Head Nurses’ Leadership Styles and Emergency Department Nurses’ Clinical Professional Autonomy in Iranian University Hospitals: A Cross-Sectional Study

Abstract

Introduction: Nurses’ clinical professional autonomy is strongly influenced by organizational management and leadership environments. This study aims to examine the relationship between head nurses’ leadership styles and the level of clinical autonomy perceived by emergency department (ED) nurses in Iranian university hospitals. Methods: This cross-sectional study recruited 221 ED nurses from Alborz province (Iran) university hospitals through convenience sampling from February to March 2022. Data were collected using a three-section questionnaire that covered demographic and work-related characteristics, the Multifactor Leadership Questionnaire (MLQ), and the Clinical Professional Autonomy Scale. Following psychometric validation in our sample, the MLQ consisted of 32 items assessing transformational, transactional, and laissez-faire leadership (Cronbach’s α = 0.71–0.95). Clinical professional autonomy was measured with the 31-item Clinical Professional Autonomy Scale (α > 0.70), with total scores classified as low, moderate, or high. Results: The mean (SD) of clinical professional autonomy (0–100 scale) was 78.68 (12.73). Transformational leadership was reported as the dominant style among head nurses (72.41 ± 18.58). The results showed the strongest correlation between transformational leadership style and clinical professional autonomy (r = 0.57). Furthermore, the multivariable linear regression analysis showed that clinical professional autonomy was significantly associated with job satisfaction (β = 0.17, p = 0.026) and nurses’ years of work experience (β = 0.23, p = 0.002). Conclusion: This study highlights that head nurses’ transformational leadership style significantly enhances nurses’ clinical professional autonomy. The findings underscore the need for targeted leadership development programs to strengthen head nurses’ transformational leadership competencies. By fostering a supportive leadership environment, clinical professional nursing autonomy can be promoted, contributing to improved patient care quality and overall organizational performance.