The mediating role of perceived organizational support in the association between challenge-hindrance stress and nurses’ work withdrawal behavior: a cross-sectional study

Background Nurses’ work withdrawal behavior has important implications for healthcare quality and patient safety. Perceived organizational support (POS) and challenge-hindrance stress have been identified as key factors associated with such behaviors. Although prior studies have examined the direct relationships between these factors and nurses’ work withdrawal behavior, the mediating role of perceived organizational support in the relationship between challenge-hindrance stress and work withdrawal behavior remains underexplored. Methods Between June and July 2024, a cross-sectional survey was conducted among 3,420 registered nurses from 13 tertiary hospitals in Anhui Province, China. Participants completed validated self-report measures of challenge-hindrance stress, perceived organizational support, and work withdrawal behavior, along with a demographic questionnaire. Structural equation modeling (SEM) with bootstrapping (5,000 resamples) was used to examine the mediating role of perceived organizational support. Results The mean scores for challenge-hindrance stress, perceived organizational support, and work withdrawal behavior were 32.76 ± 10.62, 46.40 ± 10.50, and 28.29 ± 9.92, respectively. SEM showed that perceived organizational support partially mediated the relationship between challenge-hindrance stress and work withdrawal behavior ( β = 0.103, p 0.001, 95% CI 0.087, 0.121), accounting for 29.10% of the total effect ( β = 0.354). Conclusion These findings suggest that perceived organizational support may be an important organizational resource in the relationship between challenge-hindrance stress and nurses’ work withdrawal behavior. In high-pressure clinical settings, strengthening organizational support systems, such as recognition, resource provision, and career development opportunities, may be relevant to addressing nurses’ work withdrawal behavior and maintaining workforce stability and patient safety.