Structural empowerment and psychosocial safety climate in healthcare: a systematic integrative review

Purpose Psychosocial safety climate (PSC) is associated with nurses' well-being, yet the organisational conditions under which shared PSC perceptions form remain insufficiently understood. Drawing on structural empowerment (SE) theory, PSC theory, and organisational sensemaking, this review derives propositions on the SE–PSC association in healthcare organisations. Design/methodology/approach A systematic integrative review (PRISMA 2020) of five databases identified 30 studies. The synthesis combined deductive framework analysis with abductive theorising; methodological quality was appraised using Joanna Briggs Institute tools. Findings Three propositions emerged. In the resulting framework, leadership and governance are conceptualised as organisational cues in collective sensemaking, resource availability as a signal of management commitment, and role clarity and development opportunities as signals of organisational values. Formal arrangements did not consistently correspond to nurses' experienced authority or access. These patterns support an interpretive account in which leadership coherence, resource provision, and accessible development opportunities may be associated with shared PSC perceptions. Research limitations/implications Cross-sectional designs preclude causal inference. Empirical support was stronger for Propositions 1 and 2 than for Proposition 3. Validated PSC instruments remain underused; the propositions require longitudinal and multilevel validation. Practical implications Nursing management should align leadership practices, resource allocation, and role clarity as credible signals of organisational commitment to psychological health. Social implications The framework offers an evidence-informed basis for policies improving nurses' psychosocial work environments and workforce retention. Originality/value The review reconceptualises SE as an interpretive context for PSC formation, offering grounded propositions for empirical testing.