# The mediating role of sleep quality in the relationship between professional identity and anxiety symptoms among emergency nurses: a cross-sectional study

## TL;DR

Emergency nurses with stronger professional identity and better sleep quality have lower anxiety symptoms, with sleep quality partially explaining this relationship.

## Contribution

This study identifies sleep quality as a partial mediator linking professional identity to anxiety symptoms in emergency nurses.

## Key findings

- 38.5% of emergency nurses showed anxiety symptoms, with those having anxiety reporting worse sleep and lower professional identity.
- Professional identity and sleep quality were significant predictors of anxiety symptoms.
- Sleep quality partially mediated the relationship between professional identity and anxiety symptoms, explaining 28.6% of the effect.

## Abstract

Emergency nurses have long been exposed to high-intensity workloads and psychologically demanding environments, placing them at increased risk of anxiety symptoms. Professional identity is considered an important occupational resource that may buffer psychological distress, yet little is known about the mechanisms through which it influences anxiety. Sleep quality, a crucial determinant of mental health, may serve as a potential mediator in this association.

This study aimed to examine the relationship between professional identity and anxiety symptoms among emergency nurses and to explore whether sleep quality mediates this association.

A cross-sectional study was conducted among 179 emergency nurses from a tertiary teaching hospital in China. Participants completed the Generalized Anxiety Disorder Scale (GAD-7), the Pittsburgh Sleep Quality Index (PSQI), and the Professional Identity Scale for Nurses (PISN). Based on a GAD-7 cutoff score of ≥5, participants were classified into the anxiety group (n = 69, 38.5%) and the non-anxiety group (n = 110, 61.5%). Between-group comparisons were conducted using Mann–Whitney U and Chi-square tests. Correlations were assessed using Spearman coefficients. Hierarchical regression was performed to identify predictors of anxiety, and a mediation analysis was conducted using a bias-corrected bootstrap approach.

The prevalence of anxiety symptoms was 38.5%. Nurses with anxiety showed significantly poorer sleep quality and lower professional identity levels compared with non-anxious nurses (p < 0.01). Professional identity was negatively correlated with both PSQI scores (r = −0.31, p < 0.001) and anxiety symptoms (r = −0.27, p < 0.001). Hierarchical regression indicated that poorer sleep quality (β = 0.32, p < 0.001) and lower professional identity (β = −0.15, p = 0.003) were significant predictors of anxiety symptoms. Mediation analysis revealed that sleep quality partially mediated the effect of professional identity on anxiety (indirect effect = −0.06, 95% CI: −0.10 to −0.02), accounting for approximately 28.6% of the total effect.

Lower professional identity and poor sleep quality are significant risk factors for anxiety symptoms among emergency nurses. Sleep quality plays a partial mediating role in this association. Interventions designed to strengthen professional identity while improving sleep health may effectively reduce anxiety symptoms in this workforce.