Network-based study of bullying in nursing interns: Insights for education and subgroup differences by education level

Bullying in nursing education remains a persistent concern in clinical nursing training, yet little is known about how specific attitudes and behaviors interact at the item level. To delineate the intricate interrelationships between bullying attitudes and behaviors among nursing interns using a network analysis approach, and to identify structurally central and bridge nodes that may represent statistically prominent elements within the network, while examining subgroup differences by educational level. This was a secondary analysis of a cross-sectional survey of 1408 clinical nursing interns from Southwest China. Bullying attitudes and behaviors were assessed using validated scales (12 and 22 items, respectively). A Gaussian Graphical Model was estimated with LASSO regularization to construct the network. Centrality and bridge centrality indices were calculated to identify key nodes. Network comparison tests were conducted between interns with associate degrees or below (n = 489) and bachelor's degrees or above (n = 919). A total of 1408 clinical nursing trainees participated in this study. The sample was predominantly female (88.5%, n = 1290) with a mean age of 22.1 years (SD = 1.8). The 34-item network revealed moderate connectivity. Avoidance (P_2d) emerged as the most central node (strength = 2.008), while Passive pessimism (P_3d) was the primary bridge (bridge strength = 2.877) linking attitudes and behaviors. The global network structure did not differ significantly by educational level (M = 0.152, p = 0.392), but key local differences were found. Bachelor-level interns showed greater centrality of emotional regulation and stronger bridging roles for intolerance of bullying and reconciliation. This study reveals a complex psychological architecture of bullying in nursing interns, structurally central components with avoidance and passive pessimism emerging as structurally central nodes within the network. The findings highlight structurally prominent components that may inform the design of targeted educational strategies aimed at disrupting the self-sustaining cycle of bullying in clinical training environments. • Mapped a 34-item network integrating bullying attitudes and behaviors among nursing interns, revealing their internal psychological architecture. • Identified avoidance as the most central behavioral node sustaining bullying-related processes. • Found passive pessimism to be the strongest bridge linking attitudes to maladaptive behavioral responses. • Demonstrated significant edge-level differences in network structure between diploma and bachelor trainees. • Highlighted actionable leverage points for designing precise, education-level-tailored anti-bullying interventions.