Ambidextrous Leadership and Presenteeism Among Clinical Nurses: A Moderated Mediation Model of Self-Efficacy and Leader-Member Exchange.

Authors

Xiuran Zhou, Shifang Zou, Hui Peng, Ying Yu, Xiaoying Yan

Published in

Journal of nursing management. Volume 2026. Issue 1.

Abstract

This study aimed to examine the pathways linking ambidextrous leadership (AL) to nurses' presenteeism, with a particular focus on the mediating role of self-efficacy and the moderating role of leader-member exchange (LMX) in this process.
Presenteeism among clinical nurses remains persistently high and is associated with reduced individual productivity and with risks to patient safety. Previous research has examined associations between the leadership style and attendance behavior; however, AL-the flexible combination of exploratory and exploitative behaviors-has received limited empirical attention in this context. Examining this pathway may inform nursing management practice.
A cross-sectional, descriptive, and correlational design was adopted. Data were collected from 394 clinical nurses recruited through convenience sampling at three tertiary hospitals in Guangzhou. In addition to correlational analyses, regression models were constructed to examine the mediating and moderating pathways among these variables.
AL was negatively associated with nurses' presenteeism and positively associated with self-efficacy; higher self-efficacy was, in turn, associated with lower presenteeism. Mediation analysis indicated that self-efficacy partially accounted for the association between AL and presenteeism, with the indirect pathway representing 33.3% of the total effect. In addition, LMX moderated the first stage of this pathway: the positive association between AL and self-efficacy was stronger among nurses reporting higher LMX.
The findings support the hypothesized moderated mediation model, in which self-efficacy partially mediates the association between AL and nurses' presenteeism, and in which LMX conditions the first stage of that pathway. Because the design was cross-sectional, these associations are correlational and cannot establish causal direction. The findings suggest that structural measures such as reasonable scheduling, sick-leave protection, workload adjustment, and occupational health support remain the primary responsibility of nursing management and that managerial attention to relational quality and to nurses' self-efficacy beliefs may complement, but cannot replace, them.

PMID:
42952151
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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