Nurses' Silence Behavior as a Mediator Between Authentic Leadership and Near-Miss Reporting Intention: A...

Near-miss reporting intention is essential for patient safety; however, reporting rates among nurses remain low. Nurses' silence behavior-the intentional withholding of work-related concerns-is a key barrier to reporting. While authentic leadership is known to promote nurses' voice behavior, research examining the relationships between authentic leadership, nurses' silence behavior, and near-miss reporting intention remains limited. Therefore, this study aimed to examine the abovementioned relationships and to test the mediating role of nurses' silence behavior.

A predictive correlation design was used. Data were collected from 171 nurses at three general and tertiary hospitals in South Korea between August 20 and September 15, 2022. The mediating effect of silence behavior on the relationship between authentic leadership and near-miss reporting intention was tested using the PROCESS macro (Model 4).

Authentic leadership was negatively associated with nurses' silence behavior (B = -0.27, p  < 0.001), and silence behavior was negatively associated with near-miss reporting intention (B = -0.65, p = 0.008). Authentic leadership did not have a significant direct effect on near-miss reporting intention (B = 0.36, p = 0.142) but had a significant indirect effect through the mediator (B = 0.18, 95% CI = 0.03-0.37).

Authentic leadership is indirectly linked to higher near-miss reporting intentions through lower individual silence behavior among nurses. To enhance reporting intentions, it is necessary to mitigate situational constraints associated with silence and foster an environment conducive to open communication.

Nurse managers should consistently practice authentic leadership to dismantle rigid hierarchical atmospheres and cultivate an open communication climate. This targeted strategy may help reduce nurses' silence behavior and encourage active participation in patient safety-strengthening behaviors, thereby creating a secure healthcare setting.