Creating a psychologically safe space : Nursing Management

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Department: Leadership Q&A

Creating a psychologically safe space

Foster, Rhonda R. EdD, MPH, MS, RN, NEA-BC

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Nursing Management (Springhouse): November 2022 - Volume 53 - Issue 11 - p 48
doi: 10.1097/01.NUMA.0000891452.18867.b2
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Q As a leader, how do I create an environment of psychological safety?

Thank you for asking such a critical question in this volatile, uncertain, changing, and ambiguous (VUCA) time in healthcare. It's especially important given the effects of COVID-19 that include but aren't limited to increasing patient morbidity and mortality, staffing challenges, remote or hybrid work arrangements, and financial woes in hospitals across the country. This VUCA time has made it necessary to change, adapt, and learn different ways of solving problems and addressing dilemmas that erode employees' stability and psychological safety.

Psychological safety plays a vital role in helping people overcome barriers to learning and change in interpersonally challenging work environments.1 Psychological safety is team members' shared belief that the team is safe for interpersonal risk-taking, such as speaking up or asking for help, a salient variable in work environments where learning matters.2

This doesn't mean leaders should encourage staff to be careless, be overly permissive, or have a false sense of positivity. Rather, the intent is that team members feel confident that they won't be embarrassed, rejected, punished, or retaliated against for speaking up. Employees' confidence is based on the premise of mutual respect and trust among team members. A recent McKinsey and Company survey revealed that a positive team climate is the most important driver of psychological safety and most likely to occur when leaders demonstrate supportive, consultative behaviors, and then begin to challenge their teams.3

Strategies for leadership

Leaders can build psychological safety by creating the right climate, mindsets, and behaviors within their teams.3 Those who do this best act as catalysts, empowering and enabling other leaders on the team—even those with no formal authority—to help cultivate psychological safety by role modeling and reinforcing expected behaviors.3

Leaders should assess the environment to determine if it's conducive to information sharing, asking for help, talking about errors, being innovative, and trying new approaches. Is asking for help an indication of insecurity or security? Are condemnation and judgment attached to errors, or is an error viewed as a teachable moment and an opportunity to learn and grow? Is innovation met with a crisp, “We tried that already and it didn't work” or “We can't do that here”? It's also imperative that leaders provide a frame or context when providing new information and messages. Be especially mindful of messages that may evoke a fear response or raise doubt about the truthfulness of the message or the leadership.

Strategies for staff

First, listen with the intent to understand. Understanding comes from consideration of the message, the messenger, and the context. I ascribe to the Center for Medical Simulation Basic Assumption, which states: “We believe that everyone participating in activities in this department is intelligent, capable, cares about doing their best, and wants to improve.”4

Second, be curious. This provides time for additional listening and allows you to gain clarity. Curiosity is a safe and kinder way to approach leadership and each other. Don't forget this tool isn't to be used in conjunction with judgment or accusatory statements.

Creating an environment of psychological safety is critically important for staff engagement and stakeholder involvement. It allows the entire team to raise issues and concerns related to patient care and practice. It's also necessary for ongoing learning and development, creating a safe space for creativity and innovation, and hearing what's on the hearts and minds of staff. All these benefits are essential to advancing patient care.


1. Edmondson A, Higgins M, Singer S, Weiner J. Understanding psychological safety in health care and education organizations: a comparative perspective. Res Hum Dev. 2016;31(1):65–83.
2. Edmondson A, Lei Z. Psychological safety: the history, renaissance, and future of an interpersonal construct. Annu Rev Organ Psychol Organ Behav. 2014;1(1):23–43.
3. McKinsey and Company. Psychological safety and the critical role of leadership development. 2021.
4. Rudolph J. Center for Medical Simulation. The Basic Assumption. 2014.
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