Job stress among home-visiting nurses in China: direct, moderating, and mediating pathways based on the job demands-resources model

Background Home-visiting nurses in China face escalating job stress due to the growing demand for home-based services driven by the rapidly aging population, weakening family support structures, and ongoing national healthcare reforms. Their work is characterized by limited organizational support and exposure to workplace violence, yet the stress mechanisms in this group remain underexplored. This study applied the Job Demands-Resources (JD-R) model to examine (1) the direct effect of job demands, job resources, and workplace violence on job stress, (2) the moderating role of job resources, and (3) the mediating effect of workplace violence. Methods A cross-sectional survey was conducted among 434 home-visiting nurses from 13 institutions across two Chinese provinces. Measures included the Chinese versions of the Job Demand Scale (subjective job demands), weekly working hours (objective job demands), Job Resources Scale, and the Community Nurse Stress Scale, as well as five self-developed items assessing workplace violence. Path analysis using SPSS 26.0 and AMOS 22.0 examined direct, moderating, and mediating effects under different levels of job resources. Results Path analysis showed that subjective job demands (β = 0.54, p < 0.001) and workplace violence (β = 0.15, p < 0.001) significantly increased job stress, while job resources reduced it (β = −0.18, p < 0.001). Weekly working hours had no significant effect (β = 0.05, p > 0.05). Job resources buffered the positive relationship between job demands and stress (β = −0.13, p < 0.001). Workplace violence mediated the effect of job demands on stress (β = 0.18, p < 0.001; β = 0.15, p < 0.001). The final model demonstrated excellent fit (χ²=3.73, df = 3, p = 0.29, Comparative Fit Index [CFI] = 1.00; Root Mean Square Error of Approximation [RMSEA] = 0.02), and results were consistent across different levels of job resources. Conclusions Our findings highlight the protective and moderating roles of job resources, and the mediating role of workplace violence on job stress among home-visiting nurses. Targeted interventions should focus on strengthening organizational resources and preventing workplace violence to reduce job stress and improve workforce sustainability.