BACKGROUND: The leadership practices of nurse managers significantly impact the creativity of staff nurses; however, the effects of ambidextrous leadership on nurses\' creativity are not yet clear. Additionally, the underlying mechanism of this relationship remains to be identified.
OBJECTIVE: The study aimed to examine the effect of ambidextrous leadership on nurses\' creativity, directly and indirectly through psychological safety.
METHODS: In this cross-sectional study, data were collected from October 2023 to January 2024 involving 241 nurses working at three hospitals in Port Said, Egypt. The Ambidextrous Leadership Scale, Psychological Safety Scale, and the Individual Creativity Scale were employed. Descriptive analysis, correlation analysis, and structural equation modeling were conducted.
RESULTS: Nurse managers\' ambidextrous leadership was positively associated with nurses\' creativity. Psychological safety fully mediated the association between ambidextrous leadership and nurses\' creativity.
CONCLUSIONS: The study suggests that enhancing the ambidexterity of nurse leaders can foster a sense of psychological safety, which, in effect, contributes to increased creativity among nurses.
UNASSIGNED: There is a need for healthcare policies and strategies that are supportive of the implementation of ambidextrous leadership practices and promote psychological safety among nurses.

The concept of equity recognizes historical and current barriers and promotes thriving for veterinary teams and people and animals in the community. Veterinary medicine lacks sociodemographic diversity; veterinarians and other team members who identify with systemically excluded groups offer valuable contributions but are at risk of workplace discrimination. Client families who face barriers for financial and other reasons are at risk of poor animal health and welfare outcomes, including separation from their animals. This article is part one of 2 articles reviewing how the concept of equity applies and could transform well-being in companion animal veterinary practice in North America.

UNASSIGNED: Unprofessional behaviour in healthcare systems can negatively impact staff well-being, patient safety and organisational costs. Unprofessional behaviour encompasses a range of behaviours, including incivility, microaggressions, harassment and bullying. Despite efforts to combat unprofessional behaviour in healthcare settings, it remains prevalent. Interventions to reduce unprofessional behaviour in health care have been conducted - but how and why they may work is unclear. Given the complexity of the issue, a realist review methodology is an ideal approach to examining unprofessional behaviour in healthcare systems.
UNASSIGNED: To improve context-specific understanding of how, why and in what circumstances unprofessional behaviours between staff in acute healthcare settings occur and evidence of strategies implemented to mitigate, manage and prevent them.
UNASSIGNED: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards reporting guidelines.
UNASSIGNED: Literature sources for building initial theories were identified from the original proposal and from informal searches of various websites. For theory refinement, we conducted systematic and purposive searches for peer-reviewed literature on databases such as EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases as well as for grey literature. Searches were conducted iteratively from November 2021 to December 2022.
UNASSIGNED: Initial theory-building drew on 38 sources. Searches resulted in 2878 titles and abstracts. In total, 148 sources were included in the review. Terminology and definitions used for unprofessional behaviours were inconsistent. This may present issues for policy and practice when trying to identify and address unprofessional behaviour. Contributors of unprofessional behaviour can be categorised into four areas: (1) workplace disempowerment, (2) organisational uncertainty, confusion and stress, (3) (lack of) social cohesion and (4) enablement of harmful cultures that tolerate unprofessional behaviours. Those at most risk of experiencing unprofessional behaviour are staff from a minoritised background. We identified 42 interventions in the literature to address unprofessional behaviour. These spanned five types: (1) single session (i.e. one-off), (2) multiple sessions, (3) single or multiple sessions combined with other actions (e.g. training session plus a code of conduct), (4) professional accountability and reporting interventions and (5) structured culture-change interventions. We identified 42 reports of interventions, with none conducted in the United Kingdom. Of these, 29 interventions were evaluated, with the majority (n = 23) reporting some measure of effectiveness. Interventions drew on 13 types of behaviour-change strategy designed to, for example: change social norms, improve awareness of unprofessional behaviour, or redesign the workplace. Interventions were impacted by 12 key dynamics, including focusing on individuals, lack of trust in management and non-existent logic models.
UNASSIGNED: Workplace disempowerment and organisational barriers are primary contributors to unprofessional behaviour. However, interventions predominantly focus on individual education or training without addressing systemic, organisational issues. Effectiveness of interventions to improve staff well-being or patient safety is uncertain. We provide 12 key dynamics and 15 implementation principles to guide organisations.
UNASSIGNED: Interventions need to: (1) be tested in a United Kingdom context, (2) draw on behavioural science principles and (3) target systemic, organisational issues.
UNASSIGNED: This review focuses on interpersonal staff-to-staff unprofessional behaviour, in acute healthcare settings only and does not include non-intervention literature outside the United Kingdom or outside of health care.
UNASSIGNED: This study was prospectively registered on PROSPERO CRD42021255490. The record is available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131606) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 25. See the NIHR Funding and Awards website for further award information.
For this study, we asked: how, why and in what situations can unprofessional behaviour between healthcare staff working in acute care (usually hospitals) be reduced, managed and prevented? We wanted to research how people understand unprofessional behaviour, explore the circumstances leading to unprofessional behaviour and understand how existing approaches to addressing unprofessional behaviour worked (or did not work) across staff groups and acute healthcare organisations. We used a literature review method called a ‘realist review’, which differs from other review methods. A realist review focuses on understanding not only if interventions work but how and why they work, and for whom. This allowed us to analyse a wider range of relevant international literature – not only academic papers. We found 148 sources, which were relevant either because they described unprofessional behaviour or because they provided information on how to address unprofessional behaviour. Definitions of unprofessional behaviour varied, making it difficult to settle on one description. For example, unprofessional behaviour may involve incivility, bullying, harassment and/or microaggressions. We examined what might contribute to unprofessional behaviour and identified factors including uncertainty in the working environment. We found no United Kingdom-based interventions and only one from the United States of America that sought to reduce unprofessional behaviour towards minority groups. Strategies often tried to encourage staff to speak up, provide ways to report unprofessional behaviour or set social standards of behaviour. We also identified factors that may make it challenging for organisations to successfully select, implement and evaluate an intervention to address unprofessional behaviour. We recommend a system-wide approach to addressing unprofessional behaviour, including assessing the context and then implementing multiple approaches over a long time (rather than just once), because they are likely to have greater impact on changing culture. We are producing an implementation guide to support this process. Interventions need to enhance staff ability to feel safe at work, work effectively and support those more likely to experience unprofessional behaviour.

Transparency in healthcare organizations is essential for creating a culture of patient-centered care where patients are respected, informed, and actively engaged in their health and well-being. Organizational transparency is a crucial element in healthcare, enhancing patient safety and quality improvement. Transparency involves open communication about healthcare organizations\' performance, outcomes, and processes, leading to improved accountability, trust, and patient engagement. Transparent organizations prioritize patient-centered care, involving patients in decision-making and fostering shared mental models between healthcare providers and patients. Psychological safety is vital for organizational transparency. Patient safety reporting systems play a key role in transparency, allowing anonymous reporting of safety concerns and incidents. These systems facilitate early risk identification, continuous improvement, and compliance with regulatory requirements. Transparency in reporting encourages a culture of openness, learning from near misses, and addressing systemic issues and human errors. It aligns with ethical principles, potentially mitigating legal challenges. This review synthesizes key themes, including the importance of patient-centered care, the role of psychological safety in fostering transparency, and the effectiveness of patient safety reporting systems.

We investigated psychological safety (PS) in a randomized controlled study of a group peer mentoring intervention. Forty mid-career academic medicine research faculty participated in the year-long C-Change Mentoring & Leadership Institute, completing a survey after the first session and post-intervention. Qualitative data included ethnographic observations, interviews, and participant writings. A codebook thematic analysis used PS as one sensitizing concept. PS mean scores increased from 5.6 at baseline to 6.1 (range 1-7) post-intervention (t=3.03, p=.005, mean difference=0.48, 95% CI=0.33, 0.81). In qualitative analysis, PS resulted from intervention structure, storytelling/listening curriculum, and skilled facilitation, fostering norms that enabled sharing, repaired trust, and nurtured belonging. PS enabled faculty to be authentic, vulnerable, and responsive, and to develop social bonds within a peer community.

Considering the high-risk, stressful, and fast-paced nature of the perioperative environment and vulnerability of surgical patients, the quest for maintaining a safety culture in the OR is ongoing. Speaking up-an interaction between perioperative team members to address a concern-requires team member empowerment to advocate for patient safety when needed. Hierarchical gradients, lack of psychological safety, incivility, and a nonsupportive organizational culture can impede speaking-up behaviors. Strategies to improve speaking up include using multimethod education initiatives, enhancing psychological safety, and managing conflict. Perioperative nurses can experience barriers to speaking up, such as lack of team familiarity, normalization of deviance, and differing perceptions among team members. The logistics of whole-team training initiatives can be challenging; however, such initiatives can help participants improve their understanding of the perspectives and communication goals of all involved personnel. Perioperative nurses and leaders should collaborate to promote speaking up for safety when warranted.

The challenges of present-day healthcare are urgent; there is a shortage of clinicians, patient care is increasingly complex, resources are limited, clinician turnover seems ever-increasing, and the expectations of providers and patients are monumental. To transform problems into innovative opportunities, diverse perspectives and a sense of possibility are needed. The following is a collaborative manuscript authored by the speakers of the 8th World Congress of Pediatric Cardiology and Cardiac Surgery session, \"Teamwork, Culture Change, and Strategy.\" Although this panel was diverse in the clinical roles, nationalities, and genders represented, several consistent themes emerged which are explored in this work.

Background: Cultivating internal whistleblowing among nurses is of paramount importance to nurse leaders. Yet, the literature on how nurse leaders can foster this phenomenon among nurses is limited. Additionally, the underlying mechanisms linking leadership behaviors to internal whistleblowing intentions remain underexplored.Aim: This study aimed to examine how ethical leadership is linked to internal whistleblowing intentions among nurses through the mediating effect of psychological safety.Research design: A multicenter cross-sectional research design was used for this study.Participants and research context: This study involved 201 nurses working in three tertiary governmental hospitals across three cities in Egypt. Data were collected between October and December 2023, using an introductory information form, the Ethical Leadership Scale, the Psychological Safety Scale, and the Internal Whistleblowing Intentions Scale. Structural equation modeling was used to evaluate study hypotheses.Ethical consideration: Research Ethics Committee of Faculty of Nursing, Port Said University, Egypt approved the study (reference number: NUR (6/8/2023)(28)), and each participant signed the informed consent form before participation in the study.Results: Ethical leadership was positively linked to nurses\' psychological safety and internal whistleblowing intentions. Psychological safety mediated the link between ethical leadership and nurses\' internal whistleblowing intentions.Conclusion: Our study suggests that nurse leaders can foster nurses\' intentions to blow the whistle internally by adopting ethical leadership behaviors and enhancing psychological safety among nurses.

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals\' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients\' safety (e.g., silence). Five superiors\' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals\' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.

This Medical News article is an interview with US Surgeon General Vivek Murthy, MD, MBA, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about his call for a warning label on social media platforms.