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The link between leadership and safety outcomes in hospitals

Authors

  • MAE SQUIRES RN, PhD,

    1. Recent graduate at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto
    2. Program Operational Director, Critical Care Program, Kingston General Hospital, Kingston
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  • ANN TOURANGEAU RN, PhD,

    1. Associate Professor, Graduate Chair and Lawrence S. Bloomberg Professor in Patient Safety at the Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto
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  • HEATHER K. SPENCE LASCHINGER RN, PhD, FAAN, FCAHS,

    1. Distinguished University Professor and Arthur Labatt Family Research Chair in Health Human Resource Optimization at the School of Nursing, University of Western Ontario, London
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  • DIANE DORAN RN, PhD, FCAHS

    1. Professor at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
    2. Senior Nursing Career Researcher, Ministry of Health and Long-Term Care, Province of Ontario
    3. Scientific director of the Nursing Health Services Research Unit, University of Toronto, Toronto
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Mae Squires
Critical Care Program
Kingston General Hospital
76 Stuart Street
Kingston, Ontario K7L 2V7
Canada
E-mail:squiresm@kgh.kari.net

Abstract

squires m., tourangeau a., spence laschinger h.k. & doran d. (2010) Journal of Nursing Management18, 914–925
The link between leadership and safety outcomes in hospitals

Aim  To test and refine a model examining relationships among leadership, interactional justice, quality of the nursing work environment, safety climate and patient and nurse safety outcomes.

Background  The quality of nursing work environments may pose serious threats to patient and nurse safety. Justice is an important element in work environments that support safety initiatives yet little research has been done that looks at how leader interactional justice influences safety outcomes.

Method  A cross-sectional survey was conducted with 600 acute care registered nurses (RNs) to test and refine a model linking interactional justice, the quality of nurse leader–nurse relationships, work environment and safety climate with patient and nurse outcomes.

Results  In general the hypothesized model was supported. Resonant leadership and interactional justice influenced the quality of the leader–nurse relationship which in turn affected the quality of the work environment and safety climate. This ultimately was associated with decreased reported medication errors, intentions to leave and emotional exhaustion.

Conclusions  Quality relationships based on fairness and empathy play a pivotal role in creating positive safety climates and work environments.

Implications for Nursing Management  To advocate for safe work environments, managers must strive to develop high-quality relationships through just leadership practices.

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