Introduction: Research shows steady growth in clinical leadership (CL); however, CL is still misunderstood in all clinical environments. Few studies have been conducted on the CL needs of nursing staff. No studies have linked CL needs (CLeeNs) in nursing to safety climate (SC) in clinical settings. Therefore, this study analyzed the differences in the perceived nurses' CL needs and SC between nurses and nurse managers.
Methods: A cross-sectional research design was implemented employing an online survey. A convenience sample of 252 registered nurses (RNs) and 139 nurse managers was employed using the Clinical Leadership Needs Analysis (CLeeNA) instrument and the Safety Climate Survey (SCS).
Results: The chi-square test showed that nurse managers differed from nurses in most of the sample demographics, except in their time commitment, area of work, and the reported decision-making style in their area of work. The mean score of the overall scale of CLeeNs was "very important" (M = 6.05, SE = 0.072). The highest mean of the subscales was for "standards of care." In contrast, the lowest mean of the subscales was "financial and service management." The T-test revealed that the total mean score of CLeeNs was higher among nurse managers as compared to that of nurses (6.52 ± 1.01 vs. 5.79 ± 1.55, p = .001), which held the same trend for all subscales and the individual mean scores of CLeeNs for the privilege of nurse managers. The mean score of the perceived SCS of the total sample was 3.41 (SE = 0.032), indicating negative perceptions of the SC. Although there were no statistically significant differences in the total and individual mean scores of SC (p = .252), nurse managers reported slightly higher scores (3.46 ± 0.64) than nurses (3.38 ± 0.62). This result indicates that there were no significant differences found between RNs and nurse managers in SC scores, and a weak negative correlation was observed between CLeeNs and SC.
Conclusions: CL and CLeeNs are essential for a safe climate; however, little is known about how nurses and nurse managers differ in their perceived CL and SC in practice. CL should be sustained in all hospital settings. The low perceived SC is worrying and mandates immediate intervention at all organizational levels. Notably, a negative correlation was observed between CLeeNs and SC, suggesting that stronger perceptions of CL do not necessarily translate into more favorable SC perceptions.
Keywords: clinical leadership needs; nurse managers; nurses; safety climate.
© The Author(s) 2026.