When nursing leadership turns toxic: mediating, amplifying, and buffering effects of emotional exhaustion, job insecurity, and coworker support

Toxic leadership is a growing problem in nursing settings marked by high job demands and emotional strain, yet little is known about how it leads to nurses’ turnover intention. Despite growing interest in destructive leadership behaviors, limited empirical research has examined the mechanisms and boundary conditions through which toxic leadership influences nurses’ turnover intention. Guided by the Conservation of Resources theory, Social Exchange Theory, and the Stress–Strain–Outcome model, this study examines emotional exhaustion as a key mechanism linking toxic leadership to turnover intention and explores job insecurity and coworker support as important moderating factors between Toxic leadership-turnover intention, as well as between Toxic leadership -emotional exhaustion relationships. A quantitative, cross-sectional research design was employed. Data were collected from 348 nurses working in public and private hospitals across multiple regions in Saudi Arabia. Partial Least Squares Structural Equation Modeling (PLS-SEM) was applied to test the hypothesized direct, mediating, and moderating relationships. Reliability, convergent validity, discriminant validity, and common method bias were systematically assessed. The findings revealed a significant positive relationship between toxic leadership and nurses’ turnover intention, as well as emotional exhaustion. Emotional exhaustion was found to partially mediate the relationship between toxic leadership and turnover intention, supporting the Stress–Strain–Outcome framework. Job insecurity significantly strengthened the relationship between toxic leadership and turnover intention, but unexpectedly did not moderate the relationship between toxic leadership and emotional exhaustion. Conversely, coworker support weakened the positive relationship between toxic leadership and turnover intention, while its moderating effect on emotional exhaustion was not significant. This study highlights emotional exhaustion as a central mechanism through which toxic leadership drives nurses’ intentions to leave their jobs. The findings demonstrate that job insecurity amplifies, while coworker support buffers, the harmful behavioral consequences of toxic leadership. The study offers important theoretical contributions by integrating Conservation of Resources theory, Social Exchange Theory, and the Stress–Strain–Outcome model within a nursing context. Practically, the results underscore the need for healthcare organizations to prevent toxic leadership, reduce job insecurity, and strengthen coworker support systems to improve nurse retention and well-being.