Abstract:

Objective Based on the social context theory，this study explored the influence and mechanism of the multiple leadership styles of head nurses on the safety behaviors of ICU nurses，providing a scientific basis for nursing safety management. Methods A convergent mixed-methods design was adopted. Using convenience sampling，446 ICU nurses from 14 tertiary hospitals in Zhejiang Province were surveyed with the general data questionnaire，Multifactor Leadership Questionnaire，Error Management Climate Scale，Error Strain Orientation Questionnaire and Nurse Safety Behavior Questionnaire. Multiple linear regression and structural equation modeling were conducted to analyze the pathways of influence. In addition，purposive sampling was used to conduct qualitative interviews with 15 ICU nurses，and data were analyzed using content analysis. Results Quantitative findings indicated that nurse managers’ multiple leadership style was a significant predictor of ICU nurses’ safety behaviors，with error management climate and error strain orientation playing a chain mediating role. Qualitative analysis identified four themes，including roles of leadership style，influence of organizational atmosphere，responses to unsafe events，and individual intrinsic drivers. The mixed-methods integration further revealed the roles of perceived workload，team collaboration，and error-benefit cognition in shaping safety behaviors. Conclusion Head nurses’ multiple leadership styles directly influence ICU nurses’ safety behaviors and exert an indirect influence through the serial mediating effect of error management climate and error strain orientation. In management practice，head nurses should take into account the construction of multiple leadership styles，the creation of an error management climate，and the intervention of error stress to promote nurses’ proactive safety behaviors.

Key words: ICU Nurses, Multiple Leadership Styles, Error Management Climate, Error Strain Orientation, Nurse Safety Behavior, Convergent Mixed Study