Background: Patient safety is a priority for all health care institutions, and the transformational leadership practices of nurse managers have become important skills for providing high quality and safe patient care.
Methods: This descriptive correlational study was carried out in 2014. The study sample consisted of 70 unit charge nurses (UCNs) and 357 staff nurses working at four Ministry of Health hospitals. The Nurses Data Sheet, the Leadership Practices Inventory (Self and Observer) and the Hospital Survey on Patient Safety Culture were used for data collection. Data analysis was performed using the chi-square test, the independent sample t test, means, percentages and Spearman's nonparametric correlation.
Results. The UCNs scores on the sub dimensions of challenge the process, enable others to act, encourage the heart and their total leadership practices mean scores were significantly higher than those of the staff nurses (p<.05). The most frequent leadership behavior reported by both the UCNs and the nurse observers was enabling others to act. The rate of positive responses to the items about patient safety culture was 48.16%. The lowest rate of positive answers was in the dimension of non-punitive response to errors (UCNs, 35.7%; nurse observers, 31.0%). The highest average rate of positive answers was in the dimension of unit teamwork (UCNs, 87.1%; observers, 73.4%). For both the UCNs and the observers, the average percentage of positive answers was lower than 50% in the subdimensions of frequency of errors reported and non-punitive response to errors. The average rate of positive responses to the items about patient safety culture (59.21) was also significantly higher for the UCNs than for the observers (46.66) (p<0.001) There was a positive relationship between transformational leadership practices and patient safety culture (p<0.001).
Conclusion. The leadership scores of the UCNs and nurse observers were high; however, the percentage of their positive responses to the items about patient safety culture was low. At the same time, there was a moderately positive correlation between transformational leadership and patient safety culture, and transformational leadership was found to be important in the improvement of a patient safety culture. Thus, the researcher suggests that the necessary regulations are needed to be applied immediately to improve patient safety and patient care quality in the Turkish hospitals included in this study. The transformational leadership qualities of nurse managers should be improved, and the necessary regulations should be implemented to enhance patient safety practices. Additionally, further studies are needed to determine why transformational leadership does not establish a patient safety culture in institutions that have transformational leaders.
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