Limitations
The following limitations should be consideredwhen
interpreting this study’s findings. Although the results
of the path analysis show significant interrelationships
between the study variables and an excellent
model fit, the cross-sectional design of the RN4CAST
study allows no inference or assessment of causal
relationships. In addition, the data used for this study
were derived from nurse survey data from a national
sample of acute care hospitals and may not be transferable
to other types of institutions. Social desirability
bias is always a potential limitation when self-report
data are collected. Nevertheless, this study’s findings
indicate significant associations between variables,
which are clinicallymeaningful and relevant to leadership
practices, including direct interaction with nurses
on the frontline, to buildmutual trust, thereby promoting
patient safety and overall quality of care.Given that
a major limitation of our study is the cross-sectional
design of the parent study (RN4CAST), our model requires
testing in a prospective study to understand the
nature of the indicated relationships.