Exploring how organizational support shapes nurses’ clinical leadership: evidence from Tunisia

Clinical nurse leadership is a key driver for improving care quality within the ongoing reform of the Tunisian healthcare system. This study aimed to assess the correlation between nurses’ clinical leadership levels and the organizational support available to them, as well as to identify individual and professional factors associated with clinical leadership. A cross-sectional study was conducted among nurses in the Sahel region (Sousse, Monastir, and Mahdia), using two validated instruments: the Clinical Leadership Survey (CLS) and the Organizational Environment Assessment (OEA) scales. Descriptive statistics, bivariate analyses (t-tests and ANOVA), and multiple linear regression were used to analyze the data. A total of 508 nurses participated. They demonstrated a satisfactory level of clinical leadership (M = 54.15 ± 8.64), particularly in communication and collaboration. Perceived organizational support was moderate (M = 16.20 ± 3.46). A significant positive correlation was found between clinical leadership and organizational support (r = 0.501; p < 0.001). Bivariate analysis showed that female gender (p = 0.021), prior leadership training (p = 0.004), longer work experience (p = 0.017), and older age (p = 0.045) were significantly associated with higher CLS scores. In the multivariate model, previous training (p = 0.002), female gender (p = 0.028), and work experience > 10 years (p = 0.034) remained independent predictors, while age showed a marginal association (p = 0.067). Organizational support plays a crucial role in fostering clinical nurse leadership. In addition to structural support, individual factors such as training, experience, and gender also influence leadership expression. Investing in professional recognition, continuing education, and participatory governance is essential for strengthening leadership capacities and improving the quality of care.