The influence of empowering leadership and leader member exchange on voice behaviour with mediating effect of psychological safety and intrinsic motivation among nurses in Malaysia

Healthcare organisations have continuously made innovative changes to ensure their relevancy in the medical industry by delivering top-quality healthcare services and becoming reliable institutions. Staff active participation is pivotal in achieving the hospital organisation's strategic vision. In Malaysia, the Ministry of Health (MOH) governs public hospitals, which manage resources, ensure smooth daily operation, and provide essential health care. Nurses' voice behaviour concerning issues is vital to help improve the current working conditions, especially those involving patient care. Although nurses can voice their concerns, the literature shows limited participation by nurses. Prior studies assert nurses’ involvement in speaking up behaviour is low due to poor encouragement, lack of supportive work culture and personal anxiety. Thus, examining the roles of empowering leadership and leader-member exchange in effecting voice behaviour is essential in enabling the provision of further justifications. Exploring the potential mediating effects of psychological safety and intrinsic motivators provides an added advantage to the present study. The complex relationships between the variables were confirmed using the quantitative study design. Nurses from seven hospitals in the Klang Valley of Malaysia were randomly selected to participate in the survey voluntarily. A total of 366 valid responses were received as scheduled. The response rate was promising due to the respondents' high cooperation and the strong support from the head nurses. The data was analysed using SPSS and SmartPLS. The analysis revealed a direct relationship between empowering leadership and the voice behaviour of nurses. The leader-member exchange was unable to influence nurses’ voice behaviour directly. Only intrinsic motivation mediates the relationship between empowering leadership, leader- member exchange and the voice behaviour of nurses. The underpinning theory for the conceptual framework is social exchange theory, which emphasises reciprocity in the work unit. The unique role of the mediators in this study has enriched the theory. The results offer valuable evidence for publicly funded hospitals and other healthcare providers on the need for strategic leadership that supports safety, a high-performing work culture, and progressive inherent motivation in inducing voice behaviour among nurses, which are critical to healthcare organisations. The profession requires specific standards to be adhered to during their tenure, and this thesis provides research evidence of nurses’ strengths through voice behaviour.