Impact of Authentic Leadership on Nurses' Ethically Oriented Practices and Patient-Oriented Outcomes: A Multilevel Analysis

Objectives: Authentic leadership is considered to be a popular leadership style within the health sector. However, despite the team-oriented work context in hospitals, most research in the health sector is based on data collected from individuals and not teams. Utilizing a multilevel modeling approach, this study aimed to examine the impact of authentic leadership on nursing outcomes at both individual and team levels. It aims to explore the impact of team-level authentic leadership on nursing outcomes at both team and individual levels. Methods: A survey was conducted in hospitals operating in Cairo, Egypt to test the proposed model. Data were collected from 40 nurse supervisors and 200 nurse subordinates in a time-lagged design. Given the multilevel nature of the data (individuals nested within groups), the study's hypotheses were tested utilizing multilevel modeling that incorporates the nonindependence of observations obtained from lower levels nested within higher levels. Results: Results suggest that the hypothesized model was a good fit to the data (CMIN/DF = 1.362, CFI = 0.957, TLI = 0.955, IFI = 0.958, and RMSEA = 0.049). Empirical results suggest that team-level authentic leadership positively predicted nursing teams' performance in improving patient comfort (beta = 2.17, p < 0.05) and their ethically oriented nursing practices (beta = 0.664, p < 0.05). Nurses' ethically oriented practices positively predicted nurses' patient-oriented performance (beta = 0.188, p < 0.05) and mediated the link between authentic leadership and patient-oriented performance (UCI-0.6744, LCI-0.0474). The relationship between authentic leadership and ethically oriented practices was moderated by nurses' compassion at work (beta = 0.129, p < 0.05), such that it was stronger when nurses had higher levels of compassion. Conclusion: Nursing supervisors who practice authentic leadership can enhance nursing teams' performance regarding patient comfort. Authentic leadership can also foster ethical orientation in nurses. Furthermore, a nurse's compassion at work has a synergetic effect with authentic leadership to increase ethically oriented practices.