Nurses Innovative Behaviour in the Context of Authentic Leadership: A Scoping Review

ABSTRACT

Aim

This scoping review aims to explore the existing research on the impact of authentic leadership on nurses' innovative behaviours.

Data Sources

The following databases were searched (from 2013 to 2023): PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, APA Psych Info, Educational Resources Information Centre, and ABI Inform.

Review Methods

Search results were exported into Covidence software to assist with the selection and assessment of retrieved studies. Studies were included that specifically examined the relationship between authentic leadership and innovative behaviour among nurses working in healthcare settings.

Results

12 papers remained for full‐text review after title and abstract screening. Four studies that met the inclusion criteria were included in the final analysis. Using the Crowe Critical Appraisal Tool two reviewers independently evaluated these four studies. Findings revealed that authentic leadership affects nurses' innovation and creativity in various healthcare settings and cultural contexts. It also highlighted mediating factors such as increased engagement and knowledge sharing. Resilience and technological infrastructure were identified as additional factors that affect and support this relationship and influence the development and enaction of innovative behaviours.

Conclusions

Authentic leadership was found to contribute to innovative nursing behaviours that have important implications for the best practices in healthcare and outcomes.

Impact

Innovative behaviour among nurses is essential for rising to the challenges of complex healthcare environmental challenges, and the potential for authentic leadership to act as a catalyst for this is important. Future research needs to further explore the impact of authentic leadership on innovative behaviour and the contextual and cultural influences that effect this. More research is also needed on the exact nature of nurses' innovations and their potential use in healthcare.

Reporting Method

The EQUATOR guidelines for PRISMA have been met.

Patient or Public Contribution

No patient or public contribution.

Summary.

• Implications for the profession and/or patient care

  • ○
    While there is interest in both authentic leadership and innovative behaviour, there is limited research in the field that explores the relationship between both.
  • ○
    This review reveals that authentic leadership can have a positive effect on nurses' innovative behaviour.
  • ○
    There are limited examples of successful innovations influenced by authentic leadership, and thus further research in the field is required.
• Impact

  • ○
    Innovative behaviour among nurses is essential for rising to the challenges of complex healthcare environmental challenges, and the potential for authentic leadership to act as a catalyst for this is important.
  • ○
    This study revealed the potential for a positive impact on patient care and patient outcomes.
  • ○
    There is potential for authentic leadership to influence not only innovative behaviours but also patient safety, making it a key area for further research and leadership development efforts in healthcare.

1. Introduction

The healthcare sector worldwide faces unprecedented challenges, driven by escalating demands due to aging populations, increasing prevalence of chronic diseases, complex comorbidities, shorter inpatient stays, and the growing burden on community‐based care (Maresova et al. 2019). In addition to these challenges, global issues such as migration, poverty, health disparities natural disasters, and environmental concerns further increase the complex demands and requirements of the healthcare sector (Jackson et al. 2024). Concurrently, the nursing workforce is grappling with chronic and persistent staff shortages, coupled with relentless pressure to enhance both the efficiency and quality of care (Jackson et al. 2024).

These concordant challenges have significant consequences. One major outcome is that nurses often face work demands that exceed available resources, leading to unfinished tasks. This means that vital aspects of care, such as communication and patient education, are frequently missed, which directly affects patient safety and the overall quality of care (Jackson et al. 2024; Duhalde et al. 2023). Another consequence of these fast‐paced complex environments is the negative effect on nurses' well‐being, which has become a growing concern globally (Harvey et al. 2020). In response, there are emerging efforts aimed at addressing these issues by tackling staffing shortages, ensuring safe staffing levels, and improving leadership and work environments to better support nurses' well‐being (Harvey et al. 2020).

In this context, exploring nursing leadership styles that positively influence nurse behaviour is an important step toward ensuring and sustaining improvements in complex healthcare environments (Daly et al. 2015). Beyond high‐level leadership, there is also a pressing need for nurses to engage in innovative actions that address existing challenges with creative solutions. As Jackson et al. (2024) suggested:

We need nurse researchers and educators to continue to invent and report on innovation….Much remains untapped in our ability to engage and inspire the future of health care. We need nurses to boldly advocate for policies that disrupt structural racism and social inequity which drives disparities in health outcomes among marginalized populations across the globe. (Jackson et al. 2024, 2)

For many years, transformational leadership was mooted as the preferred approach to addressing these challenges (Ystaas et al. 2023). However, despite its theoretical appeal, limited empirical testing and practical application of this leadership style have led to inconsistent results in practice, raising questions about its effectiveness (Ystaas et al. 2023; Pattison and Corser 2022).

Consequently, there has been growing interest in relationship‐focused leadership approaches that emphasise positive, supportive interactions with others (Pattison and Corser 2022). One such approach, authentic leadership, not only enhances productivity but also has the potential to foster innovative behaviour among nurses, offering promising solutions to the many challenges that the profession faces (Dirik and Seren Intepeler 2024).

De Spiegelaere et al. (2014) define innovative work behaviour as employee behaviour that encompasses the exploration, cultivation, suggestion, and execution of newly generated ideas within the workplace which are advantageous at work (De Spiegelaere et al. 2014). Likewise, Lambriex‐Schmitz et al. (2020) agreed that besides generating and presenting innovative ideas, innovative work behaviour also promotes and implements innovative ideas (Lambriex‐Schmitz et al. 2020). Innovative work behaviour is a crucial component of employee engagement and organisational success, as it involves the initial creative process that lead to potential improvement. The innovator implements the creative idea and transforms it into actual products and processes that can enhance the profitability and efficiency of the individual, group, or organisation (Wang et al. 2015). Moreover, It's important to differentiate between innovative behaviour and successful innovations. Innovative behaviour involves actions that spark the innovation process, like generating ideas, but doesn't ensure success. Successful innovations, on the other hand, emphasise the implementation, impact, and sustainability of those ideas (Rylee and Cvanagh 2023). This behaviour is crucial not only for improving patient outcomes but also for enhancing the efficiency and effectiveness of healthcare practices.

In nursing, innovative behaviour encompasses a multifaceted range of activities, such as exploring opportunities, generating ideas, and overcoming obstacles. These activities play a crucial role in advancing patient care and improving healthcare systems (Asurakkody and Shin 2018). Importantly it is perceived that this creativity and innovation is crucial to the future of healthcare:

…we know that the future of nursing is ours to shape with courage. As we move into a post‐pandemic world, we need to be proactive in shaping our future; to actively take the lead in promoting public understandings of nursing, and to take leadership roles in cultural, diversity, equity, inclusion … innovations and strategies that promote adaptive clinical and organizational change in health care. If we take our power and work collaboratively, we have every reason to look ahead to a bright future in which nurses lead the way in important health and social care reforms (Jackson et al. 2024, 2)

However at the same time, evidence of specific innovations by nurses and their impact are sparse in the nursing literature. Certainly there are calls for nurses to be innovative, explorations of characteristics of innovative behaviour (Luz et al. 2019), and examination of how innovations may be spread through networks (Luz, Drach‐Zahavy, and Shadmi 2021), but there is little existent literature that provides concrete examples of innovations.

2. Background

Authentic leadership has been recognised as an emerging approach, that supports effective leadership in nursing (Best 2022). It shows promise for enhancing care quality and patient satisfaction (Tate et al. 2023; Wong et al. 2013). This leadership style also linked to reductions in adverse patient outcomes (Wong and Giallonardo 2013), improvements in nurses' perceptions of safety (Dirik and Seren Intepeler 2017), and safety‐related behaviours (Labrague et al. 2021). Furthermore, authentic leadership has been associated with building social capital within healthcare organisations (Kida, Yumoto, and Ogata 2023; Read and Laschinger 2015). A recent review emphasised its positive impact on factors such as job satisfaction, work engagement, commitment, well‐being, and patient outcomes in nursing (Maziero et al. 2020). Although the impact on interprofessional collaboration has received limited focus, earlier research has shown beneficial effects (Regan, Laschinger, and Wong 2016). Additional studies also supported the positive influence of authentic leadership on work engagement (Lv et al. 2022; Bamford, Wong, and Laschinger 2013). Moreover, nurses are found to “thrive” under this leadership style (Mortier, Vlerick, and Clays 2016).

Authentic leadership, as originally described by Luthans and Avolio (2003), is proposed as one emerging example of effective leadership that is suitable to address the concerns of this complex modern age. It centres on four key leadership attributes: self‐awareness, transparency, balanced decision‐making, and a strong internal moral compass. Leaders who embrace this style strive to remain true to their core values, build genuine relationships with their teams, and consistently act with integrity. In the field of nursing, Wong and Avolio expanded on this idea, underscoring its potential to cultivate ethical work environments where nurses feel both empowered and engaged (Gardner et al. 2021). Authentic leaders serve as role models by fostering trust and openness, ensuring that every team member feels supported and that their contributions are acknowledged (Gardner et al. 2011). These attributes are increasingly seen as vital for driving innovation, improving patient care, and enhancing nurses' overall well‐being.

The relational aspect of authentic leadership is particularly influential, with an “unmistakable focus” on fostering strong, positive relationships (Wong and Cummings 2009, 534). Authentic leadership was first introduced as a general leadership concept by Luthans and Avolio (2003). This concept was later popularised in nursing through the seminal work of Wong (2008); Wong and Giallonardo (2013); Wong and Laschinger (2013); Wong, Spence Laschinger, and Cummings (2010). In her original PhD thesis, Wong (2008) explored the development of authentic leadership and how Avolio et al.'s (2004) framework could be used effectively within the nursing profession. Over time, authentic leadership has gained recognition as one of the most promising approaches to leadership in healthcare, with the potential to yield long‐term positive outcomes for both individual nurses and the healthcare environment (Doherty and Hunter Revell 2020).

A first and recent concept analysis of authentic leadership performed by Almutairi et al. (2024) revealed the defining attributes as self‐awareness, transparency, balanced processing, internalised moral perspective, caring, shared decision making, and ethical courage in the leader. Antecedents were authenticity, positive psychological capacities, life experiences, a supportive organisational climate, an ethical climate, and leaders having undertaken a leadership development programme. Consequences were grouped under the following heading: employee well‐being and satisfaction, positive work environment, and enhanced performance and safety (Almutairi et al. 2024). Another potential contribution of this leadership style, as yet underexplored, is the possibility to effect nurses' innovative behaviour (Mohamed et al. 2023).

Existing reviews have focused on authentic leadership in the healthcare care sector (Malila, Lunkka, and Suhonen 2017), authentic leadership in education research (Ahmed 2023), and the relationship between leadership styles and nurses' innovative behaviours (Labrague and Toquero 2023). However, the direct impact of authentic leadership on innovative behaviour specifically within nursing practice has not been thoroughly investigated. This research gap has been acknowledged in the literature, with several studies highlighting the need for more targeted research into how leadership styles, particularly authentic leadership, may influence innovation in nursing (Mohamed et al. 2023; Labrague and Toquero 2023). A comprehensive analysis of how authentic leadership fosters innovation within nursing environments is necessary, as this could potentially lead to improved health outcomes and patient care. The goal of this scoping review therefore is to explore existing evidence on how authentic leadership influences nurses' capacity for innovation to improve the quality of healthcare outcomes.

3. The Review

3.1. Aim

This scoping review was conducted to examine the extent and type of the literature, map, and summarise the evidence regarding the impact of authentic leadership on nurses' innovative behaviour (Peters et al. 2020).

3.2. Method

A scoping review, as defined by the Joanna Briggs Institute (JBI), is a type of literature review that seeks to identify and chart the existing evidence on a specific subject, with the objective of providing a comprehensive summary of the extent and scope of the literature in a particular field (Peters et al. 2020). Scoping reviews can help to identify key concepts, gaps in the literature, and potential research questions for future studies (Peters et al. 2020). Considering the complex and diverse nature of authentic leadership and its application across various disciplines such as business, education, healthcare, and more, a scoping review is an appropriate approach for this study. The scoping review allowed examination off the varied literature on the topic and identification of research gaps to guide future studies (Munn et al. 2022).

The review was conducted following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Statement for Scoping Reviews (PRISMA‐ScR) (Page et al. 2021; Tricco et al. 2018) and was based on the JBI method (Peters et al. 2020). The following guiding question for this review: What is the impact of authentic leadership on nurses' innovative work behaviour? The protocol for this review was published on the Open Science Framework (Almutairi, Timmins, and Yoder Wise 2023).

To support and underpin the literature search, the population, concept, and context (PCC) framework was used as recommended by Peters et al. (2020). This framework served as a useful way to structure the research question by breaking it down into three key elements: population (nurses), concept (innovative behaviour), and context (authentic leadership). This systematic breakdown helped ensure that the review remained focused and relevant, while also capturing the breadth of available literature. Table 1 illustrates how the PCC was applied to the scoping review question.

TABLE 1.

Population, concept, context (PCC) framework.

Element	Concept
Population	Nurses
Concept	Innovative behaviour
Context	Authentic leadership

3.2.1. Eligibility Criteria

In this scoping review, the studies analysed encompassed those that included nurses (or nurse managers) as study participants. The inclusion criteria were set broad to capture a wide range of studies that examined the relationship between authentic leadership and innovative behaviour among nurses working across various practice areas. The decision to include nurses with no restrictions on educational level, background, or experience was made to ensure that the review encompassed the full spectrum of the nursing profession. The review encompassed studies employing both quantitative and qualitative methods to provide a comprehensive exploration of the topic.

3.2.2. Concept

The primary concept of interest in this review was innovative behaviour, which is characterised by proactive actions driven by both a clear understanding of one's responsibilities and intrinsic motivation (Gogoleva, Balabanova, and Efendiev 2016). Innovative behaviour involves not only generating new ideas but also implementing these ideas effectively within the workplace (Lambriex‐Schmitz et al. 2020). This behaviour includes a range of activities, such as exploring opportunities, generating creative solutions, and overcoming obstacles, which are essential for improving patient outcomes and enhancing the overall efficiency of healthcare practices (Wang et al. 2015). Innovative behaviour is critical to advancing patient care and improving healthcare systems (Asurakkody and Shin 2018).

3.2.3. Context

This review focused on the context of authentic leadership, specifically examining the relationship between authentic leadership and nurses' innovative behaviour within healthcare settings such as hospitals and health centres. The aim was to provide a directed and specific synthesis of all pertinent literature on this topic. Studies conducted in educational settings were excluded from this review to maintain a clear focus on the clinical healthcare environment, where the dynamic of leadership and innovation directly impact patient care and outcomes. The leadership challenges and innovative behaviours in an educational context can be different. The geographical locations of the studies were not restricted, encompassing global perspectives on the subject.

3.2.4. Search Strategy

A systematic search was performed to locate relevant studies within the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Scopus, APA PsycInfo, Educational Resources Information Center (ERIC), and ABI/Inform. The identification of keywords was aided by initial literature reviews on the subject and evaluated by the research team for inclusion in the search strategy. The accumulation and final decision on the search terms and search strategy was overseen by a subject specialist librarian at the University. Studies published in English from 2013 to 2023 were included in the search. This period was chosen as it reflects the emergence of literature on authentic leadership within nursing contexts. Wong (2008); Wong and Laschinger (2013); Wong and Giallonardo (2013); Wong, Spence Laschinger, and Cummings (2010) was a seminal author who pioneered this approach in nursing, with the majority of emergent publications from her PhD thesis (Wong 2008), and post‐doctoral work arising around this time (e.g., Bamford, Wong, and Laschinger 2013). Table 2 provides a descriptive outline of her first published and early work on the topic (up until 2013), and its citation history (Scopus 2024) which clearly outlines that use of the work emerged primarily after 2013.

TABLE 2.

Citation trends related to the seminal work of Carol Wong in the field authentic leadership.

Year of publication	Reference	Number of citations	Year of first citation
2013	Wong, C.A., Cummings, G.G., Ducharme, L.The relationship between nursing leadership and patient outcomes: A systematic review update Journal of Nursing Management, 21 (5), pp. 709–724. DOI: 10.1111/jonm.12116	361	2014
2013	Wong, C.A., Giallonardo, L.M.Authentic leadership and nurse‐assessed adverse patient outcomes Journal of Nursing Management, 21 (5), pp. 740–752. DOI: 10.1111/jonm.12075	79	2013
2013	Laschinger, H.K.S., Wong, C.A., Grau, A.L.Authentic leadership, empowerment and burnout: A comparison in new graduates and experienced nurses Journal of Nursing Management, 21 (3), pp. 541–552. DOI: 10.1111/j.1365‐2834.2012.01375.x	161	2013
2013	Bamford, M., Wong, C.A., Laschinger, H. The influence of authentic leadership and areas of worklife on work engagement of registered nurses Journal of Nursing Management, 21 (3), pp. 529–540. DOI: 10.1111/j.1365‐2834.2012.01399.x	142	2013
2013	Wong, C.A., Laschinger, H.K.S.Authentic leadership, performance, and job satisfaction: The mediating role of empowerment Journal of Advanced Nursing, 69 (4), pp. 947–959. DOI: 10.1111/j.1365‐2648.2012.06089.x	217	2013
2013	Spence Laschinger, H.K., Wong, C.A., Macdonald‐Rencz, S., Burkoski, V., Cummings, G., D'amour, D., Grinspun, D., Gurnham, M.‐E., Huckstep, S., Leiter, M., Perkin, K., Macphee, M., Matthews, S., O'brien‐Pallas, L., Ritchie, J., Ruffolo, M., Vincent, L., Wilk, P., Almost, J., Purdy, N., Daniels, F., Grau, A. Part 1: The influence of personal and situational predictors on nurses' aspirations to management roles: Preliminary findings of a national survey of Canadian nurses Journal of Nursing Management, 21 (2), pp. 217–230. DOI: 10.1111/j.1365‐2834.2012.01452.x	20	2014
2012	Spence Laschinger, H.K., Wong, C.A., Grau, A.L.The influence of authentic leadership on newly graduated nurses' experiences of workplace bullying, burnout and retention outcomes: A cross‐sectional study International Journal of Nursing Studies, 49 (10), pp. 1266–1276. DOI: 10.1016/j.ijnurstu.2012.05.012	203	2013
2010	Wong, C.A., Spence Laschinger, H.K., Cummings, G.G. Authentic leadership and nurses' voice behaviour and perceptions of care quality Journal of Nursing Management, 18 (8), pp. 889–900. DOI: 10.1111/j.1365‐2834.2010.01113.x	261	2011
2010	Giallonardo, L.M., Wong, C.A., Iwasiw, C.L.Authentic leadership of preceptors: Predictor of new graduate nurses' work engagement and job satisfaction Journal of Nursing Management, 18 (8), pp. 993–1003. DOI: 10.1111/j.1365‐2834.2010.01126.x	244	2011
2009	Wong, C.A., Cummings, G.G.The influence of authentic leadership behaviours on trust and work outcomes of health care staff Journal of Leadership Studies, 3 (2), pp. 6–23. DOI: 10.1002/jls.20104	167	2010
2009	Wong, C., Cummings, G. Authentic leadership: A new theory for nursing or back to basics? Journal of Health, Organisation and Management, 23 (5), pp. 522–538. DOI: 10.1108/14777260910984014	81	2016

Manual searches of the reference lists of eligible studies were conducted. These databases were searched using a Boolean search strategy that integrated key concepts with corresponding terms, employing Boolean operators to combining terms in the searches, such as: (participant AND concept AND context).

3.2.5. Study/Source of Evidence Selection

Covidence (2024), the web‐based software management system, was used to combine search results from the aforementioned databases. These electronic searches identified 498 records. The complete selection process is described in Figure 1 in accordance with the PRISMA‐ScR (Page et al. 2021; Tricco et al. 2018).

FIGURE 1.

PRISMA‐ScR flowchart.

Out of 498 records initially identified through database searches, the duplicates (n = 82) of the same articles were eliminated. Thus 416 articles remained. Two reviewers (MA and FT) then independently screened the titles and abstracts of these articles and removed studies (n = 404) for several reasons. Many studies were excluded because they did not directly address the research question, which focused on the relationship between authentic leadership and innovative behaviour among nurses. Additionally, studies that involved populations other than practicing nurses, such as nursing students or other healthcare professionals, were excluded. Other exclusions included studies that were review articles, conference abstracts, or commentaries that did not present original research. Furthermore, studies that did not examine outcomes relevant to innovative behaviour, such as those focusing on unrelated aspects of leadership or healthcare, were also excluded. Articles for full‐text review were later evaluated according to the inclusion criteria and consistency with the research question. Conflicts were managed using the Covidence (2024) software, and these were discussed and resolved by agreement between the two reviewers. This ultimately left four published manuscripts for inclusion in this review (Figure 1).

While quality appraisal of the included research studies is not a specific requirement of scoping reviews (Munn et al. 2018), this was carried out to enhance critical analysis and screening. All included studies (Figure 1) were independently evaluated by the two reviewers' using the Crowe Critical Appraisal Tool (CCAT) to ensure that conclusions drawn from the reviewed literature are well‐supported by data, adequately robust, and methodologically sound (Crowe 2013). The reviewers did not exclude any studies based on methodological quality at this point.

3.2.6. Data Extraction

Data were extracted by using a specifically designed extraction table (Table 3). Thus, the extracted data comprised the authors name, year of publication, origin/country, aims/purpose, population/sample size, methodology, instrument, testing of the instrument, the definition of instrument variables, quality appraisal score, outcome, and key findings. Results of this data extraction can be found in Table 3.

TABLE 3.

Data extraction table.

Authors names, year of publication, origin/country	Aims/Purpose	Population/Sample size	Methodology	Instrument	Testing of instrument	Definition of instrument variables	Quality appraisal score	Outcome	Key findings
Mohamed et al. (2023) Egypt	Examine the correlation between nurses' perceptions of authentic leadership and their innovative behaviour in the healthcare setting	323 Staff Nurses	Descriptive correlational research	The Authentic Nurse Leader Questionnaire—Staff Leader Evaluation (Adopted from Barbosa 2018) The Innovative Work Behaviour Scale (Developed by Lambriex‐Schmitz et al. 2020)	Validity: Reviewed and revised by a committee of five nursing administration experts Reliability: Cronbach's alpha of 0.91 for Authentic Nurse Leader Questionnaire and 0.89 for Innovative Work Behaviour Scale Pilot Study: Conducted on 10% of target population to confirm tool applicability and time required for survey completion	Authentic Leadership, described as a relational style designed to foster a positive work atmosphere and affect employees' performance and outcomes, encompasses elements such as self‐awareness, balanced processing, relational transparency, and moral ethical perspective Innovative behaviour includes creating new ideas, promoting and realising those ideas, and sustainability of innovation within the workplace	65%	The study demonstrated a statistically significant positive correlation between all domains of authentic leadership (self‐awareness, relational transparency, moral/ethical, and balanced processing) and all domains of innovative work behaviour (opportunity exploration, idea generation, idea promotion, idea realisation, and idea sustainability) among nurses. This was measured quantitatively using correlation coefficients to show the relationship strengths	As there a gap between the perception of authentic leadership and the actual practice of innovative behaviours. Not all nurses who recognised authentic leadership traits in their superiors displayed high levels of innovative behaviours Nurse managers and healthcare organisation need to do more than just encourage authentic leadership. They must also actively cultivate environments and provide training that encourages authentic leadership and innovative behaviours among nurses, which is essential for improving healthcare outcomes and effectively meeting the challenges of an ever‐changing healthcare landscape
Lv et al. (2022) China	to explore the impact of nurse managers' authentic leadership on nursing innovation and the potential mediating effect of nurses' work engagement	Staff Nurses 2018 Nurses	Cross‐sectional study	Authentic Leadership Questionnaire (ALQ) developed by Walumbwa et al. (2008) Utrecht Work Engagement Scale created by Schaufeli et al. (2006) Chinese version of Innovation Behaviour Scale, adapted specifically for the nursing context in China, although the original developer is not specified in the provided text	ALQ, The Cronbach's α of the scale was 0.977. and internal consistency values ranging from 0.70 (Wong and Laschinger 2013) to 0.97 (Wang et al. 2019) Utrecht Work Engagement Scale, the Cronbach's α of the scale was 0.942 in the present study, had achieved satisfactory validity and reliability in China (Xianghua et al. 2020) Innovation Behaviour Scale, The validity of the scale was demonstrated by excellent model fit indices including a Comparative Fit Index (CFI) of 0.980, Goodness of Fit Index (GFI) of 0.966, Incremental Fit Index (IFI) of 0.980, Tucker–Lewis Index (TLI) of 0.917, and a Root Mean Square Error of Approximation (RMSEA) of 0.076, indicating that the scale accurately measures innovation behaviour among nurses. The Cronbach's α of the scale was 0.938	Authentic Leadership is conceptualised as a leadership style where leaders are true to their values and act with integrity, fostering an environment where trust and open communication prevail. This leadership style is pivotal in shaping positive organisational behaviours by being transparent and ethical, which in turn encourages a safe and open space for employees to thrive. Innovation Behaviour in nursing is defined as the proactive engagement in developing new methods and ideas that enhance healthcare practices. It reflects the nurse's ability to not only think creatively but also implement changes that improve patient care and operational efficiency within healthcare settings Work Engagement is described as a robust state of mental involvement in one's job, characterised by energy, commitment, and a deep focus on work tasks. It encapsulates a nurse's psychological presence and active participation in their role, which is crucial for both personal satisfaction and professional effectiveness	83%	The study quantitatively confirmed that there is a significant positive correlation between authentic leadership and nurses' innovation behaviour. It further established that work engagement plays a partial mediating role in this relationship, indicating that higher levels of perceived authentic leadership among nurse managers lead to increased work engagement, which in turn fosters greater innovation behaviour among nurses	The essence of authentic leadership extends beyond direct influence; it involves shaping a work environment that bolsters engagement, thereby nurturing innovative behaviours among nurses. The psychological state of nurses, moulded by the style of leadership they experience, plays a pivotal role in their readiness and ability to engage in innovative practices. Nurses who are actively engaged are more inclined to contribute creatively to problem‐solving and to the enhancement of processes within the healthcare setting
Anwar, Abid, and Waqas (2019) Pakistan	To explore the impact of authentic leadership on nurses' creativity, examining the mediating effect of hope and the moderating role of resilience in public hospitals	Staff Nurses 172 nurses	A three‐wave time‐lagged survey design	Authentic Leadership Questionnaire (ALQ) developed by Walumbwa et al. (2008) Hope scale, developed by Snyder et al. (2005) Resilience scale, developed by Wagnild and Young (1993) Creativity scale	Authentic Leadership: Cronbach's alpha was 0.92, indicating high reliability Hope: Cronbach's alpha was 0.71 Resilience: Cronbach's alpha was 0.78 Creativity: Cronbach's alpha was 0.88	Authentic Leadership: Leaders' genuine, ethical, transparent behaviour and their influence on the work environment Hope: Nurses' perception of their ability to achieve goals and overcome challenges Resilience: Nurses' capacity to recover from difficulties and adapt to change Creativity: The ability to generate new ideas and innovative solutions in nursing practice	75%	The study established a significant positive relationship between authentic leadership and innovative work behaviours among nurses, mediated by hope. It also found that resilience can moderate this relationship, influencing how authentic leadership impacts nurses' creativity and innovation at work	Authentic leadership positively influences hope, which in turn significantly enhances creativity among nurses. This indicates that leaders who are genuine, transparent, and ethically grounded can inspire higher levels of optimism and creative problem‐solving abilities in their teams. Hope fully mediated the relationship between authentic leadership and creativity. This suggests that the increase in creative behaviours among nurses is largely due to the heightened levels of hope instilled by authentic leaders. Nurses feeling more hopeful are more likely to engage in creative and innovative activities Resilience was found to moderate the relationship between authentic leadership and hope negatively. Surprisingly, higher levels of resilience seemed to dampen the positive effects of authentic leadership on hope, subsequently reducing creativity. This could imply that while resilience generally helps individuals cope with adversity, overly resilient nurses might be less influenced by leadership due to their inherent strength and self‐sufficiency
Malik, Dhar, and Handa (2016) India	To examine the impact of authentic leadership on the creativity of nursing staff in Indian hospitals, focusing on the mediating role of knowledge sharing behaviour and the moderating effect of information technology use	Staff Nurses and Nursing Supervisors 405 Staff Nurses 81 Nursing Supervisors	Cross‐sectional	Authentic Leadership Questionnaire (ALQ) developed by Walumbwa et al. (2008) Knowledge Sharing Behaviour scale adopted from the study by Lu et al. (2006) Information Technology Usage developed by Saga and Zmud (1993) Employee Creativity scale developed by Oldham and Cummings (1996)	The instruments used in this study were previously established scales	Authentic Leadership: Leadership that is genuine, transparent, ethical, and fosters a trusting environment Knowledge Sharing Behaviour: The behaviours and practices that facilitate the exchange of knowledge among individuals within an organisation Information Technology Usage: The application of IT tools to support, enhance, and facilitate knowledge sharing and creative processes Employee Creativity: The generation of new and useful ideas, processes, or procedures by employees	85%	The study found that authentic leadership positively influences nurse creativity, mediated by knowledge sharing behaviour, and moderated by the use of information technology	The research demonstrated a significant positive relationship between authentic leadership and the creativity of nurses. Leaders who are genuine, ethical, and transparent create an environment that promotes creative thinking and innovation among nurses Knowledge sharing was found to play a crucial mediating role in the relationship between authentic leadership and creativity. The study suggests that authentic leadership fosters an atmosphere that encourages the sharing of knowledge, which in turn enhances creative behaviours among nurses. This mediation implies that the flow of knowledge and ideas is vital for nurturing creativity, and authentic leaders effectively facilitate this flow The effectiveness of knowledge sharing in fostering creativity was further enhanced by the use of IT. IT tools and systems provide essential support for sharing and accessing knowledge, making them a key enabler in the link between leadership and creative outputs. This moderation indicates that technology can amplify the positive effects of knowledge sharing, driven by authentic leadership, on creative outcomes

4. Results

4.1. Characteristics of Included Studies

A total of four empirical studies were included in this scoping review (Mohamed et al. 2023; Lv et al. 2022; Anwar, Abid, and Waqas 2019; Malik, Dhar, and Handa 2016). These studies provide a comprehensive analysis of the relationship between authentic leadership and innovative behaviour among nurses. The studies originated from Egypt, China, Pakistan and India. The studies were published between 2016 and 2023 and included sample sizes ranging from 172 to 2018 nurses. One study Anwar, Abid, and Waqas (2019) included both nurse supervisors (n = 81) and staff nurses.

The analysis examined the research methodologies. The designs were primarily quantitative. Of the four studies, three used a cross‐sectional design (Mohamed et al. 2023; Lv et al. 2022; Malik, Dhar, and Handa 2016), while one used a time‐lagged design (Anwar, Abid, and Waqas 2019) to examine the relationship between authentic leadership and innovative behaviour over time.

The included studies were evaluated using the CCAT with all scoring above 75%, indicating high methodological quality. The CCAT assesses aspects like research design, sampling, data collection, and analysis. Studies are rated across eight categories, each scored from 0 to 5, for a total score of up to 40, which is then converted into a percentage (Crowe 2013).

Each study aimed to explore the relationship between authentic leadership and innovative behaviour, although specific research objectives varied. For instance, Mohamed et al. (2023) examined the correlation between leadership and innovation, while Anwar, Abid, and Waqas (2019) focused on the mediating role of hope and resilience. Regardless of their varied contexts, the studies continuously highlighted a positive relationship between authentic leadership and innovation among nurses.

All studies used surveys for data collection and utilised the Authentic Leadership Questionnaire (ALQ), developed by Walumbwa et al. (2008). The consistent use of this instrument demonstrates its adaptability to different cultural and healthcare settings. In terms of measurement of nurses' innovative behaviour, a variation of measures of innovation behaviour and creativity were utilised (Mohamed et al. 2023; Lv et al. 2022; Anwar, Abid, and Waqas 2019; Malik, Dhar, and Handa 2016) (Table 3).

4.2. Emerging Key Themes

In relation to the research question, this review identified four key themes that emerged from the thematic analysis of studies exploring the influence of authentic leadership on innovation in nursing.

4.2.1. Authentic Leadership Influence on Innovation Behaviour

The included studies demonstrated that authentic leadership has a positive effect on nurses' innovative behaviours (Mohamed et al. 2023; Lv et al. 2022; Anwar, Abid, and Waqas 2019; Malik, Dhar, and Handa 2016). For instance, Malik, Dhar, and Handa (2016) highlighted the link between authentic leadership and employee creativity, with knowledge sharing acting as a crucial mechanism through which innovation was facilitated. Similarly, Anwar, Abid, and Waqas (2019) demonstrated how authentic leadership fosters a healthy work culture and creativity by promoting hope among nurses. Lv et al. (2022) also found that authentic leadership positively correlates with nurses' innovation, with work engagement serving as a mediator. In Mohamed et al. (2023), authentic leadership was strongly associated with increased innovative behaviour among nurses, further reinforcing the pivotal role of leadership in fostering a culture of creativity and innovation.

4.2.2. Mediating and Mediators of Authentic Leadership Effectiveness

Mediating factors such as hope, work engagement, and knowledge sharing play a crucial mediating role in the relationship between authentic leadership and innovation or creativity. Malik, Dhar, and Handa (2016) emphasised the importance of knowledge sharing, where the exchange of information among nurses mediated the impact of leadership on innovation, allowing employees to collaborate more effectively. Similarly, Anwar, Abid, and Waqas (2019) highlights how hope acts as a key mediator, showing that when authentic leaders instill hope, it enhances nurses' creativity. Lv et al. (2022), demonstrate that work engagement partially mediates the relationship between authentic leadership and innovation, as engaged employees are more motivated to generate and implement new ideas. This emphasises how leadership drives positive outcomes through these mediators.

Additionally, the effects of authentic leadership on innovation are not always straightforward and can be moderated by factors such as resilience and information technology. Anwar, Abid, and Waqas (2019) found that resilience could reduce creativity when hope was high, suggesting that high resilience may sometimes limit the positive effects of authentic leadership. On the other hand, Malik, Dhar, and Handa (2016) show that the use of information technology can enhance the impact of knowledge sharing and further promote creativity.

4.2.3. Organisational and Contextual Factors

The studies highlighted various organisational and contextual factors that affect the relationship between authentic leadership and nurses' innovative behaviour. Mohamed et al. (2023) found a positive correlation between authentic leadership and innovative behaviour but also noted a gap between the perceived leadership traits and the actual practice of innovation. Not all nurses who identified authentic leadership traits in their superiors demonstrated high levels of innovation. This variation was linked to factors such as experience, education, personal motivation, and the specific workplace environment. Malik, Dhar, and Handa (2016) pointed to contextual challenges within the Indian healthcare system, including poor working conditions, inadequate knowledge‐sharing frameworks, and technological barriers that hindered innovation.

Experience and education were consistently identified as key factors influencing innovative behaviour. Mohamed et al. (2023) reported that nurses with higher education and more years of experience were more likely to engage in innovative behaviour. Similarly, Malik, Dhar, and Handa (2016) stressed the significance of knowledge sharing and the pivotal role of experienced nurses in driving innovation through collaboration and information exchange.

4.2.4. Leadership Development Recommendations

The studies consistently recommended leadership training programs to strengthen authentic leadership and promote innovation. Lv et al. (2022) suggested that hospitals should implement these programs to enhance leaders' authenticity, creating environments that support innovation. Mohamed et al. (2023) also emphasised that nurse managers should empower staff and cultivate a positive work atmosphere to encourage innovative behaviour.

5. Discussion

This scoping review aimed to explore the existing research on the impact of authentic leadership on nurses' innovative behaviours within healthcare settings. Understanding how effective leadership influences nursing staff is crucial for improving patient care, enhancing problem‐solving skills, and fostering adaptability in dynamic healthcare environments (Alilyyani, Wong, and Cummings 2018). A search of several key databases, including the JBI Database of Systematic Reviews and Implementation Reports, Prospero, Cochrane Database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and Google Scholar, was conducted using specific search terms such as authentic leadership, nurses innovative behaviour, and nursing leadership. This search revealed no existing or in‐progress scoping reviews or systematic reviews on this topic.

This review has systematically integrated the findings from four primary studies (Lv et al. 2022; Malik, Dhar, and Handa 2016; Anwar, Abid, and Waqas 2019; Mohamed et al. 2023). The review identified four key themes: (1) authentic leadership influence on innovation behaviour, (2) mediating and mediators of authentic leadership effectiveness, (3) organisational and contextual factors, and (4) leadership development recommendations. These highlight the critical role of authentic leadership in driving innovation at both the individual and organisational levels. The review highlights the very recent interest in this topic, with emergent papers all published within the last eight years. This confirms a growing interest in the importance of nurses' innovative behaviour and the potential for authentic leadership to influence this.

The review finding highlights the positive influences of authentic leadership on nurses' innovation behaviour, due to its emphasis on the core principles of self‐awareness, relational transparency, balanced processing, and moral perspective (Lv et al. 2022; Malik, Dhar, and Handa 2016; Anwar, Abid, and Waqas 2019; Mohamed et al. 2023). Leaders who demonstrate these qualities are more likely to create environments where nurses felt empowered to engage in creative problem‐solving and innovation. The supportive nature of these elements have been previously highlighted (Walumbwa et al. 2008).

However, while the correlation between authentic leadership and innovation is well‐supported, the review also revealed a more detailed scenario requiring closer examination. For instance, despite the finding of a positive relationship (Lv et al. 2022; Malik, Dhar, and Handa 2016; Anwar, Abid, and Waqas 2019; Mohamed et al. 2023), several studies reported low levels of innovative behaviour among nurses (Zhang et al. 2024; Mohamed et al. 2023). This inconsistency brings up important questions: truly as effective as the literature claims, why do nurses fail to consistently engage in innovative behaviours? One possible explanation, as highlighted by Mohamed et al. (2023), is the variation in individual characteristics such as experience, education, and personal motivation. Nurses who are less experienced or less educated may feel less confident in engaging in innovative activities, even when they perceive their leaders as supportive. Zhang et al. (2024) as well suggests that factors such as the type of hospital may influence these levels, with nurses in tertiary hospitals generally demonstrating higher innovation.

This highlights the complexity of fostering innovation, which requires not just leadership but also the right combination of individual, organisational, and contextual factors. Thus, while authentic leadership provides the groundwork for innovation, the review emphasises the need to address the broader framework that either supports or limits nurses' capacity to innovate (Rigtering, Spaans, and De Jong 2023).

The review pinpointed several mediating and mediators that reinforce the relationship between authentic leadership and innovation. The Lv et al. (2022) findings provide evidence that authentic leadership not only improves innovative behaviour but also acts as a mediator in this relationship by increasing work engagement. The engaged nurses are more likely to feel empowered to experiment with new ideas and implement creative solutions. The results of this study support the theoretical framework put forward by Avolio and Gardner (2005) which argues that authentic leadership, characterised by transparency and balanced decision‐making, fostering trust, and a shared sense of purpose, can increase employee engagement, which in turn stimulates innovative behaviour (Avolio and Gardner 2005).

Similarly, Malik, Dhar, and Handa (2016) highlighted the critical role of knowledge sharing, where the exchange of information among nurses mediated the relationship between authentic leadership and innovation. This leadership style is s associated with improved knowledge sharing among nurses as it promotes a culture in which team members feel respected and comfortable sharing their insights and experiences (Khalid 2024). While Anwar, Abid, and Waqas (2019) found that hope has a significant mediating effect. This leadership style is linked to enhanced knowledge sharing among nursing professionals, as it fosters an environment where individuals feel valued and safe to exchange their ideas and experiences (Best 2022). The findings of this scoping review are in keeping with existing literature, such as Walumbwa et al. (2008) and (Alilyyani, Wong, and Cummings 2018), which posit that authentic leadership is crucial for enhancing job satisfaction, commitment, and overall well‐being, thereby indirectly promoting innovative behaviours (Alilyyani, Wong, and Cummings 2018; Walumbwa et al. 2008).

However, a more critical examination reveals that these mediators may not always function as expected. For instance, Anwar, Abid, and Waqas (2019) found that resilience, while generally seen as a positive trait, could actually hinder innovation in highly resilient nurses when paired with high levels of hope. Resilience generally seen as a strength, but it can hinder innovation in high‐pressure environments like emergency units. Resilient nurses may perform well under stress but can become more risk‐averse, limiting innovation. This challenges the idea that resilience always promotes innovation and calls for further research into how personal traits and work environments interact with leadership to influence innovation (Anwar, Abid, and Waqas 2019). Resilience enables nurses to cope with immediate challenges effectively, but it can foster an over‐reliance on short‐term solutions. This focus on resolving immediate issues may hide underlying systemic problems and, in turn, impede long‐term innovation (Lyng et al. 2021). This highlights the need for more nuanced research into how different personal and contextual factors interact with leadership to influence innovation.

Additionally, the role of information technology in improving knowledge sharing, as highlighted by Malik, Dhar, and Handa (2016), adds further complexity to the situation. Information technology can improve knowledge sharing and foster innovation, but its success is contingent on sufficient resources and organisational support. In healthcare, where information technology infrastructure is often inconsistent, these advantages might not be fully achieved, raising questions about whether leaders can obtain the necessary resources for innovation. This highlights the importance of stronger organisational support to ensure that mediators like IT and work engagement effectively contribute to innovation efforts (Malik, Dhar, and Handa 2016).

The review highlights several key organisational and contextual factors that influence how well authentic leadership can promote innovation within healthcare. For example, Mohamed et al. (2023) and Malik, Dhar, and Handa (2016) identify structural barriers, such as understaffing, limited professional growth opportunities, and poor working conditions, which hinder nurses' capacity to engage in innovative practices. These findings underscore the reality that even supportive leaders may struggle to encourage innovation if the broader organisational environment stifles creativity and experimentation (Mohamed et al. 2023; Malik, Dhar, and Handa 2016).

In addition, Mohamed et al. (2023) emphasise the role of education and experience, pointing to the importance of specialised professional development programs designed to empower nurses with the necessary skills and confidence to innovate. The research shows that nurses with more experience and higher levels of education are more likely to demonstrate innovative behaviours, suggesting that leadership development alone is insufficient. Instead, healthcare organisations must offer continuous learning opportunities to foster professional growth and innovation (Mohamed et al. 2023). This conclusion is consistent with previous studies, such as Wang et al. (2015), which stress the role of ongoing professional development in enhancing nurses' innovative capacities.

The review also raises the issue of cultural and geographic limitations. Most of the studies included were conducted in non‐Western countries like China, Pakistan, Egypt, and India (Lv et al. 2022; Malik, Dhar, and Handa 2016; Anwar, Abid, and Waqas 2019; Mohamed et al. 2023). This presents a challenge when attempting to generalise the findings to Western healthcare systems, where leadership and organisational dynamics may differ significantly. Future research should investigate how authentic leadership influences innovation across various cultural and organisational settings to build a more comprehensive understanding of this relationship.

This review emphasises the vital role of leadership development programs in fostering authentic leadership, which in turn fosters innovation. Studies by Lv et al. (2022) and Mohamed et al. (2023) stress that healthcare organisations need to invest in leadership training aimed at building the core qualities of authentic leadership—transparency, ethical decision‐making, and self‐awareness. By developing these attributes, leaders can create environments that promote risk‐taking and creativity, which are essential for driving innovation. Further education of leaders is likely required.

Dirik and Seren Intepeler (2024) recently implemented a successful training programme for developing authentic leaders. This is something that is deemed a necessary prerequisite of authentic leadership (Almutairi et al. 2024). As such, authentic leadership training should be integral to leadership development programs in healthcare settings. Indeed, the very concept of authentic leadership emphasises that education and training must underpin this approach in order for it to be valid (Almutairi et al. 2024). Educational programs ought to focus on fostering qualities such as ethical behaviour, self‐awareness, and balanced processing to cultivate leaders who can effectively inspire innovative behaviour.

Moreover, healthcare organisations should consider structuring their policies and systems to support the mediating roles of work engagement and knowledge sharing. This could involve implementing systems that facilitate better communication and collaboration across departments and enhancing information technology infrastructure to support innovative practices. Additionally, healthcare organisations should work toward building systems that facilitate knowledge sharing and collaboration, which Malik, Dhar, and Handa (2016) identified as critical factors in encouraging innovation.

5.1. Limitations

Despite our efforts to perform a systematic search, it is important to acknowledge that publication bias may still exist. Although we employed different database, studies with positive results are more likely to be published, which could skew our findings. Our review is limited only to studies written in the English language and possibly excludes some relevant studies written in any other language. This language restriction could potentially limit the generalizability of the findings to non‐English‐speaking contexts. The number of included studies is relatively small, and their geographic distribution is mainly confined to non‐western contexts. Therefore, this limitation may only lead to the generalisation of the findings to similar global healthcare systems.

Additionally, while the review identified several mediators and moderators of the leadership–innovation relationship, further research is needed to unpack the complex interactions between personal traits (such as resilience), organisational factors (such as IT infrastructure), and leadership styles. The low levels of reported innovative behaviour among nurses also point to a significant research gap. More studies are needed to explore the specific barriers that prevent nurses from engaging in innovative behaviours, even when they work under supportive leaders.

An additional limitation is the methodological diversity of the included studies, which poses difficulty in drawing definite conclusions. Qualitative research exploring nurses' perspectives on leadership and innovation could offer valuable insights into the contextual factors that either facilitate or impede innovation in healthcare settings. Furthermore, future studies should investigate how authentic leadership affects patient outcomes, as this remains a crucial yet underexplored area of research.

6. Conclusions

Increasingly, there are calls to improve the innovation capability of nurses. Innovation in health care serves to make improvements in approaches to health. While there is a bulk of literature calling for the need for innovative behaviour by nurses, there is less that explores the exact nature of this innovation or methods of fostering it. Nursing leadership is increasingly singled out as a necessity to support and advance nursing practice, to enable evidence‐based and advanced practice, and to foster an optimal workplace culture that supports and enables staff. However, less is known about the effect of leadership on innovation behaviour. The potential positive benefits authentic leadership in nursing has been gaining is increasing momentum over the past decade, but yet little is known about its aetiology and effects. The literature on the correlation between nurses' innovative behaviour and authentic leadership has not been widely explored. Thus, this scoping review provides new and valuable insights to address this issue. This will help in understanding and bridging the research gap and enable the healthcare organisations to think of the strategies that would foster and lead a culture of innovation among nurses.

The findings from this scoping review provide valuable information about how authentic leadership impacts nurses' innovative behaviours, highlighting its potential to significantly enhance healthcare outcomes. By continuing to explore this area, healthcare leaders can better understand how to cultivate leadership styles that not only meet the current demands of the healthcare sector but also anticipate future challenges. These findings may have far‐reaching implications for nursing management and policy. Adopting innovative work behaviour in nursing allows nurses to adapt to the changing healthcare environment, effectively address complex patient needs, and improve the overall quality and efficiency of healthcare delivery. Fostering innovative behaviour among nurses also leads to improved job satisfaction and productivity but also significantly contributes to solving organisational problems and increasing organisational efficiency and effectiveness. Thus, there are important contributions possible through the enhancement of innovative behaviour among nurses through the influence of authentic leadership that can be enhanced through additional educational interventions and need systematic empirical examination to determine the effects.

Ethics Statement

The authors have nothing to report.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/jan.16565.

Supporting information

Data S1.

Data Availability Statement

All data is available upon request.