Transformational Leadership and the Reporting of Patient Safety Events Among Emergency Nurses: The Mediating Role of Psychological Safety

Abstract

Background/Objectives: Underreporting of patient safety events is a persistent problem in high-risk clinical settings such as emergency departments, yet the managerial and psychological conditions associated with reporting remain underexamined. This study aimed to examine the relationship between transformational leadership and patient safety event reporting behavior among emergency department nurses, and to test the mediating role of psychological safety in this relationship. Methods: This descriptive, cross-sectional study was conducted with 295 nurses working in the emergency departments of two city hospitals in Ankara, Turkey. Data were collected using a personal information form, the Transformational Leadership Scale, the Psychological Safety Scale, and the “Reporting Patient Safety Events” composite of the Hospital Survey on Patient Safety Culture 2.0 (HSOPSC 2.0). Data were analyzed using descriptive statistics, confirmatory factor analysis, Pearson correlation analysis, and path analysis with bootstrap-based mediation testing (SPSS 29 and AMOS 24). Results: Transformational leadership was positively associated with psychological safety (β = 0.505). Psychological safety was positively associated with reporting behavior (β = 0.427). Transformational leadership was associated with reporting both directly (β = 0.167) and indirectly through psychological safety (β = 0.215, 95% CI [0.134, 0.305]), consistent with partial mediation. The model explained 28% of the variance in reporting behavior. Conclusions: The findings are consistent with psychological safety functioning as a partial mediator in the association between transformational leadership and patient safety event reporting. Strengthening nurse managers’ transformational leadership skills and fostering nurses’ perceived psychological safety may support reporting in emergency departments, although longitudinal and intervention studies are needed to confirm these relationships.