Social networks, sleep quality, and nurses’ safety behavior: a mixed-methods study

Abstract

Poor sleep quality and limited social resources are common among nurses and may compromise safety behavior, yet the pathways linking them remain unclear. This study explored the pathways through which nurses’ ego-network status and sleep quality are associated with safety behavior within the JD-R model. We conducted a mixed-methods study and reported it according to the GRAMMS guidelines. Between June and December 2024, 418 nurses were recruited by convenience sampling to complete a face-to-face survey assessing the Pittsburgh Sleep Quality Index, ego-network degree centrality, perceived social support, and safety behavior. Structural equation modeling was performed using AMOS 26.0 to test the hypothesized model. Between January and February 2025, 23 nurses were purposively selected for semi-structured interviews. Directed content analysis was conducted using NVivo 12.6, guided by the JD-R model as the predetermined theoretical framework, to identify and refine the categorization of pathways related to nurses’ safety behavior. Ego-network degree centrality was positively associated with nurses’ safety behavior ( β = 0.317, p < 0.001). The Pittsburgh Sleep Quality Index was negatively associated with nurses’ safety behavior ( β = −0.184, p < 0.001). Ego-network degree centrality ( β = −0.168, p < 0.001) and perceived social support ( β = −0.008, p < 0.001) each mediated the association between the PSQI and nurses’ safety behavior, and together they formed a significant serial mediation pathway ( β = −0.018, p < 0.001), accounting for 8.11% of the total association in the unadjusted model. The qualitative findings further identified job demands and resources associated with nurses’ safety behavior and suggested potential underlying pathways. Within the JD–R framework, sleep quality may be considered a job demand related to nurses’ safety behavior, whereas ego-network degree centrality and perceived social support represent resource factors. Ego-network degree centrality and perceived social support each mediated the association between the PSQI and nurses’ safety behavior and together formed a significant serial mediation pathway. In addition, poorer sleep quality may be accompanied by psychological responses associated with lower safety behavior.