Leadership Strategies to Increase Psychological Safety of Nurses: A Longitudinal Study.

AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment

Background/Objectives: The aim of this study was to describe and examine the relationships among elements of infection prevention practices, the care environment, psychological safety, and safety climate in adult medical surgical units in the wake of the COVID-19 pandemic. Methods: Nurses in adult inpatient medical surgical units in the northeast were surveyed electronically. Each self-rated their infection prevention practices and elements of the care environment in their primary work unit. They were also asked to rate a series of questions regarding how psychologically safe they felt on their units as well as the overall patient safety climate. Results: A total of 259 nurses responded (52% response rate) to the survey. Overall psychological safety was rated neutrally among respondents, with a rating of 3.5 (1 being the lowest and 5 being the highest). Respondents reported better ratings of the safety climate on their unit (4.0) but also identified areas for improvement. Eight of twelve infection prevention practices were correlated with higher safety climate scores and ten were correlated with higher psychological safety scores. Nine of ten environmental factors were correlated with higher safety climate and higher psychological safety scores. Conclusions: Both psychological safety and patient safety climate are related to nurse self-ratings of performance of infection prevention practices. Similarly, the care environment nurses work in has important implications for psychological safety and patient safety. It is essential for nursing leadership to act as a steward in these areas to build a higher quality care environment for nurses and patients alike.

Psychological safety is a critical aspect of clinical nursing care. This study aimed to evaluate the psychological safety and its influencing factors among elderly patients following traumatic fracture surgery, to inform targeted psychological interventions in clinical practice. Elderly patients who underwent surgery for traumatic fractures at our hospital between March 2024 and March 2025 were included for survey. A validated and previously reported psychological safety scale was used to assess the psychological safety. Multiple linear regression analysis was conducted to identify the potential influencing factors. not applicable. A total of 246 elderly patients with traumatic fractures were included in this study. The mean psychological safety score was 38.60 ± 7.15. Correlation analysis revealed significant associations between psychological safety and several variables, including age (r = -0.616), marital status (ρ = 0.528), educational level (ρ = -0.610), place of residence (ρ = 0.541), average monthly household income (r = -0.623), and whether the fracture was open (ρ= -0.652) (p < 0.05). Furthermore, multiple linear regression analysis confirmed that age, marital status, educational level, place of residence, average monthly household income, and whether the fracture was open were associated with psychological safety among elderly patients following traumatic fracture surgery (p < 0.05). Specifically, patients with open fractures scored significantly lower on psychological safety (B = -2.858, p = 0.017) compared with those with closed fractures. The psychological sense of security among elderly patients following traumatic fracture surgery remains suboptimal and warrants improvement. Healthcare professionals should implement targeted interventions based on the identified influencing factors to provide effective support and enhance the psychological safety of these patients.

Background Health system reform initiatives have generated high-demand and created uncertain, complex practice environments, impacting the well-being, work conditions, and behavior of primary care professionals. Psychological safety is increasingly important to organizational success, particularly in highly complex work environments. Yet, few studies have examined its application among primary care professionals. Objectives To examine the impact of psychological safety on the well-being, work conditions and guideline adherence behavior of primary care physicians (PCPs) in Community Health Centres (CHCs) in urban China. Methods A total of 224 PCPs from 38 CHCs in four Chinese cities were recruited using convenience sampling. Research assistants conducted questionnaire surveys. Well-being was assessed through measures of depression, work-family conflict and work exhaustion, work conditions were defined by measures of professional commitment and self-directed learning, and guideline adherence behavior was measured through compliance with clinical guidelines and the provision of preventive care. Two-level hierarchical linear models were developed to analyze the impact of psychological safety. Results Psychological safety was negatively associated with depression, work-family conflict, and work exhaustion. Psychological safety was positively associated with professional commitment and self-directed learning and also greater adherence to clinical guidelines and the increased provision of preventive care. Conclusions This study in China confirms that a psychologically safe work environment in primary care is positively associated with improved PCPs’ well-being, enhanced professional commitment, and better adherence to clinical guidelines and preventive care provision. Given that psychological safety may be embedded in national culture, further studies should develop context-based, culturally and organizationally appropriate interventions.

The development of globalization and the acceleration of informatization have made the competition between enterprises more and more fierce, and organizations must respond to new opportunities and challenges through organizational change. Organizational change also makes employees' working environment more and more complex, occupational uncertainties and risks are increasing, which in turn brings employees psychological insecurity and job burnout. In this paper, through combing the related research of psychological safety and job burnout, the negative relationship between psychological safety and individual job burnout is verified by empirical analysis, and according to the conclusion, relevant suggestions are proposed to the organization management, trying to help the organization take effective measures to satisfy employees' psychological safety needs and reduce the phenomenon of job burnout.

Background: Psychological safety and occupational well-being among nurses and healthcare teams have emerged as urgent priorities in the face of escalating work overload, psychological distress, and moral injury in contemporary healthcare environments. This scoping review maps and synthesizes the scientific literature on psychological safety and well-being in the workplace among nursing professionals, with a particular focus on empirical findings, theoretical contributions, and practical applications. Materials and Methods: This scoping review followed the PRISMA-ScR guidelines and was guided by the PCC framework, which comprises the following components: Population (nurses and nursing teams), Concept (psychological safety and well-being at work), and Context (healthcare settings). Four major databases (PsycINFO, PubMed, Scopus, and Web of Science) were searched. After screening and eligibility assessment, 13 empirical studies were included. Results: Thematic analysis of the included studies identified four principal areas of emphasis: the effectiveness of interventions and organizational characteristics on well-being outcomes; perceptions of psychological safety and workplace climate; prevalence and predictors of emotional exhaustion and burnout; and the impact of long-term occupational stressors on psychosocial safety climate. Psychological safety has been consistently identified as a protective factor against burnout and emotional exhaustion; however, its promotion is hindered by structural barriers, leadership practices, and contextual variability. Most studies relied on cross-sectional designs and convenience samples, highlighting methodological limitations and the need for more longitudinal and interventionbased research. Conclusion: Psychological safety is a foundational element for nurses’ well-being and effective healthcare delivery. Integrating psychological safety into institutional policies, leadership development, and workplace culture is essential for building supportive environments. Future research should prioritize mixed-methods and intervention studies, develop context-sensitive measurement tools, and address structural and cultural barriers to implementation

AimsThis study aimed to assess predictors of patient safety competency among emergency nurses.BackgroundThe role of emergency nurses is to provide high-quality health care to patients and ensure their safety. The patient safety competency includes the absence of unnecessary or potential harm when providing health care to patients. In providing health care, effective teamwork can affect patient safety and outcomes. Psychological safety is essential to effective teamwork. Psychological safety allows health care workers to accept the interpersonal risks needed to perform effective teamwork and maintain patient safety.MethodsThis study was cross-sectional correlational research. Using convenience sampling methods, 254 emergency department nurses from five educational hospitals were enrolled in the study. Patient Safety in Nursing Education Questionnaire was used to measure the patient safety competency, the teamwork questionnaire to examine the teamwork, and Edmondson psychological safety questionnaire was used to measure psychological safety. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson’s r correlation coefficient, and multivariate stepwise linear regression analysis were applied using SPSS 14.0.ResultsParticipants’ mean patient safety competency score was 2.97 (1-4). Between 18 independent variables evaluated in the multiple regression analysis, seven had a significant effect on the patient safety competency of emergency nurses (R2: 0.39, p < .001).ConclusionsThe patient safety competency of emergency department nurses was primarily related to the structure and leadership of the team and secondary to psychological safety and experience in patient safety activity. The results demonstrated that policymakers and hospital managers should improve and enhance team structure and leadership via supervision and cooperation with the nursing staff. The development of training programs in patient safety activities, improvement, and increase of psychological safety at the levels of the nursing units is essential to increase patient safety competencies in the emergency nursing program.

SummaryPsychological safety is a beneficial social‐psychological state that promotes positive outcomes in the workplace, such as greater information sharing and enhanced organizational learning. Yet, how psychological safety dynamically develops as a process in groups generally and in demographically diverse groups particularly is understudied. Moreover, there is an insufficient understanding of how peer group members—group members who are not the leader—influence the progression and maintenance of psychological safety. We address these theoretical gaps through an inductive, qualitative study of a group‐based play context. Grounded in data collected from 97 participants, including 56 interviews and 70 h of participant observation, we build a theory that illuminates how psychological safety is co‐created through peer group member interactions during group‐based play. We find that the opportunities afforded by group‐based play disrupt exclusionary dynamics among demographically diverse adults and permit them to shift their relational risk motivation from pursuing goals of individualized self‐protection to pursuing goals of relationship promotion with one another. This breaking out of default, protective relational patterns during group play enables diverse group members to have a greater willingness to (1) engage in relational risk‐taking with each other and (2) support each other's relational risk‐taking—a process we refer to as the relational risk promotion cycle. As diverse group members relationally play off of one another during this cycle, they begin to co‐create a climate of psychological safety, in which they experience discrete events of relaxing and energizing into their differences. Our research makes theoretical contributions to the literatures on psychological safety, diversity in groups and play in organizations. Additionally, our findings suggest a critical role for leaders in which they are not solely creating the conditions for group psychological safety but supporting group members in working together to co‐create a climate of psychological safety for themselves.

Psychosocial factors are implicated in the decision to prematurely leave employment for people with multiple sclerosis (PwMS), beyond the impact of symptoms. We longitudinally tested the sequential relationship between psychological safety (PS), work self-efficacy (WSE), and the perceived impact of fatigue on work performance predicting employment exit intentions (EI). Participants (n = 372) were surveyed at three time points over a four-year period (86% female; mean age 46 at T1) using latent variable structural equation modelling. PS at T1 was positively related to WSE at T2 (β = 0.17, 95% CI: 0.05 to 0.29). WSE mediated the relationship between PS and EI (Indirect Effect (IE) = -0.03, 95% CI = -0.07 to -0.01). WSE and fatigue sequentially mediated the relationship between PS and EI (IE, -0.02, 95% CI = -0.05 to -0.01). Unexpectedly, PS directly reduced perceptions of fatigue decreasing EI. PS was directly related to EI at T3 independently of WSE and fatigue (β = -0.24, SE = 0.07, p < .01, 95% CI: -0.10 to -0.38). Our findings indicate that PS represents a supportive job resource that is critical in dealing with work-related demands, which helps explain why employees leave before medically assessed disability would indicate the need to. Over time, employees who experience a work environment characterised by PS also experience higher levels of WSE and reduced perceptions of work-related fatigue, which in turn reduces the risk of prematurely leaving employment. Interventions targeting these modifiable aspects of the workplace psychosocial climate are required.

Purpose Psychological safety is foundational for engagement in the workforce, but for employees to reach their potential, they must be willing and able to collaborate. The study examined the relationship between psychological safety and engagement as mediated by collaboration. Design/methodology/approach A longitudinal survey-based design was used. The sample included 2023 employees from a transportation agency. Findings Psychological safety at Time 1 was positively related to collaboration at Time 2 (r = 0.38, p < 0.01) and employee engagement at Time 3 (r = 0.18, p < 0.01). Likewise, a bootstrap confidence interval for the indirect effect among these factors did not straddle zero (0.028–0.055). Furthermore, tenure was seen to moderate the indirect effect; the bootstrap confidence interval for the index of moderated mediation did not straddle zero (<0.001 to 0.002). Research limitations/implications These findings indicate that the process by which psychological safety drives engagement includes collaboration and time. This has important implications for how collaborative processes within organizations (e.g. meetings) are structured and suggests that managers should seek to promote collaboration. Practical implications Given the findings, managers may want to consider what they can do to ensure their employees feel psychologically safe. Engaging in more open and inclusive communication during meetings may be an appropriate first step. Originality/value Although the relationship between psychological safety and employee engagement is well known, the major original contribution of the study is the importance of collaboration in that relationship.

BackgroundHospital managers are responsible for the delivery of organisational strategy, development of clinical services and maintaining quality standards. There is limited research on hospital managers, in particular how stress manifests and impacts managers and the presence of individual resilience. Managers must work closely with clinical colleagues, however these relationships can be hindered by the perception of stereotyping and differing priorities. This study aimed to explore the working environment of hospital managers, focusing upon the unique stresses faced, psychological safety and the presence of resilience.MethodsThis study utilised mixed methodology using an embedded approach. Participants were purposively recruited from all levels of hospital management within one National Health Service Trust in London, United Kingdom. An exploration of managers experiences was undertaken using semi-structured qualitative interviews. Psychological safety and individual resilience were additionally assessed using validated surveys. Qualitative data were analysed iteratively using inductive thematic analysis, and triangulated with quantitative data. Kruskal-Wallis statistical analysis was performed to evaluate differences in resilience and psychological safety according to seniority and background experience.ResultsTwenty-two managers were recruited and interviewed, with 20 returning completed surveys. Key findings from the thematic analysis included the importance of good working relationships with clinical colleagues, the persistence of some stereotyping, and feeling unsupported in times of challenge. Stresses described included the bureaucracy involved when delivering change, conflict with colleagues and target driven expectations.Participants described their own psychological safety as lower than desired, supported by quantitative data; but recognised its importance and strived to create it within their own teams. Sixteen participants had ‘normal’ scores for resilience, with senior managers more likely to have higher scores than those more junior (p=0.011).ConclusionPositive working relationships, high psychological safety and individual resilience are important for organisational safety and individual wellbeing. Our data illustrate unique stressors faced by hospital managers, provide detail on sometimes challenging working relationships, and demonstrate scope to improve both the psychological safety and resilience of those in managerial positions. A map for senior healthcare leaders was constructed, facilitating the identification of modifiable areas within their organisation to promote good working relationships and improve the working environment of hospital managers.

This paper investigates the mediating effect of transformative learning processes on the relationship between psychological safety and transformative learning outcomes among information technology firms in Beijing, China. With the rapid evolution of the technology industry, fostering a conducive learning environment becomes essential for employee development and organizational success. Drawing on a sample of information technology firms in Beijing, this study explores how psychological safety influences transformative learning outcomes, and whether transformative learning processes mediate this relationship. The research employs a structured questionnaire survey to collect data from employees, focusing on variables related to psychological safety, transformative learning processes, and transformative learning outcomes. Preliminary findings indicate a significant positive association between psychological safety and transformative learning outcomes. Moreover, transformative learning processes, including social support, attitude toward uncertainty, and criticality, demonstrate a mediating effect on this relationship. Specifically, employees who perceive higher levels of psychological safety are more likely to engage in transformative learning processes, leading to enhanced transformative learning outcomes. These results underscore the importance of promoting psychological safety and facilitating transformative learning processes within information technology firms. By fostering a supportive and inclusive work environment, organizations can empower employees to embrace change, cultivate innovative thinking, and ultimately drive organizational success in the dynamic technology landscape of Beijing, China.

Introduction: The increasing emphasis on creating healthy work environments is driven by their impact on both nurse and patient outcomes. Previous evidence has established a link between supportive nursing leadership and work environments, but demographic characteristics have not been adequately explored. This study aims to investigate whether demographic variations among nurses influence their perceptions of supervisory support and work environment. Methods: Secondary data analysis of a cross-sectional quantitative survey was utilized to recruit registered nurses employed in a government-owned and corporate-controlled (GOCC) tertiary hospital in the Philippines from September 2022 and October 2022. The primary data were collected through a demographic questionnaire, the validated Supervisory Support Scale tool, and the American Association of Critical-Care Nurses’ Healthy Work Environment Assessment Tool. Inferential analyses were employed to examine differences between study variables. Data processing was performed using Microsoft Excel 2022 and the R program, with a significance level set at 0.05. Results: The original dataset with a sample of 519 registered nurses was predominantly composed of non-married female nurses with bachelor’s degrees and varying clinical experiences. The secondary data analysis revealed no significant differences in work environment and supervisory support perceptions in relation to nurses’ demographic characteristics. Conclusions: This study provides critical insights into the Philippine nursing workforce literature by demonstrating that nurses’ demographic variations alone do not significantly influence their supervisory support and work environment perceptions. These results suggest that shifting the focus to broader factors beyond demographic variations among nurses may play a more critical role in shaping nurses’ work environment and supervisory support perceptions. Future research should explore the potential intersection of systemic factors such as leadership competencies, psychological safety, and workplace policies in shaping the nursing workforce dynamics.

Promoting psychological safety in a workplace is known to contribute to improved job outcomes across a wide variety of industries. This study aimed to examine the relationships between psychological safety at work and job outcomes (i.e., job satisfaction and intention to leave), and patient safety among hospital nurses; and to determine the mediating effect of communication openness on these relationships. This cross-sectional study used survey data from 867 hospital nurses working in the United States. Multiple logistic regression models and Hayes' PROCESS macro in SPSS were used. Nurses who worked in an environment with higher psychological safety levels were more likely to be satisfied in their current job, less likely to intend to leave their current job within the next year, and more likely to report favorable patient safety ratings. Communication openness mediated these relationships. When nurses feel psychologically safe at work, they are more likely to engage in open communication, which in turn can lead to greater job satisfaction, decreased turnover intention, and improved patient safety. Nurse managers should strive to develop leadership strategies that promote psychological safety in the work environment and support open communication among nurses.

This study examines physicians’ psychological safety as an internal resource amid modern challenges. A survey of 112 doctors measured their emotional intelligence (EI), resilience, and gathered personal definitions of “psychological safety.” Cluster analysis identified three profiles: about one-third of doctors had low EI and resilience, nearly half moderate, and around one-fifth high. Doctors most often described feeling safe at work as being protected from patient aggression, having a balanced workload, and receiving support from colleagues and management. EI was strongly correlated with resilience. These findings show that doctors’ psychological safety is multi-dimensional, combining external factors (organizational and social support) with internal factors (personal coping resources). The study underscores the need for measures to improve work environments and to strengthen physicians’ individual resilience and emotional skills.