A study of the impact of obstetric nurses' job insecurity on work engagement in the context of low fertility: a cross-sectional study

Background Against the backdrop of declining global fertility, obstetric nurses are encountering increasingly stressful professional environments. This study aimed to examine the impact of job insecurity among obstetric nurses on their work engagement levels. Additionally, it sought to validate the chain-mediated effects of perceived organizational support and challenging assessment in the relationship between job insecurity and work engagement. The findings aim to inform the development of targeted management strategies for nurses within healthcare organizations. Methods From April to May 2025,researchers conducted a cross-sectional study, recruiting 406 obstetric nurses from secondary and tertiary medical institutions in Chongqing.Data collection involved the use of a demographic questionnaire, the Job Insecurity Scale, the Specialist Nurse Work Engagement Scale, the Perceived Organizational Support Scale, and the Challenge Assessment Scale. Data analysis employed Pearson correlation analysis, hierarchical linear regression, and structural equation modeling. Results Obstetric nurses scored 105.97±41.84 on work engagement, falling into the medium-to-upper range. Hierarchical regression showed that nurses in secondary hospitals had significantly lower work engagement than those in tertiary hospitals (β = -37.123, p < 0.001); contract nurses also scored markedly lower than permanent staff (β = -21.876, p < 0.001). Job insecurity, perceived organizational support, and challenge assessment were key influencing factors, explaining 58.9% of the variance in work engagement (R²=0.589). Structural equation modeling verified the chain mediating effect: perceived organizational support and challenge assessment separately mediated 21.18% and 20.73% of the total effect, while their combined chain mediation accounted for 28.47%. Conclusions The nursing management department can implement a combined strategy of organizational support empowerment and positive cognitive cultivation to effectively assist obstetric nurses in reducing job insecurity and improving work engagement. The findings of this research are instrumental in guiding managers to develop supportive strategies, stabilize the nursing team, and ensure the safety of mothers and infants.