Introduction
Nurses' silence behavior plays a negative role in preventing patient safety incidents
Silence behavior refers to individuals’ tendency to remain silent even if they have important issues to discuss
Nurses working in intensive care units tend to remain silent more than those working in general units
Previous researchers have found that nurse managers’ inclusive leadership affects the psychological safety of nurses, which in turn impacts the nurses’ silence behavior in medical-surgical units

Aim
To examine the relationship between nurse managers’ inclusive leadership and nurses’ silence behaviors in the intensive care units
To examine the role of psychological safety as the mediator in the relationship

Method
This cross-sectional study used research data from 200 direct care nurses working in intensive care units in 21 hospitals in Korea
Measures
- Psychological Safety Scale (Edmondson, 1999)
- Inclusive leadership, measured using a 7-item tool by Carmeli et al. (2010)
- Silence behavior, measured using a 5-item tool by Tangirala and Ramanujam (2008)
Model 4 of Hayes’s PROCESS macro with 5000 bootstrap samples was used with SPSS/WIN 26

Results
The mediation analysis demonstrated the significant direct and indirect effect of nurse managers’ inclusive leadership on nurses’ silence behavior via psychological safety after controlling for unit tenure
Inclusive leadership was positively related to psychological safety and negatively related to silence behavior
Psychological safety was negatively related to silence behavior
Psychological safety partially mediated the relationship between inclusive leadership and silence behavior

Conclusions
When nurse managers practice inclusive leadership, which is characterized by openness, availability, and accessibility, nurses working in intensive care units are more likely to feel psychologically safe enough to reduce silence behavior

Acknowledgment
This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea Government (MSIT) (No.RS-2023-00208138)
Won Jin Seo and Sang Hwa Lee received a scholarship from Brain Korea 21 FOUR Project funded by NRF, Yonsei University College of Nursing

Reference
Carmeli A, Reiter-Palmon R, Ziv E. Inclusive leadership and employee involvement in creative tasks in the workplace: the mediating role of psychological safety. Creativity Research Journal. 2010;22(3):250-60.
Edmondson A. Psychological safety and learning behavior in work teams. Administrative Science Quarterly. 1999;44(2):350-83.
Tangirala S, Ramanujam R. Employee silence on critical work issues: the cross-effects of procedural justice climate. Personnel Psychology. 2008;61(1):37-68.

Contact information
Won Jin Seo
College of Nursing, Yonsei University, Seoul, South Korea, wjseo@yuhs.ac