Authentic leadership, nurse-assessed adverse patient events, and quality of care: the mediating role of nurses' safety actions

BACKGROUND: Authentic leadership has been consistently cited as a strong precursor of sustained job performance and work effectiveness in nurses; however, studies linking authentic leadership with nurses' safety actions, nurse-assessed adverse patient events, and nursing care quality are scarce.

AIM: To examine whether nurses' safety actions mediate the relationship between authentic leadership, nurse-assessed adverse events, and nursing care quality.

METHODS: A multi-centre, cross-sectional study involving 1,608 nurses employed in acute care facilities in Oman. Multi-stage regression analysis was conducted in testing for the mediation model.

FINDINGS: Nurse managers in Oman were perceived to be highly authentic by their staff nurses. Authentic leadership significantly predicted nurses' safety actions (β = 0.168, p < 0.001), decrease in nurse-assessed adverse events (β = -0.017, p = 0.024), and increase care quality (β = 0.121, p < 0.001). Further, the association between authentic leadership and nurse-assessed adverse events (β = -0.063, p = 0.057) and care quality (β = 0.038, p = 0.002) were mediated by nurses' safety actions.

CONCLUSION: Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' safety actions and reduce adverse patient outcomes and promote nursing care quality.

IMPLICATIONS FOR NURSING MANAGEMENT: Developing authentic leadership among nurse leaders through leadership programmes, education, and relevant policies can be a potential organisational measure to address patient safety issues and improve the quality of nursing care.