Organizational and Psychological Determinants of Nursing Performance: A PLS-SEM Analysis Among Registered Nurses in Saudi Arabia

Abstract

Background Maintaining high nursing performance is increasingly challenging in modern healthcare systems due to heavy workloads, workforce shortages, and growing psychological demands. Although work-life balance has been recognized as an important organizational resource, limited evidence has examined the statistical pathways linking work-life balance with nursing performance through employee well-being and stress reduction, particularly in Saudi Arabian healthcare settings. This study examined the associations among work-life balance, employee well-being, stress reduction, and nursing performance among registered nurses. Methods A cross-sectional study was conducted among 427 registered nurses employed at The Medical City of Medina, Saudi Arabia. Proportionate stratification was used to ensure representation across clinical departments, and all eligible nurses within each stratum were invited to participate. Data were collected using structured self-administered questionnaires and analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Direct and indirect associations were evaluated using a bootstrapping procedure with 5,000 resamples. Results Work-life balance was positively associated with employee well-being (β = 0.885, p < 0.001), stress reduction (β = 0.888, p < 0.001), and nursing performance (β = 0.219, p < 0.001). Employee well-being (β = 0.320, p < 0.001) and stress reduction (β = 0.417, p < 0.001) were also positively associated with nursing performance. Statistically significant indirect associations were observed between work-life balance and nursing performance through employee well-being (β = 0.283, p < 0.001) and stress reduction (β = 0.371, p < 0.001), consistent with partial statistical mediation. Conclusions Work-life balance was positively associated with nursing performance both directly and indirectly through employee well-being and stress reduction. The findings support the relevance of organizational conditions that address work-life balance, employee well-being, and occupational stress in nursing workforce management. Given the cross-sectional design, the observed associations and statistical mediation should not be interpreted as evidence of causal relationships. Longitudinal and multi-centre research is warranted to further examine these relationships across diverse healthcare settings.