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Leading the Transformation of Saudi Arabia's Health System Under Vision 2030: Mediating Pathway From Transformational Leadership to Job Performance via Work Engagement Among Nursing Workforce

2026Open accessMansoura University

In plain language

This study investigated the relationship between transformational leadership, work engagement, and job performance among nurses in Saudi Arabia. A cross-sectional survey of 321 nurses from five tertiary hospitals in Riyadh found that nurses reported high perceptions of transformational leadership, high work engagement, and high job performance. The research indicated that transformational leadership was positively associated with both work engagement and job performance. Significantly, work engagement was identified as a partial mediator, meaning transformational leadership improves job performance directly and by enhancing nurses' engagement. The findings suggest that leadership development and engagement-focused strategies are essential for strengthening the nursing workforce.

Key takeaways

  • Nurses in the study reported high perceptions of transformational leadership, work engagement, and job performance.
  • Transformational leadership was positively associated with increased work engagement among nurses.
  • Both transformational leadership and work engagement were positively linked to higher job performance.
  • Work engagement partially explains how transformational leadership leads to improved job performance.
  • Leadership development and engagement-focused strategies are important for strengthening nursing workforce effectiveness.

Why it matters

Understanding how leadership styles affect nurse performance is crucial for healthcare organisations. This research highlights that effective leadership not only directly improves job performance but also boosts it by increasing nurses' engagement, ultimately contributing to better patient care and more efficient health systems.

Commercialisation angle

The findings offer actionable insights for healthcare managers and policymakers to develop leadership training programmes and workforce management policies. These strategies, focused on transformational leadership and employee engagement, could optimise nurses' performance and indirectly improve patient care outcomes. This is applied research, providing evidence-based recommendations for organisational practice within healthcare settings.

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Abstract

AIM: To examine the mediating role of work engagement in the relationship between transformational leadership and job performance among nurses in Saudi Arabia. DESIGN: A multicenter cross-sectional study. METHODS: This study included a convenience sample of 321 nurses recruited from five tertiary hospitals selected from the Second and Third Health Clusters in Riyadh, Saudi Arabia. Data were collected using a structured web-based survey incorporating the Global Transformational Leadership Scale, the Utrecht Work Engagement Scale, the Job Performance Scale, and a demographic and professional characteristics questionnaire. Data were analysed using descriptive and inferential statistics in IBM SPSS Statistics (version 27), followed by mediation analysis using Hayes' PROCESS Macro (Model 4). RESULTS: Nurses reported relatively high perceptions of transformational leadership, relatively high levels of work engagement and high levels of job performance. Transformational leadership was positively associated with work engagement, while gender and education were not significantly associated with work engagement. Transformational leadership and work engagement were positively associated with job performance. Work engagement partially mediated the association between transformational leadership and job performance. CONCLUSION: Transformational leadership contributes to higher nurse job performance through both direct effects and by enhancing work engagement. Leadership development and engagement-focused strategies are essential to strengthen workforce effectiveness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: These findings provide evidence to inform leadership training and workforce management policies in healthcare organizations, emphasizing engagement as a mechanism to optimize nurses' performance and indirectly improve patient care outcomes. IMPACT: This study addresses the need for effective leadership to strengthen nursing workforce performance within healthcare transformation initiatives. Findings provide actionable insights for healthcare managers and policymakers seeking to implement leadership and engagement strategies that improve organizational outcomes and patient care in Saudi Arabia. REPORTING METHOD: This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Research topics

  • Nursing education and management
  • Organizational and Employee Performance
  • Employee Performance and Leadership

Sustainable Development Goals

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DOI: 10.1002/nop2.70767

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