Abstract
OBJECTIVES: This study aimed to investigate the dual mediating roles of psychological safety and reporting attitudes in the association between ethics-centered leadership and internal whistleblowing among nurses. METHODS: A multicenter, cross-sectional study design was employed, involving a convenience sample of 273 nurses among five university hospitals from August to October 2024. Data were collected using a demographic questionnaire, Ethical Leadership Scale, Psychological Safety Scale, Positive Attitudes Toward Whistleblowing Scale, and Internal Whistleblowing Scale. Pearson correlation and structural equation model were conducted to test the hypothesized dual mediation model. RESULTS: The average score of nurses for ethical leadership was 4.14 ± 0.57, psychological safety was 3.80 ± 0.64, reporting attitudes was 4.12 ± 0.67, internal whistleblowing was 3.93 ± 0.52. Ethical leadership had a significant effect on psychological safety (β = 0.38, P < 0.001), reporting attitudes (β = 0.44, P < 0.001), and internal whistleblowing (β = 0.21, P = 0.009). Furthermore, psychological safety (β = 0.26, P < 0.001) and reporting attitudes (β = 0.27, P < 0.001) significantly influenced internal whistleblowing among the nurses. The indirect effect of ethics-centered leadership on internal whistleblowing intermediated by psychological safety was significant (β = 0.10, P < 0.001). Similarly, reporting attitudes demonstrated a significant mediating effect (β = 0.12, P = 0.003). CONCLUSIONS: Ethical leadership encourages internal whistleblowing among nurses by fostering psychological safety and positive reporting attitudes. Therefore, healthcare managers should prioritize ethical leadership development, enhance psychological safety, and foster constructive reporting attitudes that enable nurses to report ethical violations confidently, without apprehension.