Toxic leadership and nurses’ vengeful behaviors: mediating effects of organizational citizenship behavior and moderating effects of self-efficacy: A predictive correlational study

Abstract

Toxic leadership represents a destructive phenomenon in healthcare settings that negatively affects nurses’ well-being and may provoke vengeful behaviors. Identifying organizational mechanisms that mitigate these effects remains essential. This study aimed to examine the effect of toxic leadership on nurses’ vengeful behaviors and to explore the mediating role of organizational citizenship behavior (OCB) and the moderating role of self-efficacy in this relationship. A predictive correlational design was conducted at Alexandria Main University Hospital, Egypt. A convenience sample of 352 nurses completed 4 validated instruments: the Toxic Leadership Questionnaire, Organizational Citizenship Behavior Questionnaire, General Self-Efficacy Scale, and Vengeful Behaviors Scale. Data were analyzed using Pearson correlation analysis and structural equation modeling to examine direct, mediating, and moderating relationships. Nurses reported moderate levels of toxic leadership (M = 87.13), OCB (M = 31.37), and self-efficacy (M = 28.71), along with low levels of vengeful behaviors (M = 19.00). Path analysis revealed that toxic leadership had a significant positive direct effect on vengeful behaviors (β = 0.42, P < .001) and a significant negative effect on OCB (β = −0.39, P < .001). OCB significantly mediated the relationship between toxic leadership and vengeful behaviors (indirect effect: β = −0.13, P < .001). Self-efficacy demonstrated a significant negative direct effect on vengeful behaviors (β = −0.29, P < .001) and significantly moderated the relationship between toxic leadership and vengeful behaviors, attenuating this effect (interaction: β = −0.18, P < .001). Toxic leadership was associated with higher levels of vengeful behaviors among nurses, whereas OCB and self-efficacy acted as protective mechanisms that reduced these negative effects. Healthcare organizations should prioritize leadership development strategies that promote positive and supportive leadership practices, strengthen nurses’ self-efficacy, and foster OCB to reduce vengeful behaviors and improve nurses’ well-being and the quality of patient care.

1. Introduction

Leadership in healthcare significantly influences hospital performance and quality of care. It is crucial for nurse leaders to ensure that nurses feel appreciated and respected, as their treatment significantly impacts organizational success and the quality of care provided.^[1–3] Toxic leadership, recognized for its destructive impact on team members and organizations, contributes to negative work behaviors and increased job dissatisfaction among nurses, which can adversely affect patient safety and care standards.^[4,5] Given this context, there is a compelling need for research focusing on organizational factors that trigger vengeful behaviors and the consequences of toxic leadership on nurses’ work behaviors. This study aims to advance understanding of these relationships among nurses.

1.1. Theoretical and conceptual framework of the study

This study draws on Bandura’s social learning theory (SLT)^[6] and social exchange theory (SET)^[7] to explore how toxic leadership influences nurses’ vengeful behaviors and how positive workplace behaviors may mitigate these effects. According to SLT, behaviors are acquired through observation and modeling, implying that nurses may imitate vengeful behaviors exhibited by toxic leaders. However, in a supportive work environment, they are more likely to adopt positive behaviors, such as organizational citizenship behavior (OCB), especially when they possess high levels of self-efficacy. On the other hand, SET emphasizes that the quality of leader–follower interactions shapes employees’ responses; negative interactions often provoke retaliatory behaviors, while positive exchanges foster constructive actions and reduce the negative consequences of toxic leadership.^[8] This study, therefore, examines both passive exchanges, which are often subtle but detrimental, and active supportive exchanges that contribute to a healthy organizational culture. Understanding these dynamics offers valuable insights into how fostering supportive behaviors and enhancing self-efficacy can buffer the adverse effects of toxic leadership.^[9]

1.1.1. Toxic leadership

Nurse leaders are typically viewed as knowledgeable and ethical, but there is increasing recognition of a toxic dimension to leadership. Toxic leaders are characterized by their self-serving actions, prioritizing personal gains over the well-being of their teams.^[4,10] They are often authoritarian and abusive, creating a hostile work environment marked by harassment and intimidation. This undermines staff morale, increases stress, and diminishes performance and productivity.^[11,12] Toxic leadership encompasses 4 dimensions, as described by Çelebi et al^[13]: self-interest involves leaders prioritizing their own gains over the welfare of others. Selfishness is characterized by leaders who believe they are more talented than their peers. Unappreciativeness includes actions that make team members feel undervalued, such as humiliation and relentless criticism of their faults. Finally, a negative spiritual state or mood reflects a leader’s overall demeanor that can disengage and negatively impact the workplace environment.^[13]

The literature demonstrates that toxic leadership in healthcare significantly impacts nurses, patients, and overall organizational outcomes, creating environments characterized by abuse, manipulation, and fear.^[11] Under such leadership, nurses experience decreased job satisfaction, increased stress, higher burnout rates, distrust, and anxiety, contributing to reduced organizational commitment, higher turnover, and compromised patient safety and care quality.^[4,14] This atmosphere results in poorer patient care, extended wait times, and more medical errors due to a demoralized staff.^[15] Toxic leadership also erodes organizational values, lowers morale, and disrupts teamwork, negatively impacting patient outcomes.^[10] Furthermore, nurses who perceive their leaders as toxic often engage in vengeful behaviors, attempting to inflict suffering on those perceived as harmful.^[15]

1.1.2. Toxic leadership and vengeful behaviors

In the workplace, vengeful behaviors are identified as counterproductive responses to perceived mistreatment, often leading to prolonged conflicts and detrimental psychological outcomes.^[15] Academic research emphasizes the adverse effects of revenge, noting its association with aggression, hostility, and negative impacts on individuals’ mental health and social interactions.^[16] Within organizational settings, revenge is frequently viewed as dysfunctional, unethical, and morally questionable. Moreover, toxic leadership exacerbates these issues by diminishing employees’ job satisfaction and organizational commitment, thereby increasing their propensity for revenge-seeking behaviors and significantly disrupting workplace dynamics and employee welfare.^[16]

Vengeful behaviors refer to intentional actions undertaken by employees to harm others in response to perceived injustices, mistreatment, or harmful leadership behaviors.^[15] These behaviors are often rooted in a desire to retaliate against individuals, typically supervisors or colleagues, perceived as responsible for personal harm.^[17] In organizational settings, vengeful behaviors are considered counterproductive and detrimental, leading to persistent conflicts, reduced teamwork, and intimidating work environments. Scholars emphasize that revenge can manifest as both overt and covert actions, ranging from passive-aggressive attitudes to direct confrontation and sabotage.^[15,16] Importantly, vengeful behaviors are often associated with negative emotional states, including anger, resentment, and hostility, and have been linked to psychological distress, such as anxiety, depression, and burnout.^[18]

In the context of healthcare organizations, toxic leadership could be an antecedent to vengeful behaviors. Previous research revealed that toxic leaders, characterized by abusive, manipulative, and self-serving behaviors, create environments of fear and mistrust that provoke retaliatory actions among nurses.^[4,15] Such leadership diminishes employees’ job satisfaction and organizational commitment, intensifies stress, and fosters a culture where revenge may be seen as the only way to restore personal dignity or justice.^[19] As Koç et al^[15] demonstrated, nurses exposed to toxic leadership are more likely to engage in vengeful behaviors as a reaction to being devalued, ignored, or harmed by their leaders.

Moreover, vengeful behaviors do not arise in isolation; rather, they are the result of continuous exposure to unfair treatment and hostile work conditions perpetuated by toxic leadership.^[11] These behaviors have profound consequences, including undermining patient safety, disrupting team cohesion, and damaging organizational culture. Therefore, understanding the mechanisms through which toxic leadership influences vengeful behaviors is essential for developing effective interventions to prevent such negative outcomes. One critical mechanism is identifying the role of supportive workplace factors, such as OCB and self-efficacy, which can buffer the harmful effects of toxic leadership and reduce nurses’ tendencies to engage in revenge-seeking behaviors.^[9,20]

1.1.3. OCB and toxic leadership

OCB refers to discretionary, voluntary behaviors performed by employees that are not part of their formal job requirements but significantly contribute to the functioning and success of the organization.^[21] These behaviors include helping colleagues, being flexible, and showing initiative, all of which enhance organizational effectiveness and create a collaborative work environment. According to Chattopadhyay,^[22] such discretionary efforts beyond assigned roles are crucial in achieving organizational excellence. OCB is generally categorized into 2 types: affiliation-oriented behaviors, which emphasize interpersonal cooperation, teamwork, and relationship-building, and challenge-oriented behaviors, which involve innovative and change-inducing actions that may question the status quo to improve organizational outcomes.^[23]

However, toxic leadership has been consistently found to undermine OCB. Toxic leadership, characterized by abusive, authoritarian, and self-serving behaviors, creates a work environment that damages employees’ motivation to engage in positive discretionary actions. Specifically, research has shown that under toxic leaders, employees are less likely to demonstrate citizenship behaviors because they feel devalued, unsupported, and psychologically unsafe.^[24] For example, Labrague et al^[4] emphasized that toxic leadership erodes trust and mutual respect, which are fundamental conditions for OCB to flourish. Without these essential elements, employees are likely to disengage, withdraw their effort, and refrain from contributing beyond their basic job duties.

Moreover, the relationship between toxic leadership and OCB is mediated by the psychological states of employees. When nurses are exposed to toxic leadership, their organizational commitment and job satisfaction decline, reducing their willingness to engage in behaviors that benefit the organization, such as OCB.^[19] Toxic leaders often suppress OCB by creating fear, limiting autonomy, and punishing initiative, which makes employees reluctant to go beyond their formal roles.^[14] Further understanding of this negative relationship is essential because OCB can act as a protective factor that promotes resilience and positive work dynamics even in challenging environments.^[23] However, for OCB to emerge and be sustained, a supportive and nontoxic leadership style is crucial. Therefore, addressing toxic leadership is vital not only to prevent negative behaviors such as vengefulness but also to foster and maintain high levels of OCB among nurses, ultimately contributing to better patient care and healthier work environments.

1.1.4. Self-efficacy and toxic leadership

Self-efficacy, a crucial psychological construct, reflects an individuals’ belief in their ability to successfully perform specific tasks and achieve desired outcomes.^[6] In nursing practice, self-efficacy plays a pivotal role in motivating nurses’ caregiving efforts, guiding clinical decision-making, and maintaining resilience and persistence in the face of daily work-related challenges.^[25] It directly influences nurses’ capacity to manage complex patient care, respond effectively under pressure, and prioritize appropriate interventions, thereby impacting the overall quality of care delivered.^[26] As a key motivational and affective factor, self-efficacy contributes to sustained engagement, emotional regulation, and the ability to overcome professional obstacles.^[27]

However, toxic leadership, characterized by abusive, authoritarian, and self-centered behaviors, poses a significant threat to nurses’ self-efficacy. By creating a psychologically unsafe work environment, toxic leaders undermine nurses’ confidence in their professional abilities and decision-making, leading to increased emotional exhaustion and reduced performance.^[19] Research indicates that toxic leadership behaviors, such as verbal abuse and demeaning communication, directly lower self-efficacy and foster feelings of helplessness and incompetence among nursing staff, thereby compromising both their mental health and patient care outcomes.^[28]

Moreover, diminished self-efficacy due to toxic leadership is linked to reduced organizational commitment, lower job satisfaction, and higher turnover intentions, as nurses feel disempowered and disengaged from their roles.^[19,28] Thus, self-efficacy is not only essential for individual nurse performance but also serves as a protective factor that buffers against the adverse effects of toxic work environments. Addressing the destructive impact of toxic leadership on self-efficacy is critical for sustaining nurses’ ability to cope with stress, maintain resilience, and avoid engaging in counterproductive behaviors such as withdrawal or vengefulness.

1.2. Study hypotheses

Based on this background, this study’s conceptual framework posits that toxic leadership behaviors directly influence nurses’ vengeful behaviors, with OCB acting as a mediator in this relationship. Furthermore, self-efficacy is proposed to moderate the relationship between toxic leadership and nurses’ vengeful behaviors, potentially buffering the negative effects of toxic leadership. Additionally, toxic leadership is expected to negatively influence OCB, and OCB may also have a direct relationship with vengeful behaviors, reducing such behaviors when present.

Accordingly, the following hypotheses are formulated to match the model (Fig. 1):

Figure 1.

Proposed conceptual framework of the hypothesized relationships among the study variables. H1 = Hypothesis 1, H2 = Hypothesis 2, H3 = Hypothesis 3, H4 = Hypothesis 4.

• H1: Toxic leadership significantly predicts nurses’ vengeful behaviors.

• H2: OCB mediates the relationship between toxic leadership and nurses’ vengeful behaviors.

• H3: Toxic leadership negatively affects OCB.

• H4: Self-efficacy moderates the relationship between toxic leadership and nurses’ vengeful behaviors, such that the relationship is weaker when self-efficacy is high.

1.3. Significance of the study

Toxic leadership in healthcare severely undermines trust, which is essential for effective relationships and leadership, leading to decreased work effort, lower quality of work, higher staff turnover, and erosion of team dynamics and morale, all of which are vital for organizational productivity and growth.^[29] Such leadership also increases job stress, negative job attitudes, and interpersonal conflicts among nurses, adversely affecting their emotional intelligence and OCB, and stifling both professional and personal development.^[12] Toxic leaders often fail to inspire commitment or foster a shared vision, which further reduces nurses’ engagement and commitment.^[4,12] Hence, it is crucial for organizations to understand these destructive behaviors to effectively address and mitigate their impact. This study seeks to expand existing research by exploring the prevalence of toxic leadership in hospital settings and its effects on vengeful behaviors among nurses, particularly through the mediating role of OCB and the moderating role of self-efficacy. By gaining these insights, the study aims to contribute to the development of strategies that mitigate the negative effects of toxic leadership.

1.4. Aim of the study

This study aims to investigate the effect of toxic leadership on nurses’ vengeful behaviors and to explore the mediating role of OCB and the moderating role of self-efficacy in this relationship. The study seeks to determine how toxic leadership influences vengeful behaviors directly and indirectly through OCB, while also examining whether nurses’ self-efficacy can alter the strength of this effect.

2. Methods

2.1. Design and sample

A predictive correlational research design was employed to examine the effect of toxic leadership on nurses’ vengeful behaviors and to assess the mediating and moderating roles of OCB and self-efficacy, respectively. The study was conducted at Alexandria Main University Hospital, Egypt, following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines to ensure methodological rigor.

A convenience sample of 352 nurses, each with a minimum of 1 year of clinical experience, was recruited to participate in the study. The sample size was calculated using Steven K. Thompson’s equation, which estimated a minimum required sample of 302 nurses to achieve adequate statistical power. To compensate for potential dropouts and incomplete responses, the sample size was increased to 352 nurses.

2.2. Variables and instruments

To assess the study variables, 5 tools were utilized as follows:

• •Demographic form: A personal-professional work-related data sheet developed by the researchers included information such as age, gender, place of work, educational qualifications, position, and years of experience.
• •Toxic Leadership Questionnaire: Developed by Çelebi et al,^[13] this questionnaire evaluated toxic leadership from the perspective of nurses. It consists of 30 items divided into 4 dimensions: unappreciativeness (11 items), self-interest (9 items), selfishness (5 items), and negative spiritual state (5 items). Responses were measured on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with scores ranging from 30 to 150.
• •Vengeful Behaviors Scale: Developed by Coelho et al^[17] to measure attitudes toward revenge. It consists of 10 items, with participants rating their agreement on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree), and scores ranging from 10 to 70.
• •Organizational Citizenship Behavior (OCB) Questionnaire: Developed by Fox and Spector,^[30] this questionnaire assessed OCB from the perspective of nurses. It contains 20 items divided into 2 dimensions: affiliation-oriented (10 items) and challenge-oriented (10 items). Responses were measured on a 5-point Likert scale ranging from 1 (never) to 5 (every day), with scores ranging from 20 to 100.
• •General Self-Efficacy Scale (GSES): Developed by Schwarzer and Jerusalem^[31] to measure the general sense of perceived self-efficacy. It consists of 10 items rated on a 4-point Likert scale ranging from 1 (not at all true) to 4 (exactly true). Scores on the GSES range from 10 to 40, with higher scores indicating higher perceived self-efficacy.

2.3. Translation, cultural adaptation, and pilot testing of the study instruments

The study tools used in this research were previously established instruments with documented validity and reliability in earlier studies, including the Toxic Leadership Scale,^[13] the Vengeful Behaviors Scale,^[17] the OCB Questionnaire,^[30] and the GSES.^[31] To ensure cultural and linguistic appropriateness, these tools were translated into Arabic following a rigorous forward-backward translation process to maintain conceptual equivalence. A panel of 5 academic nursing experts evaluated the translated versions to assess content validity, confirming that all items were relevant, clear, and suitable for the cultural context. The internal consistency reliability of the Arabic versions was assessed using Cronbach’s alpha coefficients, which demonstrated excellent internal consistency: 0.93 for the Toxic Leadership Questionnaire, 0.94 for the Vengeful Behaviors Scale, 0.88 for the OCB Questionnaire, and 0.83 for the GSES. Additionally, a pilot study was conducted with 10% of the total sample (n = 37 nurses), who were excluded from the main study. The pilot study aimed to evaluate the clarity, applicability, and cultural relevance of the questionnaires and to estimate the time required for completion, ensuring that the final tools were appropriate and understandable for the target nursing population.

2.4. Data collection and ethical considerations

The study was approved by the Ethics Research Committee of the Faculty of Nursing at Alexandria University (Institutional Review Board approval number: IRB00013620). Following this, official permission was secured from the hospital and nursing administration to commence data collection. Prospective participants were recruited with the help of nurse managers and ward in-charges, and the questionnaires were administered by the researchers between September and December 2023, with each nurse taking approximately 20 minutes to complete them. Written informed consent was obtained from all participants after explaining the study’s purpose, potential risks, and benefits. Measures were taken to ensure participant anonymity, privacy, and confidentiality of collected data. Participants were also informed of their right to withdraw from the study at any time.

2.5. Statistical analysis

Data were cleaned, coded, and analyzed using IBM SPSS Statistics version 25. Descriptive statistics, including mean, standard deviation (SD), frequencies, and percentages, were calculated. Pearson correlation analysis was conducted to examine the relationships among toxic leadership, OCB, self-efficacy, and vengeful behaviors prior to path analysis. Structural equation modeling (SEM) was conducted using IBM SPSS AMOS version 23 to test the hypothesized path model. All tests were two-tailed with a significance level of α < 0.05. Bootstrap resampling (5000 subsamples) was used to estimate the significance of the direct, indirect, and moderating effects. Model fit was evaluated using the Comparative Fit Index, Normed Fit Index, Goodness-of-Fit Index, and Root Mean Square Error of Approximation.

2.5.1. Assumption testing

Prior to path analysis, the assumptions underlying SEM were evaluated. Univariate normality was assessed using skewness and kurtosis statistics. Multicollinearity was examined using variance inflation factor and tolerance statistics. No missing data were reported; therefore, complete-case analysis was performed, and no imputation procedures were required.

2.5.2. Psychometric evaluation

The psychometric properties of the study instruments were evaluated using the study sample before testing the proposed structural model. Internal consistency reliability was assessed using Cronbach’s alpha coefficient, while construct validity was examined using the Kaiser–Meyer–Olkin measure of sampling adequacy and Bartlett’s test of sphericity. Skewness and kurtosis statistics were also examined to assess univariate normality. The results of the psychometric evaluation are presented in Table 2.

Table 2.

Psychometric properties of the study instruments.

Instrument	No. of items	Cronbach’s α	Skewness/kurtosis	KMO	Bartlett’s test χ2 (df), P
Toxic Leadership Scale	30	0.934	−0.05/−0.81	0.879	5924.47 (435), <.001
Organizational Citizenship Behavior Questionnaire	20	0.870	−0.05/−1.03	0.812	3002.45 (190), <.001
General Self-Efficacy Scale	10	0.781	−0.16/−0.69	0.831	772.09 (45), <.001
Vengeful Behaviors Scale	10	0.898	−0.46/−0.71	0.894	777.01 (45), <.001

χ² = Bartlett’s test of sphericity, Cronbach’s α = Cronbach’s alpha coefficient, KMO = Kaiser–Meyer–Olkin measure of sampling adequacy.

2.5.3. Measurement model adequacy

Because each study variable (toxic leadership, OCB, self-efficacy, and vengeful behaviors) was operationalized as a single composite (summated) score from its respective previously validated scale, rather than modeled as a latent variable with multiple observed indicators, the path model tested here is a manifest-variable path analysis rather than a full latent-variable structural equation model. Accordingly, standardized factor loadings, composite reliability, average variance extracted, and Fornell–Larcker discriminant validity – which are properties of a latent measurement model – were not computed, as they were not applicable to this design. Internal consistency reliability was evaluated using Cronbach’s alpha coefficients, while discriminant validity was assessed by examining the pattern of inter-construct correlations among the study variables.

2.5.4. Common method bias

Because all study variables were collected using self-report questionnaires at a single point in time, the potential for common method bias was considered. Procedural safeguards recommended to reduce common method bias were implemented, including anonymous participation, assurances of confidentiality, and the use of standardized, previously validated instruments. Harman’s single-factor test was performed to assess common method bias, and the results are presented in Table 2.

3. Results

3.1. Participant characteristics

The study participants were predominantly female and worked as bedside nurses, comprising 94.9% and 97.4% of the sample, respectively. The mean age of the participants was 41.62 years (SD = 8.03), with an average of 12.76 years of experience (SD = 8.36). Approximately two-thirds (65.6%) of the nurses held a Bachelor of Science in Nursing. Further demographic details are provided in Table 1.

Table 1.

Demographic and professional characteristics of the studied nurses (N = 352).

Items	No (%)
Age, yr
20–<30	53 (15.1)
30–<40	119 (33.8)
40–<50	144 (40.9)
>50	36 (10.2)
Mean ± SD	41.62 ± 8.03
Gender
Male	18 (5.1)
Female	334 (94.9)
Educational qualifications
Secondary nursing school diploma	81 (23.0)
Technical nursing institute diploma	24 (6.8)
Bachelor’s degree in nursing science	231 (65.6)
Master’s degree in nursing science	16 (4.5)
Position
Bedside nurse	343 (97.4)
Senior nurse	9 (2.6)
Years of experience
<5	98 (27.8)
5–<10	102 (29.0)
10–<15	61 (17.3)
15–<20	40 (11.4)
20+	51 (14.5)
Mean ± SD	12.76 ± 8.36

SD = standard deviation.

3.2. Psychometric properties of the study instruments

The psychometric evaluation demonstrated satisfactory to excellent reliability and construct validity for all study instruments (Table 2). Cronbach’s alpha coefficients ranged from 0.781 to 0.934, indicating acceptable to excellent internal consistency. The Toxic Leadership Scale demonstrated the highest reliability (α = 0.934), followed by the Vengeful Behaviors Scale (α = 0.898), the Organizational Citizenship Behavior Questionnaire (α = 0.870), and the GSES (α = 0.781). Sampling adequacy was supported by Kaiser–Meyer–Olkin values ranging from 0.812 to 0.894, while Bartlett’s tests of sphericity were statistically significant for all instruments (all P < .001), confirming the suitability of the data for factor analysis. Furthermore, skewness and kurtosis values fell within acceptable ranges, supporting the assumption of univariate normality for all study variables. These findings confirmed the suitability of the study instruments for the subsequent correlation and SEM analyses.

3.3. Descriptive analysis of perceived study variables

Table 3 indicates that nurses perceived an overall moderate level of toxic leadership (mean = 87.13 ± 20.96). All toxic leadership dimensions were predominantly reported at moderate levels, with selfishness showing the highest proportion of high-level perception (40.9%), whereas unappreciativeness was most frequently perceived at low levels (49.7%). OCB was also perceived at a moderate level, with a total mean score of 31.37 ± 5.29. Both affiliation-oriented OCB (30.90 ± 4.45) and challenge-oriented OCB (31.83 ± 7.55) were similarly reported at moderate levels. Self-efficacy demonstrated a moderate-to-high tendency, with a mean score of 28.71 ± 3.80, with the majority of nurses (83.0%) reporting moderate levels. In contrast, vengeful behaviors were perceived at low levels, with a mean score of 19.00 ± 5.30, and most nurses (84.9%) reporting low levels.

Table 3.

Level of toxic leadership, OCB, self-efficacy, and vengeful behaviors as perceived by nurses.

Variables	Low	Moderate	High	Mean ± SD
	No (%)	No (%)	No (%)
Unappreciativeness	175 (49.7)	163 (46.3)	14 (4.0)	26.8 ± 7.97
Self-interest	116 (33.0)	164 (46.6)	72 (20.5)	26.02 ± 8.4
Selfishness	41 (11.6)	167 (47.4)	144 (40.9)	17.83 ± 4.61
Nevertheless	73 (20.7)	178 (50.6)	101 (28.7)	16.48 ± 4.57
Total toxic leadership	82 (23.3)	230 (65.3)	40 (11.4)	87.13 ± 20.96
Affiliation-oriented OCB	47 (13.4)	216 (61.4)	89 (25.3)	30.90 ± 4.45
Challenge-oriented OCB	63 (17.9)	205 (58.2)	84 (23.9)	31.83 ± 7.55
Total OCB	40 (11.4)	235 (66.8)	77 (21.9)	31.37 ± 5.29
Self-efficacy	21 (6.0)	292 (83.0)	39 (11.1)	28.71 ± 3.80
Vengeful behaviors	299 (84.9)	51 (14.5)	2 (0.6)	19.00 ± 5.30

OCB = organizational citizenship behavior, SD = standard deviation.

3.4. Correlation among the studied variables

Table 4 reveals that toxic leadership was positively correlated with vengeful behaviors (r = 0.66, P < .001) and negatively correlated with OCB (r = −0.62, P < .001) and self-efficacy (r = −0.48, P < .001). OCB demonstrated a moderate negative association with vengeful behaviors (r = −0.58, P < .001) and a positive association with self-efficacy (r = 0.51, P < .001). In addition, self-efficacy was negatively correlated with vengeful behaviors (r = −0.54, P < .001), indicating that higher perceived self-efficacy was associated with lower engagement in vengeful behaviors.

Table 4.

Correlation among toxic leadership behaviors, vengeful behaviors, self-efficacy, and OCB.

Variables	Pearson correlation (r)	Total toxic leadership behaviors	Total OCB	Total self-efficacy	Total vengeful behavior
Total toxic leadership behaviors	r
	P
Total OCB	r	−0.62
	P	<.001*
Total self-efficacy	r	−0.48*	0.51
	P	<.001	<.001*
Total vengeful behavior	r	0.66	−0.58	−0.54
	P	<.001*	<.001*	<.001*

r: Pearson coefficient.

OCB = organizational citizenship behavior.

^*P: significant at P < .001.

3.5. Path analysis and hypothesis testing

Table 5 and Figure 2 present the results of the path analysis examining the direct, indirect, and moderating effects of toxic leadership on nurses’ vengeful behaviors, incorporating the mediating role of OCB and the moderating role of self-efficacy. The analysis demonstrated that toxic leadership exerted a significant positive direct effect on vengeful behaviors (B = 0.48, β = 0.42, P < .001), supporting H1. In addition, toxic leadership showed a significant negative direct effect on OCB (B = −0.44, β = −0.39, P < .001), confirming H3 and indicating that higher levels of toxic leadership were associated with lower OCB.

Table 5.

Path analysis for direct and indirect effect of toxic leadership on nurses’ vengeful behaviors with mediating role of OCB and moderating role self-efficacy.

Figure 2.

Final structural path model showing standardized path coefficients. H1 = Hypothesis 1, H2 = Hypothesis 2, H3 = Hypothesis 3, H4 = Hypothesis 4.

The mediating role of OCB was supported, as toxic leadership had a significant indirect effect on vengeful behaviors through OCB (B = −0.18, β = −0.13, P < .001). Furthermore, OCB was significantly and negatively associated with vengeful behaviors (B = −0.41, β = −0.34, P < .001), confirming H2 and indicating that reduced OCB partially explains the relationship between toxic leadership and vengeful behaviors.

Regarding self-efficacy, the findings revealed both direct and moderating effects. Self-efficacy demonstrated a significant direct negative effect on vengeful behaviors (B = −0.36, β = −0.29, P < .001) and a significant positive effect on OCB (B = 0.31, β = 0.26, P = .012), highlighting its protective and promotive role in the workplace. In addition, the interaction between toxic leadership and self-efficacy was significant (B = −0.21, β = −0.18, P < .001), supporting H4 and indicating that higher levels of self-efficacy attenuate the adverse effect of toxic leadership on nurses’ vengeful behaviors.

Overall, the findings supported all 4 hypotheses (H1–H4), confirming the proposed direct, mediating, and moderating relationships among toxic leadership, OCB, self-efficacy, and vengeful behaviors.

3.6. Perception of study variables according to demographic characteristics

Table 6 shows statistically significant differences in toxic leadership, OCB, self-efficacy, and vengeful behaviors across age groups, educational qualifications, participants’ positions, and years of experience. No statistically significant differences were observed according to gender across the studied variables (P > .05).

Table 6.

Differences in toxic leadership, organizational citizenship behavior, self-efficacy, and vengeful behaviors according to nurses’ demographic characteristics.

Demographic variable	Toxic leadership, mean ± SD	OCB, mean ± SD	Self-efficacy, mean ± SD	Vengeful behaviors, mean ± SD
Age, yr
20–<30	96.5 ± 18.7	27.6 ± 4.9	26.2 ± 3.8	22.1 ± 5.5
30–<40	89.8 ± 19.9	30.1 ± 5.1	28.4 ± 3.7	19.6 ± 5.2
40–<50	83.7 ± 21.2	32.8 ± 5.0	29.9 ± 3.6	17.8 ± 4.9
≥50	79.6 ± 22.5	34.5 ± 4.8	31.0 ± 3.4	16.3 ± 4.6
F (P)	11.84 (<.001*)	16.72 (<.001*)	18.95 (<.001*)	10.36 (<.001*)
Gender
Male	88.4 ± 21.6	30.9 ± 5.4	28.9 ± 3.9	18.7 ± 5.2
Female	87.0 ± 20.9	31.4 ± 5.3	28.7 ± 3.8	19.0 ± 5.3
t (P)	0.31 (.756)	0.42 (.675)	0.28 (.782)	0.24 (.810)
Educational qualifications
Secondary nursing diploma	94.9 ± 19.4	28.2 ± 5.0	26.9 ± 3.9	21.3 ± 5.6
Technical institute diploma	90.6 ± 20.3	29.6 ± 5.1	27.8 ± 3.7	19.9 ± 5.3
Bachelor’s degree	84.9 ± 21.1	32.1 ± 5.1	29.2 ± 3.6	18.4 ± 5.0
Master’s degree	79.1 ± 22.4	34.6 ± 4.9	30.8 ± 3.3	16.8 ± 4.7
F (P)	6.54 (<.001*)	9.12 (<.001*)	10.87 (<.001*)	5.42 (.001*)
Position
Bedside nurse	88.1 ± 20.8	30.9 ± 5.3	28.4 ± 3.8	19.3 ± 5.3
Senior nurse	79.3 ± 22.7	34.2 ± 4.8	30.6 ± 3.4	16.6 ± 4.6
t (P)	2.41 (.017*)	3.06 (.002*)	2.88 (.004*)	2.27 (.024*)
Years of experience
<5	97.1 ± 18.3	27.5 ± 4.7	26.0 ± 3.6	22.3 ± 5.6
5–<10	90.4 ± 19.8	29.9 ± 5.0	27.9 ± 3.7	20.1 ± 5.2
10–<15	85.2 ± 20.9	31.8 ± 5.2	29.1 ± 3.6	18.5 ± 5.0
15–<20	81.4 ± 21.7	33.2 ± 5.0	30.0 ± 3.5	17.4 ± 4.8
≥20	78.9 ± 22.6	34.6 ± 4.9	31.2 ± 3.3	16.2 ± 4.6
F (P)	13.27 (<.001*)	17.89 (<.001*)	19.42 (<.001*)	11.61 (<.001*)

t: independent t test for comparisons between 2 groups. F: one-way ANOVA for comparisons among more than 2 groups.

OCB = organizational citizenship behavior, SD = standard deviation.

^*Statistically significant at P < .05.

Across age groups, nurses aged 20 to <30 years reported the highest mean scores for toxic leadership (96.5 ± 18.7) and vengeful behaviors (22.1 ± 5.5). These differences were statistically significant when compared with other age groups (toxic leadership: F = 11.84, P < .001; vengeful behaviors: F = 10.36, P < .001). In contrast, nurses aged ≥50 years demonstrated the highest mean scores for OCB (34.5 ± 4.8) and self-efficacy (31.0 ± 3.4), with significant differences across age categories (OCB: F = 16.72, P < .001; self-efficacy: F = 18.95, P < .001).

With regard to educational qualifications, nurses holding a master’s degree reported lower mean scores for toxic leadership (79.1 ± 22.4) and vengeful behaviors (16.8 ± 4.7) and higher mean scores for OCB (34.6 ± 4.9) and self-efficacy (30.8 ± 3.3). The differences across educational levels were statistically significant for all study variables (P ≤ .001).

Statistically significant differences were also observed according to participants’ positions. Senior nurses reported lower toxic leadership (79.3 ± 22.7) and vengeful behaviors (16.6 ± 4.6) and higher OCB (34.2 ± 4.8) and self-efficacy (30.6 ± 3.4) compared with bedside nurses (P < .05).

Regarding years of experience, nurses with less than 5 years of experience demonstrated the highest mean scores for toxic leadership (97.1 ± 18.3) and vengeful behaviors (22.3 ± 5.6). Conversely, nurses with 20 years or more of experience reported the highest mean scores for OCB (34.6 ± 4.9) and self-efficacy (31.2 ± 3.3). Differences across experience categories were statistically significant for all variables (F values ranged from 11.61 to 19.42, P < .001).

Overall, younger, less experienced nurses and those with lower educational levels or junior positions reported higher perceptions of toxic leadership and vengeful behaviors, whereas older, more experienced nurses and those with higher educational qualifications or senior positions demonstrated higher OCB and self-efficacy.

4. Discussion

This study contributes to the health management literature by exploring and validating a model that explains the interrelationships among toxic leadership behaviors, vengeful behaviors, OCB, and self-efficacy among nurses. By examining these variables together, the study offers a deeper understanding of how destructive leadership styles impact nurses’ behaviors both directly and indirectly, while also identifying the protective roles of OCB and self-efficacy in mitigating these adverse effects.

Regarding the descriptive levels of the studied variables, it is noteworthy that two-thirds of nurses reported experiencing a moderate level of toxic leadership, including behaviors such as unappreciativeness, self-interest, and selfishness. This perception contrasts with the expected leadership qualities of integrity and care in nursing environments. One possible explanation is the prevalence of autocratic leadership styles in governmental and academic healthcare settings, where nurse leaders may exert excessive control over decisions and limit staff autonomy, creating a perception of toxicity.^[2] Some nurses may comply with such leadership styles out of fear, while others may adjust to secure benefits. This finding aligns with Brown,^[32] who observed that toxic leadership behaviors are associated with high employee turnover. Additionally, Abou-Ramadan and Eid^[33] found that many nurses view their leaders as narcissistic and unpredictable. However, contrasting studies, such as those by Labrague^[29] and Low et al^[34] highlighted the presence of nontoxic leadership in other contexts, suggesting variability in how leadership is perceived across different organizational and cultural settings.

Furthermore, the study revealed that nurses perceived moderate levels of OCB, including both affiliation-oriented and challenge-oriented behaviors. This aligns with the inherent nature of nursing, which relies heavily on teamwork, communication, and cooperation to deliver high-quality patient care.^[35,36] OCB plays a critical role in building a collaborative work environment by encouraging helping behaviors and information sharing, which foster responsibility, motivation, and job satisfaction. These results are consistent with Khalifa and Awad,^[37] who also found moderate levels of OCB among nurses, likely due to supportive peer relationships and professional norms that encourage discretionary effort. Similarly, AL-Ahmadi et al^[38] observed that OCB among nurses promotes communication and collaboration, which are essential for improving care quality and patient outcomes. Although Özlük and Baykal^[39] reported higher OCB levels, they noted that moderate levels of OCB are still common, often influenced by punctuality, regular attendance, and positive workplace attitudes.

Similarly, nearly two-thirds of nurses in this study reported a moderate level of overall self-efficacy, indicating that while many nurses feel somewhat confident in their ability to influence decisions and express their views, there are likely organizational and cultural constraints that limit their full potential. Self-efficacy is essential in the nursing profession, as it enhances psychological well-being, reduces stress, and promotes effective communication and clinical decision-making. It also contributes to nurses’ resilience, helping them adapt to the challenges of complex healthcare environments.^[40]

These findings are consistent with previous research. For example, Rafiei et al^[41] found that nurses with moderate-to-high self-efficacy levels demonstrated better role performance and experienced less psychological distress in demanding clinical situations. Likewise, Mohammad et al^[40] and Ghasempour et al^[42] confirmed that high self-efficacy is linked to enhanced resilience, effective coping, and professional growth among nurses. However, the moderate self-efficacy levels identified in this study may reflect the impact of hierarchical workplace cultures, limited decision-making autonomy, and lack of professional development opportunities that constrain nurses’ ability to act confidently and independently.

Importantly, self-efficacy is not a fixed trait but a skill that can be cultivated over time through intentional strategies and supportive environments.^[40,43] Building nurses’ self-efficacy requires leadership and organizational interventions that empower nurses and acknowledge their contributions. Creating a positive and collaborative work environment where nurse managers actively promote supportive, inclusive, and empowering practices can significantly enhance self-efficacy.^[44] Such environments encourage nurses to feel valued, enabling them to engage more confidently in patient care and organizational activities. Therefore, targeted leadership development and empowerment programs are essential to strengthening nurses’ self-efficacy, which in turn enhances care quality, reduces burnout, and improves overall organizational effectiveness.^[41]

Interestingly, despite the recognition of toxic leadership in their work environment, nurses in this study reported low levels of vengeful behaviors, suggesting a tendency toward forgiveness and restraint rather than retaliation. This finding indicates that although nurses may experience toxic leadership, many refrain from engaging in vengeful actions, possibly due to professional ethics, personal values, or fear of organizational repercussions. Such behavior reflects a culture of professional self-control, even under challenging leadership conditions. This observation is supported by Layne et al,^[45] who found that although many employees may experience vengeful urges in response to unfair treatment, only a minority act on these feelings, with most avoiding direct retaliation. Similarly, Goldner et al^[18] emphasized that while revenge tendencies may exist, they do not always translate into action unless specific conditions, such as organizational injustice or lack of support, are present. These findings align with our results, suggesting that nurses may suppress vengeful behaviors to maintain professionalism or avoid further conflict.

However, it is important to recognize that even low levels of vengeful behaviors are of concern in healthcare settings, as they can harm team dynamics, reduce trust, and indirectly affect patient care quality. Coelho et al^[17] highlighted that individuals with high tendencies toward vengeance are more likely to exhibit dark personality traits such as narcissism, psychopathy, and Machiavellianism, which are associated with counterproductive work behaviors. Furthermore, Ma and Jiang^[46] identified empathy, anger, and emotional stability as significant predictors of vengeful behaviors, underscoring the complex interplay of emotional responses in the workplace. Thus, although overt acts of revenge may be rare, latent vengeful feelings could negatively influence nurses’ interpersonal relationships and overall work atmosphere if left unaddressed.

4.1. Perception of study variables according to demographic characteristics

The present study demonstrated statistically significant differences in nurses’ perceptions of toxic leadership, OCB, self-efficacy, and vengeful behaviors according to age, educational qualifications, position, and years of experience. These findings suggest that demographic and professional characteristics play an important role in shaping nurses’ responses to leadership behaviors and workplace dynamics.

Younger nurses and those with fewer years of experience reported higher perceptions of toxic leadership and vengeful behaviors. This finding may reflect limited professional maturity, reduced coping capacity, and lower psychological resources among early-career nurses, making them more vulnerable to negative leadership behaviors. Previous studies have similarly reported that novice nurses are more sensitive to destructive leadership practices and are more likely to exhibit counterproductive or retaliatory behaviors when exposed to toxic work environments.^[15,19] Limited organizational power and reduced role clarity among younger nurses may further intensify perceptions of injustice and mistreatment, increasing emotional reactivity and vengeful tendencies.^[15,18]

In contrast, older and more experienced nurses reported higher levels of OCB and self-efficacy and lower levels of toxic leadership perception and vengeful behaviors. This pattern is consistent with SLT and SET, which suggest that accumulated experience enhances individuals’ ability to interpret, regulate, and respond constructively to adverse leadership behaviors.^[6,7,9] Experienced nurses are more likely to develop adaptive coping strategies, emotional regulation skills, and professional resilience, which may buffer the negative impact of toxic leadership.^[27,40] Similar findings have been reported in nursing studies indicating that professional experience is positively associated with self-efficacy, organizational commitment, and discretionary behaviors such as OCB.^[25,26,41]

Educational level also emerged as a significant factor influencing nurses’ perceptions. Nurses with higher academic qualifications reported lower toxic leadership and vengeful behaviors and higher OCB and self-efficacy. Advanced education may enhance critical thinking, autonomy, and confidence in professional judgment, enabling nurses to respond more effectively to leadership challenges and workplace stressors.^[40,43] Prior research supports this explanation, showing that higher educational attainment is associated with stronger self-efficacy, ethical awareness, and engagement in positive organizational behaviors.^[21,37,38]

Similarly, position within the organization significantly influenced perceptions of study variables. Senior nurses reported more favorable outcomes compared with bedside nurses. This may be attributed to increased authority, role control, and involvement in decision-making processes among senior staff, which reduce exposure to toxic leadership behaviors and mitigate feelings of powerlessness.^[4,19] Leadership proximity and participation in managerial processes may also promote OCB and strengthen self-efficacy through perceived organizational support and recognition.^[23,24]

On the other hand, no significant differences were observed according to gender. This finding aligns with previous nursing studies reporting minimal or inconsistent gender-based differences in perceptions of leadership behaviors and work-related outcomes, particularly in female-dominated professions such as nursing.^[29,34] The homogeneity of the sample in terms of gender distribution may further explain the lack of significant variation.

Overall, these findings underscore the importance of considering demographic and professional characteristics when addressing the effects of toxic leadership in healthcare settings. Younger, less experienced, and lower-ranked nurses appear to be at greater risk for negative perceptions and maladaptive responses, whereas experience, education, and seniority function as protective factors that enhance OCB and self-efficacy and reduce vengeful behaviors. These results are consistent with existing nursing and organizational literature and reinforce the need for targeted leadership and support interventions tailored to nurses’ career stages and professional roles.^{[4,9,15,40,47,48]}

The results of this study provide comprehensive support for the proposed model, confirming the complex relationships among toxic leadership, OCB, self-efficacy, and vengeful behaviors.

First, a significant positive correlation and predictive relationship were found between toxic leadership and vengeful behaviors, confirming Hypothesis 1 (H1). This indicates that nurses who perceive higher levels of toxic leadership are more likely to exhibit vengeful behaviors. Toxic leadership, characterized by abusive, authoritarian, and manipulative behaviors, appears to foster negative emotions, including anger and resentment, which may trigger retaliatory intentions. This finding is consistent with prior studies that emphasize how toxic leadership creates hostile work environments, undermines psychological safety, and provokes counterproductive behaviors such as revenge.^[4,15] Additionally, Ofei et al^[19] highlighted that toxic leadership significantly diminishes nurses’ self-confidence and self-efficacy, which may further explain the increased tendency toward retaliatory behaviors. These outcomes stress the critical impact of destructive leadership on team dynamics and the importance of addressing such behaviors within healthcare organizations to maintain a healthy work culture.

Second, the results revealed a significant negative relationship between toxic leadership and OCB, supporting Hypothesis 3 (H3). This finding demonstrates that as perceptions of toxic leadership increase, nurses’ willingness to engage in positive discretionary behaviors – such as helping colleagues, showing initiative, and promoting a supportive work climate – decreases. Toxic leaders create environments characterized by fear, mistrust, and hostility, which suppress prosocial behaviors and discourage voluntary contributions beyond formal job roles.^[9] This relationship is well-documented in the literature. For instance, Ahmed et al^[49] reported that toxic leadership significantly reduces OCB by eroding teamwork and collaboration, while Mekawy and Ismail^[24] emphasized that toxic leadership fosters negative emotions and diminishes trust, which is essential for OCB. Similarly, Labrague et al^[4] found that abusive leadership behaviors, including verbal abuse and public humiliation, significantly reduce nurses’ motivation to engage in OCB, which in turn negatively affects teamwork and patient care. Furthermore, Ofei et al^[19] confirmed that toxic leadership diminishes both job satisfaction and self-efficacy – two critical antecedents of OCB – leading to reduced organizational commitment and engagement.

Third, OCB was identified as a significant mediator in the relationship between toxic leadership and vengeful behaviors, supporting Hypothesis 2 (H2). This finding suggests that OCB serves as a protective mechanism that interrupts the pathway from toxic leadership to vengefulness. In other words, when nurses maintain OCB – despite the presence of toxic leadership – they are less likely to engage in vengeful behaviors. This aligns with SET, which posits that employees reciprocate positive workplace interactions with constructive behaviors, but when leadership is negative, OCB can serve as a buffer to reduce adverse outcomes.^[7,9] This finding is reinforced by Wang et al,^[23] who demonstrated that OCB fosters collaboration and mitigates stress related to negative leadership. Similarly, Wang and Xiao^[50] found that higher OCB reduces emotional reactions associated with abusive supervision, lowering the risk of counterproductive work behaviors. Furthermore, Fan et al^[51] highlighted that employees who exhibit OCB are more resilient and less likely to retaliate, thereby preserving organizational functioning even under toxic leadership. Thus, promoting OCB within nursing teams can be an effective strategy to mitigate the negative influence of toxic leadership and reduce vengeful tendencies.

Finally, self-efficacy was found to significantly moderate the relationship between toxic leadership and vengeful behaviors, supporting Hypothesis 4 (H4). Nurses with higher self-efficacy were less likely to engage in vengeful behaviors even when exposed to toxic leadership, suggesting that self-efficacy acts as a critical personal resource that enhances resilience and fosters constructive coping strategies. This is consistent with findings by Elliethey et al^[1] and Mohammad et al,^[40] who confirmed that self-efficacy reduces negative behavioral responses in challenging work environments. Schönfeld et al^[27] also emphasized that self-efficacy enhances emotional regulation and problem-solving abilities, enabling individuals to manage stressful situations professionally rather than reactively. Furthermore, Ma and Jiang^[46] and Yang et al^[20] demonstrated that higher self-efficacy fosters forgiveness and reduces revenge-seeking behaviors, supporting our findings that self-efficacy can mitigate the harmful consequences of toxic leadership.

Taken together, these findings underscore that toxic leadership was directly associated with increased vengeful behaviors among nurses. However, fostering OCB and enhancing self-efficacy can significantly mitigate the negative consequences of toxic leadership, emphasizing the critical role of supportive organizational practices. This highlights the urgent need for healthcare organizations to cultivate supportive leadership approaches, promote OCB, and strengthen nurses’ self-efficacy to create healthier and more collaborative work environments. In this context, Elliethey et al^[1] and Abou Hashish et al^[52,53] emphasized that leadership practices that involve nurses in organizational decision-making and acknowledge their contributions are essential for enhancing commitment, engagement, and self-efficacy. Similarly, Khalifa and Awad^[37] stressed that effective leadership fosters organizational efficiency, empathy, and collaboration, which are vital for navigating workplace challenges and sustaining a positive and supportive work culture.

It is also important to acknowledge that, because all study variables were collected through self-report questionnaires completed at a single point in time, common method variance may have influenced the strength of the observed associations. Anonymity, confidentiality, and standardized, previously validated instruments were used to reduce the likelihood of response bias; nevertheless, common method variance cannot be entirely excluded, and this consideration should be taken into account when interpreting the reported effect sizes.

4.1.1. Limitations of the study

While this study offers valuable insights into the effects of toxic leadership on nurses’ behaviors, self-efficacy, and OCB, several limitations should be acknowledged. First, participants were recruited using a convenience sampling technique from a single healthcare setting, which may limit the external validity and generalizability of the findings to other organizations, healthcare sectors, or cultural contexts.

Second, the cross-sectional design limits the ability to establish causality between toxic leadership, OCB, self-efficacy, and vengeful behaviors, as data were collected at 1 point in time.

Third, the reliance on self-report questionnaires introduces the potential for response biases, including social desirability bias, where participants may underreport negative behaviors or overstate positive ones. Because all variables were collected using self-report measures at a single time point, common method bias cannot be fully ruled out, although anonymity and standardized validated instruments were used to reduce this risk.

Despite these limitations, this study makes a significant contribution to understanding how toxic leadership influences nurses’ behaviors and highlights the important roles of OCB and self-efficacy in mitigating these negative effects. The findings provide a foundation for developing leadership and organizational strategies to support nurses and promote a healthier work environment.

4.1.2. Implications of the study

The findings of this study offer important implications for nursing practice and healthcare management. Enhancing nurses’ self-efficacy and promoting OCB emerge as critical strategies for fostering a resilient, engaged, and high-performing nursing workforce. Nurse managers and healthcare leaders should prioritize targeted professional development initiatives that strengthen nurses’ competencies, enhance confidence, and support their ability to manage workplace challenges effectively. Such initiatives may include continuous education, mentoring programs, and leadership development opportunities, as well as formal recognition of nurses’ contributions, which reinforce a sense of professional value and competence. Promoting OCB within nursing teams further requires consistent modeling of supportive and ethical leadership behaviors, acknowledgment of individual and team efforts, and active involvement of nurses in decision-making processes. These practices can foster trust, collaboration, and mutual respect, thereby strengthening team cohesion and mitigating the negative impact of toxic leadership.

To address toxic leadership more directly, healthcare organizations should implement and enforce clear policies against abusive and destructive leadership behaviors, promote transparent communication, and cultivate psychologically safe work environments in which nurses feel empowered to express concerns without fear of retaliation. In addition, the findings underscore the need for targeted leadership and support interventions for early-career nurses, who reported higher perceptions of toxic leadership and vengeful behaviors. Tailored strategies aimed at strengthening self-efficacy and enhancing OCB in this group may reduce vulnerability to negative leadership practices and support early professional resilience.

Collectively, these measures have the potential to improve organizational culture, enhance staff well-being and morale, and ultimately contribute to improved patient care quality and safety.

4.2. Implications for future research

Although this study contributes valuable insights into the dynamics of toxic leadership, OCB, and self-efficacy among nurses, further research is warranted to deepen understanding in this area. There is a need to develop and evaluate structured interventions aimed at enhancing nurses’ self-efficacy and OCB, particularly to determine how such interventions may buffer the adverse effects of toxic leadership on nurse well-being and performance. Additionally, future research should explore the long-term impact of leadership development and empowerment strategies on nurses’ organizational behaviors and patient care quality. Comparative studies across diverse healthcare settings and cultural contexts are also essential to examine how differences in organizational culture and leadership styles influence the effectiveness of such interventions. By advancing this line of research, evidence-based strategies can be developed to foster healthier, more supportive nursing work environments that mitigate the risks associated with toxic leadership.

5. Conclusion

This study highlights the detrimental effects of toxic leadership in healthcare settings and its role in fostering vengeful behaviors among nurses. The findings demonstrate that toxic leadership was associated with not only higher levels of vengeful behaviors but also reduced OCB and self-efficacy, both of which are essential for maintaining a positive and productive work environment. The results emphasize the importance of early identification and effective management of toxic leadership, as toxic leaders represent key predictors of adverse outcomes within nursing teams.

The study further underscores the protective roles of OCB and self-efficacy in buffering the harmful effects of toxic leadership and supporting nurses’ resilience. In addition, variations in perceptions of toxic leadership, OCB, self-efficacy, and vengeful behaviors across nurses’ demographic and professional characteristics suggest the need for targeted organizational support strategies.

To address these challenges, healthcare organizations should adopt evidence-based leadership practices that promote supportive, collaborative, and empowering work environments. Strengthening OCB and enhancing nurses’ self-efficacy may improve teamwork, increase job satisfaction, and reduce retaliatory behaviors. Collectively, these strategies are essential for improving organizational culture, patient safety, and quality of care. Ultimately, the findings reinforce the importance of leadership development and organizational interventions aligned with global health priorities to foster healthy, respectful, and resilient nursing workforces capable of delivering high-quality patient care.

Acknowledgments

We extend our gratitude to all the nurses who graciously consented to partake in this research.

Author contributions

Conceptualization: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman, Awatif Mansoor Alrasheeday.

Data curation: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman.

Formal analysis: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey.

Investigation: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman, Awatif Mansoor Alrasheeday.

Methodology: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman, Awatif Mansoor Alrasheeday.

Project administration: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman.

Resources: Ebtsam Aly Abou Hashish.

Software: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey.

Supervision: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Awatif Mansoor Alrasheeday.

Validation: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman, Awatif Mansoor Alrasheeday.

Visualization: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Awatif Mansoor Alrasheeday.

Writing – original draft: Ebtsam Aly Abou Hashish, Nancy Sabry Elliethey, Samia Roshdy Osman, Awatif Mansoor Alrasheeday.

Writing – review & editing: Ebtsam Aly Abou Hashish.