In April 2022, the National Health Commission of China issued the “National Nursing Development Plan (2021–2025),” designating “strengthening the construction of the nursing team” as one of the primary tasks (1). As the reform of the medical and healthcare system deepens and the scientific level of nursing management continues to improve, the issue of how to effectively mobilize and stimulate the enthusiasm of nurses, while simultaneously creating a supportive and empowering professional environment, has become an increasingly important topic for healthcare institutions. Ensuring that nurses are motivated and satisfied with their work environment is essential not only for their own well-being but also for improving the quality of healthcare services provided to patients.

Among the various factors that contribute to a positive professional environment, the quality of work life (QWL) has emerged as a critical indicator for evaluating the overall work environment of nurses. QWL refers to the extent to which nurses’ personal needs are met while also fulfilling organizational goals and objectives (2). A substantial body of research has shown that QWL is closely related to both the well-being of individual nurses and the overall performance of the organization. A high QWL is associated with greater job satisfaction, reduced burnout, lower turnover rates, and improved performance (3, 4). On the other hand, a low QWL is closely linked to job burnout, high turnover intentions, and reduced job satisfaction, which can lead to a higher attrition rate and, ultimately, a decrease in the overall quality of healthcare services provided (3, 4). Therefore, prioritizing QWL is crucial for enhancing nurse retention, improving patient care, and fostering a more efficient healthcare system.

Research on QWL among healthcare workers has identified several factors that influence this aspect of nursing, such as the quality of organizational management, interpersonal relationships with colleagues, family income, workload, and individual personality traits (5–7). Additionally, emotional labor has been recognized as one of the most significant factors affecting nurses’ quality of work life (8, 9). Emotional labor refers to the process of regulating one’s emotional state at work to meet organizational expectations and requirements (10). In the operating room (OR), emotional labor is particularly prevalent, as OR nurses must constantly adjust their emotional states to collaborate with surgeons, anesthesiologists, and other healthcare professionals, communicate effectively with patients and their families, and respond to unexpected situations such as patient emergencies or equipment malfunctions. The emotional demands placed on OR nurses can be particularly intense, making emotional labor a key element of their daily work experience. Emotional labor has been conceptualized as a three-dimensional construct, which includes surface acting, deep acting, and the expression of naturally felt emotions (11, 12). Surface acting involves the outward display of emotions that are not genuinely felt, often requiring nurses to suppress or hide their true feelings to meet workplace emotional expectations. Deep acting, on the other hand, involves a more profound internal change, where the nurse alters their emotional state to align with the required emotional display. The expression of naturally felt emotions occurs when nurses experience and express emotions that are congruent with the emotional situation at hand. While these three strategies have been identified in general, the specific emotional labor strategies adopted by OR nurses remain unclear and under-researched (11).

According to the Job Demands-Resources (JD-R) model (13), the variables of emotional labor strategies, workload, and quality of work life investigated in this study can be understood through the framework of this model. The JD-R model posits that both job demands and resources are critical factors influencing employee performance and well-being. In this study, emotional labor strategies are considered “job resources” because effective emotional labor strategies help employees cope with work pressures, enhance job performance, and improve overall well-being. Strategies such as deep acting and surface acting are ways employees regulate their emotional states in response to emotional demands. According to the JD-R model, when employees have access to sufficient emotional resources (e.g., appropriate emotional labor strategies), they are more likely to manage job demands effectively, which in turn positively impacts their QWL. On the other hand, workload is categorized as a “job demand” in the JD-R model, as it represents the pressure and stress that employees face. High workloads, especially for operating room nurses, are a significant source of strain, potentially leading to burnout and lower QWL. The JD-R model suggests that when job demands exceed available resources, it can negatively affect employees’ job satisfaction, well-being, and overall work-life quality.

To the best of our knowledge, there is limited research on the current state of emotional labor and QWL among OR nurses, and the influence of emotional labor strategies on QWL has yet to be comprehensively explored. This study aims to bridge this gap by investigating the current status of emotional labor strategies and QWL among OR nurses. Additionally, it will examine how demographic factors, such as age, gender, years of experience, and job roles, along with different emotional labor strategies, affect nurses’ quality of work life. The findings from this study are expected to provide valuable insights for nursing managers, helping them develop effective management strategies, offer appropriate organizational support, and guide nurses in adopting emotional labor strategies that enhance their well-being. Ultimately, the study aims to improve the quality of work life for OR nurses, which in turn will contribute to a higher quality of patient care and a more efficient healthcare environment.

This study aimed to explore the complex relationship between emotional labor strategies and quality of QWL, as well as to identify the demographic and job-related factors that influence QWL. Emotional labor refers to the process by which workers manage their emotions to fulfill the emotional requirements of their roles, and it can be performed through various strategies, such as deep acting, surface acting, and the expression of naturally felt emotions. Furthermore, the study identified several significant predictors of QWL, including emotional labor strategies, job positions, monthly income, and average daily working hours. These demographic and job-related factors were found to influence how nurses perceive their work life quality.

In this survey, the QWL score for OR nurses was (114.17 ± 16.54), which was notably higher than the results reported by Zhu et al. (18). This discrepancy may be explained by regional differences, as well as variations in the demographic characteristics and professional contexts of the study participants. Specifically, factors such as healthcare infrastructure, organizational management practices, and cultural differences in work-life balance could contribute to these discrepancies in QWL scores across different regions. When comparing these results to findings from other studies, it is apparent that the QWL of nurses globally remains suboptimal, with a significant proportion of nursing staff reporting poor QWL (19–21). This global trend suggests that nurses across various healthcare settings are facing challenges in maintaining a satisfactory work-life balance. The persistent issue of low QWL among nurses is well-documented in the literature, reflecting widespread concerns regarding job stress, emotional strain, work overload, and insufficient organizational support. Such challenges underscore the need for comprehensive strategies to improve QWL for nurses, as their well-being is crucial not only for their own health but also for the delivery of high-quality patient care.

Upon analyzing the dimensions of QWL, we observed that the lowest scores were in the areas of work stress and overall happiness, with average scores of 2.80 ± 0.62 and 3.49 ± 0.61, respectively. OR nurses are required to have strong professional skills, be familiar with surgical procedures and surgeons’ preferences, and stay alert to manage emergencies during operations. Moreover, their workload is heavy, often requiring overtime. The demanding nature of their work leads to high stress levels and low happiness among OR nurses.

The factors influencing QWL are multifaceted and include organizational management quality, relationships with colleagues, job stability, occupational tasks, weekly workload, and personality traits (22–24). Single-factor analysis results revealed significant differences in the QWL of OR nurses based on job position, average daily working hours, and monthly income. Nurses in management positions reported higher QWL than their clinical counterparts, which aligns with findings by Misiak B (25). This could be because nurses in management roles mainly deal with administrative tasks, which typically involve a lighter clinical workload and lower emotional labor intensity compared to clinical nurses. As noted in previous research, heavy workload is a significant negative factor influencing QWL (26). Our study also showed that as the average daily working hours increased, QWL decreased. This finding corroborates the results from Bilal et al., which suggested that extra working hours negatively impact the work-life quality of healthcare workers (27). Higher income levels were generally associated with higher QWL, supporting the idea that appropriate compensation positively impacts the work-life quality of nurses (28). Our study suggests that nurses with higher monthly incomes reported better work-life quality, emphasizing the importance of fair and reasonable salary systems in improving QWL. Previous research by Wang et al. also demonstrated that salary directly influences nurses’ QWL (29). Therefore, nursing managers should ensure sufficient human resources in OR settings, minimize overtime hours, and implement fair performance evaluation systems to achieve equitable compensation, which in turn could improve nurses’ QWL.

This study results revealed that the most commonly used emotional labor strategy among OR nurses was the expression of naturally felt emotions, followed by deep acting and surface acting. These findings are consistent with those reported by Wang et al. (30). The expression of naturally felt emotions reflects a state where the nurse’s true feelings align with the emotional requirements of the organization (31). This emotional labor strategy suggests that nurses are in a relatively authentic and psychologically comfortable state at work. Deep acting was the second most frequently used emotional labor strategy, indicating that when confronted with emotional challenges, OR nurses adjust their internal emotions, accept the situation, and actively seek solutions. This approach is beneficial for the smooth progress of teamwork (32). On the other hand, surface acting involves suppressing one’s true emotions, and frequent use of this strategy is not conducive to improving QWL (33). Compared to surface acting, both deep acting and the expression of naturally felt emotions are considered more positive emotional labor strategies.

The results of this study emphasize the strong relationship between emotional labor strategies and QWL. Regression analysis identified emotional labor strategies as key predictors of QWL. Cheng et al. (34) argued that adopting appropriate emotional labor strategies contributes to better clinical nursing work, while Gao et al. (35) found that deep acting improves job satisfaction, while surface acting tends to reduce it. Given the close relationship between emotional labor strategies and QWL, it is crucial to explore measures to help nurses adopt effective emotional labor strategies. Enhancing organizational support may be one such measure. Several studies have shown that organizational support positively correlates with nurses’ emotional labor (36–40). For nursing managers, improving organizational support, providing emotional labor training, establishing effective incentive mechanisms, and helping nurses regulate their emotions are important steps toward improving QWL.

This study has several limitations that should be considered when interpreting the results. First, the cross-sectional design limits the ability to establish causal relationships between emotional labor strategies and quality of work life. Although regression analysis provided valuable insights into the association between these variables, the temporal sequence of these relationships cannot be determined. Future longitudinal studies would help to better understand the dynamic changes over time. Second, the sample was selected from a limited number of hospitals in a specific region, which may affect the generalizability of the findings. To enhance the external validity, future research should consider expanding the sample size and including participants from diverse geographical locations and healthcare settings. Third, this study relied on self-reported data, which may introduce response biases such as social desirability or recall bias. Incorporating objective measures and multi-source data in future studies could help to reduce these biases. Lastly, while the study explored a variety of demographic factors influencing QWL, other potentially relevant variables, such as organizational culture or job satisfaction, were not examined and could be important areas for future research.

In conclusion, this study highlights the significant relationship between emotional labor strategies and the quality of work life among operating room nurses. The findings demonstrate that emotional labor strategies, such as deep acting, surface acting, and the expression of naturally felt emotions, have a substantial impact on nurses’ QWL. Additionally, demographic factors such as job position, monthly income, and daily working hours were identified as key predictors of QWL. These results emphasize the need for healthcare organizations to recognize the importance of emotional labor in nursing practice and provide adequate support to enhance nurses’ work-life quality. Improving organizational support, offering training programs, and fostering a positive work environment can contribute to better emotional well-being and job satisfaction for nurses, ultimately improving patient care outcomes. Future research should explore longitudinal studies and expand the sample size to further understand the dynamic relationship between emotional labor strategies and QWL in diverse healthcare settings.