Leadership dynamics in nursing: a comparative study of paternalistic approaches in China and Pakistan

This study aims to examine the impact of nurses' paternalistic leadership style on performance, in the presence of underlying mechanisms, i.e. self-efficacy as a mediator in the high-power distance societies, namely, China and Pakistan, based on social exchange theory. Both healthcare sectors have seen several behavioral advancements in recent years. To improve things, even more, behavioral elements such as the influence of leadership styles, personality traits and so on have become more important. However, leadership styles, particularly paternalistic leadership, have received little attention in this field and need to be highlighted along with the mediating and moderating effects.

Data were collected from public and private sector hospitals in China and Pakistan using a 6-week time lag technique. Firstly, 356 Chinese and 411 Pakistani nurses were surveyed about their perceptions of power distance, self-efficacy and paternalistic leadership. Their managers were called six weeks later for a dyadic response to provide feedback on nurses' performance. For confirmatory factor analysis, AMOS 22 and for regression analysis, SPSS 22 was used.

According to the study's findings, nurses in both countries perform well when led by a paternalistic leader. Furthermore, self-efficacy explains the relationship between paternalistic leaders and nurses' performance. The moderated-mediation result also supported the importance of power distance.

This study highlights the kind of nursing leadership which is beneficial in high-power-distance societies and leads to better performance. According to this research, paternalistic leadership improves nurses' performance in both China and Pakistan. As a result, this study will be useful in high-power-distance societies, where hospital administrators can ensure that paternalism is implemented in leadership, thereby improving nurse performance.