Is higher ego strength always better? Ego strength, ICT demands, and age in nurses' safety performance

PURPOSE: This study examines how information and communication technology (ICT) demands influence nurses' safety performance in healthcare organizations. Drawing on the Job Demands-Resources (JD-R) framework, it investigates negative rumination as a cognitive mechanism linking ICT demands to safety compliance and safety participation, and explores how ego strength and age jointly shape this process through a three-way interaction. DESIGN/METHODOLOGY/APPROACH: A two-wave survey was conducted with 498 nurses from ten hospitals in China, separated by a three-week interval. Using structural equation modeling (Mplus 8.3) and 5,000 bootstrap samples, we tested a three-way moderated mediation model linking ICT demands, negative rumination, ego strength, and age. FINDINGS: Results show that ICT demands were significantly associated with higher levels of negative rumination, which in turn was significantly related to lower safety compliance and safety participation. The indirect effects varied by ego strength and age: the three-way moderated mediation effects were statistically significant, and they were stronger among younger nurses with low ego strength and middle-aged nurses with high ego strength. ORIGINALITY/VALUE: The study extends JD-R theory to digitalized healthcare settings by identifying negative rumination as a key cognitive pathway through which ICT demands impair nurses' safety performance. It also provides novel evidence of a three-way interaction involving ICT demands, ego strength and age, highlighting differential risk profiles within the nursing workforce. From a practical perspective, the findings offer actionable insights for healthcare managers by underscoring the importance of managing ICT demands and implementing age-sensitive support strategies to sustain nurses' safety performance.