Associations between sleep quality and well-being among nurses: the serial mediating roles of psychological resilience and adversity coping

Abstract

Promoting nurses’ well-being is important for mental health and workforce stability. Poor sleep quality is common among nurses and has been associated with lower general well-being. Psychological resilience and adversity quotient may serve as protective personal resources, but their roles in this association remain unclear. This study examined the association between sleep quality and general well-being among Chinese nurses from the perspective of conservation of resources theory, focusing on the independent and serial mediation of psychological resilience and adversity quotient. This multicenter cross-sectional study enrolled 1,149 nurses from 22 tertiary medical institutions in Zhejiang Province, China, between September and November 2025. Data were collected using the Pittsburgh Sleep Quality Index, the Adversity Quotient Scale, the Connor-Davidson Resilience Scale, and the General Well-being Schedule. Descriptive statistics, Pearson correlation analysis, and common method bias tests were conducted for the study variables. Confirmatory factor analysis and structural equation modeling were used to evaluate the measurement and hypothesized structural models, respectively. Indirect effects were tested using bias-corrected bootstrapping with 5,000 resamples. Sleep quality, psychological resilience, adversity quotient, and general well-being were all significantly correlated ( P < 0.001). Psychological resilience and adversity quotient significantly mediated the association between sleep quality and general well-being. The total indirect effect accounted for 41.6% of the total effect. All three indirect effects were significant: (1) sleep quality → psychological resilience → general well-being (β = −0.137, P < 0.001, 22.2% of the total effect), (2) sleep quality → adversity quotient → general well-being (β = −0.070, P < 0.001, 11.2% of the total effect), and (3) sleep quality → psychological resilience → adversity quotient → general well-being (β = −0.051, P < 0.001, 8.2% of the total effect). Sleep quality was associated with Chinese nurses’ well-being both directly and indirectly through psychological resilience, adversity quotient, and their serial mediation effect. Nursing managers may consider sleep quality improvement and targeted strategies to strengthen psychological resilience and adversity quotient as potential approaches to supporting nurses’ general well-being.