Nurses Who Feel Like Professionals Care More About Sustainability, Study Finds

Healthcare is one of the largest contributors to national carbon footprints, and the people who keep hospitals running around the clock are increasingly being asked to think green on top of everything else. A new study published in BMC Medical Education suggests that the key to making sustainability stick in nursing may not be more lectures or checklists, but something far more personal: how strongly nurses see themselves as professionals. The research, led by Mohamed Elsayed Ahmed Allawy of Prince Sattam Bin Abdulaziz University and colleagues in Egypt and Saudi Arabia, examined whether confidence in one’s ability to integrate sustainability into practice is linked to favorable attitudes toward sustainable development, and whether professional self-identity helps explain that connection.

The team surveyed 617 internship nurses affiliated with the Faculty of Nursing at Damanhour University in Egypt. Internship nurses occupy a unique transitional position in the health workforce: they have completed their academic training but are not yet fully licensed practitioners, making them a revealing window into how professional identities form and how educational experiences translate into workplace values. Between March and April 2026, participants completed an electronic questionnaire that captured their sociodemographic and educational characteristics along with three validated psychological measures.

The first instrument, the Self-Efficacy Beliefs on Integrating Sustainability Instrument, assessed how confident nurses felt about weaving environmental and sustainability considerations into their daily clinical work. Self-efficacy, a concept rooted in Albert Bandura’s social cognitive theory, refers to a person’s belief in their own capacity to execute the behaviors required for a specific performance. The second, the Professional Self-Identity Questionnaire, measured the degree to which respondents internalized the values, norms, and sense of belonging associated with being a nurse. The third, the Attitudes toward Sustainable Development Scale, gauged how favorably participants viewed the goals of sustainable development, from environmental stewardship to social responsibility.

The results painted a picture of a workforce that is already receptive to sustainability. Sustainability integration self-efficacy scored moderate to high, with a mean of 38.08 and a standard deviation of 6.44, while attitudes toward sustainable development were favorable overall, averaging 85.10 with a standard deviation of 11.82. Those numbers matter because attitudes are generally considered a precursor to behavior: nurses who view sustainable development positively are more likely to support and adopt environmentally responsible practices, from reducing single-use plastics to advocating for energy-efficient ward operations.

To test how these variables related to one another, the researchers used Pearson correlations and an unadjusted observed-variable path model, estimated with SPSS version 26.0 and AMOS version 24.0. Path modeling allows researchers to estimate multiple regression pathways simultaneously, distinguishing direct associations between two variables from indirect ones that pass through a third. In this case, the central question was whether professional self-identity statistically carried part of the association between sustainability self-efficacy and sustainability attitudes.

The answer was yes, and the pattern was striking. Sustainability integration self-efficacy was positively associated with professional self-identity, with an unstandardized coefficient of 0.668, a standardized beta of 0.427, and a p-value below 0.001. Professional self-identity, in turn, was positively associated with sustainability attitudes, with an unstandardized coefficient of 0.179, a standardized beta of 0.153, and a p-value below 0.001. In other words, nurses who felt more confident about integrating sustainability also reported a stronger sense of professional identity, and that stronger identity was linked to more favorable attitudes toward sustainable development.

Perhaps the most intriguing finding was what disappeared. The direct association between self-efficacy and attitudes was not statistically significant once the pathway through professional self-identity was modeled: the unstandardized coefficient was 0.108, the standardized beta just 0.059, and the p-value 0.178. A nonparametric bootstrap analysis with 5,000 resamples confirmed a statistically significant indirect association through professional self-identity, with an unstandardized estimate of 0.120, a bootstrap standard error of 0.041, a standardized beta of 0.065, and a bias-corrected 95 percent confidence interval running from 0.040 to 0.203, with a bootstrap p-value of 0.002. The indirect pathway accounted for roughly 53 percent of the total unstandardized point estimate, a descriptive ratio the authors were careful to frame as a cross-sectional proportion rather than a share of a causal effect.

That caution is essential, and the researchers were explicit about it. Because all variables were measured at a single point in time, the indirect pathway can only be interpreted as a statistical cross-sectional association, not as causal mediation. It is entirely possible that nurses who already identify strongly with their profession develop both the confidence to champion sustainability and the attitudes that support it, rather than confidence flowing through identity to shape attitudes. Longitudinal designs that track nurses across their internship and early careers, or experimental interventions that deliberately strengthen professional identity, would be needed to establish the direction of these relationships.

Even with those limitations, the findings carry practical weight for nursing education. If professional self-identity is the conduit through which sustainability confidence translates into favorable attitudes, then curricula that foster identity formation, through mentorship, reflective practice, professional socialization, and early exposure to the nurse’s role as an advocate for community and environmental health, may do double duty. Rather than treating sustainability as a bolt-on module, educators could embed it within the broader project of helping students and interns understand who they are becoming as professionals. The study’s theoretical grounding in self-efficacy theory suggests that mastery experiences, vicarious learning, and supportive feedback about sustainability efforts could build the confidence that, in turn, reinforces identity.

The study also adds to a growing international conversation about the environmental responsibilities of the health sector. Healthcare systems worldwide account for a meaningful share of national greenhouse gas emissions, and professional bodies have increasingly called for climate and sustainability content in health professional education. This research offers a psychological mechanism to guide that effort, pointing to identity rather than information alone as the lever worth pulling. Funded by Prince Sattam bin Abdulaziz University through project number 2025/01/36295, with the funder having no role in the design, analysis, or interpretation, the study was approved by the Research Ethics Committee of the Faculty of Nursing at Damanhour University under research code 120-b, dated 10 January 2026, and all participants provided electronic informed consent. For a profession built on the principle of doing no harm, the message resonates: nurses who see themselves fully as professionals may be the most natural allies sustainability science could ask for.

Subject of Research: Sustainability self-efficacy, professional identity, and sustainability attitudes among internship nurses

Article Title: Sustainability integration self-efficacy and sustainability attitudes among internship nurses: the role of professional self-identity

Article References: Allawy, M. E. A., Atta, M. H. R., Hemaida, W., Khalil, H. H. S., & Mahmoud, M. F. H. (2026). Sustainability integration self-efficacy and sustainability attitudes among internship nurses: the role of professional self-identity. BMC Medical Education. https://doi.org/10.1186/s12909-026-10503-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10503-4

Keywords: nursing education, sustainability, self-efficacy, professional identity, sustainable development, internship nurses, cross-sectional study, path analysis, healthcare, attitudes, integration, internship