Development and psychometric testing of the toxic leadership behaviors of nurse managers (ToxBH-NM) scale

Leodoro J. Labrague*, Josephine Lorica, Chidozie E. Nwafor, Peter van Bogaert, Greta G. Cummings

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


Aim: This paper describes the development and testing of the psychometric property of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM) Scale. Background: Toxic leadership is growing increasingly pervasive in the field of nursing. However, the current literature lacks comprehensive attempts to explain how toxic leadership disrupts work processes in the field of nursing, a reality confounded in part by the absence of a reliable and a valid scale on which to examine toxic leadership behaviours in nurse managers. Methods: An exploratory sequential research design was used to formulate and evaluate the psychometric property of ToxBH-NM Scale. The content validity was examined by experts in nursing administration. A sample of 313 nurses from selected hospitals was recruited to assess the scale's reliability and validity. The factor structure of the newly developed scale was determined by exploratory factor analysis (EFA). Results: Exploratory factor analysis for ToxBH-NM Scale revealed 30 items loading on four factors. The overall Cronbach's α coefficient of the scale was 0.975, and Cronbach's α coefficient ranged from 0.895 to 0.965 for the four factors. Corrected item-to-total (0.310–0.69) and item-to-item correlations (0.47–0.66) were acceptable. The Scale-content Validity Index was 0.957, and the Item-content Validity Index ranged from 0.833 to 1.000. The test–retest reliability coefficient of ToxBH-NM Scale was 0.801, with a reliability coefficient that ranged from 0.745 to 0.911 for the four factors. The four factors explained 71.84% of the observed variance. Conclusions: ToxBH-NM Scale shows good psychometric properties and can be used to evaluate toxic leadership behaviours among nurse managers. Implications for Nursing Management: The use of ToxBH-NM Scale can aid nurse managers in better understanding and managing their own leadership behaviours within their organisations and in fostering desirable work outcomes among employees, a positive work climate and overall organisational success.

Original languageEnglish
Pages (from-to)840-850
Number of pages11
JournalJournal of Nursing Management
Issue number4
Publication statusPublished - May 1 2020


  • abusive supervision
  • narcissism
  • nurse manager
  • nursing
  • scale development
  • self-promotion
  • toxic leadership

ASJC Scopus subject areas

  • Leadership and Management


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