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. 2024 Mar 4;11(3):e2126. doi: 10.1002/nop2.2126

The mediating role of psychological capital on the relationship between authentic leadership and innovative behaviour among Chinese nurses

Guowen Zhang 1,2, Wenfeng Lin 1,2, Guiqi Song 1,2, Juanjuan Chen 3, Huiping Li 4, Liqin Sun 1,2, Baozhen Cheng 1,2, Xiaohong Zhang 1,2,✉
PMCID: PMC10912369  PMID: 38439120

Abstract

Aim

To explore the mediating role of psychological capital between authentic leadership and innovative behaviour among Chinese nurses.

Design

A cross‐sectional study.

Methods

In December 2021, online surveys were delivered among nurses from 37 hospitals in Anhui Province by convenience sampling approach. The data was collected using the Chinese version of the Authentic Leadership Questionnaire, Nurse Psychological Capital Questionnaire and Nurse Innovative Behaviour Scale. The structural equation model and bootstrap test examined the mediating role of psychological capital between authentic leadership and innovative behaviour.

Results

3495 Chinese nurses from 37 Anhui Province hospitals participated in this study. The mean item score of authentic leadership was 3.25 (SD 0.83), psychological capital was 4.85 (SD 0.89), and innovative behaviour was 2.82 (SD 0.84). Authentic leadership perceived by nurses, psychological capital, and innovative behaviour were statistically significant and positively correlated with each other (r = 0.524 ~ 0.806, p < 0.01). Psychological capital significantly mediated the association between authentic leadership and innovative behaviour (β = 0.449, p < 0.001), and its mediating effect accounted for 76.75% of the total effect.

Conclusion

Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' psychological capital and innovation behaviour.

Keywords: authentic leadership, innovative behaviour, nurse, psychological capital, structural equation model

1. INTRODUCTION

Nowadays, the topic of inventive behaviour is frequently discussed in the fields of business management, technology, engineering and education. Nevertheless, innovative behaviour was not much discussed in the area of health care, especially in nursing (Asurakkody & Shin, 2018). As the health field becomes aware of the significance of patient care, nurses' roles are becoming more statistically significant (Zhou et al., 2018). Nurses must always innovate to keep up with the healthcare sector and increase care quality. As a result, nursing innovation is garnering more attention. Nurses provide up to 80% of primary healthcare professionals, and their innovative behaviour and ability can improve the quality of nursing services and further facilitate medical productivity (WHO, 2020).

According to the International Council of Nurses (2009), innovation is highly needed for nursing practice in promoting health, minimizing risk factors for health conditions, avoiding diseases, improving attitudes towards a healthy life and enhancing treatment strategies and procedures. The American Nurses Association (2017) emphasized that all Registered Nurses are leaders within the profession, working to influence policies and encourage innovation. In China, nursing organizations and departments have consistently highlighted the importance of nursing innovation. Chinese Registered Nurses have achieved preliminary achievements in the following nursing fields: management system of nursing quality (Xin et al., 2021), evidence‐based nursing practice (Zhang et al., 2021), innovative nursing equipment (Lin et al., 2021) and geriatric patients with chronic disease care (Liu et al., 2022; Tian et al., 2020; Zhou et al., 2021). These nursing innovations can improve medical treatment procedures (Xin et al., 2021), satisfaction with care (Lin et al., 2021; Zhang et al., 2021), patient quality of life and patient recovery (Liu et al., 2022; Tian et al., 2020; Zhou et al., 2021) and the competitiveness and impact of Chinese hospitals. However, previous studies (Wang, Feng, & Su, 2019; Wang, Yang, et al., 2019; Yan et al., 2020) showed that Chinese nurses' innovative behaviour was at a moderately low level, and it is difficult for them to deal with the challenges of rapid nursing development.

Based on the job demands‐resources (JD‐R) model (Van Woerkom et al., 2016), both internal and external resources influence the working behaviour of employees. This study examined whether authentic leadership as an external organizational factor and psychological capital as an internal positive factor can influence innovative behaviour in Chinese nurses. Since existing literature and studies on the relationship between authentic leadership, psychological capital and innovative behaviour in nursing are limited, this study would add to the literature on nursing leadership, psychological capital and innovation and have practical implications for nursing management and leadership development.

2. BACKGROUND

2.1. Authentic leadership and innovative behaviour

A systematic review of reviews (Hult et al., 2023) showed extensive research evidence about the benefits of relational nursing leadership styles on organizational, nurse and patient outcomes. Authentic leadership is a new relational leadership style that aims to help people identify the meaning of their work, encourage transparent relationships that build trust and optimism and promote an inclusive and healthy work environment (Alilyyani et al., 2018). Authentic leadership was defined by Avolio et al. (2009) as ‘a pattern of transparent and ethical leader behaviour that encourages openness in sharing information for decision‐making while accepting inputs from those who follow’ (Avolio et al., 2009). Four components of authentic leadership were proposed by Walumbwa et al. (2008): self‐awareness, relational transparency, an internalized moral perspective and balanced processing (Walumbwa et al., 2008). Authentic leaders build a trustworthy workplace by helping subordinates with their work, sharing information and their honest thoughts and feelings, encouraging employees to express their ideas, challenges and opinions, acting in a way that is guided by ethical standards and values, acknowledging the strengths and weaknesses of subordinates and exhibiting humility.

In a systematic review of antecedents, mediators and outcomes of authentic leadership in healthcare (Alilyyani et al., 2018), 23 mediators (structural empowerment, burnout, negative work behaviours, areas of work life, trust, psychological capital, etc.) between authentic leadership and staff outcomes, including psychological states, job satisfaction, work environment factors, health and well‐being and work performances were found. However, only a study examined the statistically significant positive correlation between authentic leadership and creativity in Indian nurses (Malik et al., 2016). Research on authentic leadership and nurses' innovative behaviour was understudied. To fill this research gap, our study proposed the first hypothesis: authentic leadership has a positive impact on nurses' innovative behaviour.

2.2. Authentic leadership and psychological capital

With the rapid growth of positive psychology, researchers put greater emphasis on employees' psychological capital or their positive internal resources (Luthans et al., 2006). Psychological capital was characterized as ‘a composite construct encapsulating an individual's positive psychological state of development’ (Luthans et al., 2007). The four components of psychological capital are self‐efficacy, hope, optimism and resilience. Self‐efficacy describes an individual's conviction about his or her ability to accomplish challenging tasks. Hope is defined as a positive motivational state; individuals with hope set realistic goals and find pathways to achieve these goals. Optimism is an explanatory style; optimists explain good events as being permanent, universal and internal. Resilience describes one's capacity to recover from adversity, setbacks, failure and even induces positive changes.

Avolio and Gardner (2005) recognized the positive psychological capabilities of self‐efficacy, optimism, hope and resilience as the personal internal resources of authentic leaders in the initial framework of authentic leadership theory (Avolio & Gardner, 2005). Authentic leaders help their followers establish their cognitive, emotional and moral skills by demonstrating self‐confidence through their words and actions. This helps subordinates see their talents more clearly and boosts their self‐confidence. Meanwhile, authentic leaders may take the initiative to support their followers in responding to pressure or difficulty positively, spreading optimism and a positive outlook to help followers persist and eventually achieve goals when faced with difficulty. All these contribute to the resilience of employees.

Psychological capital mediates the association between authentic leadership and subordinates' proactive behaviour in enterprise employees (Hu et al., 2018). Authentic leadership in Indonesian public organizations had a statistically significant impact on employees' psychological capital and work engagement (Niswaty et al., 2021). In the nursing field, Malik and Dhar (2017) found that psychological capital mediated the relationship between authentic leadership and the extra‐role behaviour of nurses (Malik & Dhar, 2017). Hence, in our study, the second hypothesis was that authentic leadership had a positive impact on nurses' psychological capital.

2.3. Psychological capital and innovative behaviour

Nursing innovation is described as a process in which nurses support the development, creation, assessment and application of original ideas (Weng et al., 2015). It includes innovation in public health, clinical practices, management, education, technology and policy. The initial stage of innovation is idea generation, which depends on nurses' cognitive skills and knowledge to recognize challenges and provide fresh solutions. Nurses' capacity to convince their coworkers and managers of the value of their ideas and to develop innovative ideas to implement will be crucial to success in the evaluation and implementation stages (Bagheri & Akbari, 2018).

A previous study showed the statistically significant impact of psychological capital on workers' innovative behaviour in the information technology field (Chen et al., 2021). Based on a large cross‐sectional survey (n = 4677), higher psychological capital promoted nurses' innovative behaviour (Yan et al., 2020). A scoping review of nurses' psychological capital shows that psychological capital is associated with many positive work‐related outcomes (Flinkman et al., 2023). However, few studies included in this review reported the relationship between psychological capital and nurses' innovative behaviour. As a result, the third hypothesis was that nurses' psychological capital has a positive impact on innovative behaviour.

2.4. Theoretical framework

The job demands‐resources (JD‐R) model states that one of the most important components of the model is the job resources. Job resources primarily include internal (work autonomy, value, psychological capital) and external (fringe benefit, leadership style, social support) resources, all of which help encourage the personal development of positive workplace behaviour (Van Woerkom et al., 2016). Both internal and external resources influence innovative behaviour in nurses. Thus, we proposed the fourth hypothesis: psychological capital had a mediating role between authentic leadership and innovative behaviour (Figure 1).

FIGURE 1.

FIGURE 1

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Hypothesized model.

Therefore, based on the literature review and JD‐R model, we proposed four hypotheses, aimed at (1) investigating the current status of innovative behaviour among Chinese nurses and (2) examining whether psychological capital has a mediating role between authentic leadership and innovative behaviour.

3. METHODS

3.1. Study design and settings

This was a cross‐sectional study that was reported following the STROBE Statement (Von Elm et al., 2007). The study was conducted at 37 hospitals with 27,015 nurses in Anhui Province, including 20 tertiary hospitals, 10 secondary hospitals and 7 community hospitals. We selected the hospitals. A convenient sampling approach was adopted to select hospitals according to the geographical regions of Anhui Province. 5 tertiary hospitals, 3 secondary hospitals and 2 community hospitals were selected in the eastern region; 5 tertiary hospitals, 3 secondary hospitals and 2 community hospitals were selected in the western region; 5 tertiary hospitals, 2 secondary hospitals and 2 community hospitals were selected in the southern region; and 5 tertiary hospitals, 2 secondary hospitals and 1 community hospital were selected in the northern region. In China, tertiary hospitals are comprehensive and general hospitals with more than 500 beds at the city, provincial or national levels. They deliver specialized health care, facilitate medical education and scientific research and function as medical centres that provide care to multiple regions. Secondary hospitals are affiliated with a medium‐sized city, county or district with 100 to 500 beds. They facilitate comprehensive health care, medical education and research on the local level. Community hospitals are typically township hospitals with under 100 beds and are responsible for delivering preventive care, primary health care and rehabilitation services.

3.2. Study participants

The convenience sampling approach was utilized to recruit Registered Nurses from 37 hospitals in Anhui Province. Inclusion criteria for participants were: (1) having worked as a Registered Nurse for longer than 6 months; (2) being presently employed in a hospital as a Registered Nurse; and (3) being willing to participate in this study. Exclusion criteria were: (1) nursing managers and leaders (because this study focused on the impact of frontline Registered Nurses' perceptions of authentic leadership from nursing managers on their psychological capital and innovative behaviour); and (2) nurses who worked outside of hospitals during the research investigation period, such as by pursuing more education and internships or being on sick leave.

In our designed survey, the sociodemographic part included 11 items (gender, age, years of working, initial education level, marital status, professional title, departments, hospital level, nature of hospitals, employment status and monthly income), and the three scales contained 46 items in total. Thus, the survey contained 57 items. Based on the cross‐sectional study sample size calculation recommendation (Ni et al., 2010), the sample size was calculated according to the number of all items included in the survey multiplied by 10 times. Hence, we should collect 570 (57*10) questionnaires from nurses. We estimate 20% of the completed surveys as invalid responses (Ni et al., 2010), which led to the minimum sample size required being 713 (570/[1–0.2]).

3.3. Instruments

Nurses' sociodemographic information included 11 variables, including gender, age, years of work experience, etc. Permissions to use the Chinese versions of the following three scales were obtained from the authors.

3.3.1. Authentic leadership questionnaire

Authentic leadership was evaluated by the Chinese version of the Authentic Leadership Questionnaire (16‐item) to measure nurses' perceptions of their current leader's behaviours (Lin, 2010; Walumbwa et al., 2008). This scale is divided into four subscales, including self‐awareness (4 items), relational transparency (5 items), morals and ethics (4 items) and balanced processing (3 items). Each item is rated on a 5‐point Likert ranging from 1 (strongly disagree) to 5 (strongly agree), in which higher scores indicate higher levels of authenticity. Previous studies have established the excellent reliability of the scale in healthcare, with internal consistency values ranging from 0.70 (Wong & Laschinger, 2013) to 0.97 (Wang, Feng, & Su, 2019; Wang, Yang, et al., 2019). In this study, Cronbach's α of the entire scale was 0.96, and Cronbach's α of each domain was 0.91, 0.90, 0.85 and 0.86, respectively.

3.3.2. Nurse psychological capital questionnaire

The Chinese version of the Nurse Psychological Capital Questionnaire was used to assess nurses' psychological capital (Luo & Hao, 2010; Luthans et al., 2007). This scale had four domains and 20 items: self‐efficacy (6 items), hope (6 items), resilience (5 items) and optimism (3 items). The scale used a 6‐point Likert scale with a score ranging from 1 (strongly disagree) to 6 (strongly agree). A higher score indicates a higher level of nurses' psychological capital. A previous study established the excellent reliability of the scale among nurses, with internal consistency values ranging from 0.89 to 0.94 (Yan et al., 2020). In this study, Cronbach's α of the entire scale and four domains ranged from 0.72 to 0.92. The internal consistency of the scale is strong.

3.3.3. Nurse innovative behaviour scale

The Chinese version of the Nurse Innovative Behaviour Scale was used to assess nurses' innovative behaviour (Bao et al., 2012). It has three domains and ten items: producing ideas (3 items), receiving support (4 items) and realizing ideas (3 items). Each item is rated on a 5‐point Likert scale (from 1 = never to 5 = always), with higher scores reflecting the more prominent performance of nurses' innovative behaviours at work. The higher score indicates a nurse's more innovative behaviour. Previous studies (Lv et al., 2022; Wen et al., 2018) found that this scale showed good validity (comparative fit index = 0.98, goodness‐of‐fit index = 0.97, incremental fit index = 0.98, Tucker–Lewis coefficient = 0.92, root mean square error of approximate = 0.07). In this study, Cronbach's α for the entire scale was 0.87, and Cronbach's α for each domain was 0.85, 0.86 and 0.91, respectively.

3.4. Data collection

In this study, the online approach for collecting data was employed because it allows a large number of the population to access the questionnaires easily and participate. In December 2021, the Questionnaire Star online platform (https://www.wjx.cn) was used to make up questionnaires and form a QR code for this study. First, the project principal investigator trained 37 research assistants from 37 hospitals through a Zoom course. Training contents included the study purpose, importance, process evaluation and noted points. Second, the survey QR code was distributed to 5000 nurses via WeChat groups by 37 research assistants. The preface of the online survey noted the study purpose, inclusion and exclusion criteria, informed consent, instructions and contact information of the principal investigator. Participants would be excluded automatically if they filled out the inclusion criteria that did not match this study, and they could not enter the online survey again. A mobile phone number can only fill out one online survey, and all questions in the survey were set to be mandatory. Third, when a participant completed an online questionnaire, the principal investigator's Questionnaire Star account would receive the data immediately. The QR code for this survey would automatically expire after 7 days. Seven days later, the principal investigator would download all the data from her Questionnaire Star account in Excel format.

3.5. Data analysis

SPSS Statistics 20.0 and SPSS Amos 21.0 for Windows were used for data coding, cleaning and analysis since Amos can compensate for the inadequacies of SPSS in constructing a structural equation model. First, data were imported and analysed by SPSS 20.0. Mean (M), standard deviation (SD), frequency and percentage were used to describe participants' sociodemographic characteristics and the outcome measures. Pearson correlation analysis was used to examine the correlations among authentic leadership, psychological capital and innovative behaviour. Second, AMOS 21.0 was chosen to construct the structural equation model (SEM) because the number of variables used and the variables used for the purpose of SEM analysis can be studied using the text output variable summary. The observed variables and unobserved variables are differentiated from the model (Blunch, 2012). According to Hu and Bentler's recommendations (Hu & Bentler, 1999), the following goodness‐of‐fit statistics were used to evaluate the fit degree of SEM and data: root mean square error of approximation (RMSEA) with an acceptance level of ≤0.08, the goodness‐of‐fit index (GFI) with an acceptance level of ≥0.90, normal fit index (NFI) with an acceptance level of ≥0.90, relative fit index (RFI) with an acceptance level of ≥0.90, comparative fit index (CFI) with an acceptance level of ≥0.90, parsimony goodness fit index (PGFI) with an acceptance level of ≥0.50, Tucker–Lewis index (TLI) with an acceptance level of ≥0.90 and root means square residuals (RMR) with an acceptance level of ≤0.05. We proposed an SEM that psychological capital mediated the relationship between authentic leadership and innovative behaviour. Third, a 5000‐sample bootstrap procedure with a 95% confidence interval (CI) was used to test the significance of the mediating effect (Preacher & Hayes, 2008). The statistical significance was set at p < 0.05 (two‐sided).

3.6. Ethical consideration

This study obtained the Research Ethics Committee approval of the Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Approval No.: 2021 KY 277). The contact information was provided so that participants could get in touch with the principal investigator if they had any questions. Participants could only fill out the online questionnaires after clicking ‘Agree’ on the page for informed consent. No informed consent hard copy document needed to be signed. Participants' data was saved on a laptop with a password that only the researchers had access to, and questionnaires were filled out anonymously.

4. RESULTS

4.1. Sociodemographic characteristics of participants

A total of 5000 questionnaires were sent out, and 3662 online questionnaires from nurses were received, with a response rate of 73.24%. Six researchers checked all surveys and removed 167 invalid surveys with answers showing consistent regularity. Finally, 3495 valid surveys were included, resulting in a valid response rate of 95.44%. Among the 3495 participants, 2.69% were male and 97.31% were female; the mean age of nurses was 33.48 years (SD 7.63), with <30 years (33.87%), 30 ~ 39 years (46.12%), 40 ~ 49 years (15.15%) and ≥50 years (4.84%); and the mean years of working was 11.93 years (SD 8.47), with <1 year (3.53%), 1 ~ 2 years (4.35%), 3 ~ 5 years (14.99%), 6 ~ 10 years (26.35%), 11 ~ 20 years (33.24%) and >20 years (17.54%). The specific sociodemographic characteristics of participants are shown in Table 1.

TABLE 1.

Sociodemographic characteristics of participants (n = 3495).

Variables Groups n %
Gender Female 3401 97.31
Male 94 2.69
Age (years) (M 33.48, SD 7.63) <30 1184 33.87
30–39 1612 46.12
40–49 530 15.16
≥50 169 4.84
Years of working (years) (M 11.93, SD 8.47) <1 123 3.53
1–2 152 4.35
3–5 524 14.99
6–10 921 26.35
11–20 1162 33.24
>20 613 17.54
Initial education level ≤Associate's degree 2596 74.27
Bachelor's degree 887 25.38
≥Master's degree 12 0.34
Marital status Married 2726 77.9
Single 706 20.20
Divorced or widowed 63 1.80
Professional title Nurse 567 16.22
Nurse practitioner 1369 39.17
Nurse‐in‐charge 1362 38.96
≥Associate professor of nursing 197 5.64
Departments Internal medicine 835 23.89
Surgery 837 23.95
Obstetrics and gynaecology 286 8.18
Paediatrics 159 4.55
Emergency 180 5.15
ICU 106 3.03
Operating room 242 6.92
Outpatient department 209 5.97
Others 641 18.34
Hospital level Tertiary hospitals 2006 57.40
Secondary hospitals 1472 42.12
Community hospitals 17 0.48
Nature of hospitals Public hospitals 3044 87.10
Private hospitals 451 12.90
Employment status Permanent 840 24.03
Contract 1857 53.13
Labor dispatch 798 22.83
Monthly income (RMB) <5000 1529 43.75
5000–10,000 1775 50.79
>10,000 191 5.46
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Abbreviations: M, mean; SD, standard deviation.

4.2. Mean item scores of innovative behaviour, psychological capital and authentic leadership

The Kolmogorov–Smirnov test indicated that the three study continuous variables had a reasonable and normal distribution. The mean scores of innovative behaviour, psychological capital and authentic leadership were 28.23 (SD 8.41), 96.89 (SD 17.78) and 52.04 (SD 13.24), respectively. The mean item scores of innovative behaviour, psychological capital and authentic leadership were 2.82 (SD 0.84), 4.85 (SD 0.89) and 3.25 (SD 0.83), respectively (Table 2).

TABLE 2.

Mean item scores of innovative behaviour, psychological capital and authentic leadership.

Variables Average score range M SD
Innovative behaviour 1–5 2.82 0.84
Producing ideas 1–5 2.99 0.81
Receiving support 1–5 2.73 0.91
Realizing ideas 1–5 2.76 0.95
Psychological capital 1–6 4.85 0.89
Self‐efficacy 1–6 4.83 0.94
Hope 1–6 4.81 0.93
Resilience 1–6 4.88 0.91
Optimism 1–6 4.90 1.01
Authentic leadership 1–5 3.25 0.83
Self‐awareness 1–5 4.28 0.82
Relational transparency 1–5 4.22 0.88
Morals and ethics 1–5 4.27 0.82
Balanced processing 1–5 4.24 0.67
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Abbreviations: M, mean; SD, standard deviation.

4.3. Correlation among the three study variables

Authentic leadership and psychological capital were significantly correlated with innovative behaviour. Bivariate correlations also revealed that authentic leadership was positively related to psychological capital (r = 0.540, p < 0.01) and innovative behaviour (r = 0.524, p < 0.01). Meanwhile, psychological capital was positively associated with innovative behaviour (r = 0.806, p < 0.01).

4.4. Testing mediating model

According to the theoretical framework, we establish an SEM, including three latent variables and 11 measured variables (Figure 2). Due to the large sample sizes (n = 3495) of this study, CMIN/DF (χ 2 /df = 4.485) was excluded from the model fitting index. Table 3 shows that the fitting index of this mediating SEM adequately suited the model fitting standards perfectly: RMSEA = 0.08 (≤0.08), GF I = 0.98 (≥0.90), NFI = 0.98 (≥0.90), RFI = 0.97 (≥0.90), CFI = 0.98 (≥0.90), PGFI = 0.51 (≥0.50), TLI = 0.98 (≥0.90), RMR = 0.02 (≤0.05).

FIGURE 2.

FIGURE 2

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SEM of authentic leadership, psychological capital and innovative behaviour.

TABLE 3.

Structural equation model fitting index.

RMSEA GFI NFI RFI CFI PGFI TLI RMR
Model fitting standard ≤0.08 ≥0.90 ≥0.90 ≥0.90 ≥0.90 ≥0.50 ≥0.90 ≤0.05
Model fitting index 0.08 0.98 0.98 0.97 0.98 0.51 0.98 0.02
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Abbreviations: CFI, comparative fit index; GFI, goodness‐of‐fit index; NFI, normal fit index; PGFI, Parsimony goodness fit index; RFI, relative fit index; RMR, root means square residuals; RMSEA, root ‐mean ‐square error of approximation; TLI, Tucker–Lewis Index.

Hayes (2017) considered the bootstrap to be the most effective method of indirect effect assessment because it has no assumption about the shape of the sample distribution of indirect effects; there is also better control of type I errors (Hayes, 2017). A 5000‐sample bootstrap procedure with a 95% CI was used to test the direct and indirect effects of authentic leadership and innovative behaviour (Preacher & Hayes, 2008).

Table 4 shows that the direct effect of authentic leadership on innovative behaviour (β = 0.136, p < 0.001, 95% CI = 0.106, 0.166) and the indirect effect of authentic leadership on innovative behaviour (β = 0.449 = 0.610*0.736, p < 0.001, 95% CI = 0.417, 0.483) were also statistically significant. Authentic leadership had a statistically significant impact on the total effect of the innovative behaviour of nurses (β = 0.585 = 0.136 + 0.449, p < 0.001, 95% CI = 0.550, 0.619). In other words, the indirect effect was mediated by psychological capital (β = 0.449, p < 0.001), which suggested that there was a partial mediating effect of psychological capital between authentic leadership and innovative behaviour, and the indirect effect accounted for 76.75% (0.449/0.585). Thus, all four hypotheses of this study were supported.

TABLE 4.

Standardized direct, indirect and total effect of the SEM.

Path Point estimate SE 95% CI
Lower Upper
Standardized direct effect
Authentic leadership→Innovative behaviour 0.136 0.015 0.106 0.166
Standardized indirect effect
Authentic leadership→Innovative behaviour 0.449 0.017 0.417 0.483
Standardized total effect
Authentic leadership→Innovative behaviour 0.585 0.017 0.550 0.619
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Abbreviations: CI, confidence interval; SE, standard error; SEM, structural equation model.

5. DISCUSSION

The aims of this study were: (1) to investigate the current status of innovative behaviour among Chinese nurses in Anhui Province; and (2) to examine whether psychological capital has a mediating role between authentic leadership and innovative behaviour. Our results showed that (1) the nurses' innovative behaviour in the Anhui Province was below the moderate level and (2) psychological capital partially mediated the relationship between authentic leadership and innovative behaviour.

In this study, we found that nurses' innovative behaviour with a mean score of 2.82 (SD 0.84), was lower than that in previous research about Chinese nurses' innovative behaviour (Yan et al., 2020). The reason may be related to the hospital levels. Yan et al. (2020) recruited nurses from tertiary hospitals in China, whereas nurses in this study also included 1489 nurses from 10 secondary hospitals and 7 community hospitals, which may have influenced the nurses' innovative behaviour. As explained before, tertiary hospitals in China offer top‐notch medical care and facilitate nursing education and scientific research. Nurses working at tertiary hospitals lead the development of nursing specialties and may stimulate more innovative behaviour. Meanwhile, Chinese nurses' innovative behaviour in this study was lower than that of nurses in other countries (Li‐Ying et al., 2016; Masood & Afsar, 2017). Li‐Yang et al. showed that ICU nurses' innovative behaviour mean score was 3.21 (SD 0.37) in Denmark, and Masood et al. reported that the mean score of nurses' innovative behaviour was 3.98 (SD 0.35) in public sector hospitals in Pakistan. Therefore, nurses' innovative behaviour should be enhanced. Among the three domains of innovative behaviour, the score of ‘receiving support’ was the lowest, which was in line with the study of Yan et al. (2021). This result showed that nurses had difficulties in analysing the feasibility of the method, searching for relevant information and seeking support and help in the clinical environment. Clinical nurses require more support from the organization's external environment to achieve their innovative ideas and methods.

According to the SEM, the psychological capital of nurses partially mediated the relationship between authentic leadership and innovative behaviour. That is, authentic leadership perceived by nurses can directly precipitate their innovative behaviour, and the increase in nurses' psychological capital can enhance the impact of authentic leadership on innovative behaviour. Based on the JD‐R model (Van Woerkom et al., 2016), authentic leadership (external resource) influences psychological capital (internal resource) and thus complements each other and mutually contributes to innovative behaviour. As a result, the JD‐R model is further enriched by our study results. An increase in nurse managers' authentic leadership and nurses' psychological capital will substantially enhance nurses' innovative behaviours.

This study found that nursing managers' authentic leadership can be significantly positively correlated with nurses' innovative behaviour. According to authentic leadership theory (Walumbwa et al., 2008), nurse managers with strong self‐awareness can encourage nurses to express themselves, support autonomy, embrace creative and unconventional ideas, and provide nurses with an inspiring example through their roles, further promoting nurses' innovation. Relational transparency and ethical leadership allow nurses to understand and balance how important innovation is to the organization and not be held back from experimenting with new ideas for fear of failure. Nurse managers who handle information in a balanced way won't deny, distort, exaggerate or filter personal and external information, which might enhance task feedback interpretation and encourage nurses to be more innovative. In our study, the self‐awareness domain scored the highest, while the relational transparency domain scored the lowest of the four domains, which were different from the findings of Wong et al. (2010) and may be related to different cultures (Wong et al., 2010). As we mentioned in the literature review, limited studies have been done on authentic leadership and innovative behaviour in the nursing field. Consequently, our findings enriched the authentic leadership theory, demonstrating the importance of an effective leadership style, particularly authentic leadership, in fostering nurses' creativity in healthcare settings.

This study also found that nurses perceived authentic leadership had a statistically significant positive impact on their psychological capital. This result was consistent with previous studies where authentic leadership contributed to the staff's psychological capital (Hu et al., 2018; Niswaty et al., 2021). Nursing managers who practice authentic leadership may intentionally obey norms and regulations, treat every nurse with transparency, avoid lying and treat every subordinate equitably. Furthermore, authentic leaders encourage nurses' self‐development by providing instructions. Nurses can strengthen their psychological resiliency and self‐efficacy while obtaining timely and efficient leadership assistance. As a consequence, nurses have a more positive outlook on their circumstances and may continue to be optimistic about the organization's future potential, which may boost their psychological capital.

The statistically significant positive relationship between psychological capital and nurses' innovative behaviour was confirmed in our study, which was identical to those of previous studies (Slatten et al., 2020; Xu & Zhao, 2020). Innovation is defined as the application of novel ideas or tried‐and‐true concepts to new methodologies (American Nurses Association, ANA, 2017). The ANA pointed to the need for creative approaches and solutions to address the complex issues facing healthcare services. Therefore, innovation is not a simple thing. It requires the support of external conditions and strong and positive psychological qualities in one's heart, such as being positive and optimistic, unafraid of failure, perseverance and resilience. The four components of psychological capital are an individual's efforts to complete difficult activities successfully, keep working towards goals, attribute achievement in a positive way and recover from setbacks. This result showed that positive psychology had a better impact on nurses' innovative behaviour.

5.1. Practical implications

The results of this study had practical implications for nursing management and leadership development in real‐world health settings. (1) Based on a quasi‐experimental trial (Aboelenein & Mostafa, 2023), the authentic leadership educational program increased head nurses' authentic leadership knowledge and staff nurses' perception of their authentic leadership style after the program implementation. Nursing administrators should identify and promote effective relational leadership. Training and fostering such nursing managers may provide a competitive edge for healthcare sectors, as leadership style has an effective impact on the internal positive psychology and innovative behaviour of staff nurses; (2) undergraduate nursing education should include a leadership curriculum covering authentic leadership concepts and capabilities and enabling them to become effective practitioners and future nursing leaders; (3) educating students and new graduate nurses on positive psychology should be a priority, as it may help them overcome challenges in their nursing profession; and (4) nursing managers ought to encourage and promote nurses' creative ideas and innovative behaviour.

5.2. Limitations

Limitations should be considered in the interpretation of the current study. First, participants were recruited from a province in China, and the generalizability and representativeness of the results are constrained. Therefore, future research should focus on improving the generalizability of these findings by evaluating other clusters or regions in China. Second, this study used a cross‐sectional study design and proposed the relationship between authentic leadership and innovation behaviour based on previous studies or theories. Hence, it did not provide definite information about cause‐and‐effect relationships. Although the use of SEM permitted a simultaneous test of the entire system of variables in the hypothesized model, the explanation results should still be made with caution. In future research, longitudinal studies are warranted. Third, this study has adopted self‐reported measurements; it may be possible that a social desirability bias may have resulted in the overreporting of perceived ‘good behaviours’. Future research could try to minimize the possibility of this bias by maintaining confidentiality with participants.

6. CONCLUSION

In conclusion, this study supports the theories (authentic leadership theory and JD‐R model) with empirical data to further enrich the two theories regarding the potential influence of authentic leadership on nurses' innovative behaviour. We reported the current status of nurses' innovative behaviour and explained the mediating role of psychological capital between authentic leadership and innovative behaviour. We proposed that nursing leadership and positive psychology education should be integrated into undergraduate and novice nurses' curricula and training. We anticipate that this study will drive further research utilizing complementary research methodologies to capture the complexities hidden in the causal relationship between authentic leadership and innovation for nurses.

AUTHOR CONTRIBUTION

Guowen Zhang and Wenfeng Lin led the team, and they made a substantial contribution to the conception and design, acquisition of data and analysis and interpretation of data. Both drafted and revised the manuscript critically. Xiaohong Zhang and Guiqi Song made a substantial contribution to the conception and design and acquisition of data. Guiqi Song, Xiaohong Zhang, Juanjuan Chen and Huiping Li revised the manuscript critically for important intellectual content. Juanjuan Chen, Guowen Zhang, Liqin Sun and Baozhen Cheng made substantial contributions to the analysis and interpretation of data.

FUNDING INFORMATION

No funding was received for this research.

CONFLICT OF INTEREST STATEMENT

The authors declare no potential conflict of interest.

ETHICS STATEMENT

This study obtained the Research Ethics Committee approval of the Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Approval No.: 2021 KY 277).

ACKNOWLEDGEMENTS

All authors would like to thank all the nurses for their participation and support. Sincere thanks to Dr. Yee Tak Derek Cheung from The University of Hong Kong for language editing.

Zhang, G. , Lin, W. , Song, G. , Chen, J. , Li, H. , Sun, L. , Cheng, B. , & Zhang, X. (2024). The mediating role of psychological capital on the relationship between authentic leadership and innovative behaviour among Chinese nurses. Nursing Open, 11, e2126. 10.1002/nop2.2126

Guowen Zhang and Wenfeng Lin contributed equally to this work and share the first authorship.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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