The relationship between ethical leadership, conscientiousness, and moral courage from nurses’ perspective

Nurses form a key portion of all health care systems [1], and are known as the main guardians of the ethics of caring for a client [2, 3]. Advances in medical technology, scarcity of resources, as well as uncertain and complex clinical problems are imposing stubborn problems on nurses [4]. It can be said that nursing is a morally complex and challenging profession [5‐7], and nurses are exposed to moral distress more than other professions [8, 9]. Nurses’ conscientiousness is an important factor in meeting these challenges and is considered as an indicator of professionalism to provide good patient care [10, 11].

Nurses with conscientiousness are conscious and responsive with positive occupational motivation [12]. Conscientiousness is related to goal orientation [13], task orientation, and adaptive capacity [14], that is considered as the strongest predictor of performance [15‐17]. Conscientious nurses have more desire to play a role in different situations [12], and show higher role and extra-role performance [18]. They would likely hold strong values and set challenging goals [19]. Conscientiousness is one of the most important codes of nursing ethics in Iran [10, 20]. Acting on duty, supporting the provision of high quality care, and courageous action can be considered as the characteristics of conscientious nurses [3, 6, 21]. Conscientiousness and responsibility of nurses are essential for doing the right thing. On the other hand, insistence on doing the right thing is one of the basic characteristics of moral courage [22].

Moral courage is one of the fundamental values in the nursing profession [23]. Courage-based behavior includes rational reflection, commitment to professional values and principles, and risk-taking [24]. Moral courage helps nurses to act in accordance with what is morally right [25], and in addition to having good human characteristics, to provide acceptable care to the patient, family, and community [26]. Moral courage leads to provision of safe and professional care to clients [27, 28], sensitivity to suffering of others, action to reduce it, and empathy and love [26]. Adequate moral courage enables nurses to challenge unacceptable practices and policies. However, organizations may act defensively in response to the conscientious action of nurses, so that even the most morally courageous nurses may not dare to speak out [29].

Moral courage and conscientiousness are characteristics that are related to individual and organizational factors [10, 30]. Individual factors include socio-demographic factors such as work experience [31, 32], level of education [33, 34], age [33, 35], frequency of challenging situations [31], marital status [32] and so on. As an organizational factor, leadership can be very effective in strengthening the moral courage [36‐38], and conscientiousness of employees [39, 40].

Followers’ perspective on leadership is important and evident [41], and affect their performance [42]. According to social learning theory, employees learn by observation of the actions of their leaders. The learning in social learning theory is a cognitive process; that is, learners internalize and make sense of what they observe to reproduce the behavior themselves [43, 44].

Among leadership styles, ethical leadership has a special value and is becoming the most important tool by which leaders can influence people in the organization and their organizational performance [45, 46]. The ethical leadership literature is strongly based on the theory of social learning [47]. Ethical leaders in nursing are individuals who display characteristics such as empathetic interactions, ethical behavior, and exalted manners [48]. Ethical leaders encourage nurses to do the right thing. Also, they have considerable power to create and maintain ethical processes through the ethical climate [49]. Ethical leadership provides the ground for nurses to perform their duties effectively and in a way that satisfies the psychological needs of nurses [50]. Research has shown that ethical leadership can reduce nursing error [51], increase error reporting [51, 52], create organizational commitment [53, 54], improve the health and well-being of employees [55], provide better services [56], and create ethical behavior in employees [56, 57].

Given the issues mentioned above, and considering that conscientious people not only do their task well, but also perform extra-role behaviors such as civic virtue, chivalry, and respect for others [18]; therefore, one of the research hypotheses is that conscientiousness is positively related to nurses’ moral courage. On the other hand, ethical leadership exerts an impact on the behavior and performance of individual employees [47, 52, 58]; besides, followers’ perceptions of their own role and that of others (including the leader) underlie their behaviors and expectations [42]. Therefore, other hypotheses of the research are that ethical leadership has a positive relationship with the conscientiousness and moral courage of nurses from nurses’ perspective.

This study determined the relationship between conscientiousness, and moral courage, and ethical leadership from the perspective of nurses working in the selected hospitals of Yazd, Iran.

There was a statistically significant relationship between moral courage and nurses’ conscientiousness. Studies indicate that conscientiousness increases courage in duty, perseverance, and persistence, and overshadows fear [65, 66]. The results of Abbasi-Asl and Hashemi’s research indicated that conscientiousness, which is one of the dimensions of the five-factor model of personality, is related to moral courage. It is clear that the individual who is responsible and follows the organizational rules and values, has more moral courage, because the basic characteristic of moral courage is to continue to do the right thing [22]. Conscientious nurses feel more responsible for doing good things. They do not hesitate to do anything for the benefit of their clients [67], and act as the patients’ advocates when good care is threatened [68].

The results of this study showed that there was a positive and significant relationship between ethical leadership and nurses’ conscientiousness. Many studies have shown that the ethics-based performance of ethical leaders affects their influence and credibility, and thus enhances the conscientiousness of employees [69]. Also, when the leader is focused on promoting the norms and values of the organization, employees tend to be more involved. This motivates employees to take responsibility for their own duties and increase their engagement in achieving their career goals [70]. Nurses’ conscientiousness guides them in making ethical decisions based on ethical professional codes and guidelines [71, 72]; ethics-based leadership skills play a major role in this regard [47, 70, 73‐75].

From the nurses’ point of view participating in the study, the leader’s pioneering and task orientation are related to their conscientiousness. Pioneering means that nursing leaders must not only be moral and conscientious individuals, but they must also go one step further and promote conscientious behaviors through role models [76]. The results of other studies indicate the power of the role model in creating positive consequences for employees and emphasize the importance of studying the role model, in order to better understand the conditions of the impact of ethical leadership on the attitude and behavior of employees [77]. The dimension of task orientation includes such items as the commitment to obeying the rules and regulations and prioritizing the interests of the organization. The task orientation of leaders promotes the willingness of employees to adhere to principles of action and compliance with commitments and policies [78]. Despite the fact that ethical leaders, by sharing power, give employees a sense of competence and merit [79], leading to greater employee responsibility and participation [58], the results of this study showed that there is no relationship between power sharing and conscientiousness. It may be argued that there is no direct relationship between the two and more research is needed to examine the mediating variables between these two factors.

The results also showed that ethical leadership had a positive and significant relationship with moral courage. Because acting morally and courageously can be strenuous, nurses tend to have the support of leaders [25, 68, 80]. Supportive behavior is a characteristic of ethical leadership that helps nurses perform their duties more effectively [48, 51]. Also, the results of a study indicated the effect of moderating role of moral courage in the indirect effect of ethical leadership on the disclosure of suspicious actions (Internal Whistleblowing) [81]. In another study, it was found that ethical leadership and employee loyalty are related to moral courage and that moral courage, as a mediating variable, is relatively involved in the relationship between ethical leadership and employee loyalty [82]. Creating ethical behavior in employees and their ethical guidance is one of the consequences of ethical leadership in nursing [56]. When leaders portray role models of morality and constantly promote and encourage moral values in their followers [53, 83], followers’ motivation is strengthened by moral courage and this increases moral actions.

The results showed that demographic characteristics did not contribute to explaining variance in conscientiousness and moral courage significantly. In line with the results of the present study, the results of Hauhio et al.’s study showed that there was no relationship between age, work experience, and highest degree with moral courage [30]. No significant correlation was found between the level of conscientiousness and job factors in the study by Kwiatosz-Muc et al. [84]. Of course, these findings are inconsistent with some previous research findings [31, 33]. Difference in research units and the cultural and value differences could be the reason for these disparities. Iranian civilization emphasizes the observance of moral behaviors, meritocracy, and so on [57]. In Iranian society, nurses and nursing leaders are mostly Muslim and, regardless of any underlying factors, consider themselves responsible for performing their duties and ethics [10, 48].

The relationship between ethical leadership, conscientiousness, and moral courage suggests that nursing managers, by adopting such an approach in leadership, can increase conscientiousness and moral courage in nurses. Informing nursing managers and providing supportive programs such as periodic counseling can be effective in guiding their performance.