Job Stress and Handover Competency Among Critical Care Nurses: The Mediating Role of Clinical Decision-Making in a...

Effective nursing handover is essential for ensuring patient safety and continuity of care, particularly in critical care settings where patients are highly complex and clinical decisions must be made rapidly. Occupational stress is prevalent among critical care nurses and has been associated with impaired performance and communication failures. Clinical decision-making is a core professional competency that may influence how stress affects handover quality; however, limited evidence has examined its combined effects.

To examine the impact of job stress and clinical decision-making on handover competency among critical care nurses and to test the mediating role of clinical decision-making in this relationship.

A multicentre cross-sectional descriptive study was conducted in six hospitals in Egypt. Using a convenience sampling approach, participants completed self-administered, self-report questionnaires. Data were analysed using descriptive statistics, correlation analysis, multiple linear regression and mediation analysis with Hayes' PROCESS Macro (Model 4).

A total of 410 critical care nurses were recruited for the study. They reported moderate levels of job stress, strong clinical decision-making abilities and high handover competency. Job stress was negatively correlated with both clinical decision-making (r = -0.242, p < 0.001) and handover competency (r = -0.218, p < 0.001), while clinical decision-making was positively correlated with handover competency (r = 0.332, p < 0.001). Regression analysis showed that higher educational level, rotating shifts and stronger clinical decision-making predicted higher handover competency, whereas higher job stress predicted lower competency. Mediation analysis revealed that clinical decision-making partially mediated the relationship between job stress and handover competency, with significant direct, indirect and total effects.

Clinical decision-making plays a pivotal mediating role in the relationship between job stress and handover competency among critical care nurses. Job stress directly and indirectly impairs handover performance by diminishing nurses' decision-making capacity.

Interventions aimed at reducing job stress and strengthening clinical decision-making, such as stress-management programs, simulation-based training and structured handover protocols, may enhance communication quality and patient safety in critical care settings.