Xue Xiujuan, Tao Junrong, Li Yupei, Zhang Guochun, Wang Shuxian, Xu Cuiping, Moreira Paulo
Department of Nursing, The First Affiliated Hospital of Shandong First Medical, University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China.
International Healthcare Management Research and Development Center (IHM-RDC), the First Affiliated Hospital of the Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.
BMC Health Serv Res. 2025 Apr 16;25(1):560. doi: 10.1186/s12913-025-12515-0.
Leadership behavior among staff nurses is a critical aspect of healthcare management. Work engagement, characterized by vigor, dedication, and absorption, is a strong predictor of job performance and is believed to enhance the quality of care. However, few studies have explored the relationship between clinical leadership by bedside nurses, work engagement, and quality of care.
To explore relationships between clinical leadership and work engagement on the quality of care and to identify pathways through which clinical leadership may influence care quality via work engagement.
A sample of 1,029 staff nurses from 20 hospitals participated in the study. Three standardized scales were used: The Clinical Leadership Inventory (CLI), the Utrecht Work Engagement Scale-9 (UWES-9), and the nurse-reported quality of care scale. The study followed the STROBE guidelines for cross-sectional research.
Findings revealed that clinical leadership, work engagement, and quality of care scores were 4.10 ± 0.66, 4.09 ± 1.16, and 3.26 ± 0.60, respectively. Positive correlations were found between all three variables, with correlation coefficients ranging from 0.297 to 0.960 (p <.01). Clinical leadership showed both direct and indirect effects on care quality. When work engagement was included as a mediator, the effect size increased by 0.154 (< 0.001), resulting in a value of 0.411 (< 0.001), with a mediation proportion of 37.56%. The explanatory power of clinical leadership and work engagement for care quality was 75.9%.
Enhanced clinical leadership practices are significantly associated with increased nurse work engagement and improved care quality. Clinical leadership directly influences care quality, as well as indirectly through work engagement. These findings could stimulate further international discussions on healthcare management perspectives.
Nursing management should implement clinical leadership development programs tailored for frontline nurses, promoting positive leadership behaviors and work engagement. Creating supportive organizational environments that encourage open communication and standardized practices can further enhance clinical leadership and quality of care. This study found that 1) Nursing management should focus on implementing clinical leadership development programs; 2) Clinical leadership training program for bedside nurses can be enhanced through the use of simulation;3) Supportive organizational environments that promote open communication, and standardized practices should be provided by nurse managers.
护士的领导行为是医疗管理的关键方面。工作投入以活力、奉献和专注为特征，是工作绩效的有力预测指标，并且被认为能提高护理质量。然而，很少有研究探讨床边护士的临床领导力、工作投入和护理质量之间的关系。
探讨临床领导力与工作投入对护理质量的关系，并确定临床领导力可能通过工作投入影响护理质量的途径。
来自20所医院的1029名护士参与了本研究。使用了三个标准化量表：临床领导力量表（CLI）、乌得勒支工作投入量表-9（UWES-9）和护士报告的护理质量量表。该研究遵循横断面研究的STROBE指南。
结果显示，临床领导力、工作投入和护理质量得分分别为4.10±0.66、4.09±1.16和3.26±0.60。所有三个变量之间均存在正相关，相关系数范围为0.297至0.960（p<0.01）。临床领导力对护理质量有直接和间接影响。当将工作投入作为中介变量时，效应大小增加了0.154（<0.001），得出的值为0.411（<0.001），中介比例为37.56%。临床领导力和工作投入对护理质量的解释力为75.9%。
加强临床领导实践与提高护士工作投入和改善护理质量显著相关。临床领导力直接影响护理质量，也通过工作投入间接影响护理质量。这些发现可能会激发国际上对医疗管理视角的进一步讨论。
护理管理应实施针对一线护士的临床领导力发展项目，促进积极的领导行为和工作投入。营造鼓励开放沟通和标准化实践的支持性组织环境可以进一步提高临床领导力和护理质量。本研究发现：1）护理管理应专注于实施临床领导力发展项目；2）可以通过模拟增强床边护士的临床领导力培训项目；3）护士管理者应提供促进开放沟通和标准化实践的支持性组织环境。
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