Toxic leadership, mental well-being and work engagement among nurses: a scale adaptation study and structural equation model approach
Authors: Celebi Cakiroglu Oya , Tuncer Unver Gamze 
Published: November 2023

PurposeAlthough the background on positive and supportive leadership styles and their positive effects is constantly increasing, it is known that negative and destructive leadership styles are less researched. Thus, examining the toxic leadership behaviors of nurse managers and the effects of these on nurses has a critical significance. When the measurement tools evaluating toxic leadership are examined, it is seen that there is a need for measurement tools that evaluate the toxic leadership behaviors of nurse managers. This study's purpose is to psychometrically examine the Turkish version of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM-TR) Scale and test the hypothesized conceptual model that includes the relationships between toxic leadership, mental well-being and work engagement.Design/methodology/approachThis quantitative research was carried out in psychometric, correlational and cross-sectional design. A total of 559 nurses were included in the study by using the convenience sample method. The ToxBH-NM-TR Scale, Warwick–Edinburg Mental Well-Being Scale and Utrecht Work Engagement Scale (UWES) were used to measure the latent variables of the study. The data were collected between June and October 2020 with the online survey method. IBM SPSS Statistics 24 and Amos 21 statistical programs were used to analyze the data.FindingsThe scale-content validity index of the ToxBH-NM-TR was 0.88. Confirmatory factor analysis results showed that the fit indices were acceptable. The ToxBH-NM-TR had high internal consistency and temporal stability. In addition, the relationships between the latent variables of the study were in the expected direction and statistically significant (p < 0.001). The hypothesized conceptual model showed an acceptable or good fit to the data. Mental well-being partially mediated the relationship between toxic leadership and work engagement. The study showed that the ToxBH-NM-TR is a valid and reliable instrument and provided evidence that confirmed the hypothesized conceptual model.Research limitations/implicationsThe first of these is the fact that managers' toxic leadership behaviors were determined based on nurses' self-report. For this reason, participants' potential prejudices may have affected the results of the study. The second limitation concerns the data collection technique. Using face-to-face data collection techniques during the COVID-19 pandemic could create a danger/risk for the health of nurses, researchers and patients. Therefore, the nurses in this research were reached through an online survey on social media platforms. The participants of the study were limited to those who had access to social media. Finally, some socio-demographic and professional characteristics of the participants may be a confounding variable for the model. For this reason, this conceptual model needs to be validated on other samples in different countries to increase the generalizability of the research results.Practical implicationsThe characteristics of this leadership style should be understood, and its effects on employees and organizations should be evaluated by screening regularly to prevent the development of toxic leaders and to eliminate the harmful effects of their behavior. The nurses should respond decisively to the forces that cause them to submit in order not to encourage a toxic leadership style. Healthcare institutions should develop procedures and take a proactive approach to destructive and negative leadership behaviors and practices. In addition, nurse managers should get feedback by using informal networks and 360-degree assessment tools and evaluate whether their leadership has a toxic function by regularly screening the effects of their leadership.Originality/valueThe results of this study offer important implications for nurses, managers and healthcare institutions and can be useful in gaining awareness about the negative effects of a toxic leadership style. In addition, the study provides a valid and reliable scale that will enable the identification of managers with this leadership style to prevent the development of toxic leaders and eliminate the harmful effects of their behavior.