How digital literacy buffers stress and boosts retention in nurses: The moderated mediating role of proactive...

To test a moderated mediation model examining how interpersonal management stress (IMS) is associated with nurses' intention to stay (NIS), focusing on the mediating role of proactive socialization behavior (PSB) and the moderating role of digital communication-collaboration literacy (DCCL).

A cross-sectional online survey was conducted with 305 registered nurses recruited from 12 hospitals in Western China via WeChat-based snowball sampling. Validated instruments measured IMS, PSB, DCCL, and NIS. Descriptive statistics and Pearson correlation analyses were performed using SPSS 30.0. Path relationships between variables were analyzed using AMOS 30.0. PROCESS macro v4.3 (Model 4, 6, 7, and 58) was employed to examine direct, mediating, and moderated mediating effects with 5000-10,000 bootstrap samples.

PSB partially mediated the IMS-NIS association (β = -0.154, 95% CI [-0.242, -0.081]). This indirect effect was conditional on DCCL (index of moderated mediation = 0.054, 95% CI [0.026, 0.089]). The negative indirect effect of IMS on NIS via PSB was significant only when DCCL was below a key threshold (Johnson-Neyman point = 0.312; 30.9% of the sample), becoming non-significant at higher DCCL levels. Furthermore, high DCCL amplified the positive association between PSB and NIS by 62.6% compared to low DCCL. Nurses aged 31-40 years and those in tertiary hospitals exhibited relatively higher DCCL levels.

PSB partially mediated the negative association between IMS and NIS, with DCCL acting as a dual-stage moderator. DCCL buffers the negative impact of IMS on PSB and enhances the positive impact of PSB on NIS, thereby weakening the indirect stress-retention link and strengthening retention intention. Nursing administrators should prioritize screening for low DCCL and implement dual-focused training to mitigate interpersonal stress and boost retention.