Head Nurse Leadership and Blame Culture Among Nurses: A Cross-Sectional Study in a Public Hospital
Abstract
Head nurse leadership plays an important role in shaping organizational culture and influencing nurses’ perceptions of psychological safety in hospital settings. Ineffective leadership may contribute to fear-based work environments, reduced psychological safety, and the emergence of a blame culture among nurses, which can hinder open communication and learning from clinical errors. This study aimed to examine the relationship between head nurse leadership and blame culture among nurses in a public hospital. A quantitative analytic study with a cross-sectional design was conducted involving 220 nurses recruited from inpatient, intensive care, emergency, and outpatient units of a public hospital. Data were collected using structured questionnaires measuring perceived overall head nurse leadership and blame culture in clinical practice. Data were analyzed using descriptive statistics and Pearson correlation analysis using SPSS version 26. The results showed that overall head nurse leadership was perceived at a moderately high level (3.62 ± 0.54), while blame culture was categorized as moderate (3.41 ± 0.63). Pearson correlation analysis demonstrated a significant moderate negative relationship between head nurse leadership and blame culture (r = -0.528, p = 0.001), indicating that higher perceived leadership was associated with lower levels of blame culture among nurses. These findings highlight the importance of strengthening effective and supportive leadership practices among head nurses to promote a psychologically safe and learning-oriented organizational culture in hospital settings.
References
Alanazi, N. H., Alshamlani, Y., & Baker, O. G. (2022). The association between nurse managers’ transformational leadership and quality of patient care: A systematic review. International Nursing Review, 70(2), 175–184. https://doi.org/https://doi.org/10.1111/inr.12819
Baarle, E. van, Hartman, L., Rooijakkers, S., Wallenburg, I., Weenink, J., Bal, R., & Guy, W. (2022). Fostering a just culture in healthcare organizations: experiences in practice. BMC Health Services Research, 22(1035). https://doi.org/https://doi.org/10.1186/s12913-022-08418-z
Bass, B. M. (1990). From transactional to transformational leadership: Learning to share the vision. Organizational Dynamics, 18(3), 19–31.
Bass, B. M. (1999). Two decades of research and development in transformational leadership. European Journal of Work and Organizational Psychology, 8(1), 9–32.
Boamah, S. A., Laschinger, H. K. Sp., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nurs Outlook, 66(2), 180–189.
Brborovic, O., Brborovic, H., Nola, I. A., & Milosevic, M. (2019). Culture of Blame—An Ongoing Burden for Doctors and Patient Safety. International Journal of Environmental Research and Public Health, 1(16). https://doi.org/https://doi.org/10.3390/ijerph16234826
Cooper, J., Edwards, A., Williams, H., Sheikh, A., Parry, G., Hibbert, P., Butlin, A., Donaldson, L., & Stevens, A. C. (2017). Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database. Annals of Familiy Medicine, 15(5), 455–461. https://doi.org/https://doi.org/10.1370/afm.2123
Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P. ., Paananen, T., & Chatterjee, G. E. (2020). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies, 115. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2020.103842
da Silva Lessa, A., & da Silva, M. C. B. R. (2024). Moral Competence as an Antecedent to Transformational Leadership. In Studies on Moral Competence (pp. 99–110).
Draghici, A., Dursun, S., Basol, O., Boatca, M. E., & Gaureanu, A. (2022). The Mediating Role of Safety Climate in the Relationship between Transformational Safety Leadership and Safe Behavior The Case of Two Companies in Turkey and Romania. Sustainability, 14(14), 8464. https://doi.org/https://doi.org/10.3390/su14148464
Foguet, J. M. B., Esteve, M., & Witteloostuijn, A. van. (2021). Measuring leadership an assessment of the Multifactor Leadership Questionnaire. PLoS One, 16(7). https://doi.org/https://doi.org/10.1371/journal.pone.0254329
Khaghanizadeh, M., Koohi, A., Ebadi, A., & Vahedian-Azimi, A. (2023). The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial. BMC Medical Ethics, 24(58).
Kwisoon, C., Soojin, K., & Sunghee, K. (2022). How do ethically competent nurses behave in clinical nursing practice? A qualitative study. Journal of Nursing Management, 30(8), 4461–4471. https://doi.org/10.1111/jonm.13884
Labrague, L. J., Lorica, J., Nwafor, C. E., Bogaert, P. van, & Cummings, G. G. (2020). Development and psychometric testing of the toxic leadership behaviors of nurse managers (ToxBH-NM) scale. Journal of Nursing Management, 28(4). https://doi.org/https://doi.org/10.1111/jonm.13008
Linnik, L., Sepp, J., & Reinhold, K. (2023). Enhancing Patient Safety Through Leadership: A Comprehensive Literature Review on the Role of Head Nurses in Hospital Settings. Economics and Business, 37(1), 220–235. https://doi.org/https://doi.org/10.2478/eb-2023-0014
Maghfiroh, L. (2023). The role of nurses in implementing patient safety in hospitals to achieve patient safety goals: Literature review. World Journal of Advanced Research and Reviews, 20(2), 097–102.
Poikkeus, T., & Leino-kilpi, H. (2014). Supporting ethical competence of nurses during recruitment and performance reviews – the role of the nurse leader. Icn 2008, 792–802. https://doi.org/10.1111/jonm.12033
Rahmanida, N., & Bachtiar, A. (2022). Interprofessional Collaboration On Non-Communicable Disease Programs (NDP) In Primary Health Services. Devotion : Journal of Research and Community Service, 3(8), 707–715. https://doi.org/10.36418/dev.v3i08.172
Rehder, K. J., Adair, K. C., Hadley, A., McKittrick, K., Frankel, A., Leonard, M., Frankel, T. C., & Sexton, J. B. (2020). Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression. Joint Commission Journal on Quality and Patient Safety, 46(1), 18–26. https://doi.org/10.1016/j.jcjq.2019.09.004
Saleh, M. S. M., Elsabahy, H. E., Abdel-Latif, S., Abdel-Sattar, Elhamid, Z. N. A.-, Thobaity, A. Al, Aly, S. M. M., & Mohamed, W. (2024). Fostering green transformational leadership: the influence of green educational intervention on nurse managers’ green behavior and creativity. BMC Nursing, 23(393).
Taskiran, N., & Turk, G. (2023). The relationship between the ethical attitudes and holistic competence levels of intensive care nurses: A cross-sectional study. PLOS ONE, 18(7). https://doi.org/https://doi.org/10.1371/journal.pone.0287648
Wei, H., A Sewell, K., Woody, G., & Ann Rose, M. (2018). The state of the science of nurse work environments in the United States: A systematic review. International Journal of Nursing Sciences, 5(3), 287–300. https://doi.org/10.1016/j.ijnss.2018.04.010
Westat, Rockville, M., Joann Sorra, P. D., Laura Gray, M. P. H., Suzanne Streagle, M. A., Theresa Famolaro, M. P. S., Naomi Yount, P. D., & Jessica Behm, M. A. (2018). AHRQ Hospital Survey on Patient Safety Culture: User’s Guide.
Wu, A. W., & Kachalia, A. B. (2023). Creating a “just culture”: More work to be done. Journal Of Patient Safety and Risk Management, 28(2). https://doi.org/https://doi.org/10.1177/25160435231168152
Yu, Q., Liu, L., Tian, Y., Li, X., Yang, J., Liu, Q., Chen, Z., Ning, M., & Wang, F. (2024). Head nurse ethical competence and transformational leadership : a cross- sectional study. BMC Nursing, 23.
Zalukhu, J. (2020). Peran Perawat Dalam Meningkatkan Budaya Keselamatan Pasien. https://osf.io/preprints/kw7f6/
Keywords
Blame Culture, Head Nurse Leadership, Hospital, Patient Safety
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