Psychological safety and mental health among intensive care unit nurses: A multi-institutional cross-sectional study

The objective of this study was to examine the association between psychological safety and mental health outcomes among intensive care unit (ICU) nurses.

A multi-institutional cross-sectional survey was conducted among full-time ICU nurses across nine Japanese institutions. Psychological safety was measured using a validated Japanese version of the Workplace Psychological Safety Scale. Burnout and psychological distress were assessed using the Japanese version of the Burnout Assessment Tool (BAT-J) and Kessler Psychological Distress Scale (K-6), respectively. Correlation and linear regression analyses were used to evaluate the associations after controlling for demographic and occupational variables.

Of the 414 surveys distributed, 132 valid responses were obtained (response rate: 31.9%). The participants had a mean age of 36.3 (standard deviation [SD]: 10.2) years and a mean ICU experience of 6.8 (SD: 6.3) years. The mean scores on the psychological safety scale, symptoms of depression and anxiety scale (K-6), and burnout scale (BAT-J) were 4.7 (SD: 1.2), 6.1 (SD: 5.1), and 94.0 (SD: 18.9), respectively. Psychological safety was negatively correlated with burnout (r = -0.497, p < 0.001) and symptoms of depression and anxiety (r = -0.461, p < 0.001). Multiple regression analyses revealed that higher psychological safety significantly predicted lower burnout (β = -0.556, p < 0.001) and psychological distress (β = -0.518, p < 0.001), with each unit increase in psychological safety associated with an 8.745-point reduction in burnout scores (BAT-J) and a 2.18-point reduction in psychological distress scores (K-6).

Psychological safety was significantly associated with reduced burnout and psychological distress among ICU nurses. These findings suggest that interventions targeting psychological safety may be associated with clinically meaningful improvements in mental health outcomes. Organisations should consider implementing strategies to enhance psychological safety as part of comprehensive mental health and workforce retention initiatives in critical care settings.