Ethical leadership and nurses’ voice behavior: A longitudinal study

Background Ethical leadership is recognized as a key factor influencing proactive employee behaviors in healthcare. However, limited longitudinal evidence exists on its relationship with nurses’ voice behavior over time. Objectives This study examines the longitudinal relationship between ethical leadership and nurses’ voice behavior and investigates the mediating role of sense of professional mission. Research design A multicenter longitudinal survey was conducted with data collected at three time points over 6 months; validated scales measured all variables. Data were analyzed using Pearson correlation and structural equation modeling. Participants and research context The study included 537 registered nurses from four hospitals in China, recruited through stratified cluster sampling. Ethical considerations The Biomedical Research Ethics Subcommittee of Henan University approved the study. Written informed consent was obtained, and anonymity was ensured. Results Ethical leadership at T1 was positively associated with sense of professional mission at T2 (β = 0.18, p < 0.001), which predicted voice behavior at T3 (β = 0.20, p < 0.001). A direct path from T1 ethical leadership to T3 voice behavior was also found (β = 0.18, p < 0.001). Sense of professional mission mediated 16.98% of the total effect. The model demonstrated good fit (χ 2 /df = 2.374, RMSEA = 0.051, CFI = 0.986). Conclusions Ethical leadership influences nurses’ voice behavior both directly and indirectly through enhancing sense of professional mission. Strengthening ethical leadership and fostering professional mission may promote voice behavior in clinical settings.