Contemporary health care is rapidly reorganizing around patient-centered care, and nurses stand at the forefront of this transformation. Psychiatric-mental health nursing, in particular, constitutes a distinctive environment in which symptom trajectories can change abruptly, behavioral crises may emerge without warning, and the formation of therapeutic relationships directly affects nursing work performance. Psychiatric nurses are routinely exposed to highrisk situations-such as delusions, hallucinations, and risks of self-harm or violence [1] -and face elevated risks of burnout and secondary traumatic stress [2]. In this context, nursing work performance functions not merely as an index of task execution but as a core performance indicator encompassing patient safety, recovery and rehabilitation, and organizational efficiency [3].

Nursing work performance refers to the extent to which nurses fulfill their roles and responsibilities for patients and thereby achieve organizational goals effectively and efficiently. It is a pragmatic outcome that has direct implications for nursing service quality, productivity, and client satisfaction [4]. Whereas general nursing performance emphasizes effective and efficient completion of expected clinical roles, psychiatric nursing work performance includes these general dimensions but is further characterized by intensive relational work, ethically complex decision-making under safety threats, and sustained emotional-cognitive labor required to maintain therapeutic engagement in high-stress situations [1]. Accordingly, identifying modifiable correlates of work performance is particularly important in psychiatric inpatient settings characterized by high relational and ethical demands.

Although communication competence, job satisfaction, and organizational commitment have been widely examined among clinical nurses, their relevance may be amplified in inpatient psychiatric nursing because core work processes are delivered through sustained therapeutic interaction and rapid coordination under safety threats [1]. Communication competence in this context is not merely an interpersonal skill but a functional resource that supports de-escalation, alliance building, and multidisciplinary coordination when symptoms and risks fluctuate [5,6]. Likewise, job satisfaction and organizational commitment may be more tightly linked to performance when psychiatric nurses must sustain engagement amid high emotional-cognitive labor and ethically complex judgments, where motivation and value alignment can influence persistence and consistency of care [2,7,8]. Therefore, evidence from other clinical units should not be assumed to generalize directly to psychiatric inpatient practice, and it is important to determine the relative influence of these factors in psychiatric nursing settings.

This issue is particularly salient in the South Korean context. South Korea has been reported to remain highly reliant on inpatient psychiatric care, with a large number of psychiatric beds and a service structure in which longterm hospitalization is more likely to occur [9]. In this context, national claims-based evidence in Korea indicates that psychiatric inpatient outcomes and care processes are meaningfully associated with nursing resources and staffing levels [10]. Moreover, stakeholder accounts regarding the operation of the Admission Review Committee suggest that, as hospitalization-related decisions become more proceduralized, ensuring safety and protecting rights, communicating and reaching agreement among stakeholders (including family members), and making ethically complex judgments may be required, with attendant procedural and ethical tensions [11]. Taken together, inpatient psychiatric nursing in Korea can be characterized as a high-demand practice environment in which risk assessment and crisis response, sustained communication and coordination with patients, families, and teams, and rightsbased practice are simultaneously required; thus, communication and work-related attitudes are plausibly salient resources supporting performance in this setting.

Using the job demands-resources (JD-R) model as a framework [12,13], this study evaluates the relative associations of modifiable organizational and psychological resources with nursing work performance in psychiatric inpatient nursing, where job demands are high. The JD-R model posits that high job demands require sustained effort and may generate strain, whereas job and personal resources foster motivation, positive work attitudes, and performance [12,13]. Within this framework, communication competence can be considered a functional resource supporting therapeutic engagement, de-escalation, and multidisciplinary coordination, while job satisfaction and organizational commitment represent motivational/attitudinal resources that may help sustain effective practice.

Accordingly, the present study aims to test the relative associations of communication competence, job satisfaction, and organizational commitment with nursing work performance among psychiatric nurses. By reflecting both the complexity of psychiatric practice and nurses' internal resources, this analysis is expected to provide practical directions for performance improvement and foundation evidence to support future research.

This study evaluated the relative associations of communication competence, job satisfaction, and organizational commitment with nursing work performance among psychiatric nurses. Communication competence, the organizational commitment subdimension sense of calling, and the job satisfaction subdimensions professional status and interaction were significantly associated with performance, with the largest association observed for communication competence. These findings highlight the contributions of interactional capability (communication competence) and motivation-/identity-related resources (sense of calling and perceived professional status) to performance in psychiatric inpatient practice.

Communication competence showed the strongest association with nursing work performance. In psychiatric settings-where sensitive interpretation of patients' nonverbal cues and affective responses [5,6], rapid decision making in crises [5,6], and close interprofessional collaboration [5] are continually required-communication functions as a core competency that extends beyond information transfer and shapes care quality. The present results are consistent with prior studies linking therapeutic relationship building and team-based collaboration to improved performance [5,6]. Communication competence has also been positively associated with nursing performance in non-psychiatric settings (e.g., ICUs and home healthcare), supporting communication as a broadly relevant performance resource [20,21]. In inpatient psychiatry, however, performance is enacted through continuous therapeutic interaction and rapid coordination under safety threats and ethically complex judgments, which may amplify the practical salience of communication competence and work-related attitudes. Accordingly, while prior evidence is informative, the present findings should be interpreted as setting-specific signals about which modifi-able resources may be most consequential for psychiatric inpatient nursing performance.

Among organizational commitment subdimensions, sense of calling (β=.30, p<.001) emerged as a robust correlate, albeit smaller than communication competence. This is consistent with the classic conceptualization of organizational commitment as identification with organizational values and willingness to exert effort toward organizational goals [18]. In inpatient psychiatric nursing, sense of calling may buffer emotional exhaustion and support the continuity of recovery-oriented, long-term care, helping to stabilize value orientation and professional identity amid frequent crises, negotiations with families, and ethically charged decisions [22-24].

The job satisfaction subdimensions professional status (β=.18, p=.012) and interaction (β=.14, p=.022) were also significant. This pattern suggests that stronger professional identity and the accumulation of positive interpersonal experiences are meaningfully associated with nursing work performance via everyday communication and collaboration in clinical units [6]. Given the relative magnitude of communication competence, initiatives to enhance job satisfaction are likely to be most effective when integrated with communication-focused strategies and organizational arrangements that reinforce role recognition and supportive team climates.

By contrast, head nurse or higher position (β=-.16, p=.045) showed a negative association with nursing work performance. Prior evidence more often examines unit manager leadership effects on staff outcomes, and position effects have not been consistent when modeled across samples [25]. Accordingly, this result is best interpreted as role-measurement misfit: the performance instrument emphasizes direct-care domains (e.g., application of the nursing process and care attitudes) and may under-represent managerial performance enacted through staffing, education, and safety/quality management [2,7,25]. This interpretation is also compatible with the higher univariable means in head nurse groups but a negative adjusted coefficient after accounting for reduced direct care and psychosocial covariates.

Autonomy (β=-.13, p=.038), often discussed as a positive component of professionalism [26], showed a negative association in the present study. Psychiatric inpatient nursing involves recurrent behavioral crises and ethically sensitive decisions, including balancing safety with autonomy and dignity when restrictive or involuntary measures are considered and negotiating confidentiality boundaries during family involvement under time pressure and uncertainty [24,25]. In such contexts, expanded autonomy without clear standards or support may increase responsibility load and role ambiguity, potentially relating to low-er work performance [26]. A practical form of "structured autonomy" is a tiered de-escalation pathway with predefined escalation triggers (e.g., Level 1: verbal de-escalation and environmental modification; Level 2: enhanced observation and team consultation regarding the use of prescribed PRN medication; Level 3: rapid-response activation and consideration of restrictive interventions under institutional policy). Brief pre-shift huddles and postincident debriefings can further standardize safety- and rights-sensitive decision-making while preserving clinical discretion.

Regarding general characteristics, three-shift work was more positively associated with performance than two-shift work (β=.14, p=.041). Evidence from other inpatient units is mixed, with reported trade-offs across staff outcomes rather than a uniform advantage of a single shift pattern [27]. International studies of extended shifts likewise report mixed associations with staff outcomes (e.g., burnout and intention to leave) [28]. Therefore, shift-pattern coefficients in cross-sectional models are best interpreted cautiously as descriptive associations that may reflect contextual staffing, seniority, role allocation, and case mix rather than causal effects, warranting confirmation using longitudinal and multilevel designs.

In sum, communication competence showed the strongest association with nursing work performance, complemented by sense of calling, professional status, and interaction. Because these findings are based on associational analyses, organizational-context variables (e.g., work type and position) should be interpreted in light of operational practices and the measurement focus of the instrument. For practice, communication-centered strategies-supported by role recognition and collaborative climates-may be useful in psychiatric inpatient settings.

This study has several strengths. First, it integrates organizational-psychological factors pertinent to psychiatric practice within a single regression framework, enabling comparisons of relative magnitudes (β). Second, by sampling nurses from six institutions, it encompasses institutional and regional heterogeneity, enhancing external validity and generalizability. Third, beyond core psychosocial factors, it also considers general characteristics (e.g., work type, position, certification), providing a comprehensive view of organizational and job contexts associated with performance.

Several limitations should be acknowledged. First, because data were collected at a single time point, causal relationships cannot be established. Second, convenience sampling across multiple institutions may have left hospital-level clustering insufficiently controlled. Third, managerial performance may have been underrepresented by a direct-care-oriented tool, potentially overestimating negative associations for managers. Fourth, key variables were measured by self-report, with possible social desirability and self-referential bias. Fifth, the internal consistency of some instruments was lower than reported in prior studies (e.g., communication competence ⍺=.75; organizational commitment ⍺=.73), which may have increased measurement error and attenuated associations; thus, results involving these measures should be interpreted cautiously. Future research should apply multilevel modeling reflecting hospital type and unit characteristics to control institutional effects; combine objective performance indicators (e.g., supervisor ratings and patient outcomes) with self-reports; develop and validate instruments that include manager-role indicators (retention, roster optimization, safety/quality); and update measurement to align with contemporary psychiatric nursing practice to improve measurement-practice fit.

This study indicates that nursing work performance in psychiatric settings is explained within a multidimensional context combining communication competence, job-related attitudes (professional status and interaction), and an organizational factor (sense of calling). Limiting performance discussions to individual training risks underestimating the influence of unit operations and the measurement system; moreover, the performance of managerial roles is unlikely to be adequately captured by directcare-focused indicators alone. These interpretations are based on associative analyses and should be considered in light of the study's cross-sectional design, reliance on self-reported measures, and the possibility that betweeninstitution variation was not fully accounted for.

Building on these results, improvement of nursing work performance is likely to be more effective when individual competency development is coupled with unit-level communication operations, the adoption of a multi-axis performance framework that reflects managerial roles, and a transition toward measurement-feedback-improvement cycles. Conceptually, systems in which training-enhanced communication competence is linked to unit indicators and routinely fed back at the organizational level are appropriate, and managerial performance is more validly assessed using indicator sets that include workforce, operations, safety, and quality.

Future validation would benefit from prospective, multi-site multilevel designs in parallel with objective performance indicators. Standardization and validation of instruments suited to psychiatric nursing-particularly measures of communication competence, team interaction, and structured autonomy-constitute important next steps.