. (2025) Systematic review of the effects of decision fatigue in healthcare professionals on medical decision-making. Health Psychology Review19(4): 717–762.
39.
McGregorAMageeCACaputiP, et al. (2016) A job demands-resources approach to presenteeism. Career Development International21(4): 402–418.
40.
MerzELRoeschSC (2011) A latent profile analysis of the Five Factor Model of personality: Modeling trait interactions. Personality and Individual Differences51(8): 915–919.
41.
MirzaeiAMozaffariNHabibi SoolaA (2022) Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff. International Emergency Nursing62: 101170.
42.
NaegleMAKellyLAEmbreeJL, et al. (2023) American Academy of Nursing consensus recommendations to advance system level change for nurse well-being. Nursing Outlook71(2): 101917.
43.
NatalGSaltzmanB (2022) Decisions, decisions, decisions: decision fatigue in academic librarianship. Journal of Academic Librarianship48(1): 102476.
44.
Nylund-GibsonKGarberACCarterDB, et al. (2023) Ten frequently asked questions about latent transition analysis. Psychological Methods28(2): 284–300.
45.
OkuharaMSatoKKodamaY (2021) The nurses’ occupational stress components and outcomes, findings from an integrative review. Nursing Open8(5): 2153–2174.
46.
OtoB (2012) When thinking is hard: Managing decision fatigue. EMS World41(5): 46–50.
47.
PanGLiM (2020) Translation and validation of the Chinese version of the decision fatigue scale applied to ICU patient family members. Journal of Nursing27(12): 38–41.
48.
ParkMGuMSokS (2023) Path model on decision-making ability of clinical nurses. Journal of Clinical Nursing32(7–8): 1343–1353.
49.
PengJLuHZhangJ, et al. (2022) Need for cognition moderates the impairment of decision making caused by nightshift work in nurses. Scientific Reports12(1): 1756.
50.
PerssonEBarrafremKMeunierA, et al. (2019) The effect of decision fatigue on surgeons’ clinical decision making. Health Economics28(10): 1194–1203.
51.
PignatielloGAMartinRJHickmanRLJr (2020) Decision fatigue: A conceptual analysis. Journal of Health Psychology25(1): 123–135.
52.
PignatielloGATsivitseEO‘BrienJ, et al. (2022) Decision fatigue among clinical nurses during the COVID-19 pandemic. Journal of Clinical Nursing31(7–8): 869–877.
53.
PoškutėMBartkienėAFatkulinaN, et al. (2022) The contribution of professional autonomy in advancing ethical behaviour: A narrative review of studies in nursing. Journal of Nursing Management30(7): 2301–2307.
54.
RaoSNyquistAC (2018) The power of the nudge to decrease decision fatigue and increase Influenza vaccination rates. JAMA Network Open1(5): e181754.
55.
SchweitzerDRBaumeisterRLaaksoEL, et al. (2023) Self-control, limited willpower and decision fatigue in healthcare settings. Internal Medicine Journal53(6): 1076–1080.
56.
ScottLDArslanian-EngorenCEngorenMC (2014) Association of sleep and fatigue with decision regret among critical care nurses. American Journal of Critical Care23(1): 13–23.
57.
ShaoJYeZTangL (2016) The development of the nursing work environment scale and its reliability and validity. Chinese Journal of Nursing51(2): 142–147.
58.
SharkeySHudakSHornSD, et al. (2013) Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention. Advances in Skin & Wound Care26(2): 83–92.
59.
ShireyMREbrightPRMcDanielAM (2013) Nurse manager cognitive decision-making amidst stress and work complexity. Journal of Nursing Management21(1): 17–30.
60.
SönmezBYıldız KeskinAİspir DemirÖ, et al. (2023) Decent work in nursing: Relationship between nursing work environment, job satisfaction, and physical and mental health. International Nursing Review70(1): 78–88.
61.
SoukupTGandamihardjaTAKMcInerneyS, et al. (2019) Do multidisciplinary cancer care teams suffer decision-making fatigue: An observational, longitudinal team improvement study. BMJ Open9(5): e027303.
62.
SpoorthyMSPratapaSKMahantS (2020) Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian Journal of Psychiatry51: 102119.
63.
SpurkDHirschiAWangM, et al. (2020) Latent profile analysis: A review and “how to” guide of its application within vocational behavior research. Journal of Vocational Behavior120: 103445.
64.
SwigerPAPatricianPAMiltnerRSS, et al. (2017) The practice environment scale of the Nursing Work Index: An updated review and recommendations for use. International Journal of Nursing Studies74: 76–84.
65.
TeinJYCoxeSChamH (2013) Statistical Power to detect the correct number of classes in latent profile analysis. Structural Equation Modeling A Multidisciplinary Journal20(4): 640–657.
66.
VaziriHCasperWJWayneJH, et al. (2020) Changes to the work–family interface during the COVID-19 pandemic: Examining predictors and implications using latent transition analysis. Journal of Applied Psychology105(10): 1073–1087.
67.
WangWXiaoHLiuX, et al. (2025) Decision fatigue among nurses in a third-level grade A Hospital in China: A cross-sectional study on prevalence and predictors. International Nursing Review72(3): e70095.
68.
WilbyKJParavattilB (2021) Cognitive load theory: Implications for assessment in pharmacy education. Research in Social and Administrative Pharmacy17(9): 1645–1649.
69.
XieWSunGGaoM, et al. (2022) Status quo and correlation analysis of decision making fatigue and occupational well-being among nurses in cardiovascular medicine. China Medical Herald19(26): 43–46.
70.
YangCC (2006) Evaluating latent class analysis models in qualitative phenotype identification. Computational Statistics & Data Analysis50(4): 1090–1104.
71.
ZhuYZhangYWangX, et al. (2021) Decision fatigue among medical staff: A review. Journal of Nursing Science36(1): 101–104.
72.
ZúñigaFAusserhoferDHamersJP, et al. (2015) Are Staffing, work environment, work stressors, and rationing of care related to care workers’ perception of quality of care? A cross-sectional study. Journal of the American Medical Directors Association16(10): 860–866.
