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Toxic leadership and nurse outcomes in intensive care units: a cross-sectional analysis of emotional labor and occupational embeddedness

Year: 2026

Type: article

Abstract: Aim This study aimed to assess occupational embeddedness and examine the relationships among toxic leadership, emotional labor, and occupational embeddedness among intensive care unit (ICU) nurses. Design A cross-sectional design. Methods A cross-sectional survey was conducted among 339 ICU nurses using the Toxic Leadership Behaviors of Nurse Managers Scale, the Emotional Labor Scale, and the Occupational Embeddedness Scale. Descriptive statistics were used to assess variable prevalence. Univariate and multivariate analyses were conducted to identify factors associated with occupational embeddedness. Additionally, Pearson correlation analysis was used to examine the relationships among toxic leadership behaviors, emotional labor, and occupational embeddedness. Results ICU nurses reported low levels of toxic leadership, while occupational embeddedness was moderate. The monthly income ( p = 0.014) and working environment ( p < 0.05) were the predictors of occupational embeddedness. Pearson correlation analysis showed a positive correlation between toxic leadership and emotional labor ( r = 0.272, p < 0.01), as well as a moderate negative correlation between toxic leadership and occupational embeddedness ( r = −0.477, p < 0.01). In addition, deep acting was positively correlated with occupational embeddedness ( r = 0.273, p < 0.01). Conclusion This study clarified the relationship between toxic leadership behavior, emotional labor and occupational embeddedness among ICU nurses. Nursing managers may consider adopting supportive and constructive leadership practices and providing appropriate support for nurses' emotional demands, including strategies that may facilitate adaptive emotional regulation and deep acting. Implications Nursing managers should recognize toxic leadership issues and consider measures to minimize the potential transmission of negative emotions and behaviors to staff. Patient or public contribution No patient or public contribution.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1975548

Authors: Shuqing Zhao, Haochen Wang, Qing Liu, Chongzhong Liu, Xiaoyun Wang

Institutions: Second Hospital of Shandong University, Qilu Hospital of Shandong University, Shandong University

Language: English

Topic: Nursing education and management

Subfield: Research and Theory

Field: Nursing

Domain: Health Sciences

SDGs: Good health and well-being, Decent work and economic growth

Open Access status: gold

Estimated APC paid: $3,801