AI Insight
This cross-sectional study of 498 nursing interns in China found that a more supportive internship environment was positively associated with voice behavior (expressing suggestions and concerns). Self-efficacy and professional identity were identified as significant mediating factors, accounting for approximately 56% of the relationship between internship environment and overall voice behavior, with similar patterns observed for both promotive (improvement-focused) and prohibitive (risk-focused) voice behaviors.
Why it matters
The findings suggest that creating psychologically safe internship environments may encourage nursing interns to speak up about patient safety concerns and quality improvement opportunities. Strengthening interns' self-efficacy and professional identity could be key mechanisms for promoting this beneficial workplace behavior in healthcare settings.
Understand the Science
AimTo examine the association between the internship environment and voice behavior among nursing interns and to explore the statistical indirect effects involving self-efficacy and professional identity.DesignA multicenter cross-sectional study.MethodsFrom January to February 2026, 498 nursing interns from hospitals in Hunan Province, China, completed questionnaires on internship environment, self-efficacy, professional identity, and voice behavior. Descriptive statistics, Pearson correlation analysis, and regression analysis were conducted. PROCESS Model 6 with 5,000 bootstrap samples was used to estimate the individual and combined indirect effects involving self-efficacy and professional identity.ResultsInternship environment was positively correlated with voice behavior (r = 0.553, p < 0.001), self-efficacy (r = 0.498, p < 0.001), and professional identity (r = 0.538, p < 0.001). After adjustment for demographic and internship-related characteristics, the 95% bootstrap confidence intervals for the individual indirect effects involving self-efficacy and professional identity and the combined indirect effect involving both variables did not include zero for overall, promotive, or prohibitive voice behavior. The descriptive ratios of the estimated total indirect effect to the estimated total effect were 55.98% for overall voice behavior, 49.47% for promotive voice, and 62.48% for prohibitive voice.ConclusionA more supportive internship environment was associated with higher levels of overall, promotive, and prohibitive voice behavior among nursing interns. Significant indirect effects involving self-efficacy and professional identity were also observed in these associations. Clinical educators should consider fostering psychologically safe and supportive internship environments in which nursing interns feel able to express suggestions and patient safety concerns.