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Cross-sectional survey examines nursing leadership effects on moral courage, suggesting ethical climates impact outcomes.
In healthcare organizations, ethical conduct is strongly influenced by nursing leadership. Although prior research has emphasized the role of leadership in shaping professional behavior, limited attention has been given to how different leadership styles affect nurses' moral courage through ethical decision-making processes. This study examines the effects of three leadership styles-ethical, empowering, and authoritarian-on nurses' moral courage, with ethical dilemma identification as a mediator and perceived ethical climate and compassion fatigue as moderators. A cross-sectional survey was conducted among registered nurses in a Chinese tertiary hospital (N = 314). A moderated mediation model was tested using structural equation modeling. The results show that ethical and empowering leadership are positively associated with moral courage, whereas authoritarian leadership is negatively associated. These relationships are mediated by ethical dilemma identification, suggesting that leadership shapes moral courage by influencing nurses' recognition of ethical issues. Moreover, a supportive ethical climate strengthens the positive effects of ethical and empowering leadership, while compassion fatigue weakens these relationships. These findings highlight the critical role of leadership in promoting ethical practice in nursing. Practically, healthcare organizations should foster ethical and empowering leadership, strengthen ethical climates, and address compassion fatigue to enhance nurses' moral courage in clinical settings.
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Xie et al. (2026) studied this question.
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