The hidden cost of patient advocacy: moral courage mediating clinical advocacy behaviors and workplace ostracism among Chinese nurses

BackgroundPatient advocacy is a central ethical responsibility of nurses and is generally associated with patient protection, safety, and care quality. However, most existing studies have emphasized the benefits of advocacy for patients, whereas relatively little is known about whether advocacy may create interpersonal costs for nurses themselves. This issue is particularly relevant in Chinese tertiary hospital settings, where nurses work within high-demand, team-based, and hierarchical clinical