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The mediating role of thriving at work between emotional labor and presenteeism: a comparison between psychiatric nurses with and without sleep disturbances

Jianing Li,Xiaolian Li,Yao-mei Chen,Mei Chen,Weikang Shi,Huijun Huang

Published 2025 in BMC Psychiatry

ABSTRACT

Emotional labor is a significant component of healthcare work, yet the mechanisms linking it to presenteeism are not fully understood. Existing research has centered on negative mediating pathways, leaving the potential role of the positive psychological state of thriving at work underexplored. This study aimed to examine the mediating role of thriving at work in the relationship between emotional labor and presenteeism, and to compare this pathway between psychiatric nurses with and without sleep disturbances. A multicenter, cross-sectional study was conducted using convenience sampling among 1,311 psychiatric shift-work nurses from 19 specialized hospitals in Fujian Province, China, between January and March 2025. Participants completed the Emotional Labor Scale, Stanford Presenteeism Scale, Thriving at Work Scale, and Pittsburgh Sleep Quality Index. Mediation analysis was performed using structural equation modeling with bootstrap estimation. In the overall sample, thriving at work partially mediated the positive associations of surface acting (β = 0.122, p < 0.001) and emotional display rules (β = 0.063, p < 0.001) with presenteeism, accounting for 36.5% and 28.0% of the total effects, respectively. By contrast, deep acting exerted a significant negative indirect effect on presenteeism through thriving at work (β = -0.118, p < 0.001). When stratified by sleep quality, the indirect effect of surface acting accounted for 45.7% of the total effect in the sleep disturbance group (vs. 19.9% in the no sleep disturbance group), while the mediated proportion of emotional display rules reached 34.1% (vs. 16.1% in the no sleep disturbance group). Thriving at work mediates the relationship between emotional labor (particularly surface acting and emotional display rules) and presenteeism among psychiatric nurses. Sleep disturbances significantly amplify this mediating pathway, indicating that sleep quality is a crucial boundary condition for this psychological mechanism. Interventions aimed at enhancing thriving at work and improving sleep quality may help mitigate the negative consequences of emotional labor. Not applicable.

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