The mediation effects of moral resilience on the relationship between hospital ethical climate and work engagement among nurses: a cross-sectional study

Abstract

Purpose: Nurses work in complex healthcare environments characterized by high-stakes decisions, moral dilemmas, and ethical challenges. While prior studies link hospital ethical climate to work engagement, the mechanisms underlying this relationship remain under explored. The purpose of this study To explore the mediation effects of moral resilience on the relationship between hospital ethical climate and work engagement among nurses. Methods: A total of 281 Chinese nurses completed an online survey in October 2024, including Hospital Ethical Climate Survey, Rushton Moral Resilience Scale, and Utrecht Work Engagement Scale. Pearson’s correlation was performed to examine the associations among the three variables. The mediation model was analyzed using SPSS 25.0 and the PROCESS macro 4.3. Results: Hospital ethical climate was positive associated with moral resilience(r = 0.491, p < 0.01) and work engagement(r = 0.625, p < 0.01). Moral resilience was positive associated with work engagement (r = 0.426, p < 0.01). In the mediation model, the direct effect of hospital ethical climate on work engagement was significant (β = 0.377, 95%CI = 0.306–0.449), and moral resilience significantly mediated this relationship (β = 0.053, 95%CI = 0.013–0.097). The mediation effect accounted for 12.33% of the total effect. Conclusion: The results revealed moral resilience played a mediating role in the relationship between hospital ethical climate and work engagement in clinical nurses. Nursing administrators should prioritize cultivating hospital ethical climate and enhancing moral resilience to improve clinical nurses’ work engagement.