Associations Between Fatigue and Sleep Among Night‐Shift Nurses: Mediating Role of Depressive Symptoms and Social Support

BACKGROUND: This study examined the association between fatigue and sleep disturbance among night-shift nurses during the COVID-19 pandemic and the mediating roles of depressive symptoms and social support. METHODS: A cross-sectional survey was conducted involving 1667 night-shift nurses from multiple hospitals. The Pittsburgh Sleep Quality Index (PSQI), Fatigue Scale-14, Hospital Anxiety and Depression Scale, and Social Support Rating Scale were used for assessment. Correlation analysis and mediation effect analysis were performed using SPSS 26.0 and PROCESS macro. RESULTS: Poor sleep (PSQI ≥ 6) was reported by 70.7% of nurses. Increased workload (89.7%) and fear of infection (58.1%) were significantly associated with worse sleep (both p < 0.05). Fatigue correlated positively with depression (r = 0.607, p < 0.001) and sleep disturbance (r = 0.550, p < 0.001) and negatively with social support (r = -0.242, p < 0.001). Mediation analysis identified three pathways: depressive symptoms alone (30.25% of the total effect), social support alone (0.80%), and the sequential depression ⟶ social support path (2.23%). CONCLUSIONS: Among night-shift nurses, fatigue is directly and indirectly associated with poorer sleep quality via three mediating pathways: depressive symptoms alone, social support alone, and the sequential effect of depressive symptoms on social support. Interventions should address these pathways to improve sleep in night-shift nurses under high-load public health emergency contexts. IMPLICATIONS FOR NURSING MANAGEMENT: For night-shift nurses facing excess workload during public health emergencies, managers could adopt a tiered strategy: (1) optimize shift schedules to reduce fatigue and (2) strengthen peer and family support systems. Regular monitoring of sleep and fatigue indicators is recommended to evaluate intervention effectiveness under such high-stress contexts.