Association between obsessive-compulsive symptoms and job performance among hospital nurses: a cross-sectional study

In modern healthcare, nurses’ performance is crucial for patient safety and hospital efficiency [1]. Psychological factors, particularly obsessive-compulsive (OC) symptoms, characterized by intrusive thoughts and repetitive behaviors, can affect job performance in high-stress professions like nursing [2, 3]. These symptoms may impair cognitive functioning, emotional regulation, and interpersonal interactions, which are essential in demanding clinical settings [4].

Obsessive-Compulsive Disorder (OCD) is a chronic anxiety-related condition involving persistent thoughts and ritualistic behaviors [5]. Subclinical OC symptoms are also common in the general population and can affect daily functioning and occupational performance [6]. In hospital settings, even mild OC tendencies may influence nurses’ job performance, positively or negatively, due to demands on precision, time management, emotional resilience, and teamwork [7, 8].

Job performance is a multidimensional construct reflecting how well employees fulfill their responsibilities [9]. In nursing, it encompasses clinical competence, communication, adherence to safety protocols, decision-making under pressure, and emotional responsiveness [10]. Cognitive or emotional burdens, such as OC symptoms, can therefore affect performance outcomes [3].

Several studies indicate that mental health issues, including anxiety, depression, and burnout, can significantly reduce nurses’ productivity and job satisfaction [11‐13]. However, there is a paucity of empirical studies focusing specifically on the association between distinct OC symptom subdimensions, such as checking, ordering, and intrusive thoughts, and job performance within nursing populations. These subdimensions were selected because they may be theoretically and clinically relevant to occupational functioning in high-demand environments like hospitals. For instance, checking behaviors may lead to time-consuming rituals, ordering may affect task prioritization and workflow efficiency, and intrusive thoughts may impair concentration and decision-making [14‐16]. Focusing on these subdimensions allows for a more nuanced understanding of how specific OC tendencies could influence nurses’ cognitive, emotional, and interpersonal performance in professional settings.

Most available studies have either considered OCD in clinical terms or examined broader constructs like psychological distress without isolating these specific symptom categories in nurses. This lack of focused research represents a notable gap in the literature. While some traits associated with OC symptoms, such as attention to detail or perfectionism, might hypothetically enhance job performance in structured environments like hospitals, the maladaptive aspects of these symptoms, such as indecisiveness, doubt, and excessive checking, could hinder efficient task completion and interpersonal communication [14]. Therefore, the dual nature of OC symptoms, both adaptive and maladaptive, warrants empirical investigation within professional settings.

Moreover, nursing is exposed to stressors such as emotional labor, shift work, and constant patient responsibility [15], which can exacerbate OC symptoms and their impact on job performance [16, 17]. In regions with nurse shortages or high turnover, understanding psychological factors affecting performance is crucial for healthcare management.

This study addresses the research gap by examining how OC symptoms are associated with job performance among hospital nurses. Using a regression-based analytical approach, it aims to assess the direction and strength of this relationship while controlling for demographic and occupational factors. Findings may inform mental health screening, targeted interventions, and supportive workplace practices for nurses with OC symptoms.

This study is significant for several reasons. First, it focuses on a specific yet understudied psychological factor, OC symptoms, and examines its relevance to job performance, a critical outcome in occupational health research. Second, it targets a key professional group, hospital nurses, who serve as the backbone of healthcare systems and whose job performance directly affects patient safety and quality of care. Third, the study employs a quantitative method, regression analysis, to provide empirical evidence regarding the association of OC symptoms with job performance. By addressing these points, the research not only contributes to the literature on mental health in the workplace but also offers practical insights for interventions aimed at enhancing both nurse well-being and hospital performance.

This study is grounded in Cognitive-Behavioral Theory (CBT) and Occupational Health Psychology (OHP). CBT suggests that OC symptoms stem from maladaptive thoughts and behaviors, such as threat overestimation and perfectionism, which can impair decision-making, flexibility, and task prioritization, key skills for nursing performance [18, 19].

From an occupational psychology perspective, Job Demands-Resources (JD-R) Model can also be applied. OC symptoms may act as internal job demands that drain psychological resources, leading to reduced task efficiency and emotional exhaustion. Conversely, in some cases, traits like hyper-responsibility or orderliness (often associated with OC tendencies) might serve as personal resources enhancing task accuracy and attention to detail [20, 21]. The dynamic interplay between these aspects makes the relationship complex and context-dependent.

Therefore, this study hypothesizes that OC symptoms, especially when manifesting in maladaptive forms, are negatively associated with job performance among nurses. This theoretical lens allows for a nuanced interpretation of results and guides the development of the hypothesis.

Based on the literature review and theoretical considerations, the following hypothesis is proposed:

This hypothesis assumes that the cognitive and behavioral impairments associated with OC symptoms, such as time-consuming rituals, difficulty concentrating, and increased mental fatigue, interfere with the timely and efficient execution of nursing tasks. By empirically testing this hypothesis through regression analysis, the study aims to contribute to evidence-based strategies for supporting mental health in clinical workplaces.

This study aimed to investigate the association between OC symptoms and job performance among hospital nurses.

The results indicated that the nurses in this study experienced a moderate level of OC symptoms, a finding consistent with previous research. For example, Shamloo et al. (2022) reported that hospital-based nurses often display moderate OC tendencies due to their ongoing exposure to infection risks, responsibility for life-saving tasks, and frequent emotional strain [24]. Similarly, Moradi et al. (2021) found that nurses working in emergency and critical care units often show heightened obsessive behaviors such as excessive checking or intrusive thoughts, which are commonly triggered by the fear of making clinical errors [25]. Regarding job performance, the nurses in the current study exhibited a moderate level of occupational functioning, closely approaching the threshold of good performance. This aligns with findings from Cheraghi et al. (2025), who concluded that job performance in nursing populations often remains moderate when workload, shift instability, and emotional labor persist in the work context [26]. Together, these comparisons suggest that while hospital nurses generally strive to maintain functional performance levels, underlying psychological stressors such as OC symptoms may act as hidden impediments. In contrast, according to part of the findings of the study by Ergenc et al. (2020), the nurses under study had high levels of OC symptoms [27]. In another study, Elsayed et al. (2021) reported that nursing students had low levels of OC tendencies [28]. This discrepancy in the results of different studies may be due to differences in the study samples, organizational culture, and contextual conditions such as economic, political, and cultural factors.

An important contribution of this study lies in the identification of significant negative correlations between OC symptoms and job performance, observed both in total scores and across all OCD subdimensions. This finding aligns with previous evidence by Bragdon et al. (2018), who reported that specific OCD symptom dimensions, such as checking, obsessing, and ordering, are negatively associated with cognitive domains critical for occupational functioning, including working memory and cognitive flexibility [29]. Similarly, Mancebo et al. (2008) demonstrated that OCD severity was a strong predictor of occupational disability, with a substantial portion of affected individuals unable to maintain employment due to the impact of their symptoms [30]. The current study extends these insights by confirming that not only do OC traits correlate with diminished performance, but this pattern holds true across various symptom domains, suggesting a broad and consistent psychological burden that undermines day-to-day clinical functioning. However, the findings in the existing literature are not entirely consistent. Several studies report no strong or consistent correlation between OC symptoms and job performance [31‐38]. For instance, Frydman et al. (2020) and De Putter & Koster (2018) found that cognitive traits like impulsivity and attentional control issues did not significantly impair work functioning [35, 36]. Similarly, Stasik et al. (2012) and Moulding et al. (2014) emphasized that the impact of intrusive thoughts depends heavily on how individuals interpret and respond to them [37, 38], suggesting that symptoms alone do not determine functional outcomes. Moreover, Kontis et al. (2016) reported better functioning among individuals with OC symptoms in schizophrenia, proposing that traits like orderliness may be advantageous in some structured settings [33]. Pajouhinia et al. (2020) also highlighted the protective role of cognitive flexibility in moderating the impact of OC symptoms on functioning [32]. These inconsistent findings can be better understood through considering several theoretical and contextual moderators. For instance, cultural factors may influence how OC behaviors are perceived and managed in the workplace; in some cultures, certain compulsive traits such as meticulousness and attention to detail might be socially valued and positively linked to job performance. Similarly, organizational context, including workplace support, job demands, and role expectations, can moderate the impact of OC symptoms on performance. Nurses working in highly structured and supportive environments may experience fewer negative effects of OCD symptoms on their work outcomes. Moreover, individual differences such as personality traits, coping styles, and cognitive flexibility can also buffer or exacerbate the influence of OC symptoms on job performance. For example, nurses with high resilience or adaptive coping may maintain performance despite symptoms, whereas others may struggle more. Methodological variations across studies, including differences in sample characteristics, assessment tools, and statistical approaches, further contribute to the heterogeneity of findings.

The regression analysis further validated the significant association of OC symptoms with nurses’ job performance. Specific symptom domains, including checking compulsions, impulsive and intrusive thoughts, and ordering behaviors, were particularly influential. This finding is consistent with results from Hirschtritt et al. (2017), who found that checking compulsions and intrusive thoughts were significant negative predictors of work efficiency and decision-making performance in healthcare professionals [34]. Similarly, Wang et al. (2024) reported that ordering behaviors and intrusive thoughts significantly undermined occupational functioning and clinical judgment among nurses, particularly during the COVID-19 pandemic [2]. The associative value of these symptoms reinforces the idea that targeted mental health support, such as cognitive-behavioral interventions, should address not just general distress but specific OCD dimensions known to impair job functionality. Moreover, the presence of significant associations across multiple dimensions underscores the multifactorial nature of the psychological mechanisms at play, suggesting that interventions must be comprehensive rather than symptom-specific. On the other hand, findings from several studies have shown that OC symptoms, particularly checking compulsions, intrusive thoughts, and ordering behaviors, despite their individual impact, were not significant predictors of nurses’ job performance in regression analyses. These results suggest that although such specific OC symptoms may be present, they do not directly affect job performance according to these studies [35‐38]. A possible reason for the inconsistency between the findings of these studies and the present study may be the differences in study populations derived from different contextual backgrounds.

Nevertheless, it should be noted that OC symptoms alone do not fully explain variations in nurses’ job performance. Other psychological and organizational factors may play equally important roles. For example, burnout has been identified as a critical determinant of performance in healthcare settings, with emotional exhaustion and depersonalization directly impairing nurses’ effectiveness [39]. Similarly, organizational support, including adequate staffing, managerial support, and access to professional resources, has been shown to buffer psychological strain and enhance performance outcomes [40]. Additional factors such as work engagement, resilience, and leadership style may also contribute to nurses’ occupational functioning. These considerations suggest that while OC symptoms are important associative factors, they represent only one part of a more complex explanatory framework that requires attention in future studies.

Demographic factors also played a meaningful role in shaping both OC tendencies and job performance. Age and professional experience were inversely associated with OC symptoms and positively related to performance. This aligns with findings from Yagci, et al. (2022), which showed that OC symptom scores among healthcare workers decreased significantly over a 12‑month period, suggesting that as professionals gain experience and adapt to stress, their compulsive tendencies decline [41]. One possible explanation for this is that with age and accumulated experience, nurses develop better coping mechanisms and resilience, which in turn reduces stress-related symptoms such as OCD. Additionally, more experienced nurses may feel more confident and secure in their roles, contributing to improved job performance and lower OC tendencies. In contrast, a study conducted moderation analyses to determine whether age moderates the relationship between cognitive and metacognitive beliefs and the severity of OCD. Age did not significantly moderate this relationship [42]. Differences in personality traits, beliefs and attitudes, as well as the varying experiences of different study populations, may explain the inconsistency between these studies and the findings of the present research.

Gender differences were also observed, with female nurses showing slightly higher OC symptoms. This finding aligns with Shamloo et al. (2022), who found that female nurses had significantly higher scores on OC symptoms compared to their male counterparts [24]. This gender disparity could stem from a combination of societal and biological factors. Societally, women often face additional caregiving responsibilities and social expectations, which may increase overall stress and vulnerability to OC symptoms. Biologically, hormonal differences and neurobiological factors might contribute to a higher prevalence of OCD symptoms in females. However, gender was not significantly related to job performance, suggesting that despite experiencing higher psychological strain, female nurses may compensate through greater professional dedication, conscientiousness, and effective coping strategies.

Education level showed a significant difference in job performance, favoring nurses with Master’s degrees. Gunawan et al., (2020) also demonstrated in their study that nurses with higher education levels (such as a Master’s degree or higher) exhibit better clinical competence compared to those with lower educational qualifications [43]. In explaining the inconsistency between the findings of some studies and those of the present study, one study reported no significant relationship between nurses’ overall knowledge and their performance in tracheal tube suctioning. These findings suggest that higher education does not necessarily lead to improved job performance [44]. Moreover, a systematic review found that in some studies, nurses with lower levels of education reported better quality of work life compared to those with higher education levels. This highlights the complexity of the relationship between education and job performance [45]. Possible reasons for the discrepancies among study findings may include differences in the type and quality of education, environmental and organizational factors, individual and psychological characteristics, and nurses’ work experience.

Type of employment was another influential factor, with permanently employed nurses reporting better job performance and fewer OC symptoms. This finding is supported by a cross-sectional study conducted in Finland, which revealed that permanently employed nurses exhibited higher levels of work well-being and job performance, along with fewer psychological symptoms, compared to their temporarily employed counterparts [46]. Regarding the significant effect of type of employment, it is plausible that job stability associated with permanent employment reduces occupational stress and anxiety, thereby lowering OC symptoms and enhancing job performance. Permanent employees might benefit from greater organizational support, predictable work schedules, and increased job security, which could protect mental health and allow for better focus and dedication to work tasks. This highlights the important role of job stability as a potential buffer against psychological distress in high-stress professions such as nursing.

This study demonstrated that OC symptoms are significantly and negatively associated with job performance among hospital nurses. The findings highlight that not only are these symptoms prevalent at a moderate level among nurses, but they also substantially interfere with their professional functioning. Among the dimensions examined, compulsive checking, intrusive thoughts of harm, and ordering behaviors appeared to exert the most considerable detrimental associations. Moreover, demographic characteristics such as age, work experience, education level, gender, and employment type were associated with variations in both OC symptoms and job performance. Collectively, these results emphasize the psychological burden faced by nurses and the need for greater institutional and mental health support.