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

The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study

BACKGROUND

Patient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes.

OBJECTIVE

Firstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship.

METHOD

A cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2).

RESULTS

There was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting.

CONCLUSIONS

This study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.

Investigating Workplace Support and the Importance of Psychological Safety in General Surgery Residency Training

OBJECTIVE

Workplace interventions that increase support can mitigate burnout, improve workplace satisfaction, and increase well-being. Our aim is to provide evidence-based targets to inform future work for operationalizing support in general surgery residency.

DESIGN

This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1) in May 2022 to assess the association between perceived psychological safety (PS) and flourishing, as well as PS and languishing.

SETTING

National multi-center study including 16 ACGME-accredited academic programs.

PARTICIPANTS

General surgery residents at various training levels, in both clinical and research.

RESULTS

A total of 28 residents participated in the focus groups which revealed both enhancers and inhibitors of support pertaining to PS in the workplace. Enhancers of support included those currently implemented (i.e., allyship of mentors) and those proposed by residents (i.e., nonpunitive analysis of mistakes). Inhibitors of support included both systems (i.e., wellness initiatives as a 'band-aid' for systems issues) and culture (i.e., indefatigability, stoicism). About 251 residents (31%) responded to the survey which revealed higher perception of PS was significantly associated with flourishing at the level of residency program and departmental leadership. Lower perception of PS was significantly associated with languishing at the level of residency program leadership only.

CONCLUSION

Our findings highlight the promotion of PS, such as expansion of mentorship to include advocacy (advocating on a resident's behalf, recognition when mistreated) and affirmation (i.e., soliciting opinions on controversial social matters/events, recognizing different life experiences), cultural acceptance of asking for help (without being perceived as weak), formal help navigating interpersonal dynamics (i.e., guidance from senior residents), and leadership presentations and modeling to destigmatize asking for help, as a means of operationalizing workplace support to increase flourishing and decrease languishing.

Effects of nurse managers' inclusive leadership on nurses' psychological safety and innovative work behavior: The moderating role of collectivism

INTRODUCTION

In the rapidly evolving healthcare landscape, the capacity to foster innovative work behavior among nurses is increasingly important. This study examined the dynamics between inclusive leadership, psychological safety, collectivism, and innovative work behavior among nurses.

DESIGN

The study used a cross-sectional, correlational design.

METHODS

This study utilized data from 730 medical-surgical nurses who provided direct care to patients. Standardized instruments were used to assess key study variables. Statistical analyses, including moderated mediation regressions, were employed to investigate the complex interplay among these variables.

RESULTS

We found a positive association between inclusive leadership and innovative work behavior, and psychological safety mediated this relationship. Collectivism moderated inclusive leadership's direct relationship with psychological safety and its indirect relationship with innovative work behavior. The results revealed that nurses with lower levels of collectivism were more responsive to their managers' inclusive behaviors, strengthening the relation between inclusive leadership, psychological safety, and innovative work behavior.

CONCLUSION

Our findings suggest that promoting inclusive leadership behaviors among nurse managers to create a psychologically safe environment can motivate nurses to engage in innovative work behavior. However, it is also important to understand that the effectiveness of leadership may differ depending on the collectivist values of individual nurses.

CLINICAL RELEVANCE

Nurse managers should adopt inclusive leadership behaviors, such as valuing trust, open communication, and diversity, in order to foster psychological safety and innovative work behavior among nurses.

Factors predicting proactive work behaviors among nurses: A descriptive predictive study

AIM

This study examined the level of proactive work behavior and predictability of education level, work engagement, transformational leadership of nurse managers, and organizational support on proactive work behaviors among nurses.

BACKGROUND

Nurses face many challenges to provide quality nursing care as numbers of patients increase in particular as a result of COVID-19 and human resource shortages worldwide, this includes Myanmar. Proactive work behavior is a critical factor in providing quality nursing care.

METHODS

We collected data from 183 registered nurses in four university-affiliated general hospitals in Myanmar by using stratified random sampling. Instruments included the Utrecht Work Engagement Scale, the Global Transformational Leadership Scale, the Survey of Perceived Organizational Support, and the Proactive Work Behavior Scale. Descriptive statistics and multiple regression were used to analyze data. Findings are reported according to the STROBE checklist.

RESULTS

The overall level of proactive work behavior was perceived as moderate. Transformational leadership and work engagement were significant predictors of proactive work behaviors of nurses, explaining 33.0% of the total variance.

CONCLUSION

Findings provide that both transformational leadership and work engagement are significant predictors of proactive work behaviors which are important for improving the quality of patient care and organizational outcomes.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse administrators and hospital directors should encourage nurses to voice ideas for improving the standard of work, provide opportunities for generating ideas, support resources for taking charge and preventing problems whilst also supporting the promotion of nurse managers' transformational leadership and nurses' work engagement.

Voice, silence, perceived impact, psychological safety, and burnout among nurses: A structural equation modeling analysis

BACKGROUND

The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context.

OBJECTIVE

This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence.

DESIGN

A cross-sectional, correlational study design was employed.

SETTINGS

Study data were collected in 34 general hospitals in South Korea.

PARTICIPANTS

A total of 1255 registered nurses providing direct care to patients were included in this study.

METHODS

Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %.

RESULTS

The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = -0.10, 95 % confidence interval [-0.143, -0.059]) and silence (β = -0.04, 95 % confidence interval [-0.058, -0.014]), and psychological safety also decreased burnout through voice (β = -0.04, 95 % confidence interval [-0.057, -0.016]) and silence (β = -0.07, 95 % confidence interval [-0.101, -0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant.

CONCLUSIONS

It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ.

REGISTRATION

Not applicable.

TWEETABLE ABSTRACT

Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.

A chain mediation model of inclusive leadership and voice behavior among university teachers: evidence from China

As a vital mode in which teachers can participate in university management, voice behavior is an important way of enhancing the efficiency of organizational decision-making, promoting democratic management, and facilitating sustainable development in universities. Although previous studies have confirmed the positive impact of inclusive leadership on employees' voice behavior, the mechanism underlying this effect remains unclear. Therefore, based on the cognitive-affective system theory of personality, this study aims to examine the mediating effects of psychological empowerment and organizational identification on the relationship between inclusive leadership and voice behavior among university teachers. A total of 517 valid questionnaires were administered to university teachers in mainland China using a convenience sampling approach. Structural equation modeling and bootstrap testing were used to analyze the data, and the results reveal that inclusive leadership is positively related to teachers' promotive and prohibitive voice behavior. This relationship is mediated by psychological empowerment and organizational identification, in which context a partial mediating effect is observed in the relationship between inclusive leadership and promotive voice and a full mediating effect is observed in the relationship between inclusive leadership and prohibitive voice. These findings can enrich the extant research on the impact of inclusive leadership in the field of higher education to a certain extent. Moreover, they provide a new perspective that can support an in-depth analysis of the mechanism underlying the effect of inclusive leadership and generate valuable practical insights into ways of stimulating voice behavior among university teachers.

The effect of empowering leadership on miners' unsafe behavior: a cross-level chain mediation model

Miners' unsafe behavior has always been a key issue in coal mine safety management. Numerous studies have shown that leadership is an important factor influencing miners' unsafe behavior. A cross-level structural model was constructed based on social cognitive theory, using psychological safety and safety climate as intermediary variables, to analyze the effect of empowering leadership on miners' unsafe behavior. Data were gathered from 272 coal miners on 59 working teams. Multilevel regression analysis and the Monte Carlo method were employed to analyze the influence of the empowering leadership on miners' unsafe behavior. The results showed that empowering leadership was negatively related to miners' unsafe behavior. Psychological safety and safety climate mediated the relationship between empowering leadership and miners' unsafe behavior, and also jointly mediated in the chain. These findings enrich existing research results on miners' unsafe behavior and provide a beneficial enlightenment to coal mine safety management.

The associations between benevolent leadership, affective commitment, work engagement and helping behavior of nurses: a cross-sectional study

BACKGROUND

Benevolent leadership is common in organizations, including hospitals, and is known to have positive effects on employees. Yet, nursing literature lacks sufficient research on its relationships with nurses' behavior.

METHODS

In March to April 2022, a cross-sectional study was carried out involving 320 nurses employed across various hospitals in Sichuan Province, China. Benevolent leadership, affective commitment, work engagement, and helping behavior were evaluated using the Benevolent Leadership Scale, Affective Commitment Scale, Work Engagement Scale, and Helping Behavior Questionnaire, respectively. The study employed structural equation model and the bootstrap method to investigate the proposed relationships.

RESULTS

The SEM analysis results indicated a positive association between benevolent leadership and several outcomes among nurses. Specifically, benevolent leadership was found to be positively associated with nurses' affective commitment (β = 0.58, p < .001), work engagement (β = 0.02, p < .001), and helping behavior (β = 0.17, p = .001). Additionally, there was a significant indirect effect between benevolent leadership and nurses' work engagement through affective commitment (β = 0.08, p = .007) as well as between benevolent leadership and helping behavior through affective commitment (β = 0.16, p < .001).

CONCLUSIONS

This study's findings emphasize the crucial role of benevolent leadership in fostering nurses' positive attitudes and behaviors in the workplace. Hospital administrators could promote the benevolent leadership of head nurses to enhance nurses' affective commitment, work engagement, and helping behaviors.

The effect of smartphone dependence on learning burnout among undergraduates: the mediating effect of academic adaptability and the moderating effect of self-efficacy

Introduction

Smartphone dependence is closely related to the physical and mental health development of undergraduates and their learning. The purpose of this study was to explore the relationship between smartphone dependence, academic adaptability, self-efficacy and learning burnout among undergraduates and its underlying mechanisms.

Methods

The study was conducted on 2,110 undergraduates using the Smartphone Dependence Scale, the Undergraduates Learning Adjustment Scale, the Learning Burnout Undergraduates Scale and the Self-Efficacy Scale to develop a mediation model and a moderation model.

Results

The findings of this study revealed that (1) smartphone dependence significantly negatively predicted academic adaptability; (2) academic adaptability significantly negatively predicted learning burnout; (3) smartphone dependence significantly positively predicted learning burnout; (4) academic adaptability partially mediated the effect of smartphone dependence on learning burnout; (5) self-efficacy played a moderating role in the effect of academic adaptability on learning burnout.

Conclusion

These findings can help researchers and educators better understand the underlying mechanisms between smartphone dependence and learning burnout in undergraduates.

Safety voice climate: A psychometric evaluation and validation

INTRODUCTION

Speaking up about safety issues, termed "safety voice," is a proactive response where people across all levels of the organization express their concerns to prevent physical hazards. An understanding of safety voice requires insight into its antecedents. A perceived need to fit in with the organization and fear of consequences can trump the courage to speak out about safety concerns. Safety voice climate can be seen as a manifestation of the social exchanges in an organization and functions as a roadmap of which speaking out behaviors are encouraged and which behaviors are not. This study conceptualizes safety voice climate, presents the Safety Voice Climate Scale (SVCS) as a measurement tool, and gathers initial evidence for its validity. The study also assesses the associations between the SVCS and safety voice behavior.

METHOD

The SVCS and the measurement of safety voice behavior were derived from the Trends in Risk Level in the Norwegian Petroleum Activity questionnaire. The SVCS includes the two theoretical dimensions Work colleagues' encouragement of safety voice and Leaders' attitudes towards safety voice. Psychometric properties were tested with a representative sample from the Norwegian petroleum sector (n = 7,624).

RESULTS

Confirmatory factor analyses supported the proposed two-factor model, and the internal consistency of the factors was good. Furthermore, a structural equation model including the SVCS as predictors of safety voice behavior showed a good fit, indicating acceptable criterion validity, although only the Work colleagues' encouragement of safety voice variable was significantly associated with safety voice behavior. Conclusion and practical application: The SVCS can be used as a tool to detect some of the barriers and supporting elements relating to safety voice and guidance on the efforts needed to foster work climates that promote communication of safety issues.

The impact of utilizing inclusive leadership among nurses during crises: A multisite comparative study

Nurses' psychological wellness and satisfaction are threatened by exposure to many stressors. Adopting a promising leadership style has beneficial impacts at different levels, especially during crises. This study aimed to examine the impact of inclusive leadership on nurses' satisfaction and psychological distress during crises, focusing on three Arabic countries. A cross-sectional descriptive design was utilized to meet the study goal. Data were collected electronically in the three countries using the Kessler Psychological Distress Scale (K-10), Minnesota Satisfaction Questionnaire, and Carmel's Inclusive Leadership Scale. Two hundred seventy-four participants fully responded: 90 from Egypt, 82 from Saudi Arabia, and 102 from Jordan. Descriptive statistics, Pearson R, Spearman Rho, Point biserial, and ANOVA tests were used to answer the research questions. There were statistically significant differences between countries in the mean scores of inclusive leadership and psychological distress. In addition, statistically significant relationships between inclusive leadership, psychological distress, and job satisfaction were found. The study focused on the importance of approaching inclusive leadership to increase employee satisfaction, reduce psychological distress, and achieve organizational goals.

Addressing an Uncertain Future With a Culture of Psychological Safety

Faculty, staff, and administrators in our pharmacy colleges and schools work in well-known organizational structures that form the foundations for cultures and subcultures. The importance of promoting a positive culture and subculture is a frequent discussion in our own institutions and across the academy. However, the impact of these cultures and subcultures on individual and collective success and how they influence inclusion and innovation in our organizations are often not considered in these conversations. Psychological safety promotes an environment in an organization where an individual feels included in the culture or subculture; is safe to learn; is safe to contribute; and is safe to challenge the status quo all without the fear of being embarrassed, marginalized, or penalized in some way. Psychological safety is the foundation for enabling learning, innovation, and change in our colleges and schools of pharmacy. This commentary will highlight elements of cultures and subcultures, the importance of fostering a psychologically safe environment in our colleges and schools, and suggestions for success.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Does inclusive leadership influence task performance of hospitality industry employees? Role of psychological empowerment and trust in leader

Drawing on the social exchange theory, this research advances the understanding of leadership and task performance in the hospitality industry in China by exploring the impact of inclusive leadership on the task performance of subordinates working in dyadic forms. The current literature is scarce on the role of leadership in increasing the task performance of employees working in teams in dyadic forms. Multi-level sample of 410 leaders-subordinates in the hospitality industry was used to derive the research findings using PLS-SEM. The results indicated a positive influence of inclusive leadership on the task performance of subordinates. Psychological empowerment mediated this direct relationship. In addition, trust in leaders strengthened the direct link of inclusive leadership with task performance and psychological empowerment. The findings demonstrate that leaders in the hospitality industry should adopt an inclusive leadership style as it contributes to employee task performance, which improves the industry's performance.

Testing the association between the enabling and enacting factors of patient safety culture and patient safety: structural equation modelling

BACKGROUND

Despite evidence linking a safety culture with patient safety, the processes by which aspect of safety culture influences patient safety are not yet well understood. Thus, this study aimed to test a theoretical model of the relationships between three enabling factors (supervisor/clinical leader support for patient safety, hospital management support for patient safety, and psychological safety), and four enacting factors of patient safety culture (handoffs and information exchange, teamwork, error reporting intention, and withholding voice) with nurse assessments of patient safety.

METHODS

A cross-sectional, descriptive correlational study design was used. Between May and June 2020, 526 nurses who provided direct care to patients in medical surgical units in three Korean hospitals completed an online survey that included four standardized scales or subscales. Structural equation modelling was used to test the hypothesized model.

RESULTS

Among the three enabling factors, psychological safety was associated with all four enacting factors, and all enacting factors were associated with overall patient safety. Hospital management support was associated with all enacting factors except teamwork, but supervisor/clinical leader support was associated with only handoffs and information exchange, and withholding voice. Thus, teamwork was influenced only by psychological safety. Findings demonstrate overall support for the theoretical model of safety culture wherein enabling factors influence enacting factors which, in turn, lead to patient safety outcomes, but emphasize the critical nature of psychological safety among nursing staff.

CONCLUSION

This study provides further insight into the importance of support from hospital management and unit supervisors/clinical leaders for patient safety to motivate and enable hospital nurses to enact behaviours necessary for patient safety. However, such support must also take the form of enhancing psychological safety for nursing staff.

Nurse Managers' Leadership, Patient Safety, and Quality of Care: A Systematic Review

This review examined relationships between nurse unit managers' leadership and patient safety and quality of care outcomes in hospital settings. Employing four databases (CINAHL, Embase, PubMed, and Web of Science) and ancestry searches, we identified 14 English-language, peer-reviewed, primary studies that examined such relationships using quantitative analyses. The studies were published between 2012 and 2021, and most used a cross-sectional design. Each study's quality was assessed using the Mixed-Method Appraisal Tool. In synthesizing results by categorizing outcomes, we found a positive trend in associations between effective nurse unit manager leadership and better outcomes, including fewer patient adverse events, increased nurse error reporting, and higher patient satisfaction and care quality. However, the heterogeneity of leadership measurement approaches and outcomes limited integration of study findings. Future researchers should clearly define study concepts to support interpretation of their findings and should use a suitable theoretical framework to help determine appropriate units of analysis.

Inclusive leadership can improve nurses' psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention

Introduction

The COVID-19 pandemic continues to impact people's lives and professions worldwide. Chinese nurses face immense work pressure under the normalization of COVID-19 prevention and control, resulting in greater turnover intention. It is, therefore, crucial to study the mechanisms that influence the turnover intention of nurses in this situation.

Objective

Many studies have examined the impact of leadership style on nurses' turnover intention; however, few researchers have investigated this influence during the COVID-19 pandemic. Based on the leader-member exchange theory, this study empirically studied the effect of inclusive leadership on turnover intention of nurses under the normalization of COVID-19 prevention and control in China, while assessing the mediating role of psychological ownership.

Design

Cross-sectional study with multi-center data.

Participants

Two thousand, two hundred ninety-nine registered nurses from 17 hospitals in China were recruited from January to March, 2022, under the normalization of COVID-19 prevention and control in China.

Methods

A demographic questionnaire and scales of inclusive leadership, psychological ownership, and turnover intention integrated into an online survey were sent to registered nurses of different hospitals. Maximum likelihood structural equation modeling (ML-SEM) was used to analyze data.

Results

Independent variable inclusive leadership has a significant effect on the overall turnover intention of nurses, p < 0.001. The direct effect path coefficient from inclusive leadership to psychological ownership is significant, p < 0.001. The direct effect path coefficient from psychological ownership to turnover intention is significant, p < 0.001. The indirect effect path coefficient from inclusive leadership to turnover intention is significant, p < 0.001.

Conclusion

Psychological anxiety, burnout, turnover intention, and even suicidal thoughts were the main symptoms of Chinese nurses under the normalization of COVID-19 prevention and control in China. The absence of a mechanism to counteract these negative conditions may ultimately lead to personal psychological distress for nurses and collapse of the healthcare system. Inclusive leadership can improve nurses' psychological ownership level and reduce their turnover intention by treating them fairly, providing them with opportunities for self-development, paying attention to communication with them, and increasing their sense of belonging, self-efficacy, and self-identity.

Impact of inclusive leadership on employees' innovative behavior: A relational silence approach

Introduction

Although employees' silence is a common phenomenon in organizations, the mediating role of relational silence has not been studied in inclusive leadership and innovative behavior. In this study, based on the theory of social exchange, relational silence is used as a mediating variable to explore the internal mechanisms of inclusive leadership on employees' innovative behavior.

Methods

Data from 263 in-service leaders and employees were collected using convenience sampling and analyzed using Amos and SPSS statistical software package via questionnaires distributed to companies in six cities in the Guangdong province of China.

Results

The results showed that inclusive leadership has a significant positive predictive effect on employees' innovative behavior (β = 0.590, p < 0.01), while inclusive leadership is negative and significantly correlated with relational silence (β = -0.469, p < 0.01). More so, relational silence has a significant negative correlation with employees' innovative behavior (β = -0.408, p < 0.01), and relational silence partially mediates the relationship between inclusive leadership and employee innovation behavior.

Discussion

The mediating role of relational silence between inclusive leadership and employees' innovative behavior is revealed for the first time, theoretically broadening and enriching the connotation of inclusive leadership's influence mechanism on employees' innovative behavior and providing new ideas in practice for constructing inclusive leadership styles, reducing the incidence of relational silence, and evoking employees' innovative behavior.

Knowledge “hiding and seeking” during the pandemic: who really wins in the new normal?

Purpose

The recent COVID-19 pandemic caused a severe economic downturn. Employees working in these organisations face employment uncertainty. The pandemic disrupted their daily routines, and it added a layer of complexity to the already resource-constrained environment. During these times, employees would conserve their resources to maintain competitiveness, one of which is knowledge hiding. While economic activities are resuming, the appearance of new variants could mean the transition towards endemicity could be put on hold. Hence, there is a need to rethink the behaviour of employees as they would have elevated levels of anxiety towards resuming daily work activities. Therefore, this study aims to address the question of understanding employees’ perspectives toward knowledge sharing and knowledge hiding.

Design/methodology/approach

Drawing on the conservation of resources theory, social learning theory and the social exchange theory (SET), a conceptual framework involving ethical leadership was developed to examine if knowledge hiding or knowledge sharing behaviour is a resource for employees during these times. The partial least squares method of structural equation modelling was used to analyse results from 271 white-collar employees from Singapore.

Findings

The results show that ethical leadership encourages knowledge sharing but does not reduce knowledge hiding. At the same time, knowledge hiding, not knowledge sharing, improves one’s perception of work performance. Additionally, psychological safety is the key construct that reduces knowledge hiding and encourages sharing behaviour.

Originality/value

Overall, this study extends the theories, demonstrating that, first and foremost, knowledge hiding is a form of resource that provides employees with an added advantage in work performance during the endemic. At the same time, we provide a new perspective that ethical leaders’ demonstration of integrity, honesty and altruism alone is insufficient to encourage knowledge sharing or reduce knowledge hiding. It must lead to a psychologically safe environment.

COVID-19 Pandemic Highlights the Importance of Inclusive Leadership in Egyptian Hospitals to Improve Nurses’ Psychological Distress

Background: The pandemic has highlighted the crucial role of nurses in health services. Nurses work at the forefront of the healthcare system, provide infection control training, and help reduce the spread of misinformation about the pandemic. Inclusive leaders create psychological safety that improves motivation and boosts job performance. Aim: To explore the effect of nurse managers’ inclusive leadership style on nurses’ psychological distress during the COVID-19 pandemic in Egyptian hospitals. Method: This was a quasi-experimental study. The study subjects consisted of two groups: managers (171) and staff nurses (1573). The study was conducted in four hospitals (one university hospital, one private hospital, one therapeutic institution, and one health insurance hospital). Three tools were used for collecting data (Inclusive Leader Questionnaire, Nurse Managers’ Knowledge about Inclusive Leadership, and Kessler Psychological Distress Scale). Results: In total, 67.25% of staff nurses perceived their nurse managers as poor inclusive leaders, and only 12.86% perceived them as good inclusive leaders. Regarding nurse managers’ knowledge about inclusive leadership, 76.023% had unsatisfactory knowledge levels before awareness sessions, and only 7.017% had a satisfactory level compared to after awareness sessions, when the majority of them had satisfactory knowledge levels. Furthermore, before awareness sessions, staff nurses experienced mild to moderate psychological distress during the COVID-19 pandemic, and only 8.2% were severe. After awareness sessions, 58.55% of them experienced mild psychological distress, and others became well (25.8%). Conclusions: Nurse managers lack knowledge about inclusive leadership before conducting awareness sessions. The majority of staff nurses perceived their nurse managers as poor inclusive leaders. Satisfactory knowledge levels among nurse managers after awareness sessions improved nurses’ psychological distress. Finally, there were strong, statistically significant positive correlations between inclusive leadership and nurses’ psychological distress.

Hospital management and supervisor support and nurse speaking-up behaviors: The mediating role of safety culture perception

AIMS

This study aimed to (a) elucidate the effects of hospital management and unit supervisor support for patient safety on nurse speaking-up behaviors and (b) identify potential mediators of this relationship.

BACKGROUND

Speaking-up behavior among nurses has emerged as a critical source of patient safety. Fuller understanding of the developmental mechanisms contributing to nurses' speaking-up behaviors could help to enhance patient safety in healthcare organizations.

METHODS

A correlational approach was used to conduct a secondary analysis of cross-sectional survey data collected from 450 staff nurses in Korea. Path analysis was performed to test potential mediation effects.

RESULTS

After controlling for nurses' hospital and unit tenure, hospital management and supervisor support for patient safety had significant direct and indirect effects on nurses' speaking-up (promotive and prohibitive voice) behaviors through their perceptions of response to error and communication openness.

CONCLUSIONS

Study findings indicate that when hospital management and supervisors emphasize patient safety and provide necessary resources, nurses are likely to perceive the hospital's safety culture more positively, in turn enhancing their speaking-up behaviors.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators and nurse managers should clearly display hospital management and supervisory support for patient safety through implementation of related policies, resources, and communication standards.

How Does Inclusive Leadership Curb Workers’ Emotional Exhaustion? The Mediation of Caring Ethical Climate and Psychological Safety

The COVID-19 pandemic has transformed the politics, economy, and society of the world, which has dealt the most severe blow to the hospitality industry. Meanwhile, the pandemic and government control policies have brought high psychological pressure to hospitality front-line employees, resulting in emotional exhaustion. As a part of burnout syndrome, emotional exhaustion poses a threat to employees’ mental health, career sustainability, and well-being. Therefore, the purpose of this paper was to investigate the curb effectiveness of inclusive leadership on emotional exhaustion and to explore the mediation roles of ethical climate and psychological safety between them. Time-lagged data were collected from 65 teams and 358 hospitality front-line employees working in Chinese hotels in two stages with a one-month gap. This research verified that inclusive leadership has a negative impact on emotional exhaustion both indirectly through the mediation roles of ethical climate and psychological safety. And the ethical climate and psychological safety played partial mediation roles between inclusive leadership and emotional exhaustion. In theory, the findings explored the dual mediation mechanism of the inhibitory effect of inclusive leadership on emotional exhaustion. In practice, we provided the training and correct guidance to develop inclusive leadership for hotel enterprises and to resolve the emotional exhaustion of employees, which can enhance sustainability in careers.

Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study

AIMS

To identify factors that motivate or inhibit nurses' speaking up for patient safety.

DESIGN

A descriptive qualitative study.

METHODS

We conducted semi-structured interviews with 15 nurses from four Korean hospitals between December 2020 and January 2021. Data were analysed using inductive content analysis.

RESULTS

We identified safety culture, supportive unit managers and role models, positive reactions from or familiarity with others, high-risk situations and personal characteristics and beliefs as motivators of nurses' speaking up. Hierarchies and power differentials, seniority and unit tenure, concerns about relationships, and heavy workloads inhibited nurses' speaking up.

CONCLUSION

Individual, organizational and cultural characteristics influence nurses' decisions on whether or not to voice their concerns, suggestions or ideas. Certain characteristics of Korean culture, such as strong hierarchies and the valuing of good relationships, play an important role in nurses' speaking up behaviours. Our findings can be used to inform educational interventions and management expectations about interpersonal behaviours, especially in a culture where age- and seniority-based hierarchies and collectivism are prevalent.

IMPACT

Nurses perceived speaking up as a challenging behaviour, and they sometimes withhold their voices even when speaking up is needed for patient safety. We found that individual, organizational, and contextual factors affect the speaking up behaviours of nurses. Nurse managers can create environments that are more supportive of nurses' speaking up behaviours by using inclusive leadership to create psychological safety, by inviting and showing appreciation for staff input, and by helping physicians and senior nurses understand the importance of all nurses' voices.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution does not apply to this study as its purpose was to explore the speaking up experiences of nurses themselves.

Chinese nurses' innovation capacity: The influence of inclusive leadership, empowering leadership and psychological empowerment

AIM

To explore the relationships between inclusive leadership, empowering leadership, nurses' perceived psychological empowerment and nurses' innovation capacity.

BACKGROUND

Innovation capacity is essential for nurses to adapt to the changing healthcare environment. However, the current knowledge of nurses' innovation capacity and its' relationships between inclusive leadership, empowering leadership and psychological empowerment is limited.

METHODS

A cross-sectional survey using a convenience sample was conducted among 1355 nurses in ten hospitals in Tianjin, China. The data was analyzed by correlation analysis, univariate analysis and PROCESS macro.

RESULTS

High inclusive leadership, empowering leadership and high psychological empowerment were associated with high innovation capacity. The total effect of inclusive leadership and empowering leadership on innovation capacity through psychological empowerment was significant, with their indirect effects accounting for 69.19% and 61.29% of the total effect respectively.

CONCLUSIONS

To cultivate nurses' innovation capacity, the development of inclusive leadership, empowering leadership and psychological empowerment is important.

IMPLICATIONS FOR NURSING MANAGEMENT

This research highlights the importance of inclusive leadership and empowering leadership to foster nurses' innovation capacity. Understanding the mediating role of psychological empowerment is expected to help nurse managers develop relevant intervention strategies to cultivate nurses' innovation capacity.

Inclusive leadership and voice behavior: The role of psychological empowerment

Although there have been studies in the past that have highlighted the important role of leadership in motivating employees to speak up, relational leadership has been scarcely investigated in this context. Therefore, the current research investigates the relationship between inclusive leadership, as a form of relational leadership, and employees' voice behavior directly and indirectly via psychological empowerment. Using the data collected from 252 employees and their respective supervisors working in cargo companies across the United Kingdom, this study finds a positive relationship between inclusive leadership and voice behavior. The results further confirm the mediating role of psychological empowerment in the relationship between inclusive leadership and voice behavior. We use causal attribution theory to support the findings and discuss implications for research and practice.