The Impact of Nursing Work Environment, Ethical Leadership, and Organizational Communication on General Hospital Nurses’ Perception of Just Culture: A Cross-Sectional Study

OBJECTIVES: This study examined how the nursing work environment, ethical leadership, and organizational communication influenced just culture among hospital nurses and identified factors associated with just culture. METHODS: A descriptive cross-sectional design was used. Data were collected from 199 nurses working in 7 hospitals (3 general hospitals, 1 women's hospital, and 3 small hospitals) in a metropolitan region of South Korea. Using a structured online questionnaire, we measured the nursing work environment, ethical leadership, organizational communication, and just culture. Multiple regression analysis was performed to identify factors significantly associated with just culture. RESULTS: Ethical leadership emerged as the strongest predictor of just culture (β=0.460, P<0.001), followed by organizational communication (β=0.268, P<0.001). While the nursing work environment demonstrated a significant correlation with just culture (r=0.587, P<0.001), its effect was not significant in the final regression model. The overall model accounted for 51.8% of the variance in just culture. These findings suggest that day-to-day leadership behaviors and robust communication mechanisms exert a greater influence on nurses' perceptions of just culture than broader structural factors. CONCLUSIONS: Ethical leadership and open organizational communication appear pivotal for sustaining a culture of fairness and learning, while the work environment may operate through indirect pathways. Health care managers should prioritize ethical leadership development and strengthen communication systems to promote just culture and enhance patient safety outcomes.