The Role of Nurse Managers in Promoting Psychological Safety and Patient Safety Culture in Nursing Teams: A Scoping Review.

Background/Objectives: Psychological safety is increasingly recognized as a key factor in promoting communication, learning, and teamwork in healthcare, with implications for patient safety culture. Although psychological safety and patient safety culture have been reviewed separately, evidence on how nurse managers contribute to both constructs within nursing teams remains fragmented. This scoping review aimed to map the available evidence on the role of nurse managers in promoting psychological safety and patient safety culture in nursing teams, identify leadership behaviors, strategies, and competencies, and highlight facilitating factors and barriers. This review provides an integrated synthesis of evidence on how nurse managers contribute to fostering both psychological safety and patient safety culture within nursing teams, addressing a gap in the existing literature. Methods: A scoping review was conducted following established methodological frameworks and prospectively registered in the Open Science Framework. Systematic searches were conducted in MEDLINE (PubMed), CINAHL, Psychology and Behavioral Sciences Collection, Scopus, BVS, and WorldCat for gray literature, with the final search performed on 11 May 2026. A total of 229 records were identified, with 112 duplicates removed. The remaining 117 records were screened, resulting in 25 studies included for analysis. Data were extracted and synthesized using thematic analysis. Results: Twenty-five sources were included, comprising predominantly quantitative (mainly cross-sectional) studies, together with qualitative studies, systematic reviews, conceptual papers, expert opinion papers, and gray literature. The findings highlight a close and interdependent relationship between psychological safety and patient safety culture. Nurse managers' relational leadership behaviors-such as visible presence, active listening, emotional support, and constructive feedback-emerged as key strategies for fostering psychologically safe environments. The reviewed evidence suggests that psychological safety may mediate the relationship between leadership practices and communication, speaking up, incident reporting, and organizational learning. Facilitators include supportive leadership and a just culture, while barriers encompass punitive environments, hierarchical structures, workload pressures, and resource constraints. Conclusions: The findings suggest that psychological safety may be an important mechanism through which nurse managers contribute to patient safety culture. However, leadership alone is insufficient, requiring alignment with organizational conditions and system-level support. These findings support strategies to strengthen safety culture and guide leadership development.