The Mechanism of Ethical Leadership’s Influence on Nurses’ Voice Behavior: An Empirical Study Based on a Chain Mediation Model

BACKGROUND: Nurses' voice behavior plays an irreplaceable role in optimizing nursing practices, improving healthcare quality, and fostering organizational innovation. However, existing research on the influencing factors and underlying mechanisms of nurses' voice behavior remains limited and requires further exploration. OBJECTIVE: This study aims to examine the relationship between ethical leadership and nurses' voice behavior and further investigate the potential mediating roles of psychological contract and organizational commitment. METHODS: From August to October 2024, a questionnaire survey was conducted, collecting valid data from 1357 nurses in China. The survey included the Ethical Leadership Scale, Psychological Contract Scale, Organizational Commitment Scale, and Voice Behavior Scale. Data were statistically analyzed using SPSS 25.0, and structural equation modeling (SEM) was performed using Amos 26.0 to examine the mediating roles of psychological contract and organizational commitment in the relationship between ethical leadership and nurses' voice behavior. RESULTS: Ethical leadership, psychological contract, organizational commitment, and voice behavior were significantly correlated (p < 0.001). Ethical leadership had a direct impact on voice behavior (effect = 0.360, 95% CI = [0.319, 0.399]). Psychological contract and organizational commitment played partial mediating roles in the relationship between ethical leadership and voice behavior (effect = 0.101, 95% CI = [0.086, 0.118], and effect = 0.010, 95% CI = [0.004, 0.016]). Additionally, a significant chain mediation effect of psychological contract and organizational commitment was found in the relationship between ethical leadership and voice behavior (effect = 0.024, 95% CI = [0.018, 0.031]), accounting for 4.848% of the total effect (0.024/0.495). CONCLUSION: Ethical leadership not only directly promotes nurses' voice behavior but also indirectly enhances this effect through the chain mediation of psychological contract and organizational commitment. Strengthening ethical leadership can optimize nurses' psychological contracts and enhance their organizational commitment, thereby effectively stimulating voice behavior. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital administrators should recognize the critical role of ethical leadership in nursing management and adopt multilevel strategies to foster a positive organizational climate, optimize nurses' psychological contracts, and strengthen their organizational commitment. These efforts will encourage nurses to actively voice their opinions, thereby enhancing team effectiveness and stability.