Purpose
This study aimed to explore the mediating role of organizational silence in the effect of leader-member exchange on patient safety culture among perioperative nurses.
Methods
This descriptive study surveyed 201 perioperative nurses from five university hospitals. Data were collected via online questionnaires from November 8, 2022, to February 6, 2023, measuring demographics, work-related factors, leader-member exchange, organizational silence, and patient safety culture. The Data were analyzed using SPSS 26.0 and PROCESS Macro model 4.
Results
Leader-member exchange showed a significant direct effect on patient safety culture (β=.44, p<.001). The indirect effect of leader-member exchange on patient safety culture through acquiescent silence was also significant (β=.05, 95% CI: 0.02 to 0.13). The total effect of leader-member exchange on patient safety culture (β=.52, p<.001) was larger than its direct effect, indicating that acquiescent silence partially mediated the relationship between leader-member exchange and patient safety culture.
Conclusion
To improve perioperative nurses perception of patient safety culture, healthcare organizations should enhance leader-member exchange by promoting strong emotional connections and open communication between nurse managers and staff nurses. Additionally, encouraging autonomous decision-making and reducing acquiescent silence are essential to facilitate the active expression of patient safety concerns.

Purpose
This study examined the relationships between organizational silence, organizational commitment, organizational justice, and organizational citizenship behavior among clinical nurses. Additionally, it determined the mediating effect of organizational commitment moderated by organizational justice on the relationship between organizational silence and organizational citizenship behavior among clinical nurses.
Methods
A total of 160 clinical nurses were recruited from a university hospital. Data were collected from June to July, 2023. The collected data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Scheffé test, Pearson’s correlation coefficient, Baron and Kenny’s three-step regression analysis, Hayes’ PROCESS macro model, and bootstrapping using SPSS/WIN 27.0 program.
Results
Organizational commitment had a full mediating effect on the relationship between organizational silence and organizational citizenship behavior (B=-0.04, CI [-0.098~-0.001]). Among the subscales of organizational justice, distributive justice had a moderating effect on the relationship between organizational silence and organizational commitment (B=-0.17, p=.009). There was no significant mediating effect of organizational commitment moderated by organizational justice on the relationship between organizational silence and organizational citizenship behavior.
Conclusion
Appropriate strategies are needed to effectively manage nursing personnel and improve nursing performance.

Purpose
This study identified the influence of self-leadership, managers’ authentic leadership, and nurses’ organizational culture relationships on hospital nurses‘organizational silence.
Methods
An explanatory sequential mixed-method study was conducted. For the quantitative portion, 138 nurses from seven hospitals participated. For the qualitative portion, ten nurses with high organizational silence scores were interviewed. Quantitative data were analyzed with SPSS/WIN 26.0. Qualitative data were analyzed by content analysis using NVivo 12.0.
Results
Quantitative results indicated that self-expectations and a relation-oriented culture explained 14.0% of the variance in acquiescent silence. The combined effect of rehearsal, constructive thought, and relational transparency associated with managers’ authentic leadership on prosocial silence was 15.0%. Qualitative results revealed eight primary themes related to organizational silence: 1) being unable to voice my opinion because I feel insignificant, 2) things that middle managers cannot say, 3) earnest managers, 4) receptive managers, 5) indifferent managers, 6) feeling of camaraderie, 7) selective silence based on performance, and 8) mandatory following of directives.
Conclusion
Programs to improve managers’ leadership skills and reduce hospital nurses’ organizational silence should be implemented consistently. Hospitals should strive to foster a positive and equitable organizational culture.

Purpose
This study used a structural model to identify organizational characteristics, such as work environment, nursing organizational culture, and manager leadership of general hospital nurses, and to examine the effect of organizational characteristics on turnover intention through organizational silence.
Methods
Data were collected from July 1, 2017 to August 30, 2017, using structured questionnaires. Participants were nurses in general hospitals with more than 250 beds and less than 500 beds in Busan City and Gyeongsangnam Province. The collected data were analyzed using IBM SPSS 23.0 and AMOS 23.0.
Results
The nursing work environment, external employment opportunities, relationship-oriented culture, and acquiescent and defensive silence directly impacted turnover intention. Additionally, the nursing work environment and external employment opportunities indirectly affected turnover intention through acquiescent silence.
Conclusion
To lower general hospital nurses’ turnover intention, the external environment should be reviewed and continuously compared to provide a better internal nursing work environment. In addition, it is necessary to find a way to lower the acquiescent silence, which can negatively affect the organization, by creating a relationship-oriented culture that emphasizes the relationship between members.