Transformational Leadership and Nurse Job Performance Through Self-Efficacy in Chinese Tertiary Hospitals.

AIM: To examine the associations among transformational leadership, nurse self-efficacy and job performance in tertiary hospitals in Shanghai, China. DESIGN: A cross-sectional quantitative study guided by social cognitive theory and the Job Demands-Resources (JD-R) model. METHODS: Using convenience sampling, registered nurses were recruited from three tertiary Grade-A public hospitals in Shanghai between September and November 2024. Eligibility criteria included holding a valid nurse licence, having at least 1 year of independent clinical experience, and being currently employed full-time. Of 675 invitations distributed, 460 valid responses were included in the final analysis. Validated instruments were used to measure transformational leadership, nurse self-efficacy and job performance. Data were analysed using SPSS 25.0 and AMOS 25.0. Confirmatory factor analysis and covariance-based structural equation modelling were conducted using maximum likelihood estimation, and indirect effects were tested via bootstrapping with 5000 resamples. RESULTS: Transformational leadership was positively associated with nurse self-efficacy (β = 0.33, p < 0.001) and job performance (β = 0.18, p < 0.001). Nurse self-efficacy was positively associated with job performance (β = 0.47, p < 0.001) and partially mediated the association between transformational leadership and job performance. The indirect effect was significant (β = 0.15, 95% CI 0.09, 0.21) and accounted for 46.3% of the total effect. The final model demonstrated acceptable fit (CFI = 0.97, RMSEA = 0.05). CONCLUSION: Among nurses in three Shanghai tertiary public hospitals, transformational leadership was associated with higher self-efficacy and better self-reported job performance and self-efficacy showed a statistically significant mediating role. Because the data were cross-sectional and based on single-source self-report, the findings should be interpreted as associational rather than causal. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.