Factors influencing nurses' safety voices about patient safety concerns: A cross-sectional study

This study aimed to examine the relationships among perceived concerns about patient safety, patient safety culture, systems thinking, and nurses' safety voices.

Nurses' speaking up behavior is a crucial strategy for enhancing patient safety and preventing incidents in hospital settings. As patient advocates, nurses should be encouraged to speak up appropriately when they encounter situations that threaten patient safety.

A descriptive cross-sectional design was used. Questionnaires were used to collect data on socio-demographic information, perceived concerns about patient safety, patient safety culture, systems thinking, and safety voices. An online survey tool was used from May 25 to June 30, 2023. This study was conducted in South Korea, and 235 clinical nurses participated. Data were analyzed using multiple linear regression analysis and Hayes' PROCESS macro with the bootstrap method.

Perceived concerns about patient safety, patient safety culture ('communication openness' and 'handoffs and information exchange') and job tenure were significant predictors of both types of safety voices. Patient safety culture partially mediated the relationship between perceived concerns about patient safety and speaking up (β = -0.087, 95 % confidence interval: -0.160 to -0.032), and also between perceived concerns about patient safety and withholding voice (β = 0.140, 95 % confidence interval: 0.069 to 0.222).

Creating a supportive and open communication environment that fosters information sharing is essential for encouraging nurses to voice their opinions regarding patient safety. Further research is needed to develop and implement assertive communication programs for clinical nurses.