Authentic leadership, nurse-assessed adverse patient events and quality of care: The mediating role of nurses' safety actions

Background Authentic leadership has been consistently cited as a strong precursor of sustained job performance and work effectiveness in nurses; however, studies linking authentic leadership with nurses' safety actions, nurse-assessed adverse patient events and nursing care quality are scarce. Aim To examine whether nurses' safety actions mediate the relationship between authentic leadership, nurse-assessed adverse events and nursing care quality. Methods A multi-centre, cross-sectional study involving 1,608 nurses employed in acute care facilities in Oman. Multi-stage regression analysis was conducted in testing for the mediation model. Findings Nurse managers in Oman were perceived to be highly authentic by their staff nurses. Authentic leadership significantly predicted nurses' safety actions (beta = 0.168, p < .001), decrease in nurse-assessed adverse events (beta = -0.017, p = .024) and increase in care quality (beta = 0.121, p < .001). Further, the association between authentic leadership and nurse-assessed adverse events (beta = -0.063, p = .057) and care quality (beta = 0.038, p = .002) was mediated by nurses' safety actions. Conclusion Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' safety actions and reduce adverse patient outcomes and promote nursing care quality. Implications for nursing management Organizational efforts to address patient safety issues should be directed towards developing authentic leadership in nurse managers through leadership programmes, periodic evaluation of leadership competencies (e.g., 360-degree or a bottom-up performance evaluation), and a creation of a safe culture in which nurses can openly report safety concerns for corrective action.

Automated summary

The study in Oman found that nurse managers were perceived as highly authentic leaders, and their authentic leadership significantly predicted nurses' safety actions, decrease in nurse-assessed adverse events, and increase in nursing care quality. Furthermore, the relationship between authentic leadership and nurse-assessed adverse events and care quality was mediated by nurses' safety actions.