Transformational leadership as a mediator between work–family conflict, nurse-reported patient safety outcomes, and job engagement

Purpose: Work–family conflict (WFC) is an important issue in nursing administration and management that is associated with reduced work effectiveness and patient safety issues. To date, very few studies have attempted to explain the mechanisms underlying these relationships. The aim of this study was to determine the influence of work–family conflict (WFC) on patient safety outcomes and job engagement via the intermediary role of transformational leadership (TL). Design: Cross-sectional study. Methods: Seven hundred fifty-four nurses from 10 acute care hospitals in the Philippines were included in this cross-sectional study. Findings: A higher perception of WFC was associated with increased adverse events, reduced quality of care and decreased job engagement. WFC was indirectly associated with quality of care, adverse events and job engagement through the intermediary of TL. Conclusions: The results of this study underscore the important role of nurse managers’ TL in sustaining work–family balance and, in turn, improving patient safety outcomes and enhancing job engagement among nurses. Clinical relevance: Institutional measures to foster patient safety outcomes and sustain the nursing workforce should involve enhancing nurse managers’ leadership behaviors through theory-driven interventions, periodic leadership assessment, and implementation of leadership development activities. WFC may be addressed by creating empowering work conditions, providing adequate coaching and mentorship to nurses, and implementing work–family friendly policies in the workplace.