Effects of Perceived Stress on Occupational Burnout Among Chinese Nurses：A Moderated Chain Mediation Model Via Insomnia and Psychological Distress

Background Occupational stress is a confirmed precursor to nurse burnout, yet the underlying mechanisms—the "black box" of how stress translates into burnout—require elucidation. The potential protective role of psychological resilience in this process, particularly through a pathway involving sleep and emotional disturbances, lacks robust empirical evidence. This study aimed to test the chain-mediating effect of insomnia and psychological distress linking occupational stress to burnout and examine whether psychological resilience moderates this entire pathway. Methods A cross-sectional survey of 1133 registered nurses from China was conducted. Participants completed validated scales: the Perceived Stress Scale (PSS-10), Insomnia Severity Index (ISI), Generalized Anxiety Disorder (GAD-2), Patient Health Questionnaire (PHQ-2), Connor-Davidson Resilience Scale (CD-RISC-10), and Maslach Burnout Inventory (MBI). The data were analyzed via correlation analyses and moderated mediation analysis with the PROCESS macro of IBM ®SPSS. Ethical approval was obtained from the Medical Science Research Ethics Committee of the First Affiliated Hospital of China Medical University (Approval No. 2025–595), and all participants provided informed consent. Results The nurses’ average MBI score was 57.27 ± 19.47, and their PSS score was 17.37 ± 5.89. Correlation analyses revealed that stress was positively associated with insomnia (r = 0.28, P < 0.01), psychological distress (r = 0.28, P < 0.01), and job burnout (r = 0.28, P < 0.01). The mediation analysis indicated that stress influenced job burnout through four significant pathways: 1) a direct effect (β = 0.49, P < 0.001); 2) through the mediator of psychological distress; 3) through the mediator of insomnia; and 4) through the chain-mediating path of insomnia → psychological distress. Specifically, resilience buffers the effects of stress on both insomnia and negative emotion, with relationships being stronger for individuals with low resilience than for those with high resilience. Bootstrap analyses confirmed the significance of this moderated mediation model. Conclusions The findings illuminate a key mechanism—the insomnia-distress pathway—through which occupational stress leads to burnout while highlighting psychological resilience as a critical buffer. Interventions aimed at promoting resilience and addressing sleep and mental health issues could be effective strategies for mitigating burnout in the nursing workforce.