Ethical leadership, nurse innovation, and mediating roles

BackgroundNurses' innovative behaviors play an irreplaceable role in advancing nursing practice, improving healthcare service quality, and driving transformation in the nursing profession. However, existing studies on the factors influencing nurses' innovative behaviors and their underlying mechanisms remain limited, necessitating further investigation.ObjectiveThis study investigated the impact of ethical leadership on nurses' innovative behaviors, examining the mediating roles of innovative climate and self-efficacy.Research designThis is a multicenter longitudinal study with three-wave data collection (February-August 2024) following STROBE guidelines. Structural equation modeling was employed to examine mediation effects.Participants and research contextA total of 1,522 nurses from 16 tertiary hospitals in China completed baseline assessments (T1), with 1,409 (T2) and 1,298 (T3) completing follow-ups. Participants were registered nurses with ≥1 year of experience, sampled through stratified cluster sampling across clinical departments.Ethical considerationsapproved by the Henan University Biomedical Research Ethics Committee (HUSOM2023-478). Participants provided informed consent, data were collected anonymously, and confidentiality was maintained throughout.ResultsEthical leadership significantly predicted innovative behavior (β = 0.334, 95% CI [0.284,0.386]). Both innovative climate (β = 0.059 [0.046, 0.072]) and self-efficacy (β = 0.017 [0.011, 0.023]) served as partial mediators, with a significant chain mediation effect (β = 0.021 [0.015, 0.027]) accounting for 4.87% of total effect.ConclusionEthical leadership not only directly promotes nurses' innovative behaviors but also strengthens this effect indirectly through the chain-mediated roles of innovative climate and self-efficacy. Enhancing ethical leadership can optimize the innovative climate in nursing departments and improve nurses' self-efficacy, thereby effectively fostering their innovative behaviors.