The influencing factors of work alienation among emergency nurses in Guangzhou, China: A fuzzy-set qualitative comparative analysis

<title>Abstract</title> <p> <bold>Objective:</bold> To explore the configurational effect of the factors influencing the work alienation among emergency nurses. <bold>Background:</bold> In recent years, work alienation of emergency nurses has become increasingly prominent. This issue not only affects nurses’ professional burnout and mental health, but also may compromise the quality of nursing care and even increased the risk of medical errors. Existing studies on work alienation among emergency nurses primarily focus on examining the independent effects of individual factors. However, the formation mechanism of work alienation typically involves complex interactions among multiple factors, and the underlying configurational effects and developmental pathways have not yet received sufficient attention. <bold>Method:</bold> A cross-sectional study design was employed. From December 2025 to March 2026, 274 emergency nurses were recruited from 8 tertiary Grade-A hospitals through online surveys in Guangzhou, China. Univariate analysis, correlation analysis and linear regression analysis were used to explore the influencing factors of work alienation among emergency nurses. In addition, the configurational effect of the factors affecting work alienation was explored through fuzzy-set qualitative comparative analysis (fsQCA). <bold>Results:</bold> The score of work alienation among emergency nurses was 25.00 (17.00, 34.25). Linear regression analysis showed that sex, experience of workplace violence, work stress, overall perceived humanistic care and psychological resilience were significant factors influencing work alienation of emergency nurses. The fsQCA results identified seven configurational pathways leading to work alienation, which could be categorized into three types: (C1) high work stress, experience of workplace violence, lack of perceived humanistic care; (C2) experience of workplace violence, lack of perceived humanistic care, low psychological resilience; and (C3) high work stress, lack of perceived humanistic care, poor health status. <bold>Conclusion:</bold> The development of work alienation among emergency nurses arises from the interactive and synergistic effects of multiple factors, with humanistic care plays a central and universal role. Nursing managers should formulate multidimensional and multi-path intervention strategies to reduce work alienation among emergency nurses based on varying contextual combinations, thereby promoting team stability and development. </p>