Engaging leadership and nurses’ mental health in German acute care hospitals: the mediating role of job resources

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dc.contributor.authorKleine, Joan
dc.contributor.authorKohnen, Dorothea
dc.contributor.authorCampione, Alessandro
dc.contributor.authorBusse, Reinhard
dc.contributor.funderEuropean Union’s Horizon 2020 research and innovation programme
dc.contributor.funderProjekt DEAL
dc.contributor.funderHorizon 2020 Framework Programme, 848031
dc.contributor.funderRobert Bosch Stiftung, RBS, 1000643-001
dc.date.accessioned2026-07-09T14:50:05Z
dc.date.available2026-07-09T14:50:05Z
dc.date.issued2026-06-29
dc.description.abstractBackground: Nurses in German acute care hospitals face high levels of work-related stress, including symptoms of burnout, depression, and anxiety. This study investigates whether engaging leadership is associated with burnout, depressive, and anxiety symptoms among nurses and whether these associations operate through job resources. Methods: A cross-sectional online survey was conducted among registered nurses working in acute care hospitals participating in the German branch of Magnet4Europe. Data collection took place between September and December 2023. Engaging leadership was measured with a validated twelve-item scale. Job resources included role clarity, skill use, autonomy, performance feedback and opportunities for development. Burnout symptoms were measured using the Burnout Assessment Tool. Depressive and anxiety symptoms were assessed with the PHQ-2 and GAD-2. The preregistered analysis used complete case analysis and structural equation modelling to test direct and indirect associations. Results: In total, 1,502 nurses from eighteen hospitals were included in the analysis. Engaging leadership was strongly associated with perceived job resources. Job resources were associated with lower burnout, depressive, and anxiety symptoms. Engaging leadership also showed small direct associations with burnout and depressive symptoms, but not with anxiety symptoms. Indirect effects were significant across all three models, suggesting that job resources may be an important mechanism linking engaging leadership to nurses’ mental health. Conclusions: Nurses who experience more engaging leadership also report more job resources and fewer symptoms of mental ill-health. These findings suggest that leadership practices which support meaning, competence, connection and autonomy may strengthen resilience and reduce psychological strain among nursing staff in Germany. Leadership development and resource strengthening may therefore represent important strategies for improving nurses’ well-being and retention in German hospital settings. Trial registration: Not applicable. This cross-sectional secondary analysis was conducted within the Magnet4Europe project, which is registered in the ISRCTN registry (ISRCTN10196901, registered on 10 April 2020).en
dc.description.sponsorshipThis study was conducted within the framework of the Magnet4Europe project, funded under the European Union’s Horizon 2020 Research and Innovation Programme (Grant Agreement No. 848031) and registered in the ISRCTN registry (ISRCTN10196901, registered on 10 April 2020). All procedures were carried out in accordance with the Declaration of Helsinki. Participation was voluntary, and informed consent was obtained electronically from all participants prior to survey completion. For the German study sites, ethical approval was obtained from the Ethics Committee of Charité – Universitätsmedizin Berlin (EA1/243/20). Open Access funding enabled and organized by Projekt DEAL. This study was supported by the European Union’s Horizon 2020 Framework Programme (848031
dc.description.sponsorshipproject: Magnet4Europe – Improving Mental Health and Wellbeing in the Healthcare Workplace). Additional national funding for the German study sites was provided by the Robert Bosch Stiftung (1000643-001). Open access funding was enabled and organized by Projekt DEAL.
dc.description.versionPublished Version
dc.format.extent11
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid569
dc.identifier.authororcidKleine, Joan
dc.identifier.authororcidKohnen, Dorothea
dc.identifier.authororcidCampione, Alessandro
dc.identifier.authororcidBusse, Reinhard
dc.identifier.citationKleine, J, Kohnen, D, Campione, A & Busse, R 2026, 'Engaging leadership and nurses’ mental health in German acute care hospitals: the mediating role of job resources', BMC Nursing, vol. 25, no. 1, 569, pp. 1-11. https://doi.org/10.1186/s12912-026-04953-w
dc.identifier.doi10.1186/s12912-026-04953-w
dc.identifier.endpage11
dc.identifier.issn1472-6955
dc.identifier.issued1
dc.identifier.journaltitleBMC Nursing
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/19042
dc.identifier.volume25
dc.language.isoen
dc.publisherBioMed Central Ltd
dc.rights© 2026, the Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
dc.rights.accessrightsopen access
dc.rights.licensenameAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.statusPeer reviewed
dc.subjectAnxiety
dc.subjectBurnout
dc.subjectDepression
dc.subjectEngaging leadership
dc.subjectJob resources
dc.subjectMental health
dc.subjectNurse well-being
dc.subject[NursingMidwifery]
dc.titleEngaging leadership and nurses’ mental health in German acute care hospitals: the mediating role of job resourcesen
dc.typeArticle (peer-reviewed)
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