Nurses’ perceived authentic leadership and moral courage: The mediating role of psychological safety

BackgroundHospital nurses frequently encounter ethical conflicts in daily practice. Moral courage is essential for acting according to ethical principles. Leadership and a supportive unit climate may enable nurses to enact moral courage, yet empirical evidence on the mechanism linking authentic leadership to moral courage remains limited.AimTo examine relationships among nurses' perceptions of unit managers' authentic leadership, psychological safety, and nurses' moral courage and to evaluate whether psychological safety mediates the association between authentic leadership and moral courage.DesignA cross-sectional descriptive correlational design with mediation analysis.Participants and research contextA total of 211 hospital nurses in South Korea completed an online survey. Moral courage, authentic leadership, and psychological safety were measured using validated Korean versions of the Nurses' Moral Courage Scale, the Authentic Leadership Questionnaire, and the team psychological safety scale. Data were analyzed using Pearson's correlations, multiple linear regression, and PROCESS model 4 with 5000 bootstrap resamples.Ethical considerationThis study was approved by the Institutional Review Board of the authors' affiliated university. Before accessing the questionnaire, participants reviewed an online information sheet describing the study purpose and procedures, potential risks and benefits, assurances of anonymity, and the voluntary nature of participation, including the right to withdraw at any time. Only those who provided electronic consent by selecting "I agree" proceeded to the survey.FindingsHigher psychological safety and authentic leadership were associated with higher moral courage. Moral courage was also higher among nurses working in intensive care units, operating rooms, or emergency departments, charge nurses, and nurses who had received ethics education during the past year. Psychological safety partially mediated the association between authentic leadership and moral courage.ConclusionInterventions that develop authentic leadership and strengthen psychologically safe unit climates, alongside meaningful ethics education, may support nurses' ethical action in clinical practice.