Baseline Work Engagement Moderates the Effect of a Nurse Engagement Intervention on Patient Safety Culture Among ICU Nurses: A Randomized Controlled Trial in Saudi Arabia

Abstract

Background: Patient safety interventions may not benefit all nurses equally. Baseline work engagement may shape nurses' capacity to absorb and apply safety-focused training, but this effect has rarely been tested in intensive care settings.

Objective: To examine whether baseline work engagement moderated the relationship between a nurse engagement intervention and post-test patient safety culture.

Methods: This prespecified secondary analysis used data from a two-group randomized controlled trial involving 232 ICU nurses from three governmental hospitals in Hail, Saudi Arabia. Nurses were allocated 1:1 to a four-week, four-module engagement intervention or usual practice. The moderation analysis included 220 nurses with post-test data. Patient safety culture was measured using the four-item Primary Patient Safety Culture Index, and baseline work engagement using the 17-item Utrecht Work Engagement Scale. Hayes' PROCESS Model 1 adjusted for baseline patient safety culture and hospital and used 5,000 bootstrap resamples.

Results: Baseline work engagement averaged 3.76 (SD = 0.54). The model was significant, F(6, 213) = 87.82, p < .001, R² = .712. The intervention-by-engagement interaction was positive and significant (B = 0.528, bootstrap SE = 0.126, 95% bootstrap CI [0.288, 0.775], p < .001). Conditional intervention effects increased from B = 0.297 at low engagement to B = 0.580 at the mean and B = 0.863 at high engagement; all effects were significant.

Conclusion: Baseline work engagement amplified the intervention's effect on patient safety culture. Nurses with lower engagement still benefited, but may require added organizational and educational support to achieve comparable gains