Treffer: Creating a Healthy Work Environment by Balancing Work-Family Conflict Through Ethical Leadership: A Structural Equation Modeling Approach.
Title:
Creating a Healthy Work Environment by Balancing Work-Family Conflict Through Ethical Leadership: A Structural Equation Modeling Approach.
Authors:
Della Bella V; Nursing Department, University Hospital Tor Vergata, Rome, Italy.; Italian Evidence-Based Practice Nursing Scholarship, A JBI Centre of Excellence, Rome, Italy., Moraca E; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy., Basso RR; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy., Carosi N; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy., Imoletti D; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy., Palladino L; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy., Pulcini F; Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy., Trebbi E; Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy., Tognaccini L; Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy., Fiorini J; Nursing Department, University Hospital Tor Vergata, Rome, Italy.; Italian Evidence-Based Practice Nursing Scholarship, A JBI Centre of Excellence, Rome, Italy., Sili A; Nursing Department, University Hospital Tor Vergata, Rome, Italy.
Source:
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing [J Nurs Scholarsh] 2026 Jan; Vol. 58 (1), pp. e70060. Date of Electronic Publication: 2025 Dec 15.
Publication Type:
Journal Article; Multicenter Study
Language:
English
Journal Info:
Publisher: Wiley Country of Publication: United States NLM ID: 100911591 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1547-5069 (Electronic) Linking ISSN: 15276546 NLM ISO Abbreviation: J Nurs Scholarsh Subsets: MEDLINE
Imprint Name(s):
Publication: Hoboken, NJ : Wiley
Original Publication: Indianapolis, IN : Sigma Theta Tau International, 2000-
Original Publication: Indianapolis, IN : Sigma Theta Tau International, 2000-
MeSH Terms:
References:
Aiken, L. H., K. B. Lasater, D. M. Sloane, et al. 2023. “Physician and Nurse Well‐Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety.” JAMA Health Forum 4, no. 7: E231809. https://doi.org/10.1001/jamahealthforum.2023.1809.
Al Sabei, S. D., L. J. Labrague, A. Miner Ross, et al. 2020. “Nursing Work Environment, Turnover Intention, Job Burnout, and Quality of Care: The Moderating Role of Job Satisfaction.” Journal of Nursing Scholarship 52, no. 1: 95–104. https://doi.org/10.1111/jnu.12528.
Aldhafeeri, N. A., E. A. Abou Hashish, and H. M. Abo Shereda. 2025. “The Effect of Work‐Family Conflict on Staff Nurses' Job Performance: The Mediating Role of Emotional Intelligence.” BMC Nursing 24, no. 1: 614. https://doi.org/10.1186/s12912‐025‐03280‐w.
Barnett, M. D., K. J. Martin, and C. J. Garza. 2019. “Satisfaction With Work–Family Balance Mediates the Relationship Between Workplace Social Support and Depression Among Hospice Nurses.” Journal of Nursing Scholarship 51, no. 2: 187–194. https://doi.org/10.1111/jnu.12451.
Barrett, P. 2007. “Structural Equation Modelling: Adjudging Model Fit.” Personality and Individual Differences 42, no. 5: 815–824. https://doi.org/10.1016/j.paid.2006.09.018.
Bell, T., M. Sprajcer, T. Flenady, and A. Sahay. 2023. “Fatigue in Nurses and Medication Administration Errors: A Scoping Review.” Journal of Clinical Nursing 32, no. 17–18: 5445–5460. https://doi.org/10.1111/jocn.16620.
Bentler, P. M., and K. H. Yuan. 1999. “Structural Equation Modeling With Small Samples: Test Statistics.” Multivariate Behavioral Research 34, no. 2: 181–197. https://doi.org/10.1207/S15327906Mb340203.
Bothma, C. F. C., and G. Roodt. 2013. “The Validation of the Turnover Intention Scale.” SA Journal of Human Resource Management 11, no. 1: 1–12. https://doi.org/10.4102/sajhrm.v11i1.507.
Broetje, S., G. J. Jenny, and G. F. Bauer. 2020. “The Key Job Demands and Resources of Nursing Staff: An Integrative Review of Reviews.” Frontiers in Psychology 11: 84. https://doi.org/10.3389/fpsyg.2020.00084.
Brown, M. E., L. K. Treviño, and D. A. Harrison. 2005. “Ethical Leadership: A Social Learning Perspective for Construct Development and Testing.” Organizational Behavior and Human Decision Processes 97, no. 2: 117–134. https://doi.org/10.1016/j.obhdp.2005.03.002.
Cheung, G. W., and R. B. Rensvold. 2002. “Evaluating Goodness‐Of‐Fit Indexes for Testing Measurement Invariance.” Structural Equation Modeling: A Multidisciplinary Journal 9, no. 2: 233–255. https://doi.org/10.1207/S15328007SEM0902_5.
Colombo, L., and C. Ghisleri. 2008. “The Work‐To‐Family Conflict: Theories and Measures.” TPM‐Testing, Psychometrics, Methodology in Applied Psychology 15, no. 1: 35–55.
Dall'Ora, C., J. Ball, O. Redfern, et al. 2019. “Are Long Nursing Shifts on Hospital Wards Associated With Sickness Absence? A Longitudinal Retrospective Observational Study.” Journal of Nursing Management 27, no. 1: 19–26. https://doi.org/10.1111/jonm.12643.
Della Bella, V., J. Fiorini, and A. Sili. 2025. “Toward a Situation‐Specific Theory of Nursing Organizational Well‐Being: An Early‐Stage Development.” Research and Theory for Nursing Practice 39, no. 2: RTNP‐2024‐0116.R1. https://doi.org/10.1891/RTNP‐2024‐0116.
Della Bella, V., J. Fiorini, F. Zaghini, and A. Sili. 2024. “The Influence of the Clinical Context on Nursing Organizational Well‐Being: A Cross‐Sectional Study.” Infermieristica Journal 3, no. 4: 221–229. https://doi.org/10.36253/if‐2908.
Della Bella, V., E. Moraca, J. Fiorini, and A. Sili. 2025. “Ethical Leadership to Promote Healthy Work Environments: The Mediating Role of Work–Home Conflicts on Errors, Turnover Intention, and Nurses' Health in a Structural Equation Model.” https://doi.org/10.17605/OSF.IO/8JK37.
El‐Gazar, H. E., M. Shawer, S. A. Alkubati, and M. A. Zoromba. 2024. “The Role of Psychological Ownership in Linking Decent Work to Nurses' Vigor at Work: A Two‐Wave Study.” Journal of Nursing Scholarship 56, no. 6: 780–789. https://doi.org/10.1111/jnu.12970.
Farnese, M. L., F. Zaghini, R. Caruso, R. Fida, M. Romagnoli, and A. Sili. 2019. “Managing Care Errors in the Wards: The Contribution of Authentic Leadership and Error Management Culture.” Leadership and Organization Development Journal 40, no. 1: 17–30. https://doi.org/10.1108/LODJ‐04‐2018‐0152.
Fiorini, J., F. Zaghini, A. Mannocci, and A. Sili. 2022. “Nursing Leadership in Clinical Practice, Its Efficacy and Repercussion on Nursing‐Sensitive Outcomes: A Cross‐Sectional Multicentre Protocol Study.” Journal of Nursing Management 30, no. 7: 3178–3188. https://doi.org/10.1111/jonm.13739.
Flora, D. B., and P. J. Curran. 2004. “An Empirical Evaluation of Alternative Methods of Estimation for Confirmatory Factor Analysis With Ordinal Data.” Psychological Methods 9, no. 4: 466–491. https://doi.org/10.1037/1082‐989X.9.4.466.
Freire, C., and C. Bettencourt. 2020. “Impact of Ethical Leadership on Job Satisfaction: The Mediating Effect of Work–Family Conflict.” Leadership and Organization Development Journal 41, no. 2: 319–330. https://doi.org/10.1108/LODJ‐07‐2019‐0338.
Gander, P., K. O'Keeffe, E. Santos‐Fernandez, A. Huntington, L. Walker, and J. Willis. 2019. “Fatigue and Nurses' Work Patterns: An Online Questionnaire Survey.” International Journal of Nursing Studies 98: 67–74. https://doi.org/10.1016/j.ijnurstu.2019.06.011.
Gao, Y., L. Xiang, H. Yi, et al. 2025. “Confounder Adjustment in Observational Studies Investigating Multiple Risk Factors: A Methodological Study.” BMC Medicine 23, no. 1: 132. https://doi.org/10.1186/s12916‐025‐03957‐8.
George, D., and P. Mallery. 2018. IBM SPSS Statistics 25 Step by Step: A Simple Guide and Reference. 0 ed. Routledge. https://doi.org/10.4324/9781351033909.
Haji Matarsat, H. M., H. A. Rahman, and K. Abdul‐Mumin. 2021. “Work‐Family Conflict, Health Status and Job Satisfaction Among Nurses.” British Journal of Nursing 30, no. 1: 54–58. https://doi.org/10.12968/bjon.2021.30.1.54.
Hauser, C., J. Stahl, M. Simon, S. Valenta, L. Favez, and F. Zúñiga. 2023. “Identifying Work‐Related Factors Associated With Work–Family Conflict of Care Workers in Nursing Homes: A Cross‐Sectional Study.” Journal of Advanced Nursing 79, no. 10: 3935–3945. https://doi.org/10.1111/jan.15704.
Labrague, L. J., and A. A. Obeidat. 2022. “Transformational Leadership as a Mediator Between Work–Family Conflict, Nurse‐Reported Patient Safety Outcomes, and Job Engagement.” Journal of Nursing Scholarship 54, no. 4: 493–500. https://doi.org/10.1111/jnu.12756.
Lambert, J. R., L. W. Brown, T. A. Lambert, and C. Torres Nava. 2024. “The Effect of Ethical Leadership on Nurse Bullying, Burnout, and Turnover Intentions.” Journal of Nursing Management 2024, no. 1: 3397854. https://doi.org/10.1155/2024/3397854.
Liu, X., F. He, T. Tian, F. Guo, J. Zhang, and Y. Zhong. 2025. “Ethical Leadership and Nurses' Job Performance: The Mediating Role of Self‐Compassion.” Frontiers in Public Health 12: 1535065. https://doi.org/10.3389/fpubh.2024.1535065.
Marsh, A. A., S. A. Stoycos, K. M. Brethel‐Haurwitz, P. Robinson, J. W. VanMeter, and E. M. Cardinale. 2014. “Neural and Cognitive Characteristics of Extraordinary Altruists.” Proceedings of the National Academy of Sciences of the United States of America 111, no. 42: 15036–15041. https://doi.org/10.1073/pnas.1408440111.
Mehra, M., N. Vasu, P. Joshi, and S. K. Tiwari. 2024. “Job Turnover Intention, Social Support and Fear of COVID‐19 Among Frontline Nurses in Hospital Setting: An Exploratory Survey.” Clinical Epidemiology and Global Health 26: 101524. https://doi.org/10.1016/j.cegh.2024.101524.
Moraca, E., F. Zaghini, J. Fiorini, and A. Sili. 2024. “Nursing Leadership Style and Error Management Culture: A Scoping Review.” Leadership in Health Services 37, no. 4: 526–547. https://doi.org/10.1108/lhs‐12‐2023‐0099.
Muthén, L. K., and B. O. Muthén. 1998. Mplus User's Guide. Eight Edition. Muthén & Muthén.
Németh, Z., P. Deák, R. Szűcs, A. Makai, and M. Hock. 2024. “Validation of the Hungarian Version of the 6‐Item Turnover Intention Scale Among Elderly Care Workers.” Scientific Reports 14: 15593. https://doi.org/10.1038/s41598‐024‐66671‐0.
Netemeyer, R. G., J. S. Boles, and R. McMurrian. 1996. “Development and Validation of Work–Family Conflict and Family–Work Conflict Scales.” Journal of Applied Psychology 81, no. 4: 400–410. https://doi.org/10.1037/0021‐9010.81.4.400.
Polit, D. F., and C. Tatano Beck. 2014. Fondamenti di Ricerca Infermieristica (A. Palese, A c. Di). McGraw‐Hill.
Pyo, E., M. B. Weber, J. Sivaram, et al. 2024. “Construct Validity of the 12‐Item Short Form Health Survey (SF‐12) Version 2 and the Impact of Lifestyle Modifications on the Health‐Related Quality of Life Among Indian Adults With Prediabetes: Results From the D‐CLIP Trial.” Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation 33, no. 6: 1593–1603. https://doi.org/10.1007/s11136‐024‐03648‐6.
Rhéaume, A. 2022. “Job Characteristics, Emotional Exhaustion, and Work–Family Conflict in Nurses.” Western Journal of Nursing Research 44, no. 6: 548–556. https://doi.org/10.1177/01939459211005712.
Rhemtulla, M., P. É. Brosseau‐Liard, and V. Savalei. 2012. “When Can Categorical Variables Be Treated as Continuous? A Comparison of Robust Continuous and Categorical SEM Estimation Methods Under Suboptimal Conditions.” Psychological Methods 17, no. 3: 354–373. https://doi.org/10.1037/a0029315.
Royston, P. 1992. “Approximating the Shapiro‐Wilk W‐Test for Non‐Normality.” Statistics and Computing 2, no. 3: 117–119. https://doi.org/10.1007/BF01891203.
Schermelleh‐Engel, K., H. Moosbrugger, and H. Müller. 2003. “Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness‐of‐Fit Measures.” https://doi.org/10.23668/PSYCHARCHIVES.12784.
Si, X., H. Xue, X. Song, X. Liu, and F. Zhang. 2023. “The Relationship Between Ethical Leadership and Nurse Well‐Being: The Mediating Role of Workplace Mindfulness.” Journal of Advanced Nursing 79, no. 10: 4008–4021. https://doi.org/10.1111/jan.15719.
STROBE Checklists. 2023. “STROBE Statement—Checklist of Items That Should Be Included in Reports of Observational Studies.” file:///Users/vdb/Downloads/STROBE‐checklist‐v4‐combined.pdf.
Ware, J. E., M. Kosinski, and S. D. Keller. 1996. “A 12‐Item Short‐Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity.” Medical Care 34, no. 3: 220–233. https://doi.org/10.1097/00005650‐199603000‐00003.
World Medical Association. 2025. “World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects.” https://www.wma.net/policies‐post/wma‐declaration‐of‐helsinki/.
Yang, Q., L. Yang, C. Yang, X. Wu, Z. Xu, and X. Wang. 2025. “How Is Work–Family Conflict Linked to Nurse‐Assessed Patient Safety Among Intensive Care Unit Nurses? A Serial Multiple Mediation Analysis.” Australian Critical Care 38, no. 1: 101053. https://doi.org/10.1016/j.aucc.2024.03.008.
Yildiz, B., H. Yildiz, and O. Ayaz Arda. 2021. “Relationship Between Work–Family Conflict and Turnover Intention in Nurses: A Meta‐Analytic Review.” Journal of Advanced Nursing 77, no. 8: 3317–3330. https://doi.org/10.1111/jan.14846.
Zappalà, S., and F. Toscano. 2020. “The Ethical Leadership Scale (ELS): Italian Adaptation and Exploration of the Nomological Network in a Health Care Setting.” Journal of Nursing Management 28: 634–642. https://doi.org/10.1111/jonm.12967.
Al Sabei, S. D., L. J. Labrague, A. Miner Ross, et al. 2020. “Nursing Work Environment, Turnover Intention, Job Burnout, and Quality of Care: The Moderating Role of Job Satisfaction.” Journal of Nursing Scholarship 52, no. 1: 95–104. https://doi.org/10.1111/jnu.12528.
Aldhafeeri, N. A., E. A. Abou Hashish, and H. M. Abo Shereda. 2025. “The Effect of Work‐Family Conflict on Staff Nurses' Job Performance: The Mediating Role of Emotional Intelligence.” BMC Nursing 24, no. 1: 614. https://doi.org/10.1186/s12912‐025‐03280‐w.
Barnett, M. D., K. J. Martin, and C. J. Garza. 2019. “Satisfaction With Work–Family Balance Mediates the Relationship Between Workplace Social Support and Depression Among Hospice Nurses.” Journal of Nursing Scholarship 51, no. 2: 187–194. https://doi.org/10.1111/jnu.12451.
Barrett, P. 2007. “Structural Equation Modelling: Adjudging Model Fit.” Personality and Individual Differences 42, no. 5: 815–824. https://doi.org/10.1016/j.paid.2006.09.018.
Bell, T., M. Sprajcer, T. Flenady, and A. Sahay. 2023. “Fatigue in Nurses and Medication Administration Errors: A Scoping Review.” Journal of Clinical Nursing 32, no. 17–18: 5445–5460. https://doi.org/10.1111/jocn.16620.
Bentler, P. M., and K. H. Yuan. 1999. “Structural Equation Modeling With Small Samples: Test Statistics.” Multivariate Behavioral Research 34, no. 2: 181–197. https://doi.org/10.1207/S15327906Mb340203.
Bothma, C. F. C., and G. Roodt. 2013. “The Validation of the Turnover Intention Scale.” SA Journal of Human Resource Management 11, no. 1: 1–12. https://doi.org/10.4102/sajhrm.v11i1.507.
Broetje, S., G. J. Jenny, and G. F. Bauer. 2020. “The Key Job Demands and Resources of Nursing Staff: An Integrative Review of Reviews.” Frontiers in Psychology 11: 84. https://doi.org/10.3389/fpsyg.2020.00084.
Brown, M. E., L. K. Treviño, and D. A. Harrison. 2005. “Ethical Leadership: A Social Learning Perspective for Construct Development and Testing.” Organizational Behavior and Human Decision Processes 97, no. 2: 117–134. https://doi.org/10.1016/j.obhdp.2005.03.002.
Cheung, G. W., and R. B. Rensvold. 2002. “Evaluating Goodness‐Of‐Fit Indexes for Testing Measurement Invariance.” Structural Equation Modeling: A Multidisciplinary Journal 9, no. 2: 233–255. https://doi.org/10.1207/S15328007SEM0902_5.
Colombo, L., and C. Ghisleri. 2008. “The Work‐To‐Family Conflict: Theories and Measures.” TPM‐Testing, Psychometrics, Methodology in Applied Psychology 15, no. 1: 35–55.
Dall'Ora, C., J. Ball, O. Redfern, et al. 2019. “Are Long Nursing Shifts on Hospital Wards Associated With Sickness Absence? A Longitudinal Retrospective Observational Study.” Journal of Nursing Management 27, no. 1: 19–26. https://doi.org/10.1111/jonm.12643.
Della Bella, V., J. Fiorini, and A. Sili. 2025. “Toward a Situation‐Specific Theory of Nursing Organizational Well‐Being: An Early‐Stage Development.” Research and Theory for Nursing Practice 39, no. 2: RTNP‐2024‐0116.R1. https://doi.org/10.1891/RTNP‐2024‐0116.
Della Bella, V., J. Fiorini, F. Zaghini, and A. Sili. 2024. “The Influence of the Clinical Context on Nursing Organizational Well‐Being: A Cross‐Sectional Study.” Infermieristica Journal 3, no. 4: 221–229. https://doi.org/10.36253/if‐2908.
Della Bella, V., E. Moraca, J. Fiorini, and A. Sili. 2025. “Ethical Leadership to Promote Healthy Work Environments: The Mediating Role of Work–Home Conflicts on Errors, Turnover Intention, and Nurses' Health in a Structural Equation Model.” https://doi.org/10.17605/OSF.IO/8JK37.
El‐Gazar, H. E., M. Shawer, S. A. Alkubati, and M. A. Zoromba. 2024. “The Role of Psychological Ownership in Linking Decent Work to Nurses' Vigor at Work: A Two‐Wave Study.” Journal of Nursing Scholarship 56, no. 6: 780–789. https://doi.org/10.1111/jnu.12970.
Farnese, M. L., F. Zaghini, R. Caruso, R. Fida, M. Romagnoli, and A. Sili. 2019. “Managing Care Errors in the Wards: The Contribution of Authentic Leadership and Error Management Culture.” Leadership and Organization Development Journal 40, no. 1: 17–30. https://doi.org/10.1108/LODJ‐04‐2018‐0152.
Fiorini, J., F. Zaghini, A. Mannocci, and A. Sili. 2022. “Nursing Leadership in Clinical Practice, Its Efficacy and Repercussion on Nursing‐Sensitive Outcomes: A Cross‐Sectional Multicentre Protocol Study.” Journal of Nursing Management 30, no. 7: 3178–3188. https://doi.org/10.1111/jonm.13739.
Flora, D. B., and P. J. Curran. 2004. “An Empirical Evaluation of Alternative Methods of Estimation for Confirmatory Factor Analysis With Ordinal Data.” Psychological Methods 9, no. 4: 466–491. https://doi.org/10.1037/1082‐989X.9.4.466.
Freire, C., and C. Bettencourt. 2020. “Impact of Ethical Leadership on Job Satisfaction: The Mediating Effect of Work–Family Conflict.” Leadership and Organization Development Journal 41, no. 2: 319–330. https://doi.org/10.1108/LODJ‐07‐2019‐0338.
Gander, P., K. O'Keeffe, E. Santos‐Fernandez, A. Huntington, L. Walker, and J. Willis. 2019. “Fatigue and Nurses' Work Patterns: An Online Questionnaire Survey.” International Journal of Nursing Studies 98: 67–74. https://doi.org/10.1016/j.ijnurstu.2019.06.011.
Gao, Y., L. Xiang, H. Yi, et al. 2025. “Confounder Adjustment in Observational Studies Investigating Multiple Risk Factors: A Methodological Study.” BMC Medicine 23, no. 1: 132. https://doi.org/10.1186/s12916‐025‐03957‐8.
George, D., and P. Mallery. 2018. IBM SPSS Statistics 25 Step by Step: A Simple Guide and Reference. 0 ed. Routledge. https://doi.org/10.4324/9781351033909.
Haji Matarsat, H. M., H. A. Rahman, and K. Abdul‐Mumin. 2021. “Work‐Family Conflict, Health Status and Job Satisfaction Among Nurses.” British Journal of Nursing 30, no. 1: 54–58. https://doi.org/10.12968/bjon.2021.30.1.54.
Hauser, C., J. Stahl, M. Simon, S. Valenta, L. Favez, and F. Zúñiga. 2023. “Identifying Work‐Related Factors Associated With Work–Family Conflict of Care Workers in Nursing Homes: A Cross‐Sectional Study.” Journal of Advanced Nursing 79, no. 10: 3935–3945. https://doi.org/10.1111/jan.15704.
Labrague, L. J., and A. A. Obeidat. 2022. “Transformational Leadership as a Mediator Between Work–Family Conflict, Nurse‐Reported Patient Safety Outcomes, and Job Engagement.” Journal of Nursing Scholarship 54, no. 4: 493–500. https://doi.org/10.1111/jnu.12756.
Lambert, J. R., L. W. Brown, T. A. Lambert, and C. Torres Nava. 2024. “The Effect of Ethical Leadership on Nurse Bullying, Burnout, and Turnover Intentions.” Journal of Nursing Management 2024, no. 1: 3397854. https://doi.org/10.1155/2024/3397854.
Liu, X., F. He, T. Tian, F. Guo, J. Zhang, and Y. Zhong. 2025. “Ethical Leadership and Nurses' Job Performance: The Mediating Role of Self‐Compassion.” Frontiers in Public Health 12: 1535065. https://doi.org/10.3389/fpubh.2024.1535065.
Marsh, A. A., S. A. Stoycos, K. M. Brethel‐Haurwitz, P. Robinson, J. W. VanMeter, and E. M. Cardinale. 2014. “Neural and Cognitive Characteristics of Extraordinary Altruists.” Proceedings of the National Academy of Sciences of the United States of America 111, no. 42: 15036–15041. https://doi.org/10.1073/pnas.1408440111.
Mehra, M., N. Vasu, P. Joshi, and S. K. Tiwari. 2024. “Job Turnover Intention, Social Support and Fear of COVID‐19 Among Frontline Nurses in Hospital Setting: An Exploratory Survey.” Clinical Epidemiology and Global Health 26: 101524. https://doi.org/10.1016/j.cegh.2024.101524.
Moraca, E., F. Zaghini, J. Fiorini, and A. Sili. 2024. “Nursing Leadership Style and Error Management Culture: A Scoping Review.” Leadership in Health Services 37, no. 4: 526–547. https://doi.org/10.1108/lhs‐12‐2023‐0099.
Muthén, L. K., and B. O. Muthén. 1998. Mplus User's Guide. Eight Edition. Muthén & Muthén.
Németh, Z., P. Deák, R. Szűcs, A. Makai, and M. Hock. 2024. “Validation of the Hungarian Version of the 6‐Item Turnover Intention Scale Among Elderly Care Workers.” Scientific Reports 14: 15593. https://doi.org/10.1038/s41598‐024‐66671‐0.
Netemeyer, R. G., J. S. Boles, and R. McMurrian. 1996. “Development and Validation of Work–Family Conflict and Family–Work Conflict Scales.” Journal of Applied Psychology 81, no. 4: 400–410. https://doi.org/10.1037/0021‐9010.81.4.400.
Polit, D. F., and C. Tatano Beck. 2014. Fondamenti di Ricerca Infermieristica (A. Palese, A c. Di). McGraw‐Hill.
Pyo, E., M. B. Weber, J. Sivaram, et al. 2024. “Construct Validity of the 12‐Item Short Form Health Survey (SF‐12) Version 2 and the Impact of Lifestyle Modifications on the Health‐Related Quality of Life Among Indian Adults With Prediabetes: Results From the D‐CLIP Trial.” Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation 33, no. 6: 1593–1603. https://doi.org/10.1007/s11136‐024‐03648‐6.
Rhéaume, A. 2022. “Job Characteristics, Emotional Exhaustion, and Work–Family Conflict in Nurses.” Western Journal of Nursing Research 44, no. 6: 548–556. https://doi.org/10.1177/01939459211005712.
Rhemtulla, M., P. É. Brosseau‐Liard, and V. Savalei. 2012. “When Can Categorical Variables Be Treated as Continuous? A Comparison of Robust Continuous and Categorical SEM Estimation Methods Under Suboptimal Conditions.” Psychological Methods 17, no. 3: 354–373. https://doi.org/10.1037/a0029315.
Royston, P. 1992. “Approximating the Shapiro‐Wilk W‐Test for Non‐Normality.” Statistics and Computing 2, no. 3: 117–119. https://doi.org/10.1007/BF01891203.
Schermelleh‐Engel, K., H. Moosbrugger, and H. Müller. 2003. “Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness‐of‐Fit Measures.” https://doi.org/10.23668/PSYCHARCHIVES.12784.
Si, X., H. Xue, X. Song, X. Liu, and F. Zhang. 2023. “The Relationship Between Ethical Leadership and Nurse Well‐Being: The Mediating Role of Workplace Mindfulness.” Journal of Advanced Nursing 79, no. 10: 4008–4021. https://doi.org/10.1111/jan.15719.
STROBE Checklists. 2023. “STROBE Statement—Checklist of Items That Should Be Included in Reports of Observational Studies.” file:///Users/vdb/Downloads/STROBE‐checklist‐v4‐combined.pdf.
Ware, J. E., M. Kosinski, and S. D. Keller. 1996. “A 12‐Item Short‐Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity.” Medical Care 34, no. 3: 220–233. https://doi.org/10.1097/00005650‐199603000‐00003.
World Medical Association. 2025. “World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects.” https://www.wma.net/policies‐post/wma‐declaration‐of‐helsinki/.
Yang, Q., L. Yang, C. Yang, X. Wu, Z. Xu, and X. Wang. 2025. “How Is Work–Family Conflict Linked to Nurse‐Assessed Patient Safety Among Intensive Care Unit Nurses? A Serial Multiple Mediation Analysis.” Australian Critical Care 38, no. 1: 101053. https://doi.org/10.1016/j.aucc.2024.03.008.
Yildiz, B., H. Yildiz, and O. Ayaz Arda. 2021. “Relationship Between Work–Family Conflict and Turnover Intention in Nurses: A Meta‐Analytic Review.” Journal of Advanced Nursing 77, no. 8: 3317–3330. https://doi.org/10.1111/jan.14846.
Zappalà, S., and F. Toscano. 2020. “The Ethical Leadership Scale (ELS): Italian Adaptation and Exploration of the Nomological Network in a Health Care Setting.” Journal of Nursing Management 28: 634–642. https://doi.org/10.1111/jonm.12967.
Contributed Indexing:
Keywords: error; ethical leadership; mental health; nurse; physical health; turnover intention; work environment; work–family conflict
Entry Date(s):
Date Created: 20251216 Date Completed: 20251231 Latest Revision: 20260109
Update Code:
20260109
DOI:
10.1111/jnu.70060
PMID:
41398976
Database:
MEDLINE
Weitere Informationen
Introduction: Creating a healthy work environment requires balancing organizational goals with ethical responsibilities, where head nurses' ethical leadership can shape staff outcomes by mitigating work-family conflicts and promoting nurses' well-being, retention, and patient safety. This study aims to analyze the mediating role of work-family between head nurses' ethical leadership and nurses' reported errors, turnover intention, and physical and mental health.
Design: Nationwide Multicenter cross-sectional study.
Methods: Validated self-report scales were used to assess nurses' perceptions of head nurses' ethical leadership, work-family conflict, error, turnover intention, physical and mental health. Descriptive and inferential analyses were conducted. Structural equation modeling examined the relationships among these variables based on Della Bella's and Fiorini's framework.
Results: Data from 409 nurses across seven Italian hospitals was analyzed. The structural equation model showed an excellent fit. Head nurses' Ethical leadership was negatively associated with work-family conflicts, turnover intention, and errors, and positively associated with nurses' health. Work-family conflicts were significantly linked to turnover intention, errors, and nurses' health. Work-family conflicts mediate the relation between ethical leadership and turnover intention, errors, and nurses' health.
Conclusion: Promoting healthy work environments is crucial for nurses', patients', and organizations' well-being. Ethical leadership helps achieve this condition by reducing work-family conflicts, fostering nurses' well-being, decreasing turnover intention, and improving care quality. Disseminating ethical leadership programs and integrating with work-life balance policies can therefore strengthen both staff retention and organizational outcomes.
Clinical Relevance: Ethical leadership can foster patient care, reduce turnover intention and errors, and improve nurses' well-being. Therefore, maintaining employee performance and organizational results requires integrating work-life balance policies with ethical leadership development programs.
Reporting Method: The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist.
No Patient or Public Contribution: This study did not include patient or public involvement.
Protocol Registration: The study was preregistered on the Open Science Framework https://osf.io/8jk37/overview.
Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.
(© 2025 Sigma Theta Tau International.)