Exploring distributed leadership and proactive change behavior in nursing: the roles of psychological safety and...

The proactive behavioral change of nurses is gradually emerging as a pivotal driving force in optimizing the healthcare systems and maintaining organizational competitive edge. How to effectively stimulate such healthcare management processes represents an ongoing challenge to health services managers. This study aimed to determine how distributed leadership may impact proactive behavioral change among nurses. Also, it explored the mediating role of psychological safety in this context and examined whether the inclusive climate exerts a moderating effect on the direct and indirect effects of the mediating model approach. Cross-sectional study following STROBE guidelines. A total of 2,228 nurses participated in this study. Distributed leadership, psychological safety, inclusive climate, and proactive change behavior were measured. Our findings suggest that distributed leadership has a significant promoting effect on proactive change behavior (B = 0.354, P < 0.001). Psychological safety played a partial mediating role between distributed leadership and nurses' proactive change behavior (B = 0.149, 95% CI 0.128, 0.172). Furthermore, the data generated suggests that the indirect effect of the mediation model can be significantly strengthened with the elevation of the level of inclusive climate (distributed leadership - psychological safety: B = 0.087, 95% CI 0.044, 0.131; psychological safety - proactive change behavior: B = 0.103, 95% CI 0.060, 0.145). Distributed leadership can directly impact nurses' proactive change behaviors. It also exerts an indirect effect via the mediating effect of mental wellbeing, and the inclusive climate moderates this relationship. Our findings provide theoretical support for healthcare managers involved in formulating incentive strategies for nurses' proactive change behaviors. Healthcare and nursing managers can implement collaborative intervention measures centered on leadership, psychological resources, and organizational climate to promote nurses' proactive change behavior.