Psychological Safety and Workaholism Among Nurses: The Mediating Role of Patient Expectation Management and the Moderating Role of Age.

BACKGROUND: Psychological safety is an important organizational resource that promotes open communication, learning, and collaboration in nursing. However, its potential association with less desirable outcomes, such as workaholism, remains unclear. This study examined the associations between perceived psychological safety and workaholism among nurses, focusing on the mediating roles of supporting and suppressing patient expectations and the moderating role of age. METHODS: Data for this study were obtained from 523 nurses employed in public hospitals across Türkiye using a cross-sectional survey design. Data were collected using validated measures of perceived psychological safety, patient expectation management, and workaholism. Gender, marital status, professional experience, unit experience, and role were included as covariates. The hypothesized conditional process model was evaluated using Hayes' PROCESS macro (Model 58), incorporating 5000 bootstrap samples and HC3 robust standard error estimates. RESULTS: Perceived psychological safety was positively associated with supporting expectations (b = 0.762, p < 0.001) and suppressing expectations (b = 0.241, p < 0.001). Both dimensions were positively associated with workaholism. Significant indirect effects were observed through supporting expectations (effect = 0.170, 95% CI [0.057, 0.291]) and suppressing expectations (effect = 0.209, 95% CI [0.126, 0.292]) at mean age. Age moderated the association between psychological safety and suppressing expectations, with stronger effects among older nurses. Age also moderated the association between supporting expectations and workaholism, such that the indirect effect was significant only at mean and higher age levels. CONCLUSIONS: Perceived psychological safety may be associated with workaholism through patient expectation management behaviors, with age strengthening specific pathways. These findings highlight the importance of balancing psychologically safe work environments with strategies that promote sustainable work practices. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should complement psychological safety initiatives with workload monitoring, role clarity, boundary-setting support, and patient expectation management training. Age-sensitive workload and support policies may help reduce the risk of workaholism and promote nurse well-being.