Nursing work is an important part of the medical industry and is of great importance for comprehensively promoting the construction of a healthy China. Nurses provide various medical and nursing services to people, playing an important role in the prevention, treatment, nursing, rehabilitation, and hospice care of diseases. As of 2020 [1], there were a total of 4.71 million registered nurses in China, with an average of 3.34 registered nurses per thousand people. Compared to economic and social development and the growing health needs of people, there are still imbalances and inadequacies [2] in the current development of nursing in China. The National Development Plan for the Nursing Industry (2021–2025) [3] states that to transform China’s nursing industry into personalized and diversified nursing services, it is necessary to cultivate excellent nursing talent. As a guarantee of effective change, quality promotion, and innovation, nursing leadership is an indispensable part of high-quality nursing for clinical nurses and has been increasingly applied in clinical scenarios to improve patient care quality [4].
Nursing leadership refers to the practice in which nursing staff focus on self-directed leadership in routine work [5]; apply knowledge, attitudes, and skills related to their own leadership; motivate other members of the health team (service recipients, colleagues, or subordinates); and encourage them to take certain measures and engage in certain behaviors to achieve common organizational goals [6]. It includes four attributes: clinical ability, self-awareness, influence, and change management ability [7]. Multiple studies abroad have shown [8, 9] that the development of nurse leadership is an important measure for stabilizing nursing teams and an effective strategy for improving nursing quality. Some studies [10, 11, 12] have also shown that good nursing leadership can improve the quality of nursing services and patient satisfaction, improve organizational empathy and professional identity among nurses, reduce turnover intentions, and reduce nurse turnover rates. However, current research on leadership remains mainly at the level of nursing managers [13], and a comprehensive study on the leadership behavior, leadership ability, and leadership style of nursing managers has been conducted, lacking an exploration of leadership for ordinary clinical nurses. The domestic scholar Ma Hui [14] also pointed out that in the field of nursing, the research objective of leadership should gradually transition from nursing managers to ordinary clinical nurses [15], and training projects for nursing leadership should be gradually carried out in China.
Therefore, a comprehensive understanding of the current level of clinical leadership of nurses in China can provide a basis for cultivating their clinical leadership, further improving the level and quality of nursing services in China, ensuring patient safety, and ultimately improving patient outcomes.
Sociologist Arlie [16] conducted a survey on the emotional expression of airline flight attendants and found that according to the company’s service regulations, flight attendants should show a positive attitude toward passengers regardless of their inner feelings, thus proposing the concept of "emotional labor". Emotional labor [17] refers to service workers who regulate and manage an individual’s emotions, showing facial and physical states that meet specific roles’ needs. It includes surface acting, deep acting, and natural emotional expression [18]. Surface acting refers to individuals concealing their true emotions and expressing emotional states that meet the needs of the organization. Deep acting refers to individuals changing their cognition to make internal and external emotions coordinated and consistent. Natural emotional expression refers to the emotions expressed by individuals, which are real emotions. Nursing work is complex and multifaceted [19]. Clinical nurses are in high demand for emotional labor due to their high workload, complex interpersonal relationships [20], and susceptibility to emotional fluctuations. When individuals cannot express emotions in a timely and correct manner, it can have adverse effects on individuals and organizations. Research [21] has shown that emotional labor can predict the risk of depression among healthcare workers, and nursing workers with intermediate to high levels of surface play have a greater risk of developing depressive symptoms two years later. Unreal emotional interactions can increase the levels of negative emotions [22] and occupational burnout [23] among nurses. In addition, emotional disorders can also affect the level of organizational commitment and overall performance improvement [24]. However, a good emotional state not only has a positive impact on patient satisfaction [25] but also alleviates pressure on nurses’ work [26], improves happiness [27], reduces turnover intention [28], and improves quality of life [29]. Therefore, appropriate emotional labor can improve the quality of nursing work [30] and improve professional identity [15]. It is beneficial for nurses to improve the level of clinical leadership.
In 1998, Etzion [31] proposed the original concept of “psychological detachment”. He defined psychological detachment as a psychological state in which an individual, after stopping work, is detached from work in terms of time, space and psychology; is unaffected by work-related problems; and stops thinking about work [32]. Psychological detachment belongs to the category of positive psychology. Doing so not only helps people recover emotional resources consumed by work but also allows people to increase their participation in work and better complete work during work hours [33]. With the development of society, nurses need to not only complete their corresponding work in the workplace but also handle work matters during nonworking hours. The psychological distance between nurses and nonworkers is greatly reduced [34], and psychological detachment is gradually weakened. A decrease in the level of psychological detachment can easily increase individual psychological pressure [35] and reduce individual adaptability [36]. Psychological detachment, as an effective self-regulation method [37–38], can help nurses recover energy and improve work efficiency, ensuring treatment efficiency and nursing quality and thus enhancing nurses’ leadership.
Perceived organizational support refers to the overall experience and perception of employees toward the organization, whether they value individual contributions, and whether they care about personal welfare. Social exchange theory suggests that people can achieve the best benefits by evaluating the potential costs and benefits of exchange, and people feel an obligation to return support or help to their people or organizations [39]. If a person feels consistent with the organization and can easily adapt to it, positive behavior is likely to occur. However, if the opposite is true, negative behavior may occur [40]. In the workplace, if the organization provides expected support to employees, their enthusiasm will increase, and their sense of value and organizational commitment will also increase, thereby reducing their turnover intention. Nurses have a heavy workload and are eager to receive support from hospitals and leaders, affirm their work, and realize their value. Research has shown that high-level organizational support can improve nursing work performance [41], improve job satisfaction [42], reduce occupational burnout [43], and reduce turnover behavior. Other studies [44–45] also suggest that high-level organizational support has a positive impact on the innovative behavior of nurses. These positive behaviors are helpful in improving the level of leadership of nurses, and the sense of organizational support they receive has a certain impact on their level of leadership.
According to the previous literature, there have been separate studies on these three variables both domestically and internationally, but few have explored the effects of emotional labor, psychological detachment, and perceived organizational support on leadership. Therefore, in this study, we investigated the leadership level of nurses in Tianjin and analyzed the effects of demographic characteristics, emotional labor, psychological detachment, and perceived organizational support on leadership.