Investigating the complex relationships between leadership, psychological safety, intrinsic motivation, and nurses’ voice behavior in public hospitals using PLS-SEM

Background: Voice behavior among nurses in public hospitals lacks profound disclosure
despite knowing its imperatives. This situation needs to be continuously studied, and the best
practices discovered, disclosed, and implemented in hospitals that are serious in curbing
unprofessional conduct while advancing healthcare requirements for the benefit of humanity.
Objective: This empirical research investigated the significant implications of psychological
safety and intrinsic motivation in the mostly uncultivated link concerning the empowering
leadership style and leader-member exchange (LMX) constructs and the practice of voice
behavior among nurses in the selected Malaysian public hospitals.
Methods: Primary data of the study were from nurses employed in the selected large public
hospitals within the Klang Valley, also known as the Greater Kuala Lumpur of Malaysia. A
total of 366 complete and valid responses were collected with the help of head nurses via a
self-administered survey in February 2020. The SmartPLS 4 for Windows software generated
the standard partial least squares structural equation modeling (PLS-SEM) to estimate
associations between research variables and evaluate the model’s strength in explaining the
proposed constructs.
Results: This research disproved the indirect effects of psychological safety on the
connection explorations between empowering leadership-voice behavior (β = 0.015, t-value =
0.300, 95% CI [-0.090, 0.110]) and LMX-voice behavior (β = 0.002, t-value = 0.285, 95% CI [-
0.014,0.020]). Intrinsic motivation partially mediates the link between empowering leadershipvoice behavior (β = 0.214, t-value = 7.116, 95% CI [0.160, 0.279]) and LMX-voice behavior (β
= 0.114, t-value = 4.669, 95% CI [0.071, 0.168]) of the nurses.
Conclusion: Patients, non-governmental organizations, volunteers, nurses, and other
hospital staff are vested in how voice behavior signifies in the healthcare context. Essential
factors for nurses to become more outspoken are discovered in this study, providing nurse
managers and other leaders with numerous recommendations for encouraging vocal behavior
and bolstering psychological safety and intrinsic motivation. More competent nurses will
improve workplace culture, deliver superior healthcare services, and manage publicly
financed hospitals with an overall sense of trust, but only after a substantial effort to execute
reforms.