Drawing on a comprehensive literature review, the researchers developed a survey tailored to the study’s objectives. The questionnaire first ensured respondents met the core inclusion criterion of “being female nurses with two children” and then gathered detailed information on their demographic, professional, and family characteristics to explore potential influencing factors of core variables. The specific items included: hospital affiliation, age, professional title, educational background, department, position, personnel relationships, spouse’s occupation, years of work experience, monthly income, number of night shifts per month, the age and gender of both the first and second child, whether the second child was planned (designed to investigate the impact of fertility decision-making background and core study variables), the family’s primary caregiver, and total household income.

This study utilized the Chinese version of the WFBRCS, translated by Sun et al. (2023) from the original 2019 version developed by Clark (2019). The scale includes two core subdimensions, 30 items in total, to measure bidirectional work-family conflict (WFC). The first is Work-to-Family Interference (WIF), which contains 15 items focusing on how work roles disrupt family life, with scores reflecting the frequency of work interfering with family responsibilities; the second is Family-to-Work Interference (FIW), which includes 15 items assessing how family roles hinder work performance, with scores capturing the frequency of family interfering with work duties. By assessing specific behavioral role conflicts, the scale offers a comprehensive understanding of the WFC process and informs the design of targeted interventions. All items are rated on a 5-point Likert scale (1 = “never,” 5 = “always”), with a theoretical mean score of 3 serving as the threshold—scores below 3 indicate low conflict, while scores of 3 or higher indicate high levels of WFC. In the present study, the scale demonstrated excellent reliability, with a Cronbach’s α coefficient of 0.952.

The RESES, originally developed by Caprara et al. (2008) and later localized and revised by Sun et al. (2023), comprises three dimensions: perceived POS, DES, and ANG. The scale consists of 12 items, each rated on a 5-point scale, where 1 represents “very inconsistent” and 5 represents “very consistent,” with higher total scores reflecting greater RESE. Based on average item scores, RESE levels can be classified as low (≤2.5), medium (2.6–4.0), or high (≥4.1). In this study, the scale demonstrated excellent reliability, with a Cronbach’s α coefficient of 0.967.

The TIS, originally developed by Michaels and Spector (1982) in 1982 and later translated and revised by Li and Li (2000), is designed to assess an individual’s level of TI. The scale consists of six items across three dimensions: TI I (Intention to Search for Alternative Jobs) includes 2 items measuring the willingness to actively seek other positions; TI II (Intention to Resign) contains 2 items assessing the specific intention to leave the current job; TI III (Evaluation of Job Mobility) includes 2 items reflecting the attitude toward job switching. All items are rated on a 4-point Likert scale (1 = never, 2 = rarely, 3 = occasionally, 4 = frequently), yielding a total score range of 6 to 24. Higher scores indicate stronger TI. Based on average item scores, TI is categorized as very low (≤1), low (>1 to ≤2), high (>2 to ≤3), and very high (>3). In the present study, the scale demonstrated good reliability, with a Cronbach’s α coefficient of 0.838.

Our study found that the level of WFC among female nurses with two children was higher than that of Gan et al. regarding the general nurse population in China (Gan et al., 2025), consistent with COR theory: rotating night shifts compete directly with childcare needs, such as disrupted sleep versus school routines, while emotional labor is divided between patient care and parenting responsibilities (Hwang and Yu, 2021). Recent research indicates that nurses endure dual sources of emotional exhaustion arising from professional empathy at work (Huaman et al., 2023). The data reveal a significant imbalance between WIF (50.63 ± 10.81) and FIW (32.38 ± 11.17, p < 0.001). This discrepancy stems from the unique nature of nursing work: Female nurses with two children face rigid work requirements such as fixed hospital schedules and unexpected overtime (Chen et al., 2022). These demands make it difficult to flexibly allocate working hours and energy, thereby exerting greater pressure on family care responsibilities. Moreover, in China’s public hospitals, where nurses face expanding responsibilities including clinical care, teaching, and research (Cooper et al., 2019), these tasks take up a lot of downtime. In contrast, FIW had a weaker impact, which is associated with the “work-first” professional culture in China’s healthcare settings (Pajakoski et al., 2025). Most nurses proactively adjust family matters to minimize interference with work. Although this approach may temporarily enhance productivity, chronic role overload elevates turnover risk by straining family relationships (Gehri et al., 2023).

This study found that the score of RESE among female nurses with two children exhibited above-average (Sun et al., 2023), this result is consistent with the findings of Wang et al., who conducted a study on infectious disease nurses in China (Wang et al., 2023), suggesting an adaptive capacity developed through prolonged dual-role exposure. This prolonged dual training may passively enhance their emotional regulation capabilities, which aligns with Bandura’s “practical reinforcement efficacy” theory (Bandura, 1977). However, their lowest scores were observed in anger management ANG, the possible reasons for this result are: First, in professional settings, nurses continuously cope with emotional events such as patient anxiety and conflicts in family communication (Pace et al., 2023). Long-term passive exposure to negative emotions easily depletes their emotional resources for anger regulation. Second, the complex task of childcare has left nurses extremely exhausted, physical fatigue further impairs their ability to perceive and manage anger (Getie et al., 2025). From the perspective of COR theory, these two factors essentially reflect the continuous depletion of emotional and physical resources among this group. Thus, it is suggested that healthcare institutions prioritize targeted interventions, such as providing regular anger regulation training to replenish emotional resources.

This study revealed elevated TI among female nurses with two children, with a mean item score of 2.18 ± 0.66. This score exceeds both the established benchmarks (Clark, 2019) and the TI score of nurses in a Chinese hospital reported by Zhang et al. (2023). Several factors likely contribute to this finding. First, 64.7% of participants held mid-level professional titles, reflecting high professional competence and career maturity; according to human capital theory (Yakusheva et al., 2024), such individuals may perceive resignation as a strategic career decision rather than a passive response to dissatisfaction. Second, 38.5% of nurses worked night shifts at least five times per month, interfering with family responsibilities (He et al., 2024). Within the context of traditional Chinese gender norms, where men are expected to work outside the home and women manage domestic duties, female nurses may be more inclined to leave their jobs to prioritize family obligations. Third, limited career advancement opportunities elevate turnover risk (Şahin et al., 2025). Specifically, among the three dimensions of TI, the subdimension “motivation for seeking other jobs” (TI II) had the highest average score (2.33 ± 0.71). This pattern is likely driven by the fact that 92.7% of participants held mid-level professional titles, which creates a bottleneck for further career progression. Compounding this, 78.8% of the nurses had a second child under 6 years old, a stage marked by particularly intensive parenting demands that may further amplify their inclination to seek other childcare support jobs. These findings suggest that nursing managers should closely address the unique needs of female nurses with two children and implement proactive measures to enhance job satisfaction and retention.

Grounded in COR theory, this study demonstrates that WFC significantly depletes the personal and emotional resources of female nurses with two children, ultimately elevating their TI (β = 0.42, p < 0.01), consistent with existing evidence on nursing stress and attrition (He et al., 2024). Nursing, inherently demanding due to high work intensity and disruptive shift schedules (Yao et al., 2024), conflicts with the substantial resource demands of raising two children, including time, energy, and emotional labor. When these competing strains exceed nurses’ resource thresholds, COR theory’s “resource loss spiral” is triggered: the chronic depletion of critical resources, such as work-life balance and psychological stamina, diminishes job satisfaction and amplifies withdrawal behaviors like TI, as nurses seek to halt further resource erosion. Notably, the asymmetrical impact of FIW (r = 0.440) versus WIF (r = 0.412) reflects the defensive prioritization of family resources within Chinese cultural contexts. According to COR theory, individuals safeguard non-replenishable resources, such as maternal roles and family harmony, when threatened; consequently, unavoidable family crises, such as a child’s illness, often lead nurses to compromise career resources, including job retention, to preserve familial stability rather than risk irreversible damage to valued kinship roles (Yildiz et al., 2021). The administrator can develop a flexible shift system for the group of nurses, such as avoiding spouse shift overlaps, requesting daytime shifts during children’s exams. This measure does not require additional technical input, and the current intelligent shift system can complete it, which directly reducing turnover due to work-family conflict.

This study demonstrates that RESE negatively predicts TI, consistent with prior research in the Chinese context showing that emotional regulation self-efficacy (RESE) significantly influences nurse burnout (Moloney et al., 2018). From a COR theory perspective, RESE functions as a key “personal resource caravan,” a modifiable internal resource that buffers against resource loss spirals triggered by WFC. Dimensional analysis further highlights the DES subscale as the most influential protective factor, suggesting that nurses adept at managing distress, for example, through cognitive reappraisal, are less likely to resign despite the dual-role pressures of parenting and shift work. Self-determination theory (Song et al., 2023) supports this connection, positing that chronic unregulated emotions foster negative cognitions that elevate turnover risk. This aligns with COR’s proposition that individuals prioritize protecting resources most susceptible to depletion; for female nurses with two childrens, distress from unmet family demands or work overload is a primary vulnerable resource, which makes DES a critical buffer. Accordingly, interventions such as mindfulness training and emotion-focused workshops (Karahan Kaplan et al., 2024) may enhance RESE, particularly DES skills, helping nurses navigate the tensions between childcare and professional responsibilities while reducing attrition.

This study confirms a negative correlation between WFC and RESE, demonstrating that persistent conflicts erode nurses’ confidence in managing emotions, a pattern consistent with Wang et al. (2023) and French studies on stress-induced self-efficacy reduction (Murtaza et al., 2021). From a COR theory lens, chronic WFC acts as a “resource drain” that weakens RESE: scenarios like guilt from missing a child’s parent-teacher conference or anxiety over declining work performance due to family demands deplete emotional resources, in turn reducing nurses’ perceived ability to manage future emotional challenges, as supported by Australian interventions showing that resilience training can restore coping capacity (Foster et al., 2024). By concurrently mitigating external stressors and strengthening internal resources, healthcare systems can disrupt the WFC-RESE depletion cycle, transforming it into a positive reinforcement loop whereby improved conflict management enhances emotional competence and reduces vulnerability to future stress.