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February 16, 2026Nursing Outlook7 citationsOpen Access

Formal vs. informal authority: A mixed-methods study of nursing leadership and patient safety in Palestinian hospitals

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IAIbrahim AqtamMSMustafa ShouliETEhab Tumeh

Key Points

  • Examine the impact of formal versus informal authority on nursing leadership and patient safety in Palestinian hospitals.
  • Mixed-methods approach combining qualitative and quantitative analysis.
  • Assessment of nursing leadership roles and structures in hospitals.
  • Evaluation of patient safety outcomes associated with leadership authority types.
  • Highlighting the drawbacks of relying on informal influence among nursing leaders.
  • Identifying the need for structural reforms like executive nursing roles and governance integration.
  • Suggesting that reforms could enhance sustainability and effectiveness of patient safety initiatives.

Abstract

Strategic disempowerment of nursing leaders creates an unsustainable reliance on informal influence, which carries high emotional labor and systemic fragility. To sustainably improve patient safety, structural reforms-such as establishing executive nursing roles (e.g., Chief Nursing Officers) and integrating nursing leadership into hospital governance-are urgently needed in Palestine and similar constrained settings.

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Cite This Study

Aqtam et al. (2026) studied this question.

synapsesocial.com/papers/6992b3319b75e639e9b081fchttps://doi.org/10.1016/j.outlook.2026.102702
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