Change Fatigue and Attitudes Toward AI in County‐Level Nurses: The Mediating Role of AI Literacy

OBJECTIVE: Grounded in the conservation of resources theory, this study aimed to examine the mediating role of artificial intelligence literacy in the relationship between change fatigue and attitudes toward AI application among nurses in county-level hospitals, thereby providing insights for enhancing AI technology acceptance in primary care settings. BACKGROUND: County-level hospitals in China are undergoing significant organizational transformations alongside rapid technological advancements. Nurses in these settings frequently experience change fatigue due to continuous institutional reforms, while simultaneously facing challenges in adapting to artificial intelligence technologies. Understanding the psychological mechanisms underlying nurses' acceptance of AI is crucial for successful technology implementation in primary care settings. DESIGN: A cross-sectional analytic study employing mediation analysis. METHODS: A cross-sectional survey was conducted using convenience sampling from August to September 2025. A total of 460 clinical nurses from a county-level tertiary B hospital in Nantong City, China (99.6% female; mean age 31-40 years: 43.3%), were assessed. Data were analyzed using structural equation modeling with the maximum likelihood estimation method, and the significance of indirect effects was tested using the bootstrap method (5000 samples). RESULTS: The mean scores for change fatigue, AI literacy, and AI application attitudes were 29.27 ± 6.98, 49.82 ± 5.27, and 45.26 ± 2.45, respectively. Change fatigue showed a significant negative association with AI application attitudes (β = -0.36, p < 0.001), while AI literacy demonstrated a significant positive effect (β = 0.34, p < 0.001). AI literacy partially mediated the relationship between change fatigue and AI application attitudes (indirect effect = -0.185, 95% CI: [-0.231, -0.142]), accounting for 37.7% of the total effect. CONCLUSION: AI literacy plays a significant partial mediating role. To improve nurses' acceptance of AI technologies, nursing administrators should implement dual interventions aimed at both alleviating change fatigue (e.g., paced change management and psychological support) and systematically enhancing AI literacy (e.g., stratified training programs).