This was a cross-sectional study, and the reporting of this study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist[19].

The general information questionnaire was designed by the researcher by reviewing the literature and included thirteen variables, including gender, age, marital status, nature of employment, education level, operating room-related working experience, technical title, administrative position, whether the operating room specialist nurse certificate (municipal level and above) has been obtained, whether the person has participated in study abroad or further training (a total of ≥ 1 week), whether he has participated in teaching, scientific research and other activities, whether he has a personal career plan, work pressure, etc.

Nurse Job Remodeling Scale was developed by Dvorak[24] in 2014 and adapted for Chinese use by Chinese scholar Zhu Shixiao[25]. It comprises three dimensions: Cognitive Redesign (7 items), Relational Redesign (7 items), and Task Redesign (7 items), totaling 21 items. The scale employs a 5-point Likert scale ranging from “Strongly Disagree” (1 point) to “Strongly Agree” (5 points). The total score ranges from 21 to 105 points, with higher scores indicating greater levels of work reshaping among nurses. The scale's Cronbach's α coefficient is 0.92. In this study, the overall Cronbach's α coefficient for the scale was 0.959.

A total of 334 operating room nurses were surveyed in this study, including 51 males (15.3%) and 283 females (84.7%). Age 21 ~ 59 (34.6 ± 7.65) years old. Table 1 shows the demographic characteristics of the sample population and the results of the univariate models. The CIRN and N-RS scores are presented in Table 2. This study revealed that the total core competency score for operating room nurses in Southwest China was 173.15 ± 28.90. Notably, the highest-scoring dimension was Legal/Ethical Practice (30.27 ± 5.73), while Critical Thinking/Research Competency scored the lowest (18.43 ± 3.46).

In the latent profile analysis, this study employed the seven dimensions of the Operating Room Nurse Core Competency Scale as manifest indicators, fitting a total of 2 to 5 models. The model fitting results are presented in Table 3. Three models were selected as the optimal number of categories for the following reasons: (1) Lower AIC, BIC, and aBIC values indicate better model fit for Model 3; (2) Both LMR and BLRT tests were statistically significant (P < 0.05), demonstrating classification significance; (3) The corresponding model entropy value was 0.962, exceeding 0.80, indicating approximately 90% classification accuracy; (4) The average membership probabilities for the three-category profile are 99.3%, 97.0%, and 97.0%, respectively, all exceeding 85%, indicating high discriminative power. (5) The minimum profile share for the 4- and 5-category models was less than 5%, making them unsuitable as standalone profiles. Based on the above analysis and the practical significance of model classification, Model 3 was selected as the optimal model. Subsequently, each latent category was named according to its manifest characteristics across the seven dimensions of core competencies, as shown in Fig. 1. The three categories in Model 3 were named “Basic Group,” “Advanced Group,” and “Professional Group.”

Table 1 presents the univariate analysis of demographic data and comparisons among operating room nurses with different categories of latent core competencies. Results indicate statistically significant differences (P < 0.05) in gender, age, educational attainment, years of service, technical title, administrative role, operation room specialized nursing certification status, work stress, Job Remodeling, and scores across the three dimensions. Please refer to Table 1.

Using the three latent dimensions of core competencies for operating room nurses as dependent variables (C1= “Advanced Group”, C2= “Basic Group”, C3= “Professional Group”), statistically significant variables were incorporated as independent variables. with job remodeling

scores entered as raw totals. Comparison between C1 (Advanced Group) and C2 (Basic Group): Multivariate analysis indicates that educational level is significantly correlated with whether one belongs to the basic group (compared to the advanced group). Specifically, nurses with a diploma or below (OR = 0.096, P = 0.033) and those with a bachelor's degree (OR 0.003, P = 0.003) are less likely to be classified into the basic group (C2) compared to the advanced group; in other words, those with these educational qualifications are relatively more likely to be in the advanced group (C1), while those with a master's degree or above are more likely to be in the basic group. Please refer to Table 4.

C3 (Specialist Group) Compared with C1 (advanced group, reference group: C1): After controlling for other covariates, the comparison conducted with the advanced group as the reference revealed several significant protective and risk factors: junior nurses (OR = 0.093, P = 0.004) and chief nurses (OR = 0.255, P = 0.038) significantly reduced the probability of being classified into the professional group. On the contrary, nurses with the title of "deputy chief nurse/ chief nurse" in the operating room were more likely to be classified into the professional group compared to the advanced group. This indicates that the technical title has a strong protective effect on maintaining or enhancing clinical competence. However, it is worth noting that higher working years (≥ 20 years) significantly reduced the probability of being classified into the professional group. Specifically, nurses with less than 5 years of experience (OR = 8.685, P = 0.014), 6–11 years (OR = 4.451, P = 0.046), and 16–20 years (OR = 4.341, P = 0.038) were more likely to be classified into the professional group (C3) rather than the advanced group (C1) compared to nurses with long-term (≥ 20 years) clinical experience. These findings indicate that working years and professional titles have independent effects on category classification. Please refer to Table 4.

Pearson correlation analysis was employed to evaluate the relationships between the dimensions of core competencies for operating room nurses and the dimensions of job remodeling (see Table 5). Results indicated a strong positive correlation between the total core competency score and the total job remodeling score (r = 0.826, P < 0.01). Each dimension of core competencies showed significant positive correlations with all three dimensions of job remodeling (cognitive remodeling, relational remodeling, and task remodeling), with correlation coefficients ranging from moderate to strong. Taking the total core competency score as an example, the correlation coefficients with cognitive, relational remodeling, and task remodeling were r = 0.719, r = 0.742, and r = 0.769 (all P < 0.01), respectively. This indicates that higher core competencies correlate with higher levels of job remodeling among nurses.

A one-way ANOVA was conducted to compare the total job remodeling scores and scores across dimensions among the three nurse groups categorized by latent profiles (Advanced Group C1, Basic Group C2, Professional Group C3). The ANOVA results revealed significant differences in cognitive remodeling (F = 3.824, P = 0.023), relational remodeling (F = 4.328, P = 0.014), task remodeling (F = 3.400, P = 0.035), and total job remodeling scores (F = 4.328, P = 0.014) differed significantly across groups (see Table 6). Post hoc pairwise comparisons revealed a gradient pattern of intergroup differences: the professional group (C3) scored significantly higher than both the advanced group (C1) and the basic group (C2) on the total job remodeling score and all three dimensions. Overall, a “C3 > C1 > C2” gradient relationship emerged across the three categories, indicating a positive correlation between core competency characteristics and job remodeling levels, with hierarchical differences present.

Nurse core competencies are important competencies necessary for nurses. They are also the comprehensive capabilities that nurses must possess to identify educational needs, ensure quality assurance, and conduct workforce planning and human resource management[28]. As one of the more special departments in the hospital, The core competency of nurses is the important indicators that reflects the professionalism of operating room nurses[29, 30]. This study is based on the questionnaire data of 334 operating room nurses from 13 tertiary hospitals in the southwest region. The results show that the overall core competencies of nurses are at an upper-middle level, which is consistent with research by domestic scholars such as Cheng Lixin. It shows that the core competencies of operating room nurses in southwest region are strong. However, the dimensions of core competencies are significantly uneven: the legal/ethical practice and professional development dimensions have the highest scores, consistent with reports by scholars such as Huang Qianyu[31]. in recent years, as my country's nursing practice supervision and medical legal systems have become increasingly improved, legal/ethical related knowledge has become compulsory and often emphasized. Hospital managers have also regularly strengthened nurses' legal awareness and compliance practices through standardized institutional processes and case discussions. In addition, the emergence of new information media such as artificial intelligence has also improved the accessibility of legal knowledge to operating room nurses[32, 33]. This improves the score of this dimension. Secondly, the relatively high scores in professional development may reflect clear pathways for job qualifications, specialty certification, and career advancement within operating room practice. These external incentives motivate nurses to engage in continuing education and professional capacity building, thereby enhancing indicators related to professional development. In contrast, lower scores in critical thinking/research capabilities align with findings reported by Morrison[34] scholars. This competency represents advanced cognitive and academic skills requiring systematic curriculum design, research methodology training, and sustained practice with reflection[35]. However, current nursing education and hospital-based training predominantly emphasize skill acquisition and standardized procedures, with insufficient systematic cultivation of this capability. On one hand, the operating room environment demands rapid work pace, immediate task execution, and high stress levels. On the other hand, many frontline clinical nurses lack formal research training, resulting in insufficient mastery of research knowledge and methodologies[36]. Even for those who have received basic research methodology training, translating theoretical approaches to address specific operating room challenges remains challenging, further diminishing nurses' confidence in their research capabilities. Research capabilities are closely linked to critical thinking skills. A study of nursing undergraduates revealed a positive correlation between their critical thinking scores and overall research competency scores[37]. This suggests that nursing administrators could implement problem-based learning through courses such as case discussions and simulated emergency decision-making drills to foster a virtuous cycle between critical thinking and research capabilities[38].

This study divided the core competencies of operating room nurses into three types, namely basic group, advanced group, and professional group, indicating that there is group heterogeneity in the core competencies of operating room nurses. Among them, the basic group accounts for 10.2%. This category of nurses lacks work experience and faces various challenges such as transformation impact and work pressure[39]. Their knowledge and skills are insufficiently prepared and their psychological quality is biased. It is recommended that nursing managers give priority to providing basic skills and psychological support to new nurses, implement the strategy of "paired teaching and protective learning time" to reduce workload, and at the same time set short-term achievable ability goals to enhance the sense of achievement[40, 41]. Nurses in the advanced group account for 63.2%. Most of these nurses hold administrative positions in the department and often participate in hospital management, teaching and quality improvement work. Most of these nurses have experience studying abroad. Through out-of-hospital further education and special training, these nurses can be exposed to advanced surgical nursing standards and management concepts, The knowledge, skills and professional abilities related to operating room nursing have been improved[42]. this type of nurses has a high level of job remodeling, and nurses can learn more proactively, take responsibility and optimize nursing practices, thereby transforming the potential given by the platform and training into their own core competencies. The proportion of nurses in the professional group is 26.7%. This type of nurses mainly has high seniority and holds a specialist nurse certificate in the operating room. They show strong clinical practice ability and professional literacy. Their long-term accumulated clinical experience enables them to have a high degree of proficiency and judgment in key aspects such as operating room work. They have high investment in work, and high work investment is closely related to the core competencies of nurses[43].

This study identified individual heterogeneity in the core competencies of operating room nurses through LPA analysis. The findings established three distinct profiles of core competencies and further investigated influencing factors, with particular focus on educational attainment, technical professional title, and years of experience.

The research revealed that nurses with educational levels below bachelor's degree exhibited a significantly lower likelihood of belonging to the foundational group, though the difference was not significant compared to the specialized group. Specifically, nurses with associate or bachelor's degrees were 0.096 and 0.003 times as likely to belong to the foundational group as those with master's degrees, with p-values of 0.033 and 0.003, respectively. Operating room nurses holding master's degrees or higher were more likely to fall into the foundational group, indicating that educational attainment significantly influences nursing core competencies. We hypothesize that structural biases within the educational system may underlie this phenomenon. While higher education provides nurses with robust theoretical foundations, research capabilities, and critical thinking skills, it cannot fully replace the long-term experience accumulated in complex clinical settings like operating rooms[44–47]. Within China's nursing master's education system, particularly for academic-oriented master's programs, the primary objective has long been cultivating research talent. Curriculum design and training programs emphasize theoretical research, while training and assessment standards for clinical practice skills remain relatively vague or inadequate[48]. Even for the Master of Nursing Science (MNS) program, designed to cultivate clinical specialists, its clinical practice training model remains in an ongoing phase of exploration and refinement[49]. A large-scale survey of 670 master's-level clinical nurses nationwide conducted in 2018–2019 explicitly indicated that while the core competencies of China's master's-level clinical nurses are generally at a high level, their scores in the dimensions of “clinical nursing practice ability” and “consultation and guidance ability” were relatively low[50]. Second, the “transition shock” and ambiguous role positioning further exacerbate this issue. Undergraduate and associate degree graduates follow relatively direct career paths, enabling them to enter a specialized field earlier. Through 2–3 years of clinical rotations and deep immersion, they establish solid clinical experience and skill systems. In contrast, most nursing master's students in China are recent bachelor's graduates who choose to pursue further education. Entering the master's degree phase, they inherently lack the clinical experience of their associate or bachelor's counterparts. When they discover their “clinical skills” fall short of even some experienced associate or bachelor's nurses, a significant psychological gap and sense of professional crisis emerge[39, 51, 52]. Compounding this, hospital administrators may fail to clearly define their roles or manage expectations appropriately, instead viewing them as “jack-of-all-trades” professionals. Assigning them heavy clinical, research, teaching, and even administrative responsibilities forces them to juggle multiple roles, preventing mastery in any single area and consequently undermining the depth and proficiency of their clinical practice. The solution lies in establishing a differentiated, integrated system for talent development and utilization. The education sector should deepen reforms in nursing master's programs, particularly professional degree programs, strengthening clinical practice training and establishing scientifically designed curricula and assessment standards closely aligned with clinical job requirements. Second, nursing administrators should engage in reasonable role positioning and expectation management for master's-level nurses, focusing on their clinical adaptation period. This involves providing more practice-oriented pre-service or on-the-job support to mitigate short-term “fundamentalization” resulting from role transitions, thereby facilitating a smooth transition phase. Third, healthcare institutions must avoid simplistic assumptions based solely on academic credentials when designing staffing and career development pathways. Instead, personalized development plans should be tailored to both positional requirements and individual career trajectories.

This study also examined the potential impact of the influencing factor "technical title". The title of a nurse is an important indicator for predicting their classification into different core competence categories. Compared with the "basic group" and the "advanced group", nurses with the title of "deputy chief nurse and above" have a higher probability of being classified into the "professional group" than those with the title of "senior nurse". This result strongly demonstrates the positive correlation between technical title and core competence category, that is, the higher the title, the more likely the nurse's core competence tends to reach the expert level. This is consistent with the results of researchers such as Chen Xia[23]. As a core step in the career development of nursing, technical title is the result of the continuous accumulation and systematization of professional knowledge, clinical experience and practical ability in the career of nurses. In the current nursing technical title evaluation system in China, from senior nurse to chief nurse, and then to deputy chief nurse and chief nurse, not only are there clear requirements for working years, but more importantly, they need to pass strict examination and/or review standards at each stage[53]. The research results clearly reveal a significant and robust positive relationship between the technical title of operating room nurses and their potential core competence categories. Future nursing management should pay more attention to precise training based on technical title and ability stratification. For the largest proportion of senior and chief nurses, the training focus should be on consolidating the foundation, while for nurses with senior titles, training should expand to higher-level abilities and regular assessments should be conducted. This precise investment can not only effectively improve training efficiency, but also promote the rational utilization of human resources and provide a clear upward channel for the career development of nurses.

The length of working experience also has a notable non-linear relationship with core competence. Specifically, compared with nurses with long-term working experience (≥ 20 years), nurses with working experience in different intervals (< 5 years, 6–11 years, 16–20 years) are more likely to be classified as the "professional group" (OR values are 2.162, 1.493, and 1.468 respectively, all P values < 0.05). This result indicates that the middle and short-term experience group is more likely to enter the professional group, while long-term workers (≥ 20 years) are less likely to be in the professional group. Stephen PR's career development theory suggests that after the individual's career reaches maturity, they will enter the career decline stage[54]. We speculate that skill solidification and occupational burnout are important factors affecting the core competence of senior nurses. These nurses, due to their relatively long career spans, are prone to experiencing a decline in physical condition, occupational burnout, and possibly developing a relatively fixed work pattern and thinking habits[55–57]. The operating room is different from other departments. With the rapid development of modern surgical techniques, the working patterns of operating room nurses have undergone fundamental changes, which makes it difficult for them to adapt to the rapidly developing surgical techniques and concepts[58, 59]. During the initial and middle stages of entry (especially within 5–20 years), nurses are at the peak of technical accumulation and ability improvement. They frequently participate in clinical tasks and continuing education, and can quickly master and demonstrate professional skills, thus being more likely to be classified as the professional group[60]. Additionally, differences in the era and educational background can also explain this phenomenon. Different age groups have certain differences in the education system and training opportunities. Nurses who received education within the past two decades may have been exposed to more modern nursing techniques and evidence-based practice, thus having certain advantages in some professional ability indicators.

The results of the correlation analysis show that the total score of core competencies and each dimension of operating room nurses are moderately to highly positively correlated with the total score and each dimension of job crafting. Among the three potential categories divided based on the scores of the seven dimensions of core competencies, the mean values of job crafting levels show a clear gradient distribution: professional group (C3) > advanced group (C1) > basic group (C2). This result initially indicates that nurses with stronger core competencies are more inclined to actively reshape their own tasks, relationships, and cognition to better adapt to personal needs and organizational goals. This conclusion is consistent with the positive correlation (r = 0.436, P < 0.01) found by Xue Limei et al. in respiratory nurses[18]. From the perspective of the Conservation of Resources Theory (COR), core competencies are valuable personal resources for nurses to cope with work challenges and maintain career development, which can enhance self-efficacy and psychological capital[6, 61, 62]. They not only buffer the loss caused by work pressure but also stimulate nurses' motivation and ability to engage in job crafting [2–4]. Research shows that job crafting can significantly enhance nurses' work engagement, job satisfaction, and reduce job burnout and turnover intention[63, 64]. Nurses with high levels of job crafting are better at optimizing the balance between "job demands and job resources"[65, 66]. For example, they can use their professional knowledge and influence to actively optimize surgical procedures (alter tasks), or establish more harmonious collaborative relationships with team members (alter relationships), or change their perception of repetitive work (alter cognition) to achieve the best match between themselves and their work, thereby creating more resource gains for the organization. Therefore, nursing managers should establish a hierarchical training and management system based on core competencies. For nurses in the "professional group" category, managers should provide more authorization and display platforms. For nurses in the "basic group" and "advanced group" categories, regular communication should be conducted to help them build confidence and jointly formulate personalized career development plans. In addition, managers should foster a team culture atmosphere of active communication and collaboration within the organization, encouraging nurses of all categories to communicate and provide feedback actively. Regular case discussion meetings and team-building activities should be organized to promote the sharing of experiences and emotional support among members. When nurses feel that their improvement suggestions are valued, their willingness and ability to engage in job crafting will also increase.

Although this study provides valuable insights into the development of core competencies for operating room nurses, there are several limitations. First of all, this study only selected operating room nurses from tertiary-level hospitals in southwest China as the research subjects. The sample source is relatively concentrated and may not fully represent the characteristics of operating room nurses in different regions and hospitals of different levels. Secondly, the study is a cross-sectional study design, which can only reveal the correlation between the latent categories of core competencies of operating room nurses and job reshaping at a specific time point. It cannot clarify the causal relationship and dynamic evolution trend between the two, and does not fully consider possible mediating or moderating variables. Finally, research data are collected through self-report questionnaires, which may be affected by subjective factors such as social desirability bias and recall bias.