From Shadows to Spotlight: Courageous Followers Shape Leaders Perceptions and Influence Followers' Job Performance

In health care, leadership is often viewed through top-down lens, which leaves the active role of followers unrecognized. Nurses do not just comply with orders-they shape leadership, culture, and performance through their behavior. Courageous followership, reflected in accountability, integrity, and speaking up, is central to this influence. Yet, this perspective remains underexamined in hierarchal healthcare environments.

This study examines how courageous followership affects leaders' implicit followership theories (LIFTs) and followers' job performance. It also explores LIFTs as mediating mechanisms within healthcare teams.

Multisource data were collected from 472 healthcare professionals in Pakistan using cross-sectional survey design. Partial least squares structural equation modeling (PLS-SEM) was used to test direct and mediated relationships among five courageous followership dimensions, LIFTs and follower job performance.

Four dimensions of courageous followership, that is, assume responsibility, serve, challenge, and participate in transformation-positively influence both LIFTs and job performance with LIFTs as a mediator. However, the dimension of "taking moral action" had a negative effect, suggesting that ethical dissent may be viewed unfavorably in high-power distance environments. The structural model demonstrated strong explanatory and predictive power (Q ² for LIFT = 0.587 and Q ² for performance = 0.478).

This study offers a novel theoretical integration of followership theory and implicit followership theories, emphasizing how followers' courage, ethics, and agency shape leadership perceptions and outcomes. It shifts attention from leader-centric views to more relational, followers-focused understanding of healthcare leadership.

Health care leaders should recognize and encourage follower behaviors that promote responsibility with accountability. Leadership development must address perceptual biases, strengthen leader openness to follower contributions to fully harness the value of nursing followership.