Predictors of toxic leadership behaviour among nurse managers: A cross-sectional study

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


AIM: To identify the predictors of toxic leadership behaviour in nurse managers.

BACKGROUND: Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers.

METHODS: A descriptive, cross-sectional design was used. Two hundred and forty nurse managers from ten hospitals in the Central Philippines were included in the study. Data were collected using the Nurse Information Form and the Toxic Leadership Behaviours of Nurse Managers Scale (ToxBH-NM). Hierarchical multiple regression was used to analyse the data collected.

RESULTS: The mean of average item score of the ToxBH-NM was 1.250 (SD = 0.470). Multiple regression analyses identified the years of experience in a managerial role (β = -0.165, p = .031), job status (part time) (β = 0.177, p = .002), ward census (30 patients, 40 patients and above 40 patients) ([β = 0.231, p = .005]; [β = 0.345, p < .004]; [β = 0.262, p = .012]), number of units managed (2 units and > 3 units) ([β = 0.292, p < .001]; [β = 0.235, p < .001]), hospital type (private hospital) (β = 0.271, p = .007) and hospital level (secondary hospitals) (β = 0.226, p = .036) predicted toxic leadership behaviour in nurse managers.

CONCLUSIONS: Overall, nurse managers were appraised as non-toxic leaders. Nurse managers who held a part-time job status, those who had lower experience in the managerial role and those who were assigned to wards or units with high patient admission numbers reported increased toxic leadership behaviours. Further, nurse managers who managed more than 2 units, those who were employed in private hospitals and those who worked in secondary hospitals reported increased toxic leadership behaviours.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators can consider the different predictors identified when planning and developing leadership interventions and organisational strategies (e.g. limiting the number of units per nurse manager, provision of full-time job employment, assignment of assistant nurse managers, formulation of policy specific to managing toxic behaviours), which may assist in the determent of toxic behaviours in nurse managers.

Original languageEnglish
Pages (from-to)165-176
Number of pages12
JournalJournal of Nursing Management
Issue number2
Publication statusPublished - Oct 3 2020


  • abusive leadership
  • health care
  • narcissism
  • nurse managers
  • toxic leadership
  • Leadership
  • Cross-Sectional Studies
  • Nurse Administrators
  • Humans
  • Philippines
  • Surveys and Questionnaires

ASJC Scopus subject areas

  • Leadership and Management


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