The Mediating Role of Speak-up Climate in the Relationship Between Nurse Managers' Inclusive Leadership, Patient Safety, and Nurse Job Outcomes

초록

Aim: To examine how nurse managers' inclusive leadership is related to patient safety and nurse job outcomes among Korean hospital nurses and to determine whether speak-up climate mediates these relationships.<br /> Background: Although inclusive leadership has been linked to lower turnover intention and enhanced patient safety, the mechanisms underlying these associations remain unclear. Speak-up climate, defined as a shared perception that voicing concerns is safe and encouraged, may be a key explanatory factor.<br /> Methods: This cross-sectional study surveyed 953 hospital nurses in Korea. Participants completed measures of inclusive leadership, speak-up climate, reporting patient safety events, overall patient safety, job satisfaction, and turnover intention. Mediation analyses were conducted using PROCESS Model 4.<br /> Results: Perceived inclusive leadership was significantly associated with a stronger speak-up climate. A stronger speak-up climate was associated with more frequent reporting of patient safety events, higher overall patient safety, higher job satisfaction, and lower turnover intention. Speak-up climate fully mediated the inclusive leadership-event reporting relationship and partially mediated the associations with overall safety, job satisfaction, and turnover intention.<br /> Discussion: Speak-up climate emerged as an important factor in the relationships between inclusive leadership, patient safety, and nurse job outcomes.<br /> Conclusion: Strengthening inclusive leadership and cultivating a supportive speak-up climate may enhance patient safety and contribute to a more satisfied nursing workforce.<br /> Implications for Nursing: Training that fosters inclusive behaviors and voice-inviting routines may strengthen speak-up climate, enhance safety perceptions, and support satisfaction and retention.<br /> Implications for Nursing Policy: Beyond leadership development, institutionalizing a speak-up climate at organizational and policy levels, for example, through national safety benchmarks, can provide a strategic path toward safer and more sustainable healthcare systems.

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