Influence of nurse managers' toxic leadership behaviours on nurse-reported adverse events and quality of care

Leodoro J. Labrague*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)


AIM: To assess the impact of toxic leadership behaviours among nurse managers on nurse-reported adverse events and quality of care.

BACKGROUND: Toxic leadership, a form of ineffective leadership, is increasingly becoming rampant in the field of nursing and has been strongly linked to poor nurse job outcomes including job dissatisfaction, higher stress levels, and increased turnover intention. To date, no studies have been conducted to examine how this type of leadership behaviours affects patient outcomes and care quality.

METHODS: A multicentre, cross-sectional study. This study involved a sample of 1,053 registered nurses working in 20 hospitals in the Philippines. Three standardized scales were deployed, including the Toxic Leadership Behaviors of Nurse Managers Scale, the Adverse Patient Events Scale and the single-item quality-of-care-measure.

RESULTS: Overall, nurses (96.2%) appraised the quality of care of their respective units as 'good to excellent' and cited complaints from patients and their families as the most commonly reported adverse events. Toxic leadership behaviours in nurse managers were strongly associated with increased nurse-reported adverse events including reports of complaints (β = .619; p < .001) and verbal mistreatment from patients and their families (β = .407; p < .001), patient falls (β = .834; p < .001), health care-associated infections (β = .629; p < .001) and errors in administering medication (β = .708; p < .001) and with decreased quality of care (β = -.216; p < .001).

CONCLUSION: Nurses who experience working under a nurse manager exhibiting toxic behaviours reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit.

IMPLICATIONS FOR NURSING MANAGEMENT: Organizational measure to reduce the occurrence of adverse events and enhance the quality of care provided in medical units may include intervention to develop positive leadership practices among nurse managers.

Original languageEnglish
Pages (from-to)855-863
Number of pages9
JournalJournal of Nursing Management
Issue number4
Publication statusPublished - Dec 20 2020


  • adverse events
  • clinical practice
  • nurse managers
  • nursing
  • quality of care
  • toxic leadership
  • Leadership
  • Cross-Sectional Studies
  • Nurse Administrators
  • Humans
  • Philippines
  • Nursing Staff, Hospital
  • Job Satisfaction
  • Surveys and Questionnaires
  • Quality of Health Care

ASJC Scopus subject areas

  • Leadership and Management


Dive into the research topics of 'Influence of nurse managers' toxic leadership behaviours on nurse-reported adverse events and quality of care'. Together they form a unique fingerprint.

Cite this