Abusive supervision in healthcare settings can have detrimental effects on employee behavior and patient care, making it crucial to understand the underlying mechanisms and mitigating factors. This study examines the impact of abusive supervision on patient-directed service sabotage, focusing on the mediating role of workplace rudeness and the moderating effect of work ethics. Data were collected from 305 hospital nurses, and structural equation modeling (SEM) was used to test the proposed model. The findings reveal that abusive supervision significantly increases workplace rudeness, which in turn escalates to service sabotage. However, strong work ethics were found to weaken the link between rudeness and sabotage, demonstrating their protective role in this negative cycle. The moderated mediation analysis further confirms that work ethics reduce the indirect impact of abusive supervision on service sabotage through rudeness. These results contribute to our understanding by illustrating how ethical standards can buffer against the negative consequences of abusive supervision, providing practical implications for enhancing leadership practices and promoting ethical behavior in healthcare environments.