Anticipatory Attitudes and Emotional Responses of Nurses in the Central Sterile Supply Department towards Prospective Service Outsourcing: A Qualitative Descriptive Study

Background The outsourcing of Central Sterile Supply Department (CSSD) services has been increasingly adopted in public hospitals worldwide, yet little is known about how frontline nurses psychologically anticipate this organizational transformation when no outsourcing decision has been announced in their own hospital, even though outsourcing is already in place elsewhere. Understanding nurses' anticipatory attitudes and emotional responses is critical for designing supportive transition strategies and maintaining workforce stability. This study aimed to explore CSSD nurses' anticipatory attitudes and emotional experiences towards the prospect of outsourcing reform in Chinese public hospitals where no outsourcing plan had been announced. Methods This study adopted a qualitative descriptive research design. From June to July 2026, 17 CSSD nurses were recruited from seven tertiary hospitals in Anhui Province where no outsourcing plan had been announced or implemented, although outsourcing had already been adopted in comparable local hospitals and was known to participants through professional networks and peer hospitals. Data were collected through individual semi-structured​ interviews conducted online via Tencent Meeting, using a study information sheet and a semi-structured interview guide. Data were analysed using reflexive thematic analysis. Reporting followed the COREQ guidelines. Results Four main themes were identified: (1) perceived uncertainty risks of outsourcing; (2) identity threat and emotional experiences; (3) coping strategies and emotional expression; (4) making sense of the prospect of outsourcing: information gaps, institutional contradictions, and a contested professional niche. Twelve subthemes further elaborated on these dynamics. Conclusions CSSD nurses hold no monolithic stance towards outsourcing. Multiple risk perceptions trigger negative emotions and differentiated coping behaviours. Even before any outsourcing decision is announced, nurses already perceive structural contradictions between the public-hospital system and market-driven outsourcing, aggravated by information deficiency. Administrators should establish an outsourcing management framework integrating rights protection and humanistic care. Measures including information transparency, participatory decision-making and phased transition are required to stabilize the nursing workforce and facilitate sustainable development of speciality nursing. Trial registration Not applicable. This study is not a clinical trial.