Flipped learning for leader empowering leadership among nurse leaders in residential aged care facilities: a pilot cluster quasi-experimental study

Empowering leadership by nurse leaders is crucial for creating positive workplace environments. However, no previous studies have investigated the effects of educational interventions utilizing a flipped-learning approach to cultivate empowering leadership behaviors among nurse leaders in aged care settings. Hence, in this exploratory pilot study, we aimed to obtain preliminary descriptive information on delivering a flipped-learning approach to develop empowering leadership behaviors among nurse leaders in aged care settings. A pilot clustered quasi-experimental study was conducted from August 2018 to May 2019 in six non-profit residential aged-care facilities in Taiwan. A 12-week, 24-h empowering leadership program using flipped learning was implemented. Ten nurse leaders participated in the intervention group, while 11 served as booklet-only controls. The program was guided by the theory of leader empowerment behavior. The outcome measured at pre- and post-intervention was leader empowering behaviors. Three ancillary facility-reported contextual indicators (nursing staff retention and turnover rates and resident hospitalization transfer rates) were also collected. The leader-level outcome was analyzed at the facility level, the level at which the intervention was assigned, with a three-level linear mixed model reported as an exploratory sensitivity analysis. Leader empowering behavior improved in both intervention facilities (+ 37.2 and + 39.6 points) and declined in all four control facilities (− 8.5 to − 13.0 points). With only six facilities, statistical significance is not claimed for this difference. An exploratory mixed model gave a consistent estimate (B = 48.13). Three ancillary facility-reported contextual indicators are described: mean staff retention rose from 83.0% to 85.0% and turnover fell from 13.9% to 11.5% in the two intervention facilities, whereas retention fell from 61.0% to 58.8% and turnover rose from 26.2% to 28.8% in the four control facilities. Resident hospitalization transfer rates were 8.0% and 7.9% in the intervention facilities and 4.2% at both time points in the control facilities. The observed facility-level pattern was consistent with improvement in self-reported empowering leadership behaviors and warrants evaluation in a prospectively randomized cluster trial. The three ancillary facility-reported indicators are descriptive and cannot be definitively attributed to the intervention. ClinicalTrials.gov NCT07774767. Registered 13 August 2026 (retrospectively registered).