Between October and December 2023, a cross-sectional study was conducted in Guangdong Province, China, employing snowball and convenience sampling methods. The sample size was determined according to Wu (2010) recommendation that a sample size exceeding 200 is necessary to establish a robust model. Thus, our objective was to gather a minimum of 200 valid questionnaires. The inclusion criteria are as follows: (Roche et al., 2015) possession of a nursing practice certificate and participation in clinical work; (World Health Organization, 2010) self-assessment of no mental or cognitive impairment; and (Efendi et al., 2019) volunteering to participate in this study. The exclusion criteria are as follows: (Roche et al., 2015) practice nurses and trainee nurses who have not obtained the practice qualification and (World Health Organization, 2010) nurses who did not work in a hospital during the survey period (such as studying abroad, not participating in clinical work while engaged in management tasks, and those who requested leave or were hospitalized).

In this study, a QR code and a link were generated using the questionnaire network. The researcher then shared the link and QR code with hospital nursing department directors through the WeChat platform. These directors coordinated the participation of nurses who met the inclusion criteria. Nurses had the option to participate voluntarily and could stop at any point, whether they answered all, some, or none of the questions, without fear of being penalized. To avoid duplication, each account and IP address was restricted to a single submission.

IBM SPSS 27.0 was used for analysis. First, the data with the normal distribution of continuous variables were represented by mean and standard deviation. The categorical variables were described as frequency and percentage. Second, Pearson’s correlation analysis was used to analyze the relationship between psychological resilience, perceived organizational support, and intention to stay for normally distributed data. Finally, we used the PROCESS macro mediation model (model 4) (Hayes, 2013) in SPSS. We set psychological resilience as the independent variable, perceived organizational support as the intermediary variable, and intention to stay as the dependent variable to estimate the size and significance of the mediation effect. The bootstrap method was used, with a sample size of 5,000 and a confidence interval of 95%. The mediation effect was considered significant if the confidence interval did not include zero (Zhang et al., 2021).

The study protocol was ethically approved by the Ethics Committee of Guangdong Provincial People’s Hospital (Approval No. KY2023-433-03). Before the start of the study, all participants were provided with detailed information about the purpose and procedures of the study. Subsequently, they signed an informed consent form, indicating their voluntary participation and understanding that their responses would remain anonymous. The researchers implemented measures throughout the data collection and analysis process to ensure the confidentiality of the data and to prevent any unauthorized use of the data.

The sample consisted of 1,402 nurses from five Grade 3A hospitals in Guangdong Province. Of these, 57 were male individuals, representing 4.1% of the sample, while 1,345 were female individuals, accounting for 95.9% of the total number of nurses. In terms of education level, 455 nurses (32.5%) held a junior college degree, 937 nurses (66.8%) had undergraduate degrees, and 10 nurses (0.7%) had a master’s degree or higher. Table 1 shows the remaining demographic features of this sample.

Table 2 shows the scores of psychological resilience, perceived organizational support, and intention to stay among nurses. The overall mean scores for resilience, perceived organizational support, and intention to stay are 60.54 ± 19.17, 45.77 ± 11.49, and 20.82 ± 4.65, respectively.

Table 3 shows the results of the correlation analysis between the total psychological resilience score and dimensions, the total perceived organizational support score and dimensions, and the willingness of nursing staff to stay in their jobs. Intention to stay was significantly and positively correlated with psychological resilience (r = 0.388, p < 0.01) and perceived organizational support (r = 0.550, p < 0.01); psychological resilience was significantly and positively correlated with perceived organizational support (r = 0.570, p < 0.01).

The results showed that the 95% CI for both the direct and indirect effects of psychological resilience on nurses’ intention to stay in the profession did not include zero, suggesting that perceived organizational support partially mediates the relationship between psychological resilience and intention to stay.

The direct effect of psychological resilience on intention to stay was 0.027, the mediating effect was 0.067, and the total effect was 0.094, with the mediating effect percentage accounting for 71.28% of the total effect (see Table 4).

The results of this study initially showed that the psychological resilience score of nurses was 60.54 ± 19.17, which is considered a medium level. This score was lower than that in the Han Binru study which included a psychological resilience survey of 71,477 nurses in China (Han et al., 2021). This finding could be attributed to the fact that the study’s participants were from Guangdong Province in China, a region that is more economically developed.

Due to the nature of their work, patient interactions, workplace conditions, and societal expectations, nurses experience higher levels of psychological stress and work pressure compared to other professions (Chen et al., 2024). In China, the rapid advancement of the nursing profession, heavy workload, frequent occurrence of nurse–patient disputes, and the psychological pain brought about by the discrepancy between intrinsic expectations and reality have resulted in increased work pressure on nurses, causing long-term mental stress, which hinders the development of their robust psychological resilience (Pan et al., 2019).

Therefore, to help nurses express their thoughts, develop their psychological stamina, enhance their ability for psychological recovery, and actively shape and continuously strengthen their psychological resilience to deal with a variety of unexpected medical events and a constantly changing work environment, managers could arrange a variety of psychological training courses or workshops and seek advice from psychologists.

Furthermore, the results of this study showed that the perceived organizational support score among nurses was 45.77 ± 11.49, which is moderate but lower than that in Chen et al. (2023) study. In this group, 65.3% of nurses held junior professional titles. Studies have shown that nurses with higher professional titles tend to experience better job stability, adapt more easily to their work environment, and perceive greater organizational support (Wang and Wang, 2021).

Additionally, the instrumental support score of the nurses in this group was higher than the emotional support score, indicating that the organization places more emphasis on providing material support, such as welfare benefits, training opportunities, and improved working environment, while neglecting emotional care, such as psychological counseling and humanistic support.

Consequently, it is advised that managers foster a supportive organizational culture in clinical nursing practice and prioritize the beneficial effects of organizational support on nurses’ work. By implementing initiatives such as humanizing the scheduling process, offering frequent skill-building opportunities, and encouraging further education, managers can enhance nurses’ perceptions of organizational support and create an environment that promotes professional growth. In addition, proactive attention should be paid to nurses’ emotional well-being by providing emotional support. This can help alleviate negative emotional states, prevent burnout, and ultimately improve job satisfaction.

Subsequently, the results of this study showed that the total score of nurses’ intention to stay in their jobs was 20.82 ± 4.65, which is considered a medium level. This finding is similar to the results of the studies conducted by Wang and Wang (2021) and Zhang et al. (2019) and slightly lower than the results of the study conducted by Hao et al. (2022). The highest score (4.04 ± 1.11) was given to the reverse-scored item 3 (How often do you try to find a new job?). The lowest score (2.68 ± 1.19) was given to the reverse-scored item 2 (Would you consider leaving your current nursing job position if you had another job opportunity?) in the Intention to Stay Scale, which indicates that nurses do not actively search for another job with a high frequency but are willing to give up their current nursing job position. Upon analyzing the reasons, it is notable that the respondents of this study come from Guangdong Province, a region well-known for abundant medical resources and robust economic development, offering more opportunities for employment and promotion (Gan et al., 2020). The promising prospect of re-employment after leaving the job encourages nurses to aspire for better jobs. Furthermore, all the nurses investigated in this study work in public hospitals, and even though the hospitals provide a certain degree of remuneration and benefits, the uncertainty of the job market in the nursing profession and the limitations of job searching compel the nurses to remain in their current nursing positions. It can be seen that the nurses’ intention to stay in their jobs has not yet been stabilized. This suggests that in order to foster and preserve on-the-job nursing talent and stabilize the nursing workforce, nursing administrators must consider the unique demands of nurses and develop effective career advancement programs tailored to these professionals.

The results of this study showed a positive correlation between psychological resilience and intention to stay, validating the H1 hypothesis that higher levels of psychological resilience increase the willingness to stay, while insufficient resilience leads to higher turnover rates. This result aligns with the findings of Lee et al. (2023), which showed that nurses with greater psychological resilience are better equipped to adapt to their work environment, increasing their sense of commitment and intention to stay. Similarly, Wang et al. (2021) study revealed that psychological resilience allows nurses to quickly adapt to difficult situations, effectively manages stress and challenges, and positively influences retention intentions.

Based on these findings, it is recommended that managers implement psychological resilience training and support measures, such as mental health resources, stress management training, and team-building activities. These interventions can enhance psychological resilience of nurses through structured intervention strategies, in order to provide a work environment that supports nurses’ career development and improves their intention to stay in their jobs, which helps in creating a more stable and efficient nursing workforce.

The positive correlation between nurses’ perceived organizational support and psychological resilience verified hypothesis H2, which posits that higher levels of organizational support lead to increased psychological resilience. This finding is consistent with the results of Xue (2023) research, indicating that organizational support can enhance nurses’ self-awareness, self-confidence, teamwork, and communication, thereby improving their psychological resilience. Therefore, nursing managers should prioritize building strong organizational support systems, improving the work environment, and providing resources that promote nurses’ mental health and career development. The positive correlation between nurses’ perceived organizational support and retention intention validates hypothesis H3, which posits that increasing nurses’ perceived organizational support promotes their retention intention, which is consistent with the study of Huang et al. (2016). A high level of perceived organizational support can stimulate nurses’ sense of responsibility, increase organizational commitment, reduce burnout, and thus increase retention intentions (Bobbio et al., 2012). Nursing work is characterized by high risk and high workload, and to cope with this stress, nurses need to obtain a full range of support from their families, organizations, and society. Organizational support is crucial for long-term nursing retention. When nurses perceive care and support from their organization, they are more likely to develop stable working relationships and remain in their positions (Li et al., 2020). This indicates that nursing managers have the potential to enhance nurses’ perception of organizational support through initiatives such as vocational training, enhancements to the work environment, and the implementation of effective communication channels. Moreover, fostering a supportive organizational culture can play a pivotal role in bolstering nurses’ commitment to remaining in their roles.

Finally, the results of this study showed that nurses’ perceived organizational support partially mediated the relationship between psychological resilience and intention to stay, with a mediation effect value of 0.067, which accounted for 71.28% of the total effect. This finding suggests that nurses’ psychological resilience directly predicts their retention intentions and indirectly influences these intentions through their perceived organizational support, validating hypothesis H4. Perceived organizational support is employees’ overall perception and belief about how the organization perceives their contributions and cares about their interests. Nurses with high psychological resilience are more capable of coping with work challenges. Nurses who are more flexible and resilient in dealing with stress, complexity, and change at work are more likely to be recognized and supported by the organization, thereby enhancing nurses’ sense of support for the organization and establishing a mutually reinforcing relationship. When individuals genuinely perceive the organization’s care and support during their work, it enhances nurses’ trust, job satisfaction, and commitment, ultimately increasing their willingness to remain with the organization (Li et al., 2020). The perceived organizational support mediated the relationship between nurses’ retention intentions to some extent. This process reveals the strength of the support, further confirming the JD-R model.

Hence, nursing managers are encouraged to recognize the significance of nurses’ psychological resilience and perceived organizational support in influencing their intention to remain in their roles. This involves two key strategies: first, prioritizing nurses’ mental well-being by implementing proactive measures to cultivate psychological resilience. This could include developing tailored resilience-building programs that help nurses navigate the complexities of their roles within the dynamic healthcare landscape. Second, this can be done by creating structured and equitable career advancement pathways, enhancing career development opportunities for nursing personnel, and accommodating flexible scheduling preferences to foster a supportive workplace environment that aligns with nurses’ needs.