Nurses’ perceptions of ethical climate, work environment, and quality of care in the UAE

Abstract

The ethical climate and work environment in healthcare are vital factors influencing nursing practice and patient care quality. Although widely studied internationally, little research has explored how these factors interact to affect nursing care quality in the United Arab Emirates (UAE), a region with a diverse workforce and evolving healthcare system. This study aimed to explore registered nurses’ perceptions of the ethical climate and its relationship to the quality of nursing care, and to examine how these perceptions are influenced by key characteristics of the work environment within the healthcare context of the UAE. A quantitative correlational study was conducted using survey data collected from 396 registered nurses. Validated instruments, including the Practice Environment Scale of the Nursing Work Index, the Revised Ethical Climate Questionnaire, and the Nursing Quality of Care scale, were used to assess the work environment, ethical climate, and quality of care. Descriptive and inferential statistical analyses, including Pearson correlation and analysis of variance, were performed to examine the relationships among the study variables. Descriptive analysis indicated a generally favorable perception of the work environment and nursing care quality, while the ethical climate was perceived as moderate. Significant positive correlations were found between the nursing work environment and ethical climate, particularly in the principled, benevolent, and egoism dimensions. Additionally, the ethical climate was positively associated with perceived quality of care. A positive nursing work environment combined with a supportive ethical climate is associated with higher perceptions of care quality. Promoting ethical leadership, fostering collaborative team dynamics, and ensuring adequate staffing are essential for improving nurse well-being and patient outcomes. Based on the study findings, healthcare organizations should prioritize structured ethics training, supportive leadership, and safe staffing ratios to strengthen the ethical climate and enhance quality of care. Creating psychologically safe, non-punitive systems and fostering nurse participation in decision-making can further improve ethical perceptions. Tailored support for clinical nurse specialists is also essential, given their complex roles.