Factors Associated With Decent Work Perception Among Chinese Medical Nursing Assistants: A Cross-Sectional Study With Exploratory Mediation Analysis.

BACKGROUND

Medical nursing assistants are non-professional auxiliary care workers who provide daily living care and assist with basic activities under the guidance of healthcare professionals in China. Guided by the Job Demands-Resources (JD-R) model, this study examined how job demands, job resources, and personal resources were associated with decent work perception and whether occupational burnout statistically accounted for part of the psychological capital-decent work perception association.

METHODS

A cross-sectional convenience sample of 846 medical nursing assistants was recruited from 21 general hospitals in Guangdong Province, China, in December 2025. The primary regression used variables selected through univariate screening at two-tailed p < 0.05, while JD-R categories were prespecified for conceptual interpretation. Random forest reproducibility was evaluated through nested five-fold cross-validation, explicit hyperparameter tuning, held-out repeated permutation importance, and conditional permutation for correlated predictors.

RESULTS

The primary regression explained 42.8% of the variance and achieved a five-fold cross-validated R2 of 0.414; the random forest nested cross-validated R2 was 0.393. Psychological capital, occupational burnout, and innovation climate remained the leading random-forest predictors. CR2 standard errors with Satterthwaite degrees of freedom supported six of the eight primary adjusted associations; daily working hours and insurance were attenuated to p = 0.059 and p = 0.057, respectively.

CONCLUSION

Decent work perception was associated with personal resources, job demands, and organizational resources. The cross-sectional indirect association through occupational burnout was small and does not establish temporal causality.