Objectives: Work stress is a threat to the well-being of nurses in China and also globally, and many studies have been conducted on the risk factors for stress symptoms. However, research on the process and mechanism between work environment risk factors and perceived stress symptoms among nurses remains limited. This study aimed to examine the direct and indirect relationships between nurse-rated structural empowerment, professional competence, thriving and nurses' perceived stress symptoms.

Design: This was a cross-sectional correlational study.

Setting and participants: This study was conducted between April and October 2023, and 2172 nurses at three general hospitals in a Chinese province were recruited.

Method: A questionnaire that included demographic information, the Conditions of Work Effectiveness Questionnaire, the Nurse Professional Competence Scale, the Thriving at Work Scale and one factor from the Psychosomatic Health Aspects Questionnaire that measured perceived stress symptoms was used. The PROCESS macro (model 4) with a parallel mediation model and bootstrapping tests was conducted to examine the direct and indirect relationships of structural empowerment, professional competence and thriving at work on perceived stress symptoms.

Result: The regression analysis showed that structural empowerment, professional competence and thriving at work were negatively related to stress symptoms (β=-0.42, p<0.001; β=-0.06, p=0.009; β=-0.28, p<0.001, respectively), after controlling for marital status (yes/no), clinical experience and night shift (three groups). The results of the bootstrap analysis with a parallel mediator model revealed indirect relationships between structural empowerment and stress symptoms through both professional competence and thriving at work (β=-0.033 (95% CIs -0.059 to -0.009); β=-0.164 (95% CIs -0.204 to -0.126), respectively).

Conclusions: Structural empowerment was related to stress symptoms both directly and indirectly via professional competence and thriving at work. The findings suggest that managers should alleviate nurses' stress symptoms through measures aimed at providing access to empowering structures, strengthening professional competence and promoting thriving at work.