The average age of nurses working in Korean general and tertiary hospitals is approximately 33.4 years, suggesting a potential future decline in the active nursing workforce due to retirement and aging [1]. This concern has prompted numerous studies on the retention of experienced married nurses, underscoring the importance of understanding how these nurses balance professional obligations with family responsibilities [2,3]. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has heightened interest in the quality of life (QoL) of married nurses [4]. Despite growing attention to nurse well-being, particularly since the pandemic, there remains a scarcity of research investigating the complex factors influencing the QoL of married nurses [4,5].

Married nurses often encounter greater challenges managing dual roles at work and at home [5,6]. Although several studies have examined the QoL of nurses in general, there is limited understanding of the specific factors affecting QoL among married nurses in Korea. While prior research has addressed various perspectives on nurses’ QoL [7,8], studies focused on married nurses have primarily explored aspects such as lifestyle [9], physical health [10], job satisfaction [11], parenting stress [12,13], and family–work conflict [3,13].

Recent research consistently demonstrates that self-determination is positively associated with psychological stability and life satisfaction [4,14]. For instance, higher self-determination has been shown to improve life satisfaction among college students facing adjustment difficulties [4]. Moreover, self-determination is recognized as a predictor of psychological well-being, which is an essential component of QoL [8,15].

Health-promoting behaviors (HPBs) are vital for sustaining well-being, managing stress, and enhancing the QoL of married nurses, who frequently encounter unique challenges in balancing work and family life. According to Pender’s Health Promotion Model, individuals actively engage in HPBs shaped by personal, social, and environmental factors [16]. These behaviors not only promote physical health but also contribute to emotional resilience and increased job satisfaction—both of which are especially important in the nursing profession.

Married nurses with children commonly experience role conflict and parenting stress, which can significantly impact their job satisfaction and overall QoL [3,17]. As married nurses manage dual responsibilities at home and work, increased role conflict is associated with decreased job satisfaction and QoL [3]. Notably, conflict between professional and domestic spheres remains a major stressor closely linked to reduced QoL [3,12]. From the perspective of self-determination theory (SDT), parenting stress should thus be regarded as a key variable substantially influencing QoL [8,15]. Addressing parenting stress and role conflict is especially important for married nurses in their 30s and 40s, as these factors affect both their personal well-being [3,18] and job satisfaction [17].

Job satisfaction is crucial for enabling nurses to effectively apply their skills to achieve professional objectives and improve their QoL; it also plays a key role in increasing retention, thereby preserving the expertise of seasoned nurses within healthcare organizations [11]. Given the aging nursing workforce, urgent strategies are needed to strengthen retention and safeguard the accumulated experience of senior nurses [2,3].

Identifying core factors such as self-determination, health-promoting lifestyle (HPL), job satisfaction, and parenting stress is essential for designing institution-wide interventions and supportive policies to enhance the QoL of married nurses with children. By examining the distinct challenges these nurses face in reconciling professional and personal responsibilities, this study aims to provide foundational insights for more effective support. Addressing these issues will empower nurses to achieve a healthier work–life balance and offer actionable data to promote their well-being.

This study found a moderate overall level of QoL among married nurses with children (77.67±12.75). Compared to a previous study on nurses in tertiary general hospitals (3.19–3.41 on a 1–5 scale) [6], this level is relatively low (point average of 2.98 on a 1–5 scale), suggesting that balancing professional and parental roles may present additional challenges in general hospital settings.

Among the factors examined, HPL emerged as the most significant predictor of QoL, with participants reporting moderate engagement in HPBs. Subdomain analysis indicated that interpersonal relations had the highest average (24.9), reflecting the importance of strong social networks both at work and at home. In contrast, Physical Activity was notably low (15.6), likely due to shift work, heavy workloads, and childcare responsibilities [9,18]. Nurses aged 40 years or older tended to maintain healthier lifestyles, possibly due to greater health awareness and accumulated life experience [9]. Nonetheless, consistent physical activity remained a challenge for those balancing shift work and caregiving responsibilities [17]. Previous studies suggest that capacity-building efforts, such as continuing education, mentoring, and family-support programs, can enhance HPBs and reduce burnout among married nurses [9,15]. Therefore, structured physical activity initiatives, flexible scheduling, and institutional family support are recommended to address these barriers and promote sustained health behaviors.

Self-determination was also a significant positive predictor of QoL in our regression analysis. The high average score of 81.44 on the BPNS (range, 18–90) indicates that autonomy, competence, and relatedness needs were generally well met. Importantly, after controlling for other factors, higher need satisfaction remained independently associated with better QoL, supporting SDT’s central assertion that fulfilling these psychological needs enhances well-being [15]. Nurses who experience decision-making freedom, such as participation in work-related decisions or negotiating shift patterns, report lower stress and higher professional QoL. In studies of nurses in general hospitals in Korea [8] and among shift-working nurses [20], autonomy was identified as a major predictor of work-related QoL. Nevertheless, unpredictable shift work continues to exacerbate work–family imbalance and childcare stress among married nurses, thereby diminishing overall QoL [17].

Parental stress is a key factor in reducing the QoL of married nurses, and its influence has been consistently demonstrated in previous studies as well as in the present findings. In particular, a study of married nurses working shifts showed a strong negative correlation between parenting stress and QoL, and when combined with role conflict, the explanatory power increased to 53% [17]. These findings indicate that the burden of childcare affects both work performance and emotional stability. During the COVID-19 pandemic, parenting stress increased by 47% [3], and nurses with children needing care reported the lowest QoL [17]. This is attributed to a lack of time for childcare caused by unpredictable shift patterns, which heighten stress. Notably, 65.3% of nurses in general hospitals in Korea cited “inability to balance work and family life” as a reason for considering leaving their jobs [12], demonstrating that parental stress can lead to job turnover. Organizational strategies are essential to mitigate parental stress. Actual spousal involvement in childcare reduced stress by 34% [13], while employee support systems improved QoL by reducing work–family conflict by 20% [31]. Additionally, the introduction of flexible working hours was found to improve job satisfaction by reducing role conflict by 0.26 standard deviations [11]. These results highlight the importance of family-friendly policies and the development of social support networks in managing parental stress.

Furthermore, strong relatedness, manifested through supportive colleagues at work and spousal assistance at home, has been shown to enhance nurses’ QoL; when these sources of support operate together, they buffer stress and improve overall well-being [8,13]. In contrast, increased parenting stress was associated with significantly lower QoL, a finding consistent with studies of married nurses working shifts in general hospitals in Korea, which found that nurses caring for children requiring long-term care had the lowest QoL [17]. This added care burden can result in emotional and financial strain. For nurses with children, the conflict between work and family life—particularly the lack of time for childcare due to unpredictable shifts—further exacerbates this burden. In a survey of nurses in general hospitals in Korea, 65.3% reported that they were considering job changes for this very reason [11,12]. These results suggest that organizational measures such as in-house childcare, childcare subsidies, and flexible working hours are needed to help nurses balance their professional and domestic roles and reduce parenting stress.

Although job satisfaction was not a significant predictor of QoL in this study, this does not diminish its potential influence on nurses’ well-being. Previous research indicates that low job satisfaction can adversely affect both physical and mental health [6,11]. Meanwhile, practical support from primary caregivers or spouses proved beneficial: nurses who received consistent, hands-on assistance at home reported reduced parenting stress and improved QoL [7,13]. Positive social relationships and cooperative work environments also contributed to better well-being; however, irregular shift patterns frequently hinder the formation or maintenance of these supportive connections [17,20].

Therefore, this study has several limitations. First, the key predictors—HPL, self-determination (autonomy, competence, relatedness), and parenting stress—were all assessed via self-report measures, which may introduce social desirability and recall biases. Future research should incorporate objective assessments (e.g., wearable health monitors, ecological momentary assessment via digital diaries) to capture real-time behaviors and stress fluctuations. Second, this study did not fully examine several factors known to influence nurses’ psychological well-being and QoL, including organizational culture [8], sleep quality [7,20], workplace stress [5], leadership support, and shift work [17,20]. Incorporating these variables in subsequent investigations could yield a more comprehensive understanding of QoL determinants among married nurses with children. Third, data were collected using convenience sampling, and a substantial proportion of participants held a university degree or higher (83.4%), with 26.7% having attained a master’s degree or above. This suggests that the sample may be skewed toward highly educated nurses, which may not accurately represent the broader population of married nurses with children in Korea. Similarly, the majority of participants reported relatively high monthly incomes (87.3% earning 3 million KRW or more), reflecting a socioeconomic status higher than the national average for nurses. This overrepresentation of highly educated and high-income individuals may have influenced the self-reported HPL, stress, and QoL outcomes, and may not accurately reflect the broader population of married nurses with children in Korea. Although higher income has been consistently associated with better QoL among nurses, the impact of education level on QoL is less clear and may not be significant in all contexts. Fourth, the sample was predominantly composed of staff nurses (76.7%), with relatively few participants in managerial or advanced roles, which may limit the generalizability of these findings to nursing leaders who face distinct work–life balance challenges and stressors [32].

In conclusion, this study demonstrated that, among married nurses with children, QoL is most strongly and positively associated with HPL, followed by self-determination (autonomy, competence, and relatedness), and is inversely associated with parenting stress. Targeted interventions, such as programs that encourage regular engagement in HPBs and strengthen psychological need satisfaction, are likely to yield the greatest improvements in QoL. Furthermore, implementing flexible work policies, peer support initiatives, and family-friendly measures to reduce parenting stress and childcare burdens may further empower this group, ultimately enhancing their QoL and promoting a more sustainable nursing workforce.