Relationships of perceived direct supervisor affiliation, direct supervisor leadership style, and nurses' voice behavior




Aranzamendez, Gina

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Patient safety and quality improvement in healthcare have been underscored since the Institute of Medicine (IOM) published its landmark report To Err is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000). One of the central tenets of quality improvement is the belief that people are forthcoming about quality issues. The reluctance of nurses to speak up about their issues and concerns has a negative impact on patient safety and on the organization's ability to learn from error. The purpose of this study is to explore the relationship of perceived direct supervisor leadership style, the quality of leadership affiliation, and the voice behavior of clinical nurses.

A cross-sectional survey study was conducted during the summer of 2014. Members of the Houston Chapter Oncology Nursing Society were invited to participate and encouraged to forward the invitation to nurse colleagues currently working in oncology care settings in the greater Houston area. 154 nurses responded to the survey but due to inclusion criteria and completeness of the survey, only 146 were used in the analysis.

Hierarchical regression analysis was used to answer the research questions. After controlling for age, tenure, gender, and work shift, the contextual leadership characteristics showed a significant influence in the clinical nurses' voice behavior explaining 25.4% of the variance. After entry of the perceived psychological safety, the overall variance explained by the model as a whole was 26.4%. However, perceived psychological safety did not show mediating influence between leadership characteristics and voice behavior of clinical nurses. In the final model, leadership affiliation made a significant unique contribution to the variance, β= .262, p = 0.054.

Result of this study affirmed the importance of the direct supervisors' contextual characteristics in promoting voice behavior among clinical nurses. It also illustrated the significant impact of the clinical nurses' perception on their direct supervisor's affiliation and their decision to engage in speaking up about their work-related improvement areas.



Social sciences, Health and environmental sciences, Education, Leadership affiliation, Leadership behavior, Psychological safety, Voice behavior