AIM: To examine the relationship between role stress and decision fatigue and the mediating role of psychological capital among clinical nurses. DESIGN: A descriptive cross-sectional study. METHOD: A total of 418 clinical nurses were recruited through convenience sampling from Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, a tertiary hospital in Zhuhai, China, between May and August 2025. Data were collected using the role stress scale, the psychological capital scale and the decision fatigue scale. RESULTS: Role stress is positively correlated with decision fatigue. After controlling for confounding factors, psychological capital partially mediated the effect of role stress on decision fatigue, with the mediating effect accounting for 34.82% of the total effect. CONCLUSIONS: Clinical nurses' psychological capital partially mediates the relationship between role stress and decision fatigue, suggesting that healthcare administrators may consider addressing decision fatigue by focusing on nurses' psychological resources to support patient safety and the stable operation of the healthcare system. PATIENT OR PUBLIC CONTRIBUTION: This study involved only nursing staff in its design and implementation, without directly inviting patients or the public to participate. However, the research findings indirectly benefit patients and the public. IMPACT: This study examined the mediating role of psychological capital between role stress and decision fatigue. Results indicate that higher role stress significantly increases nurses' decision fatigue levels, while psychological capital exerts an indirect protective effect on decision fatigue by alleviating role stress. The findings advocate for collaborative strategies to reduce nurses' role stress, enhance individual psychological capital and decrease decision fatigue. The ultimate goal is to improve nurses' professional well-being, contribute to maintaining their mental health, reduce turnover rates and thereby ensure the stability of nursing teams. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: By fostering positive psychological resources, hospitals can alleviate nurses' role stress and decision fatigue while enhancing their confidence and self-efficacy in decision-making. Strengthened psychological capital promotes sound clinical judgement, professional growth and engagement, ultimately improving teamwork, reducing burnout and turnover and enhancing patient safety and care quality.
Li et al. (Fri,) studied this question.