Authentic Leadership, Psychological Safety, Missed Nursing Care, and Intention to Leave Among Hospital Nurses
Hyeonmi Cho, Linsey M. Steege
Abstract
AIMS: The aims of this study were to examine the relationships between authentic leadership, missed nursing care, and intention to leave in hospital nurses and to investigate the mediating role of psychological safety in these relationships. BACKGROUND: Nursing managers' authentic leadership and unit psychological safety influence nursing practice and work attitudes. However, the relationships among authentic leadership, psychological safety, missed nursing care, and turnover intention remain underexplored, highlighting the need for further investigation. METHODS: This cross-sectional descriptive study analyzed online survey data collected from 504 registered nurses in the United States between April 2021 and July 2022. Multiple linear and logistic regression models, along with Hayes' PROCESS macro, were used for data analysis. RESULTS: Nurses who perceived their unit managers as exhibiting greater authentic leadership reported fewer missed nursing care tasks and were less likely to intend to leave. Psychological safety mediated these relationships, as authentic leadership was positively associated with psychological safety. In turn, psychological safety was associated with reduced levels of missed nursing care and decreased turnover intention among hospital staff nurses. IMPLICATIONS: Organizational initiatives to enhance nurse managers' authentic leadership through targeted training, resource support, and relevant policies are essential for improving psychological safety, patient care quality, and nurses' job outcomes. CONCLUSION: These findings emphasise the need for organisational investment in authentic leadership development to promote safer, more supportive care environments and improve outcomes for both nurses and patients.