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. 2025 Jun;22(3):e70035.
doi: 10.1111/wvn.70035.

Association of Nurse Managers' Anger Expression and Nurses' Intention to Report Medication Errors: The Role of Perceived Uncertainty

Heba Emad El-Gazar  1 , Mona Shawer  2   3 , Aqeel M Alenazi  4 , Mohamed Ali Zoromba  5
Affiliations

Association of Nurse Managers' Anger Expression and Nurses' Intention to Report Medication Errors: The Role of Perceived Uncertainty

Heba Emad El-Gazar et al. Worldviews Evid Based Nurs. 2025 Jun.

Abstract

Background: Although medication errors pose life-threatening risks to patients, and reporting them can help prevent future incidents, our understanding of the factors influencing nurses' intentions to report such errors remains incomplete. Furthermore, the underlying mechanisms driving this association have yet to be fully identified.

Aims: The study aimed to explore the association between nurse managers' anger expression and nurses' intentions to report medication errors and to examine the mediating role of perceived uncertainty in this association.

Methods: Two separate studies were conducted. In Study 1, a methodological study was carried out between January and February 2024 to develop and validate a scale assessing nurses' intentions to report medication errors. This study involved 209 clinical nurses from two tertiary governmental hospitals in Mansoura, Egypt. In Study 2, a cross-sectional survey was conducted between April and June 2024 to test the study hypotheses. A total of 286 clinical nurses from three different tertiary governmental hospitals in Mansoura, Egypt, completed a questionnaire measuring leader anger expression, perceived uncertainty, and intentions to report medication errors. Data were analyzed using structural equation modeling.

Results: In Study 1, the findings provided evidence for the reliability and validity of the Medication Errors Reporting Intention Scale. In Study 2, nurse managers' anger expression was negatively associated with nurses' intentions to report medication errors (β = -0.77, p < 0.001). Perceived uncertainty mediated this association (β = -0.62, 95% CI [-2.80, -0.96]).

Linking evidence to action: Nurse managers should implement strategies to regulate their expressions of anger, thereby alleviating uncertainty among nurses and potentially enhancing their intention to report medication errors.

Keywords: leader anger expression; medication errors reporting intention; nurses; uncertainty.

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