Objective To explore the impact of nurses' empathy ability on work engagement in Class A tertiary hospitals, as well as the role of perceived social support and psychological capital in this relationship, so as to provide a basis for improving nurses' mental health and the quality of nursing services.

Methods From March to May 2024, a convenience sampling method was used to select 585 nurses from Class A tertiary hospitals in Weifang, Shandong Province, for an online questionnaire survey. The used questionnaires included a general information questionnaire, the Jefferson Scale of Empathy-Health Professionals (JSE-HP), the Perceived Social Support Scale (PSSS), the Psychological Capital Questionnaire (PCQ-R), and the Utrecht Work Engagement Scale (UWES-9). SPSS 25.0 software was used to analyze the correlations between the scores of the various scales, and the Process V3.3 plugin was used to examine the chain-mediated effects of perceived social support and psychological capital in the relationship between empathy ability and work engagement.

Results A total of 548 valid questionnaires were obtained, with a valid response rate of 93.68%. The scores for empathy ability, work engagement, perceived social support, and psychological capital among these nurses were (111.26 ± 16.70), (31.95 ± 10.05), (67.83 ± 11.75), and (92.38 ± 15.34), respectively. Nurses who were aged ≥ 40 years, or had ≥ 11 years of work experience, or held the title of deputy chief nurse or above, or had no or few night shifts, or were in good health had higher total work engagement scores and scores in all dimensions, whereas nurses in the emergency and ICU departments had lower scores (all P < 0.05). The nurses'work engagement was positively correlated with the empathy ability, perceived social support, and psychological capital (r = 0.492 to 0.772, P < 0.05). Path analysis showed that nurses' empathy ability had a direct effect on work engagement, with a direct effect value of 0.105 (95%CI: 0.058 to 0.152), accounting for 40.70% of the total effect. The empathy ability could also influence work engagement through psychological capital with a mediated effect value of 0.029 (95%CI: 0.003 to 0.056), accounting for 11.24% of the total effect. The perceived social support and psychological capital played a chain-mediated role in the impact of empathy ability on work engagement with a mediated effect value of 0.121 (95%CI: 0.091 to 0.157), accounting for 46.90% of the total effect.

Conclusions Nurses' empathy ability had a direct impact on work engagement and also influenced work engagement through the chain-mediated effects of perceived social support and psychological capital. Nursing managers can optimize human resource allocation, enhance nurses' perception of social support, build up their psychological capital, and improve their empathy ability to further improve work engagement levels.