Psychological Safety as a Mediator of the Relationship Between Inclusive Leadership and Nurse Voice Behaviors and Error Reporting

Purpose The purpose of this study was to examine psychological safety as a mediator of the relationship between inclusive leadership and nurses' voice behaviors and error reporting. Voice behaviors were conceptualized as speaking up and withholding voice. Design This correlational study used a web-based survey to obtain data from 526 nurses from the medical/surgical units of three tertiary general hospitals located in two cities in South Korea. Methods We used model 4 of Hayes' PROCESS macro in SPSS to examine whether the effect of inclusive leadership on the three outcome variables was mediated by psychological safety. Findings Mediation analysis showed significant direct and indirect effects of nurse managers' inclusive leadership on each of the three outcome variables through psychological safety after controlling for participant age and unit tenure. Our results also support the conceptualization of employee voice behavior as two distinct concepts: speaking up and withholding voice. Conclusions When leader inclusiveness helps nurses to feel psychologically safe, they are less likely to feel silenced, and more likely to speak up freely to contribute ideas and disclose errors for the purpose of improving patient safety. Clinical Relevance Leader inclusiveness would be especially beneficial in environments where offering suggestions, raising concerns, asking questions, reporting errors, or disagreeing with those in more senior positions is discouraged or considered culturally inappropriate.