Abstract

Background Nurses in China’s public hospitals face high-pressure environments and emotional labor, leading to professional fatigue, identity conflicts, and reduced work efficacy. These challenges impact job satisfaction and engagement. Despite these issues, job crafting mechanisms, which could help nurses reshape their work roles to improve job satisfaction and efficacy, and managerial interventions remain underexplored. This study investigates the key factors that influence how nurses proactively adjust their tasks, relationships, and work environments, aiming to enhance engagement, performance, and workforce retention. Aim This study explores key factors influencing nurses’ job crafting in China through a multi-level qualitative approach. Methods From 2023 to 2024, semi-structured interviews were conducted with 18 registered nurses at a tertiary public hospital in China. Data collection included literature review and research group discussions, while data analysis was conducted using grounded theory. Ethical considerations The study was approved by the Ethics Committee of Gansu Provincial Hospital (No. 2025-267). Informed consent was obtained from all participants, and confidentiality was strictly maintained throughout the research process. Findings Three themes emerged: adaptability (including knowledge–action gaps, task preferences, and learned helplessness), organizational support (leadership styles, incentives, and resource access), and interpersonal relationships (team effectiveness and contextual dependence). These themes reflect multilevel factors influencing nurses’ job crafting behaviors within clinical and organizational contexts. Conclusion Nurses’ job crafting is shaped by individual adaptability, value-driven decision-making, and organizational support, with leadership playing a mediating role. Aligning with Maslow’s hierarchy, job crafting requires a localized framework integrating management innovation and Chinese strategic wisdom to enhance adaptability and job satisfaction.