Emotional intelligence and clinical decision-making confidence in nurses: the chain mediating effect of creative self-efficacy and self-directed learning.

Background: Clinical decision-making competence underpins autonomous nursing practice. While external influences are documented, context-dependent psychological mechanisms linking emotional intelligence (EI) to clinical decision-making confidence (CDMC) remain unexplored. Using social cognitive theory, this cross-sectional study of 1,126 nurses from 12 Zhejiang tertiary hospitals examined EI' s influence on CDMC via sequential mediation by creative self-efficacy (CSE) and self-directed learning (SDL), moderated by department stress and clinical experience. Methods: Nurses completed measures of EI (WLEIS), CDMC (CDMSCS), CSE, and SDL. Analyses used structural equation modeling (SEM) with bias-corrected bootstrapping and multi-group SEM with Bonferroni correction to test moderation by department type (high-stress: ICU/emergency/OR vs. non-high-stress) and experience (≤5 vs. >5 years). Results: The model showed excellent fit ( Conclusion: EI enhances CDMC through context-contingent pathways: CSE is pivotal in high-stress environments, SDL prevails in non-high-stress units (notably pediatrics/gynecology), and experiential knowledge supersedes mediation pathways with seniority. These findings challenge uniform decision-making models, urging healthcare systems to implement context/experience-specific strategies-such as stress-adapted EI training for critical care nurses and experiential integration for seniors-to optimize clinical decision-making across nursing settings.