The Influence of Speaking Up Climate, Psychological Safety, Organizational Learning Culture, and Supervisor Support for Patient Safety on Clinical Nurses’ Silence Behavior

Abstract

Purpose: The aim of this study was to identify the effects of speaking up climate, psychological safety, organizational learning culture, and supervisor support for patient safety on clinical nurses’ silence behavior. Methods: A cross-sectional online survey was conducted among 189 nurses working at a tertiary hospital. Data were analyzed using Pearson correlation coefficients and multiple linear regression. Results: The average score of nurses’ silence behavior was 2.23±0.62 out of 5 points. The strongest factor influencing nurses’ silence behavior was speaking up climate (β=-.33, <i>p</i><.001), followed by psychological safety (β=-.20, <i>p</i>=.013), and organizational learning culture (β=-.15, <i>p</i>=.040). The regression model explained approximately 38% of the overall variance in the nurses’ silence behavior. Conclusion: This study found that the speaking up climate was the most important predictor of nurses’ silence behavior. Thus, we suggest that hospital administrators and nurse managers should encourage nurses to speak up by having regular meetings among healthcare professionals to enhance the psychological safety of nurses. In addition, to reduce nurses’ silence behavior, it is essential to create a culture wherein all members of the organization can constantly learn from mistakes or errors, which will, in turn, make it possible to improve patient safety at the system level.