Transformational Nurse Leaders and Nurse Well-Being: Examining Mediating Influences of Organizational Justice and Quality of Work Life Mixed Methods Study.

Transformational leadership is recognized as a crucial factor influencing nurses' work experiences and well-being. However, the mechanisms through which transformational leadership affects nurse well-being, especially concerning organizational justice and quality of work life, are not fully understood. This study investigates the direct and indirect effects of transformational leadership on nurse well-being, focusing on the mediating roles of organizational justice and quality of work life. Using a sequential explanatory mixed methods design, quantitative data were collected from 580 nurses across five hospitals in Saudi Arabia with validated tools: the Global Transformational Leadership Scale, Organizational Justice Scale, Quality of Nursing Work-Life Scale, Emotional Exhaustion Subscale of the Maslach Burnout Inventory, Job Satisfaction Scale, and Perceived Stress Scale. Qualitative data were obtained from 25 focus group discussions using a validated semistructured discussion guide. Quantitative analyses included hierarchical multiple regression and mediation analyses, while qualitative data wereanalyzed thematically. Transformational leadership significantly reduced emotional exhaustion ( = -0.48, < 0.001), increased job satisfaction ( = 0.53, < 0.001), and lowered perceived stress ( = -0.46, < 0.001). Mediation analyses showed significant indirect effects through organizational justice and quality of work life (indirect effects: -0.34 to 0.38, < 0.001). Qualitative findings highlighted the importance of inspirational motivation, individualized consideration, intellectual stimulation, and idealized influence. Transformational leadership directly and indirectly enhances nurses' well-being through improved organizational justice and quality of work life. These findings emphasize the need for healthcare organizations to foster transformational leadership and promote fair, supportive work environments to enhance nurse well-being.