Effects of Toxic Leadership Behavior and Emotional Exhaustion on Patient Safety Incident Reporting

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INTRODUCTION: Patient safety is a vital component of healthcare delivery, and identifying and reporting incidents are essential to raising the standard of care. Nurse managers are noted in some organizations to display a toxic leadership style, which exacerbates nurses' already existing emotional exhaustion. Nurses' emotional exhaustion may harm the reporting of patient safety incidents. Using the job demands-resources theory as the primary guiding framework, the study assessed the relationship between emotional exhaustion and patient safety incident reporting among nurses while examining the mediating role of toxic leadership of nurse managers in a teaching hospital in Ghana. METHODS: The study employed a cross-sectional design. Using convenience sampling, 282 nurses from the various units of a teaching hospital completed the Maslach Burnout Inventory, the Toxic Leadership Behavior of Nurse Managers Scale, and the Survey on Patient Safety Culture tools. Pearson moment-product correlation and Hayes' PROCESS Macro mediation analyses were conducted to examine the effects of toxic leadership behavior of nurse managers on the relationship between nurses' emotional exhaustion and patient safety incident reporting. Analysis was performed at a significance of 0.05. RESULTS: Close to half (43.6%, n = 123) of participants indicated their likelihood of reporting patient safety incidents in their units. There was a significant negative correlation between patient safety incident reporting and emotional exhaustion (r = -0.617, p < 0.01). The results also showed a significant indirect effect of emotional exhaustion on patient safety incident reporting through nurse managers' toxic leadership behavior (c = -0.0590, 95% CI: [-0.0818, -0.0370]). IMPLICATIONS FOR NURSING MANAGEMENT: The toxic leadership behavior of nurse managers acts as a mediator, exacerbating the negative relationship between emotional exhaustion and patient safety incident reporting. The results highlight the need to address emotional exhaustion and toxic leadership behavior of nurse managers to foster a culture of transparent patient safety incident reporting. Improving reporting and minimizing the harmful effects of emotional exhaustion require addressing the role of toxic leadership.

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