Conscientiousness is related to purposefulness, striving to achieve goals, high self-discipline, and planning- and task-orientation (12). Work engagement is a positive behavioral state in which employees integrate physical, cognitive, and emotional aspects into their work (13). TAW was proposed by Spreitzer et al. (14) and it refers to the simultaneous experience of “vitality” and “learning” by employees in their work. It is both a psychological state and a subjective perception of work.

The COR theory has been one of the most influential theories in organizational behavior research over the past 30 years, exploring the employees’ psychological and behavioral motivations (15). It is commonly applied to research topics, such as self-regulation in the workplace (16), interpersonal interaction (17), and work–family conflict (18), providing theoretical explanations for a wide range of organizational psychological and behavioral phenomena.

COR theory suggests that individuals strive to preserve and maintain existing resources while continuously acquiring new resources (15). Conscientious employees place greater emphasis on personal achievement, exert more effort at work, set higher goals, and strive to achieve them (19). Furthermore, traditional Chinese culture emphasizes a sense of responsibility and spirit of dedication, especially in the medical field, where medical staff often see their work as a mission. This value system prompts them to transform their intrinsic sense of responsibility and meaning perception into more emotional resources, exhibit more positive and proactive behaviors (4), and contribute to the improvement of organizational performance. Sethi & Kaur (20) suggested that conscientiousness was related to increased work engagement.

According to COR theory, driven by intrinsic motivation and achievement needs, conscientiousness prompts employees to actively and purposefully focus on their work tasks. This task focus enables TAW directly because purposeful participation in work tasks facilitates the learning of new things and injects employees with positive energy (14). Consistent with this reasoning, Alikaj et al. (21) discovered that proactive personality traits, such as conscientiousness, can promote TAW.

Furthermore, according to COR theory, TAW encourage employees to continuously accumulate high-quality resources, motivating them to invest more effort in the work they identify with (22). When individuals have abundant resources, they can prevent resource depletion more effectively, actively acquire new resources, and consequently achieve a more positive work experience. According to this logic, employees who reach the TAW state can gain a sense of competence by completing challenging tasks, which increases their work resources and induces a positive cycle. Consistent with this reasoning, Imran et al. (23) empirically found that TAW positively impacts work engagement.

Conscientiousness endows employees with a stronger motivation to learn, and it actively reinforces their work motivation (24), providing more intrinsic meaning to their work. In turn, this promotes self-thriving at work through perceiving vitality and embracing learning changes in the job. When employees enter a state of vibrant and energized TAW, they may seize various opportunities for learning, growth, and development, which compels them to become more engaged in their work. Therefore, we propose the following hypothesis:

Workload refers to the number and variety of tasks that employees are required to perform (25). It also represents the physiological and psychological costs that employees invest in accomplishing their tasks (26).

Conscientious employees are more inclined to allocate personal resources to meet job performance requirements, and they are willing to invest energy in overcoming work-related challenges (27). According to management practices in China, medical staff often have a higher sense of conscientiousness compared to other professionals (1). When balancing work, rest, and family time, they tend to prioritize work. In addition, considering factors such as patient needs and teamwork, they may voluntarily accept additional tasks, be willing to work overtime or adjust work arrangements when needed, as well as be willing to take on more responsibilities and contribute more to their work, thus presenting a workload state.

The COR theory suggests that the total amount of resources possessed by an individual is limited. When facing a high workload, an imbalance among an individual’s limited resources can result in emotional resource depletion across multiple roles, conflicting with their pursuit of work–family harmony, which exacerbates their role stress (28) and triggers a resource loss spiral effect. To change the conflict caused by incompatible roles, employees may reallocate resources and choose conventional ways of handling work, thereby weakening their willingness to engage in the work. Most studies on workload have indicated that an excessive workload negatively affects employees’ emotions and outcomes. Wang et al. (29) discovered that an elevated workload negatively affects work engagement. Therefore, we propose the following hypothesis:

In the field of organizational behavior, many scholars have started using the concepts of “insiders” and “outsiders” based on social exchange theory to explore the relationship between employees and organizations. Social exchange theory is a sociological theory proposed by Blau (30) to study the behavioral relationships between individuals. This is one of the most influential conceptual paradigms for understanding workplace behavior in organizational behavior (31). PIS refers to an individual’s subjective perception of being acknowledged as a member of an organization, reflecting a sense of belonging and influencing individual cognition, emotions, and behavioral tendencies toward the organization (11). In the context of Chinese culture, employees attach great importance to being accepted by their organization. Becoming an “insider” is of great significance to employees, and it directly affects their performance (31).

According to Tracy and Judith (32), when an individual has high PIS, it is easier to stimulate individual learning behaviors. According to the social exchange theory, when employees perceive recognition from an organization, a strong sense of ownership is generated. They believe that they need to make additional efforts to attract more work resources to the organization, which enhances their vitality and learning status. However, individuals with low PIS position themselves outside the organization. They perceive work as a task to be completed and do not recognize the importance of actively acquiring various knowledge and skills or being actively involved in change, thereby reducing the TAW likelihood. Therefore, we propose the following hypothesis:

According to social exchange theory, social exchange is reciprocal behavior. Employees’ PIS is based on the foundation of high-quality relationships with the organization and its members (33). Employees with higher PIS perceive the organization as another “family,” which leads to experiencing psychological job security (34); this provides them with confidence that they can receive help from others when encountering problems at work (35). Therefore, when employees have a higher PIS, they are more likely to seek help from the organization and collaborate with colleagues to share and solve the workload together, especially in the face of a high workload (36), thereby decomposing the workload to a certain extent and weakening the positive effect of conscientiousness on individual workload. In contrast, when employees have lower PIS, it means that they often “float” outside the organization (11). In such cases, high workload can lead to negative physical and mental experiences. This situation is worse than simply being driven by conscientiousness to handle high workloads. In this scenario, the positive impact of conscientiousness on individual workload was expected to increase. Therefore, we propose the following hypothesis:

Building on Hypotheses 1 and 3, this study suggests that PIS positively moderates the mediating effect of TAW on the relationship between conscientiousness and work engagement. Employees with higher PIS are granted greater autonomy in their inherent roles. Conscientiousness drives them to actively acquire the cognitive, knowledge, and skill-based resources needed for work, thereby enhancing their work learning and vitality, igniting a positive work attitude and consequently leading to wholehearted work engagement. Similarly, in line with Hypotheses 2 and 4, this study suggests that PIS negatively moderates the mediating effect of workload on the relationship between conscientiousness and work engagement. When employees have a higher PIS, the self-discipline and sense of responsibility brought about by conscientiousness prompt them to actively seek organizational support when facing a high workload, aiming to quickly recover from resource loss and fully immerse themselves in their work. Thus, we propose the following hypotheses:

The conceptual model of this study is presented in Figure 1.

The study sample was drawn from four public hospitals in the Jiangsu Province, Shanghai City, and Zhejiang Province. The research team distributed the survey questionnaires to the HRM departments. Questionnaires were randomly distributed onsite in the hospitals. Medical staff were free to decide whether to participate in the survey. We assured the respondents that the questionnaire would be anonymous and that the research data would be used solely for academic purposes, encouraging them to respond based on their genuine thoughts. To avoid common method variance (CMV), we distributed the questionnaires at separate times with a 1-month interval (37). At the initial time point, Questionnaire A was distributed, in which employees completed items on demographic variables, conscientiousness, and PIS. One month later, questionnaire B was distributed among the valid samples, which included surveys on TAW and workload. In another month, the survey questionnaire on work engagement was completed. We meticulously matched prenumbered questionnaires following a strict procedure, with the assistance of the relevant hospital HRM departments. After excluding the invalid questionnaires with responses exhibiting patterns or multiple selections, 322 valid questionnaires were paired.

Of the 322 valid questionnaires, 41.30% were completed by male participants. Doctors accounted for 56.52%, whereas nurses accounted for 43.48%. The majority of respondents were aged between 31 and 40 years (39.13%) and 41 and 50 years (30.43%). Regarding education, the majority of the participants held a bachelor’s degree (63.04%), followed by a master’s degree (26.08%). In terms of organizational tenure, the primary ranges were 5–10 years (26.08%) and 10–20 years (36.95%).

The questionnaire used a 5-point Likert-type scaling method as follows:

Conscientiousness: A 12-item scale from the NEO Personality Inventory developed by McCrae and Costa (38) was used to measure conscientiousness. A sample item was “I am able to get organized” (α = 0.819).

TAW: A 10-item scale developed by Spreitzer et al. (14) was used to measure the TAW. A sample item was “I feel alive and vital” (α = 0.737).

Work Engagement: A 17-item scale developed by Schaufeli et al. (39) was used to measure work engagement. A sample item was “I am immersed in my work” (α = 0.863).

Workload: A 5-item scale developed by Spector and Jex (25) was used to measure workload. A sample item was “I have to speed up in order to complete the work” (α = 0.865).

PIS: A 6-item scale developed by Stamper and Masterson (11) was used to measure PIS. A sample item was “I feel very much a part of my work organization” (α = 0.772).

Control Variables: Based on previous research, we controlled for the medical staff’s sex, age, education, position, and organizational tenure.

This study utilized Amos software for confirmatory factor analysis (CFA) to evaluate the discriminant validity of the five-factor model, including conscientiousness, TAW, workload, work engagement, and PIS. Table 1 indicates that the data fit for the five-factor model was better than that for the alternative models, suggesting its suitability for further research.

Rigorous procedural controls were implemented before and during the survey to mitigate the effects of CMV on the study results (37). However, as the same participants were involved in different measurements, Harman’s single-factor test was used to examine the presence of CMV. The results show that 10 factors were extracted from the nonrotating principal component analysis, accounting for 73.45% of the total variance, among which the first factor explained 20.15%. This percentage does not constitute the majority, indicating that the CMV does not influence the results.

As shown in Table 2, conscientiousness was significantly and positively correlated with work engagement (r = 0.480, p < 0.001), workload (r = 0.186, p < 0.05), and TAW (r = 0.410, p < 0.01). Additionally, TAW is significantly positively correlated with work engagement (r = 0.509, p < 0.01), whereas workload is significantly and negatively correlated with work engagement (r = −0.298, p < 0.05). These results provide the initial evidence to test our hypotheses.

First, this study enriches the existing research findings on conscientiousness and employee work engagement. The conscientiousness and work engagement of medical staff in China are closely correlated with the quality of medical care and doctor–patient relationships. Scholars have investigated the correlation between conscientiousness and research productivity (40), well-being (4), and other factors. However, limited research has specifically connected conscientiousness to the work engagement of medical staff. This study added variables such as workload and work engagement to the comprehensive model of conscientiousness, expanding the research on outcome variables, and provided a new theoretical perspective on how conscientiousness as a personality trait drives the work engagement of medical staff.

Second, this study revealed the double-edged sword effect of conscientiousness on employee work engagement and its impact process. Previous studies focused predominantly on the positive impact of conscientiousness on individual work states (4, 6). Recent research in personality theory has introduced the “too-much-of-a-good-thing effect” in the relationship between conscientiousness and ideal outcomes, challenging the “more is better” view that has been dominating research on this trait for a long time (41). However, little is known regarding how conscientiousness leads to negative outcomes (9). We develop an integrative model that provides a balanced and dialectical understanding of the impact of conscientiousness. It simultaneously promotes our understanding of the consequences of conscientiousness from the “bright” and “dark” sides. This study fills a research gap regarding the effectiveness of the impact of conscientiousness and provides a broader perspective on the systematic comprehension of the role of conscientiousness in academia. These findings also expanded the application of COR theory by sustaining the view that not all behaviors deemed “good” can realize resource enhancement (42).

Third, we expand the boundary condition of the conscientiousness–work engagement linkage. China emphasizes collectivism and PIS has research significance in the Chinese cultural context (43). This study introduced PIS as a moderating variable, providing new boundary conditions for exploring the relationship between conscientiousness and medical staff work states. It confirms the impact of PIS on the relationships between conscientiousness, TAW/workload, and work engagement, enriching research that uses PIS as a moderating variable. This provides a new perspective for improving TAW of medical staff and providing interventions in their workloads. However, the integration of PIS with personality trait factors provides important insights for future research on its effectiveness.

First, public hospitals should stimulate a sense of conscientiousness among medical staff. In organizational environments, conscientiousness significantly affects employees’ work attitudes, behaviors, and performance. However, this impact may be negative. Therefore, organizations need to provide relevant training to employees to strengthen their passion for their profession and work. Simultaneously, it is important to remind employees to be mindful of resource depletion, while focusing on their work and to manage their sense of conscientiousness more dynamically.

Second, public hospitals should create a working environment conducive to improving the TAW and reducing the experience of workload for medical staff. On the one hand, creating a working atmosphere characterized by respect and trust from superiors and colleagues, expanding avenues for accessing work-related information, optimizing information dissemination methods, establishing an environment conducive to sharing information and resources, and enabling medical staff to achieve their ideal work state. Public hospitals should employ measures to prevent and intervene in the high workload of medical staff and reduce the perceived burden caused by emotional, physical, and mental resource depletion, thereby lowering the burden efficiency caused by a sense of conscientiousness. Specific measures may include (1) collaborating with the HRM departments of public hospitals to establish relevant support mechanisms, such as stipulating that medical staff must take paid leave each year and generally do not allow explicit or implicit overtime; (2) providing employees with health promotion programs and regularly conducting group/individual physical and mental intervention measures; and (3) establishing an adequate pool of specialized and flexible human resources to address high-intensity medical service work at any time.

Finally, public hospitals should consider PIS as a self-concept factor. Medical staff with higher levels of PIS are better equipped to experience work vitality and prosperity guided by conscientiousness. They can handle job tasks calmly, reduce the sense of being overwhelmed, and increase their levels of work engagement. Therefore, public hospitals can improve the PIS of medical staff by granting them more autonomy, enhancing their professional skills in performing job tasks, assisting them in overcoming work difficulties, creating more career opportunities, and ultimately boosting their PIS.

This study reached a relatively comprehensive conclusion through empirical analysis; however, it still has limitations that require further refinement in future research. First, the use of homogeneous data may have introduced bias. Despite the tests showing that the CMV is not severe, future research should use multisource and longitudinal data to minimize such biases. Second, contextual factors such as organizational context, leadership styles, and job characteristics may also moderate employees’ work attitudes and behaviors (44). Future studies could use contextual factors such as organizational support and environmental uncertainty (45) as moderating variables to further explore the boundary conditions that influence conscientiousness. Third, due to the limitations of the study conditions, the sample was drawn from only four public hospitals in China. Van et al. (46) noted that individuals’ cultural contexts influence their informational and cognitive processes, which drives the construction of specific cognitive interpretative models. Therefore, future research should consider collecting data from other countries, while selecting other specific industries (such as education and legal practice) to enhance sample diversity and improve the generalizability of the research results.