Positive leadership and health-related long-term outcomes among hospital nurses: a cross-sectional study

Nurses face high job demands that increase the risk of burnout, reduced job satisfaction, and intention to leave the profession. Leadership is a key resource for improving working conditions in healthcare, yet research has largely focused on deficit-oriented approaches. Positive leadership, grounded in positive psychology, aims to actively promote well-being and flourishing. The PERMA-Lead model operationalizes this approach through five dimensions: Positive Emotions, Engagement, Relationships, Meaning, and Accomplishment. Evidence on PERMA-Lead in nursing contexts remains limited.

This study examined perceptions of positive leadership among nurses and nurse managers and investigated associations between PERMA-Lead and health-related long-term outcomes.

A cross-sectional survey was conducted in an acute care hospital in the German-speaking part of Switzerland. Nurses and nurse managers (N = 211; response rate 23%) completed an online questionnaire including the PERMA-Lead Profiler and validated Copenhagen Psychosocial Questionnaire scales assessing job satisfaction, burnout symptoms, and intention to leave the profession. Group differences were analyzed using Welch's t-tests. Associations were examined using multiple linear regression models with robust standard errors, controlling for established workplace factors. Sensitivity analyses using more parsimonious models were conducted to assess the influence of model specification. Missing data were handled using multiple imputation.

PERMA-Lead levels were high across all dimensions (means >78 on a 0-100 scale). Managers rated their leadership higher than non-management staff (p = .002). Higher PERMA-Lead was consistently associated with lower intention to leave the profession (β = -0.64, p = .002; R² = .53). In contrast, associations with job satisfaction depended on model specification, with no significant association observed in the fully adjusted model (β = 0.00, p = .95), whereas no association was found for burnout symptoms (β = 0.11, p = .52). Burnout symptoms were associated with work-private life conflict and insecurity of the working environment, while job satisfaction was mainly associated with core work resources.

Positive leadership appears relevant for nurse retention. In contrast, its association with job satisfaction is less clear and depends on model specification, while no association was observed with burnout symptoms. Leadership may need to be complemented by structural improvements in working conditions.