Organizational Climate and Individual Resilience as Bidirectional Predictors of Career Compromise: A Longitudinal Mixed-Methods Investigation in Tertiary Healthcare Settings.

This 18-month longitudinal mixed-methods study employed an explanatory sequential design QUAN→qual examining 412 healthcare workers (nurses and physicians) from four tertiary hospitals in China to explore the bidirectional relationships between organizational climate, individual resilience, and career compromise. Quantitative data were collected at baseline, 9 months, and 18 months using validated instruments: Practice Environment Scale-Nursing Work Index, Connor-Davidson Resilience Scale-10, and Career Compromise Scale. Random-intercept cross-lagged panel models (RI-CLPM) examined bidirectional relationships. Semi-structured interviews (n = 45) conducted at the third timepoint explored mechanisms underlying quantitative patterns, analyzed via thematic analysis. RI-CLPM revealed significant bidirectional effects. Organizational climate at baseline predicted increased resilience at 9 months and reduced career compromise at 18 months. Resilience predicted improved perceptions of organizational climate and lower career compromise. Career compromise predicted decreased resilience and more negative climate perceptions. Qualitative themes highlighted support mechanisms, resilience adaptation, and decision-making dynamics, showing that positive organizational climates enhance resilience through psychological safety and development opportunities, reducing career compromise. Organizational climate, resilience, and career compromise demonstrate reciprocal relationships over time, supporting a dynamic systems perspective. Interventions should simultaneously target organizational factors and individual capacities to optimize healthcare workforce retention. Findings inform evidence-based policies for tertiary hospital management.