Nursing leadership in emergency and critical care settings: An explanatory mixed-method study

Most of the available evidence regarding nursing leadership in emergency and critical care settings does not show how it is experienced in low-income healthcare systems. This study aimed to analyze the association between self-reported leadership behavior among emergency and critical care nurses and selected organizational outcomes.

An explanatory mixed-method design was conducted in a tertiary public hospital in Honduras. The quantitative phase included emergency and critical care nurses surveyed by using a validated questionnaire. Binary logistic regression was performed to identify factors associated with transformational leadership. The qualitative phase involved 17 nurses who participated in in-depth semi-structured interviews and analyzed using thematic analysis.

Humanized care was a positive predictor (p = 0.042), while self-perceived clinical experience (p = 0.001) and teamwork incentive (p = 0.013) were negatively associated to transformational leadership. Qualitative findings revealed two main themes: (1) leadership conceptualized as guidance, adaptability, and transformational influence in high-pressure environments; and (2) structural barriers including workload, staffing shortages, limited supervision, and organizational culture constraints.

These findings indicate that nursing leadership in emergency and critical care settings is shaped by both individual and systemic factors, highlighting the need for targeted educational and organizational investments in resource-limited contexts.