Nurse Managers' Toxic Leadership: Its Relation to Nurses' Internal and External Intentions to Whistleblowing.

This study aimed to explore the relationship between toxic leadership by nurse managers and staff nurses' intentions to engage in whistleblowing practices, both within and outside their hospital. Nurses are pivotal in providing high-quality care, but toxic nurse manager leadership in the workplace can lead to challenges in patient care and the workplace environment. In response, whistleblowing serves as a mechanism to mitigate these problems and foster accountability. This descriptive correlational study was conducted from October 2023 to March 2024 with 292 inpatient and critical care unit nurses from a university hospital who were selected through simple random sampling. They completed the 15-item Toxic Leadership Scale to assess their views of toxic leadership in five domains: self-promotion, abusive supervision, unpredictability, narcissism, and authoritarian leadership. Nurses' intention to report misconduct was assessed using the 8-item whistleblowing intention questionnaire, including both internal and external whistleblowing. Descriptive statistics summarised the data; relationships between variables were evaluated using Spearman's correlation. Linear regression analysis provided the predictors of whistleblowing intention, exploring how personal characteristics and toxic leadership can affect this intention. The study revealed that nurses reported moderate levels of toxic leadership among their managers, with a total mean of 45.97 ± 11.545. They were more likely to intend to blow the whistle within the organisation (15.63 ± 3.085) than outside the organisation (10.77 ± 3.331), with the overall whistleblowing intention mean being 26.4 ± 5.008. Toxic leadership was significantly positively correlated with external whistleblowing ( = 0.282, < 0.001). A positive correlation was found between toxic leadership and external whistleblowing. Toxic leadership is a significant predictor of nurses' intentions to blow the whistle, and the educational level of nurses also contributes to these intentions. Addressing toxic leadership is crucial for encouraging whistleblowing and fostering a healthier work environment. Hospital managers and leaders need to combat toxic leadership, encourage a culture of safe whistleblowing practices, reinforce legal protections for whistleblowers and create ethical leadership training programs for nurse managers.