Aim To cross-culturally adapt the Hospital Ethical Climate Survey into Arabic, evaluate its psychometric properties, and describe ethical-climate perceptions among Moroccan nurses and midwives. Background Ethical climate influences how healthcare professionals recognize, discuss, and manage ethical issues. However, no culturally adapted HECS has been validated among Arabic-speaking nurses and midwives in Morocco. Methods This cross-sectional methodological study included 425 nurses and midwives working in Moroccan public healthcare settings. Following translation, expert review, and clarity testing, the Arabic HECS was evaluated using exploratory and confirmatory factor analyses, internal consistency, convergent and discriminant validity, measurement invariance across hospital/non-hospital public healthcare settings, floor and ceiling effects, and known-groups validity. Results The final 22-item Arabic HECS retained the five relational dimensions of the original instrument, with context-specific item reorganization and four items removed. Confirmatory factor analysis showed acceptable fit (robust CFI = 0.926, TLI = 0.912, RMSEA = 0.058, SRMR = 0.050). Composite reliability ranged from 0.725 to 0.881, and scalar invariance was supported across hospital/non-hospital settings. The total A.HECS-22 mean-item score was 3.30 (SD = 0.68), with higher Patients and Peers scores and lower Hospital and Managers scores. Conclusions The A.HECS-22 showed acceptable structural fit and reliability in this sample, although convergent validity was only partially supported, and may support research and preliminary organizational assessment of ethical climate among Moroccan nurses and midwives. The score pattern identified comparatively weaker institutional and managerial conditions. Independent cross-validation in broader Arabic-speaking samples is needed before routine institutional use.
