Background The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to promote an ethical climate that support nurses’ moral courage for sustaining excellence in patient and family care. Aim This study is directed to develop a structure equation model of crisis, ethical leadership and nurses’ moral courage: mediating effect of ethical climate during COVID-19. Ethical consideration Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University, Egypt. Methods A cross-sectional design was used to conduct this study using validated scales to measure the study variables. It was conducted in all units of two isolated hospitals in Damanhur, Egypt. A convenient sample of 235 nurses was recruited to be involved in this study. Results This study revealed that nurses perceived a moderate mean percent (55.49 ± 3.46) of overall crisis leadership, high mean percent (74.69 ± 6.15) of overall ethical leadership, high mean percent (72.09 ± 7.73) of their moral courage, and moderate mean percent of overall ethical climate (65.67 ± 12.04). Additionally, this study declared a strong positive statistical significant correlation between all study variables and indicated that the independent variable (crisis and ethical leadership) can predict a 0.96, 0.6, respectively, increasing in the dependent variable (nurses’ moral courage) through the mediating impact of ethical climate. Conclusion Nursing administrators should be conscious of the importance of crisis, ethical leadership competencies and the role of ethical climate to enhance nurses’ moral courage especially during pandemic. Therefore, these findings have significant contributions that support healthcare organizations to develop strategies that provide a supportive ethical climate. Develop ethical and crisis leadership competencies in order to improve nurses' moral courage by holding meetings, workshops, and allowing open dialogue with nurses to assess their moral courage.

Aim: This study aimed to investigate the relationship between toxic leadership and nurse followership effectiveness. Design: A quantitative cross-sectional study. Methods: This study was carried out in all medical and surgical inpatient care units at Alexandria Main University Hospital. In total, 343 nurses completed the toxic leadership scale and followership styles questionnaires. Frequencies and percentages were used to present demographic characteristics; means and standard deviations were used to present continuous variables. An independent sample t-test, Pearson correlation, and linear regression analysis were conducted to test the nature of the relationship between study variables. Results: The results indicated a slightly moderate mean percentage score for toxic leadership and a slightly high mean percentage score for nurse followership effectiveness. In addition, there was a significant negative weak correlation between toxic leadership and nurse followership effectiveness. Conclusion: Training programs should be designed for leaders and followers to develop self-insight / awareness, maintain self-control and accountability, and advance followership skills. Controlling systems should be developed for the immediate identification of ongoing toxic leadership behavior in the organization, and a whistleblower protection system should be established.

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Background: Clinical risk management (CRM) is the cornerstone of the system approach to achieve patient safety, human error management in health care, and reduction of the incidence and impact of preventable adverse events. It is related to risk management of clinical care in healthcare setting. Research objectives: The main purpose of this study is to assess the perception of staff nurses of the clinical risk management in private and governmental hospital. Subjects and Methods: A descriptive research design was used in carrying out this study. It was conducted at two hospitals: private and governmental hospital. Subjects of the study included 300 nurses. The data collection forms consisted of two tools namely, clinical risk management questionnaire and risk program occurrence checklist. Results: The overall study subject had perceived moderate level of CRM (40.54 ± 16.89). However, the studied nurses in the private hospitals had perceived higher level of clinical risk management than nurses in governmental hospital (53.23 ± 15.43, 27.85 ± 3.17 ) respectively. Conclusion: This study concluded that all the studied staff nurses perceived moderate level of CRM. However, there was a significant difference according to hospital ownership, as the governmental hospital perceived lower level of CRM and risk management program than those in private hospital. Recommendation: Developing training programs for nurses to improve their knowledge and skills of CRM.