Nursing work environment and moral sensitivity as factors influencing nurses’ safety behaviors: the mediating role of professional identity

Objective This study is based on the competency-opportunity-motivation-behavior (COM-B) theoretical model to measure the levels of nurses ‘safety behavior, professional identity, moral sensitivity, and nursing work environment, and to explore the relationship between professional identity and nursing work environment and nurses’ safety behavior. Methods A cross-sectional survey was conducted among 589 nurses in six public hospitals in Jiangsu and Zhejiang provinces, China. The professional identity scale for nurses, the moral sensitivity questionnaire-revised Chinese version, the Chinese Version of the Nursing Work Environment Scale, and the Chinese version of the nurses’ safety behavior questionnaire were used to measure the level of nurse professional identity, moral sensitivity, nursing work environment, and nurse safety behavior. Person correlation analysis was used to verify the relationships between variables. SEM was used to validate the theoretical hypothesis model. Results The total average score of nurses’ safety behaviors was 54.10 ± 7.04, which was above the medium level. In this study, moral sensitivity indirectly affected nurses’ safety behaviors through professional identity ( β = 0.277, p < 0.001, 95%CI = [0.200, 0.371]). Nursing work environment directly affected nurses’ safety behaviors ( β = 0.239, p < 0.001, 95%CI = [0.200, 0.278]) and indirectly affected them through nurse professional identity ( β = 0.063, p < 0.001, 95%CI = [0.015, 0.114]). Conclusion This study found that a higher sense of professional identity and a harmonious nursing work environment with adequate support conditions are the foundation for enhancing nurses’ safety behaviors. Hospital administrators and policy makers should provide comfortable working conditions to nurses to increase their professional identity, and should incorporate continuous ethical training into the professional competency development system of nurses to ensure high-quality nursing care and patient safety.