Speak-up behavior among oncology nurses was facilitated by a work environment that fosters organizational trust and structural empowerment, according to results of a recent study. The study findings were reported in the Journal of Nursing Administration.

Speak-up is defined as “expressing concerns for the benefit of patient safety and quality of care, upon awareness or recognition of the risky or incomplete actions of others within healthcare teams,” the researchers conducting the study explained in their report. They set out to evaluate variables of speak-up behavior, organizational trust, and structural empowerment.

The descriptive, survey-based study was conducted at 2 hospitals in Ankara, Turkey, and took place between January and September of 2019. Oncology nurses at both hospitals who met several criteria were given a form for collecting sociodemographic data, in addition to the Employee Voice Scale, the Organizational Trust Scale, and the Conditions of Work Effectiveness Questionnaire II (CWEQ). The Employee Voice Scale was used to measure speak-up behavior, the Organizational Trust Scale was used to evaluate organizational trust, and the CWEQ was used to assess empowerment.

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The study included 232 participants; 52.2% were aged 30 to 39 years. Most of the nurses (76.7%) had at least a bachelor’s degree, and 6.9% were working in a managerial position. More than one-third (35.8%) of participants had been working as a nurse for more than 15 years, and more than half (52.6%) were working at least 40 hours per week.

Scores were considered to be high on the questionnaires. Respondents had a mean score of 21.71±6.07 on the Employee Voice Scale, a mean score of 179.44±38.57 on the Organizational Trust Scale, and 62.00±10.83 on the CWEQ.

Sociodemographic characteristics associated with greater speak-up behavior included age 30 to 39 years, having worked in the clinic for 5 or more years, working 40 hours per week (compared with working more than 40 hours per week), and working in a training and research hospital (P <.05 for each). Educational status and certain other sociodemographic characteristics did not appear linked to speak-up behavior.

Speak-up behavior was also positively associated with total organizational trust scores and scores related to “trust in the manager,” “trust in the organization,” and “trust in colleagues” (P <.05 each). The speak-up behavior mean score showed negative associations with “access to support,” “access to resources,” and “formal power” (P <.05 each).

“In light of these findings, nurses and nurse managers should create and support policies and environments where working conditions and strong organizational trust, support, and structural empowerment are present, thus promoting speak-up behaviors,” the researchers concluded.


Gencer O, Duygulu S. Speak-up behavior of oncology nurses: organizational trust and structural empowerment as determinants. J Nurs Adm. 2023;53(9):453-459. doi:10.1097/NNA.0000000000001315