Courageous leadership and nurses’ speaking-up' behavior - the indirect roles of just culture and psychological safety: a cross-sectional study

Abstract

Background : Nurses’ speaking-up behavior is essential for preventing patient harm, yet it is shaped by leadership practices, organizational culture, and team climate. Courageous leadership may encourage nurses to voice patient safety concerns by supporting fair responses to errors and psychologically safe work environments. Aim : This study examined the association between courageous leadership and nurses’ speaking-up behavior and explored the indirect roles of just culture and psychological safety among clinical nurses in Port Said, Egypt. Methods : A quantitative, descriptive, cross-sectional correlational design was used. Data were collected from 288 clinical nurses working in thirteen hospitals in Port Said, Egypt, using structured self-administered questionnaires. The study variables were courageous leadership, just culture, psychological safety, and speaking-up behavior. Data were analyzed using descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson’s correlation, and PROCESS Macro Model 6 with 5,000 bootstrap samples and HC3 heteroskedasticity-consistent standard errors. Results : Courageous leadership was positively correlated with just culture, psychological safety, and speaking-up behavior. Just culture was strongly correlated with psychological safety and weakly correlated with speaking-up behavior, while psychological safety was not significantly correlated with speaking-up behavior. In the serial indirect pathway analysis, courageous leadership remained significantly and directly associated with speaking-up behavior. However, neither just culture nor psychological safety showed a significant indirect role in this association. The serial indirect pathway through just culture and psychological safety was also not significant. All bootstrap confidence intervals for the indirect effects included zero. Conclusion : The findings therefore indicate that courageous leadership was directly associated with speaking-up behavior, while the observed association was not statistically accounted for by the proposed indirect pathways through just culture and psychological safety.