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Management by Walking Around and Nurses' Voice Behaviour: A Structural Equation Modelling Approach to the Mediating
Sara Abd-Elmongy Mostafa Mohamed1, Sally Abd-Elmongy Mostafa Mohamed1, Mona Gamal Mohamed2
1Nursing Administration Department, Faculty of Nursing, Tanta University, Tanta, Egypt.
Background:
Management by walking around (MBWA) is a leadership practice in which head nurses maintain a visible presence in clinical settings, interact directly with nurses, promote open communication, observe workflow and foster a supportive work environment. These practices may contribute to building nurses' trust and encouraging them to speak up.
Aim:
To examine the direct and indirect effects of head nurses' MBWA on nurses' voice behaviour with trust as a single mediating variable.
Study Design:
A cross-sectional correlational design was employed using a convenience sample of nurses working in intensive care units at a tertiary university hospital in Tanta, Egypt. Data were collected using Head Nurses' Management by Walking Around Questionnaire, Nurses' Trust Questionnaire, and Nurses' Voice Behaviour Scale. Structural equation modelling with bootstrapping (5, 000 resamples) was used to test a single-mediator model in which trust mediated the relationship between MBWA and nurses' voice behaviour.
Results:
MBWA was positively associated with trust (β = 0.620, p < 0.001) and nurses' voice behaviour (β = 0.468, p < 0.001). Trust significantly predicted voice behaviour (β = 0.471, p < 0.001). The indirect effect of MBWA on voice behaviour through trust was statistically significant (β = 0.292, 95% CI [0.115, 0.547]). Approximately 38.4% of the total effect of MBWA on voice behaviour was transmitted through trust, indicating partial mediation.
Conclusion:
MBWA was directly associated with nurses' voice behaviour and indirectly associated with voice behaviour through trust. These findings suggest that head nurses' visible leadership practices may strengthen trust and open communication, particularly in high-risk environments such as ICUs.
Relevance To Clinical Practice:
The findings of this study highlight the importance of a positive workplace ecology in enhancing nurses' job satisfaction and their intention to leave. Enhancing leadership practices, particularly those that promote effective communication, staff involvement in decision-making and adequate staffing and resources, can directly influence nurses' work experiences and retention. For clinical practice, fostering a positive work environment may improve teamwork, reduce turnover and ultimately contribute to better patient care outcomes. These findings underscore the need for nurse leaders and healthcare administrators to prioritize workplace improvements as part of organizational safety, quality and workforce sustainability initiatives.
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