The Mediating Role of Organizational Silence in the Relationship Between Change Fatigue and Work Engagement Among Chinese Clinical Nurses.

BACKGROUND: Healthcare institutions are undergoing ongoing organizational changes to optimize clinical services and patient care. These changes may induce change fatigue and organizational silence among nursing staff, undermining their work attitudes and professional performance and potentially compromising patient safety. While previous studies have explored the relationship between change fatigue, organizational silence, and work engagement, few have examined the mediating effect of organizational silence in this relationship, especially within the Chinese healthcare context. OBJECTIVE: This study aimed to examine the mediating role of organizational silence in the relationship between change fatigue and work engagement among clinical nurses. METHODS: This descriptive cross-sectional study was conducted online from March to May 2025. A total of 1067 registered nurses were recruited from five tertiary public hospitals in Ningxia, China, using the convenience sampling method. Data were collected using the following instruments: (1) a demographic questionnaire, (2) the Change Fatigue Scale, (3) the Organizational Silence Scale, and (4) the Work Engagement Scale. Data analysis was performed using descriptive statistics, Pearson correlation analysis, and structural equation modeling (SEM). RESULTS: The average scores for change fatigue, organizational silence, and work engagement were 25.40 ± 9.27, 49.76 ± 19.37, and 44.70 ± 13.72, respectively. Change fatigue was positively associated with organizational silence (r = 0.440, p < 0.001) and negatively correlated with work engagement (r = -0.332, p < 0.001). Organizational silence was negatively correlated with nurses' work engagement (r = -0.402, p < 0.01). The mediation analysis showed that organizational silence played a partial mediating role in the relationship between change fatigue and work engagement, with a mediation effect value of -0.153 (95% CI [-0.087, -0.055]), accounting for 44.1% of the total effect. CONCLUSIONS: This study confirmed significant correlations among change fatigue, organizational silence, and work engagement among Chinese clinical nurses. Moreover, organizational silence exerted a partial mediating effect on the association between change fatigue and work engagement. Nevertheless, causal inferences should be drawn with caution, as this research adopted a cross-sectional design. IMPLICATIONS FOR NURSING MANAGEMENT: To maintain nurses' work engagement amid organizational changes, nursing managers should implement integrated intervention strategies to alleviate change fatigue and dismantle organizational silence. Such managerial measures help foster a supportive, high-efficiency environment for healthcare transformation, thereby promoting nurses' occupational wellbeing and underpinning the long-term sustainable development of nursing teams. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.