摘要
目的：本研究旨在探讨护士长的双向领导力与员工护士临床领导力的关系，以及护理组织文化的中介效应。 研究背景临床护士是护理团队的重要组成部分，其临床领导力对提高护理质量、发展护理事业具有重要意义。将变革型领导与交易型领导相结合的护士长双向领导是一种新的领导方式。关于护士长的双向领导对员工护士临床领导力的影响研究较少。 研究方法本研究为横断面研究，采用方便抽样法从浙江省杭州市一级综合医院抽取 500 名护士作为研究对象。研究人员接受电子问卷调查，问卷内容包括一般信息问卷、Ambidextrous 领导风格量表、中文版护理文化评估工具和中文版临床领导力调查。本研究中使用的三个量表均具有令人满意的建构效度、内容效度和信度。本研究采用多元逐步线性回归分析来探讨员工护士临床领导力的影响因素。使用 AMOS 24.0 软件构建结构方程模型，以验证护理组织文化在护士长双向领导力与员工护士临床领导力之间的中介效应。 结果显示护士长临床领导力得分（66.69±7.42）分。员工护士临床领导力与护士长的双向领导力之间（r = 0.461，p <0.01）、护理组织文化与员工护士临床领导力之间（r = 0.685，p <0.01）、双向领导力与组织文化之间（r = 0.641，p <0.01）呈显著正相关。专业职称、工作角色、婚姻状况、参加领导力培训和护理组织文化是员工护士临床领导力的主要预测因素，共占总变异的 49.8%。护理组织文化在护士长领导力与护士临床领导力之间起着完全的中介作用，中介效应为 0.555（95% CI [0.454，0.692]），占总效应的 98.8%。 结论员工护士临床领导力代表了临床领导力的中上层水平。护理组织文化可以独立预测护士长临床领导力的水平，并在护士长领导力与护士长临床领导力之间具有完整的中介效应。然而，由于时间、精力和抽样方法等原因，本研究的样本不足以代表全国护理人员。未来的研究应进一步扩大调查的地域范围和样本量。 对护理管理的启示：高级管理者可以鼓励护士长采用双面领导风格，从而提高组织文化的积极性，改善护士的临床领导能力。管理者应重新制定规章制度，提高护士的工作热情。此外，对护士进行临床领导力的分层培训，合理授权，提高护士的工作自主性和自我效能感，鼓励和支持护士进行临床领导力实践。
Aim: This study aims to explore the relationship of head nurses’ ambidextrous leadership with staff nurse clinical leadership and the mediating effect of nursing organizational culture.
Background: Clinical nurses are an important part of the nursing team, and their clinical leadership is of great significance to improving the quality of nursing and developing a nursing career. The ambidextrous leadership of head nurses, which combines transformational and transactional leadership, is a new leadership style. There are few studies on the effect of head nurses’ ambidextrous leadership on staff nurse clinical leadership.
Methods: This study was a cross-sectional study, and convenient sampling method was used to extract 500 nurses from first-class comprehensive hospital in Hangzhou City, Zhejiang Province, as research participants. The participants were administered an electronic questionnaire consisting of the General Information Questionnaire, Ambidextrous Leadership Style Scale, the Chinese version of Nursing Culture Assessment Tool, and the Chinese version of Clinical Leadership Survey. All the three scales used in this study had satisfactory construct validity, content validity, and reliability. Multiple stepwise linear regression analysis was used to explore the influencing factors of staff nurse clinical leadership. AMOS 24.0 software was used to construct a structural equation model to verify the mediating effect of nursing organizational culture between the ambidextrous leadership of head nurses and staff nurse clinical leadership.
Results: The score of staff nurse clinical leadership was 66.69 ± 7.42. Significant positive correlations were noted between staff nurse clinical leadership and head nurses’ ambidextrous leadership (r = 0.461, p < 0.01), between nursing organizational culture and staff nurse clinical leadership (r = 0.685, p < 0.01), and between ambidextrous leadership and organizational culture (r = 0.641, p < 0.01). Professional title, role at work, marital status, participation in leadership training, and nursing organizational culture were the main predictors of staff nurse clinical leadership, collectively accounting for 49.8% of the total variation. Nursing organizational culture played a complete mediating role between head nurses’ ambidextrous leadership and staff nurse clinical leadership, and the mediating effect was 0.555 (95% CI [0.454, 0.692]), accounting for 98.8% of the total effect.
Conclusion: Staff nurse clinical leadership represents the upper-middle level of clinical leadership. Nursing organizational culture can independently predict the level of staff nurse clinical leadership and has a complete mediating effect between head nurses’ ambidextrous leadership and staff nurse clinical leadership. However, due to time, energy, and sampling methods, this study’s sample is insufficient to represent the national nursing staff. Future research should further expand the survey’s geographical scope and sample size.
Implications for Nursing Management: Senior managers can encourage the head nurses to adopt the ambidextrous leadership style and consequently raise the enthusiasm of the organizational culture to improve staff nurse clinical leadership. Managers should rework the rules and regulations and increase work enthusiasm among nurses. Furthermore, they should carry out hierarchical training of clinical leadership for nurses and reasonably empower them to increase their work autonomy and self-efficacy and to encourage and support them in their clinical leadership practice.
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