Leaders and Patient Safety: Leader-Member Exchange and Structural Empowerment Influencing Patient Safety Climate

Well-staffed nursing units and healthy working environments for nurses have been significantly linked to better patient outcomes (Kirwan, Matthews, & Scott, 2013). In 2014, the Canadian Nurses Association (CNA) reported the first decline in the number of registered nurses in over two decades (2015). Nursing leaders have the ability to foster supportive work environments through the development and maintenance of staff job satisfaction (Bawafaa, Wong & Laschinger, 2015). In addition, the ability to provide access to information, support, opportunity, and resources empowerment is associated with positive working environments that prevent nursing shortages while enhancing patient outcomes (Josephson et al., 2008). Structural Empowerment is the degree to which employees are provided access to the four structures of opportunity, support, resources, and information. Effective leaders play a key role in ensuring nurses have access to these structures, that contribute to enhanced working environments and ultimately enhance patient safety (Laschinger & Havens, 1997; Kanter, 1979).

Traditional nursing leadership examines stimuli response that emphasized the collective while little attention to knowing staff as individuals (Risan, 2013). Unlike the traditional method, Leader-Member Exchange (LMX) theory places emphasis the leader and the follower to identify key features in the dyadic relationship. These features are pertinent to the development of trust within the effective working relationship. By examining the individual relationships, LMX can be used to examine leadership techniques that are effective in enhancing patient and environmental safety, as well as organizational commitment when applied to performance outcomes (Higgins, 2015). Nursing leaders foster staff performance through the provision of appropriate resources.

Acting as an extension of safety culture, Patient Safety Climate consists of the values, competencies, perceptions, and behavioural patterns that define an organizations level of commitment and proficient towards health and safety management (Thomas, Sexton, Neilands, Frankel & Helmreich, 2005). Nurses’ availability of the four domains of structural empowerment (information, support, resources, and opportunity) are a predictor of nurses’ perceptions of patient safety climate (Armstrong & Laschinger, 2006). Within hospital acute care settings, research has suggested a positive link between continuous quality improvement and effective leadership style (McFadden, Stock & Gowen, 2015), although a direct link between the combination of leadership style using LMC and structural empowerment has not been established in nurses perception of patient safety climate. Therefore, using a sample of 230 registered nurses working across the province of Ontario in acute care teaching hospitals in both rural and urban settings have been surveyed. The findings of this research serve to fulfill this gap in nursing literature.