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Abstract

Aim

This study aimed to assess staff nurses’ perceptions of their immediate supervisors’ authentic leadership (AL) within a Saudi Arabian hospital and to determine whether demographic and work-related characteristics of the nursing staff predicted these perceptions.

Background

AL is critical for fostering positive nursing work environments, staff well-being, and patient safety. While its outcomes are well-documented, a significant gap exists in understanding how the characteristics of the followers (staff nurses) influence their perceptions of leadership. This relational dynamic is particularly understudied in the Saudi Arabian context.

Methods

A descriptive, cross-sectional, comparative study was conducted at King Khaled Hospital, Majmaah. A census sample of 267 nursing staff was invited, with 154 participating (58.8% response rate). Participants completed the Authentic Leadership Questionnaire (ALQ) to rate their immediate supervisors. Data were analyzed using descriptive statistics, ANOVA, and multiple regression.

Results

Nursing staff rated their supervisors’ AL at a critically low overall level (mean = 1.57/4, 18th percentile). Comparative analysis revealed perceptions differed significantly based on the staff's age, marital status, education, employment status, position, and experience. Multiple regression identified marital status (β = .326, p < .001) and experience in the current unit (β = .444, p = .005) as the two strongest significant positive predictors of AL ratings, explaining 22.1% of the variance.

Conclusion

The findings indicate a significant deficit in perceived AL among nurse supervisors. Crucially, a staff nurse's personal and professional profile significantly marks their perception of leadership, suggesting that AL is not judged on behavior alone but through the relational interplay between leader and follower.

Implications for Nursing Management

Addressing this AL deficit requires targeted interventions. Recommendations include implementing structured AL development programs focused on its core components, prioritizing leadership stability to build long-term trust, and creating tailored support strategies for vulnerable groups like mid-career nurses.

Keywords

Authentic leadership nurses leadership perception nurse managers relational leadership

Introduction

Authentic leadership (AL) distinguishes itself from other leadership paradigms by grounding its effectiveness not merely in transactional outcomes or inspirational influence, but in the verifiable psychological safety fostered by a leader's self-awareness, balanced processing, relational transparency, and internalized moral perspective (Gardner et al., 2011). Whereas transformational leadership can sometimes be perceived as performative in its charisma (Bakker et al., 2023; Chukwuma & Zondo, 2024), and transactional leadership is fundamentally contingent on reward-and-punishment exchanges, AL's emphasis on genuineness and ethical integrity has been shown to be a more robust and direct predictor of critical outcomes in contemporary work environments (Graciana et al., 2024; Khairy et al., 2023; Macamo & Klasmeier, 2024). AL, characterized by self-awareness, relational transparency, balanced processing, and an internalized moral perspective, is increasingly recognized as a critical factor in fostering positive nursing work environments (Avolio & Gardner, 2005). In the demanding context of healthcare, authentic nurse leaders play a crucial role in enhancing staff well-being, reducing burnout, and improving patient safety outcomes (Alilyyani, 2022; Laschinger & Fida, 2015).

Historically, there has been little research on AL in Saudi Arabia. Early studies have concentrated on nurse educators (Alshammari et al., 2020; Maniago & Alamri, 2019), hospital staff members in general (Alangari, 2021), and dissertations that examine outcomes unique to nurses, such as satisfaction with care quality and intention to leave (Alilyyani, 2022). Nonetheless, a growing body of empirical research has enhanced our understanding of AL in Saudi nursing practice. As an illustration of its protective function in high-acuity settings, Alsalmi and Alilyyani (2023) found that real leadership dramatically decreased stress and burnout among emergency department nurses. AL was found to be positively correlated with perceived quality of care in a large, multi-site setting, while its effects on well-being were mediated by nurses’ psychological capital and the nursing practice environment (Alhalal et al., 2024). To support these conclusions, Gonzales (2023) discovered that, among Saudi nurses, AL was substantially connected with a higher internal locus of control; however, self-efficacy during the COVID-19 pandemic did not show a significant correlation with AL. When taken as a whole, these studies demonstrate how AL not only influences feelings of trust in leadership and quality care but also reduces stress, builds resilience, and promotes nurse well-being. This broadens the body of evidence beyond educator-focused research to include frontline clinical contexts in Saudi Arabia.

The prevailing body of research has largely focused on the outcomes of AL, demonstrating its positive associations with nurses’ job satisfaction, organizational commitment, and trust in management (Allan & Rayan, 2023; Almutairi et al., 2025). However, a critical, yet underexplored, question remains: are perceptions of a leader's authenticity a true reflection of the leader's behavior alone, or are they influenced by the characteristics of the rater? The lens through which nursing staff view their leaders may be colored by their own personal and professional experiences, demographics, and career stage. Emerging research suggests that follower characteristics can significantly influence their perceptions of leadership, yet this area remains underdeveloped within the nursing literature (Giordano-Mulligan et al., 2023).

For instance, a nurse's level of experience might shape their expectations of leadership; novice nurses may prioritize guidance and support, while experienced nurses may value autonomy and shared decision-making (Brunt & Bogdan, 2025). Similarly, an individual's personal circumstances, such as their marital status (Cattani & Rizza, 2024), or experience in the current unit (Lohikoski et al., 2019; Palweni et al., 2023), could influence their psychological resources and, consequently, their interpersonal assessments at work. Understanding these predictive factors is not an exercise in attributing bias, but rather it is essential for accurately interpreting leadership data and developing targeted leadership development programs that account for the diverse perspectives of the nursing workforce.

The originality of this study lies in its focus on assessing the AL of immediate nurse supervisors from the perspective of nursing staff, rather than relying on self-assessment by leaders themselves. Additionally, it examines how perceptions of leadership vary across different demographic and professional profiles of staff nurses, providing a nuanced understanding of leadership effectiveness in a Saudi Arabian hospital context.

Therefore, this study aims to address this significant gap by investigating the extent to which nursing staff demographic and work-related characteristics predict their ratings of their immediate supervisors’ AL. By identifying which staff profiles are associated with variations in AL perceptions, our findings will provide a more nuanced understanding of the relational dynamics of leadership in healthcare settings.

Literature Review

The conceptual paradigm of AL emphasizes self-awareness, relational transparency, balanced processing, and an internalized moral perspective, going beyond transactional exchanges or inspirational charisma (Walumbwa et al., 2008). When used in nursing practice, AL creates positive work environments that foster staff resilience, trust, and confidence—all of which are crucial for productivity, well-being, and safe patient care (Cunha et al., 2020; Gardner et al., 2011). When nurses observe authentic leaders, they describe them as individuals who act in accordance with their principles, consider the opinions of others, and demonstrate a genuine concern for the well-being of their team. The healthcare industry, where leadership behaviors have a direct impact on staff morale and patient outcomes, is a perfect fit for AL because of its ethical and relational orientation (Graciana et al., 2024; Macamo & Klasmeier, 2024). Assi et al. (2024) showed that nurses’ work engagement was positively correlated with the AL of nurse managers in Jordan, underscoring the importance of moral integrity and relational transparency in inspiring and sustaining frontline workers. Likewise, in a quasi-experimental study conducted in Turkey, Dirik and Seren Intepeler (2024) evaluated a multifaceted AL training program and found notable improvements in nurses’ assessments of their leaders’ authenticity, particularly in the areas of self-awareness and relational transparency. Importantly, the study demonstrated that structural empowerment and AL were important determinants of a favorable patient safety climate, highlighting the usefulness of developing authenticity in nurse leaders. Collectively, these results bolster the argument for AL as a crucial framework for developing organizational priorities like patient safety and care quality as well as for improving nurse engagement and well-being.

In addition to supporting employee retention and satisfaction, a healthy nursing work environment has a direct impact on the standard and safety of patient care (Alexander & Lopez, 2018; Park et al., 2019; Schmalenberg & Kramer, 2008). The importance of nurses in changing workplace cultures to promote patient safety has long been highlighted in Institute of Medicine reports (2004, 2011). This argument is supported by more recent data, which indicates that genuine leadership among nurse managers is linked to increased psychological safety, decreased burnout, and decreased intention to leave (Alhalal et al., 2024; Cho & Steege, 2021). In this sense, AL is a strategic tool for promoting health system transformation and guaranteeing safe care delivery, in addition to being a leadership style.

As frontline providers of comprehensive patient care, nurses need to possess advanced leadership skills to manage services, organize teams, and ensure continuity of care (Maziero et al., 2020). The foundation for these abilities is provided by AL, which empowers nursing leaders to create open lines of communication, foster trust, and match employee values with corporate objectives. Research indicates that AL directly improves burnout and emotional weariness while also indirectly lowers turnover intention by improving the workplace (Alsalmi & Alilyyani, 2023; Lee et al., 2019). Additionally, AL motivates teams by creating a positive environment that increases resilience and engagement (Brunt & Bogdan, 2025). AL improves the atmosphere for professional practice and the standard of patient care by fusing relational integrity with managerial efficacy.

The Relational Gap: The Underexplored Role of the Follower

While the outcomes of AL are well-documented, a significant gap exists in understanding the antecedents of these perceptions. The prevailing question is whether perceptions of a leader's authenticity are a pure reflection of the leader's behavior or if they are filtered through the characteristics of the rater (Giordano-Mulligan et al., 2023). This aligns with Relational Leadership Theory, which posits that leadership is co-created through the interactions between leaders and followers (Uhl-Bien, 2006). Emerging research suggests that follower characteristics can significantly influence their perceptions of leadership, yet this area remains underexplored within the nursing literature (Allirol & Leienbach, 2015).

Methods

Design

This study employed a descriptive, cross-sectional, comparative design to assess the level of AL and its subcomponents among immediate nurse supervisors as rated by nursing staff at King Khaled Hospital, Majmaah, Saudi Arabia. It is descriptive because it summarizes and presents the characteristics and leadership levels of the participants; cross-sectional because data were collected at a single point in time; and comparative because it examines differences in AL and its subscales across groups based on demographic and professional characteristics of the nursing staff, including age, marital status, education, employment status, position, and years of experience.

Setting

The study was conducted at King Khaled Hospital, located in Majmaah, Saudi Arabia. This is a tertiary-level healthcare facility that serves as a primary referral center for the Majmaah region. It provides a wide range of medical, surgical, and specialized services, and employs a diverse nursing workforce, including staff nurses and nurse managers across various departments. The hospital's organizational structure, size, and leadership hierarchy make it an appropriate setting to examine AL among nurse managers, as it allows for the assessment of leadership practices within a real-world, clinical context. Conducting the study in this hospital ensures access to participants with relevant managerial experience and provides insight into leadership dynamics within a representative Saudi Arabian healthcare setting. The hospital has a total bed capacity of 225.

Sample Size Calculation

In this study, a census sampling approach was employed, whereby all 267 nursing staff at the hospital who met the inclusion criteria were invited to participate. Nursing staff with less than 3 months of experience at the hospital were excluded to ensure that participants had adequate exposure to their immediate nurse supervisors, allowing them to provide informed assessments of leadership behaviors. Of these, 154 nursing staff members agreed and completed the questionnaire, resulting in a response rate of 58.8%, which is above the average response rate for organizational surveys (52.7%; Baruch & Holmot, 2008). Because all eligible nursing staff were approached, no formal sample size calculation was required, and the sample reflects the accessible population of interest. In this study, nursing staff refers to the collective workforce of nurses who provide direct patient care and support services at King Khaled Hospital, Majmaah, Saudi Arabia. This includes staff nurses, nurse administrators, and nurse assistants, each playing distinct roles in patient care and hospital operations.

Measures

The Authentic Leadership Questionnaire (ALQ), a self-report measure, was used to assess nurses’ impressions of their immediate supervisors’ AL skills (Avolio et al., 2018). It consists of 16 items, divided into four subscales that reflect the AL components: self-awareness (four items), moral/ethical behavior (four items), balanced processing (three items), and transparency (five items). These 16 items are evaluated on a 5-point Likert scale, ranging from 0 (not at all) to 4 (often, if not always). No new items were independently developed for this study. The originality of this research lies in applying the ALQ to nurses at King Khaled Hospital, Majmaah, Saudi Arabia, a population and context in which AL has not previously been examined. The Arabic version of the ALQ is available on the Mind Garden website along with the ALQ License to Administer and the accompanying manual. The translation is accessible with ALQ Research Permission. The online questionnaire was delivered in English with Arabic translation. AL was measured from the perspective of staff nurses, who rated the leadership behaviors of their immediate supervisors using the ALQ. This study did not employ a 360-degree assessment; neither supervisors nor peers provided ratings.

Previous studies have reported reasonable internal consistency ranging from 0.70 to 0.90. with Cronbach's alpha. The four dimensions have been supported by confirmatory factor analysis (Regan et al., 2015). For this study, the scale demonstrated good reliability, with a Cronbach's alpha of .865 and a standardized alpha of .868. Item-total correlations ranged from 0.299 to 0.666, indicating that each item contributed meaningfully to the overall scale. The mean item scores ranged from 2.37 to 2.83, with standard deviations ranging from 0.859 to 1.145, reflecting moderate variability among responses. Inter-item correlations averaged 0.291, ranging from 0.028 to 0.619, further supporting adequate internal consistency.

The ALQ was selected to measure nurses’ perceptions of their immediate supervisors’ AL behaviors for several reasons (Avolio et al., 2018). First, it is the foremost instrument directly aligned with the theoretical components of AL Theory. Second, it has consistently demonstrated strong psychometric properties in diverse populations, making it a validated and reliable choice. Finally, the availability of a professionally translated Arabic version ensured linguistic and conceptual accuracy for our bilingual study sample.

Data Collection and Ethical Considerations

The study was approved under the category of Exempt by the Central Institutional Review Board with log number 20–28E. Data were collected cross-sectionally from mid-March to mid-April 2020. The study population included all nurses at King Khaled Hospital, Majmaah, Saudi Arabia, who met the inclusion criteria of working at least 3 months at the hospital. A total of 267 eligible nurses were identified through the hospital's human resources department.

Participants were invited via official hospital email, which included a brief explanation of the study, a secure link to the online questionnaire, and the online informed consent form. Completion of the questionnaire indicated voluntary consent. Reminder emails were sent 2 weeks after the initial invitation to maximize the response rate. Participants were informed that they could withdraw at any time without consequence, that responses would remain anonymous, and that all data would be stored securely in password-protected files. Consent was obtained electronically via a checkbox (“I Agree”) before accessing the questionnaire. Contact information for the research team was provided for any questions or concerns. Questionnaire responses were compiled electronically and stored in a password-protected Excel file accessible only to the research team.

Data Analysis

The mean scores were used to determine the overall level of AL of immediate nurse supervisors as rated by nursing staff and its subscales. These scores were interpreted using the ALQ Percentile Table (Avolio et al., 2018). To assess significant differences in supervisors’ ratings (rated by the nursing staff) across groups based on nursing staff profiles, independent-samples t-tests and one-way ANOVA (F-test) were conducted, with the significance level set at α = .05. Effect sizes were calculated using η and η² (Cohen, 1988). Multiple regression analysis was performed to examine the relationships among multiple predictors and a single continuous outcome. Assumptions of multiple regression were evaluated and met. Visual inspection of residual plots indicated linearity and homoscedasticity, and the Q-Q plot and histogram suggested normality of residuals, which was supported by a non-significant Shapiro–Wilk test (p = .072). The Durbin–Watson statistic (DW = 1.93) indicated independence of errors. No multicollinearity concerns were identified, as all variance inflation factors (VIFs) were below 2.0 and tolerance values exceeded .10. These results suggest that the assumptions for multiple regression were adequately satisfied. Descriptive, comparative, and multiple regression statistical analyses were performed using IBM SPSS Statistics version 23. JASP 2025 Version 0.95.1 was used to check the assumptions.

Results

Overall Perception of Authentic Leadership

Regardless of stratum assignment, nursing staff rated their immediate supervisors at a low percentile of 18 for overall AL (mean = 1.572 out of 4). This low rating was also observed across the subscales of AL. Overall, AL differed significantly from experience in the current hospital and current unit. These findings indicate that nurses’ ratings of their immediate supervisors’ AL differ according to the nurses’ demographic and professional characteristics, such as age, marital status, education, employment status, position, and years of experience (Tables 1 and 2).

Table 1.

Mean Scores of Authentic Leadership of Immediate Nurse Supervisors as Rated by Nursing Staff, Grouped by Nursing Staff Demographic and Professional Profile.

Demographic characteristics			Transparency		Moral/ethical		Balanced processing		Self-awareness		Authentic leadership
	f	%	x̄	S	x̄	s	x̄	s	x̄	s	x̄	s
Age
18-25	8	5.2	1.950	1.099	1.531	0.901	1.792	1.208	1.594	0.823	1.717	0.938
26-34	101	65.6	1.499	0.534	1.542	0.626	1.578	0.784	1.391	0.702	1.502	0.522
35-44	26	16.9	1.669	0.765	1.615	0.831	1.577	0.709	1.577	0.666	1.610	0.581
>45	19	12.3	1.610	0.657	2.025	0.683	1.917	0.683	1.900	0.671	1.863	0.597
Marital status
Single	42	27.3	1.367	0.568	1.286	0.643	1.254	0.643	1.173	0.626	1.270	0.514
Married	104	67.5	1.659	0.657	1.728	0.659	1.743	0.765	1.596	0.681	1.682	0.551
Others	8	7.7	1.400	0.385	1.967	0.920	1.967	0.920	2.250	0.971	1.905	0.625
Education
Diploma	38	24.7	1.553	0.580	1.513	0.601	1.553	0.626	1.520	0.686	1.535	0.513
Bachelors	102	66.2	1.508	0.634	1.642	0.711	1.699	0.816	1.501	0.712	1.589	0.607
Masters	14	9.0	2.029	0.646	1.750	0.849	1.405	0.953	1.393	0.853	1.644	0.529
Employment status
Full time	145	94.2	1.535	0.615	1.603	0.702	1.618	0.777	1.476	0.707	1.556	0.563
Part time	9	5.8	2.067	0.800	1.889	0.601	1.926	0.954	1.917	0.750	1.949	0.703
Position
Staff nurse	115	73.2	1.463	0.632	1.533	0.700	1.626	0.808	1.476	0.719	1.524	0.603
Nurse administration	39	24.8	1.872	0.548	1.878	0.633	1.667	0.733	1.577	0.705	1.748	0.456
Nurse assistant	3	1.9	1.133	0.643	1.167	1.010	1.222	0.694	0.917	0.629	1.110	0.723
Grand mean
	154	100	1.558	0.637	1.611	0.703	1.628	0.786	1.490	0.715	1.572	0.580

Legend:

• f = Frequency (number of nursing staff in each category).

• % = Percentage of the total sample in each category.

• x̄ = Mean score for the respective subscale or overall Authentic Leadership.

• s = Standard deviation, indicating variability of scores around the mean.

Table 2.

Mean Scores of Authentic Leadership of Immediate Nurse Supervisors as Rated by Staff Nurses, Grouped by Nursing Staff's Experience Profile.

Experience			Transparency		Moral/ethical		Balanced processing		Self-awareness		Authentic leadership
	f	%	x̄	s	x̄	s	x̄	s	x̄	s	x̄	s
Total clinical experience
Less than a year	4	2.6	1.850	0.342	1.938	0.774	1.583	1.101	1.563	0.944	1.733	0.694
1–2 years	9	5.8	2.000	1.039	1.611	0.928	1.778	1.258	1.500	0.771	1.722	0.933
3–5 years	32	20.8	1.488	0.539	1.429	0.699	1.531	0.708	1.289	0.635	1.434	0.518
6–10 years	42	27.3	1.329	0.513	1.410	0.487	1.484	0.487	1.393	0.488	1.404	0.394
11–15 years	43	27.9	1.726	0.649	1.907	0.746	1.783	0.746	1.612	0.920	1.757	0.622
16–20 years	12	7.8	1.500	0.658	1.542	0.689	1.694	0.689	1.750	0.522	1.612	0.537
21+ years	12	7.8	1.683	0.652	1.812	0.667	1.778	0.667	1.792	0.713	1.766	0.625
Experience in current hospital
Less than a year	5	3.3	1.720	0.460	1.900	0.720	2.267	1.116	1.800	1.242	1.922	0.698
1–2 years	17	11.0	1.741	0.821	1.500	0.862	1.588	1.084	1.411	0.770	1.560	0.794
3–5 years	46	29.9	1.335	0.556	1.419	0.628	1.551	0.741	1.277	0.583	1.395	0.467
6–10 years	44	28.6	1.450	0.470	1.619	0.582	1.508	0.571	1.574	0.628	1.538	0.435
11–15 years	30	19.5	1.893	0.733	1.858	0.801	1.800	0.900	1.567	0.830	1.780	0.668
16–20 years	5	3.2	2.000	0.316	1.900	0.762	2.067	0.435	2.000	0.433	1.992	0.423
21+ years	7	4.6	1.566	0.636	1.821	0.641	1.667	0.745	1.893	0.802	1.738	0.662
Experience in current unit
Less than a year	8	5.2	1.650	0.602	1.688	0.832	1.792	1.168	1.406	1.187	1.634	0.816
1–2 years	30	19.5	1.480	0.717	1.425	0.760	1.533	0.882	1.341	0.658	1.445	0.649
3–5 years	51	33.1	1.400	0.551	1.417	0.565	1.543	0.724	1.348	0.627	1.427	0.468
6–10 years	32	20.8	1.519	0.518	1.758	0.604	1.573	0.640	1.656	0.659	1.623	0.474
11–15 years	25	16.2	1.976	0.684	1.990	0.745	1.920	0.829	1.700	0.767	1.897	0.568
16–20 years	4	2.6	1.950	0.342	1.938	0.875	2.083	0.500	2.063	0.473	2.008	0.487
21+ years	4	2.6	1.600	0.952	1.812	0.851	1.583	0.957	1.812	0.851	1.702	0.895
Grand mean
	154	100	1.558	0.637	1.611	0.703	1.628	0.786	1.490	0.715	1.572	0.580

Legend:

• f = Frequency (number of nursing staff in each category).

• % = Percentage of the total sample in each category.

• x̄ = Mean score for the respective subscale or overall Authentic Leadership.

• s = Standard deviation, indicating variability of scores around the mean.

Differences by Demographic Characteristics

A significant difference was observed in ratings of moral/ethical behavior and self-awareness of immediate supervisors. Older nurses tended to rate their supervisors higher in moral/ethical behavior. Nurses aged 45 years and above rated their supervisors significantly higher than other age groups in both moral/ethical behavior and self-awareness (Table 3).

Table 3.

Comparative Analyses of Authentic Leadership of Immediate Nurse Supervisors as Rated by Staff Nurses, Grouped by Nursing Staff Demographic, Professional, and Clinical and Unit-Based Experience.

	Transparency				Moral/Ethical				Balanced processing				Self-awareness				ALQ
	F	p	η	η²	F	p	η	η²	F	p	η	η²	F	p	η	η²	F	p	η	η²
Demographic characteristics
Age	1.745	0.160	0.182	0.033	2.826	0.041	0.229	0.053	1.225	0.303	0.153	0.023	3.310	0.022	0.247	0.061	2.559	0.057	0.219	0.048
Marital status	3.162	0.045	0.199	0.039	6.440	0.002	0.278	0.077	8.505	0.000	0.315	0.099	7.426	0.001	0.297	0.088	8.789	0.000	0.320	0.102
Education	4.501	0.013	0.235	0.055	0.671	0.513	0.093	0.009	1.022	0.362	0.114	0.013	0.161	0.852	0.046	0.002	0.188	0.829	0.049	0.002
Professional characteristics
*Employment status	6.306	0.013	0.198	0.039	1.490	0.224	0.098	0.010	1.370	0.244	0.094	0.009	3.441	0.065	0.147	0.022	4.121	0.044	0.161	0.026
Position	7.234	0.001	0.293	0.086	4.302	0.015	0.230	0.053	0.444	0.642	0.076	0.006	1.277	0.282	0.128	0.016	3.232	0.042	0.201	0.040
Clinical and unit-based experience
Total clinical experience	2.613	0.019	0.308	0.095	2.676	0.017	3.110	0.097	0.706	0.646	0.166	0.027	1.450	0.199	0.234	0.055	2.107	0.056	0.279	0.078
Current hospital	3.217	0.005	0.338	0.114	1.729	0.118	0.254	0.065	1.169	0.326	0.221	0.045	1.761	0.111	0.257	0.066	2.125	0.054	0.280	0.078
Current unit	2.764	0.014	0.316	0.100	2.787	0.013	0.317	0.100	0.841	0.540	0.180	0.033	1.713	0.122	0.253	0.064	2.480	0.025	0.301	0.091

Legend:

• F = F-statistic from ANOVA or multivariate test, indicating whether differences between groups are statistically significant.

• * = Instead of F-statistics, an Independent Sample t-test was done since there are only two groups.

• p = p-value, probability of observing the result if the null hypothesis is true; significance set at α = .05.

• η = effect size (Cohen's η), indicating the strength of the association.

• η² = partial eta squared, representing the proportion of variance explained by the factor.

∘ η² = 0.01–0.05 indicates a small effect.

∘ η² = 0.06–0.13 indicates a medium effect.

∘ η² > 0.14 indicates a large effect.

Note: All p-values reported were tested at α = .05.

Marital Status

Married nursing staff rated their immediate supervisors higher across all subscales compared to single nursing staff. Nursing staff categorized as others (widowed, divorced, or separated) also rated their supervisors higher in most subscales than both single and married nursing staff, except for transparency (Table 3).

Education

Nursing staff with a master's degree rated their immediate supervisors higher in most dimensions of AL compared to those with a diploma or bachelor's degree, except for balanced processing and self-awareness. Diploma-prepared nursing staff rated their supervisors higher in self-awareness than the other groups, higher in transparency compared to bachelor's-prepared nursing staff, and higher in balanced processing compared to master's-prepared nursing staff. Bachelor's degree–prepared nursing staff rated their supervisors higher in balanced processing compared to the other groups and higher in self-awareness compared to master's-prepared nursing staff (Table 3).

Differences by Professional Characteristics

It is interesting to note that part-time employees rated their immediate supervisors higher in terms of transparency and AL compared to the full-timers. In terms of position, nurse administrators rated their immediate supervisors higher in transparency, moral/ethical behavior, and overall, AL compared to staff nurses and nurse assistants. Similarly, staff nurses rated their supervisors higher on these dimensions than nurse assistants (Table 3).

Differences by Clinical and Unit-Based Experience

In terms of total clinical experience, it is noted that there is a significant difference among the groupings in terms of transparency and moral/ethical considerations. It is observed that those with 2 years or less of work experience scored higher in both transparency and moral and ethical aspects. In terms of experience in the current hospital, those with 2 years of work experience or less, and those with experience of 11 years or more, rated higher in terms of transparency and AL. Those with 3–10 years of experience received the lowest ratings. In terms of experience in the current unit, those with 6 years or more are rated higher in terms of transparency, morality/ethics, and AL compared to those with 5 years or less of experience. Those working less than a year in the current unit have a slightly higher rating in transparency, moral/ethical, and AL compared to those working in the same unit for 1–5 years (Table 3).

Regression Analysis of Predictors of Authentic Leadership Ratings

A multiple regression analysis was conducted to determine whether staff nurses’ demographic and work-related characteristics predicted the AL ratings they assigned to their immediate supervisors. The model was statistically significant, F(12, 140) = 3.30, p < .001, indicating that the set of predictors reliably distinguished differences in AL. The model accounted for approximately 22.1% of the variance in AL (R² = .221), with an adjusted R² of .154, suggesting a moderate effect size. The standard error of the estimate was 0.53, and the Durbin–Watson statistic of 1.85 indicated that the assumption of independence of residuals was met (Table 4).

Table 4.

ANOVA for Multiple Regression Analysis of Nursing Staff Characteristics Predicting Their Ratings of Their Supervisors’ Authentic Leadership.

Source	SS	Df	MS	F	p-value
Regression	11.145	12	0.929	3.304	<.001
Residual	39.353	140	0.281
Total	50.498	152

Note. Dependent Variable = Authentic Leadership; Predictors = Age, Gender, Nationality, Marital Status, Education, Experience, ExpCurHosp, ExpCurUnit, EmpStatus, Position, Area, Hrs/Week.

Multiple regression analysis was performed to assess whether staff nurses’ demographic and work-related characteristics predicted the AL ratings they assigned to their immediate supervisors. As shown in Table 5, the overall regression model was statistically significant, F(12, 140) = 3.304, p < .001, explaining approximately 22.1% of the variance in AL ratings (R² = .221; adjusted R² = .154) (Table 5).

Table 5.

Multiple Regression Analysis of Nursing Staff Characteristics Predicting Their Ratings of Their Supervisors’ Authentic Leadership.

Predictor	B	SE B	β	t	p-value
(Constant)	0.227	0.489	—	0.465	.643
Age	0.031	0.087	.041	0.352	.726
Gender	−0.047	0.107	-.037	−0.437	.663
Nationality	−0.023	0.053	-.038	−0.436	.664
Marital status	0.356	0.089	.326	4.004	<.001
Education	0.059	0.083	.058	0.708	.480
Total clinical experience	−0.025	0.062	-.059	−0.395	.693
Experience in current hospital	−0.134	0.083	-.308	−1.618	.108
Experience current unit	0.193	0.068	.444	2.841	.005
Employment status	0.327	0.189	.134	1.728	.086
Position	0.161	0.114	.122	1.416	.159
Area	0.000	0.008	.003	0.032	.975
Hours per week	0.023	0.084	.021	0.269	.788

Note. Dependent Variable = Authentic Leadership.

Model was significant: F(12, 140) = 3.304, p < .001, R² = .221 (Adjusted R² = .154).

Significant predictors: Marital Status (p < .001) and Experience in Current Unit (p = .005).

All other predictors were not significant.

Among the predictors, marital status (B = 0.356, β = .326, p < .001) and experience in the current unit (B = 0.193, β = .444, p = .005) were significant positive predictors of AL ratings. This indicates that nurses who were married and those with longer tenure in their current unit tended to give higher AL scores to their immediate supervisors.

Other variables, including age, gender, nationality, education level, overall experience, experience in the current hospital, employment status, position, work area, and weekly working hours, did not significantly predict AL ratings (all p > .05).

Discussion

This study assessed staff nurses’ perceptions of AL qualities among their immediate supervisors within a Saudi Arabian hospital setting. The findings revealed a critically low overall perception of AL. Such results suggest a substantial deficit in the experience of nursing leadership at the frontline. AL, as clarified by Almutairi et al. (2025), is grounded in self-awareness, relational transparency, balanced processing, and an internalized moral perspective—competencies considered essential for fostering trust and credibility in nursing leadership. The consistently low scores across all subscales indicate that this is not an isolated weakness but rather a systemic leadership challenge. The implications of these findings are concerning. AL has been shown to influence psychological safety, nurse retention, and care outcomes. Cho and Steege (2021) demonstrated that nurses who perceive their leaders as authentic are more likely to experience psychological safety, which in turn reduces missed nursing care and lowers their intention to leave the profession. Conversely, a pervasive perception of in AL, as observed in this study, risks contributing to burnout, reduced job satisfaction, and compromised patient safety. Taken together, these findings underscore the urgent need for organizational interventions that strengthen AL capacity within nursing management. Prioritizing leadership development in alignment with the four key AL dimensions identified by Almutairi et al. (2025) is crucial for enhancing psychological safety

The study reveals that a nurse's demographic and professional profile have a significant influence on their perception of leadership, with notable differences observed based on age, marital status, education, and experience. Older, more experienced nurses may rate leaders higher in moral/ethical behavior and self-awareness due to greater professional maturity and a more nuanced understanding of leadership complexities. Similar findings from Saudi research indicate that nurses’ backgrounds are strong determinants of their appraisal of AL, suggesting that leadership perception is contextually mediated (Alhalal et al., 2024).

Differences of the Authentic Leadership of Immediate Nurse Supervisors as Rated by Staff Nurses

In terms of age, nurses aged 45 years and above consistently provided higher ratings in these areas compared to their younger colleagues. This finding aligns with a generational or lifespan perspective on work values and expectations. Older, more experienced nursing staff have likely encountered a wider variety of leadership styles (Alasiry & Alkhaldi, 2024; Alilyyani et al., 2024) and complex ethical dilemmas throughout their careers (Haddad & Geiger, 2023; Nopita Wati et al., 2023; Stucky & Wymer, 2024). This accumulated experience may foster a more nuanced, perhaps more forgiving (Khan & Butt, 2022), understanding of the challenges inherent in a leadership role, allowing them to recognize and value attempts at ethical decision-making and self-reflection even when they are imperfect (Haddad & Geiger, 2023; Nopita Wati et al., 2023; Stucky & Wymer, 2024). Conversely, younger nurses, who are often newer to the profession and may hold idealistic standards (Powers, 2023) forged in academic settings (Bimray et al., 2019; Hallaran et al., 2023), might apply a more critical lens to the same leadership behaviors, perceiving any shortfall as a significant failure (Alkhatib & Alhusami, 2024).

A significant determinant of AL perceptions was marital status, with married staff and those categorized as “other” (widowed, divorced, or separated) assigning higher AL ratings than single staff. Although direct literature addressing this specific finding is limited, research on interpersonal and empathetic skill development offers potential explanations. Individuals navigating complex family dynamics are often required to cultivate advanced interpersonal and empathetic abilities, which may enhance their capacity to recognize and appreciate relational efforts in leadership (Babatunde et al., 2023; Drigas et al., 2023). The constant negotiation, understanding, and management of diverse emotional needs within family units can serve as a rich context for honing these skills, thereby influencing how leadership behaviors are perceived in professional settings.

The observed variation in ratings based on educational preparation warrants careful consideration. Diploma-prepared staff tended to rate supervisors higher in self-awareness, whereas bachelor's-prepared staff assigned higher ratings in balanced processing, potentially reflecting the differing pedagogical emphases of their respective training programs. Notably, master's-prepared nurses did not rate their leaders significantly higher in any domain, which is particularly revealing. While direct literature addressing this specific finding is scarce, research on higher education and critical thinking offers valuable insights. Advanced educational programs explicitly cultivate critical thinking, moving beyond rote memorization toward the systematic processing and evaluation of information (Batdı et al., 2024). This process emphasizes making informed judgments, considering multiple perspectives, and appreciating the complexity and nuance of issues (Dong et al., 2023). Consequently, master's-prepared nurses may possess a more refined evaluative framework, enabling them to assess leadership behaviors with heightened discernment and potentially leading to more critical appraisals of supervisors’ competencies.

The analysis of employment status and position in relation to perceptions of AL highlights important nuances in the leader–follower dynamic within nursing units. Notably, part-time employees rated their immediate supervisors significantly higher in transparency and overall, AL compared with full-time staff. This discrepancy may reflect differences in workplace interactions and expectations (Eslamdoust et al., 2025; Thawornlamlert et al., 2026). Part-time staff may engage in more focused interactions with supervisors, fostering stronger relationships and clearer communication (Feldman, 1990; Golden & Veiga, 2008; Kramer, 1995). Reduced exposure to office politics and greater engagement with core tasks may also contribute to more positive perceptions of leaders’ authenticity (Epitropaki & Martin, 2005; Ferris et al., 2002; Gardner et al., 2011). Additionally, supervisors may tailor their leadership style to meet the specific needs of part-time employees, resulting in more personalized and transparent interactions (Graen & Uhl-Bien, 1995; Hersey & Blanchard, 1969; Wang & Seibert, 2015). Conversely, this finding may indicate less favorable dynamics for full-time staff, suggesting that longer working hours (Sianoja et al., 2022) or the structure of full-time roles (Sianoja et al., 2022; Silva et al., 2024) could hinder authentic connections with supervisors.

The results also uncovered a clear hierarchical gradient in AL perceptions based on the rater's position. Nurse administrators rated their immediate supervisors the highest, followed by staff nurses, and then nurse assistants. This pattern can be interpreted through the lens of Leader-Member Exchange (LMX) theory (Chami-Malaeb, 2022; Furtado, 2016; Oprea et al., 2025; Pan et al., 2021; van den Berg et al., 2025; Vasset et al., 2023). Administrators, who are closer to their supervisors in the organizational hierarchy and likely share more strategic communication and responsibilities, often develop high-quality, trust-based exchanges with their leaders (Badru et al., 2024). This privileged relationship fosters a more positive perception of the leader's authenticity. Conversely, nurse assistants, who may have less direct and empowering communication with unit leaders (Al-Rjoub, 2025; Travers et al., 2020) and are more task-oriented in their interactions (Al-Rjoub, 2025; Travers et al., 2020), may feel more disconnected from leadership decisions, leading to lower ratings. This gradient underscores that proximity to power and the quality of leader–follower interactions are pivotal in shaping AL perceptions.

The significant differences related to experience within the current hospital and unit, as opposed to total clinical experience, highlight the profound impact of immediate, localized workplace culture and leader–follower relationships. This aligns with recent research emphasizing that the local unit environment is the primary determinant of staff well-being and perception of leadership (Lohikoski et al., 2019; Palweni et al., 2023; Palweni et al., 2023; Sonnentag et al., 2023).

The analysis of how clinical experience shapes perceptions of AL reveals a complex and non-linear relationship, challenging the assumption that perceptions uniformly improve with tenure. The most striking pattern is the U-shaped curve observed across multiple experience metrics. Nurses with minimal experience (≤2 years) and those with extensive experience (≥11 years) consistently rated their supervisors higher in transparency, moral/ethical behavior, and overall AL, while those in the mid-career range (3–10 years) provided the lowest ratings. This pattern can be interpreted through the lens of career stage theory and evolving professional expectations. New nurses (≤2 years) often find themselves in a “honeymoon phase” or socialization period, viewing their leaders through an idealistic lens and granting them greater leeway, as they interpret their actions more charitably while learning the unit norms (Baharum et al., 2023; Wakefield, 2018; Ye, 2025). Conversely, most veteran nurses (≥11 years) have likely developed emotional maturity (Prezerakos, 2018; Sihvola et al., 2022), organizational knowledge (Atalla et al., 2025), and resilience to inform contextualized leadership decisions (Sihvola et al., 2022). They may value stability and demonstrate long-term ethical intent over short-term missteps, leading to more favorable perceptions (Buchan et al., 2020; Montayre et al., 2023; Poorchangizi et al., 2017).

Predictors of Authentic Leadership Ratings

The results of the multiple regression analysis provide valuable insights into the factors that shape staff nurses’ perceptions of their immediate supervisors’ AL. The finding that the overall model was statistically significant and accounted for a moderate portion of the variance (22.1%) indicates that staff demographics and work characteristics collectively contribute to how leadership is perceived. This aligns with contemporary research suggesting that leadership perception is not formed in isolation but is filtered through the individual characteristics and experiences of the follower (Labrague et al., 2023).

The most compelling finding emerged regarding marital status, which proved to be the strongest positive predictor of AL ratings. Married nurses consistently rated their supervisors higher in AL than their single counterparts. This finding may be explained by the broader social support systems typically available to married individuals, which might buffer against workplace stressors and foster more resilient interpretations of leadership behaviors (Woo & Newman, 2019). Furthermore, married individuals may have more experience navigating complex interpersonal dynamics and balancing multiple roles, leading them to appraise a leader's attempts at transparency and ethical decision-making with greater empathy and understanding. This suggests that personal life context significantly influences professional perceptions, a factor often overlooked in leadership studies.

Equally important was the significance of experience in the current unit. The positive relationship indicates that the longer a nurse works within a specific unit under the same leadership, the more likely they are to perceive their supervisor as authentic. This finding strongly supports the tenets of Leader-Member Exchange (LMX) theory, which posits that high-quality, trust-based relationships between leaders and followers develop over time through repeated interactions (Duffy et al., 2002). Longitudinal exposure allows nurses to observe behavioral consistency, witness how a leader handles crises, and experience their genuine commitment to staff well-being, all of which are foundational to AL. This result underscores that leadership authenticity is not perceived instantaneously but is judged over a significant period of direct interaction and shared experience.

The non-significance of other variables, such as age, education, and overall clinical experience, is highly instructive. It suggests that once the effects of unit-specific tenure and marital status are accounted for, these broader demographic factors do not add significant explanatory power. This challenges assumptions that more seasoned nurses or those with higher education will automatically be more critical or discerning of leadership. Instead, it emphasizes the primacy of the immediate relational and contextual environment—the specific leader-follower dynamic on a specific unit—over broader life or career stages (Alhalal et al., 2024).

Strengths and Limitations

This research is strengthened by its innovative focus on how nurses’ perceptions of AL are shaped by their work-related and demographic characteristics, shifting from leader-only behavior to a relational viewpoint. It provides important data from the relatively unexplored Saudi Arabian setting and is based on solid theoretical frameworks. While the useful suggestions provide unambiguous direction for nurse administration, the exacting methodology, use of a validated instrument, and subtle findings add depth and dependability.

This study was conducted at a single government hospital in Majmaah, Saudi Arabia, which was selected due to its proximity to the research team and as the primary work setting of the principal investigator. While this facilitated access to participants and ensured feasibility, it may also limit the generalizability of the findings to other hospitals or regions. The convenience sampling of the facility introduces a potential selection bias, as the characteristics of nurses and leadership practices at this hospital may not fully represent those in other healthcare settings.

Implications for Nursing Management

To promote self-awareness and transparency, healthcare organizations should fund structured AL development programs for nurse leaders that incorporate coaching, self-reflection, and feedback. Programs that educate staff nurses about the fundamentals of AL should also be developed. These programs can improve frontline employees’ comprehension of AL perspectives, enabling them to more effectively identify AL behaviors, coordinate expectations with their managers, and actively contribute to the development of an open and trustworthy workplace. Maintaining a psychologically secure and cohesive workplace requires that leaders and followers have a common language and relational congruence, which is fostered by teaching staff nurses about AL.

To bridge perception gaps and reestablish trust and transparency with full-time employees, leaders must adapt their communication and decision-making processes to accommodate a diverse, multigenerational workforce. All team members, but especially nurse assistants and aides, should be included in engagement initiatives. It is essential to address mid-career nurses’ disillusionment through mentorship and career development. Perceived authenticity depends critically on leadership stability, which in turn lowers turnover and fosters close, trustworthy relationships. Along with prioritizing excellent, customized relationships with every employee, leaders should also recognize the variety of personal circumstances.

Conclusion and Recommendation

This study provides a comprehensive assessment of staff nurses’ perceptions of AL within a Saudi Arabian hospital context, revealing several critical insights. The most salient finding is the critically low overall perception of AL among immediate supervisors. This indicates a substantial leadership deficit that requires urgent attention within the organization. Additionally, the identification of a U-shaped curve in AL perceptions based on experience, where the newest and most veteran nurses rate leadership highest, while mid-career nurses are most critical, highlights a vulnerable population that requires targeted support.

These results demonstrate that perceptions of AL are not merely a product of objective leader behaviors but are co-created through the complex interaction between leaders and the unique characteristics, experiences, and expectations of their followers. This finding exemplifies Relational Leadership Theory, offering a more nuanced and relational understanding of leadership effectiveness in healthcare settings.

Implementing structured AL development programs with 360-degree coaching and feedback, prioritizing leadership stability within units to build trust, providing mid-career nurses with specialized support, educating leaders in inclusive communication for diverse workforces, and regularly conducting disaggregated leadership climate assessments to identify and close perceptual gaps are some recommendations to improve nursing staff perceptions of AL. Nurse leaders who promote excellence and trust may be developed with a sophisticated approach to AL perception.

Footnotes

Acknowledgments

The authors extend their appreciation to King Khalid Majmaah Hospital and the Deanship of Postgraduate Studies and Scientific Research at Majmaah University for the material support in the conduct of the research.

ORCID iDs

Mohammed Saed Almudhaybiri

Brian A. Vasquez

Gil P. Soriano

Bader Alrasheadi

Abdulrhman Saad Albougami

Ethical Approval

The Central Institutional Research Board of the Ministry of Health approved the conduct of the study with Log No. 20-28E.

Funding

The authors extend their appreciation to the Deanship of Postgraduate Studies and Scientific Research at Majmaah University for funding this research work through the project number R-2025–2234.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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How do Nursing Staff's Personal and Professional Experiences,Demographics,and Career Stage Influence Their Perceptions of Authentic Leadership?

Abstract

Aim

Background

Methods

Results

Conclusion

Implications for Nursing Management

Keywords

Introduction

Literature Review

The Relational Gap: The Underexplored Role of the Follower

Methods

Design

Setting

Sample Size Calculation

Measures

Data Collection and Ethical Considerations

Data Analysis

Results

Overall Perception of Authentic Leadership

Differences by Demographic Characteristics

Marital Status

Education

Differences by Professional Characteristics

Differences by Clinical and Unit-Based Experience

Regression Analysis of Predictors of Authentic Leadership Ratings

Discussion

Differences of the Authentic Leadership of Immediate Nurse Supervisors as Rated by Staff Nurses

Predictors of Authentic Leadership Ratings

Strengths and Limitations

Implications for Nursing Management

Conclusion and Recommendation

Footnotes

Acknowledgments

ORCID iDs

Ethical Approval

Funding

Declaration of Conflicting Interests

References