Work-life balance as a mediator between perceived stress and work withdrawal behavior among critical care nurses in China: a multicenter cross-sectional study

Background The working environment of ICU nurses, which is high-intensity and fast-paced, contributes to elevated levels of perceived stress, which may consequently lead to work withdrawal behavior. Although work-life balance is regarded as a critical resource in coping with perceived stress, its mediating mechanism between perceived stress and work withdrawal behavior has not yet been fully elucidated. Objective This study aims to examine the relationships between perceived stress, work-life balance, and work withdrawal behavior among ICU nurses in China. Methods This cross-sectional study was conducted between September and October 2025. A total of 1,279 ICU nurses were enrolled from 58 hospitals across 16 Chinese provinces using convenience and snowball sampling. Data were collected employing validated scales: the Work-Life Balance Scale (WLBS), the Perceived Stress Scale (PSS), and the Work Withdrawal Behavior Scale (WWBS). Structural equation modeling (SEM) was applied to examine the relationships among variables, and the bootstrap method was utilized to test the mediating effects. Results The questionnaire response rate was 91.35% (1,279/1400). Path analysis confirmed that perceived stress negatively influenced work-life balance ( β = −0.234, p 0.001) and positively influenced work withdrawal behavior ( β = 0.207, p 0.001). Work-life balance also showed a significant negative effect on withdrawal behavior ( β = −0.439, p 0.001). The mediation analysis indicated that work-life balance played a significant mediating role between perceived stress and work withdrawal behavior, with the indirect effect accounting for 33.23% of the total effect. Conclusion The results indicate a significant association between perceived stress and work withdrawal behavior, with work-life balance playing a crucial mediating role in this relationship. These findings highlight the potential of work-life balance-focused interventions to alleviate stress, reduce withdrawal, and improve occupational health outcomes for ICU nurses.