Work withdrawal behavior and its associations with perceived stress and work-life balance among nurses: a multicenter cross-sectional study.

Background: Work withdrawal behavior adversely affects both individual nurses' career development and team performance. However, the current status of work withdrawal behavior among nurses in China and its relationship with perceived stress and work-life balance has received limited attention. Objective: This study aims to examine the current status of work withdrawal behavior among nurses in Chinese hospitals and to analyze its associations with perceived stress and work-life balance. Methods: A cross-sectional survey was conducted from February to March 2025 using convenience sampling to recruit 2,707 nurses from 203 primary, secondary, and tertiary hospitals across 27 provinces in China. Validated scales were used to assess nurses' work withdrawal behavior, perceived stress, and work-life balance. Univariate analysis and multiple linear regression analysis were conducted to examine factors associated with work withdrawal behavior. Results: Among 2,594 valid questionnaires (response rate: 95.8%), the mean Work Withdrawal Behavior Scale score was 19.14 (SD = 6.90). Multiple linear regression revealed that male gender, older age, working in intensive care units or emergency departments, lower monthly income, longer overtime hours, higher perceived stress, and poorer work-life balance were significantly associated with increased work withdrawal behaviors (all p < 0.05). Among these, perceived stress (β = 0.291) and work-life balance (β = -0.201) were the strongest predictors. Conclusion: Work withdrawal behaviors are observable among Chinese nurses, with psychological withdrawal aspects showing relatively higher manifestation. Among the range of associated factors, increased perceived stress and poorer work-life balance were the most salient. Hospitals should therefore implement adequate organizational support, regular psychological screenings, and counseling services to alleviate stress and improve work-life balance, thereby reducing work withdrawal behaviors.