Job Resources Show Modest Buffering Association With Stress in Home Visiting Nurses

A cross-sectional survey of 434 home visiting nurses in southern China found that stronger job demands were associated with higher job stress, while greater job resources were associated with lower stress. An interaction analysis indicated a modest buffering association: the positive relationship between demands and stress was weaker when nurses reported more resources. The survey, conducted from March through June 2024 at 13 comprehensive public hospitals and affiliated community health centres in Guangdong and Guangxi, involved hospital-based home visiting and internet nursing services.

Because the study was cross-sectional and relied on self-reports, it cannot establish that resources caused stress to decrease or that any intervention would produce such an effect. Home visiting nurses provide personalised care to people with disabilities, dementia, immobility or terminal illness, bringing services into homes and other community settings. The researchers tested the Job Demands-Resources framework, which treats job stress as a response to the balance between physical, psychological and social demands and the physical, psychological, social and organizational resources available to workers.

In this analysis, job demands included work overload, role conflict, work–family conflict and role ambiguity, while job resources included autonomy, social support, performance feedback and career-development opportunities. The researchers used anonymous questionnaires distributed online and on paper. The 19-item Job Demands Questionnaire used a seven-point scale from 1, strongly disagree, to 7, strongly agree, with total scores ranging from 19 to 133; higher scores indicated greater demands.

The 22-item Job Resources Questionnaire used the same seven-point response format, with total scores from 22 to 154; higher scores indicated more resources. The 25-item Community Nurse Job Stress Scale measured management and interpersonal relationships, patient care, work environment and resources, and career promotion on a four-point scale from never to always, with total scores from 25 to 100. Internal consistency was good for all three instruments: Cronbach’s alpha was 0.903 for job demands, 0.911 for job resources and 0.893 for job stress.

Of 511 people initially screened, 434, or 84.9%, were eligible and included; 77 submissions were excluded because of illogical, uniform or patterned responses. The participants were 22 to 56 years old, and 432 of 434 were women. Their average time in home care was four years.

Most were affiliated with community health centres: 302 of 434, or 69.6%, worked there, compared with 99 at tertiary hospitals and 33 at secondary hospitals. A total of 236 nurses, or 54.4%, reported working 41 to 50 hours per week, while 113 reported making more than 30 home visits per month. Most visits were made alone: 341 nurses, or 78.6%, said they usually visited without a colleague.

Forty-six participants, or 10.6%, reported experiencing physical threats. The study characterized these as features of the hospital-based home visiting population, but the convenience sample does not establish that it represents all home visiting nurses. Mean item scores were 3.84 of seven for job demands, 4.54 of seven for job resources and 1.73 of four for job stress.

Work–family conflict was the highest demand dimension, with a mean of 4.64, followed by work overload at 4.33. Role conflict scored 3.51 and role ambiguity 3.06. Social support was the strongest resource dimension, scoring 5.18, while performance feedback scored 5.10, career-development opportunities 4.65 and autonomy 3.88.

Career promotion produced the highest stress dimension score at 2.29, compared with 1.83 for work environment and resources, 1.62 for patient care and 1.48 for management and interpersonal relationships. The overall stress mean was relatively low compared with the instrument’s possible range, but validated cutoff scores were unavailable, so the result should not be interpreted as membership in a clinically established low-stress category. Job stress was positively correlated with job demands at r = 0.643 and negatively correlated with job resources at r = −0.464, with both p values below 0.001.

Job demands and job resources were also negatively correlated, at r = −0.546, p below 0.001. These bivariate findings measure association at one survey occasion and do not show how stress changes over time. Hierarchical regression provided the main moderation test.

After demographic and work-related covariates were included, the interaction between mean-centred overall job demands and overall job resources was associated with job stress at B = −0.036, with a 95% confidence interval from −0.058 to −0.013 and p = 0.002. The interaction accounted for an additional 1.1% of explained variance in stress, indicating a statistically detectable but modest contribution beyond the models’ main effects. Simple-slope analysis showed that the association between demands and stress remained positive at both resource levels.

One standard deviation above the mean for job resources, a one-unit increase in job demands was associated with a 0.146-point increase in predicted stress, with a 95% confidence interval of 0.108 to 0.184 and p below 0.001. One standard deviation below the mean, the corresponding association was stronger at 0.210 points, with a 95% confidence interval of 0.172 to 0.248 and p below 0.001. The final model explained 52.2% of stress-score variance, but that total should not be interpreted as proof that workplace conditions alone determine stress.

The interaction more specifically indicates that the demands–stress slope differed by resource level: resources attenuated the association but did not eliminate it. When the four resource dimensions were entered separately while controlling for one another and the relevant covariates, social support and career-development opportunities had inverse associations with job stress. Social support was associated with a 0.042-point lower stress score, with a 95% confidence interval from −0.075 to −0.008 and p = 0.014.

Career-development opportunities were associated with a 0.063-point lower stress score, with a 95% confidence interval from −0.090 to −0.036 and p below 0.001. Job autonomy and performance feedback did not have statistically significant independent associations in the final model. These dimension-specific results are distinct from the overall moderation test: they show associations of particular resources with stress after adjustment, whereas the interaction analysis tested whether the overall demands–stress relationship changed at different levels of overall job resources.

Reported working conditions also differed in average job stress. Nurses conducting more than 30 home visits per month reported higher stress than those making fewer than five or 11 to 30 visits per month in Tukey-adjusted comparisons. Nurses working 51 to 60 hours per week and those working more than 60 hours reported higher stress than nurses working no more than 40 or 41 to 50 hours.

Nurses who had experienced physical threats had an average stress score of 2.00, compared with 1.70 among those who had not. Those who visited alone scored 1.76, compared with 1.63 among nurses who did not. These are cross-sectional group differences; they do not show that additional visits, longer hours, threats or solitary work caused the higher reported stress.

Several limitations constrain the findings. Participants were recruited through convenience sampling from two provinces, restricting generalisability and permitting selection and nonresponse bias. Predictors and outcomes were self-reported in the same questionnaire, creating potential response bias and common-method bias, while the combination of online and paper administration could have introduced mode effects.

The cross-sectional design cannot establish temporal relationships or causal effects. Hospital-level clustering was not included in the statistical analyses, potentially affecting standard-error estimates. Five missing values for a background variable were imputed with the sample mean at the item level.

The study therefore documents a modest buffering association among hospital-based home visiting nurses in Guangdong and Guangxi, identifies social support and career-development opportunities as the resource dimensions independently associated with lower stress, and provides a basis for prospective evaluation rather than proof that increasing those resources will reduce occupational stress.

Subject of Research: Occupational stress, job demands and job resources among hospital-based home visiting nurses in southern China

Article Title: The Relationship Between Job Demands and Job Stress Among Home Visiting Nurses: The Moderating Role of Job Resources

Article References: Xiong, J., Dai, L., Sun, Y.-J., & Zhang, L. (2026). The Relationship Between Job Demands and Job Stress Among Home Visiting Nurses: The Moderating Role of Job Resources. Nursing Open, 13(10), Article e70916. https://doi.org/10.1002/nop2.70916

Image Credits: AI Generated

DOI: 10.1002/nop2.70916

Keywords: home visiting nurses, occupational stress, job demands, job resources, social support, career development, community nursing, cross-sectional survey, China, work–family conflict, nursing workforce, Relationship