With the widespread adoption of artificial intelligence (AI) in healthcare and nursing, nurses’ subjective perception of AI has become a key indicator of their professional adaptability. However, the underlying mechanisms shaping this perception remain insufficiently understood. This study adopts a dual-perspective approach, integrating organizational management and individual psychology, to investigate the synergistic role of ethical leadership and moral sensitivity in facilitating nurses’ technological adaptation. The findings provide new insights into the development of a supportive and ethically grounded nursing work environment in the digital era.
Objective
To examine how ethical leadership influences nurses’ AI perception over time and the mediating role of moral sensitivity.
Methods
Data were collected in three waves from 584 nurses across six tertiary hospitals in China. Cross-lagged panel modeling and structural equation modeling were used to analyze the temporal predictive pathways and mediating mechanisms among the key variables.
Results
Ethical leadership measured at Time 1 (T1) significantly and positively predicted AI perception at Time 2 (T2; β = 0.25, p < .001) and Time 3 (T3; β = 0.26, p < .001) and also significantly enhanced nurses’ moral sensitivity (T2: β = 0.36, p < .001; T3: β = 0.18, p < .001). Further mediation analysis revealed that moral sensitivity at T2 partially mediated the effect of ethical leadership on AI perception at T3, accounting for 18.50% of the total effect. These results highlight a synergistic mechanism between the organizational ethical climate and individual moral resources in the process of adapting to AI technologies.
Conclusions
Ethical leadership and moral sensitivity jointly promote nurses’ understanding and acceptance of AI systems, thereby strengthening their psychological adaptability and professional integration during technological transitions. These factors serve as essential supports for fostering a healthy nursing work environment.
KittleJ. The great resignation’s impact on nursing: a phenomenological study. Int Nurs Rev2025; 72: e70046.
2.
AbdelhayESTahaSMEl-SayedMM, et al.Nurses retention: the impact of transformational leadership, career growth, work well-being, and work-life balance. BMC Nurs2025; 24: 148.
3.
LaukkaEHammarénMKansteO. Nurse leaders’ and digital service developers’ perceptions of the future role of artificial intelligence in specialized medical care: an interview study. J Nurs Manag2022; 30: 3838–3846.
4.
HassaneinSEl ArabRAAbdrboA, et al.Artificial intelligence in nursing: an integrative review of clinical and operational impacts. Front Digit Health2025; 7: 1552372.
5.
ReisA.AloisX.MalpaniR.VayenaE.AmirJ. S.Ethics and governance of artificial intelligence for health: WHO guidance. World Health Organization, 2021.
6.
CharDSShahNHMagnusD. Implementing machine learning in health care - addressing ethical challenges. N Engl J Med2018; 378: 981–983.
7.
KleibMDarkoEMAkingbadeO, et al.Current trends and future implications in the utilization of ChatGPT in nursing: a rapid review. Int J Nurs Stud Adv2024; 7: 100252.
8.
BienefeldNKellerEGroteG. AI interventions to alleviate healthcare shortages and enhance work conditions in critical care: qualitative analysis. J Med Internet Res2025; 27: e50852.
9.
AtallaADGMousaMAE-GHashishEAA, et al.Embracing artificial intelligence in nursing: exploring the relationship between artificial intelligence-related attitudes, creative self-efficacy, and clinical reasoning competency among nurses. BMC Nurs2025; 24: 661.
10.
ShinnersLGraceSSmithS, et al.Exploring healthcare professionals’ perceptions of artificial intelligence: piloting the shinners artificial intelligence perception tool. Digit Health2022; 8: 20552076221078110.
11.
AtallaADGEl-AshryAMMohamedSMS. The moderating role of ethical awareness in the relationship between nurses’ artificial intelligence perceptions, attitudes, and innovative work behavior: a cross-sectional study. BMC Nurs2024; 23: 488.
12.
ZirarA. Can artificial intelligence’s limitations drive innovative work behaviour?Rev Manag Sci2023; 17: 2005–2034.
13.
TangLLiJFantusS. Medical artificial intelligence ethics: a systematic review of empirical studies. Digit Health2023; 9: 20552076231186064.
14.
TarsusluSAgaogluFOBasM. Can digital leadership transform AI anxiety and attitude in nurses?J Nurs Scholarsh2025; 57: 28–38.
15.
SommerDSchmidbauerLWahlF. Nurses’ perceptions, experience and knowledge regarding artificial intelligence: results from a cross-sectional online survey in Germany. BMC Nurs2024; 23: 205.
16.
BoyaciHSoyukS. Healthcare workers’ readiness for artificial intelligence and organizational change: a quantitative study in a university hospital. BMC Health Serv Res2025; 25: 813.
17.
AgaogluFOBasMTarsusluS, et al.Serial mediating role of transformational leadership and perception of artificial intelligence use in the effect of employee happiness on innovative work behaviour in nurses. BMC Nurs2025; 24: 137.
18.
YuQHuangCYanJ, et al.Ethical climate, moral resilience, and ethical competence of head nurses. Nurs Ethics2025; 32: 56–70.
19.
El-GazarHEBaghdadiNAAbdelaliemSMF, et al.Linking ethical leadership to nurses’ internal whistleblowing through psychological safety. Nurs Ethics2025; 32: 837–850.
20.
KimJLeeSYunS, et al.When ethical leadership becomes eclipsed: the moderating roles of workplace uncertainty and need for status in the relationship between ethical leadership and organizational citizenship behavior. J Bus Psychol2025; Vol. ahead-of-printNo. ahead-of-print. https://doi.org/10.1007/s10869-025-10051-6
21.
QinYZhaoYLiuY. Path analysis of how digital health literacy influences social frailty among community-dwelling older adults with chronic diseases. Journal of Nursing Science2025; 40: 95–99.
22.
YiYWangDLiJ-Y, et al.Be ethical then proficient: navigating employees’ ethical adoption of generative AI in the workplace. J Commun Manag2025; Vol. ahead-of-printNo. ahead-of-print. https://doi.org/10.1108/JCOM-10-2024-0206
23.
HossainSFernandoMAkterS. The influence of artificial intelligence-driven capabilities on responsible leadership: a future research agenda. J Manag Organ2025; 31: 2360–2384. Early Access.
24.
ZhangNRenXXuZ, et al.Effects of dispositional and contextual moral sensitivity in moral decision-making: a cross-sectional study among nursing students. J Adv Nurs2024; 81: 4758–4767. Early Access.
25.
MengJGuoX. The relationship between ethical leadership, moral sensitivity, and moral courage among head nurses. BMC Nurs2025; 24: 538.
26.
LambertJRBrownLWLambertTA, et al.The effect of ethical leadership on nurse bullying, burnout, and turnover intentions. J Nurs Manag2024; 2024: 3397854.
27.
VenkateshVDavisF. A theoretical extension of the technology acceptance model: four longitudinal field studies. Social Science Electronic Publishing, 2000.
28.
PodsakoffPMMacKenzieSBBommerWH. Meta-analysis of the relationships between Kerr and Jermier’s substitutes for leadership and employee job attitudes, role perceptions, and performance. J Appl Psychol1996; 81: 380–399. Meta-Analysis.
29.
TannerK. Chapter 6 - survey designs. In: Research methods. 2nd ed.Chandos Publishing, 2018, pp. 159–192.
30.
MaunderRGHeeneyNDHunterJJ, et al.Trends in burnout and psychological distress in hospital staff over 12 months of the COVID-19 pandemic: a prospective longitudinal survey. J Occup Med Toxicol2021; 17: 11.
31.
FaulFErdfelderEBuchnerA, et al.Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods2009; 41: 1149–1160.
32.
BrownMETreviLKHarrisonDA. Ethical leadership: a social learning perspective for construct development and testing. Organ Behav Hum Decis Process2005; 97: 117–134.
33.
YabinB. A study on the influence of ethical leadership to workplace deviant behavior. Doctoral Central University of Finance and Economics, 2015.
34.
LützénKEvertzonMNordinC. Moral sensitivity in psychiatric practice. Nurs Ethics1997; 4: 472–482.
35.
HuangFFYangQZhangJ, et al.Cross-cultural validation of the moral sensitivity questionnaire-revised Chinese version. Nurs Ethics2016; 23: 784–793.
36.
WangXFeiFWeiJ, et al.Knowledge and attitudes toward artificial intelligence in nursing among various categories of professionals in China: a cross-sectional study. Front Public Health2024; 12: 1433252.
37.
DukerichJMAshforthBE. Role transitions in organizational life: an identity-based perspective. Routledge, 2000, p. 670.
38.
HuangKJiaoZCaiY, et al.Artificial intelligence-based intelligent surveillance for reducing nurses’ working hours in nurse-patient interaction: a two-wave study. J Nurs Manag2022; 30: 3817–3826.
39.
MarasGGundayEASurmeY. Examining the anxiety and preparedness levels of nurses and nurse candidates for artificial intelligence health technologies. J Clin Nurs. 2024; Vol. ahead-of-print No. ahead-of-print.. https://doi.org/10.1111/jocn.17562
40.
BianXWangB. The impact of ethical leadership on innovation behavior of public-sector employees in the data-intelligence era. Leadership Science. 2025; 04: 45–53.
41.
SchneiderBEhrhartMGMaceyWH. Organizational climate and culture. Annu Rev Psychol2012; 64: 361–388.
42.
EdmondsonA. Psychological safety and learning behavior in work teams. Adm Sci Q1999; 44: 350–383.
43.
Gonzalez-GarciaAPerez-GonzalezSBenavidesC, et al.Impact of artificial intelligence-based technology on nurse management: a systematic review. J Nurs Manag2024; 2024: 3537964.
44.
ZhangBXuSYangC. The impact of craftsmanship on employee innovation behavior: the roles of psychological availability and different types of ethical leadership. Technology Economics. 2025; 44: 96–108.
45.
MayerDMAquinoKGreenbaumRL, et al.Who displays ethical leadership, and why does it matter? An examination of antecedents and consequences of ethical leadership. Acad Manag J2012; 55: 151–171.
46.
Darzi-RamandiMSadeghiATapakL, et al.Relationship between moral sensitivity of nurses and quality of nursing care for patients with COVID-19. Nurs Open2023; 10: 5252–5260.
47.
ChenFLiuRLinZ, et al.Status and influencing factors of moral resilience among clinical nurses. Chinese Evidence-Based Nursing2025; 11: 2522–2526.
48.
KhodaveisiMOshvandiKBashirianS, et al.Moral courage, moral sensitivity and safe nursing care in nurses caring of patients with COVID-19. Nurs Open2021; 8: 3538–3546.
49.
TurkmenEVaizogluDYesilyurtT, et al.Effect of moral sensitivity on professional values of undergraduate nursing students: mediating effect of empathic tendency. J Prof Nurs2023; 49: 44–51.
