Nurse Media Journal of Nursing
Vol 16, No 2 (2026): (August 2026) [In Progress]

Multilevel Factors Influencing Nurses' Job Performance in Tertiary Hospitals in Northern Thailand: A New Normal Perspective

Jirarat Ruetrakul (Department of Nursing Administration, Faculty of Nursing, Naresuan University)
Pattamaporn Bumrungkhet (Department of Nursing Administration, Faculty of Nursing, Naresuan University)



Article Info

Publish Date
31 Aug 2026

Abstract

Background: Professional nurses’ job performance is fundamental to delivering high-quality patient care, particularly in tertiary hospitals. In the post-COVID-19 era, tertiary hospitals in northern Thailand have faced increased patient care complexity, workforce shortages, greater technological demands, and persistent psychological stress among nurses. These changes highlight the importance of improving nurses’ quality of work life and fostering spiritual leadership to create supportive organizational climates that sustain high performance. Although both individual- and group-level factors are known to influence nurses’ job performance, their multilevel interplay in post-pandemic healthcare settings remains unclear.Purpose: This study investigated the empirical validity of a hypothesized model of individual- and group-level factors influencing professional nurses’ job performance in tertiary hospitals under the Ministry of Public Health in northern Thailand.Methods: A predictive correlational design was used with multilevel structural equation modeling. Data were collected from 284 professional nurses working in tertiary hospitals in northern Thailand. At the individual level, quality of work life was specified as the independent variable, work engagement as the mediator, and job performance as the dependent variable. At the group level, spiritual leadership was specified as the independent variable, organizational climate as the mediator, and job performance as the dependent variable. Data were analyzed using Mplus version 8.8.Results: The model demonstrated a good fit to the empirical data (χ²/df = 1.25, CFI = 0.95, RMSEA = 0.06, SRMR = 0.04). At the individual (within) level, quality of work life and work engagement had significant positive direct effects on nurses’ job performance. Work engagement significantly mediated the relationship between quality of work life and job performance. The within-level model explained 71% of the variance in nurses’ job performance. At the group (between) level, spiritual leadership and organizational climate had significant positive direct effects on nurses’ job performance. Organizational climate also significantly mediated the relationship between spiritual leadership and job performance. The between-level model explained 95% of the variance in job performance.Conclusion: Quality of work life and work engagement at the individual level, along with spiritual leadership and organizational climate at the group level, were significantly associated with nurses’ job performance. Strengthening these factors may improve nurses’ performance and support high-quality patient care in tertiary hospitals.

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Journal Info

Abbrev

medianers

Publisher

Subject

Nursing

Description

Nurse Media Journal of Nursing (e-ISSN: 2406-8799, p-ISSN: 2087-7811) is an international journal that provides a forum for publishing the scientific works of nurse practitioners, academics, and researchers. The focus and scopes of the journal include adult nursing, emergency nursing, gerontological ...