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• W2901585465 abstract "To examine the association between components of safety climate and psychosocial hazards with safe work behaviours and test the moderating effects of psychosocial hazards on the safety climate-safety performance relationships. The effects of a strong safety climate on safety performance are well cited, however, the conditions that have an impact on this relationship warrant attention. While the psychosocial hazards commonly reported by nurses are predictors of well-being and job attitudes, evidence suggests that these may also place boundaries on the effects of safety climate on safe work practices. This study used a cross-sectional design to collect data from 146 nurses. Participants were recruited through convenience sampling and snowball sampling methods in 2017. Nurses completed an online questionnaire and received a $5 e-gift card as compensation. SPSS v.23 and PROCESS v3.0 were used to analyse the data. A strong safety climate was positively associated with nurses' safety performance. While psychosocial hazards did not predict safety performance, they did moderate the safety climate-performance relationship. High levels of perceived stressors weakened the association between promoting two-way safety communication, the use and implementation of procedures to promote safe work practices and management's endorsement of health and safety with safe work performance. The positive effects of safety climate on nurses' safety performance are contingent on the levels of psychosocial hazards nurses experience. When aiming to improve safety performance among nurses, it is important for efforts to also focus on the psychosocial conditions of the work environment. 检查安全氛围和心理社会危害成分与安全工作行为之间的关联,测试心理社会危害对安全氛围-安全绩效关系的调节作用。 浓厚安全氛围对安全绩效的影响已经有充分引述,但关注这一关系的影响条件仍然十分必要。虽然护士一般报告的心理社会危害是作为福利和工作态度的预测因素,但有证据表明,这些因素也可能会限制安全氛围对安全工作实践的影响。 本研究采用横断面设计,收集了146名护士的数据。 2017年,通过任意抽样和雪球式抽样招募了参与者。护士们完成了一份在线问卷,并收到价值5美元的电子礼品卡作为报酬。数据分析采用了SPSS v.23和PROCESS v3.0软件。 浓厚安全氛围与护士的安全绩效呈正相关。虽然心理社会危害并不能预测安全绩效,但确实缓和了安全氛围与安全绩效之间的关系。较高的压力因素削弱了促进双向安全交流、使用和实施促进安全工作实践的程序以及管理层认可健康和安全与安全工作绩效之间的联系。 安全氛围对护士安全绩效的积极影响取决于护士经受的心理社会危害水平。提高护士的安全绩效还必须努力关注工作环境的心理社会状况。 The promotion of employee safety and well-being in the healthcare industry is especially challenging, given that workers in this field are often expected to put patient's safety and health above their own (WHO, 2016). However, poor worker health and safety is also directly related to the health and safety of patients. For example, unsafe practices (Koppel, Wetterneck, Telles, & Karsh, 2008), burnout (Shanafelt et al., 2010) and fatigue (Lockley et al., 2007) have resulted in medical errors, which is the third-leading cause of death in Americans (Hanlon, Sheedy, Kniffin, & Rosenthal, 2015). Worker safety and well-being can also affect healthcare organizations as a whole, with the cost of worker's compensation claims in the US reaching $1.6 billion in recent years (Aon Risk Solutions, 2014). Consequently, researchers and practitioners can further benefit from better understanding how healthcare workers' perceptions of organizational safety and workplace factors can interact to influence safe work practices in nurses. The degree to which employees believe safety is valued in their organization, defined as their perceptions of safety climate, can have an impact on safety performance. An organization's safety climate can be defined as its employees' collective perception of safety in the workplace (Neal, Griffin, & Hart, 2000). A recent review examining healthcare populations suggest that safety climate predicts both worker injury rates and employee safety behaviour in healthcare workers (Flin, Burns, Mearns, Yule, & Robertson, 2006). Safety climate also predicted patient-related outcomes such as medication errors, patient health, and patient satisfaction, as well as nurse well-being outcomes (e.g., Hofmann & Mark, 2006; Nixon et al., 2015). Safety climate has been studied across industries and has consistently shown a negative relationship with workplace accidents and under-reporting (Christian, Bradley, Wallace, & Burke, 2009; Hahn & Murphy, 2008; Probst, Brubaker, & Barsotti, 2008). In a meta-analysis by Christian et al. (2009), perceptions of safety climate were found to influence accidents and injuries through overall safety performance, defined by compliance and participatory behaviours. Safety compliance refers to following an organization's core safety policies and procedures, while safety participation consists of safety-related extra-role behaviours that are not required by the organization (Griffin & Neal, 2000; Neal et al., 2000). Strong, positive safety climates are the ones where employees feel that two-way safety-related communication is present, their organization prioritizes and values worker safety and proper safety procedures and policies are in place. Employees with positive perceptions of safety communication report frequent opportunities to discuss safety concerns and are consulted about safety issues (Griffin & Neal, 2000; Hofmann & Stetzer, 1998). Consistent positive relationships between safety communication and safety performance are reported across several high-risk industries (Cigularov, Chen, & Rosecrance, 2010; Griffin & Neal, 2000; Manapragada & Bruk-Lee, 2016). Having high quality communication is especially important in the healthcare industry, given that it has been implicated with several detrimental safety outcomes. Indeed, the Joint Commission of Healthcare Organizations identified poor communication as the root cause of 65% of sentinel or unexpected events in healthcare organizations (see Shaw, 2007). Poor communication can also affect the quality of care given by healthcare professionals (Haig, Sutton, & Whittington, 2006), which can result in medical errors and/or negative patient health outcomes (Brock et al., 2013). The management values component of safety climate captures employees' perceptions of their organization's upper management's concern for and prioritization of safety and the emphasis and importance that management places on worker safety (Griffin & Neal, 2000). Employee perceptions of their management's safety values may develop from several situations, such as observing leaders' general tendencies in responding to accidents and injuries (e.g., blaming, punishing), treatment of workers who are involved in safety accidents (Hofmann & Stetzer, 1998) and overall prioritization of worker safety over production (Griffin & Neal, 2000). In a two-part study, Griffin and Neal (2000) found that employees' perceptions of management's values of safety have strong positive relationships with safety performance behaviours. Hypothesis 1: Perceptions of (a) safety communication, (b) management values, and (c) safety systems will be positively related to safety performance. This study addresses a call for research (Zohar, 2010) by examining the influence of psychosocial hazards on the relationships between nurses' perceptions of three components of their organization's safety climate and their safety performance. Psychosocial hazards can be defined as work factors that “have a hazardous influence over employees' health through their perceptions and experience” (Leka & Jain, 2010, p.1) and can encompass factors such as workplace conflict, high workload, and a lack of social support. These psychosocial hazards act as workplace stressors that often result in the long-term strain outcomes of decreased mental, social, and behavioural health, cognitive impairments, and increased likelihood of physical disease (Leka, Griffiths, & Cox, 2003). Figure 1 presents a theoretical model of the moderating effects of psychosocial hazards on the safety climate and safety performance relationship. Psychosocial hazards are especially relevant in the healthcare industry. Conflict, heavy workload, and poor quality of social support were among the most frequently reported job stressors found among UK nurses (Edwards & Burnard, 2003). These common psychosocial hazards may result in increased rates of nurses' turnover intentions, burnout, job dissatisfaction, absenteeism, and workplace injuries (Constable & Russell, 1986; Firth & Britton, 1989; Jenkins & Elliott, 2004; Lanz & Bruk-Lee, 2017; Zeytinoglu et al., 2007). This study examines three common psychosocial hazards stemming from the social, psychological, and physical work environment: conflict with other nurses, lack of support and workload, respectively (McCarthy, Power, & Greiner, 2010). Conflict with other nurses captures difficulty working with other nurses or facing criticism by supervisors (Gray-Toft & Anderson, 1981). Although there is little empirical research on the relationship between workplace conflict and safety performance, there is a myriad of research examining the relationship between workplace conflict and job performance, especially in a team context. For example, in a meta-analysis by De Dreu and Weingart (2003), conflict was found to have negative relationship with team performance. Conflict was also found to have an association with job performance, at the individual and team level, in a more recent meta-analysis by De Wit, Greer, and Jehn (2012). More specifically, relationship conflict was found to have a strong negative relationship with extra-role behaviour, suggesting that interpersonal conflict can affect the degree to which individuals engage in supplementary behaviours that contribute to the effectiveness of their organization, such as safety participation. Hypothesis 2: Conflict with other nurses will be negatively related to safety performance. Hypothesis 3: Conflict with other nurses will moderate the relationships between (a) safety communication, (b) management values, (c) safety systems and safety performance, such that higher levels of conflict with other nurses will weaken these relationships. Lack of support consists of having little to no opportunity to talk openly, share feelings, and discuss problems with others on the job (Gray-Toft & Anderson, 1981). The role of support has been studied in a variety of workplace contexts, especially in terms of work stress. Indeed, in a meta-analysis examining the role of support in the work stress process, Viswesvaran, Sanchez, and Fisher (1999) found that workplace social support was associated with lower perceived stressors (e.g., role conflict, role ambiguity, work overload) and reduced experienced strains (e.g., job dissatisfaction, burnout, withdrawal). In a more recent study involving healthcare workers, Higazee, Rayan, and Khalil (2016) found that a lack of organizational support predicted perceived stress in nurses. Reduced well-being has also been studied as a common outcome of a lack of support, with several studies suggesting that a lack of support is associated with employee burnout, in both nursing and non-nursing populations (Constable & Russell, 1986; Cordes & Dougherty, 1993; Lee & Ashforth, 1996). Perceived organizational support has also been found to have negative relationships with burnout and stress and positive relationships with job satisfaction and job performance, in a meta-analysis by Kurtessis et al. (2017). In essence, research suggests that when workers do not feel supported, they are more likely to experience stressors and strains, having an impact on their satisfaction and performance. Hypothesis 4: Lack of support will be negatively related to safety performance. Hypothesis 5: Lack of support will moderate the relationships between (a) safety communication, (b) management values, (c) safety systems and safety performance, such that higher levels of lack of support will weaken these relationships. Workload can be described as the perception that the quantity of tasks that an individual is given to complete in a certain period of time is greater than what is manageable (Greenglass, Burke, & Moore, 2003). In the nursing profession, the term “workload” can be used to describe having heavy demands and time pressures, and facing unpredictability in staffing and demands in the nursing profession (Gray-Toft & Anderson, 1981). A heavy workload has been found to be one of the most consistent stressors in the nursing profession (McVicar, 2003; Moore, Kuhrik, Kuhrik, & Katz, 1996; Tyler & Cushway, 1995) and has also been found to be related to anxiety, frustration (Spector, 1987), and burnout (Greenglass, Burke, & Fiksenbaum, 2001). In addition, work overload has been found to have a negative impact on healthcare workers' quality of care (Shirom, Nirel, & Vinokur, 2006) and has been associated with higher patient safety incidents (Carlesi, Padilha, Toffoletto, Henriquez-Roldán, & Juan, 2017). Hypothesis 6: Workload will be negatively related to safety performance. Hypothesis 7: Workload will moderate the relationships between (a) safety communication, (b) management values, (c) safety systems and safety performance, such that higher levels of workload will weaken these relationships. The aims of this study were to test the direct relationships of safety climate components and psychosocial hazards with safe work behaviours and the moderating role of psychosocial hazards on the relationships between nurses' perceptions of their organization's safety climate and their safety performance. A series of seven hypotheses were proposed to examine these relationships. The study design consisted of cross-sectional survey data and quantitative methods. Participants were a convenience sample of 146 nurses recruited by posting study announcements on professional nursing listservs and social media nursing blogs, and using snowball sampling where participants examined to share the study with other qualifying nurses. Inclusion criteria required participants to be at least 18 years old and work as an Advanced Practice Registered Nurse, Nurse Practitioner, Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse. Participants worked at least 20 or more hours per week and lived in the United States. Out of the 204 participants that began the survey, 15 participants failed to meet the inclusion criteria. Additionally, 43 participants were screened out due to failing attention checks (e.g., select “strongly disagree” as your response to this question) or not having any data. A post hoc power analysis was conducted using G*Power v3.1 (Faul, Erdfelder, Lang, & Buchner, 2007). Given our sample size, the achieved power to detect a medium effect (f2) of 0.15 at an alpha level of 0.01 was 0.93 (β = 0.07), hence, our sample size was adequate for conducting correlation and regression analyses and exceeded minimum recommended standards for power (0.80; see Cohen, 1988). Data were collected in January 2017, using an online, 20-min questionnaire. Safety communication, management values, safety systems, and safety performance were measured using the Safety Climate and Safety Performance Scale (Griffin & Neal, 2000). All items were measured on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). Safety communication was measured with five items that addressed the way safety issues are communicated, illustrated by the following sample item, “There is frequent communication about safety issues in this workplace.” Management values were measured by four items that investigated about the degree to which management supports and prioritizes safety in the workplace. A sample item is “Safety is given a high priority by management.” Safety systems were measured with three items that assessed individuals' perceptions of safety policies, practices, and procedures in the workplace, with a sample item such as “Safety procedures and practices are sufficient to prevent incidents from occurring.” Lastly, an 8-item safety performance composite measure was calculated by averaging scores on the two subscales of safety compliance and safety participation. A sample safety compliance item used was “I use all the necessary safety equipment to do my job” and a sample safety participation item was “I voluntarily carry out tasks or activities that help to improve workplace safety.” Conflict with other nurses, lack of support, and workload were measured using the Nursing Stress Scale (Gray-Toft & Anderson, 1981). Conflict with other nurses was assessed through a 5-item subscale. One item was dropped (“Floating to other units that are short-staffed”) as it displayed a low factor loading (0.36) compared with all other items which had loadings of 0.56 or higher, reduced Cronbach's alpha and conceptually was different from other conflict items that examined about disagreements or conflict arising from working with others (e.g., “Difficulty in working with a particular nurse (or nurses) outside of the unit.”). The four-item factor model also resulted in a greater total variance explained (61%) than a five-factor model (52%) of conflict with other nurses. Therefore, only four of five items were retained for this measure. Lack of support and workload were measured with 3 and 6 item subscales, respectively. Sample items for these included “Lack of an opportunity to talk openly with other unit personnel about problems on the unit” and “not enough time to complete all of my nursing tasks”. All items were measured on a 4-point scale (1 = Never, 4 = Very Frequently). Ethics committee approval was obtained from a university internal review board prior to data collection. Participants received a $5 e-gift card as compensation for study completion. Hypotheses 1, 2, 4, and 6 were tested via correlational analyses. To examine the moderating effects of psychosocial hazards, ordinary least squares regression models were tested using the PROCESS macro version 3.0 for SPSS (Hayes, 2018). PROCESS is a computational tool that may be installed as a custom dialogue menu in SPSS. PROCESS model 1 which tests simple moderation was used. Model coefficients, standard errors, p-values, t-values, change in R2 statistics, and conditional effects for each analysis were calculated. Continuous predictor variables were mean centred to improve the interpretability of the results by providing meaningful zero points (Aiken & West, 1991). Unstandardized simple slopes were examined at the mean and ±1 SD from the mean in the case of significant moderators. Psychometric evidence for the Nursing Stress Scale has been reported in prior research (French, Lenton, Walters, & Eyles, 2000; Gray-Toft & Anderson, 1981; Holzemer & Julia Faucett, 2007). Our study provides further evidence of reliability: “conflict with other nurses” (α = 0.79), “lack of support” (α = 0.75), and “workload” (α = 0.79). The Safety Climate and Safety Performance Scale (Griffin & Neal, 2000) is also a valid, reliable scale used to assess “safety communication” (α = 0.79), “management values” (α = 0.85), “safety systems” (α = 0.69), and “safety performance” (α = 0.75). The nurses in the sample were predominantly female (96.6%) and Caucasian or Hispanic (80.1% and 14.4%, respectively), with ages ranging from 22 to 61 years (mean = 32.0, SD 7.2). Participants reported working between 20 and 80 hr per week (mean = 37.2, SD 6.6). Additionally, most participants were Registered Nurses (69.2%); however, other participants were Advanced Practice Registered Nurses/ Nurse Practitioners (24.7%) or Licensed Practical Nurses/Licensed Vocational Nurses (6.2%). Last, most participants worked in direct patient care (85%). Table 1 displays means, standard deviations, and intercorrelations among all variables of interest. Perceptions of safety communication (r = 0.24), management values (r = 0.25), and safety systems (r = 0.39) were all found to have significant positive relationships with safety performance, supporting hypothesis 1. The three psychosocial hazards (conflict with other nurses, lack of support, and workload) did not significantly correlate with safety performance (r = −0.12, −0.16, and 0.02, respectively). Hypotheses 2, 4, and 6 were not supported. Hypothesis 3 proposed a conditional effect of safety communication, management values, and safety systems on safety performance dependent on levels of conflict with other nurses. Across the three safety climate components (i.e., communication, management values, and safety systems), the increase in variance explained in safety performance (∆R2 = 0.03, F(1,142) = 4.70, p < 0.05, ∆R2 = 0.09, F(1,142) = 14.09, p < 0.05, ∆R2 = 0.07, F(1,142) = 12.41, p < 0.05, respectively) was significant when the interaction term was entered into the regression (see Table 2). As indicated in Table 3, under high levels of conflict with other nurses (i.e., +1 SD), the correlations between safety climate components and safety performance did not significantly differ from zero. Hypothesis 5 tested the moderating effects of lack of support on the relationships between safety communication, management values, and safety systems with safety performance. The interaction term in each of the three regressions indicated a significant increase in the variance explained in safety performance (∆R2 = 0.06, F(1,142) = 9.36, p < 0.05, ∆R2 = 0.08, F(1,142) = 13.13, p < 0.05, ∆R2 = 0.08, F(1,142) = 14.55, p < 0.05, respectively). As shown in Table 4, results indicated that the relationships between safety climate components and safety performance were weakened when nurses perceived low levels of support (i.e., high lack of support). As indicated by the simple slopes shown in Table 5, perceptions of safety climate components were not significantly related to safety performance for nurses reporting high levels (i.e., +1 SD) of this psychosocial hazard. Support for hypothesis 7 was also found, indicating a significant interaction between workload and each of the three safety climate components in predicting safety performance (∆R2 = 0.04, F(1,142) = 7.13, p < 0.05, ∆R2 = 0.06, F(1,142) = 10.63, p < 0.05, ∆R2 = 0.04, F(1,142) = 7.04, p < 0.05, for safety communication, management values, and safety systems, respectively). Indeed, the workload by safety communication, management values, and safety systems interactions suggest that under high levels of workload the safety climate-performance relationships are weakened (see Table 6). Unstandardized simple slopes (see Table 7) show that in the case of safety communication and management values, the relationships with safety performance are not significantly different from zero when nurses report high levels (+1SD) of workload. The simple slopes across levels of workload are significant when safety systems is the predictor, however, the correlation with safety performance is weaker for nurses reporting high levels of workload than average or low levels of the moderator. Although safety and stress are two heavily researched topic areas in the healthcare industry, examining how these two processes interact has not been as common. To our knowledge, our study is the first to explore the impact of common psychosocial hazards in the nursing population on the well-established relationships between perceptions of safety climate and safety performance. Our findings suggest that the effects of safety climate on safe work behaviours among nurses are conditional on conflict with other nurses, lack of support, and workload. Indeed, when levels of these psychosocial hazards are high, we found most relationships between perceptions of safety climate and safety performance to be non-significant. Our results confirmed existing findings about the relationship between safety climate and safety performance (Christian et al., 2009) and contributed new ideas to our knowledge of safety and stress in nurses. This study sought to examine the impact of three psychosocial hazards commonly reported by nurses on the relationship between nurses' perceptions of their organization's safety climate and their safety performance. We measured nurses' perceptions of three important components of safety climate: safety communication, management's safety values, and safety systems. Perceptions of safety climate have consistently been found to positively predict safety performance behaviours (Cigularov et al., 2009; Griffin & Neal, 2000; Hofmann & Stetzer, 1996; Zohar, 1980), which was also supported by the present research. When nurses believe that their management is committed to safety, promote an open, two-way channel of safety-related communication, and acknowledge and support the safety systems in place in their workplace, they are more likely to comply with workplace safety policies and practices and go above and beyond to promote the safety agenda of the organization. Our findings did not support significant relationships between conflict with other nurses, lack of support and workload with safe work behaviours. Further research should explore whether the effects of psychosocial hazards on safety performance are mediated by affective states, such as burnout. For example, when employees experience psychosocial hazards that lead to burnout, they may not have the mental energy to perform safely and are more likely to make mistakes or errors (Nahrgang et al., 2011). Burnout may play a key role in the underlying mechanism through which psychosocial hazards can have an impact on safety performance. Indeed, the effects of psychosocial hazards on burnout and other attitudinal variables (e.g., turnover intent) have been previously documented (Jenkins & Elliott, 2004; Lanz & Bruk-Lee, 2017; Van Bogaert, Clarke, Willems, & Mondelaers, 2013). Our last set of predictions tested the conditional relationships between perceptions of safety climate and safety performance. All three psychosocial hazards were found to moderate relationships between components of safety climate and safety performance. Specifically, none of the three safety climate components predicted safety performance when nurses reported high levels of either conflict with other nurses or a lack of support. Similarly, safety communication and management values did not predict safety performance under high levels of workload. While the safety systems component was positively related to safety performance under all levels of workload, the relationship was weaker when nurses reported higher levels of the moderator. Overall, nurse perceptions of management's endorsement of two way communication about safety issues at work, use and implementation of procedures to promote safe work practices, and concern for safety were not associated to their safe work practices when experiencing high levels of psychosocial stressors. These findings are especially concerning in the healthcare industry, where psychosocial hazards have a high prevalence. Indeed, in our sample, most participants reported that they experienced conflict with other nurses, a lack of support, or heavy workloads frequently or very frequently. When psychosocial hazards are consistently faced by workers, organizational efforts to improve safety performance in the workplace through fostering a strong and positive safety climate may be derailed. Our findings indicate that psychosocial work conditions can impose limits on the effectiveness of efforts to promote safety at work. Research on psychosocial safety climate, characterized by a work environment and management that values and promotes psychological health, supports its role in reducing psychosocial hazards and promoting employee well-being (Dollard & Bakker, 2010); however, research in this area has not investigated its effect on the safety compliance and participation of nurses. Future research is encouraged that examines the role of psychosocial safety climate in promoting work conditions that maximize the safety climate—safety performance relationship. The results of the study also support the practical implications of reducing the psychosocial stressors experienced by nurses at work. Stress management interventions have been shown effective in coping with psychosocial stressors among nurses (Edwards & Burnard, 2003). Similarly, the importance of developing resilience in nurses has received attention as a tool for ameliorating the impact of psychosocial hazards (e.g., Aburn, Gott, & Hoare, 2016; Lanz & Bruk-Lee, 2017). Reducing the negative effects of conflict with other nurses and excessive workload is not only relevant from the perspective of employee well-being, but also as shown here, because it sets contingencies on the effects of safety climate. Job redesign efforts that focus not only on the promotion of a positive safety climate, but on reducing work psychosocial hazards are encouraged. As noted earlier, these may include the promotion of a strong psychosocial safety climate, which has been previously shown to have an impact on performance indirectly through enhanced well-being (Idris, Dollard, & Tuckey, 2015). Additionally, creating a work environment that is structurally empowering (Kanter, 1993; Laschinger, Finegan, Shamian, & Wilk, 2001), defined in part by having access to support from supervisors and coworkers, can reduce the experience of psychosocial hazards (Laschinger et al., 2001; Wagner et al., 2010) and promote extra role performance behaviours (e.g., Gilbert, Laschinger, & Leiter, 2010) like the ones desired from safety participatory work practices. Although this study makes a novel contribution, there are limitations that should be noted and addressed in future research. First, cross-sectional data do not allow us to make causal inferences. However, given that there is a dearth of research examining the impact of psychosocial hazards on safety performance, cross-sectional methods may be most appropriate for preliminary investigations. Future research should take a longitudinal approach to understand how the relationships between perceptions of safety climate, psychosocial hazards, and safety performance evolve over time. Second, data were collected through self-report surveys, which make common method bias a possible limitation (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). Future research should use more objective measures or “other-report” data to address this limitation. For example, supervisors could be asked to rate nurses' safety performance, or metrics such as the numbers of accidents/injuries reported could be used. In addition, management's safety values could be assessed through surveying managers or leaders. In addition, while the use of individual-level perceptions of safety climate were appropriate for this study given the nature of the sample, we encourage future researchers to consider measuring safety climate as a group-level construct if data can be collected in one healthcare organization. Lastly, this study focused on a small convenience sample of nurses, which limits the generalizability of our findings. However, since this study was one of the first to explore the moderating effects of psychosocial hazards on the relationship between safety climate and safety performance in nurses, our findings offer preliminary insight into the interaction between safety and stress in this population. Replicating this study using a larger sample can help provide additional support for the conclusions drawn from this study. In addition, our participants were mostly female, Caucasian and Registered Nurses working in direct patient care, hence results may differ in organizations with varying demographic compositions. When aiming to improve safety in the workplace by promoting a strong and positive safety climate, additional factors such as psychosocial hazards should be considered. Indeed, safety interventions would benefit from the inclusion of training components aimed at helping nurses manage commonly experienced psychosocial hazards. Organizations should also attempt to foster an environment where nurses feel comfortable talking openly and discussing problems with others on the job, without fear of judgement or retribution. Addressing psychosocial hazards in addition to promoting workplace safety will allow nurses to benefit most from working in an environment where safety is valued, communicated, and prioritized. No conflict of interest has been declared by the author(s)." @default.
• W2901585465 created "2018-11-29" @default.
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• W2901585465 date "2019-01-10" @default.
• W2901585465 modified "2023-10-13" @default.
• W2901585465 title "When safety climate is not enough: Examining the moderating effects of psychosocial hazards on nurse safety performance" @default.
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• W2901585465 doi "https://doi.org/10.1111/jan.13911" @default.
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