Toxic leadership and quality of work life: the moderating role of nurses’ agility

Abstract

Background: Toxic leadership undermines morale, job satisfaction, and retention among nurses. While previous studies have established its detrimental effects, the moderating role of nurses’ agility—a capacity for adaptation and resilience—remains underexplored, especially in the Egyptian healthcare context. Objective: This study examines the direct impact of toxic leadership on nurses’ quality of work life and explores whether nurses’ agility can mitigate these negative effects. Design and Methods: A cross-sectional, correlational design was used involving 265 full-time nurses across three hospitals in the Beni-Suef governorate, Egypt. Data collection instruments included the Toxic Leadership Scale, the Work-Related Quality of Life Scale, and the Workforce Agility Scale. Statistical analyses involved Pearson’s correlation, multiple linear regression, and moderation analysis via Hayes’ PROCESS macro. Results: Toxic leadership had a statistically significant negative impact on nurses’ quality of work life (r = -0.503, p < 0.001). Conversely, agility was positively associated with both toxic leadership (r = 0.159) and quality of work life (r = 0.425). Moderation analysis showed that nurses’ agility significantly buffered the negative effect of toxic leadership on quality of work life (β = 0.0049, p < 0.05). Conclusion: Toxic leadership erodes nurses’ quality of work life, but nurses with high agility experience less deterioration in work satisfaction and well-being. This suggests that agility operates as a protective factor. Implications for Nursing & Policy: Healthcare institutions must address toxic leadership through leadership development programs and should proactively enhance nurses’ agility through training in adaptability, stress management, and situational problem-solving. This dual strategy can improve nurse retention and ultimately, patient care outcomes. Patient or Public Contribution: Not applicable. Clinical trial number: Not applicable.