J Korean Acad Nurs Adm.  2024 Dec;30(5):462-472. 10.11111/jkana.2024.30.5.462.

Effect of Leader-Member Exchange on Patient Safety Culture in Perioperative Nurses: The Mediating Role of Organizational Silence

• Lee N
• Lee Y

• KMID: 2566066
• DOI: http://doi.org/10.11111/jkana.2024.30.5.462

Abstract

Purpose
This study aimed to explore the mediating role of organizational silence in the effect of leader-member exchange on patient safety culture among perioperative nurses.
Methods
This descriptive study surveyed 201 perioperative nurses from five university hospitals. Data were collected via online questionnaires from November 8, 2022, to February 6, 2023, measuring demographics, work-related factors, leader-member exchange, organizational silence, and patient safety culture. The Data were analyzed using SPSS 26.0 and PROCESS Macro model 4.
Results
Leader-member exchange showed a significant direct effect on patient safety culture (β=.44, p<.001). The indirect effect of leader-member exchange on patient safety culture through acquiescent silence was also significant (β=.05, 95% CI: 0.02 to 0.13). The total effect of leader-member exchange on patient safety culture (β=.52, p<.001) was larger than its direct effect, indicating that acquiescent silence partially mediated the relationship between leader-member exchange and patient safety culture.
Conclusion
To improve perioperative nurses perception of patient safety culture, healthcare organizations should enhance leader-member exchange by promoting strong emotional connections and open communication between nurse managers and staff nurses. Additionally, encouraging autonomous decision-making and reducing acquiescent silence are essential to facilitate the active expression of patient safety concerns.

Keyword

Perioperative; Nurse; Patient safety; Leader-member exchange; Organizational silence