Organizational climate, critical thinking, self-efficacy, and perceived stress as correlates of evidence-based practice competence among clinical nurses: a cross-sectional study

Evidence-Based Practice (EBP) is essential for enhancing healthcare quality and patient outcomes. Clinical nurses, as the largest professional group in healthcare, play a critical role in translating evidence into practice. In China, ongoing healthcare reforms and the hospital accreditation system have increasingly emphasized evidence-based nursing, yet nurses’ EBP competence remains understudied, particularly in less-developed western regions such as Ningxia. Specifically, the factors associated with nurses’ EBP competence, particularly the combined effects of organizational and psychological factors, remain underexplored. This study aimed to examine the associations among organizational climate, critical thinking, self-efficacy, perceived stress, and EBP competence. A cross-sectional study was conducted from January to February 2026 using convenience sampling. A total of 652 clinical nurses from seven tertiary public hospitals across five cities in Ningxia Hui Autonomous Region, China, were approached, and 616 completed the questionnaires (response rate: 94.48%). Participants completed self-reported questionnaires measuring EBP competence, organizational climate, critical thinking, self-efficacy, and perceived stress. Data were analyzed using descriptive statistics, independent samples t -tests, one-way ANOVA , Pearson correlation, and hierarchical multiple linear regression. The mean item score of EBP competence was 3.94 ± 0.86 out of 5. EBP competence showed significant positive correlations with organizational climate ( r = 0.508, P < 0.01), critical thinking ( r = 0.482, P < 0.01), and self-efficacy ( r = 0.386, P < 0.01), and a significant negative correlation with perceived stress ( r = -0.284, P < 0.01). Hierarchical regression analysis revealed that self-reported organizational climate ( β = 0.252, P < 0.001), critical thinking ( β = 0.198, P < 0.001), self-efficacy ( β = 0.138, P < 0.001), and perceived stress ( β = -0.104, P = 0.008) were independently associated with EBP competence after controlling for demographic and professional characteristics, collectively explaining 40.3% of the variance. Organizational climate was the strongest correlate, with a β value 0.054 higher than that of critical thinking, 0.114 higher than self-efficacy, and 0.356 higher than perceived stress (absolute value). Self-reported organizational climate, critical thinking, self-efficacy, and perceived stress are significant independent correlates of clinical nurses’ self-reported EBP competence, with organizational climate showing the strongest association. These findings highlight the importance of fostering supportive organizational climates, cultivating critical thinking skills, enhancing self-efficacy, and managing stress to improve nurses’ EBP competence. Healthcare administrators and educators should prioritize multi-level interventions targeting organizational, cognitive, and psychological resources to promote evidence-based nursing practice. However, as all variables were assessed via self-reported questionnaires, the findings reflect nurses’ perceptions rather than objectively measured competence, which should be considered when interpreting the results. Furthermore, the sample was drawn solely from Ningxia Hui Autonomous Region, China, which may limit the generalizability of the findings to other regions or healthcare settings.