WORK STRESS, WELL-BEING, AND CARE QUALITY AMONG CLINICAL NURSES: A HUMAN RESOURCE PERSPECTIVE

Abstract

Occupational stress among clinical nurses remains a persistent challenge in health systems worldwide, with important implications for psychological well-being, workforce sustainability, and care quality. This review aimed to synthesise evidence on the interrelationships between work stress, nurse well-being, and care quality through a human resource management (HRM) and organisational governance lens. A structured, purposive literature review with reflexive thematic synthesis was conducted. Targeted searches of Scopus, PubMed, and CINAHL were supplemented by backward citation tracking. Core clinical-nursing evidence was prioritised, while selected methodological and organisational sources were used to support conceptual framing. Where applicable, methodological quality was appraised using design-appropriate Joanna Briggs Institute (JBI) critical appraisal tools. Four interrelated themes were identified: (1) sources of work stress, particularly workload intensity, staffing shortages, long or irregular shifts, and emotional labour; (2) well-being and psychological resilience, with burnout and moral distress as prominent manifestations; (3) effects on care quality, including clinical errors, reduced empathy, impaired attentiveness, and lower patient satisfaction; and (4) HRM and organisational factors, including leadership, performance appraisal, scheduling, support systems, and shared governance. Across the evidence, nurse well-being emerged not only as an individual concern but also as an organisational capability with direct implications for patient safety and workforce retention. Sustainable improvement therefore requires integrated HR strategies, supportive leadership, workload-sensitive staffing, recovery-supportive scheduling, and governance systems that monitor staff well-being alongside patient-safety and quality indicators, particularly in resource-constrained settings such as Indonesia.