研究背景：新進護理師在入職初期面臨臨床環境之衝擊及角色適應之壓力，若缺乏有效因應，極易導致疲潰甚至離職，其中韌力被視為重要的保護因子，然而在高壓工作環境中，韌力可能無法充分發揮作用，而過去研究多聚焦於韌力對疲潰的保護作用，較少探討工作壓力在韌力與疲潰間的角色。
研究目的：探討新進護理師工作壓力在韌力與疲潰之間的中介效果。
研究方法：採次級資料分析進行縱貫性研究，研究對象為南部某醫學中心之新進護理師。收案條件為：（1）到職三個月及六個月的新進護理師；（2）實際從事第一線接觸照顧病人之工作；排除條件為：（1）到職一週內即離職者；（2）任職於非住院單位者。最終有效樣本數為58人。研究工具包括工作壓力量表、Connor-Davidson 韌力量表（CD-RISC）與Maslach疲潰量表。資料分析採用描述性統計、成對樣本t檢定、皮爾森積差相關分析，以及由 SPSS PROCESS Macro Model 4 進行中介效果分析。
研究結果：新進護理師在到職三個月及到職六個月之整體工作壓力顯著下降（t=4.30，p<.01），在專業知識、專業技術、工作流程、工作負荷與病人及家屬等次構面最為明顯。疲潰的情緒耗竭次構面顯著下降（t=2.29，p=0.03），但去人性化次構面則顯著上升（t=-2.56，p=0.01），而整體韌力則未呈顯著變化。中介分析結果發現，三個月韌力雖無顯著直接預測六個月疲潰，但能透過降低工作壓力間接減少疲潰，證實工作壓力在韌力與疲潰之間具有顯著中介效果（間接效果=-0.2335，95% CI [-0.49，-0.07]）。
結論：研究中介模型分析結果顯示，韌力雖無法直接顯著預測疲潰，但可透過降低工作壓力，進而間接減緩疲潰程度，證實工作壓力在韌力與疲潰之間具有顯著中介效果，代表單一提升韌力可能不足以有效預防新進護理師疲潰，若未同步降低其所面臨的工作壓力，韌力的發展或保護作用將受到限制。
未來建議：臨床實務建議醫療機構應加強支持新進護理師初期工作壓力適應，建構韌力培養之訓練，預防疲潰的累積。學校教育建議學校課程提前融入壓力調適與韌力培養訓練，強化學生面對臨床現實環境的準備度。未來研究建議後續可擴大樣本數、延長追蹤期，並納入多元背景的新進護理師，進一步驗證中介模型之普遍性。

Background:New nurses often face considerable challenges in adapting to the clinical environment and their professional roles. The transition from being a nursing student to becoming a practicing registered nurse involves managing complex clinical responsibilities, interacting with interdisciplinary teams, and caring for acutely ill patients in high-pressure settings. These challenges, combined with heavy workloads and limited clinical experience, often result in elevated levels of stress. Without effective coping mechanisms or appropriate support systems, new nurses are at increased risk of experiencing emotional exhaustion, job dissatisfaction, burnout, and even premature resignation. Burnout is a serious occupational phenomenon characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. High turnover among new nurses due to burnout not only compromises the continuity and quality of patient care but also imposes significant financial and operational burdens on healthcare institutions.
Resilience, defined as the capacity to adapt well in the face of adversity and stress, has been identified as an essential protective factor for psychological well-being in the nursing profession. It enables nurses to recover from setbacks and maintain effective functioning despite challenges. However, the role of resilience in buffering burnout may be limited if work-related stress remains unaddressed. In high-acuity clinical environments, the persistent presence of stressors such as insufficient staffing, emotionally charged patient care situations, and time pressures can overwhelm even highly resilient individuals. While existing literature has mainly emphasized the direct negative correlation between resilience and burnout, few studies have explored how work-related stress mediates this relationship, particularly in the early stages of a nursing career. Understanding this mechanism could inform more targeted interventions to support nurse retention and well-being.
Purpose: This study aimed to investigate the mediating effect of work stress on the relationship between resilience and burnout among new nurses during the first six months of clinical practice. Specifically, it sought to determine whether resilience could indirectly reduce burnout by alleviating perceived work-related stress.
Methods: A longitudinal secondary data analysis was conducted using a dataset originally collected from new nurses working at a major medical center in southern Taiwan. The inclusion criteria were: (1) registered nurses with three and six months of clinical work experience, and (2) those directly involved in inpatient patient care. Nurses who resigned within one week of employment or were assigned to non-inpatient units (e.g., outpatient clinics or administrative departments) were excluded. After applying the criteria, 58 valid participants were included in the final analysis.
Three validated instruments were used to measure the main study variables. Work-related stress was assessed using the Work Stress Scale for Nurses, resilience was measured by the 25-item Connor-Davidson Resilience Scale (CD-RISC), and burnout was evaluated using the Maslach Burnout Inventory (MBI), which includes subscales for emotional exhaustion, depersonalization, and personal accomplishment. Data were analyzed using SPSS. Descriptive statistics were used to describe participants’ characteristics and scale scores. Paired-sample t-tests were conducted to compare stress, resilience, and burnout levels between the third and sixth months of employment. Pearson’s correlation analysis assessed the relationships among variables. Finally, mediation analysis using PROCESS Macro Model 4 was applied to test whether work stress mediated the relationship between resilience at three months and burnout at six months.
Results: Paired-sample t-tests revealed a significant decrease in overall work stress from the third to the sixth month of employment (t = 4.30, p < .010). Reductions were particularly noted in stress related to professional knowledge, technical skills, workflow, workload, and interactions with patients and their families. Emotional exhaustion also significantly decreased over time (t = 2.29, p = 0.03), suggesting some adaptation to the clinical environment. However, depersonalization significantly increased (t = –2.56, p = 0.01), indicating that emotional distancing from patients may be a coping response to ongoing stress. No statistically significant changes were observed in resilience scores, implying that individual levels of resilience remained relatively stable over the six-month period.
Mediation analysis showed that resilience at three months did not have a significant direct effect on burnout at six months. However, resilience significantly predicted lower levels of work stress, which in turn predicted lower burnout levels, supporting a significant indirect effect (indirect effect = –0.2335, 95% CI [–0.49, –0.07]). This finding confirmed the mediating role of work stress in the relationship between resilience and burnout.
Conclusions: This study highlights that resilience alone may not directly reduce burnout among new nurses. Instead, its protective effect operates through the reduction of perceived work-related stress. In other words, resilient nurses experience less work stress, which subsequently lowers their risk of burnout. However, if high levels of workplace stress persist, even individuals with strong personal resilience may eventually succumb to burnout. These findings emphasize the importance of considering both individual and environmental factors in burnout prevention strategies. Supporting new nurses through both resilience training and structural interventions aimed at reducing work stress may be more effective than focusing solely on individual traits.
Recommendations: For clinical practice, healthcare institutions should implement comprehensive support systems that address both emotional and environmental sources of stress. Mentorship programs, preceptorship models, structured orientation, and mental health resources can facilitate smoother adaptation. Furthermore, leadership should actively monitor unit-level stressors and promote open communication to identify areas for improvement. For nursing education, integrating resilience training and stress management strategies into curricula can better equip nursing students to manage real-world challenges. Future research is encouraged to replicate this mediation model with larger and more diverse samples, longer follow-up periods, and in different cultural or institutional contexts to enhance generalizability and identify specific interventions that effectively

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