Nursing interns are in a critical transitional period, shifting from “students” to “nurses.” Due to changes in their roles, interpersonal relationships, responsibilities, knowledge, and skills, they may experience feelings of confusion, perplexity, doubt, and ambiguous self-positioning (1). Moral sensitivity refers to nurses’ continuous attention to and perception of patients’ ethical needs. As the core starting point of nursing ethical decision-making (2), the level of moral sensitivity is directly related to the ethical quality of nursing services (3). Current research has focused on the impact of transition shock on nurses’ morality-related literacy (4–6) and the positive influence of calling on ethical practice in the nursing profession (7). However, deficiencies remain. First, the mechanism by which transition shock affects nursing interns’ moral sensitivity is unclear. Second, the moderating role of calling is often explored in isolation (8), and there is a lack of integrated analysis on how it synergizes with the mediating effect of self-compassion to regulate the impact pathway of transition shock on moral sensitivity. This study constructs and verifies a moderated mediation model (see Figure 1) to identify key influencing factors and action pathways. This will facilitate the development of targeted intervention strategies that alleviate transition pressure and enhance moral sensitivity and ethical practice capabilities among nursing interns.

As reserve forces of the medical team, the transition shock experienced by nursing interns has become a key factor affecting their professional development and ethical practice (9). From a theoretical perspective, Duchscher’s Transition Shock Theory (10) suggests that nursing interns must progress through the stages of “role expectation,” “role practice,” and “role identity.” Transition shock is essentially role conflict and adaptation pressure triggered by insufficient environmental support (e.g., inadequate preceptorship guidance) and a mismatch between abilities and needs (e.g., difficulty in translating theoretical knowledge into practical operational skills). According to Hobfoll’s Conservation of Resources Theory (COR), this type of shock constitutes a loss of psychological resources, consuming the energy nursing interns use for emotional regulation and cognitive focus. When transition shock leads to the exhaustion of these resources, nursing interns become prone to cognitive biases that prioritize their own dilemmas. This diverts their attention from patients’ ethical situations, thereby reducing their moral sensitivity (11). From an empirical research perspective, although existing studies have not directly examined the relationship between the two, relevant evidence has provided support. Studies have found that transition shock can lead to job burnout (12), increase turnover intention (13), and cause cognitive biases and impulsive decision-making (14), resulting in errors. These findings suggest that transition shock continuously consumes nursing interns’ psychological resources and occupies their attention, thus impairing their ability to perceive ethical issues. Thus, the following hypothesis is proposed:

As a positive psychological resource, self-compassion emphasizes an individual’s kind acceptance of oneself, mindful awareness of pain, and recognition that difficulties are shared human experiences (15). This concept aligns perfectly with the psychological adjustment needs of nursing interns in the context of transition shock. From a theoretical perspective, according to COR (16), the depletion of psychological resources caused by transition shock directly weakens the level of self-compassion. Further deduced from Self-Compassion Theory (17), a high level of self-compassion can reduce self-criticism and alleviate emotional exhaustion (18), preserving the psychological energy for individuals to focus on external ethical situations (19). In other words, when nursing interns possess good self-compassion abilities, even in the face of transition shock, they can avoid being distracted by self-negation and are more likely to perceive patients’ ethical needs—for example, consciously protecting patients’ privacy during daily nursing care.

In empirical studies, Miller et al. (20) found that mindfulness and kindness have a positive impact on moral sensitivity. Kotera et al. (21) identified self-compassion as a key explanatory variable for mental health, noting a significant relationship between self-compassion and moral judgment, with self-compassion contributing to reducing negative emotions and enhancing mental health. Kroshus et al. (22) surveyed 5,509 first-year college students and demonstrated that self-compassion plays a vital role in alleviating transition shock-related stress and improving well-being among undergraduates. These findings suggest that self-compassion may act as a mediating role between transition shock and ethics-related literacy. Integrating theoretical logic and gaps in empirical research, the following research hypotheses are proposed:

Calling is defined as “the integration of occupation and life meaning” (23), manifested as internal recognition of the value of the nursing profession and willingness to dedicate oneself to it long-term. Its characteristic of “meaning reconstruction” makes it a potential variable for moderating the impact of transition shock (24). Nursing interns with high calling tend to interpret transition shock as a necessary test for professional growth rather than a mere stressor (25). This meaning reconstruction can reduce the consumption of self-compassion resources caused by shock (26). Specifically, when facing transition conflicts, interns with high calling are more likely to accept their own shortcomings and avoid falling into self-criticism due to short-term difficulties, thereby maintaining their level of self-compassion.

In terms of empirical research, Xin et al. (13) studied 739 newly graduated nurses and found that transition shock can reduce the level of calling, thereby decreasing retention intention. Li et al. (4) investigated 506 healthcare professionals and showed that moral injury has a negative impact on calling, while self-compassion and ethical leadership can buffer this negative effect. These findings indicate a potential internal connection between transition shock, self-compassion, and calling. Based on theoretical characteristics and empirical clues, the fifth research hypothesis is proposed:

The study found that the median score of moral sensitivity was 30, indicating that nursing interns had a low level of moral sensitivity. The score of moral sensitivity in this study was significantly lower than that reported in the study by Guo et al. (42). The main reason for this difference was the variation in research subjects: the latter investigated registered nurses with more than 1 year of work experience, confirming that there was a significant difference in moral sensitivity between nursing interns and registered nurses. The median score of transition shock among nursing interns was 50, indicating a relatively high level, which was broadly consistent with the findings of Zhao et al. (43). This suggests that nursing interns experience severe transition shock. High transition shock can reduce work efficiency, deplete psychological resources, and hinder the transition to the role of a professional nurse, which warrants attention from nursing managers (44). The median score of self-compassion was 82, at moderate-high level, slightly lower than that reported by Wang et al. (45). The reason is that the latter surveyed nursing students in school who had not entered clinical internships and were not affected by transition shock, so they had higher self-compassion scores. This finding also indirectly confirms the negative impact of transition shock on self-compassion. The median score of calling was 30, broadly consistent with the study by Chen et al. (46) among nursing students not yet in clinical practice, with both groups at a moderate level per the scale’s scoring criteria. This indicates that educational institutions lack effective cultivation of calling among nursing students. Some nurses have limited cognition of the nursing profession, failing to fully understand the sacred mission it bears in safeguarding life and health, and only regard it as a technical job of “carrying out procedures and completing tasks,” ignoring the humanistic care and noble value inherent in the profession (47).

The results confirmed that the higher the level of transition shock among nursing interns, the lower their moral sensitivity scores, supporting Hypothesis 1. This finding was highly consistent with the findings of Ryus et al. (48) that stress impairs the ability to perceive ethical issues. From clinical practice perspective, nursing interns are in a critical transition period and face stressors and challenges such as “theory-practice gap” and “high pressure from clinical skill performance” (44). When confronted with these shocks, their cognitive resources were prioritized to meet core needs—such as how to perform tasks assigned by preceptors and how to avoid operational errors—thereby reducing their ability to perceive ethical cues including patient privacy and patients’ right to informed consent. Fundamentally, this result supported the core proposition of the Conservation of Resources Theory: as a resource-depleting event, transition shock caused nursing interns to shift attention away from non-urgent needs (e.g., ethical perception). This established a mechanism whereby transition shock induces resource depletion, which in turn reduces moral sensitivity.

The results showed that transition shock was significantly negatively correlated with self-compassion among nursing interns—specifically, the stronger the transition shock, the weaker the interns’ capacity for self-kind acceptance and mindful awareness—supporting Hypothesis 2. This finding could be interpreted from the psychological characteristics of nursing interns. On one hand, the frustrating experiences associated with transition shock (such as criticism from preceptors and misunderstandings by patients) were likely to trigger self-criticism, which contradicts the core dimension of self-compassion, namely “self-kindness.” On the other hand, “emotional exhaustion” caused by transition shock would weaken individuals’ mindfulness capacity. Combined with the Conservation of Resources Theory (COR) (16) and the Self-Compassion Theory (17), an analysis from a clinical practice perspective reveals that transition shock, as a profession-specific stressor, directly impairs the self-compassion capacity of nursing interns. This impairment in turn exacerbated difficulties in transition adaptation, creating a vicious cycle in which transition shock leads to decreased self-compassion, which further increases adaptation challenges. This suggests that self-compassion may be a key buffering variable to break this cycle.

The study confirmed that the higher the level of self-compassion among nursing interns, the stronger their moral sensitivity, supporting Hypothesis 3. This provided new empirical evidence for the viewpoint that positive psychological resources foster ethical literacy (49). An analysis from the core dimensions of self-compassion revealed three key mechanisms: First, “self-kindness” helped nursing interns reduce self-criticism, enabling them to allocate more psychological resources to patients’ ethical needs (50). Second, “common humanity” allowed interns to recognize that difficulties during the transition period are shared experiences among all novice nurses, preventing self-isolation and encouraging them to proactively attend to patients’ ethical appeals (51). Third, “mindful awareness” enhanced interns’ ability to detect ethical situational cues (52). This result indicated that in addition to ethical knowledge training, efforts to cultivate psychological resources among nursing interns should also be strengthened. It suggested that self-compassion is not merely a self-regulatory tool; rather, it can act as an intrinsic driver force for the development of moral sensitivity among nursing, by enhancing psychological resilience, optimizing interpersonal perception, and strengthening ethical awareness.

Bootstrap testing results showed that the mediating effect of self-compassion between transition shock and moral sensitivity was significant, accounting for 42.59% of the total effect, which supported Hypothesis 4. Specifically, transition shock could directly impair the moral sensitivity of nursing interns, and could also indirectly weaken their moral sensitivity by reducing self-compassion. In practice, when nursing interns face high transition shock, the resource-buffering effect of self-compassion is impaired. On one hand, the decline in self-compassion makes it difficult for interns to alleviate anxiety through self-kindness, thereby failing to detect ethical cues (53). On the other hand, the lack of mindful awareness leads interns to experience emotional exhaustion (54), diminishing their ability to perceive patients’ ethical needs. Conversely, if nursing interns have high levels of self-compassion, even in the face of transition shock, they can maintain sensitivity to ethical situations by accepting their limitations and being mindful of their emotional states, thereby buffering the negative impact of transition shock. Verification of this mediating mechanism provides a targeted focus for the design of subsequent intervention programs. It indicated that improving the self-compassion of nursing interns can serve as a dual strategy that both alleviates transition shock and preserves moral sensitivity.

The moderating effect analysis showed that calling significantly moderated the relationship between transition shock and self-compassion: as calling increased, the negative impact of transition shock on self-compassion gradually weakened, supporting Hypothesis 5. This result was consistent with the core tenet of the Meaning Maintenance Model (24)—that is, as a source of meaning, calling helps nursing interns reconstruct their appraisal of difficulties when confronted with transition shock. Interns with high calling tended to view clinical procedural errors and criticism from preceptors as necessary experiences for becoming qualified nurses, rather than threats to their self-worth, and thus were more likely to maintain self-kindness. Meanwhile, recognition of the value of the nursing profession endows interns with psychological energy to cope with stress, reducing the loss of mindfulness caused by shock (55). This study confirmed that calling acts as a protective factor, creating a psychological buffer for nursing interns under high transition shock. For instance, when both face patient complaints, interns with high calling were more likely to reflect on how to improve their communication methods (self-compassion-oriented), whereas those with low calling tended to lapse into self-negation such as “I am not suitable for nursing work” (self-criticism-oriented).

First, this study adopted convenience sampling and online questionnaires, which may be subject to selective response bias. Interns experiencing severe transition shock are more likely to refuse participation, resulting in underrepresentation of cases with high transition shock in the sample and potential underestimation of the true magnitude of associations between variables. Second, transition shock, self-compassion, and moral sensitivity among nursing interns all exhibit stage-specific characteristics and may change with the duration of the internship. The cross-sectional design of this study pooled samples from different internship stages for analysis, which to a certain extent obscures differences in the magnitude of mediating and moderating effects across stages. Future studies could expand the sample size and conduct subgroup analyses accordingly. Third, the sample was only recruited from 6 hospitals in one province, lacking sufficient representativeness in terms of geography and hospital levels, which may limit the generalizability of the results. Future research could expand the research settings and populations to verify the generalizability of the findings. Fourth, the measurement tools relied on self-report scales, which are inherently subjective and prone to measurement bias. In future studies, the accuracy of measurement could be improved by integrating methods such as situational simulation assessments. Fifth, this study did not incorporate potential moderating variables (e.g., preceptorship quality). These variables may jointly influence the relationship between transition shock and self-compassion alongside calling, and thus deserve further in-depth exploration in future research.

This study empirically confirmed that transition shock among nursing interns negatively affects moral sensitivity and self-compassion, in which self-compassion plays a mediating role; furthermore, calling serves to buffer the negative impact of transition shock on self-compassion. This result not only enriches the theoretical research on the relationship between nursing internship transition and ethical literacy but also provides actionable intervention targets for educational institutions and hospitals to develop “psychological support and ethical cultivation programs for nursing interns” in practice. By fostering self-compassion and enhancing calling, nursing interns can be helped to better cope with transition shock, protect the development of their moral sensitivity, and lay a solid foundation for their development into qualified nurses equipped with empathy and ethical literacy.