How responsible leadership fosters ICU nurses' innovation in China: a mediated model of perceived insider status and voice behavior.

BACKGROUND

Responsible leadership may be associated with ICU nurses' innovative behavior, but the underlying mechanisms remain unclear. This study examined the mediating roles of perceived insider status and voice behavior.

METHODS

A cross-sectional survey was conducted between January and February 2025 in three tertiary hospitals in northern China. A total of 372 ICU nurses were recruited using convenience sampling. Validated instruments were used to measure responsible leadership, perceived insider status, voice behavior, and innovative behavior. Structural equation modeling was employed to test the hypothesized model and mediating pathways.

RESULTS

The results indicated significant positive correlations among responsible leadership, perceived insider status, voice behavior, and innovative behavior (all p < 0.01). Responsible leadership not only directly influenced the innovative behavior of ICU nurses but also had indirect effects through the mediating roles of perceived insider status and voice behavior. Specifically, perceived insider status and voice behavior accounted for 22.56 and 21.05% of the total effect, respectively. In addition, perceived insider status and voice behavior played a sequential mediating role between responsible leadership and innovative behavior, with the chain mediation effect accounting for 8.77% of the total effect.

CONCLUSION

This study highlights the critical role of responsible leadership in enhancing ICU nurses' innovative behavior within the Chinese healthcare context. By fostering a strong sense of insider identity and encouraging upward communication, responsible leadership can create an inclusive, psychologically safe environment that empowers nurses to generate and implement innovative ideas. Hospital administrators should promote leadership practices that emphasize ethical responsibility, stakeholder engagement, and open communication to stimulate innovation and improve care outcomes in intensive care settings.