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Ethical leadership and nurses' voice behavior: A longitudinal study.
Zhengyi Ma1,2, Dongrun Liu2, Yongkang Fu2
1Nursing Department of Huaihe Hospital, Henan University, Kaifeng, China.
Nursing Ethics
|May 20, 2026
Summary
Ethical leadership positively impacts nurses' voice behavior over time, both directly and by strengthening their sense of professional mission. This highlights the importance of ethical leadership in healthcare settings.
Area of Science:
- Healthcare Management
- Organizational Behavior
- Nursing Leadership
Background:
- Ethical leadership is crucial for proactive employee behaviors in healthcare.
- Longitudinal evidence on ethical leadership and nurses' voice behavior is limited.
Purpose of the Study:
- To examine the longitudinal relationship between ethical leadership and nurses' voice behavior.
- To investigate the mediating role of sense of professional mission in this relationship.
Main Methods:
- A multicenter longitudinal survey of 537 registered nurses in China over 6 months.
- Data collected at three time points using validated scales.
- Analyzed using Pearson correlation and structural equation modeling.
Main Results:
- Ethical leadership at T1 positively predicted sense of professional mission at T2 (β = 0.18).
- Sense of professional mission at T2 predicted voice behavior at T3 (β = 0.20).
- A direct positive association was found between ethical leadership at T1 and voice behavior at T3 (β = 0.18).
- Sense of professional mission mediated 16.98% of the total effect.
Conclusions:
- Ethical leadership directly influences nurses' voice behavior.
- Ethical leadership indirectly promotes nurses' voice behavior by enhancing their sense of professional mission.
- Strengthening ethical leadership and professional mission can foster voice behavior in clinical settings.
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