Spillover effects of organizational support for patient and workplace safety on safety outcomes: The mediating role of safety compliance.

AIM(S): To investigate spillover effects of organizational support for patient and workplace safety on safety outcomes and to examine the mediating role of safety compliance in these relationships. DESIGN: A cross-sectional, correlational survey design. METHODS: This study analysed data from 1255 nurses in 34 Korean hospitals. A structured questionnaire was used including items from the Hospital Survey on Patient Safety Culture and Safety Compliance scales. Data were collected between February and June 2022. We employed structural equation modelling (SEM) for analysis with a significance level set at 0.05. RESULTS: Organizational support for patient and workplace safety showed direct impacts on patient and workplace safety outcomes. Findings supported our hypotheses regarding spillover effects, as organizational support for patient safety was related to enhanced workplace safety and organizational support for workplace safety was associated with improved patient safety. SEM analysis showed safety compliance's mediating role. When the distribution of serial indirect effects was examined, three out of eight indirect pathways were statistically significant. CONCLUSION: Improving organizational support for patient safety can lead to better workplace safety outcome, and enhancing support for workplace safety can result in better patient safety outcome. Given this mutually beneficial relationship, healthcare organizations should simultaneously promote safety in both areas rather than focusing on just one. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Study results highlight the need to recognize the interconnected nature of patient and workplace safety in order to achieve better overall safety outcomes. IMPACT: This study shows that organizational safety efforts for patients and workers are interconnected and mutually beneficial. The study's results have both theoretical and practical implications in demonstrating that organizational support for both patient and workplace safety plays a strong role in promoting nurses' safety compliance and improving overall safety outcomes. REPORTING METHOD: STROBE checklist. PATIENT CONTRIBUTION: No patient or public contribution.

Effects of workplace incivility and workload on nurses' work attitude: The mediating effect of burnout.

AIM: The study's aim was to examine how workplace incivility and workload influence nurses' work attitudes (turnover intention, job satisfaction, and organizational commitment) using the stress-strain-outcome framework. BACKGROUND: There is a lack of comprehensive research on the combined effects of workplace incivility and workload on nurses' work attitudes. INTRODUCTION: Two workplace stressors, incivility and workload, were hypothesized to lead to burnout, which in turn influences nurses' work attitudes. METHODS: A cross-sectional, descriptive correlational study was conducted. Survey data were collected from 1,255 direct care nurses with a minimum of 6 months' nursing experiences in 34 general hospitals across Korea. Structural equation modeling was used to test the hypothesized model. This study is reported using the STROBE checklist. RESULTS: As hypothesized, both workplace incivility and workload increased burnout. Heightened burnout correlated with increased turnover intention, lowered job satisfaction, and reduced organizational commitment. While workplace incivility impacted these outcomes both directly and indirectly via its effect on burnout, workload influenced the outcomes solely through burnout. CONCLUSION: The study's findings are based on one, nonrandomized sample of nurses working at South Korean hospitals. Despite such study limitations, the study findings support the adverse impact of two workplace stressors on burnout and nurses' work attitudes. IMPLICATIONS FOR NURSING: Evidence-informed interventions for both workplace stressors include training programs, clear policy guidelines, open communication channels, and supportive work environments. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Zero tolerance and equity, diversity and inclusivity policies to promote workplace civility must be enforced. Workload needs to be patient-centered, ensuring a "fit" between patient needs and nurse staffing.

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 (ß = -0.10, 95 % confidence interval [-0.143, -0.059]) and silence (ß = -0.04, 95 % confidence interval [-0.058, -0.014]), and psychological safety also decreased burnout through voice (ß = -0.04, 95 % confidence interval [-0.057, -0.016]) and silence (ß = -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.

Patient Safety Culture and Speaking Up Among Health Care Workers.

PURPOSE: Although previous research showed the importance of safety culture on health care workers' speaking up behaviors, it is not clear how particular safety culture domains are associated with the speaking up behaviors of hospital staff. Also, researchers have suggested that health care workers' speaking up behaviors vary by profession, but there has been limited research into such differences. Thus, this study examined differences in perceptions of patient safety culture and the promotive and prohibitive speaking up behaviors of health care workers by profession and investigated the relationships between patient safety culture and the two types of speaking up behaviors. METHODS: A descriptive correlational study was conducted using secondary data collected through an online survey of health care workers at a private, nonprofit, tertiary-level teaching hospital in South Korea. The sample (N = 831) consisted of nurses (54.0%), physicians (13.0%), and other licensed and unlicensed hospital personnel (33.0%). Analyses of variance were conducted to examine differences in study variables by profession. Hierarchical regression analyses were conducted to evaluate the effects of the seven patient safety culture factors on promotive and prohibitive voice after controlling for tenure and profession. RESULTS: Perceptions of safety culture and promotive voice behaviors were higher for physicians compared with nurses. Communication openness, reporting patient adverse events, and unit supervisors' and hospital managements' support for patient safety were significant predictors of both types of voice behaviors. CONCLUSION: Hospital administrators and unit managers should create a supportive environment where staff feel free to voice their concerns and suggestions. They should also pay attention to the varying perspectives held by different groups of hospital workers and their different voice behaviors. Knowing which dimensions of patient safety culture are most strongly related to health care workers' voice behaviors can guide patient safety improvement activities in health care organizations.

The relationship between religiosity and meaningful work among Malaysian Muslim employees: The mediating role of existential labor.

This study aimed to explore how religiosity affects the level of meaningful work among Malaysian Muslims, owing to Malaysia's highly religious background. Although religiosity constitutes a major part of an individual's value system, the influence of religiosity on the meaningfulness of work remains unclear. To address this gap, this study examined the indirect effects of the two types of religiosity-intrinsic religiosity (IR) and extrinsic religiosity (ER)-on meaningful work through existential labor, namely, surface acting and deep acting. Self-reported survey responses from 303 Malaysian Muslim employees were analyzed using structural equation modeling and bootstrapping analysis. The results showed that both surface acting and deep acting had significant mediation effects on the relationship between IR and meaningful work. By contrast, in the relationship between ER and meaningful work, surface acting's mediation effect was not significant, whereas deep acting showed a positive mediation effect. Our findings suggest that even if employees share the same religion, meaningful work is shaped differently by the specific type of religiosity and those existential labor strategies that individuals develop. This study advances the understanding of the underlying psychological mechanisms of the impact of individual religious values in the workplace. Implications and limitations were discussed.

Mediating roles of patient safety knowledge and motivation in the relationship between safety climate and nurses' patient safety behaviors: a structural equation modeling analysis.

BACKGROUND: Few studies have examined the relationship between patient safety climate and two forms of patient safety behavior (i.e., safety compliance and safety participation) among nurses. Better understanding of factors contributing to nurses' safety behaviors could enhance patient safety. Therefore, this study aimed to examine the effect of patient safety climate on nurses' patient safety behavior and to explore whether patient safety knowledge and motivation mediate this relationship. METHODS: This correlational, cross-sectional study used survey data from 1,053 staff nurses working at a general hospital located in a metropolitan area of South Korea. Structural equation modeling was employed to test a hypothesized multiple mediation model that was guided by Griffin and Neal's model of safety performance. RESULTS: The results indicated that patient safety climate was directly related to both patient safety compliance behavior (ß = 0.27, p < 0.001) and patient safety participation behavior (ß = 0.25, p < 0.001). Concerning indirect effects, patient safety climate was associated with patient safety compliance behavior through both patient safety knowledge (ß = 0.26, p < 0.001) and patient safety motivation (ß = 0.04, p = 0.038), whereas patient safety climate was related to patient safety participation behavior only through patient safety knowledge (ß = 0.27, p < 0.001) and not through patient safety motivation (ß = 0.00, p = 0.985). CONCLUSION: Based on this study's findings, building an organizational climate focused on patient safety is vital for improving nurses' patient safety behavior. Improving an organization's patient safety climate could promote both safety knowledge and motivation in nurses and thereby potentially enhance their patient safety behavior. Hence, healthcare organizations should implement practical interventions to improve their patient safety climate. Also, nursing management interventions designed to transfer patient safety knowledge to nurses would be particularly effective in improving their safety behavior.

Hospital management, supervisor support and nurse speaking-up behaviours: 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 behaviours and (b) identify potential mediators of this relationship. BACKGROUND: Speaking-up behaviour among nurses has emerged as a critical source of patient safety. Fuller understanding of the developmental mechanisms contributing to nurses' speaking-up behaviours could help to enhance patient safety in health care organisations. 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) behaviours 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 behaviours. 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.