ORIGINAL RESEARCH article
Front. Med.
Sec. Healthcare Professions Education
Emotional intelligence and clinical decision-making confidence in nurses: the chain mediating effect of creative self-efficacy and self-directed learning
Provisionally accepted
- Zhejiang Chinese Medical University, Hangzhou, China
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Background: Clinical decision-making competence underpins autonomous nursing practice. While external influences are documented, context-dependent psychological mechanisms linking emotional intelligence (EI) to clinical decision-making confidence (CDMC) remain unexplored. Using social cognitive theory, this cross-sectional study of 1,126 nurses from 12 Zhejiang tertiary hospitals examined EI' s influence on CDMC via sequential mediation by creative self-efficacy (CSE) and self-directed learning (SDL), moderated by department stress and clinical experience. Methods: Nurses completed measures of EI (WLEIS), CDMC (CDMSCS), CSE, and SDL. Analyses used structural equation modeling (SEM) with bias-corrected bootstrapping and multi-group SEM with Bonferroni correction to test moderation by department type (high-stress: ICU/emergency/OR vs. non-high-stress) and experience (≤5 vs. >5 years). Results: The model showed excellent fit (χ²/df = 2.999, RMSEA = 0.030, CFI = 0.963, GFI = 0.934). EI predicted CDMC directly (27.16% of total effect) and indirectly via CSE (23.16%), SDL (25.26%), and sequential mediation (24.42%; 72.84% total indirect effect). Moderation revealed: In high-stress units (n=159), the EI→CSE→ CDMC path was stronger (β=0.28, 95% CI [0.22, 0.35] vs. non-high-stress β=0.21, 95% CI [0.17, 0.26]; Δ β=0.07, P=0.012). Conversely, EI →SDL →CDMC dominated in non-high-stress units (β=0.27 vs. 0.20; Δ β=0.07, P=0.018), particularly pediatrics/gynecology. For nurses with ≤5 years' experience (n=254), sequential mediation (EI→CSE→SDL→CDMC; β=0.31, 95% CI [0.25, 0.38]) was primary, with negligible direct effects (β=0.08, P=0.12). Nurses with >5 years' experience (n=872) showed strengthened direct EI→CDMC effects (β=0.19, P=0.003) and reduced SDL reliance (Δβ=0.12, P=0.007), suggesting experience compensates for psychological resource utilization. Conclusion: EI enhances CDMC through context-contingent pathways: CSE is pivotal in high-stress environments, SDL prevails in non-high-stress units (notably pediatrics/gynecology), and experiential knowledge supersedes mediation pathways with seniority. These findings challenge uniform decision-making models, urging healthcare systems to implement context/experience-specific strategies — such as stress-adapted EI training for critical care nurses and experiential integration for seniors—to optimize clinical decision-making across nursing settings.
Keywords: Clinical nurse, Emotional Intelligence, Creative self-efficacy, Self-directed learning, Clinical decision-making confidence, Chain mediating effect
Received: 22 Sep 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Ma, Tang and Yue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaoqin Ma, 20041028@zcmu.edu.cn
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