Leading the Transformation of Saudi Arabia's Health System Under Vision 2030: Mediating Pathway From Transformational Leadership to Job Performance via Work Engagement Among Nursing Workforce

AIM: To examine the mediating role of work engagement in the relationship between transformational leadership and job performance among nurses in Saudi Arabia. DESIGN: A multicenter cross-sectional study. METHODS: This study included a convenience sample of 321 nurses recruited from five tertiary hospitals selected from the Second and Third Health Clusters in Riyadh, Saudi Arabia. Data were collected using a structured web-based survey incorporating the Global Transformational Leadership Scale, the Utrecht Work Engagement Scale, the Job Performance Scale, and a demographic and professional characteristics questionnaire. Data were analysed using descriptive and inferential statistics in IBM SPSS Statistics (version 27), followed by mediation analysis using Hayes' PROCESS Macro (Model 4). RESULTS: Nurses reported relatively high perceptions of transformational leadership, relatively high levels of work engagement and high levels of job performance. Transformational leadership was positively associated with work engagement, while gender and education were not significantly associated with work engagement. Transformational leadership and work engagement were positively associated with job performance. Work engagement partially mediated the association between transformational leadership and job performance. CONCLUSION: Transformational leadership contributes to higher nurse job performance through both direct effects and by enhancing work engagement. Leadership development and engagement-focused strategies are essential to strengthen workforce effectiveness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: These findings provide evidence to inform leadership training and workforce management policies in healthcare organizations, emphasizing engagement as a mechanism to optimize nurses' performance and indirectly improve patient care outcomes. IMPACT: This study addresses the need for effective leadership to strengthen nursing workforce performance within healthcare transformation initiatives. Findings provide actionable insights for healthcare managers and policymakers seeking to implement leadership and engagement strategies that improve organizational outcomes and patient care in Saudi Arabia. REPORTING METHOD: This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.