Professional Identity as a Mechanism Linking Moral Sensitivity to Moral Courage Among Clinical Nurses: A...

This study examined whether professional identity mediates the association between moral sensitivity and moral courage among clinical nurses.

Moral courage enables nurses to advocate for patients in ethically challenging situations, yet nurse managers lack evidence-based guidance on how to cultivate this competency. While moral sensitivity is a known antecedent of moral courage, the mechanisms translating recognition into action remain unclear.

A cross-sectional survey of 1049 clinical nurses was conducted at two tertiary hospitals in Dalian, China (March 22-April 9, 2026). Participants completed validated measures of moral sensitivity, professional identity, and moral courage. Mediation analysis used PROCESS Macro Model 4 with 5000 bootstrap resamples.

Moral sensitivity was positively correlated with professional identity (r = 0.333, p < 0.001) and moral courage (r = 0.517, p < 0.001). Professional identity partially mediated this relationship, accounting for 26.38% (95% CI: 0.298-0.473) of the total effect. Head nurses reported significantly higher moral courage scores than staff nurses (p < 0.001). Operating room nurses had the lowest scores (mean = 68.21, SD = 8.53), and nurses working ≥ 5 night shifts per month scored significantly lower than those working 0 or 1-4 shifts (p < 0.001).

Concurrent associations suggest professional identity accounts for approximately one-quarter of the correlational linkage between moral sensitivity and self-reported moral courage in this sample. This concurrent pattern implies that nurses' capacity to identify clinical ethical issues does not inherently align with self-reported willingness to take ethical action. Based solely on cross-sectional correlational evidence, nursing leaders may tentatively regard professional identity development as a potential direction for workplace ethics support activities rather than a definitive intervention target.

Preliminary practice directions derived from these correlational patterns are as follows. Nursing administrators may integrate reflective activities focused on nursing professional values into standard ethics training curricula. Customized ethical support resources can be offered to two subgroups with lower average moral courage scores: operating room nurses and staff completing five or more monthly night rotations. Institutional informal acknowledgment mechanisms for nurses' ethical advocacy conduct may also be explored, though all above suggestions require longitudinal validation before formal implementation.