Toxic leadership, psychological capital and caring behaviors among nurses: a cross-sectional study in Türkiye

The objectives of this study are to examine nurses' perceptions of their managers' toxic leadership behaviors and their levels of psychological capital and caring behaviors, and to identify the demographic and professional factors predicting these variables.

This descriptive, correlational and cross-sectional study was conducted with 217 nurses working in a public hospital in Istanbul, Türkiye. The data were collected between June 2024 and March 2025 using the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM), the Psychological Capital Questionnaire (PCQ) and the Caring Behaviors Inventory-24 (CBI-24). The data were analyzed using a range of analytical methods, including descriptive statistics, Pearson correlation and multiple linear regressions, with a significance level of 0.05.

The nurses reported low perceptions of toxic leadership (M = 52.8 ± 27.2), high psychological capital (M = 4.40 ± 1.04) and high caring behaviors (M = 5.34 ± 0.74). Regression analyses revealed that working in emergency departments and lower psychological capital predicted higher toxic leadership perceptions (Adj. R2 = 0.109), while working in surgical units and lower toxic leadership predicted higher psychological capital (Adj. R2 = 0.103). The presence of a surgical unit was a significant predictor of higher levels of caring behaviors (Adj. R2 = 0.092).

This study is the first to simultaneously define nurses' perceptions of toxic leadership, psychological capital and caring behaviors within the same empirical model. By integrating these three variables, the research provides original insights into how managerial attitudes and nurses' psychological resources jointly shape the quality of nursing care. These findings have practical implications for nursing management, highlighting the importance of leadership development initiatives and organizational strategies aimed at strengthening nurses' psychological capital to sustain caring behaviors in demanding healthcare environments.