One of the key priorities of Saudi Vision 2030 is to ensure that all Saudi citizens have access to high-quality healthcare, but this goal is constrained by international and domestic nursing staff shortages. Nursing directors have recommended introducing a professional career path focused on developing nurses’ leadership skills. Despite recognition of nurse managers’ key role in recruiting, retaining, and engaging nurses, few studies have explored how Saudi managers acquire and deploy leadership skills. This study explores how nurse managers view and experience workplace leadership.
This ethnographic study examined nurse managers’ perceptions and experiences of leadership development in a Saudi hospital affiliated with the Ministry of Health. Qualitative data were collected during periodic visits over eight months, including workplace and continuing medical education observations, document examinations, and informal and semistructured interviews with 21 nurse managers. A framework analysis approach was used to interpret and summarize the data.
The data were organized into four major themes: imbalanced power dynamics, no shared vision, workplace rituals and behaviors, and the need for learning. The findings indicated a power imbalance, consistent with international studies. The hospital had hierarchical and transactional management structures and a culturally pervasive leadership approach framed by wasta (“middleman” or “go-between” in Arabic). Such nepotism, normalized in Saudi business practice, is officially recognized and condemned as corrupt by state legislators. The Saudi government is rigorously combating this practice through strict regulations and enforcement. A climate encouraging adherence with the directorate’s guidelines led managers to comply, even though they employed strategies to subvert some of its authority.
Wasta was used to enhance performance, obtain rewards, secure favorable work assignments, gain meritless promotions, and allocate staff arbitrarily. Paradoxically, while managers criticized the capricious use of wasta, they also employed it to secure what they believed they deserved, sometimes at the expense of their colleagues’ careers.
Based on the Conservation of Resources and Leader–Member Exchange theories, this study investigates the relationship between psychological stress and emotional exhaustion among first-line nurse managers (FLNMs), while also examining the mediating role of presenteeism (i.e., working while ill) and the moderating effect of leader loyalty on this relationship.
A survey-based study was carried out on 161 French FLNMs. A mediated moderation model was tested through bootstrap regression analyses using PROCESS Macro.
The analyses yielded three primary findings. First, psychological stress among FLNMs is positively related to their level of emotional exhaustion. Second, presenteeism is found to be an explanatory mechanism of the psychological stress—emotional exhaustion relationship. Third, leader loyalty was found to moderate the indirect link between psychological stress (i.e., through presenteeism) and emotional exhaustion.
The results provide a better understanding of the relationship between psychological stress and emotional exhaustion in the case of French FLNMs. They also clarify the role of other mechanisms, such as presenteeism and leader loyalty, that may be involved.
Considering the pivotal role of FLNMs within hospitals, findings from this study raise awareness of the detrimental consequences of psychological stress and presenteeism on FLNMs’ health, while also showing the constructive aspects of the relationships between FLNMs and their superiors.
This study explores emergency nurses’ lived experiences of cognitive mental workload (CMW) within high-pressure, resource-limited environments, where excessive mental demands may compromise both clinician well-being and care delivery.
An exploratory qualitative research design was used with registered nurses (n = 10) working in Australian rural emergency departments. Online semistructured interviews were conducted in 2023. The collected data were analysed using reflective thematic analysis.
The data analysis revealed four primary contributors of high CMW among nurses during care delivery, namely, external demands, excessive cognitive processing, emotional demands and individual characteristics. Despite challenges in describing the phenomenon, participants clearly associated their high CMW to adverse patient outcomes like patient harm and near misses as well as negative impacts on their own welfare, such as burnout, compassion fatigue and intention to leave profession.
This study offers new perspectives on emergency nurses’ CMW experiences, foregrounding their lived experience in high pressure, emotionally charged and dynamic clinical settings. By giving voices to the often overlooked phenomenon in nursing, it has revealed the critical impact of the health professional’s CMW on their well-being, patient safety and care quality.
In depth knowledge about the phenomenon can inform tailored measurement tools and targeted strategies for nurses, to reduce errors and enhance care delivery.
Policymakers can integrate the insights to strengthen healthcare infrastructure and policies that reduce error-related patient harm and support nurse well-being for reducing resource and financial expenditure.
Nurses’ clinical professional autonomy is strongly influenced by organizational management and leadership environments. This study aims to examine the relationship between head nurses’ leadership styles and the level of clinical autonomy perceived by emergency department (ED) nurses in Iranian university hospitals.
This cross-sectional study recruited 221 ED nurses from Alborz province (Iran) university hospitals through convenience sampling from February to March 2022. Data were collected using a three-section questionnaire that covered demographic and work-related characteristics, the Multifactor Leadership Questionnaire (MLQ), and the Clinical Professional Autonomy Scale. Following psychometric validation in our sample, the MLQ consisted of 32 items assessing transformational, transactional, and laissez-faire leadership (Cronbach’s α = 0.71–0.95). Clinical professional autonomy was measured with the 31-item Clinical Professional Autonomy Scale (α > 0.70), with total scores classified as low, moderate, or high.
The mean (SD) of clinical professional autonomy (0–100 scale) was 78.68 (12.73). Transformational leadership was reported as the dominant style among head nurses (72.41 ± 18.58). The results showed the strongest correlation between transformational leadership style and clinical professional autonomy (r = 0.57). Furthermore, the multivariable linear regression analysis showed that clinical professional autonomy was significantly associated with job satisfaction (β = 0.17, p = 0.026) and nurses’ years of work experience (β = 0.23, p = 0.002).
This study highlights that head nurses’ transformational leadership style significantly enhances nurses’ clinical professional autonomy. The findings underscore the need for targeted leadership development programs to strengthen head nurses’ transformational leadership competencies. By fostering a supportive leadership environment, clinical professional nursing autonomy can be promoted, contributing to improved patient care quality and overall organizational performance.
Nurses may experience organizational dehumanization, perceiving themselves as mere tools to achieve institutional goals rather than as valued healthcare professionals. Such perceptions not only harm their well-being and work engagement but also threaten the quality and sustainability of healthcare delivery. While prior research has primarily focused on the negative consequences of organizational dehumanization, limited attention has been given to identifying effective organizational strategies to alleviate this issue. Drawing on self-determination theory, this study explores whether, how, and when developmental human resource management (DHRM) practices can mitigate nurses’ organizational dehumanization.
We conducted a three-wave time-lagged study with 311 nurses across multiple hospitals. Hypotheses were tested using structural equation modeling.
DHRM was positively related to nurses’ work meaningfulness, which in turn was negatively associated with organizational dehumanization. Work meaningfulness mediated the relationship between DHRM and dehumanization. In addition, mastery climate strengthened the positive effect of DHRM on work meaningfulness, thereby amplifying its indirect association with reduced dehumanization.
This study highlights the value of implementing comprehensive DHRM practices in healthcare settings to enhance nurses’ experience of meaningful work and alleviate organizational dehumanization. Additionally, fostering a mastery-oriented climate within hospitals can further strengthen the positive influence of DHRM.
Leadership significantly influences nurses’ occupational well-being, particularly their levels of burnout and work engagement, according to the Job Demands-Resources (JD-R) model. This model posits that job demands increase burnout, whereas resources, such as leadership, promote work engagement.
To analyze the influence of leadership styles on burnout and work engagement among nurses within the theoretical framework of the JD-R model.
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between July and October 2024 in PubMed, CINAHL, WOS, SCOPUS, PROQuest, and PsycInfo. Quantitative observational studies focused on nurses and evaluating leadership, burnout, and work engagement within the JD-R model were included. A total of 38 relevant studies were identified and assessed for methodological quality using the STROBE tool.
Of the studies, 89.47 were cross-sectional and 10.53% were longitudinal. Transformational, authentic, and servant leadership styles demonstrated protective effects against burnout and promoted engagement. Transformational leadership emerged as the most frequently studied style, consistently associated with lower burnout levels and higher engagement. Conversely, negative styles such as abusive leadership were linked to increased burnout. Most studies used the Maslach Burnout Inventory (MBI) and the Utrecht Work Engagement Scale (UWES) to measure key variables.
Effective leadership is a critical resource for improving nurses’ well-being and performance. Investing in leadership development programs can reduce burnout and enhance engagement, benefiting both nurses and patients. Future studies should include longitudinal designs and explore innovative approaches, such as secure base leadership.
Burnout negatively affects nurses’ well-being and patient care. This study examines whether meaning in life, conceptualized as presence (sense that life is meaningful) and search (active pursuit of meaning), is associated with burnout symptoms among early- and mid-career nurses. Additionally, we explore whether job resources (influence at work, supervisor and colleague support, and professional development) moderate these associations.
A cross-sectional analysis was conducted using baseline data from a longitudinal panel study among 375 nurses (≤ 10 years of experience) across six hospitals in Flanders, Belgium. Data were collected via an online survey in March-April 2024. Burnout symptoms were assessed using the Burnout Assessment Tool, and meaning in life using the Meaning in Life Questionnaire. Job resources, including supervisor and colleague support, influence at work, and professional development, were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ) and tested as moderators. Demographic and occupational variables were included as covariates. Pearson correlations and multiple linear regressions were performed.
Presence of meaning was negatively associated with burnout symptoms (B = −0.037, p < 0.001), whereas search for meaning was positively associated with burnout (B = 0.011, p < 0.05). Job resources moderated these associations. The negative association between presence of meaning and symptoms such as exhaustion and emotional dysregulation was stronger in high-resource contexts. In contrast, the positive association between search for meaning and symptoms like exhaustion and mental distancing was only observed in low-resource contexts.
Presence and search for meaning relate differently to burnout symptoms. Presence was linked to fewer symptoms, while search showed a positive association, especially in low-resource settings. Strengthening job resources and supporting a stable sense of meaning, rather than prolonged search, may contribute to nurses’ well-being. Targeted initiatives such as mentorship and career development could help foster resilience and meaningful work engagement.
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