Risk Attitudes, Not Anxiety, Shape Nursing Safety Perceptions

Nursing students are often assumed to be driven primarily by anxiety when navigating the high-pressure environments of clinical placements. However, a new study published in Scientific Reports challenges this conventional wisdom, revealing that students’ attitudes toward workplace risks play a significantly larger role in shaping their perception of safety than their levels of occupational anxiety. This finding, derived from a comprehensive path analysis of 591 undergraduate nursing students in Türkiye, suggests that educational interventions focused on risk management and psychological safety may be more effective in fostering a positive clinical learning environment than strategies aimed solely at reducing student stress.

The research, conducted between April and June 2025 at Gaziantep University, utilized three validated instruments to measure key psychological and environmental factors: the Occupational Anxiety Scale for Healthcare Students (OAS-HS), the Nurses’ Attitudes Toward Workplace Risks Scale (NATWRS), and the Safety Climate Questionnaire (SCQ). The study’s internal consistency was notably high, with Cronbach’s alpha values ranging from 0.94 to 0.97 across the three scales, indicating robust reliability in the data collected. By employing advanced statistical modeling, the researchers were able to disentangle the complex interplay between these variables, offering a nuanced view of how nursing students process the risks inherent in their training.

Participants in the study reported moderate-to-high levels of occupational anxiety, with a mean score of 69.6 and a standard deviation of 17.3. In contrast, their attitudes toward workplace risks were generally positive, averaging 144.5 with a standard deviation of 22.5. Perceptions of the clinical learning safety climate were moderately favorable, with a mean score of 71.9 and a standard deviation of 11.3. These baseline metrics provide a snapshot of the typical psychological state of nursing students in this demographic, highlighting a population that is anxious yet generally optimistic about their ability to manage workplace risks.

Demographic and academic factors also played a role in shaping these perceptions. Independent-samples t-tests and one-way ANOVA analyses revealed that occupational anxiety was significantly higher among female students, Turkish students, and those with a grade point average of 2.00 or above, with all p-values less than 0.001. Conversely, more positive attitudes toward workplace risks were observed among male students and international students, with p-values of 0.029 and 0.011, respectively. These findings suggest that gender, nationality, and academic performance are not merely background variables but active contributors to how students engage with the risks of their profession.

Perhaps most strikingly, the study found that students who reported no trust in healthcare institutions or inadequate knowledge of occupational risks exhibited higher levels of anxiety and less favorable perceptions of the safety climate, with p-values less than 0.001. This correlation underscores the importance of institutional trust and risk literacy in the nursing curriculum. When students feel that the institutions they are training in do not prioritize safety or that they lack the knowledge to identify hazards, their anxiety increases and their confidence in the learning environment diminishes.

The core of the study’s contribution lies in its path analysis, performed using AMOS 29.0 software. The model tested the direct and indirect associations among occupational anxiety, attitudes toward workplace risks, and safety climate perceptions. The results showed that more positive attitudes toward workplace risks were strongly associated with more favorable safety climate perceptions, with a standardized beta coefficient of 0.52 and a p-value less than 0.001. This relationship accounted for 27% of the variance in safety climate perceptions, indicating that risk attitudes are a substantial predictor of how safe students feel in their clinical environments.

In contrast, occupational anxiety was not significantly associated with safety climate perceptions, either directly or indirectly through attitudes toward workplace risks. The direct path from anxiety to safety climate had a beta coefficient less than 0.001 and a p-value of 0.997, indicating a lack of statistical significance. This finding is counterintuitive, as one might expect that higher anxiety would lead to a more negative perception of safety. However, the data suggest that anxiety and safety perception are distinct psychological constructs in this context, with risk attitudes serving as the primary bridge between a student’s internal state and their external environment.

The implications of these findings for nursing education are profound. If safety perceptions are driven more by risk attitudes than by anxiety, then curricular reforms should prioritize the development of risk management skills and the cultivation of a positive risk culture. This includes improving the quality and psychological safety of clinical placements, ensuring that students feel supported and empowered to identify and mitigate risks. Additionally, supporting professional motivation may help students develop the confidence and resilience needed to navigate the complexities of clinical practice.

Furthermore, the study highlights the need for targeted support for specific subgroups of nursing students. Those reporting higher anxiety or less favorable risk attitudes, such as female students or those with lower academic performance, may benefit from additional resources and mentorship. By addressing the specific needs of these students, nursing programs can create a more inclusive and supportive learning environment that promotes both student well-being and patient safety. The study’s findings also suggest that fostering trust in healthcare institutions and enhancing knowledge of occupational risks are critical components of a comprehensive approach to nursing education.

In conclusion, this study provides valuable insights into the psychological dynamics of nursing students in clinical learning environments. By demonstrating that risk attitudes, rather than anxiety, are the primary drivers of safety perceptions, the research offers a new framework for understanding and improving the clinical learning experience. As nursing programs continue to evolve in response to changing healthcare demands, integrating these findings into curricular design and placement strategies will be essential for preparing the next generation of nurses to deliver safe, high-quality care. The study underscores the importance of a holistic approach to nursing education that addresses not only the technical skills required for practice but also the psychological and cultural factors that shape a student’s experience in the clinical setting.

Subject of Research: The relationship between occupational anxiety, risk attitudes, and safety climate perceptions in nursing students

Article Title: Occupational anxiety, workplace risk attitudes, and clinical learning safety climate among nursing students: a path analysis

Article References: Kızıltan, B., Ağar, A., & Berşe, S. (2026). Occupational anxiety, workplace risk attitudes, and clinical learning safety climate among nursing students: a path analysis. Scientific Reports. https://doi.org/10.1038/s41598-026-74777-w

Image Credits: AI Generated

DOI: 10.1038/s41598-026-74777-w

Keywords: nursing students, occupational anxiety, workplace risks, safety climate, clinical learning, path analysis, healthcare education, patient safety, risk management, psychological safety, Occupational, anxiety