Background: Cultivating internal whistleblowing among nurses is of paramount importance to nurse leaders. Yet, the literature on how nurse leaders can foster this phenomenon among nurses is limited. Additionally, the underlying mechanisms linking leadership behaviors to internal whistleblowing intentions remain underexplored.
Aim: This study aimed to examine how ethical leadership is linked to internal whistleblowing intentions among nurses through the mediating effect of psychological safety.
Research design: A multicenter cross-sectional research design was used for this study.
Participants and research context: This study involved 201 nurses working in three tertiary governmental hospitals across three cities in Egypt. Data were collected between October and December 2023, using an introductory information form, the Ethical Leadership Scale, the Psychological Safety Scale, and the Internal Whistleblowing Intentions Scale. Structural equation modeling was used to evaluate study hypotheses.
Ethical consideration: Research Ethics Committee of Faculty of Nursing, Port Said University, Egypt approved the study (reference number: NUR (6/8/2023)(28)), and each participant signed the informed consent form before participation in the study.
Results: Ethical leadership was positively linked to nurses’ psychological safety and internal whistleblowing intentions. Psychological safety mediated the link between ethical leadership and nurses’ internal whistleblowing intentions.
Conclusion: Our study suggests that nurse leaders can foster nurses’ intentions to blow the whistle internally by adopting ethical leadership behaviors and enhancing psychological safety among nurses.
MalakMZSaloukJAl-ShawawrehR, et al.Perceptions of patient safety culture among emergency room nurses in Jordanian accredited hospitals. J Nurs Manag2022; 30: 3131–3138.
WiisakJSuhonenRLeino-KilpiH. Reasoning for whistleblowing in health care. Scand J Caring Sci2023; 37: 316–327.
4.
FirtkoAJacksonD. Do the ends justify the means? Nursing and the dilemma of whistleblowing. Aust J Adv Nurs : A Quarterly Publication of the Royal Australian Nursing Federation2005; 23: 51–56.
5.
GagnonMPerronA. Whistleblowing: a concept analysis. Nurs Health Sci2020; 22: 381–389.
6.
MannionRBlenkinsoppJPowellM, et al.Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews. Health Serv Deliv Res2018; 6: 1–190. DOI: 10.3310/hsdr06300.
7.
AnugerahRAbdillahMRAnitaR. Authentic leadership and internal whistleblowing intention: the mediating role of psychological safety. J Financ Crime2019; 26: 556–567.
8.
PohjanoksaJStoltMSuhonenR, et al.Wrongdoing and whistleblowing in health care. J Adv Nurs2019; 75: 1504–1517.
9.
SachdevaSChaudharyNS. Exploring whistleblowing intentions of Indian nurses: a qualitative study. Int J Organ Anal. 2022; 31: 3479–3501. DOI:10.1108/IJOA-06-2021-2804.
10.
ÇekiçYTunaREskin BacaksizF. The relationship between ethical position and whistleblowing: a cross-sectional study among nurses. J Clin Nurs2022; 32: 4878–4886. DOI: 10.1111/jocn.16607.
11.
LeeSEDahintenVSJiH, et al.Motivators and inhibitors of nurses’ speaking up behaviours: a descriptive qualitative study. J Adv Nurs2022; 78: 3398–3408.
12.
RobbinsJMcAlearneyAS. Encouraging employees to speak up to prevent infections: opportunities to leverage quality improvement and care management processes. Am J Infect Control2016; 44: 1224–1230.
13.
JacksonDHutchinsonMPetersK, et al.Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies. J Nurs Manag2013; 21: 572–580.
14.
OgunfoworaBMaerzAVartyCT. How do leaders foster morally courageous behavior in employees? Leader role modeling, moral ownership, and felt obligation. J Organ Behav2021; 42: 483–503.
15.
El-GazarHEZorombaMA. Ethical leadership, flourishing, and extra-role behavior among nurses. SAGE Open Nursing2021; 7: 23779608211062668.
16.
SmailiN. Building an ethical culture by improving conditions for whistleblowing. J Bus Strat2023; 44: 37–43.
17.
SachdevaSChaudharyNS. Exploring whistleblowing intentions of Indian nurses: a qualitative study. Int J Organ Anal2023; 31: 3479–3501.
18.
BanduraA. Social learning theory. Oxford, England: Prentice-Hall, 1977.
19.
BrownMETreviñoLKHarrisonDA. Ethical leadership: a social learning perspective for construct development and testing. Organ Behav Hum Decis Process2005; 97: 117–134.
20.
KuljuKStoltMSuhonenR, et al.Ethical competence: a concept analysis. Nurs Ethics2015; 23: 401–412.
21.
SimsRR. A contemporary look at business ethics. USA: Information Age Publishing Inc, 2017.
22.
StorakerAHeggestadAKTSæterenB. Ethical challenges and lack of ethical language in nurse leadership. Nurs Ethics2022; 29: 1372–1385.
23.
El-GazarHEAbdelhafezSZorombaMA. Effects of the areas of worklife on job embeddedness: a national cross-sectional study among Egyptian nurses. BMC Nurs2022; 21: 353.
24.
MostafaAMSEl-MotalibEA. Ethical leadership, work meaningfulness, and work engagement in the public sector. Rev Publ Person Adm2020; 40: 112–131.
25.
McKennaJJeskeD. Ethical leadership and decision authority effects on nurses’ engagement, exhaustion, and turnover intention. J Adv Nurs2020; 77: 198–206.
26.
WiisakJSuhonenRLeino-KilpiH. Whistle-blowers – morally courageous actors in health care?Nurs Ethics2022; 29: 1415–1429.
27.
ParkHRehgMTLeeD. The influence of confucian ethics and collectivism on whistleblowing intentions: a study of South Korean public employees. J Bus Ethics2005; 58: 387–403.
28.
LiuYZhaoSLiR, et al.The relationship between organizational identification and internal whistle-blowing: the joint moderating effects of perceived ethical climate and proactive personality. Review of Managerial Science2018; 12: 113–134.
29.
FriedrichCQuickR. Organizations’ perspectives on whistleblowing: evidence from interviews with unregulated companies. J Account Organ Change2023; 20: 702–723. DOI: 10.1108/JAOC-01-2023-0001.
30.
IslamTAhmedIAliG. Effects of ethical leadership on bullying and voice behavior among nurses: mediating role of organizational identification, poor working condition and workload. Leader Health Serv2019; 32: 2–17.
31.
JunaidiJ. The role of ethical leadership to employees work engagement: a social learning theory perspective. Int J Soc Econ. 2023; 51. DOI:10.1108/IJSE-03-2023-0218.
32.
CevaEBocchiolaM. Theories of whistleblowing. Philos Compass2020; 15: e12642.
33.
Tran PhamTKNguyenLTQHT. Impacts of ethical leadership, innovative climate on project success: the role of innovative behavior and time pressure. Baltic J Manag2024; 19: 19–35.
34.
EdmondsonA. Psychological safety and learning behavior in work teams. Adm Sci Q1999; 44: 350–383.
35.
ItoASatoKYumotoY, et al.A concept analysis of psychological safety: further understanding for application to health care. Nursing Open2022; 9: 467–489.
36.
ChoHSteegeLMArsenault KnudsenÉN. Psychological safety, communication openness, nurse job outcomes, and patient safety in hospital nurses. Res Nurs Health2023; 46: 445–453.
37.
WangX-LWangM-YLiuJ-N. Study on the influence mechanism of leaders’ abusive supervision on employees’ bootlegging innovation behavior. Int J Conflict Manag2023; 34: 887–906.
38.
VakiraEShereniNCNcubeCM, et al.The effect of inclusive leadership on employee engagement, mediated by psychological safety in the hospitality industry. J Hospit Tour Insights2023; 6: 819–834.
39.
von ElmEAltmanDGEggerM, et al.The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet2007; 370: 1453–1457.
HairJFBlackWCBabinBJ, et al.Multivariate data analysis. 8th ed.London: Cengage Learning, 2019. DOI: 10.1002/9781119409137.ch4.
43.
NunnallyJ. Psychometric theory. New York: McGraw-Hill, 1978.
44.
PodsakoffPMMacKenzieSBLeeJY, et al.Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol2003; 88: 879–903.
45.
PodsakoffPMOrganDW. Self-reports in organizational research: problems and prospects. J Manag1986; 12: 531–544.
CollierJ. Applied structural equation modeling using AMOS: basic to advanced techniques. New York: Routledge, 2020.
48.
HoxJJ. Confirmatory factor analysis. In: The Encyclopedia of Research Methods in Criminology and Criminal Justice2021, pp. 830–832.
49.
FornellCLarckerDF. Evaluating structural equation models with unobservable variables and measurement error. J Market Res1981; 18: 382–388.
50.
HenselerJRingleCMSarstedtM. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Market Sci2015; 43: 115–135.
51.
AkhtarMWJavedMSyedF, et al.Say no to wrongdoing: the serial mediation model of responsible leadership and whistleblowing intentions. Int J Manpow2021; 42: 889–903.
52.
TuYLuXChoiJN, et al.Ethical leadership and team-level creativity: mediation of psychological safety climate and moderation of supervisor support for creativity. J Bus Ethics2019; 159: 551–565.
53.
AhmadIGaoYSuF, et al.Linking ethical leadership to followers’ innovative work behavior in Pakistan: the vital roles of psychological safety and proactive personality. Eur J Innovat Manag2023; 26: 755–772.
54.
MenCFongPSWHuoW, et al.Ethical leadership and knowledge hiding: a moderated mediation model of psychological safety and mastery climate. J Bus Ethics2020; 166: 461–472.
55.
LeeSEDahintenVS. Psychological safety as a mediator of the relationship between inclusive leadership and nurse voice behaviors and error reporting. J Nurs Scholarsh2021; 53: 737–745.
