This study employed a qualitative research design using thematic analysis to explore nurses’ perceptions of the mediating role of employee engagement in the relationship between nursing resilience, emotional intelligence, and work efficiency. An interpretive qualitative approach was adopted to obtain an in-depth understanding of nurses’ experiences and perceptions regarding the psychological factors influencing their work efficiency. The study was conceptually informed by the Job Demands-Resources (JD-R) Theory, the Conservation of Resources (COR) Theory, and Emotional Intelligence Theory, which guided data collection, analysis, and interpretation of the findings.

The study was conducted at King Fahad Specialist Hospital, Qassim Health Cluster, Saudi Arabia, a tertiary referral hospital characterized by a large nursing workforce, high clinical workload, and complex healthcare services. The hospital plays an important role in supporting Saudi Vision 2030 through initiatives aimed at strengthening the healthcare workforce and improving healthcare quality. Data were collected between January and March 2026, with recruitment continuing until data saturation was achieved.

Participants were recruited using purposive sampling to ensure the inclusion of nurses with experiences relevant to the study objectives. Eligible participants were registered nurses employed at King Fahad Specialist Hospital who had at least six months of clinical experience, were actively involved in patient care, and were able to communicate effectively in English or Arabic. Nurses on extended leave, those with health conditions preventing participation in interviews, and individuals who did not complete the interview process were excluded. Recruitment continued until data saturation was achieved, resulting in interviews with 25 nurses representing the intensive care unit, emergency department, medical ward, surgical ward, and outpatient department. The diversity of clinical settings enabled the collection of a broad range of perspectives regarding workplace challenges and nursing work efficiency.

Data were collected using three complementary techniques: semi-structured in-depth interviews, limited non-participant observations, and document review. In-depth interviews served as the primary data source and were conducted face-to-face in quiet and private rooms within the hospital using a semi-structured interview guide. The interviews explored participants’ experiences of managing emotions in clinical practice, coping with workplace pressures, maintaining employee engagement, and sustaining work efficiency in patient care.

Limited non-participant observations were conducted to better understand the clinical work environment, interpersonal interactions, and organizational dynamics influencing employee engagement and work efficiency. In addition, relevant institutional documents, including hospital policies related to staff well-being, psychological support programmes, and nursing competency development initiatives, were reviewed to provide contextual information and support the interpretation of interview findings.

In qualitative research, the researcher served as the primary research instrument responsible for conducting interviews, observing the research setting, interpreting participants’ narratives, and analysing the data. To enhance consistency throughout the study, several supporting instruments were used, including a semi-structured interview guide, observation checklist, digital voice recorder, and field notes. The interview guide was developed based on the study constructs of nursing resilience, emotional intelligence, employee engagement, and work efficiency, and was informed by the JD-R Theory, COR Theory, and Emotional Intelligence Theory.

Interview recordings were transcribed verbatim and analysed using thematic analysis. The analysis involved repeated familiarization with the interview transcripts, open coding to identify meaningful statements, grouping related codes into categories and themes, interpreting the themes using the JD-R Theory, COR Theory, and Emotional Intelligence Theory, and developing narrative descriptions of participants’ experiences. Interview transcripts were analysed manually using thematic analysis. NVivo version 14 was used to facilitate data management, coding, and the organization of themes throughout the analytical process.

The trustworthiness of the findings was established using the framework proposed by Lincoln and Guba, encompassing credibility, transferability, dependability, and confirmability. Credibility was enhanced through methodological triangulation by integrating data obtained from in-depth interviews, limited observations, and supporting documents. Transferability was supported by providing detailed descriptions of the research setting, participants, and study procedures. Dependability and confirmability were strengthened by maintaining clear documentation of the data analysis process and theme development throughout the study.

Participants consistently described emotional intelligence as a fundamental psychological resource that enabled them to regulate emotions, communicate effectively, and maintain professional performance in demanding clinical situations. Nurses emphasized that emotional regulation facilitated therapeutic communication with patients and families, reduced interpersonal conflict, and supported clinical decision-making during high-pressure situations. Observational data also indicated that nurses who demonstrated greater emotional control remained calm, focused, and maintained effective interpersonal communication despite busy clinical environments.

One participant explained: “When working in the ICU, we must remain calm even in highly emotional situations. If we cannot control our emotions, patient care may be disrupted.” (Participant 9).

The second theme highlighted nursing resilience as an important adaptive mechanism for maintaining professional performance under demanding working conditions. Participants described resilience as the capacity to remain psychologically strong, recover from emotionally challenging situations, and continue delivering high-quality patient care despite heavy workloads and repeated exposure to stressful clinical events. Nurses working in critical care units particularly emphasized the importance of resilience in sustaining motivation and preventing emotional exhaustion.

One participant stated: “Sometimes we work under intense pressure for hours. Without strong mental endurance, it is very easy to feel exhausted and lose motivation.” (Participant 3).

Participants consistently identified employee engagement as a psychological state characterized by enthusiasm, commitment, and a strong sense of purpose in their work. Nurses explained that feeling engaged encouraged collaboration with colleagues, strengthened their dedication to patient care, and motivated them to undertake additional responsibilities when necessary. Engagement was perceived as an important source of energy that enabled nurses to maintain high-quality healthcare services despite increasing workplace demands.

One participant commented: “When I feel engaged with my work, I have more energy to help patients and collaborate with the team.” (Participant 9).

Participants viewed work efficiency as more than completing tasks quickly. Instead, efficient nursing practice was described as the ability to deliver safe, accurate, and high-quality patient care while effectively managing time, prioritizing clinical responsibilities, and maintaining professional standards under demanding conditions. Participants perceived that emotional intelligence, resilience, and employee engagement collectively contributed to improving work efficiency and sustaining healthcare quality.

One participant explained: “When emotional conditions are stable and work motivation is high, the work becomes more organized and the quality of service improves.” (Participant 11)

This study explored nurses’ perceptions of the mediating role of employee engagement in the relationship between nursing resilience, emotional intelligence, and work efficiency within a tertiary referral hospital in Saudi Arabia. Four interconnected themes emerged from the thematic analysis: emotional intelligence as a psychological resource for effective nursing practice, nursing resilience as an adaptive psychological mechanism, employee engagement as the motivational pathway, and work efficiency as the outcome of psychological resources. Collectively, these findings suggest that emotional intelligence and resilience enhance nurses’ work efficiency not only by strengthening individual psychological resources but also by fostering greater employee engagement, which motivates nurses to maintain high-quality clinical performance. These findings are consistent with the Job Demands-Resources Theory, which proposes that personal resources facilitate work engagement and subsequently improve performance outcomes (Bakker & Demerouti, 2017), as well as the Conservation of Resources Theory, which emphasizes that individuals utilize psychological resources to cope with workplace demands and sustain effective functioning (Hobfoll, 2011).

The findings indicate that emotional intelligence represents an essential psychological resource enabling nurses to regulate emotions, communicate effectively, and maintain professional performance under emotionally demanding clinical conditions. Participants consistently described emotional regulation as fundamental to maintaining therapeutic relationships with patients and families while reducing interpersonal conflict within multidisciplinary healthcare teams. These findings support Emotional Intelligence Theory, which argues that recognizing, understanding, and managing emotions contribute to effective interpersonal functioning and professional performance (Salovey & Mayer, 1990). Previous studies have likewise demonstrated that emotionally intelligent nurses exhibit stronger communication skills, greater empathy, lower emotional exhaustion, and improved quality of patient care (Kim et al., 2022; Zhang et al., 2023). Within the context of Saudi Arabia’s rapidly evolving healthcare system, emotional intelligence may become increasingly important as nurses encounter greater clinical complexity and higher expectations for patient-centered care.

The second major finding emphasizes nursing resilience as an adaptive psychological capacity that enables nurses to maintain professional performance despite continuous workplace challenges. Participants described resilience as the ability to recover from emotionally demanding situations, remain psychologically strong, and sustain motivation despite heavy workloads and repeated exposure to stressful clinical events. These findings align closely with the Conservation of Resources Theory, which proposes that psychological resources protect individuals from stress-related resource depletion and facilitate adaptive coping strategies (Hobfoll, 2011). Previous studies similarly report that resilient nurses experience lower burnout, greater psychological well-being, and stronger work performance in high-pressure healthcare environments (Hart et al., 2014; Delgado et al., 2022; Lee et al., 2024). The present findings therefore reinforce resilience as an essential component of sustainable nursing practice within specialist hospitals.

One of the most important findings of this study is that employee engagement emerged as the central motivational mechanism connecting emotional intelligence and resilience with nurses’ work efficiency. Rather than functioning as an independent psychological characteristic, employee engagement appeared to translate nurses’ psychological resources into greater enthusiasm, dedication, and commitment toward patient care. Participants consistently described engagement as providing meaning, motivation, and energy that enabled them to sustain high-quality healthcare services despite challenging working conditions. This interpretation strongly supports the motivational pathway proposed by the Job Demands–Resources (JD–R) Theory, whereby personal resources enhance work engagement, ultimately leading to improved work performance (Bakker & Demerouti, 2017). Similar conclusions have been reported in previous nursing and organizational studies demonstrating that work engagement mediates the relationship between psychological resources and employee performance (Mousa et al., 2020; Schaufeli, 2021).

The findings have important implications for nursing management and healthcare organizations. Improving nurses’ work efficiency should extend beyond strengthening technical competencies alone and should also incorporate strategies that enhance emotional intelligence, resilience, and employee engagement. Hospital administrators may consider implementing emotional intelligence training, resilience development programmes, psychological support services, mentorship initiatives, and leadership approaches that foster supportive work environments. Such interventions may strengthen nurses’ psychological resources, improve employee engagement, and ultimately contribute to higher-quality patient care and organizational performance. These recommendations are particularly relevant within the context of Saudi Vision 2030, which emphasizes healthcare workforce development and continuous quality improvement across Saudi healthcare institutions.

This study provides an in-depth exploration of the psychological mechanisms influencing nurses’ work efficiency by integrating Emotional Intelligence Theory, the Job Demands-Resources Theory, and the Conservation of Resources Theory within a qualitative research design. The use of multiple data sources, including in-depth interviews, observations, and document review, strengthened the credibility of the findings through methodological triangulation. However, the study was conducted in a single specialist hospital within one health cluster, which may limit the transferability of the findings to other healthcare settings. In addition, the qualitative design was intended to provide rich contextual understanding rather than statistical generalization. Future studies employing longitudinal or mixed-methods designs across multiple healthcare institutions may provide a broader understanding of the relationships among psychological resources, employee engagement, and nursing work efficiency.

The qualitative interview data supporting the findings of this study are not openly available because the transcripts contain contextual information that could potentially identify individual participants despite de-identification. In accordance with the ethical approval granted by the Research Ethics Committee (Institutional Review Board) of Lincoln University College, participant confidentiality and privacy must be protected.

Researchers who wish to access the de-identified interview data for non-commercial academic research may contact the corresponding author at [email protected]. Each request will be reviewed individually, and access may be provided where the proposed use is consistent with the approved ethical protocol and institutional requirements for safeguarding participant confidentiality.

The authors gratefully acknowledge Lincoln University College for its support.

•  Bakker AB, Demerouti E: Job demands–resources theory: Taking stock and looking forward. J. Occup. Health Psychol. 2017; 22(3): 273–285. PubMed Abstract | Publisher Full Text
•  Bakker AB, Demerouti E:Multiple levels in job demands-resources theory: Implications for employee wellbeing and performance. InKelloway EK, Nielsen K, Dimoff J (Eds.), Leading to Occupational Health and Safety;(2020). (pp. 1–20).
•  Budler LC, Gosak L, Kmetec S, et al.: Emotional intelligence and job performance among nurses: A systematic review. Front Psychol. 2022; 13: 847343. Publisher Full Text
•  Connor KM, Davidson JRT: Development of a new resilience scale: The Connor–Davidson Resilience Scale (CD-RISC). Depress. Anxiety. 2003; 18(2): 76–82. Publisher Full Text
•  Cummings GG, Lee S, Tate K, et al.: The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. Int. J. Nurs. Stud. 2021; 115: 103842. PubMed Abstract | Publisher Full Text
•  Delgado C, Upton D, Ranse K, et al.: Nurses' resilience and the emotional labour of nursing work: An integrative review. J. Clin. Nurs. 2022; 31(1–2): 16–33. Publisher Full Text
•  Dyrbye LN, West CP, Sinsky CA, et al.: Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clinic Proceedings. 2020; 95(5): 911–920. Publisher Full Text
•  Godoy LR, Jones AE, Anderson TN, et al.: Resilience, burnout, and well-being among healthcare workers during the COVID-19 pandemic: A systematic review. Curr. Psychol. 2022; 41: 6534–6551. Publisher Full Text
•  Gotterson J, McGillion M, Wong CA, et al.: The impact of nursing leadership on patient and workforce outcomes: A systematic review. J. Nurs. Manag. 2021; 29(8): 2415–2432.
•  Hart PL, Brannan JD, De Chesnay M: Resilience in nurses: An integrative review. J. Nurs. Manag. 2014; 22(6): 720–734. Publisher Full Text
•  Hobfoll SE: Conservation of resource caravans and engaged settings. J. Occup. Organ. Psychol. 2011; 84(1): 116–122. Publisher Full Text
•  Htay M, Whitehead D: The effectiveness of interventions to reduce burnout in nurses: A systematic review. J. Nurs. Manag. 2021; 29(7): 2063–2078.
•  Kaushik A, Guleria N: The impact of pandemic COVID-19 in workplace. Eur. J. Bus. Manag. Res. 2021; 6(3): 1–10.
•  Kim S, Han K, Kim M: Emotional intelligence and nursing performance among clinical nurses. J. Nurs. Manag. 2022; 30(5): 1193–1202.
•  Lee H, Kim Y, Park J: Nursing resilience, work engagement, and job performance among hospital nurses: A cross-sectional study. BMC Nursing. 2024; 23: 115.
•  Mousa M, Ayoubi RM, Massoud HK: The effect of employee engagement on job performance in healthcare organizations. Manag. Res. Rev. 2020; 43(5): 519–538.
•  Salovey P, Mayer JD:Emotional intelligence. In The Handbook of Intelligence(2nd ed.). Cambridge Universit Press; (2020).
•  Salovey P, Mayer JD: Emotional intelligence. Imagin. Cogn. Pers. 1990; 9(3): 185–211. Publisher Full Text
•  Schaufeli WB:Engaging leadership: How to promote work engagement?Front. Psychol.2021;12:754556. Publisher Full Text
•  Schaufeli WB, Bakker AB, Salanova M: Burnout and work engagement: The JD-R approach. Annu. Rev. Organ. Psychol. Organ. Behav. 2020; 7: 389–411.
•  Shanafelt TD, Dyrbye LN, West CP, et al.: Addressing physician burnout: The way forward. JAMA. 2022; 327(10): 901–902. Publisher Full Text
•  Zhang Y, Li X, Wang H, et al.: Emotional intelligence and nursing performance: The mediating role of work engagement. BMC Nursing. 2023; 22: 318.

Current Reviewer Status:

AWAITING PEER REVIEW

AWAITING PEER REVIEW

?