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Article

Sustainable Employer Branding as a Catalyst for Safety Voice Behavior in Healthcare: The Mediating Role of Employee Engagement

by
Mohammad Ta’Amnha
1,
Selma Kurtishi-Kastrati
1,
Ihab K. Magableh
2 and
Hosam Alden Riyadh
3,4,*
1
College of Business Administration, American University of the Middle East, Egaila 54200, Kuwait
2
Small and Medium Enterprises Center, Arab Planning Institute, Safat 13059, Kuwait
3
Accounting Department, School of Economics and Business, Telkom University, Bandung 40257, Indonesia
4
Accounting and Finance Department, Faculty of Business, Curtin University Malaysia, Miri 98009, Malaysia
*
Author to whom correspondence should be addressed.
Sustainability 2025, 17(11), 4890; https://doi.org/10.3390/su17114890
Submission received: 29 March 2025 / Revised: 3 May 2025 / Accepted: 12 May 2025 / Published: 26 May 2025
(This article belongs to the Section Sustainable Management)
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Abstract

:
Sustainable marketing emphasizes the integration of social and environmental responsibility into business strategies, positioning employer branding as a vital tool for advancing sustainable organizational practices. Within the healthcare context of Jordan—a country facing unique socio-cultural and systemic challenges—employer branding may foster a culture that promotes safety and employee well-being. While the findings are context-specific, they offer preliminary insights that may be useful in similar healthcare environments in the Middle East or other collectivist settings. This study explores the use of employer branding as a strategic lever to enhance nurses’ safety voice behavior, a critical component of organizational safety and patient care, through the mediating role of employee engagement. Drawing on employer brand theory and self-determination theory, this research investigates how a strong employer brand image contributes to a more engaged nursing workforce, thereby encouraging proactive communication regarding safety concerns. Data were collected from 240 nurses employed at Jordanian hospitals between September and November 2024. The findings reveal that sustainable employer branding—characterized by transparent, ethical, and inclusive organizational values—significantly enhances employee engagement and, in turn, motivates safety voice behavior. By cultivating a supportive work environment that aligns with nurses’ intrinsic motivations, hospitals can improve not only internal communication around safety but also long-term organizational resilience and trust. This aligns with sustainable marketing principles, which advocate for responsible internal stakeholder engagement as part of a broader sustainability agenda.

1. Introduction

Due to the challenging, high-stress nature of medical jobs, it is unsurprising that medical staff, particularly nurses, experience exhaustion, anxiety, and job burnout [1]. As a result, nurses’ mental health and well-being constitute a primary concern for medical institutes’ administrations, leading to the development of various strategies and interventions [2].
In addition, the demand for health services globally is increasing significantly due to changes in demographic factors, such as an increasing life expectancy and aging societies; therefore, it is expected that the number of medical staff positions that need to be filled will exceed 30 million globally by 2030 [3]. Furthermore, more than half the world’s population still needs medical coverage according to the World Health Organization and other similar institutes that extensively allocate financial funds to sponsor various medical projects in less privileged areas [3].
According to a World Health Organization report, a global shortage of 7.2 million healthcare workers is projected, with the required number of nurses alone expected to reach 12.9 million by 2035 [4]. In Jordan, the nursing shortage is primarily driven by the immigration of nurses to countries like Germany, Canada, the UK, and the Gulf states, where they can access better salaries and benefits [5]. Poor working conditions and an unsupportive work environment also drive nurses to migrate as they seek better opportunities abroad.
Nurses in Jordan experience sustained stress, burnout, and job demands that exceed their capacity or resources, affecting their attitudes toward their jobs and organizations [6]. In addition, the increasing number of refugees who are escaping to Jordan is placing more pressure on the country’s infrastructure and health system [7]. This situation requires a significant intervention to assist nurses in coping with their job-related hindrances and challenging stressors in order to help them achieve their job objectives and satisfy their demands [8]. Since employees are an organization’s most valuable asset, employer branding stresses that investing in employees’ development and well-being boosts organizational performance [9]. Therefore, in this study, we adopt a unique and vital approach by exploring how employer branding within healthcare institutions influences nurses’ work engagement and safety voice behavior. Focusing specifically on the healthcare sector, we aim to highlight how strong employer branding can improve job satisfaction and engagement among nurses and encourage behaviors that promote safety and better patient care.
This topic has yet to be extensively explored, but it has immense potential for improving healthcare [10]. Employer branding reflects the quality of an employee’s working experiences, centered around the Employee Value Proposition (EVP), which comprises the various values organizations offer their employees [11]. Ref. [12] conceptualized employer branding as an institute comprising three fundamental pillars: regulative, professional, and cultural–cognitive aspects. Constantly investing in these three pillars strengthens and enhances an organization’s employer brand, which leads to favorable outcomes. Certainly, employer branding is a significant strategy that enables organizations to enhance their growth and survival [13].
We conducted a literature review that revealed there are few studies on employer branding in the healthcare sector, with a few notable exceptions [10,14], which have made valuable contributions to the topic within this context. However, there is a pressing need for further research to address more aspects of employer branding and its mechanism and impacts, underlining the importance of this topic within the healthcare sector. There is a dearth of research addressing the impact of the employer brand on safety voice behavior and the role of employee engagement in this relationship. However, despite a growing interest in employer branding, the existing literature has predominantly focused on its implications for recruitment, retention, and organizational commitment in general business contexts [15,16]. There remains a significant theoretical gap in understanding how employer branding influences employee safety voice behavior, particularly in high-stakes environments such as healthcare. In settings like hospitals—where voicing safety concerns can directly impact patient well-being—employees often face heightened psychological and contextual barriers to speaking up. Yet, the extent to which employer branding can mitigate these barriers and foster a climate conducive to voicing safety concerns remains underexplored. Most prior studies have either examined safety voice in isolation [17] or employer branding in terms of broader workforce management [10,14], without integrating the two constructs within the unique constraints of clinical environments. Therefore, in this study, we aim to fill this critical void by examining how employer branding—through the mediating mechanism of employee engagement—facilitates safety voice behavior among nurses in Jordanian hospitals, contributing new insights to both the employer-branding and healthcare safety literature.
Employer brands are crucial in motivating employees to contribute meaningfully to their work. According to social exchange theory [18,19], employees tend to evaluate the benefits they receive from their employers, affecting their attitudes and behaviors [20]. Accordingly, it is assumed that a solid and appealing employer brand encourages employees to exhibit positive attitudes and behaviors [12]. This study proposes that employer brands encourage employees to voice their concerns regarding safety. While the conceptual framework grounded in self-determination theory (SDT) offers valuable insight, it is equally essential to support this link empirically. Existing studies have shown that social value, a key dimension of employer branding, fosters trust and collegiality that lowers perceived risks associated with speaking up—both of which are critical to safety voice. For example, ref. [21] found that socially responsible HRM practices significantly enhance moral voice behavior through the SDT-based mechanisms of relatedness and autonomy. Similarly, ref. [22] empirically demonstrated that psychological safety, derived from supportive interpersonal relationships (i.e., social value), is positively correlated with voice behavior. Moreover, development value, encompassing professional growth and skill-building, has been linked to safety outcomes via increased perceptions of competence—one of SDT’s core psychological needs. Ref. [23] showed that high-performance work systems emphasizing employee development were associated with stronger engagement climates and higher rates of voicing safety concerns. These findings underscore that employer brand attributes, when aligned with SDT needs (autonomy, competence, and relatedness), not only enhance engagement but also predict proactive safety behaviors in organizational settings.
Safety voice behavior refers to employees’ willingness to express concerns about health and safety issues and propose constructive ways to improve organizational health and safety, particularly within the healthcare sector [23]. Strong employer brands are also thought to encourage employees to share their ideas and advice with their colleagues. This is especially critical for the fast-paced nature of medical work, which requires prompt and effective responses from medical staff [24]. In this study, we employ Deci and Ryan’s self-determination theory (SDT) [25]. This significant motivational theory provides insights into an individual’s motivation to meet their psychological needs. This theory, which suggests that individuals are most productive when their needs are met, is particularly relevant to understanding and improving nurses’ safety voice behavior in the workplace.
Our research aligns with self-determination theory (SDT), which proposes that employees become more engaged and motivated when their core psychological needs, including autonomy, competence, and relatedness, are met [26]. Notably, employees become motivated when they perceive themselves as competent and able to meet their job responsibilities at the highest level [27]. In addition, when employees are given flexibility and autonomy in executing their tasks, they sense a deep feeling of responsibility and ownership and become more committed to their organizations [28]. This sense of empowerment increases employees’ levels of engagement and fosters the reciprocal desire to add significant value to their companies [29]. Therefore, employees’ tendency to share their ideas with their employers increases, and their ideas become more effective [30].
SDT suggests there are three core psychological needs: Autonomy is a core psychological need that is a powerful force. It empowers individuals to make decisions and shape their work uniquely, instilling a sense of control over their actions and choices, inspiring them to take charge of their work and contribute to a safer work environment. Competence, another core psychological need, is the key factor in an individual’s sense that they are seeing to their job responsibilities adequately and skillfully. It allows individuals to confidently and skillfully meet their job responsibilities and fulfill objectives. It makes them feel competent and skilled, enhancing their job performance and safe voice behavior. Relatedness, the need to feel related and validated by others, is crucial. It fosters a sense of belonging, support, and effective exchange of benefits within social networks. It makes individuals feel connected and supported, enhances their safety voice behavior, and contributes to a safer work environment.
Concerning our research interest in nurses’ safety voice behavior, SDT can be integrated as follows. Employer branding as an independent factor: Maintaining a robust employer brand is a significant strategy used to maintain current employees’ health and productivity and promote the perception of an organization as an employer of choice. So, employer brands serve to tell employees that they and their psychological needs are cared for as well as foster a culture of mutual trust and acknowledgment. Employer brands meet employees’ needs for autonomy through fostering a feeling of empowerment and implicit value, meeting the needs of competence through training and career development, and meeting the needs of relatedness through social value and well-being. Job engagement as a moderator: Job engagement is a positive attitude that reflects one’s emotional attachment and intellectual commitment to one’s job, thereby enhancing an organization’s results [31]. This can be noticed through employees striving to achieve job objectives, staying committed to their employer, and sharing their ideas and concerns [32]. Employer branding rewards employees for seizing developmental opportunities that allow them to engage in their work at the highest level and enhance their competencies, and, therefore, they tend to exercise voice behavior as part of their performance evaluation of initiative and teamwork [33].
Employer brands enhance employee engagement, allowing employees to express their concerns in order to keep an organization in operation and sustain it through a promotive voice that enhances the organization’s operations, and they also allow employees to share their prohibitive opinions in order to reduce risks that negatively affect the operations of an organization [34]. In our study, we focus on the safety aspect of job engagement. When employees are highly engaged in their work, they are more likely to voice their safety concerns or suggestions, contributing to a safer work environment. In sum, when employees feel empowered and competent due to a robust employer brand, they are more likely to be motivated to use their safety voice. Therefore, as per SDT, the employer brand becomes a significant driver of safety voice behavior. The importance of this study stems from focusing specifically on the healthcare sector in Jordan, a topic that has rarely been explored in previous research. This region has specific characteristics linked to the Jordanian culture and other contextual factors that differentiate this research from previous studies. Indeed, most employer-branding and safety voice behavior research has been conducted in Western countries, which are different from Arabic countries in several ways that affect organizations’ operations and activities [35]. Therefore, this study offers substantial knowledge about the impact of the employer branding in the Jordanian healthcare sector. In addition, Jordan has a very competitive and advanced healthcare system in comparison to other nations in the Middle East [36]. This competitiveness leads to intense competition over highly qualified medical staff, including the nurses critical to a hospital’s performance and reputation [37]. By creating and building a strong employer brand, medical organizations can attract and retain highly qualified employees and enhance their performance and productivity [12]. Focusing mainly on service quality and neglecting the quality of the working experience and values is problematic. This is because the quality of the services provided to patients and clients depends mainly on the employees who deliver these services [38]. Employer brands enhance the reputation of organizations in the labor market by promoting a work–life balance culture that increases employees’ commitment and performance [39]. In addition, nurses may find that the developmental opportunities provided by their medical institutes promote positive attitudes at the workplace and improve their work outcomes [40]. Employee career motives and interests are also critical in employee motivation and performance [41]. As mentioned above, healthcare institutes can become more adept and efficient at attracting highly qualified medical staff and keeping current employees engaged and productive by creating and maintaining robust employer brands that promote attractive values.
Moreover, this research sheds more light on employer-branding activities, which receive less attention from medical institutes than service-branding strategies. Indeed, there is no doubt that healthcare institutes can gain a competitive advantage in the medical sector through ongoing investment in the quality of the services provided [42], especially in small but highly challenging markets such as the Jordanian market [43]. However, attracting highly qualified staff and maintaining motivation are crucial to sustaining medical care institutes. This is because the quality of health services relies heavily on the people delivering them. In addition, there must be compliance with regulatory requirements and license conditions that require specific employee certificates and experience.
Therefore, we aim to contribute to the academic discourse and provide the healthcare sector with valuable and meaningful insights that could significantly improve work engagement and safety voice behavior among nurses, paving the way for a promising future for healthcare professionals. In sum, this research provides substantial theoretical, practical, and contextual insights into employer branding. It offers significant insight into how employer branding impacts employee safety voice behavior through the mediating impacts of employee engagement in an Arabic context. In this vein, the findings of this research can provide significant professional advice on how healthcare institutions can increase employee safety and voice behavior linked with citizenship behavior, which is usually voluntary and not rewarded. When organizations offer their support and resources to their employees, the employees become more indebted to their organizations, and, therefore, they increase their engagement in their organizations and offer more opinions. This paper is structured as follows: Section 2 reviews relevant theoretical frameworks and the prior literature. Section 3 details the methodology and data collection from Jordanian hospitals. Section 4 presents the empirical results. Section 5 discusses key findings in relation to prior research. Section 6 concludes this study, providing practical implications, study limitations, and suggestions for future research.

2. Literature Review and Hypothesis Development

This study is grounded in self-determination theory (SDT) [25,44] and employer brand theory [15], which together provide a coherent framework for understanding how employer branding may influence safety voice behavior through employee engagement. According to SDT, individuals are intrinsically motivated to engage in behaviors that satisfy their psychological needs for autonomy, competence, and relatedness. In organizational settings, when these needs are fulfilled through employer practices and branding efforts, employees become more engaged and willing to take the initiative, including voicing safety-related concerns [25]. Simultaneously, employer brand theory posits that organizations cultivate distinctive employment value propositions (EVPs) that affect employee perceptions, attitudes, and behaviors. These include values such as career development, work–life balance, fairness, and ethical leadership [45]. Integrating these theories, in this study, we propose that employer branding enhances safety voice behavior via increasing employee engagement. Employer branding practices—such as engaging in ethical communication, offering developmental opportunities, and fostering an inclusive culture—are assumed to satisfy SDT’s core psychological needs, leading to heightened engagement and, subsequently, proactive safety behaviors. This theoretical framework guides the development of this study’s two main hypotheses, as shown in Figure 1. The research model suggests that a robust employer brand positively impacts employee safety voice behavior—i.e., employees’ desire and willingness to share their thoughts and ideas related to safety issues in the workplace through high employee engagement. When employees view their employer’s reputation based on experience and the several values within their organization, they become more engaged with and attached to their organization, encouraging them to speak up about safety issues actively. In other words, this model proposes that high levels of employee engagement play a substantial mediating role between employer brand and safety voice behavior, leading to valuable outcomes.

2.1. The Impact of the Employer Brand on Employee Safety Voice Behavior

Employer branding has become a vital approach in the search for top talent, as organizations recognize the importance of differentiating themselves in a competitive job market. A strong employer brand not only attracts skilled candidates but also helps retain existing employees, fostering a positive organizational culture and enhancing overall employee satisfaction and engagement [16]. Employer branding is a strategy [12] including the tangible and intangible benefits offered by organizations through HR activities and policies [46] that enables organizations to win the war for talent [47]. It comprises various benefits provided to employees, and when effectively communicated internally and externally, organizations can create favorable and unique images that differentiate themselves from competitors [13]. Employer brands enhance employee organizational commitment, engagement, and performance [48], which play a crucial role in talent acquisition strategies, attracting highly qualified candidates from the labor market [49,50]. This is particularly relevant in the medical sector and among nurses, as their work is demanding and risky, leading to high stress and emotional exhaustion [51]. Given these challenging conditions, healthcare management must provide nurses with substantial support to maintain their effectiveness and resilience [2]. In this study, we propose that strengthening employer brands significantly enhances safety voice behavior among nurses in Jordan.
Employer branding represents how desirable an organization’s brand appears to current and future talent. An attractive workplace setting promotes various values assumed to positively impact safety voice behavior. Ref. [45] grouped these values and their aspects into five distinct categories. First, social values, a significant component of the employer brand, refer to employees’ experiences regarding friendship, enjoyment, supportive colleagueship, and an enjoyable working atmosphere. This collaborative and motivating work atmosphere, fostered by a strong employer brand, encourages employees to share their voices, as they feel safer and less threatened by potential retaliation [21]. It also instills a sense of acknowledgment, value, and appreciation for their contributions, motivating them to engage in safety voice behavior extensively.
Second, interest values refer to how employees evaluate their work, specifically whether they find it motivating and inspiring. When employees find their work encouraging and challenging, they become more engaged and are more willing to exert extra effort and take responsibility for their surrounding environment [52], including by exhibiting safety voice behavior [22]. Third, development value, an essential aspect of employer branding, refers to personal and professional growth within an organization. By investing in employees’ career development and enhancement, organizations can foster a sense of security and a willingness among employees to express their constructive voices, including safety concerns, proactively [23]. Fourth, application value refers to an employee’s ability to convert their skills and knowledge into practices that enable them to perform their jobs effectively and enhance the quality of the work [45].
When employees can apply their knowledge in an intellectually stimulating environment, they become more engaged and confident in sharing their ideas, even beyond their formal tasks and responsibilities [53]. This includes suggesting safety-related changes to enhance the attractiveness and comfort of their workplaces [54]. Fifth, economic value refers to competitive financial rewards, benefits, and job security that enhance an organization’s attractiveness [45], providing employees with a safe foundation to express their ideas in promotive and prohibitive ways without feeling threatened by management. Based on the above description, we propose the following hypothesis.
H1. 
Employer branding has a significant and direct impact on employee safety voice behavior.

2.2. The Mediating Impact of Employee Engagement on the Relationship Between Employer Branding and Employee Voice Behavior

Employee engagement refers to employees’ emotional, psychological, and behavioral commitment to their organization [31]. Employee engagement is positively associated with proactive behavior, such as voicing safety concerns, as engaged employees feel more empowered and motivated to contribute beyond their current roles. When employees develop a sense of ownership of their work and contribution to their organization’s sustainability, they develop a strong sense of responsibility to share their constructive ideas and feedback, including those associated with safety, for the refinement of their organization.
Employer branding refers to intentionally institutionalizing workplace attractiveness through organizational investment in various resources [12]. This involves fostering a supportive and intellectually stimulating organizational culture that enriches employees’ experiences, including team-building activities, training and development initiatives, and integration activities [55]. Such efforts attract highly qualified individuals with solid personal resources, like resilience, self-efficacy, and engagement, who add value to organizations. Research has revealed that the stronger the employer brand, the more engaged employees become, encouraging them to exert more significant efforts and strive to fulfil their job responsibilities [56].
The employer brand creates a foundation for employee engagement, motivating employees to express their safe voice behavior. Thus, we propose the following hypothesis.
H2. 
Employee engagement mediates the relationship between employer branding and safety voice behavior.

3. Materials and Methods

3.1. Research Approach

We adopted a quantitative research approach based on a cross-sectional survey to investigate the predictive relationship between employer branding, employee engagement, and employee safety voice behavior. Although longitude studies offer more insight into the phenomenon of interest, a cross-sectional survey allows the collection of data at a single point in time, enabling the capture of a snapshot of the research variables within the targeted nursing population.

3.2. Sample and Population

The population analyzed in this study consists of workers in healthcare organizations, specifically nurses, since they are critical staff members whose expression of safety concerns contributes significantly to the organization’s outcomes. A sample of 240 nurses was selected randomly to ensure a representative response would be obtained and reduce data collection biases. The nurses invited to participate in this study work in healthcare institutes in Jordan, where safety voice behavior is a critical factor and has a direct impact on the nursing work.

3.3. Data Collection

Data were collected through a self-administered, online Google form questionnaire. The questionnaire consists of four main sections related to the study factors: general information about the participants, employer brand, employee engagement, and safety voice behavior.
  • General Information: This included age, gender, years of experience, educational attainment, etc.
  • Employer Brand: A scale adapted from [45] was used to assess perceptions of brand value. This scale consists of 25 items measuring the five dimensions of the employer brand. Social value (a fun working environment), interest value (working in an exciting environment), development value (recognition/appreciation from management), application value (opportunities to apply what was learned at a tertiary institution), and economic value (good promotion opportunities within the organization).
  • Employee Engagement: A 17-item scale [57] captured the nurses’ identification and attachment to their organization (I find the work that I do full of meaning and purpose).
  • Safety Voice Behavior: This was measured through items that gauge employees’ willingness to speak up about safety-related issues and offer constructive feedback [58] (e.g., I proactively make suggestions for overall safety planning, and I report the consequences of hazardous working conditions to my leader).
The participants were asked to rate their perceptions of the research variables based on a 5-point Likert scale ranging from strongly disagree to strongly agree.

3.4. Analytical Approach

Data were analyzed based on descriptive statistics that investigated the distribution of each variable. Correlation analysis was conducted to examine the relationships between variables and their strength and significance. Linear analysis was used to investigate the impact of the employer brand on employee safety voice behavior. A hierarchical regression analysis was employed to assess the mediating impact of employee engagement in the relationship between employer branding and employee safety voice behavior.

4. Results

4.1. Correlations

The data revealed a strong interconnectedness between all the study variables, namely, employer branding, employee engagement, and safety voice behavior, indicating that an increase in one factor, such as employer branding, is associated with a positive increment in the other factors, such as employee engagement (Table 1). The high level of correlations is more likely to support our hypotheses that proposed there would be a positive impact of the employer brand on employee safety voice behavior and that there would be a mediating impact of employee engagement in the relationships between employer branding and employee safety voice behavior. Lastly, these findings align well with self-determination theory. This theory was adopted in this research to justify the proposed model and was used in interpreting and discussing the research findings. Specifically, this theory proposes that the extrinsic motivator (employer branding) and the intrinsic motivator (employee engagement) promote proactive behavior, such as voicing safety concerns, as employees feel valued and supported.

4.2. Descriptive Statistics

The descriptive statistics (Table 2) for employer branding, employee engagement, and safety voice behavior offer an overview of the nurses’ responses. All three variables reveal relatively high mean values across the 240 responses.
For employer branding, the mean score is 3.75, with a standard deviation of 0.62, indicating a generally positive evaluation of the employer brand among the research participants. Concerning employee engagement, the mean score is 3.82, with a standard deviation of 0.63, suggesting that, on average, nurses reported fairly high levels of engagement as well. Similarly, the findings show that the participants are highly willing to share their voices with their institutes, as the mean score is 3.91, with a standard deviation of 0.55. Thus, safety voice behavior showed the highest mean of the studied variables.
The relatively high mean scores for employer branding, employee engagement, and safety voice behavior indicate a positive tendency in the sample toward these factors. The moderate variation in scores, as shown in the standard deviations, aligns strongly with the robust positive correlation found between the research factors, which will be investigated further in the following regression analysis. We propose that greater employer branding leads to higher employee engagement and a greater likelihood of engaged employees expressing safety concerns in their workplaces.

4.3. Normal Distribution Analysis

The skewness and kurtosis values of the three variables—employer brand, employee engagement, and safety voice behavior—were used to gauge the data’s normality (Table 3). Skewness and kurtosis values between −1 and 1 are typically acceptable for a normal distribution.
For the employer brand, the skewness value of −0.305 (SE = 0.157) demonstrates a slight left skew, showing that the responses are slightly concentrated on the higher end of the scale, which indicates a positive perception of the employer brand. The kurtosis for the employer brand is 0.311 (SE = 0.331), close to zero, indicating a normal distribution with no extreme peaks or tails.
The skewness for employer engagement is −0.388 (SE = 0.157), indicating a minor left skew, demonstrating that the employee engagement scores minorly lean toward higher values. The kurtosis value of 0.369 (SE = 0.313) is also close to zero, showing that the distribution of the employer brand scores is normal, without any significant deviation in the form of extreme peaks or outliers.
For employee safety voice behavior, the skewness value of −0.416 (SE = 0.157) reveals a moderate left skew. This shows that the answers are concentrated on the higher end of the scale. This signifies that employees mostly exhibit positive safety voice behaviors by energetically sharing concerns or proposing ideas about safety issues. The kurtosis value of 0.728 (SE = 0.313) is slightly higher than zero, indicating a somewhat more peaked distribution than a normal distribution. This means the nurses’ responses are more clustered around the mean, with fewer extreme values, reflecting consistency in the employees’ safety voice behaviors.
In conclusion, all three variables—employer brand, employee engagement, and employee safety voice behavior—show a slight left skewness, indicating that the responses rated these factors positively. The kurtosis values, being close to zero, suggest roughly normal distributions with no significant deviations.

4.4. Linear Regression

A simple linear regression analysis was executed using employer brand as the independent variable and safety voice behavior as the dependent variable to examine the predictive relationship between employer brands and safety voice behavior.
The model summary table (Table 4) shows that the employer brand predictor variable explains approximately 53.2% of the variance in safety voice behavior (R2 = 0.532). The adjusted R2 value of 0.530 confirms that the employer brand is still a strong predictor of employee safety voice behavior, even after adjusting for the sample size. The standard error of the estimate is 0.378, showing the average distance from which the observed values fall from the regression line.
In Table 5, the ANOVA results support the model’s strength and indicate a significant regression effect (F (1, 238) = 270.896, p < 0.000). This significant F-value confirms that the relationship between employer branding and safety voice behavior is statistically strong, with employer branding effectively predicting variance in safety voice behavior beyond random chance.
As shown in the coefficients (Table 6), the unstandardized coefficient for the employer brand is B = 0.651, demonstrating a significant change in the employer’s voice behavior when employer brand perception improves. This means that employer branding is a significant predictor of employee safety voice behavior that should therefore receive more attention from medical institutes’ administrations given the positive impact of nurses’ safety voice behavior on promoting desirable behavior and the benefits of suggesting prohibitive actions to safeguard institutions against expected undesirable practices. The constant is 1.470, representing the baseline level of employee safety voice behavior when employer brand perception is zero.

4.5. Mediation Need Work

A hierarchical regression analysis was employed to investigate the predictive relationship between employer branding, employee engagement, and employee safety voice behavior. In the first model, we investigated the impact of the employer brand, serving as an independent factor, on safety voice behavior, the dependent variable. In the second model, employee engagement was added as an additional mediator predictor.
As explained previously, the first model showed (Table 7) that employer branding explained 53.2% of the variance in safety voice behavior (R2 = 0.532), with an adjusted R2 of 0.530, indicating a strong predictive capability of employer brand perception. The standard error of the estimate for this model is 0.378, suggesting a good fit. The addition of employee engagement as a mediating factor in Model 2 increased the explained variance to 59.7% (R2 = 0.597), with an adjusted R2 of 0.594, which reflects a 6.5% improvement in the model’s explanatory power.
The significant F-change value of F (1, 237) = 38.305, p < 0.000, reveals that the employee engagement factor contributes significantly to predicting employee safety voice behavior beyond the effect of employer brand alone.

4.6. Coefficients and Predictive Relationships

The ANOVA results presented in Table 8 assess the predictive power of two regression models on employee safety voice behavior. Overall, the results confirm that both employer brand and employee engagement are significant predictors of employee safety voice behavior, with employee engagement contributing additional explanatory value.
In Model 1 (See Table 9), the unstandardized coefficient for employer brand is B = 0.651 (t = 16.459, p < 0.000), signifying that a one-unit increase in employer brand perception is linked to a 0.651 increase in employee safety voice behavior, on average. The high standardized coefficient (Beta = 0.730) highlights the robust effect of employer branding on employee safety voice behavior.
In Model 2, with both employer branding and employee engagement included, the unstandardized coefficient of employer branding declines to B = 0.325 (t = 5.056, p < 0.000), and its standardized Beta decreases to 0.364. This change shows that while employer branding remains a significant predictor, its effect is partially mediated by employee engagement. Employee engagement itself has a significant unstandardized coefficient of B = 0.391 (t = 6.189, p < 0.000) and a standardized Beta of 0.446, stressing its substantial independent contribution to predicting employee safety voice behavior.
With respect to the correlations and collinearity, as shown in Table 9, both predictors (employer brand and employee engagement) show strong zero-order correlations with employee safety voice behavior (employer brand: r = 0.730, employee engagement: r = 0.744), and the partial correlations confirm their unique contributions after the influence of the other predictor (employer Brand partial = 0.312, employee engagement partial = 0.373) is controlled. The collinearity diagnostics show that there are no multicollinearity issues, with tolerance values of 0.328 and VIF values of 3.053 for both predictors, well within the acceptable limits.

5. Discussion

The main objective of this research was to investigate the impact of employer branding on nurses’ safety voice behavior, considering the mediating impact of their engagement. We employed self-determination theory, which stresses the significance of meeting the basic psychological needs, namely, autonomy, competence, and relatedness, for engagement and well-being. Hence, this standpoint offers rich insights into the relationships between the research factors, namely, employer branding, engagement, and safety voice behavior. The current study offers valuable insights into how employer branding (EB) influences nurses’ safety voice behavior (SVB), with employee engagement (EE) serving as a mediating factor. The findings align with both self-determination theory (SDT) [25,44] and employer brand theory [15], highlighting how strategic investments in employer branding can shape employee behavior and foster a culture of safety. The results of this study confirm that a strong employer brand significantly enhances safety voice behavior among nurses by creating a positive and secure work environment where employees feel valued, respected, and motivated to contribute proactively. Specifically, the positive relationship between employer branding and safety voice behavior reflects the core SDT concept of psychological need satisfaction. When organizations meet employees’ needs for relatedness, competence, and autonomy, they facilitate the internalization of organizational goals, such as maintaining a safe work environment. In healthcare contexts, especially among nurses, who often work in highly stressful and risky environments, this psychological security is critical. A strong employer brand conveys the message that an organization cares for its employees’ well-being and professional development, reducing the perceived risks associated with speaking up. Prior studies (e.g., [17,21,59]) support this assertion, suggesting that the social value components of the employer brand—such as collegiality, support, and mutual respect—are essential drivers of safety voice behavior.
The mediating role of employee engagement adds further depth to this relationship. Engagement—characterized by vigor, dedication, and absorption [31]—amplifies the influence of employer branding on proactive behavior. When employees view their workplace as attractive and supportive, they experience a greater sense of emotional and cognitive commitment, which translates into increased safety voice behavior. This supports the tenets of [60] engagement theory, which asserts that meaningfulness, psychological safety, and availability lead employees to invest in their roles fully. Employer branding enhances these conditions through initiatives such as professional development opportunities, recognition programs, and transparent communication, which increase employees’ sense of autonomy and competence—key drivers of safety voice behavior, according to SDT [61]. Moreover, this mediating relationship is consistent with previous empirical findings. The research by [52,61] highlighted that employer brand perceptions significantly boost employee engagement, which in turn fosters behaviors like voicing concerns. The current study reinforces this by showing that engaged employees are more likely to take ownership of organizational outcomes and speak up about safety concerns, contributing to their organization’s internal safety climate and external reputation. By translating a positive perception of the employer brand into meaningful work engagement, employees become more responsible, psychologically empowered, and intrinsically motivated to contribute to safety and well-being. Although our hierarchical regression analysis revealed employee engagement played a partial mediating role between employer branding and safety voice behavior, we did not apply bootstrapping techniques to calculate confidence intervals for the indirect effects. As such, the statistical significance of the mediation should be interpreted with caution. Contemporary mediation testing standards recommend using resampling-based methods (e.g., 5000 bootstrap samples) to derive bias-corrected confidence intervals, which provide a more reliable test of indirect effects. In future studies, researchers should consider employing the PROCESS macro or structural equation modeling (SEM) with bootstrapping to robustly validate the mediation pathways identified here.
Integrating SDT into this analysis yielded a comprehensive understanding of how and why employer branding fosters SVB. Relatedness is cultivated through supportive social environments; competence is enhanced by training and skill application opportunities; and autonomy is encouraged through participative leadership and inclusive communication. These elements, inherent in strong employer-branding strategies, not only promote engagement but also serve as the psychological foundation for constructive concern voicing. This study extends the theoretical application of SDT within healthcare by operationalizing the psychological mechanisms that translate employer branding into safety-focused action. In sum, this study underscores the importance of employer branding as a strategic tool for healthcare organizations aiming to promote a culture of safety. By investing in and displaying an attractive, supportive, and meaningful workplace, healthcare employers can not only attract and retain talent but also engage them in ways that drive proactive behaviors like voicing safety concerns. The mediating role of engagement illustrates a clear pathway through which employer branding impacts outcomes, offering both theoretical advancement and practical strategies for hospital administrators and HR leaders striving to improve organizational safety and performance. However, despite the strong associations observed between employer branding, employee engagement, and safety voice behavior, this study’s cross-sectional design limits the ability to draw causal inferences. Specifically, it is not possible to confirm the directionality of the relationships—such as whether a robust employer brand increases engagement and voice, or whether highly engaged employees retrospectively view their organization more favorably. Although our findings align with theoretical expectations derived from self-determination theory and social exchange theory, longitudinal or experimental studies are necessary to validate the temporal sequence of these constructs and rule out potential reverse causality.
The results of this study align with and extend those of several prior empirical investigations. For example, ref. [56] found that a positive employer brand significantly predicts organizational citizenship behavior, including voice behavior, through the mediating role of employee engagement—a finding consistent with our findings. Similarly, ref. [21] demonstrated that socially responsible HRM practices enhanced moral voice behavior via SDT mechanisms, echoing our evidence that employer branding contributes to voicing safety concerns through engagement. Furthermore, ref. [23] emphasized the importance of high-performance work systems in fostering organizational engagement climates that promote concern voicing, confirming our mediation pathway. In the healthcare context, refs. [22,54] found that supportive climates and perceived competence both significantly predicted safety-related voice behavior. Our results support this by showing that nurses’ engagement—fueled by employer-branding values like development and autonomy—leads to increased safety voice behavior. However, unlike prior research conducted in Western healthcare settings, our study in a Middle Eastern (Jordanian) context highlights the role of cultural and systemic factors in shaping the strength of these associations. Interestingly, while prior studies such as [17] emphasized leadership openness as the primary antecedent to voice behavior, our results suggest that employer branding—an upstream, strategic-level intervention—may act as a cultural signal, shaping engagement and voice even beyond day-to-day leadership behavior.
The findings offer healthcare administrators and HR professionals actionable strategies to enhance safety voice behavior through strategic employer branding. Based on the employer brand dimensions and the SDT framework, the following actions are recommended: First, foster transparent communication channels. Hospitals should institutionalize regular “open forums” or anonymous digital suggestion systems where nurses can voice safety concerns without fear of reprisal. These initiatives signal ethical transparency and support psychological safety. Second, embed ethical and inclusive values into employer branding. HR departments should co-develop value charters with frontline staff—especially nurses—to promote fairness, respect, and patient safety as visible employer brand pillars. These can be showcased during onboarding and in internal communications. Third, invest in professional development for nurses. Tailored development programs (e.g., safety certification workshops, leadership training, etc.) not only reinforce perceived competence—a core SDT need—but also empower nurses to voice safety issues confidently. Fourth, appoint safety voice champions and identify and train peer ambassadors or “safety voice champions” in each unit. These individuals encourage open discussion of safety concerns and serve as bridges between nursing teams and leadership. Fifth, align internal branding with performance appraisal and include safety voice behavior and safety initiative participation as positive indicators in performance reviews, thereby reinforcing that proactive safety engagement is valued and rewarded. Finally, implementing these strategies can create a workplace climate where employer branding is not just an external narrative but an internal operational reality—leading to safer, more resilient healthcare organizations.

6. Conclusions

Employer branding is crucial in developing employee commitment and loyalty, particularly in service organizations. By creating a strong and positive employer brand, organizations can enhance employee engagement, boost retention, and foster a sense of belonging, ultimately contributing to better overall performance and service delivery. This research, situated in the context of Jordanian hospitals, highlights how employer-branding strategies may influence safety voice behavior among nurses. While these findings provide meaningful insights, they should be interpreted in accordance with the socio-cultural and healthcare-specific characteristics of Jordan. Cross-cultural differences—such as norms around power distance, voice behavior, and employer–employee expectations—may limit generalizability to more individualistic or Western healthcare systems. Future research should investigate these dynamics in diverse cultural contexts to assess the universality or variability of these mechanisms. The standpoint of self-determination theory gives rich insights into how meeting employees’ psychological needs for autonomy, competence, and relatedness leads to desirable outcomes. Organizations seeking to create and promote a safe organizational culture should invest in building and maintaining an attractive employer brand and stimulating engagement in working settings that protect them from harmful activities and risky situations, thereby satisfying employees’ basic psychological needs. By doing so, they can encourage employees to be actively concerned about their proactive safety voice behavior and developing more sustainable organizations. Our research makes the following contributions: First, it makes a theoretical contribution to the employer-branding and organizational behavior literature. This research enhances the available knowledge framework regarding employer branding by identifying employee safety voice behavior as a new and critical outcome within the healthcare environment. Prior employer-branding research has largely focused on areas like recruitment, retention, and organizational attractiveness [15]; yet, this research shifts the focus towards internal behavioral outcomes, i.e., proactive safety communication, thus expanding theoretical literature on employer branding. Second, through the application of self-determination theory (SDT) in a healthcare context [44], this research provides empirical evidence of the importance of basic psychological needs—i.e., autonomy, competence, and relatedness—in explaining the mediating effect between employer branding and safety voice behavior. This use is novel, and the SDT literature has been extended by demonstrating how organizational-level interventions (specifically employer branding) meet individual psychological needs, which in turn contribute to significant safety outcomes. Third, we have introduced employee engagement as a key mediator. Our research empirically confirms the mediating role of employee engagement within the relationship between employer branding and safety voice behavior. This contribution positions engagement as a mechanism through which employer branding influences behavioral outcomes. The mediation model extends earlier research (e.g., [60,62]) by showing that engagement not only improves performance but also encourages proactive safety communication, which is a critical outcome in high-risk environments like healthcare. Fourth, our work makes a contextual contribution to employer-branding research in non-Western healthcare contexts. This research makes important contextual contributions by conducting research on Jordanian hospitals, thus investigating a non-Western healthcare context. Employer-branding studies have predominantly been conducted in Western corporate contexts; thus, this research provides cross-cultural validation of and sector-specific evidence supporting the global relevance of employer brand theory and SDT in healthcare.
Regarding practical implications, first, the practical implications for safety management in the healthcare industry were discussed. This study provides hospital leaders and human resource practitioners with actionable recommendations regarding the strategic application of employer branding in order to create a culture of safety. It stresses that investments in internal branding initiatives not only enhance employee commitment but also induce more expressive behaviors among employees, ultimately resulting in increased organizational safety and sustainability—a facet often overlooked in the literature on safety management. Next, this research discussed the junction between human resource management and patient safety research. The findings link patient safety research and human resource management (HRM) by showing that employer branding and other human resource practices can impact nurses’ conversations about safety, which is highly related to patient outcomes. This integrated approach addresses the need for a variety of interventions to enhance the quality of healthcare.
The key limitation of this research is its reliance on a cross-sectional survey design, which captures perceptions at a single point in time. While this approach is valuable for exploring initial relationships, it precludes the ability to make causal claims. In particular, we cannot determine whether employer branding truly leads to increased engagement and safety voice behavior or whether more engaged employees tend to perceive their employers more favorably. Future research employing longitudinal or time-lagged designs could assess the stability and causal direction of these associations over time. Experimental interventions involving employer-branding initiatives may also help establish temporal precedence and clarify the underlying mechanisms. Furthermore, in the current study, we utilized hierarchical regression to assess the mediating role of employee engagement; however, we did not apply bootstrapping to generate confidence intervals for indirect effects. This restricted the statistical rigor with which the mediation hypothesis could be confirmed. Without such procedures, the presence of mediation cannot be definitively established. Future studies should incorporate resampling methods, such as the bootstrapping approach recommended by [63], to enhance inferential confidence in mediation analyses. In the end, although this study provides valuable insights into the role of sustainable employer branding in healthcare, it is limited by its cross-sectional design, single-country context, and reliance on self-reported data. Future researchers could use longitudinal or experimental designs to establish causal relationships, replicate findings in different cultural and sectoral settings, and explore moderating variables such as organizational culture or leadership style.

Author Contributions

Study conception and design, I.K.M.; data collection, S.K.-K.; analysis, M.T.; draft manuscript preparation and interpretation of results, H.A.R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the American University of the Middle East, Kuwait City 15453, Kuwait, on the date of approval, 9 October 2023.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, Hosam Alden Riyadh, upon reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Sustainability 17 04890 g001
Figure 1. Theoretical framework linking sustainable employer branding to safety voice via employee engagement.
Figure 1. Theoretical framework linking sustainable employer branding to safety voice via employee engagement.
Sustainability 17 04890 g001
Table 1. Correlations.
Table 1. Correlations.
Employer BrandEmployee EngagementEmployee Safety Voice Behavior
Employer BrandPearson Correlation10.820 **0.730 **
Sig. (2-tailed) 0.0000.000
N240240240
Employee EngagementPearson Correlation0.820 **10.744 **
Sig. (2-tailed)0.000 0.000
N240240240
Employee Safety Voice BehaviorPearson Correlation0.730 **0.744 **1
Sig. (2-tailed)0.0000.000
N240240240
** Correlation is significant at the 0.01 level (2-tailed).
Table 2. Descriptive statistics.
Table 2. Descriptive statistics.
NMinimumMaximumMeanStd. Deviation
Employee Engagement2401.475.003.82350.62841
Employer Brand2401.525.003.74550.61883
Employee Safety Voice Behavior2402.005.003.90670.55179
Valid N (listwise)240
Table 3. Skewness and kurtosis.
Table 3. Skewness and kurtosis.
NSkewness Kurtosis
StatisticsStatisticStd. ErrorStatisticStd. Error
Employer Brand240−0.3050.1570.3110.313
Employee Engagement240−0.3880.1570.3690.313
Employee Safety Voice Behavior240−0.4160.1570.7280.313
Valid N (listwise)240
Table 4. Model summary.
Table 4. Model summary.
ModelRR SquareAdjusted R SquareStd. Error of the Estimate
10.730 a0.5320.5300.37815
a Predictors: (constant), employer brand.
Table 5. ANOVA.
Table 5. ANOVA.
ANOVA a
Model Sum of SquaresdfMean SquareFSig.
1Regression38.737138.737270.8960.000 b
Residual34.0332380.143
Total72.769239
a Dependent variable: employee safety voice behavior. b Predictors: (constant), employer brand.
Table 6. Coefficients.
Table 6. Coefficients.
Coefficients a
Model Unstandardized Coefficients Standardized CoefficientstSig.
BStd. ErrorBeta
1(Constant)1.4700.150 9.7970.000
Employer Brand0.6510.0400.73016.4590.000
a Dependent variable: employee safety voice behavior.
Table 7. Model summary.
Table 7. Model summary.
ModelRR SquareAdjusted R SquareStd. Error of the EstimateChange Statistics
R Square ChangeF Changedf1df2Sig. F Change
10.730 a0.5320.5300.378150.532270.89612380.000
20.773 b0.5970.5940.351590.06538.30512370.000
a Predictors: (constant), employer brand. b Predictors: (constant), employer brand, employee engagement.
Table 8. ANOVA.
Table 8. ANOVA.
ANOVA a
ModelSum of SquaresdfMean SquareFSig.
1Regression38.737138.737270.8960.000 b
Residual34.0332380.143
Total72.769239
2Regression43.472221.736175.8320.000 c
Residual29.2972370.124
Total72.769239
a Dependent variable: employee safety voice behavior. b Predictors: (constant), employer brand. c Predictors: (constant), employer brand, employee engagement.
Table 9. Coefficients.
Table 9. Coefficients.
Coefficients a
Model Unstandardized Coefficients Standardized CoefficientstSig.
BStd. ErrorBeta
1(Constant)1.4700.150 9.7970.000
Employer Brand0.6510.0400.73016.4590.000
2(Constant)1.1940.146 8.1550.000
Employer Brand0.3250.0640.3645.0560.000
Employee Engagement0.3910.0630.4466.1890.000
a Dependent variable: employee safety voice behavior.
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Ta’Amnha, M.; Kurtishi-Kastrati, S.; Magableh, I.K.; Riyadh, H.A. Sustainable Employer Branding as a Catalyst for Safety Voice Behavior in Healthcare: The Mediating Role of Employee Engagement. Sustainability 2025, 17, 4890. https://doi.org/10.3390/su17114890

AMA Style

Ta’Amnha M, Kurtishi-Kastrati S, Magableh IK, Riyadh HA. Sustainable Employer Branding as a Catalyst for Safety Voice Behavior in Healthcare: The Mediating Role of Employee Engagement. Sustainability. 2025; 17(11):4890. https://doi.org/10.3390/su17114890

Chicago/Turabian Style

Ta’Amnha, Mohammad, Selma Kurtishi-Kastrati, Ihab K. Magableh, and Hosam Alden Riyadh. 2025. "Sustainable Employer Branding as a Catalyst for Safety Voice Behavior in Healthcare: The Mediating Role of Employee Engagement" Sustainability 17, no. 11: 4890. https://doi.org/10.3390/su17114890

APA Style

Ta’Amnha, M., Kurtishi-Kastrati, S., Magableh, I. K., & Riyadh, H. A. (2025). Sustainable Employer Branding as a Catalyst for Safety Voice Behavior in Healthcare: The Mediating Role of Employee Engagement. Sustainability, 17(11), 4890. https://doi.org/10.3390/su17114890

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