Sleep quality among operating room nurses across secondary and tertiary hospitals in China: associations with perceived stress and job satisfaction in a multicentre cross-sectional study

Sleep problems are common among nurses, but evidence regarding the independent roles of perceived stress and job satisfaction in operating room (OR) nurses remains limited. This study examined their associations with sleep quality and explored a potential indirect pathway through perceived stress. This multicentre cross-sectional study was conducted from January to March 2025 across six hospitals (three tertiary and three secondary) in Jiangsu Province, China. A total of 351 OR nurses completed the Pittsburgh Sleep Quality Index (PSQI), 14-item Perceived Stress Scale (PSS-14), and a validated Chinese Nurse Job Satisfaction Scale. Theory-driven hierarchical multiple linear regression was used to examine independent associations with sleep quality, with cluster-robust standard errors accounting for clustering by hospital. Exploratory indirect-association analysis was conducted using PROCESS Model 4 with 5,000 bootstrap resamples. Sensitivity analyses were performed to assess the robustness of the findings. The mean PSQI score was 12.47 ± 3.22, and 85.5% of participants ( n = 300) had poor sleep quality (PSQI ≥ 7). In the fully adjusted model, higher perceived stress (β = 0.297, p < 0.001) and lower job satisfaction (β = −0.307, p < 0.001) were independently associated with poorer sleep quality. The model explained 33.8% of the variance in PSQI scores (adjusted R 2 = 0.338), with psychosocial variables contributing an additional 18.3% of explained variance (ΔR 2 = 0.183, p < 0.001). Exploratory analysis showed a significant indirect association between job satisfaction and sleep quality through perceived stress (B = −0.747; bootstrapped 95% CI: −1.079, −0.452), accounting for 30.1% of the total association. Poor sleep quality was highly prevalent among OR nurses. Perceived stress and job satisfaction were independently associated with sleep quality, and perceived stress accounted for a significant proportion of the association between job satisfaction and sleep quality. These findings support the need for occupational interventions addressing psychosocial factors among OR nurses. Not applicable, as this was an observational, multicentre cross-sectional survey involving no intervention assignment or treatment allocation and therefore did not require clinical trial registration.