Evaluating the association between job stress and presenteeism among nurses: the mediating role of emotional exhaustion and the moderating effect of leisure crafting.

Background: Exploring the relationship between job stress and presenteeism is essential for safeguarding nurses' well-being and patient safety. To further clarify the mechanisms underlying this relationship, this study applied the Conservation of Resources theory (COR) and the Job Demands-Resources (JD-R) model to examine the mediating role of emotional exhaustion between job stress and presenteeism, with particular emphasis on the potential moderating role of leisure crafting in this process. Methods: A cross-sectional survey was conducted from April to June 2025, involving 458 nurses recruited via convenience sampling from three tertiary Grade-A general hospitals in Sichuan Province, China. Data were collected via scales measuring job stress, emotional exhaustion, leisure crafting, and presenteeism. Mediation and moderation analyses were conducted using Hayes' PROCESS macro (Models 4 and 7) in SPSS 26.0 with 5,000 bootstrap samples. Results: The results showed that job stress was positively associated with presenteeism among nurses. Emotional exhaustion partially mediated this relationship. Higher job stress was linked to greater emotional exhaustion, which in turn was associated with higher levels of presenteeism. Leisure crafting significantly moderated the link between job stress and emotional exhaustion and the association was weaker among nurses with higher levels of leisure crafting. The moderated mediation effect was significant, suggesting that leisure crafting buffered the indirect effect of job stress on presenteeism via emotional exhaustion. Conclusion: Emotional exhaustion serves as a key psychological mechanism through which job stress translates into presenteeism among nurses. Job stress may exacerbate nurses' susceptibility to suboptimal health by increasing emotional exhaustion, thereby accelerating their progression along the continuum of occupational health deterioration. Nurses experiencing suboptimal health are more likely to engage in presenteeism. Leisure crafting serves as a valuable resource for alleviating emotional exhaustion and mitigating presenteeism among nurses under stress. These results enhance the understanding of the mechanisms underlying nurse presenteeism and offer practical implications for developing supportive interventions in nursing management.