Well-being critically influences healthcare professionals’ job satisfaction, performance, and the quality of care they provide to patients (Almeida et al., 2024). Low levels of well-being among hospital staff are associated with poorer patient safety, higher rates of medical errors, and weaker teamwork and communication (Hall et al., 2016; Lee et al., 2013). Studies in China have identified several key factors influencing hospital staff well-being, including social support (Lu et al., 2023), occupational burnout (Xiao et al., 2022), and exposure to workplace violence (Tang and Thomson, 2019). Chinese hospital staff face distinctive occupational challenges. Chinese healthcare workers report lower social support, weaker workplace belonging, poorer role clarity, and greater job insecurity compared with their counterparts in Canada, Spain, France, Germany, Sweden, and Turkey (Wang F. et al., 2025). Additionally, nurses from Eastern cultural backgrounds exhibited higher burnout rates than their Western counterparts during the COVID-19 pandemic (Frey et al., 2025). These contextual factors underscore the unique occupational pressures on Chinese hospital staff and provide a rationale for the present study’s focus on this population. Understanding these dynamics is essential for developing effective interventions to sustain healthcare system performance.

Hospital staff frequently experience stress and anxiety due to heavy workloads, doctor-patient relationships, and workplace pressures (Liu et al., 2024; Liu et al., 2020; Zhang et al., 2024), significantly impacting their overall well-being. Previous studies have reported that stress and anxiety are closely associated with well-being. For example, psychological stress and anxiety substantially affect mental health and overall well-being in high school and university students (Freire et al., 2016; Moeini et al., 2008). Similarly, dental students’ well-being is influenced by anxiety and stress (Stormon et al., 2022). Notably, the incidence of depression and anxiety was very high among healthcare workers during the COVID-19 pandemic, which significantly reduced their psychological well-being (Dhingra and Dhingra, 2020; Xu et al., 2020). These findings suggest that individuals in high-pressure environments are more likely to experience diminished well-being consistent with cognitive appraisal theory, which posits that individuals’ subjective evaluation of situations determines their emotional responses (Lazarus and Folkman, 1984). However, the psychological mechanisms that mediate or moderate these relationships, particularly in high-pressure healthcare environments such as Chinese hospitals, remain insufficiently understood.

Self-efficacy, defined as an individual’s belief in their capacity to achieve goals through their actions (Bandura et al., 1997), may play a key role in mitigating the effects of stress and anxiety on the well-being of hospital staff. By strengthening an individual’s sense of control in difficult circumstances, self-efficacy helps manage emotional reactions and encourages adaptive coping strategies (Hobfoll, 1989). Self-efficacy, in turn, enhances individuals’ perceived control over stressors, thereby fostering better psychological outcomes (Schwarzer and Hallum, 2008). For instance, a study of 240 female healthcare workers found that higher anxiety levels corresponded to lower self-efficacy, suggesting that interventions to bolster self-efficacy may benefit those with high anxiety (Muñoz et al., 2018). Another study demonstrated that self-efficacy fully mediated the relationship between job stress and psychological well-being among home-visiting nursing care workers during the COVID-19 pandemic (Kim et al., 2022). Based on these findings, we hypothesized that high stress and anxiety may reduce self-efficacy, thereby decreasing well-being.

The mediation effect of self-efficacy on well-being may be moderated by psychological factors, with empathy being particularly significant. Empathy is defined as the ability to understand and vicariously experience others’ emotional states (Davis, 1983). Higher empathy is associated with increased psychological well-being among emergency nurses, medical residents, and surgical residents (Bourgault et al., 2015; Graziano et al., 2024; Swenson et al., 2024; Vinh-Long et al., 2019). However, while high empathic ability can enhance well-being by promoting emotional connections and professional fulfillment, excessive empathy may contribute to compassion fatigue and emotional exhaustion (Cadet and Sainfort, 2023; Wang R. et al., 2025). Furthermore, for individuals with high self-efficacy, greater empathy may enhance well-being by strengthening patient relationships and job satisfaction, whereas low empathy may reduce these benefits by limiting emotional resilience in interpersonal interactions. Conversely, when self-efficacy is low, high empathy may increase emotional exhaustion due to heightened sensitivity to patient distress, while low empathy may hinder well-being due to difficulties in social engagement. Thus, we hypothesize that empathy, as a psychological resource, moderates the relationship between self-efficacy and well-being.

Based on the theoretical framework and empirical evidence discussed above, this study aimed to explore the relationships among perceived stress, anxiety, self-efficacy, empathy, and well-being among Chinese hospital staff. Specifically, it investigates whether self-efficacy mediates the effects of perceived stress and anxiety on well-being, and whether empathy moderates this mediation pathway. This study contributes to the literature by elucidating the conditional mechanisms through which psychological resources buffer occupational stress among Chinese hospital staff, offering theoretical and practical value for developing targeted interventions. Although prior research has established the adverse effects of perceived stress on well-being, few studies have examined this relationship within a mediated moderation framework in which self-efficacy functions as a mediating mechanism while empathy simultaneously operates as a contextual moderator. Thus, this approach represents a distinctive contribution of the present study. The need for such investigation is further underscored by evidence that Chinese hospital staff experience comparatively high occupational stress alongside relatively low well-being. In work environments where stress reduction is often challenging, identifying psychological mediators and moderators that attenuate its negative impact on well-being helps inform the development of effective intervention strategies to promote the well-being of healthcare personnel. The hypothesized moderated mediation model is presented in Figure 1. The following three hypotheses were proposed:

This study highlights the intricate relationships between perceived stress, anxiety, self-efficacy, empathy, and well-being among hospital staff in China, offering valuable insights into the psychological mechanisms underlying occupational stress and anxiety in high-pressure healthcare environments. The results reveal negative correlations between perceived stress and well-being, as well as between anxiety and well-being. Moreover, self-efficacy mediated the associations between perceived stress/anxiety and well-being, while empathy moderated the relationship between self-efficacy and well-being, confirming our initial hypotheses. Overall, these findings contribute to a deeper understanding of how perceived stress and anxiety influence well-being in healthcare settings.

Consistent with prior research (Liu and Aungsuroch, 2019; Strizhitskaya et al., 2019), this study demonstrates that perceived stress and anxiety significantly predict reduced well-being. Stress and anxiety are inevitable aspects of work environments, particularly in high-pressure occupations such as healthcare, where demands often exceed coping capacities. These findings align with cognitive appraisal theory, which posits that stress arises when individuals perceive environmental demands as exceeding their coping abilities (Lazarus and Folkman, 1984). Chinese nurses are particularly prone to moderate-to-severe stress and anxiety, with reported anxiety rates ranging from 26.4 to 43.4% (Gao et al., 2012; Liu et al., 2024). Mid- to late-career nurses also exhibit higher anxiety sensitivity than early-career nurses (Li et al., 2016). Similarly, Goh et al. (2015) identified ten stressors negatively affecting healthcare workers’ mental health in the United States, including job insecurity (which increases the likelihood of poor health outcomes by approximately 50%) and excessive work hours (linked to an increase of approximately 20% in mortality risk). Furthermore, perceived stress has been shown to be negatively correlated with clinical performance among Chinese nursing trainees (Ye et al., 2018). Therefore, effectively managing perceived stress and anxiety in high-pressure healthcare environments is critical not only for improving the well-being of hospital staff but also for maintaining optimal clinical performance.

Perceived stress and anxiety not only directly reduce well-being but also indirectly reduce it by lowering self-efficacy, thereby mitigating the sense of well-being. Research employing the GSES highlights that healthcare workers with high self-efficacy demonstrate greater problem-solving abilities and emotional regulation when managing occupational stress (Schwarzer and Jerusalem, 1995). These adaptive responses are influenced by workplace factors, including workload intensity, systemic stressors, compensation equity, and collegial support (Hu et al., 2018; Molero et al., 2018). For example, enhancing self-efficacy among healthcare professionals can increase work engagement and personal satisfaction (Cabrera-Aguilar et al., 2023) and mediates the relationship between job stress and burnout, as well as subsequent mental health challenges such as depression and anxiety (Lin et al., 2016). Consistent with these findings, our results show that hospital staff experiencing high stress or anxiety report lower self-efficacy, which reduces well-being. Therefore, interventions that enhance self-efficacy are crucial for improving overall well-being among hospital staff.

The results further demonstrate the moderating role of empathy in the relationship between self-efficacy and well-being. Empathy, as a moderator, indicates that individual differences in empathetic capacity influence the effectiveness of stress-management strategies, suggesting the potential benefits of interventions to strengthen empathy. Moreover, empathy can prevent burnout, enhance the quality of care, and improve job satisfaction (Bogiatzaki et al., 2019; Yu et al., 2022). Healthcare workers with higher empathy may experience greater professional fulfillment, reduced stress, and improved well-being (Decety, 2020). In addition, individuals with high empathy tend to exhibit compassion satisfaction, transpersonal thinking, and altruistic behavior, whereas those with low empathy are more likely to feel compassion fatigue and personal distress (Gleichgerrcht and Decety, 2013). This dynamic aligns with Davis’s (1983) empathy framework, in which cognitive and affective components interact with professional confidence to sustain well-being. Clinicians who strike a balance between empathy and self-efficacy often find fulfillment in patient care, and empathetic interactions are associated with improved patient outcomes (Gerdes and Segal, 2011). However, high-pressure healthcare environments and systemic constraints can disrupt this balance. For example, medical students and residents frequently experience declines in empathy during training (Neumann et al., 2011). Furthermore, interventions such as mindfulness-based stress reduction can alleviate anxiety, enhance self-efficacy, and promote empathic capacity among hospital staff (Shapiro et al., 2005). Promoting empathic competencies may, therefore, improve well-being and performance among healthcare workers.

This study identifies self-efficacy as a mediating variable and empathy as a moderating variable in mitigating the adverse effects of perceived stress and anxiety on well-being among hospital staff, providing actionable insights for designing targeted interventions to support healthcare workers. For example, interventions focused on self-efficacy could include stress management training, goal-setting strategies, and fostering transformational leadership in healthcare settings to enhance mental health and job satisfaction (Nielsen et al., 2009). In addition, empathy can be developed through mindfulness-based intervention, which not only enhances empathetic capacity but also significantly reduces stress and burnout among healthcare workers (Raab, 2014). Similarly, emotional intelligence training can help healthcare workers maintain empathy during high-stress situations (Sharp et al., 2020). Promoting self-regulation skills among healthcare workers further contributes to a better understanding of the factors influencing well-being and the underlying mechanisms, thereby improving strategies for staff support and organizational intervention.

This study has some limitations. First, the cross-sectional nature of this study precludes causal inference. Because temporal ordering among the variables cannot be determined, inverse or bidirectional associations remain plausible. For example, lower well-being may increase perceived stress and anxiety, rather than merely resulting from them. Future longitudinal and prospective studies are needed to clarify causal directions and to examine how self-efficacy and empathy dynamically interact with stressors over time. Second, single-site sampling from Hainan Province limits the generalizability of the findings. Future research should incorporate multi-regional comparisons to account for disparities in healthcare resources and workloads across urban and rural China. Third, although prior studies have conceptualized empathy as a “double-edged sword”—with the potential to contribute to compassion fatigue under specific conditions (Cadet and Sainfort, 2023; Wang R. et al., 2025)—our findings primarily support its protective role. Future research is warranted to identify the circumstances under which empathy may shift from a protective factor to a risk factor. Fourth, the empathy measure used in this study consists of four subscales, which are sometimes grouped into two higher-order dimensions—cognitive empathy (e.g., perspective-taking) and affective empathy (e.g., empathic concern). However, the present study treated empathy as a single composite construct for analytic purposes. Future research should examine the differential effects of these subdimensions to more precisely identify the pathways through which empathy relates to well-being. Fifth, well-being among healthcare workers is influenced by a wide range of individual, interpersonal, and organizational factors that were not fully captured in the present study. Future research should include additional predictors—such as social support, organizational culture, resilience, and coping strategies—which may further explain variance in well-being. Finally, the broad categorization of “hospital staff” overlooks potential differences among doctors, nurses, and non-medical staff, which may influence the relationships between variable. Future studies should recruit larger samples and stratify analyses by occupational subgroups.

This study demonstrates that perceived stress and anxiety significantly undermine the well-being of Chinese hospital staff, with self-efficacy acting as a partial mediator and empathy serving as a moderator in this relationship. Specifically, self-efficacy mitigates the negative psychological impacts of stress by enhancing an individual’s perceived control over the stressor, whereas empathy, when combined with strong self-efficacy, amplifies this protective mechanism. Based on these findings, hospital staff should be supported through interventions that simultaneously enhance self-efficacy and foster empathy, ultimately promoting their well-being. This approach can strengthen individuals’ ability to cope with mental health challenges and life adversity.