Nurses’ Perceptions of Climate Change and Attitudes Toward Sustainability Practices: The Mediating Role of Nurse Managers’ Sustainable Management Behaviors

Introduction Climate change poses major health threats, yet awareness among nurses does not always translate into sustainable practice. Nurse managers’ leadership behaviors may play a pivotal role in embedding environmental accountability within healthcare. Objectives To examine the relationships between nurses’ perceptions of climate change and their attitudes toward sustainability practices, and to assess the mediating role of nurse managers’ sustainable management behaviors. Methods A descriptive correlational study was conducted at an Egyptian university hospital using a convenience sample of 415 staff nurses and 23 nurse managers. Data were collected using validated tools for climate change cognition, sustainability attitudes, and sustainable management behaviors. Descriptive statistics, correlations, regression analyses, and structural equation modeling were performed. Results Nurses reported moderate sustainability attitudes (M = 3.29; 57.3%) but relatively low climate change cognition and behaviors (M = 2.80; 45.1%). Nurse managers’ sustainable management behaviors were moderate (M = 3.58; 64.5%) and had a significant positive effect on nurses’ climate change cognition and behaviors (β = 0.61, p < .001). Mediation analysis confirmed that sustainability attitudes had a significant direct effect on sustainable management behaviors (β = 0.57, p < .001), which mediated their impact on awareness, concern, and behavior, though not intrinsic motivation ( p = .207). Climate education predicted nurses’ climate engagement but not nurse managers’ sustainable management behaviors. Conclusion Sustainable leadership is critical for translating nurses’ awareness of climate change into environmentally responsible healthcare practices. Integrating sustainability into nursing curricula, leadership training, and health system policies is vital to translate awareness into action.