Title : Strengthening organizational salutogenesis: The mediating role of sense of coherence in managing burnout among operating room nurses

Background: Operating room (OR) nurses face sustained high-intensity occupational stress, placing them at significant risk of burnout, which threatens perioperative safety and workforce sustainability. While sense of coherence (SOC) is a known protective resource, its role as a modifiable management mechanism remains insufficiently explored in high-intensity clinical settings.
Objectives: This study aimed to describe burnout prevalence among OR nurses and examine SOC as a theoretically grounded mediator linking occupational stress to burnout from a nursing management perspective.
Methods: A multicenter cross-sectional survey was conducted among 431 OR nurses from 12 hospitals in Southwest China. Data were collected using validated instruments for occupational stress, SOC, and burnout. Structural equation modeling with bootstrap mediation analysis (5,000 resamples) was employed to test the framework.
Results: The prevalence of burnout was alarmingly high at 82.13%. Notably, nurses with master’s degrees reported significantly higher burnout levels, suggesting a "master’s degree paradox" related to role strain. Occupational stress was positively correlated with burnout (r = 0.63, p < 0.001). Mediation analysis revealed that SOC partially mediated this relationship, accounting for 56.27% of the total effect (indirect effect = 0.377, p < 0.001).
Conclusions & Management Implications: SOC represents a critical pathway through which nursing leadership can mitigate burnout. Management should shift from focusing on individual resilience to providing organizational resources that enhance work comprehensibility, manageability, and meaningfulness. Strategic interventions include AI-assisted scheduling to reduce unpredictability and implementing stratified practice models to provide protected non-clinical time for highly educated nurses. Investing in the workforce’s SOC is a strategic necessity for high-performing perioperative teams.
Keywords: Nursing Management; Burnout; Operating Room Nurses; Sense of Coherence; Salutogenesis; Workforce Sustainability.

Ms Zhong is a senior operating room nurse manager with 22 years of clinical and managerial experience in perioperative nursing. She holds a Master’s degree in Nursing and the professional title of Associate Chief Nurse. Her research interests focus on nursing management, occupational stress, burnout, and organizational interventions in operating room settings. She has published 9 academic articles in China and holds three  patents related to clinical nursing practice.She is currently the Operating Room Nurse Manager of theThe First Affiliated Hospital of Chongqing Medical University.