Associations of empathy, occupational commitment, and ego-resilience with perceived stress among nurses in non-family-accompanied care wards

To examine the association between empathy and perceived stress among nurses in non-family-accompanied care wards and to explore the potential mediating roles of occupational commitment and ego-resilience. A convenient sampling method was employed to recruit 359 nurses from non-family-accompanied care wards in eight tertiary Grade A hospitals in Fujian Province from March to June 2025. The perceived stress, empathy, occupational commitment, and ego-resilience were assessed using the Chinese versions of the Jefferson Scale of Empathy-Health Professionals (JSE-HP), the Chinese Perceived Stress Scale (CPSS), the Measurement of Occupational Commitment (MOC), and the Ego-Resilience Scale (ERS), respectively. Chain mediation analysis was conducted to examine the potential indirect associations among these variables. Nurses in non-family-accompanied care wards reported a moderate level of perceived stress (35.38 ± 8.42), with significant differences observed across clinical departments ( P < 0.05). Empathy was negatively associated with perceived stress ( r = − 0.303, P < 0.01) and positively associated with occupational commitment ( r = 0.288, P < 0.01) and ego-resilience ( r = 0.233, P < 0.01). Occupational commitment was positively associated with ego-resilience ( r = 0.341, P < 0.01), and both variables were negatively associated with perceived stress ( P < 0.01). Mediation analysis identified three significant indirect associations: (1) an indirect association through occupational commitment (effect = − 0.0339, 95% CI [− 0.0560, − 0.0134]); (2) an indirect association through ego-resilience (effect = − 0.0429, 95% CI [− 0.0733, − 0.0147]); and (3) a sequential indirect association through occupational commitment and ego-resilience (effect = − 0.0463, 95% CI [− 0.0678, − 0.0291]). A significant direct association between empathy and perceived stress remained after accounting for the mediators (B = − 0.1106, P < 0.001). Perceived stress among nurses working in non-family-accompanied care wards varied across clinical departments. Empathy was negatively associated with perceived stress and was associated with perceived stress both directly and indirectly within the hypothesized serial mediation model through the sequential mediating pathway involving occupational commitment and ego-resilience. Nursing managers should recognize the potential value of fostering empathy, occupational commitment, and ego-resilience to support nurses’ role adjustment and adaptation to the non-family-accompanied care model. These findings may provide insights for developing targeted strategies to support nurses’ psychological well-being and stress management.