To identify latent profiles of change fatigue among nurses in Southwestern China and explore factors associated with distinct profiles. Healthcare resources in Southwestern China are unevenly distributed, and the region features considerable ethnic diversity. Against the backdrop of ongoing reforms in the healthcare system, nurses-as frontline implementers-are constantly exposed to intensive and frequent updates in policies, technologies, and workflows, making them susceptible to change fatigue. This sustained exposure precipitates "change fatigue," a syndrome that erodes psychological resilience and professional identity, and is prospectively linked to heightened turnover intention, measurable deterioration in nursing quality and an increased incidence of patient-safety events. From July to September 2025, we recruited nurses from various tiers and types of medical institutions across Southwestern China. Data were collected using a general information questionnaire, the Change-Related Stress Scale, the Grandey Emotional Labor Strategy Scale, the Connor-Davidson Resilience Scale (CD-RISC), and the Chinese Nurse Job Stressors Scale. Latent profile analysis (LPA) was employed to identify subgroups of change fatigue. Univariate analysis and multinomial logistic regression with Firth's penalized likelihood estimation were used to examine factors associated with profile membership. A total of 1383 valid questionnaires were included. LPA revealed three distinct profiles of change fatigue: low fatigue (17.5%, n = 242), moderate fatigue (61.6%, n = 852), and high fatigue (20.9%, n = 289). Multinomial logistic regression showed that nurses in the high fatigue group were significantly more likely to work in the intensive care unit (OR = 2.31, 95% CI: 1.40-3.85, p = 0.001) and internal medicine (OR = 2.12, 95% CI: 1.26-3.61, p = 0.005). Working 1-2 night shifts per week increased odds of high fatigue by 53% (OR = 1.53, 95% CI: 1.03-2.27, p = 0.034). Compared with minimal emotional labor (Level 1, 14-30 points), both moderate (Level 2, 31-50 points: OR = 0.14, p = 0.030) and high (Level 3, 51-70 points: OR = 0.09, p = 0.010) emotional labor levels were associated with significantly lower odds of high fatigue, suggesting that deficient emotional labor engagement may represent a risk configuration. Work stress Level 3 increased odds of high fatigue 33-fold (OR = 32.71, 95% CI: 13.27-103.37, p < 0.001). Psychological resilience showed no independent significant association with profile membership in multivariate models. Change fatigue exhibits a heterogeneous tripartite structure. Minimal emotional labor engagement (Level 1) was associated with higher odds of high fatigue compared with moderate and high levels, suggesting that deficient emotional labor may represent a distinct risk configuration. Both modifiable workplace factors (ICU/internal medicine placement, night shifts, and job stress) and emotional labor patterns were associated with profile membership, supporting the potential value of organizational interventions and targeted emotional labor training. These findings provide an evidence-based foundation for precision prevention. Nursing leaders should integrate the six-item Change Fatigue Measurement Scale into routine occupational health surveillance to enable profile-based risk stratification. High-fatigue nurses (20.9%) require immediate workload relief and mental health referral; moderate-fatigue nurses (61.6%) represent a critical prevention window for resilience training and peer support; low-fatigue nurses (17.5%) should serve as peer mentors and change champions. Priority interventions should target ICU and internal medicine units given the 2- to 2.3-fold increased high-fatigue risk. Leaders should limit consecutive night duties to ≤ 2 shifts, ensure ≥ 11 h rest between shifts, and enforce weekly overtime caps (≤ 8 h). Differentiated emotional labor training is essential: Nurses with minimal engagement need professional identity strengthening and authentic expression workshops, while those with excessive engagement require boundary-setting training and mindfulness-based stress reduction. Resilience-building interventions must be embedded within organizational support initiatives rather than implemented as standalone programs. In ethnically diverse, resource-constrained contexts, culturally tailored change communications and phased implementation timelines are critical to avoid "reform stacking."
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arXiv · 2014-04-09
arXiv · 2013-12-06