Profiles of error aversion culture and moral courage and candidate intervention targets among clinical nurses: a multicenter network analysis

Abstract Background Moral courage may support error acknowledgement and disclosure, whereas error aversion culture may discourage nurses from speaking up. However, little is known about how these two constructs co-occur within subgroups of clinical nurses. This study aimed to identify latent profiles of error aversion culture and moral courage, compare profile-specific network structures, and estimate candidate intervention targets using computer-simulated perturbation. Methods A multicenter cross-sectional survey recruited 1,107 clinical nurses from tertiary hospitals in four Chinese provinces between June 2025 and March 2026 using stratified convenience sampling. Participants completed the Error Aversion Culture Scale and the Nurses’ Moral Courage Scale. Analyses included latent profile analysis, profile-specific network estimation, Network Comparison Tests, and computer-simulated perturbation. Results Two profiles were identified: Profile 1, “low error aversion culture–low moral courage” (31.3%, n = 346), and Profile 2, “high error aversion culture–high moral courage” (68.7%, n = 761). In Profile 1, moral integrity was the most central node, compassion and true presence was the key bridge node, and stress from errors was the strongest simulated intervention target, reducing the expected total network score from 39.58 to 37.29. In Profile 2, difficulty admitting errors was the most central node and strongest candidate target, while perceived benefits of concealing errors was the key bridge node, reducing the expected total network score from 54.15 to 51.84. Conclusions The findings identify distinct profiles and candidate targets for nursing management strategies addressing error-related stress and difficulty admitting errors. Their potential to strengthen moral courage and patient safety requires longitudinal and experimental validation.