Path analysis the influence of self-efficacy and professional identity on attitudes toward prescriptive authority among oncology nurse specialists.

Background: Global tumor incidence rises and therapies advance, driving oncology nursing specialization. Granting nurses prescriptive authority optimizes care but polarizes nurses' attitudes due to factors like risk and competence, hindering policy implementation.

Aim: To investigate the current status of the attitudes of oncology specialist nurses toward having prescribing authority, specifically concerning symptom management and supportive care in oncology practice, and we conducted a path analysis of their influencing factors.

Methods: As participants in the survey, oncology specialist nurses working in hospitals of different grades in Jiangsu Province were selected from March 2025 to May 2025 using a stratified sampling method. The questionnaires were administered using the general information questionnaire, the beliefs and attitudes about nurses' prescriptive authority scale, the nurses' professional identity scale, and the self-efficacy scale. Pearson's method was used to analyze the correlation between beliefs and attitudes about the prescriptive authority, professional identity, and self-efficacy of nurses. Multiple linear regression was performed to analyze the factors influencing the beliefs and attitudes of nurses' prescriptive authority. The Amos plug-in was used to construct structural equation models to analyze the influencing pathways.

Results: A total of 329 questionnaires were distributed, and 328 valid questionnaires were returned (effective recovery rate: 99.70%). The total score of the 328 oncology nurses on the beliefs and attitudes about nurses' prescriptive authority scale was 101.88 ± 15.13, indicating a moderately high level. Univariate analysis revealed that gender and hospital grade were associated with this score (P < 0.05). The Pearson correlation analysis revealed that self-efficacy was positively correlated with the scores of the beliefs and attitudes about nurses' prescriptive authority scale and the nurses' professional identity scale (r = 0.4999, P < 0.0001 and r = 0.7048, P < 0.05, respectively), whereas occupational identity was positively correlated only with the former (r = 0.6209, P < 0.05). Multiple linear regression analysis revealed occupational identity and self-efficacy as the factors influencing the scores of the beliefs and attitudes about nurses' prescriptive authority scale (P < 0.05). The results of the path analysis revealed that self-efficacy significantly positively affected nurses' occupational identity and their beliefs and attitudes about having prescriptive authority; occupational identity played a mediating role between the two, with a mediating effect accounting for 54.46% of the total effect, and the structural equation model was well-fitted.

Conclusion: Oncology nurses have more positive attitudes toward prescriptive authority. In addition, self-efficacy positively and indirectly affects nurses' attitudes toward prescriptive authority through the mediating effect of occupational identity. This can be used as a basis for clinical practice to take targeted measures to improve nurses' self-efficacy and occupational identity, thus creating favorable conditions for effectively implementing the policy of prescriptive authority.