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J Nurs Manag. 2010 Nov;18(8):914-25. doi: 10.1111/j.1365-2834.2010.01181.x.

The link between leadership and safety outcomes in hospitals.

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Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto.



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.


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.


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.


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.


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


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

[Indexed for MEDLINE]

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