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A Relational Leadership Perspective on Unit-Level Safety Climate

Thompson, Debra N. PhD, RN, CNAA-BC; Hoffman, Leslie A. PhD, RN, FAAN; Sereika, Susan M. PhD; Lorenz, Holly L. MSN, RN; Wolf, Gail A. PhD, RN, FAAN; Burns, Helen K. PhD, RN, FAAN; Minnier, Tamra E. MSN, RN, FACHE; Ramanujam, Rangaraj PhD

JONA: The Journal of Nursing Administration: November 2011 - Volume 41 - Issue 11 - p 479-487
doi: 10.1097/NNA.0b013e3182346e31

Objective: This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences.

Background: Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions.

Methods: Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted.

Results: Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors.

Conclusion: The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors.

Author Affiliations: Adjunct Faculty (Dr Thompson), Professor (Drs Hoffman and Wolf), Associate Professor (Dr Sereika), University of Pittsburgh, Pennsylvania; Associate Professor (Dr Ramanujam), Owen School of Management, Vanderbilt University, Nashville, Tennessee; Chief Nursing Officer and Vice President, Patient Care Services, UPMC Presbyterian and Chief Nurse Executive (Ms Lorenz), Chief Quality Officer (Ms Minnier), UPMC Health System, Pittsburgh, Pennsylvania; Senior Vice President and Chief Nursing Officer (Dr Burns), Excela Health, Latrobe, Pennsylvania.

Funding: This work was funded by the National Institute of Nursing Research (F31-NR011255) Debra N. Thompson, predoctoral fellow, the Pauline Thompson Clinical Nursing Research Award, Nursing Foundation of Pennsylvania, and the Leslie A. Hoffman Endowed Research Award University of Pittsburgh. The authors also acknowledge support of the unit directors and hospital staff who provided data for this study.

The authors declare no conflict of interest.

Correspondence: Dr Thompson, School of Nursing, University of Pittsburgh, Room 450, Victoria Bldg, Pittsburgh, PA 15261 (

© 2011 Lippincott Williams & Wilkins, Inc.