Psychological Well‐Being as a Mediator Between Paternalistic Leadership and Organisational Dissent in Critical Care Nursing Settings

BACKGROUND: Leadership styles play a crucial role in shaping nurses' psychological well-being and communication behaviours, especially in high-stress settings like critical care. Paternalistic leadership-characterised by benevolence, moral integrity and authority-has gained recognition for its impact on healthcare outcomes. However, its influence on organisational dissent, particularly through the lens of psychological well-being, remains underexplored. AIM: To Investigate the Mediating Role of Psychological Well-Being in the Relationship Between Paternalistic Leadership and Organisational Dissent Among Nurses in Critical Care Settings. STUDY DESIGN: A cross-sectional descriptive study was conducted. A convenience sample from 23 critical care units in a large educational government hospital participated. Data were collected using the Paternalistic Leadership Scale, Psychological Well-Being Scale and Organisational Dissent Scale. Statistical analyses included Pearson correlation, regression and path analysis. RESULTS: Among 460 nurses, paternalistic leadership was positively correlated with psychological well-being (r = 0.263, p < 0.001) and negatively correlated with organisational dissent (r = -0.278, p < 0.001). Psychological well-being also negatively correlated with dissent (r = -0.258, p = 0.001). Regression and path analysis confirmed that psychological well-being partially mediated the relationship between paternalistic leadership and organisational dissent. The mediation model showed statistically significant direct and indirect effects. CONCLUSIONS: Paternalistic Leadership Enhances Nurses' Psychological Well-Being and Reduces Organisational Dissent. Psychological Well-Being Acts as a Partial Mediator, Emphasising Its Importance in Translating Leadership Support Into Reduced Dissent Behaviours. RELEVANCE TO CLINICAL PRACTICE: Fostering paternalistic leadership and supporting nurses' psychological well-being are critical to maintaining constructive communication and reducing harmful dissent. Healthcare institutions should implement leadership development and mental health support initiatives to improve workforce morale and patient care.