Background <p>As nursing evolves, innovations in management, technology, and services are critical. The innovative capacity of nurses directly influences healthcare quality, making it essential to explore the factors driving nurses’ innovative behaviors.</p> Aims <p>This study aimed to examine the impact of head nurse empowerment on the innovative behavior of clinical nurses and to explore the mediating role of organizational climate and professional autonomy.</p> Methods <p>This study surveyed 676 clinical nurses from June to September 2024, using scales for head nurse empowerment, innovative behavior, organizational climate, and professional autonomy. Data analysis was conducted using SPSS 25.0, while AMOS 26.0 was utilized for model mapping and mediation path analysis.</p> Results <p>Head nurse empowerment was significantly and positively related to clinical nurses’ innovative behavior, organizational climate and professional autonomy. Clinical nurses’ organizational climate and professional autonomy acted as chain mediators between empowerment and innovative behavior. The overall effect of empowerment on clinical nurses’ innovative behaviors (β = 0.635) consisted of both direct (β = 0.185) and indirect (β = 0.450) forms, with the mediating effect accounting for 70.70% of the total effect. The mediator model demonstrated a good fit (χ²/df = 3.248, GFI = 0.930, AGFI = 0.908, RMR = 0.027, NFI = 0.971, RFI = 0.966, IFI = 0.980, TLI = 0.976, CFI = 0.980, RMSEA = 0.058).</p> Conclusions <p>Head nurse empowerment positively predicts clinical nurses’ innovative behaviors, with organizational climate and professional autonomy acting as chain mediators. This study constructs and validates both dual and chain mediation models, systematically revealing the mechanisms through which empowerment influences nurses’ innovative behavior. These findings provide a new theoretical perspective and practical insights for research on innovation in the nursing field. Hospitals should enhance head nurse empowerment, optimize the organizational climate, and support professional autonomy to promote innovative behaviors among clinical nurses.</p> Clinical trial number <p>Not applicable.</p>