Work pressure, communication skills, empathy, professional identity, and workplace violence in psychiatric nurses: a structural equation model analysis

BACKGROUND: Psychiatric nurses face elevated workplace violence (WPV) risk and high occupational stress globally. This structural equation modeling study examined relationships among work pressure, communication skills, empathy, professional identity, and WPV. METHODS: Between January and July 2024, 634 nurses from six Grade-A tertiary psychiatric hospitals in Shandong Province, China, completed validated instruments assessing work pressure, communication skills, empathy, professional identity, and WPV. Structural equation modeling with path analysis was used to examine direct and mediating effects. RESULTS: WPV was positively associated with work pressure and negatively associated with communication skills, empathy, and professional identity. Work pressure showed direct effects on WPV (β = 0.357, P < 0.001) and indirect effects through empathy (β = 0.091, P < 0.05). Communication skills (β=-0.206, P = 0.010), empathy (β=-0.219, P < 0.001), and professional identity (β=-0.390, P < 0.001) demonstrated significant negative direct effects on WPV. Multiple mediation pathways were identified, including sequential mediation through empathy and professional identity. The structural model demonstrated good fit to the data. CONCLUSIONS: Work pressure, empathy, communication skills, and professional identity are associated with WPV among psychiatric nurses through both direct and indirect pathways. Healthcare administrators should implement targeted interventions including workplace improvements, psychological support services, stress management programs, and professional identity enhancement to reduce WPV risk and support nursing staff well-being. CLINICAL TRIAL NUMBER: Not applicable.