The dynamic relationship between ethical leadership and nurses’ innovative behavior

Background Nurses’ innovative behavior serves as a crucial driver for organizational improvement and technological advancement. However, the demanding nature of the nursing work environment (characterized by high intensity, risk, and pressure) hinders the sustained development and quality of such innovation. Investigating the factors influencing nurses’ innovative behavior is therefore essential for enhancing overall nursing quality and patient recovery outcomes, yet research on these factors and their underlying mechanisms remains limited. Aim To examine the effect of ethical leadership on nurses’ innovative behavior and explore the longitudinal mediating role of moral sensitivity. Design A longitudinal mediated follow-up study with three waves (January–July 2024). Participants: and research Context 397 nurses from three Chinese hospitals via multicenter stratified cluster sampling. Inclusion criteria: registered nurses with ≥1 year of experience. Ethical considerations Approved by the relevant Ethics Subcommittee. Anonymous surveys with informed consent; voluntary participation. Findings Significant positive correlations existed between innovative behavior and both ethical leadership and moral sensitivity at each time point (T1, T2, T3). Longitudinal path analysis demonstrated that T1 ethical leadership significantly predicted T2 moral sensitivity (β = 0.26, p < .001), T2 moral sensitivity significantly predicted T3 innovative behavior (β = 0.24, p < .001), and T1 ethical leadership significantly predicted T3 innovative behavior (β = 0.14, p < .001). Moral sensitivity significantly mediated the relationship between ethical leadership and innovative behavior, accounting for 30.24% of the total effect. Discussion Ethical leadership fosters innovation both directly (through psychological safety) and indirectly by strengthening moral sensitivity, which empowers nurses to identify ethical dilemmas and develop novel solutions. Conclusions Healthcare institutions should cultivate ethical leadership in nurse managers and implement moral sensitivity training (e.g., ethics case discussions) to sustainably promote nurses’ innovative behavior and care quality.