Beyond Individual Resilience - A Social–Ecological Perspective on Sustaining the NICU Nursing Workforce

Q: What is the study’s main objective regarding NICU nurses?

To examine resilience, communication competence, and the nursing work environment as multilevel factors associated with nursing workforce sustainability, using job satisfaction as a proxy for retention.

Q: How was the study conducted?

A descriptive cross-sectional survey was conducted with 145 NICU nurses from three tertiary and three general hospitals in South Korea, followed by statistical analyses including correlations and multiple regression.

Q: Which factors were significantly associated with job satisfaction?

Resilience, the nursing work environment, communication competence, and working at a tertiary hospital were significant predictors of job satisfaction, explaining 55.1% of its variance.

Sep 13, 2026

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Sustaining a stable, competent NICU nursing workforce is essential for delivering high-quality care to vulnerable neonates, yet job dissatisfaction and turnover persist in high-acuity settings. Guided by a social–ecological model, the study evaluates resilience, communication competence, and the nursing work environment as multilevel correlates of workforce sustainability, using job satisfaction as a retention proxy. A descriptive cross-sectional survey of 145 South Korean NICU nurses links multilevel factors to satisfaction, supporting integrated strategies.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages17

Reading Time6 min

AccessFree to download

Introduction

Workforce sustainability in NICUs

Role and challenges of NICU nurses

Methods

Study design and participants

Measures and data analysis

Results

Correlates of job satisfaction

Multiple regression findings

Conclusions

Multilevel implications for workforce strategies

Article Beyond Individual Resilience: A Social–Ecological Perspective on Sustaining the NICU Nursing Workforce Ji Suk Ryu 1 and So Ra Kang 2, * Received: 13 April 2026 Revised: 19 May 2026 Accepted: 20 May 2026 Published: 22 May 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea 2 College of Nursing, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Republic of Korea * Correspondence: [srkang01@wku.ac.kr](srkang01@wku.ac.kr) Abstract Background/Objectives: Sustaining a stable and competent workforce in neonatal intensive care units (NICUs) is critical for ensuring high-quality care for vulnerable neonates. However, workforce-related challenges such as job dissatisfaction and turnover remain significant concerns in high-acuity settings. Guided by the ecological model, this study aimed to examine resilience, communication competence, and the nursing work environment as multilevel factors associated with nursing workforce sustainability, with job satisfaction serving as a proxy indicator related to workforce retention and sustainability. Methods: A descriptive cross-sectional survey was conducted among 145 NICU nurses from three tertiary and three general hospitals in South Korea. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression analyses using SPSS version 29.0 . Results: Job satisfaction was positively associated with resilience (r = 0.67, p < 0.001), communication competence (r = 0.52, p < 0.001), and the nursing work environment (r = 0.57, p < 0.001) . Multiple regression analysis indicated that resilience (β = 0.43, p < 0.001), nursing work environment (β = 0.30, p < 0.001), communication competence (β = 0.15, p = 0.040), and employment in a tertiary hospital (β = 0.12, p = 0.038) were significant factors associated with job satisfaction, explaining 55.1% of the variance (adjusted R2 ) in job satisfaction (F = 30.42, p < 0.001) . Conclusions: Job satisfaction, used as a proximal indicator related to workforce sustainability, was associated with multilevel factors across intrapersonal, interpersonal, and organizational domains. Although resilience showed the strongest association, communication competence and the nursing work environment also showed meaningful associations with job satisfaction. These findings highlight the need for integrated, multilevel strategies to support nursing workforce sustainability and sustained nursing practice in NICU settings. Keywords: neonatal intensive care unit; NICU nurses; job satisfaction; resilience; communication competence; nursing work environment; social–ecological model 1. Introduction In South Korea, the number of births has steadily declined in recent years. In 2023, the total number of births was 230,028, representing a decrease of 19,200 compared with the previous year, and the total fertility rate declined to 0.72, which was 0.06 lower than the previous year [1] . Despite this decline, the proportion of high-risk newborns has increased, largely due to rising maternal age and the growing use of assisted reproductive technologies [2,3] . Consequently, both preterm births (gestational age < 37 weeks) and low-birth-weight infants (birth weight < 2.5 kg) have increased substantially over the past decade, with rates in South Korea reaching 9.9% and 7.7%, respectively [1,4] . Preterm and low-birth-weight infants often have unstable physiological functions and immature central nervous systems, making them highly vulnerable to extrauterine adaptation immediately after birth and therefore requiring intensive monitoring, treatment, and individualized nursing care in the NICU [5] . Advances in medical technology have improved the

FAQs

What is the study’s main objective regarding NICU nurses?

To examine resilience, communication competence, and the nursing work environment as multilevel factors associated with nursing workforce sustainability, using job satisfaction as a proxy for retention.

How was the study conducted?

A descriptive cross-sectional survey was conducted with 145 NICU nurses from three tertiary and three general hospitals in South Korea, followed by statistical analyses including correlations and multiple regression.

Which factors were significantly associated with job satisfaction?

Resilience, the nursing work environment, communication competence, and working at a tertiary hospital were significant predictors of job satisfaction, explaining 55.1% of its variance.

Sep 13, 2026

Upload by Skyler