Network analysis identifies two distinct error culture profiles among clinical nurses

A multicenter cross-sectional survey investigating clinical nurses in tertiary hospitals has identified two distinct latent profiles combining error aversion culture and moral courage, revealing separate network structures and potential intervention targets. Published in BMC Nursing, the study evaluated survey data gathered from 1,107 clinical nurses across tertiary hospitals in four Chinese provinces to understand how workplace norms regarding medical mistakes interact with personal ethical agency.

While moral courage is understood to support error acknowledgement and voluntary disclosure, a prevailing culture of error aversion can actively discourage healthcare workers from speaking up about clinical mistakes. Prior to this research, little was known about how these two constructs co-occur within specific subgroups of clinical nurses. Consequently, the study aimed to identify latent profiles of error aversion culture and moral courage, compare profile-specific network structures, and estimate candidate intervention targets using computer-simulated perturbation.

Data collection took place between June 2025 and March 2026 across tertiary healthcare facilities utilizing a stratified convenience sampling framework. To parse the complex interactions between these domains, the authors applied latent profile analysis to segment participants into empirical subgroups. This was followed by profile-specific network estimation and formal Network Comparison Tests, which allowed the team to evaluate structural differences across the resulting psychological networks.

The latent profile analysis separated the participants into two distinct classifications based on their survey responses. The smaller cohort, designated as Profile 1, comprised 31.3 percent of the total sample with 346 nurses and was characterized as low error aversion culture and low moral courage. In contrast, the majority of participants belonged to Profile 2, which accounted for 68.7 percent of the cohort, representing 761 nurses.

Network estimation revealed notable structural differences in node centrality and connectivity between the two groups. Within Profile 1, moral integrity emerged as the most central node in the network structure, while compassion and true presence functioned as the primary bridge node linking disparate psychological dimensions. Computer-simulated perturbation indicated that addressing stress from errors served as the most potent candidate intervention target for this subgroup, successfully reducing the expected total network score from 39.58 down to 37.29 during the computational modeling.

For nurses classified within Profile 2, a contrasting network architecture was observed across the analyzed dimensions. Difficulty admitting errors served as both the most central node and the strongest candidate intervention target within the network. Additionally, the perceived benefits of concealing errors operated as the key bridge node connecting the system components. When computer-simulated perturbation was applied to the network of this second profile, targeted reduction of difficulty admitting errors decreased the expected total network score from 54.15 down to 51.84.

The authors concluded that findings from this multicenter network analysis identify distinct profiles and candidate targets for nursing management strategies addressing error-related stress and difficulty admitting errors.

Subject of Research: Error aversion culture and moral courage profiles among clinical nurses

Article Title: Profiles of error aversion culture and moral courage and candidate intervention targets among clinical nurses: a multicenter network analysis

Article References: Chen, F., Xie, Y., Wen, L., Cai, J., Zhou, Q., Li, J., & Ye, Z. (2026). Profiles of error aversion culture and moral courage and candidate intervention targets among clinical nurses: a multicenter network analysis. BMC Nursing. https://doi.org/10.1186/s12912-026-05568-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05568-x

Keywords: clinical nurses, error aversion culture, moral courage, latent profile analysis, network analysis, computer-simulated perturbation, Network Comparison Tests, Error Aversion Culture Scale, Nurses’ Moral Courage Scale, moral integrity, compassion and true presence, stress from errors, difficulty admitting errors, perceived benefits of concealing errors, patient safety, tertiary hospitals, cross-sectional survey