Professional Values, Moral Resilience and Professional Competence in Critical Care Nursing: A Mediation Analysis

Professional values and moral resilience are recognized as essential attributes of nursing practice. In critical care settings, where nurses routinely face ethical complexity and high-stakes decisions, it is important to understand how these attributes shape professional competence.

To examine the relationship between professional values and professional competence among critical care nurses, and to determine whether moral resilience mediates this relationship.

This descriptive and correlational study was conducted among nurses working in the critical care units of six hospitals between August and October 2025. The reporting was conducted in accordance with the STROBE guidelines. Three validated instruments were used: a professional values scale (range 1-5, with higher scores indicating stronger professional values), a moral resilience scale (range 1-4, with higher scores indicating greater moral resilience) and a professional competence scale (range 1-5, with higher scores indicating greater professional competence).

In total, 201 nurses participated in the study. Mean scores were high for professional values (4.45 ± 0.61 out of 5), moral resilience (3.27 ± 0.43 out of 4) and professional competence (4.26 ± 0.36 out of 5). Professional values were significantly and positively correlated with professional competence (r = 0.329, p < 0.001), whereas moral resilience showed no significant association with either variable. The direct effect of professional values on professional competence was significant (β = 0.193, p < 0.001), whereas the indirect effect through moral resilience was non-significant (β = 0.003, 95% CI [-0.005, 0.014]).

Professional values appear to play an important role in promoting professional competence among critical care nurses, whereas moral resilience did not mediate this relationship. Strengthening ethics-based education and professional value development may enhance competence in critical care practice.

Nurse educators and managers should prioritize the integration of professional values into nursing curricula, continuing professional development and clinical practice to strengthen professional competence among critical care nurses. Because moral resilience was not associated with competence, resilience-supporting initiatives may be directed primarily at nurses' well-being and retention rather than competence.