The concept of job esteem is rooted in social identity theory and self-determination theory, both of which hold that people derive part of their self-concept from the groups and roles they inhabit. For nurses, whose work is anchored in care and ethics, this occupational self-regard is not a soft abstraction. Previous research has linked higher job esteem to better clinical decision-making, stronger moral agency, and improved quality of care, while lower job esteem tracks with burnout, emotional detachment, and the intention to quit. Nurses with a firm sense of professional worth are also more resilient when confronting ethical challenges, such as defending patient autonomy or addressing institutional unfairness. Conversely, diminished job esteem feeds the emotional exhaustion, depersonalization, and reduced sense of accomplishment that define burnout, and can ultimately push nurses out of the profession altogether.

To investigate what drives this critical psychological resource, researchers from Capital Medical University and collaborating institutions surveyed nurses in three tertiary, two secondary, and two primary hospitals in Beijing between January 2023 and September 2024. Eligible participants held valid Chinese nursing licences, worked in clinical roles, and had at least two years of full-time experience. Using systematic random sampling within each hospital and an anonymous online questionnaire, the team achieved a remarkable 99.1 percent response rate among eligible invited nurses. The survey captured demographic and employment details, a battery of work-intensity measures, job satisfaction, intention to leave, and job esteem as measured by the validated Chinese version of the Job-Esteem Scale, a 25-item instrument spanning five dimensions from professional self-awareness to social trust and respect.

The demographic picture reflected the realities of China’s nursing workforce. Nearly all participants—95.4 percent—were female, consistent with the national distribution, and 63.6 percent were aged 35 or younger, a younger profile than national workforce data suggest. Two-thirds were contract nurses rather than permanent staff, and 72 percent reported monthly incomes above 8,000 renminbi, roughly 1,127 US dollars, reflecting Beijing’s high cost of living and concentration of advanced hospitals. The workload data were striking: 61 percent of nurses worked more than 40 hours per week, 35.3 percent worked continuously for at least nine hours a day, and 46.1 percent regularly took on tasks beyond their formally defined responsibilities. Nearly a third perceived their workload as quite or extremely heavy, and 46.6 percent reported working more than 12 hours in a day at least occasionally within a month.

Against this backdrop, the mean total job esteem score was 81.8 on a scale running from 25 to 125. When the researchers examined the five dimensions individually, professional self-awareness and social trust and respect scored highest, followed closely by professional competence. The weakest dimension, by a clear margin, was professional authority and future value, with a mean item score of just 2.9 on a five-point scale. Organizational respect and recognition also lagged. In other words, Beijing’s nurses feel reasonably confident in their own skills and in the trust society places in them, but they see their professional standing, career prospects, and recognition within their own institutions as comparatively fragile. This gap between societal appreciation and organizational recognition echoes the dissonance created during the COVID-19 pandemic, when a celebratory hero narrative was rarely matched by sustainable working conditions or institutional support.

The statistical heart of the study was a linear mixed-effects model that accounted for the clustering of nurses within hospitals and adjusted for a wide range of demographic and occupational variables simultaneously. The results upended several intuitive expectations. Most indicators of work intensity—night shifts, working days per week, perceived workload, additional duties, extended workdays, and continuous working hours—showed no significant independent association with job esteem. The single exception was weekly hours: nurses working 41 to 45 hours per week scored about 1.5 points lower than those working 40 hours or fewer. Hospital tier, meanwhile, was entirely unrelated to job esteem, and the estimated between-hospital variance was effectively zero, indicating that differences in professional self-worth arise from individual circumstances rather than institutional prestige.

What did matter were employment circumstances and career stage. Nurses earning at least 10,001 renminbi per month scored 2.5 points higher than the lowest earners, an association that appeared only at the top of the income distribution, suggesting that remuneration functions less as a linear driver and more as a visible acknowledgement of expertise and contribution. Contract nurses and those with other employment arrangements unexpectedly scored nearly two points higher than permanent staff, a finding the authors attribute to the broader salary structures, incentives, and mobility that often accompany different contractual categories rather than the contract label itself. Nurses with 6 to 20 years of experience scored two to three and a half points higher than those in their first five years, a pattern consistent with recent evidence that reality shock among junior Chinese nurses weakens their professional identity during the difficult transition from training to independent practice.

By far the largest effects involved how nurses evaluated their current jobs. Compared with nurses who were very satisfied, those who were only a little satisfied scored nearly nine points lower, neutral nurses fourteen points lower, and those who were a little dissatisfied nineteen points lower on the adjusted scale. Intention to leave the current hospital told a similar story: nurses planning to depart scored six points lower than those committed to staying, and even the undecided scored nearly four points lower. The authors caution that these magnitudes partly reflect the conceptual proximity between job satisfaction and job esteem—both concern how nurses evaluate their working lives—but the pattern suggests that dissatisfaction and ambivalence about staying may be early warning signs of eroding professional worth, detectable before a formal decision to leave is ever made.

For nursing managers and policymakers, the message is that boosting nurses’ sense of professional value requires more than reducing workloads. The study points toward fair and transparent remuneration, mentoring and career guidance for nurses in their first five years, clear promotion pathways, greater involvement of nurses in clinical and organizational decision-making, and visible recognition of nursing contributions. Monitoring job satisfaction and turnover intention alongside job esteem could help administrators identify units and individuals needing support. The authors also stress the study’s limits: the cross-sectional design cannot establish causation, the sample was confined to seven Beijing hospitals and excluded nurses with diagnosed psychiatric disorders or severe chronic conditions, and single-item measures of satisfaction and turnover intention limit measurement precision. Longitudinal studies across wider regions will be needed to test whether organizational changes can genuinely strengthen the pride nurses take in their profession—and, in doing so, help keep them at the bedside.

Subject of Research: Occupational and work-related factors associated with job esteem among nurses in Beijing

Article Title: Occupational and Work‐Related Factors Associated With Job Esteem Among Nurses in Beijing: A Cross‐Sectional Study

Article References: Yan, Z., Ma, X., Jin, C., Zhang, H., Su, Q., Ji, M., & Zhang, W. (2026). Occupational and Work‐Related Factors Associated With Job Esteem Among Nurses in Beijing: A Cross‐Sectional Study. Nursing Open, 13(10), Article e70842. https://doi.org/10.1002/nop2.70842

Image Credits: AI Generated

DOI: 10.1002/nop2.70842

Keywords: nurses, job esteem, job satisfaction, workload, burnout, turnover intention, Beijing, cross-sectional study, nursing workforce, professional identity, employment contract, remuneration