Participative leadership and nurses' error reporting: psychological safety as a mediator in multi-hospital data

Nurses' willingness to report medication-related events is central to organizational learning, yet speaking up still varies across units and leadership climates. This study examined whether psychological safety mediates the association between participative leadership and nurses' intentions to report medication errors.

We analyzed data from a cross-sectional survey of staff nurses in South Korea (n = 200). Participative leadership (6 items, 5-point scale), psychological safety (7 items, 5-point scale), and reporting intentions (9 items, 6-point scale) were measured using validated instruments. Mediation was examined using regression-based analyses with bias-corrected bootstrap confidence intervals (5000 resamples), adjusting for relevant covariates.

Participative leadership was positively related to psychological safety (a = 0.443, P<.001), and psychological safety was associated with stronger reporting intentions (b = 0.295, P=.004). The indirect effect was significant (0.132; 95% bootstrap CI [0.021, 0.265]). After psychological safety was included, the direct association between participative leadership and reporting intentions was no longer significant (β = 0.108, P=.169).

In this multi-hospital sample, participative leadership was associated with higher intentions to report medication errors primarily through greater psychological safety. Efforts to strengthen reporting may benefit from leadership development combined with unit-level practices that reduce interpersonal costs of speaking up and support feedback following reports.