How does spiritual leadership promote nurse taking charge? The roles of spiritual well-being and pay-for-performance perception

Abstract

Background

As a critical form of proactive behaviors, taking charge plays a central role in facilitating hospitals’ improvement and development. Although prior research has extensively examined how to encourage nurses to engage in taking charge, the relationship between the concept of “spirit at work” and taking charge remains insufficiently understood. This study was designed to examine the impact of spiritual leadership on the nurses’ taking charge and its internal mechanism.

Methods

Drawing on the conservation of resources (COR) theory, we developed a moderated mediation model to elucidate how spiritual leadership fosters nurses’ taking charge through spiritual well-being, and how this effect is contingent on nurses’ pay-for-performance perceptions. We conducted a field study in China to test our theoretical model, with data collected from 353 nurses and 88 head nurses across three different time points. Data analysis was run using descriptive statistics and confirmatory factor analyses. And regression analyses were used to examine the hypotheses.

Results

The regression results revealed that spiritual leadership was positively associated with nurses’ taking charge. Spiritual well-being significantly mediated the relationship between spiritual leadership and nurses’ taking charge. Moreover, we observed that the indirect effect of spiritual leadership on taking charge through spiritual well-being was stronger for nurses who perceived higher levels of pay-for-performance than for those with lower perceptions.

Conclusions

These findings highlight the essential role of spiritual leadership in promoting nurses’ positive psychological states and proactive behaviors. Hospital administrators may consider strengthening head nurses’ spiritual leadership to enhance nurses’ spiritual well-being and their propensity to take charge. Additionally, implementing performance-based compensation practices can cultivate a climate that reinforces distributive fairness and further encourages proactive behavior.

Clinical trial number

Not applicable.

Introduction

With the rapid evolution of society and the economy, nursing management faces numerous challenges, including heavy workloads, high turnover rates, increasing demand for human-centered care services, and constrained healthcare budgets, making it a puzzle [1, 2]. Compounding these difficulties, hospitals and managers cannot always delineate all aspects of nurses’ roles and responsibilities in advance [3]. “Taking charge”, defined as voluntary and constructive efforts made by nurses to influence organizational functional change related to work execution in their jobs, teams, or organizations [4], has therefore emerged as an important approach to overcome this challenge. The expression of taking charge in nursing context, however, displays several unique characteristics. Because nursing work is highly regulated and safety-sensitive, proactive changes must operate within strict professional boundaries and often entail considerable psychological and professional risks [5]. Unlike in general organizational contexts, nurses must simultaneously adhere to clinical norms and identify opportunities for improvement, making taking charge both more challenging and more essential for maintaining high-quality care. Furthermore, extensive theoretical and empirical evidence indicates that taking charge yields a wide range of benefits for both nurses and hospitals, including greater career potential [3], higher innovation [4], improved job performance [6, 7], greater job satisfaction [8], increased affective organizational commitment [8], better evaluations [9] and so on.

Considering the favorable outcomes associated with taking charge, substantial research has examined the antecedents that stimulate this proactive behavior (e.g., [7, 10–13]). However, an important gap remains in understanding how “spirit at work” or “meaning at work” influences nurses’ taking charge. This gap is noteworthy because the spirit at work is an essential feature of what it means to be human [14]. Therefore, the primary purpose of our research is to link the spirit and meaning of work to taking charge. Spiritual leadership, a value-oriented and spirit-centered form of leadership, can make nurses experience the meaning of work and feel understood and appreciated through the satisfaction of spiritual well-being [15], proactively seeking to improve work methods and organizational policies. Consequently, we argue that spiritual leadership represents a critical motivating force that can effectively promote nurses’ taking charge behavior.

What, then, are the underlying mechanisms through which spiritual leadership promotes taking charge? Addressing this question enables us to clarify why the process unfolds in the way it does [16]. Guided by conservation of resources (COR) theory, we develop a theoretical framework to explain how and when spiritual leadership effectively influences nurses’ taking charge. When spiritual leaders exhibit spiritual behaviors (i.e., delivering an inspiring vision, hope/faith, and altruistic love) [15, 17], nurses are likely to acquire valuable psychological resources. These resources arise from enhanced feelings of calling and strengthened emotional connections with their departments or hospitals. In a resource gain spiral, the resources taken from the organization are reinvested in the organization [18]. That is, the resources provided by spiritual leaders cultivate nurses’ spiritual well-being, which subsequently motivates them to reinvest these resources back into their organizations in the form of taking charge. As a result, we believe that spiritual leadership serves as a kind of organizational resource to foster nurses taking charge by fulfilling their spiritual well-being.

However, it’s important to recognize that the effect of spiritual leadership is unlikely to remain uniform across all situations. According to the “resource caravans and passageways” principle within COR theory, individual resources tend to exist in clusters rather than in isolation [19], meaning that the presence of one type of resource can influence the effectiveness of other related resources. In addition to the fulfillment of internal spiritual needs through spiritual leadership, external material rewards play an indispensable role in organizations to motivate nurses [20]. While the former provides essential energy resources, the latter supplies object resources, and the integration of these internal and external resources can generate a synergistic effect that enhances nurses’ taking charge. In this study, we consider the pay-for-performance perception as a pivotal boundary condition that influences the effectiveness of spiritual leadership. The extent to which nurses perceive conformity between their pay and performance significantly influences their efforts and behaviors at work [21, 22]. When such alignments are perceived, nurses are motivated to enhance their performance [23, 24]. Moreover, COR theory suggests that when individuals face threats of resource loss, they are inclined to conserve resources and avoid unnecessary expenditure [18, 25]. Consequently, when pay and performance as misaligned, nurses may withdraw from taking charge to mitigate the risk of “investing effort without returns”. Therefore, we incorporate nurses’ pay-for-performance perceptions as an additional organizational resource to further supplement the resources gained arising from spiritual leadership.

This study contributes to the existing literature on spiritual leadership and proactivity in three significant ways. First, by identifying spiritual leadership as a crucial antecedent of taking charge, we establish a conceptual link between the spirit of work and proactive behavior. This finding enriches the specific literature on taking charge (e.g., [6, 9]), as well as the broader proactivity literature (e.g., [26, 27]). In line with previous research (e.g., [6, 10–12]), our study further reinforces the view that the support and resources provided by head nurses encourages nurses to engage in autonomous and constructive actions for improving work processes and approaches [4]. Second, drawing on COR theory [25], we clarify that spiritual leadership stimulates nurses’ taking charge through their spiritual well-being, thereby delineating a psychological pathway in which spiritual leadership shapes proactive behavior. In doing so, this study echoes the call for more attention on linking various leadership to well-being [28]. Finally, our research expands the horizons of how distinct boundary conditions influence the relative effectiveness of spiritual leadership, especially in the production of taking charge. Given that the motivating effect of mental motivation is limited [29], some nurses may perceive spiritual leadership as false and artificial without sufficient salary rewards. By introducing the pay-for-performance perception as a critical contingency factor, we demonstrate that spiritual leadership is more effective when complemented by external material reward. Our theoretical model is shown in Fig. 1.

Fig. 1.

The theoretical model

Theoretical background and hypotheses development

Conservation of resource theory

The central premise of conservation of resources (COR) theory is that individuals strive to retain, protect, and build resources [18, 25]. The term resources is broadly defined as objects, personal characteristics, energies, and conditions that individuals value, or means through which valued outcomes can be attained. COR theory classifies resources into four primary categories: (1) object resources related to economic or social status, such as property or vehicles; (2) condition resources are the conditions that individuals value and pursue, such as valued work roles; (3) personal resources are individual traits that help them buffer stress, such as self-esteem and mastery; (4) energy resources are ways and means to help access other kinds of resources, such as money, time and knowledge. These resource losses and gains, respectively, generate perceptions of threat or experiences of positive well-being. Therefore, individuals prevent resource loss, recover from such losses, and obtain additional resources through continued investment in resources. People who possess resources are more able to acquire resources, and resource gain from initial resources leads to further gain. This dynamic process is known as the “resource gain spiral” [18]. In everyday work contexts, nurses draw upon available resources to adapt to job demands, which in turn facilitates the generation of new resources. Such gains further equip them to cope with future changes. For example, when interacting with spiritual leaders, nurses receive valuable resources from leaders’ spiritual behaviors, such as enhanced clarity of work purpose and experiences of care, respect, and altruistic support. Subsequently, nurses invest the resources they acquired into the organization by voluntarily optimizing the ways and procedures of their jobs.

Taking charge

As a form of organizational citizenship behavior, taking charge refers to discretionary, extra-role actions that are not formally prescribed by the organization but ultimately benefit it [6]. Taking charge involves challenging the status quo and proactively identifying and addressing the problems concerning how work is performed in jobs, teams, or organizations [4]. By driving functional-level changes, such behavior contributes to improvements of work methods, procedures, and related policies. Compared with other proactive behaviors, like voice, innovation, or problem prevention, taking charge is distinguished by its action-oriented nature, broader scope, and strong problem-solving focus [3, 12]. Indeed, research on proactivity suggests that taking charge may best capture the core attributes of proactive behavior—self-initiated, future-oriented, and change-oriented—better than any other established constructs [9]. Despite its organizational benefits, nurses may not always derive direct personal gains from such behavior, and may even risk being stigmatized as “troublemakers” [3]. Therefore, the extent to which nurses perceive support from their surrounding environment plays a significant role in determining whether they engage in such behavior [27], such as supportive managerial practice or leadership behavior in the organization [4, 10, 27].

Spiritual leadership and taking charge

As articulated in the causal model of spiritual leadership [15], this leadership style motivates individuals by fostering an intrinsic motivation cycle based on the vision, hope/faith, and altruistic love, so that they have a sense of spiritual survival (e.g., calling and membership). Spiritual leadership comprises three core dimensions: vision, hope/faith, and altruistic love. Vision describes the organization’s future direction and goals, along with a compelling rationale for why people should strive for such a future [15, 17]. Hope/faith is a firm belief in achieving something desired, enabling nurses to overcome obstacles in striving toward shared goals. Altruistic love entails a sense of wholeness, harmony, and happiness that arises from experiencing and expressing care, concern, and appreciation for oneself and others. By aligning values and vision across individual, team, and organizational levels, spiritual leadership enhances organizational commitment and productivity [15]. Since spiritual leadership was proposed mainly to cope with the continuous change and success of a learning organization [15], we theorize that it also fosters change-oriented behaviors such as taking charge.

Drawing on the COR theory [25], it is plausible to expect that nurses regard spiritual leadership as a crucial source of psychological and social resources. When nurses acquire such resources, including meaning, support, and emotional strength, they are more inclined to engage in resource investments, including taking charge. Specifically, the inspiring vision articulated by spiritual leadership clarifies organizational goals and direction, helping nurses understand their role in a meaningful collective mission [17]. This understanding can strengthen nurses’ sense of responsibility and self-efficacy, prompting them to exceed formal job requirements [11], such as proactively improving work procedures, offering constructive suggestions, and solving impending organizational problems.

Moreover, taking charge is inherently challenging and risky [13], as it often involves questioning or altering the status-quo, which may provoke resistance or disapproval from others [30]. The rewards for such behavior are also often uncertain. Thus, nurses are more likely to take charge in a relatively safe environment [27]. Spiritual leadership focuses on nurses’ needs, shows care and concern for them, and acknowledges their contributions [17]. This creates an environment in which nurses feel safe and valued within the organization, fostering their organizational commitment [31, 32]. In such a supportive context, these nurses are more willing to take charge that benefit the organization. Supporting this logic, prior research has linked spiritual leadership to increased proactive and organizational citizenship behaviors among nurses (e.g., [33–35]). In summary, we hypothesize:

Hypothesis 1

Spiritual leadership is positively related to taking charge.

Mediating role of spiritual well-being

Spiritual well-being, a core manifestation of workplace spirituality, encompasses two dimensions: “calling” and “membership” [15]. Calling refers to the experience of deriving meaning and purpose in life through making a difference and serving others. In the workplace, individuals are driven not only by the pursuit of mastery and competence but also by the need for meaningful work [34]. Membership, conversely, denotes the sense of being understood and appreciated, arising from social interactions and interconnectedness with others in groups. According to the spiritual leadership theory [15], the inspiring vision that spiritual leaders create helps nurses perceive a deeper purpose in their work, thereby fostering a sense of calling. Simultaneously, by cultivating an organizational culture rooted in altruistic love, spiritual leaders make nurses feel valued as integral members of the community, which enhances their sense of membership and mutual care [15, 17]. Substantial empirical evidence supports that spiritual leadership is positively associated with spiritual well-being (e.g., [32, 35]). Therefore, we hypothesize:

Hypothesis 2

Spiritual leadership is positively related to spiritual well-being.

As outlined in COR theory [25], positive psychological states constitute key personal resources that can counteract resource depletion and augment nurses’ overall resource reservoirs. The fulfillment of spiritual needs engenders feelings of joy, serenity, and peace [36], thereby enhancing both physiological health and psychological well-being (e.g., [14, 15]). Consequently, when nurses experience spiritual well-being, they accumulate substantial psychological resources, which in turn enable them to initiate functional and constructive changes in their work, teams, or organizations. On one hand, nurses with high spiritual well-being perceive deeper meaning and value in their work, which motivates them to exceed formal role expectations [32], for instance, by pioneering new work approaches. The resource surplus afforded by spiritual well-being also bolsters their confidence and capacity to navigate challenges inherent in the change process. On the other hand, spiritual well-being makes nurses feel understood and valued by the organization. Therefore, in return, they will proactively exhibit behaviors that benefit the organization [32], including changing counterproductive organizational rules. Supporting this logic, extant research indicates that workplace spirituality is associated with increased productivity, lower turnover, and improvements in job performance and organizational commitment [36]. We therefore hypothesize:

Hypothesis 3

Spiritual well-being is positively related to taking charge.

Integrating the arguments of Hypotheses 1–3, we propose that spiritual leadership, by embodying and promoting spiritual values and practices [37], serves as a critical resource source for nurses from the standpoint of COR. The resource gained, manifested as enhanced spiritual well-being, then motivates nurses to reinvest them into the organization through change-oriented behaviors such as taking charge, with the aim of securing further resource gains. Consequently, spiritual well-being is posited to mediate the relationship between spiritual leadership and nurses taking charge. This proposition is corroborated by existing studies, which have documented that spiritual well-being serves as a mechanism through which spiritual leadership promotes outcomes such as organizational citizenship behavior [32, 33] and creative service performance [38, 39]. Thus, we hypothesize:

Hypothesis 4

Spiritual well-being mediates the relationship between spiritual leadership and taking charge.

Moderating role of pay-for-performance perception

Pay-for-performance, a compensation system that links financial rewards to individual or organizational performance, plays a crucial role in HRM practices [21]. Widely regarded as an HRM “best practice” [22], pay-for-performance has been shown to enhance individual job performance and bolster organizational effectiveness [32, 40]. When nurses perceive a strong connection between their performance and remuneration, they are motivated to increase effort to achieve higher performance [23]. Indeed, pay and rewards constitute important determinants of nurses’ behavioral and emotional responses to work [32, 40, 41]. Hence, we expect that the pay-for-performance perceptions of nurses strengthen the positive relationship between spiritual leadership and spiritual well-being.

Specifically, nurses with strong pay-for-performance perceptions recognize that their diligent work will be equitably compensated [41], reinforcing their sense of organizational justice [42]. In such an environment, nurses have greater incentive to seek out and leverage organizational resources, including engagement with spiritual leaders, to improve performance and secure financial rewards [43]. Thus, these nurses are better positioned to derive spiritual resources from their leaders’ values and actions, thereby experiencing heightened spiritual well-being. In contrast, when pay-for-performance perceptions are weak, nurses perceive little connection between high performance and generous rewards [41]. This weak performance-reward linkage can foster perceptions of organizational unfairness and erode trust in leadership. Under such conditions, nurses tend to adopt a resource conservation strategy, becoming less willing to invest personal resources in their work. This defensive posture diminishes the motivational influence of spiritual leadership, thereby attenuating its effect on spiritual well-being.

Therefore, we hypothesize:

Hypothesis 5

Pay-for-performance perception moderates the relationship between spiritual leadership and spiritual well-being, such that the positive relationship is stronger when nurses perceive a higher level of pay-for-performance.

The integrated model

We presented a moderated mediation model that synthesizes the rationales presented in Hypotheses 1–5, in which pay-for-performance perception moderates the indirect relationship between spiritual leadership and nurses taking charge via spiritual well-being. Specifically, high levels of pay-for-performance perception serve as a valuable resource that amplifies the effect of spiritual leadership on spiritual well-being and subsequent taking charge. In contrast, when pay-for-performance perception is low, the resources that spiritual leadership provides to nurses may be depleted, which further decreases resultant spiritual well-being and taking charge. Therefore, we hypothesize:

Hypothesis 6

Pay-for-performance perception moderates the indirect relationship between spiritual leadership and taking charge through spiritual well-being, such that the indirect relationship is stronger when nurses perceive a higher level of pay-for-performance.

Methods

Participants and procedure

Using a convenient sampling procedure, we collected research data from three public hospitals of Sichuan province in China. Before data collection commenced, one of the authors initiated contact with the hospital directors to explain the study’s purpose and procedures and to obtain permission. These hospitals were selected because they matched the research context and were willing to support multi-wave data collection, which also allowed us to invite eligible nurses in a manner that retained a certain degree of randomness rather than relying on purely ad hoc selection. Nurses received informed consent forms through the directors, and confidentiality was emphasized. Subsequently, questionnaires were distributed to each participant via email, with participants completing them during work hours.

To mitigate concerns related to common method bias, we collected data at three distinct time points [44]. At Time 1, we distributed questionnaires to 481 full-time nurses in these hospitals. Of these, 445 nurses returned their completed surveys measuring controls, spiritual leadership, and pay-for-performance perception. In return for completing the Time 1 survey, participants received an incentive of $2. Two weeks later, at Time 2, 398 nurses reported their spiritual well-being. Those who participated in the Time 2 survey were rewarded with a $1 incentive. Four weeks later, at Time 3, we asked 398 nurses to invite their head nurses to rate their taking charge behaviors. Finally, 88 head nurses completed the Time 3 survey, with each receiving a $2 incentive for their participation.

A total of 353 nurses and 88 head nurses were retained as final valid responses, after applying standard data-screening procedures designed to ensure data quality. These procedures involved excluding responses that met any of the following criteria: (1) unrealistically short completion times, (2) excessive missing values, (3) patterned or inattentive responding, and (4) mismatched head nurse–nurse dyads. Among nurses, 97.45% were female; 15.9% had a high school degree or less, 20.1% had an associate degree, 53.5% had an undergraduate degree, and 10.5% had a postgraduate degree or higher; the average age is 36.5 years old; the average job tenure is 13.2 years. More detailed descriptive information was presented in Table 1.

Table 1.

Means, SDs, reliabilities, and correlations

Variables	Mean	SD	1	2	3	4	5	6	7	8	9	10
1. Nurse gender	0.026	0.158	--
2. Nurse age	36.473	7.323	-0.062	--
3. Nurse job tenure	13.227	7.232	-0.087	0.914**	--
4. Nurse educational level	2.586	0.878	-0.006	0.057	-0.076	--
5. Positive affect	3.579	0.922	-0.028	-0.019	-0.005	-0.040	(0.886)
6. Negative affect	3.636	0.834	-0.037	0.031	0.037	0.155**	-0.045	(0.864)
7. Spiritual leadership	3.387	0.823	-0.048	0.047	0.098	-0.128*	0.149**	-0.060	(0.973)
8. Pay-for-performance perception	3.241	0.978	0.038	-0.044	-0.048	-0.021	-0.039	0.047	-0.261**	(0.928)
9. Spiritual well-being	3.444	0.797	0.005	0.075	0.104	-0.153**	0.130*	-0.121*	0.331**	0.290**	(0.945)
10. Taking charge	3.396	0.834	-0.058	0.072	0.088	-0.064	0.162**	-0.195**	0.384**	0.149**	0.333**	(0.956)

Note. N = 353; Cronbach’s alpha reliabilities are reported in the parentheses on the diagonal

^*p < 0.05; ^**p < 0.01

Measures

Following a back-translation procedure [45], we translated all scales in this study. First, the first author translated the original English items into Chinese, and then the second author independently translated the Chinese version back into English. Any inconsistencies between the two versions were discussed among the two authors and the corresponding author until a consensus was reached. Second, to further ensure content validity and cultural appropriateness, a panel of five experts (two management professors, one head nurse, and two registered nurses) reviewed both versions and provided detailed feedback. Third, we conducted a pre-test with 35 nurses, based on which minor refinements were made to improve item clarity. It is also noteworthy that the focal scales have been widely used in prior research in China, supporting their effectiveness. Unless otherwise noted, participants evaluated all the items with a 5-point Likert-type scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).

Spiritual leadership

Spiritual leadership was assessed using a 17-item scale from Fry et al. [17], which comprises three dimensions: vision, hope/faith, and altruistic love. Sample items were “I understand and am committed to my hospital’s vision” (vision), “I persevere and exert extra effort to help my hospital succeed because I have faith in what it stands for” (hope/faith), and “The head nurse in my hospital is honest and without false pride” (altruistic love) (α = 0.973).

Spiritual well-being

Spiritual well-being was measured using Fry et al.’s [17] 9-item scale, encompassing two dimensions. Sample items were “My job activities are personally meaningful to me” (meaning/calling) and “I feel my hospital appreciates me and my work” (membership) (α = 0.945).

Taking charge

Taking charge was evaluated by using 10-item scale from Morrison and Phelps [4]. A sample item was “[Nurse’s name] often tries to adopt improved procedures for doing his/her job” (α = 0.956).

Pay-for-performance perception

Pay-for-performance perception was assessed using Perry and Pearce’s [29] 4-item scale. A sample item was “If I perform especially well on my job, it is likely that I would get a pay raise” (α = 0.928).

Control variables

To enhance the robustness of our findings, we controlled for several nurse demographic characteristics, like gender, age, job tenure, and educational level, as prior research has established their influence on leadership perceptions [10, 12] and taking charge behaviors [11, 12]. Gender was coded as 1 (male) and 0 (female). Educational level was categorized as 1 (high school or below), 2 (associate degree), 3 (undergraduate degree), and 4 (postgraduate degree or higher). Age and job tenure were measured in years. Additionally, given the potential influence of affective states on proactive behaviors [12], we controlled for positive and negative affect using the short version of the Positive and Negative Affect Schedule (PANAS; [46]). Five items for positive affect included “inspired”, “alert”, “excited”, “enthusiastic”, and “determined” (α = 0.886), and five items for negative affect included “afraid”, “upset”, “nervous”, “scared”, and “distressed” (α = 0.864).

Results

Descriptive statistics and confirmatory factor analyses

Table 1 presented the descriptive statistics and correlations of all studied variables. As shown, spiritual leadership demonstrated significant positive correlations with both spiritual well-being (r = 0.331, p < 0.01) and taking charge (r = 0.384, p < 0.01), and spiritual well-being positively associated with taking charge (r = 0.333, p < 0.01), initially supporting our hypotheses.

Next, using the Mplus 8.3 [47], we made confirmatory factor analyses to determine the discriminant validity of the key variables (i.e., positive affect, negative affect, spiritual leadership, pay-for-performance perception, spiritual well-being, and taking charge). Table 2 showed that the hypothesized six-factor model had a better fit (χ² = 2414.157, df = 1160, χ²/df = 2.081, CFI = 0.919, TLI = 0.914, SRMR = 0.039, RMSEA = 0.055) than other alternative models. As such, the discriminant validity of our model was confirmed. In addition, the multicollinearity test indicated that the maximum variance inflation factor (VIF) was 1.390, which is well below the threshold of 5, and the minimum tolerance value was 0.719, exceeding the recommended cutoff of 0.10. These results suggest that multicollinearity was not a concern and that the regression analyses were appropriate.

Table 2.

Results of the confirmatory factor analyses

Model	2	2		2/df	CFI	TLI	SRMR	RMSEA
Six-factor model: SL, PA, NA, PFP, SW, TC	2414.157	—	1160	2.081	0.919	0.914	0.039	0.055
Five-factor modela: SL + PA, NA, PFP, SW, TC	3287.803	873.646***	1165	2.822	0.863	0.855	0.066	0.072
Five-factor modelb: SL, PA, NA + PFP, SW, TC	3652.250	1238.093***	1165	3.135	0.839	0.831	0.089	0.078
Five-factor modelc: SL, PA, NA, PFP, SW + TC	4654.751	2240.594***	1165	3.995	0.774	0.762	0.105	0.092
Four-factor model: SL + PA, NA, PFP, SW + TC	5527.194	3113.037***	1169	4.728	0.718	0.704	0.118	0.103
Three-factor model: SL + PA, NA + PFP, SW + TC	6720.764	4306.607***	1172	5.734	0.641	0.624	0.141	0.116
Two-factor model: SL + PA+SW + TC, NA + PFP	7895.659	5481.502***	1174	6.725	0.565	0.546	0.150	0.127
One-factor model: SL + PA+NA + PFP+SW + TC	10078.016	7663.859***	1175	8.577	0.423	0.399	0.177	0.147

Note. N = 353; df = degrees of freedom, CFI = comparative fit fix, TLI = Tucker-Lewis index, SRMR = Standardized Root Mean Square Residual, RMSEA = root mean square error of approximation. SL = Spiritual leadership, PA = Positive affect, NA = Negative affect, PFP = Pay-for-performance perception, SW = Spiritual well-being, and TC = Taking charge

^*p < 0.05; ^**p < 0.01; ^***p < 0.001

Hypotheses testing

We employed hierarchical regression analysis to test our proposed relationships. As shown in Table 3, spiritual leadership was positively associated with nurses’ taking charge (M6: β = 0.354, p < 0.001) and had a positive relationship with spiritual well-being (M2: β = 0.297, p < 0.001), supporting Hypotheses 1 and 2. Results also demonstrated that nurses’ spiritual well-being was positively related to their taking charge (M7: β = 0.294, p < 0.001), supporting Hypothesis 3.

Table 3.

Regression results of the mediation and moderation

Variables	Spiritual well-being				Taking-charge behavior
	M1	M2	M3	M4	M5	M6	M7	M8
Control variable
Nurse gender	0.013	0.023	0.013	0.013	-0.052	-0.040	-0.056	-0.045
Nurse age	-0.022	0.032	0.045	0.076	-0.025	0.040	-0.019	0.033
Nurse job tenure	0.121	0.044	0.042	0.018	0.113	0.022	0.078	0.013
Nurse educational level	-0.122*	-0.097	-0.073	-0.063	-0.019	0.012	0.017	0.032
Nurse positive affect	0.121*	0.079	0.079	0.080	0.152**	0.102*	0.116*	0.086
Nurse negative affect	-0.100	-0.086	-0.103*	-0.109*	-0.191***	-0.175***	-0.162**	-0.157**
Independent variable
Spiritual leadership		0.297***	0.404***	0.334***		0.354***		0.293***
Mediator
Spiritual well-being							0.294***	0.207***
Moderator
Pay-for-performance perception			0.405***	0.399***
Interaction
Spiritual leadership ×Pay-for-performance perception				0.151**
R²	0.057	0.141	0.293	0.311	0.074	0.193	0.156	0.230
ΔR²	—	0.084	0.236	0.254	—	0.119	0.082	0.156
F	3.515**	8.099***	17.839***	17.179***	4.630***	11.799***	9.103***	12.835***
ΔF	—	4.584***	14.324***	13.664***	—	7.169***	4.473***	8.205***

Note. N = 353; ^*p < 0.05; ^**p < 0.01; ^***p < 0.001

To test the mediating effect proposed in Hypothesis 4, we first applied the causal steps approach [48]. As demonstrated in Table 3, when both spiritual leadership and spiritual well-being were included in the regression model predicting taking charge, spiritual well-being was positively associated with taking charge of nurses (M8: β = 0.207, p < 0.001), whereas the positive effect of spiritual leadership on taking charge became weaker (M8: β = 0.293, p < 0.001). At the same level of significance, the regression coefficient of spiritual leadership decreased from 0.354 to 0.293. Hence, the linkage of spiritual leadership and taking charge was partially mediated by spiritual well-being. In addition, we followed the processing program [49] to further verify the mediating role of spiritual well-being. Our findings showed that spiritual leadership exerted a positive impact on taking charge through spiritual well-being (estimate = 0.062, SE = 0.018, 95% CI [0.031, 0.101], excluding zero). Although the indirect effect was statistically significant, its magnitude was modest, which is consistent with typical effect sizes observed in behavior models. Therefore, Hypothesis 4 was further supported.

The analysis of the interaction effect of Model 4, shown in Table 3, indicated a statistically significant positive interaction between spiritual leadership and pay-for-performance perception in predicting spiritual well-being (M4: β = 0.151, p < 0.001). To visually reflect the interaction, we plotted this interaction at 1 SD above and below the mean of pay-for-performance perception. As illustrated in Fig. 2, the results of simple slope analyses revealed that the effect of spiritual leadership on spiritual well-being was more positive and significant when nurses’ pay-for-performance perception was high (β = 0.437, p < 0.001) than low (β = 0.215, p < 0.05). Thus, Hypothesis 5 was supported.

Fig. 2.

The moderating effect of pay-for-performance perception on the relationship between spiritual leadership and spiritual well-being

Finally, we tested the moderated mediation model according to Hayes’s [49] processing method. Based on 5000 resamples. As Table 4 showed, the findings indicated that the indirect effect of spiritual leadership on taking charge via spiritual well-being was strengthened for nurses with higher levels of pay-for-performance perception (estimate = 0.100, SE = 0.027, 95% CI [0.049, 0.156], excluding zero) than lower levels of pay-for-performance perception (estimate = 0.041, SE = 0.023, 95% CI [-0.002, 0.087], including zero), and index = 0.030, p < 0. 001, CI [0.007, 0.065]. Therefore, pay-for-performance perception positively moderated the indirect effect of spiritual leadership on taking charge via spiritual well-being, thereby supporting Hypothesis 6.

Table 4.

Mediation effect at different levels of moderator value

	Moderator value	Indirect Effect	SE(Boot)	95% BootLLCI	95% BootULCI
Pay-for-Performance Perception
High (M + 1 SD)	0.978	0.100	0.027	0.049	0.156
Mean	0.000	0.070	0.020	0.033	0.113
Low (M − 1 SD)	-0.978	0.041	0.023	-0.002	0.087
Difference	—	0.059	0.025	0.051	0.069

Discussion

In summarize, drawing on COR theory, this study clarifies how spiritual leadership promotes taking charge among nurses through the mediating mechanism of spiritual well-being. Furthermore, we demonstrate that external material rewards, operationalized as pay-for-performance perception, positively moderate the effectiveness of spiritual leadership. Specifically, the indirect effect of spiritual leadership on taking charge via spiritual well-being was significantly stronger when pay-for-performance perception was high rather than low. Below, we discuss the theoretical implications and practical applications arising from these findings.

Theoretical implications

This study made several advances in the existing literature. First, we demonstrate that spiritual leadership promotes nurses’ taking charge, thereby enriching research on the antecedents of taking charge. As scholars noted, head nurses take a central role in shaping nurses’ work environment and behavioral tendencies [50]. Considering its change-oriented and extra-role nature of proactive behavior, such actions are highly sensitive to leader influence [12]. Accordingly, we examined whether spiritual leadership, a leadership style beneficial for organizational transformation, serves as a potent driver of nurses’ taking charge. In alignment with previous studies (e.g., [10, 51]), our results show that spiritual leaders foster greater taking charge by providing nurses with sufficient resources and support. These insights contribute to a deeper understanding of the leadership and proactivity literature.

Second, taking the COR lens, we clarify that spiritual leadership influences nurses’ taking-charge through the mediating mechanism of spiritual well-being, thereby shedding new light on how spiritual well-being emerges and functions in the workplace. By investigating spiritual leadership as a primary source, we have generated novel insights into the occurrence of spiritual well-being and answered the call for in-depth investigations into the role of head nurses in nurturing spiritual well-being [28]. Although the indirect effect was statistically significant, its magnitude was relatively modest, a pattern commonly observed in proactive behavioral models, where multiple motivational pathways tend to coexist. This suggests that spiritual well-being represents one important but not exclusive mechanism through which spiritual leadership promotes taking charge, pointing to additional mediating processes that merit future examination. Furthermore, we have examined taking charge as a novel outcome of spiritual well-being, which helps us introduce the spirit and meaning at work into the proactivity literature and encourages further dialogue between the domains of spirituality and proactivity. Through these efforts, we extend the theoretical framework about spiritual well-being.

Finally, although prior research has identified a variety of individual and contextual factors of spiritual leadership, such as leader integrity [34], power distance orientation [52], relational energy differentiation [34], and work centrality [39], the role of spiritual leadership is rarely achieved without taking external material rewards into account. In this study, we explored nurses’ pay-for-performance perception as a key boundary condition that enhances the effectiveness of spiritual leadership. The results showed that the benefits of spiritual leadership are amplified under conditions of high pay-for-performance perception, enabling nurses to experience greater spiritual well-being and subsequently engage in more taking charge. This finding provides a more nuanced understanding of when spiritual leadership exerts stronger effects and underscores the importance of aligning value-based leadership with material reward systems.

Practical implications

This study offers several practical implications for hospitals and head nurses. First, we identify spiritual leadership as a crucial factor influencing nurses’ taking charge. This underscores the need for hospitals to strengthen the selection and development of head nurses who possess strong spiritual leadership qualities. In practical, hospitals may prioritize candidates with high levels of personal spirituality [53], and provide structured training to help head nurses articulate a compelling vision and demonstrate spiritual leadership behaviors effectively. In addition, to fully leverage the benefits of taking charge, hospitals should cultivate a culture characterized by altruistic love, in which head nurses genuinely care for, value, and support their staff [15, 37].

Second, based on COR theory, our findings reveal that spiritual leadership promotes taking charge through enhanced spiritual well-being. As a proximal predictor of taking charge, spiritual well-being provides an additional avenue for hospitals to stimulate proactive behavior. To encourage taking charge, hospitals can implement targeted measures aimed at enhancing spiritual well-being, such as embracing more inclusive leadership styles [33], emphasizing the meaning and value of work, creating a meaningful climate [34], and providing more autonomous support for nurses at work.

Third, our research elaborated that nurses’ pay-for-performance perceptions amplify the positive impact of spiritual leadership on spiritual well-being and taking charge. This highlights the joint importance of spiritual fulfillment and material rewards in motivating nurses. Our work places a potentially powerful lever in the hands of managers. Put another way, an intervention strategy for hospitals aiming to make the best of spiritual leadership is to apply managerial practices largely focusing on pay for performance. For instance, hospitals can provide systematic training for head nurses to help them minimize personal bias and evaluate nurse performance as objectively as possible [54], design PFP systems that clearly link the nurse pay levels to their past or expected performance [21], and cultivate an atmosphere of distributive justice in the workplace.

Limitations and future directions

As with all empirical research, this study has several limitations. First, methodological constraints should be acknowledged. Our data were collected from three hospitals located in Sichuan province, which may restrict limit the generalizability of our findings [55]. Although our sampling approach aligned well with the research context and incorporated a degree of randomness within hospitals, the geographic concentration of the sample remains a limitation. Accordingly, we recommend that future research draw on more diverse samples across regions and hospital types to enhance external validity. Second, although the time-lagged and multisource design partially strengthened causal inference and mitigated common method bias [44], the study employed a single-level dyadic head nurse-nurse design, which does not capture potential cross-level influences. We acknowledge this limitation and suggest that future research adopt multilevel designs to examine how team- and organizational-level factors shape the effectiveness of spiritual leadership, providing a more comprehensive understanding of contextual influences. Third, quasi-experimental or longitudinal designs would further bolster causal claims and the external validity of the results.

Beyond these limitations, the study suggests several promising avenues and directions for future research. First, previous research has shown that leaders can promote subordinates’ taking charge behavior through role breadth self-efficacy [11], organizational identification [12], work engagement [51], and feedback-seeking behavior [56]. Our study examined how spiritual well-being transmitted spiritual leadership into taking charge through the lens of COR theory, but it did not establish whether spiritual well-being has a unique mediating role relative to those established mechanisms. A productive next step is to test the unique contribution of spiritual well-being while statistically controlling for other known mediators. Relatedly, future research also needs to put more effort into identifying other potential intermediaries. For example, drawing on regulatory focus theory, spiritual leadership, by articulating an inspiring organizational vision, valuing subordinates’ spiritual needs, and demonstrating care, may evoke a promotion focus. Nurses who adopt a promotion focus tend to pursue growth and achievement, which may increase their propensity to take charge.

Finally, as Podsakoff and his colleagues point out [57], there remains limited empirical attention to moderators of leadership effects, even though subordinates, tasks, and organizational characteristics are often discussed conceptually. Future research should therefore explore boundary conditions that influence the impact of spiritual leadership. One candidate is nurses’ proactive personality, which reflects a relatively stable individual tendency that takes initiative to influence and shape the environment [58]. Nurses with high levels of proactive personality have a more positive orientation, proactively seek out information, explore the environment, and try to identify more future opportunities [58, 59]. As a result, when head nurses display spiritual behaviors, these nurses have the capability to discover and leverage opportunities and resources, amplifying the effect of spiritual leadership.

Conclusions

On the basis of COR theory, we proposed a moderated mediation model to explain why and when spiritual leadership fosters nurses’ taking charge. The findings revealed that the effect of spiritual leadership was carried to nurses’ taking charge through spiritual well-being. Further, when nurses perceived high pay-for-performance, the indirect effect of spiritual leadership on taking charge was enlarged. Going beyond the existing literature, we realized that we took a step toward the field of proactivity by throwing light on the importance of spirit at work for the emergence of taking charge. As the society and economy are changing rapidly, hospitals depend more on nurses’ taking charge for continued growth and improvement [3, 13]. Thus, we hope that our efforts spur future research into more explorations of the antecedents of taking charge.

Author contributions

Ying Ouyang wrote the main manuscript text and Peng Han review and editing the manuscript. Lei Shi and Xiaoyuan Cheng supported with the data analysis, Ying Ouyang, Bin Wan and LeYong Ou provide the support for data collection. All authors have contributed to the article and approved the published version of the manuscript.

Funding

This study was funded by “2020 National Natural Science Foundation of China” (project No. 72002174) and “2024 Academic Degree and Postgraduate Education Reform Project of Southwestern University of Finance and Economics” (project No. YJGXM24-C176).

Data availability

The study’s data are not accessible through a public archive, but they can be provided upon request if the request is deemed reasonable and complies with the study’s requirements for the protection of human participants. All questions should be sent through email to the corresponding author.

Declarations

Ethics approval and consent to participate

The study was approved by the institutional review board of West China Hospital, Sichuan University (NO. 2025065). Before participation in the study, hospital administrators were contacted. With their help, meticulous written informed consent was obtained from all participants, ensuring that participants were fully aware of the purpose of the study, the procedures, and their right to withdraw from the study at any time without consequence, and that their privacy would be fully protected. All methods were conducted in accordance with the Declaration of Helsinki (DoH-Oct2008) and other relevant guidelines and regulations. The results of this study have no effect on the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.