Butun, A.Özbay, H.Ersü, N.F.2025-07-152025-07-1520251472-6955https://doi.org/10.1186/s12912-025-03168-9https://hdl.handle.net/20.500.12514/9078Background: Preventing medication errors and ensuring safe medication application for students to enhance their self-efficacy are important for patient safety. Improving self-efficacy and self-confidence and teaching strategies for managing the anxiety of nursing students during medication administration to children are crucial in paediatric clinical practises. Aim: The primary aim of this study was to evaluate nursing students’ medication administration self-efficacy in children, self-confidence anxiety, and self-esteem in clinical decision-making. The second aim was to reveal the mediating role of self-esteem in the relationship between nursing students’ self-efficacy in medication administration in children and self-confidence and anxiety levels in clinical decision-making. Methods: This study employed a cross-sectional survey research design. A total of 317 nursing students participated in the study. The data were collected between 16/09/2024 and 30/09/2024 via face-to-face survey technique. The data were collected using Student Introduction Form, Medication Administration Self-Efficacy Scale in Children for Nursing Students, Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale, and Rosenberg Self-Esteem Scale Short Form. Results: Nursing students reported low self-efficacy (45.53 ± 15.85) and self-confidence (62.61 ± 30.16) in paediatric medication administration, along with moderate anxiety levels (89.20 ± 41.99). However, self-esteem levels were high (1.91 ± 0.52). Self-esteem was found to partially mediate the relationship between self-efficacy and self-confidence but did not significantly mediate the relationship between self-efficacy and anxiety. Among the participants, 39.4% stated that they did not make a mistake in calculating the medication dose in children. 69.1% of participants reported a need for training in the preparation and administration of paediatric medications. Conclusion: The results suggest that interventions to improve self-esteem could enhance nursing students’ self-confidence in clinical decision-making, particularly in paediatric medication administration. Incorporating self-esteem-building activities and targeted training into nursing curricula is recommended to address low self-efficacy and moderate anxiety levels. These results have important implications for nursing education, suggesting that such interventions could reduce medication errors and improve patient safety. Future research should explore the long-term impact of these interventions on clinical performance and patient outcomes. Clinical trial number: Not applicable. © The Author(s) 2025.en10.1186/s12912-025-03168-9info:eu-repo/semantics/closedAccessAnxietyClinical Decision-MakingMedication AdministrationNurse EducationNursing StudentSelf-ConfidenceSelf-EfficacySelf-EsteemArticle241Q1Q12-s2.0-105009706014