The link between leadership and safety outcomes in hospitals.

AIM To test and refine a model examining relationships among leadership, interactional justice, quality of the nursing work environment, safety climate and patient and nurse safety outcomes. BACKGROUND The quality of nursing work environments may pose serious threats to patient and nurse safety. Justice is an important element in work environments that support safety initiatives yet little research has been done that looks at how leader interactional justice influences safety outcomes. METHOD A cross-sectional survey was conducted with 600 acute care registered nurses (RNs) to test and refine a model linking interactional justice, the quality of nurse leader-nurse relationships, work environment and safety climate with patient and nurse outcomes. RESULTS In general the hypothesized model was supported. Resonant leadership and interactional justice influenced the quality of the leader-nurse relationship which in turn affected the quality of the work environment and safety climate. This ultimately was associated with decreased reported medication errors, intentions to leave and emotional exhaustion. CONCLUSIONS Quality relationships based on fairness and empathy play a pivotal role in creating positive safety climates and work environments. IMPLICATIONS FOR NURSING MANAGEMENT To advocate for safe work environments, managers must strive to develop high-quality relationships through just leadership practices.

[1]  M. Leiter,et al.  The Impact of Nursing Work Environments on Patient Safety Outcomes: The Mediating Role of Burnout Engagement , 2006, The Journal of nursing administration.

[2]  G. Pepper,et al.  Barriers to nurses' reporting of medication administration errors in Taiwan. , 2006, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[3]  G. Cummings,et al.  Factors contributing to nursing leadership: A systematic review , 2008, Journal of health services research & policy.

[4]  E. Larson,et al.  Nurse Working Conditions and Patient Safety Outcomes , 2007, Medical care.

[5]  Timothy J. Vogus,et al.  The Safety Organizing Scale: Development and Validation of a Behavioral Measure of Safety Culture in Hospital Nursing Units , 2007, Medical care.

[6]  Y. Donchin,et al.  Healthcare climate: A framework for measuring and improving patient safety* , 2007, Critical care medicine.

[7]  Remus Ilies,et al.  Leader-member exchange and citizenship behaviors: a meta-analysis. , 2007, The Journal of applied psychology.

[8]  Janie Heath,et al.  Healthy Work Environments: A Validation of the Literature , 2004, The Journal of nursing administration.

[9]  P. Pearson,et al.  Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS. , 2009, Journal of nursing management.

[10]  Peter Y. Chen,et al.  Using Social Exchange Theory to Distinguish Procedural from Interactional Justice , 2002 .

[11]  M Patterson,et al.  Use of a safety climate questionnaire in UK health care: factor structure, reliability and usability , 2006, Quality and Safety in Health Care.

[12]  M. Kho,et al.  Safety Climate Survey: reliability of results from a multicenter ICU survey , 2005, Quality and Safety in Health Care.

[13]  Rebecca A. Feather.  Emotional intelligence in relation to nursing leadership: does it matter? , 2009, Journal of nursing management.

[14]  M. Wenten,et al.  Turnover intention in new graduate nurses: a multivariate analysis , 2008, Journal of advanced nursing.

[15]  Cheryl B. Jones,et al.  The role of theory in improving patient safety and quality health care. , 2004, Nursing outlook.

[16]  Diane Doran,et al.  Effects of leadership and span of control on nurses' job satisfaction and patient satisfaction. , 2009, Nursing leadership.

[17]  A. Mushlin,et al.  Association between nurse-physician collaboration and patient outcomes in three intensive care units. , 1999, Critical care medicine.

[18]  G. Graen,et al.  Relationship-based approach to leadership: Development of leader-member exchange (LMX) theory of leadership over 25 years: Applying a multi-level multi-domain perspective , 1995 .

[19]  A. Altaffer.  First-line managers. Measuring their span of control. , 1998, Nursing management.

[20]  Scott Mondore,et al.  Safety climate as a mediator between foundation climates and occupational accidents: a group-level investigation. , 2006, The Journal of applied psychology.

[21]  Birgit Schyns,et al.  Comparing antecedents and consequences of leader – member exchange in a German working context to findings in the US , 2005 .

[22]  S M Shortell,et al.  The Performance of Intensive Care Units: Does Good Management Make a Difference? , 1994, Medical care.

[23]  Deborah E. Rupp,et al.  The mediating effects of social exchange relationships in predicting workplace outcomes from multifoci organizational justice , 2002 .

[24]  S. Sheps,et al.  The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada , 2004, Canadian Medical Association Journal.

[25]  H. Laschinger.  Hospital nurses' perceptions of respect and organizational justice. , 2004 .

[26]  S. Clarke.  The relationship between safety climate and safety performance: a meta-analytic review. , 2006, Journal of occupational health psychology.

[27]  Elaine Larson,et al.  Perceived Nursing Work Environment of Critical Care Nurses , 2004, Nursing research.

[28]  Charlotte R. Gerstner,et al.  Meta-Analytic Review of Leader-Member Exchange Theory: Correlates and Construct Issues , 1997 .

[29]  Carol A. Wong,et al.  Workplace empowerment, work engagement and organizational commitment of new graduate nurses. , 2006, Nursing leadership.

[30]  L. Shanock,et al.  Organizational Justice in an Exchange Framework: Clarifying Organizational Justice Distinctions , 2006 .

[31]  C. Estabrooks,et al.  Mitigating the Impact of Hospital Restructuring on Nurses: The Responsibility of Emotionally Intelligent Leadership , 2005, Nursing research.

[32]  T. Habermann,et al.  Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. , 2006, JAMA.

[33]  M. Blegen,et al.  Nurse staffing and patient outcomes. , 1998, Nursing research.

[34]  Donald E. Conlon,et al.  Justice at the millennium: a meta-analytic review of 25 years of organizational justice research. , 2001, The Journal of applied psychology.

[35]  R. Flin,et al.  Human and organizational factors in offshore safety , 2001 .

[36]  Jack V Tu,et al.  Impact of hospital nursing care on 30-day mortality for acute medical patients. , 2007, Journal of advanced nursing.

[37]  Kyle Lewis,et al.  Integrating Justice and Social Exchange: The Differing Effects of Fair Procedures and Treatment on Work Relationships , 2000 .

[38]  D. Hofmann,et al.  An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. , 2006 .

[39]  L. Cranley,et al.  Nurse intention to remain employed: understanding and strengthening determinants. , 2006, Journal of advanced nursing.

[40]  G. Goodman.  A fragmented patient safety concept: the structure and culture of safety management in health care. , 2004, Nursing economic$.

[41]  Marko Elovainio,et al.  Organizational justice: evidence of a new psychosocial predictor of health. , 2002, American journal of public health.

[42]  H. S. Spence Laschinger,et al.  The effects of emotionally intelligent leadership behaviour on emergency staff nurses' workplace empowerment and organizational commitment. , 2009, Nursing leadership.

[43]  V. Savicki,et al.  Impact of fairness, leadership, and coping on strain, burnout, and turnover in organizational change. , 2006 .

[44]  R. Gershon,et al.  Nurse Work Environments and Occupational Safety in Intensive Care Units , 2006, Policy, politics & nursing practice.

[45]  N. Hoffart,et al.  Elements of a nursing professional practice model. , 1996, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.

[46]  F. Schoorman,et al.  A model of relational leadership: The integration of trust and leader–member exchange , 2000 .

[47]  E. Severinsson,et al.  Emotional intelligence: a review of the literature with specific focus on empirical and epistemological perspectives. , 2007, Journal of clinical nursing.

[48]  H. Laschinger,et al.  The impact of emotional intelligent leadership on staff nurse empowerment: the moderating effect of span of control. , 2008, Journal of nursing management.

[49]  Paul E. Spector,et al.  The Role of Justice in Organizations: A Meta-Analysis , 2001 .

[50]  G. Lowe,et al.  Correlates of Employees' Perceptions of a Healthy Work Environment , 2003, American journal of health promotion : AJHP.

[51]  Annie Mckee,et al.  Resonant leadership: a new kind of leadership for the digital age , 2006 .

[52]  L R Murphy,et al.  Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. , 2000, American journal of infection control.

[53]  Sean P Clarke,et al.  Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. , 2002, American journal of infection control.

[54]  T. Habermann,et al.  Association of resident fatigue and distress with perceived medical errors. , 2009, JAMA.

[55]  J. A. N. Eedleman,et al.  Nurse-Staffing Levels and the Quality of Care in Hospitals , 2002 .

[56]  H. Laschinger,et al.  A profile of the structure and impact of nursing management in Canadian hospitals. , 2008, Healthcare quarterly.

[57]  Eitan Naveh,et al.  Treatment Errors in Healthcare: A Safety Climate Approach , 2005, Manag. Sci..

[58]  R. Cropanzano,et al.  Social Exchange Theory: An Interdisciplinary Review , 2005 .