The Mediation of Workplace Upward Networking on Affective Leadership and Employee Safety Voice Among Primary Nurses: A Cross‐Sectional Study

<b>Background:</b> Primary nurses hesitated to communicate directly with leaders about safety concerns due to apprehension about confrontation, fear of blame, and their undervalued opinions. Affective leadership's impact on voice behaviors was characterized by top-down impression management and an absence of upward management. This study aimed to validate the mediating role of workplace upward networking between affective leadership and employee voice behaviors. <b>Methods:</b> This study was a cross-sectional survey, using purposive sampling to select 639 nurses from all primary hospitals in Hangzhou X district. Measurement tools included the demographic information questionnaire, affective leadership scale, employee safety voice scale, and workplace upward networking scale. <b>Results:</b> The relationship between affective leadership and employee safety voice mediated by workplace upward networking was confirmed. Affective leadership affected workplace upward networking (<i>B</i> = 0.70, <i>p</i> < 0.0001), with an explained variation of 37%. Affective leadership and workplace upward networking affected employee safety voice (<i>B</i> = 0.45 and 0.21, <i>p</i> < 0.001), with an explained variation of 71%. Workplace upward networking's total, direct, and indirect effects were 0.65, 0.20, and 0.45, respectively. <b>Conclusions:</b> The study offers a theoretical basis for enhancing the safety management framework in primary care. It highlights the importance of affective leadership, improving upward management systems and establishing a supportive safety culture to bolster nurse engagement and initiative in patient safety.