Occupational Stigma and Unethical Behavior Among Hospital Nursing Assistants: Parallel Mediating Roles of Core Self-Evaluation and Organizational Disidentification

Background This study aims to investigate the mechanism through which perceived occupational stigma influences the unethical behavior of hospital nursing assistants. It focuses on the parallel mediating roles of core self-evaluation and organizational disidentification. The goal is to reveal the complex psychological pathways through which occupational stigma affects behavior, providing theoretical and empirical evidence for improving the nursing assistants' work environment and preventing unethical conduct. Methods A cross-sectional survey was conducted from March to June 2025 using convenience sampling among nursing assistants from several tertiary hospitals in Guangdong Province, China. Established scales were used to measure occupational stigma, core self-evaluation, organizational disidentification, and unethical behavior. Data were analyzed using AMOS and SPSS software, including structural equation modeling (SEM) for mediation analysis and the Bootstrap method (5,000 resamples) to test mediation effects. Results Occupational stigma significantly negatively affected core self-evaluation (β= -0.376, p < 0.001) and significantly positively affected organizational disidentification (β = 0.438, p < 0.001). Core self-evaluation significantly negatively influenced unethical behavior (β= -0.312, p < 0.001), while organizational disidentification significantly positively influenced it (β = 0.563, p < 0.001). The mediating effects of both core self-evaluation (indirect effect = 0.114, 95% CI [0.071, 0.175]) and organizational disidentification (indirect effect = 0.239, 95% CI [0.174, 0.321]) were significant. However, the direct effect of occupational stigma on unethical behavior was negative and significant (β= -0.108, p = 0.002), contrary to the initial hypothesis, indicating a typical "masking effect." Conclusions Occupational stigma influences nursing assistants' unethical behavior through complex dual pathways and a masking effect. The risk of unethical behavior arises not only from the depletion of individual psychological resources (core self-evaluation) but also from the erosion of organizational identity. This finding underscores the need for dual-pronged interventions: reducing occupational stigma at societal and organizational levels, while also enhancing nursing assistants' psychological resilience and organizational belonging through psychological capital development and positive organizational climate building, thereby safeguarding the quality of the "last mile" of healthcare services.