Nurse Managers’ Authentic Leadership and their Relationship with Work Engagement among Registered Nurses

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Introduction
For many decades, nurses' disengagement from one's job has been an area of interest for researchers due to its profound efect on job performance and patient outcomes [1,2].It is also found in recent literature that there are increasingly serious discussions among nurse researchers about the role of leadership styles of nurse managers in improving various nursing outcomes including nurses' job performance, motivation, mental health, turnover intention, and experiences of workplace bullying [3][4][5].
Recently, work engagement among nurses has been identifed as a positive organizational construct that is critical to the organization's success [6].Nurse work engagement is a commonly used term to describe people who are committed, dedicated, or have a sense of pride in the nursing feld and the institutions in which they work [7].Nurse work engagement or lack thereof afects the overall healthcare delivery system's institutions' outcomes, including hospitals [8].Previous research found that nurses with high levels of work engagement have higher levels of job satisfaction and better teamwork collaboration than nurses with lower levels of work engagement [9].Healthcare organizations seeking to improve outcomes must identify human factors and leadership styles that could afect employee work engagement [10].Efective leadership increases employee motivation, job satisfaction, and loyalty to the organization [3,11].In addition, employing efective leadership styles such as authentic leadership could address various challenges related to employee work engagement in healthcare organizations [12].According to Du Plessis and Boshof [2], authenticity is the most important part of effective leadership because it improves patient safety and employee engagement by building trust and healthy work environments.
Over the last decade, numerous empirical studies have emphasized the signifcant role of authentic leadership in contributing to key performance indicators in healthcare and infuencing followers' job outcomes [13].In addition, previous research indicated a need for more empirical studies that examine the outcomes of employing authentic leadership across diferent disciplines [13].According to the theory of authentic leadership, authentic leaders can increase the engagement of followers by generating hope, trust, optimism, and other positive feelings [14].In particular, nurse managers (NMs) are uniquely positioned within hospital organizations to improve nurses' work engagement due to their direct interaction with nursing staf and their understanding of department concerns [15].
In the Arab culture, leaders are appreciated and considered to be great individuals who guide their followers and attend to their needs.Te Arabic or Islamic perspective of leadership adheres to ethical principles such as justice, consultation, commitment, honesty, trust, and integrity [16].Tese ethical principles are directly relevant to authentic leadership dimensions [14].Authentic leadership is a relatively new concept in the Arab work culture that difers substantially from its Western counterparts [17].
An understanding of nurses' work engagement and the factors that infuence it has been gained in Western countries [18].However, more research studies are needed to understand the factors that could improve work engagement among nurses in the context of Arab countries such as Jordan.In addition, there is a lack of satisfactory evidence in the literature about the link between authentic leadership and nurses' work engagement in Arab culture.While some studies have established a correlation between leadership styles and nurse work engagement [19][20][21], these studies showed that this relationship is confounded by demographic and organizational factors.
Te current study aimed to investigate the relationship between authentic leadership demonstrated by nurse managers and work engagement among Jordanian registered nurses (RNs) for controlling demographic and organizational factors.Te current study adds to the literature on work engagement and develops current knowledge on work engagement in sectors other than business.

Research Design.
Te study used a cross-sectional correlational design.

Settings.
In this study, data were collected from two major government hospitals located in Amman.Tese hospitals were chosen because they are large and easily accessible for patients from all governorates.Tese hospitals are also similar in terms of leadership and organizational structure and are considered the largest public hospitals in Jordan.

Participants.
Te target population consisted of all registered nurses working in the governmental hospitals in Jordan.Te accessible population included registered nurses working in the selected hospitals.Inclusion criteria were a registered nurse in Jordan, currently employed in the hospital, and at least one year of experience in the current position.Nurses in administrative roles and nurses who do not work at the bedside were excluded from the study.
Te study sample was recruited by using a convenience sampling technique.Te sample size was estimated by using the G * Power version 3.1.9.2 program [22].A minimum sample size of 233 participants was required for regression analysis with a small to medium efect size, a power of 0.90, and an alpha � 0.05.Te sample size was increased to 260 to account for the possibility of incomplete questionnaires or a high rate of nonresponse.

Measurement.
Tis study used a sociodemographic sheet and well-recognized scales to measure the main study variables, including authentic leadership and work engagement.

Te Sociodemographic Sheet.
Te sociodemographic sheet was used to collect participants' demographic data including age, gender, marital status, education level, university of graduation, whether private or governmental, total years of experience in nursing, total years of experience in the current hospital, hospital type, and working units.
2.6.Te Authentic Leadership Scale.Perception of authentic leadership was measured by using the Authentic Leadership Scale [14].Te subscales are self-awareness, relational transparency, internalized moral perspective, and balanced processing.Participants reported the frequency (0 � not at all to 4 � frequently) with which their leaders assumed the 16 behaviors.Examples of these behaviors are as follows: (a) "seeks feedback to improve interactions with others" (selfawareness); (b) "says exactly what he or she means" (relational transparency); (c) "demonstrates beliefs that are consistent with actions" (internalized moral perspective); and (d) "listens carefully to diferent points of view before coming to conclusions" (balanced processing).A variety of research studies conducted have yielded support for the reliability and validity of the ALQ [23][24][25].Internal consistency was evaluated by using Cronbach's alpha and was equal to 0.96 [26].Cronbach's alpha in this study was 0.93.and absorption (engrossed in work).Tese dimensions were refected through seventeen items: vigor (six items), dedication (fve items), and absorption (six items).Responses to each item ranged between 0 (never) and 6 (always).A higher score refects higher levels of work engagement.Te UWE-9S has been validated in diferent organizational settings in diferent countries worldwide [28,29].Te internal consistency of the vigor, dedication, and absorption items was 0.86, 0.89, and 0.76, respectively [27].Te internal consistency reliability of the UWES-9 was excellent (0.92) [27].Discriminant validity and predictive validity are ensured as compared with job involvement and organizational commitment scales [30].

Work Engagement
Te UWES-9S has a good construct validity to measure work engagement [27].Cronbach's alpha in this study was 0.88.

Data Collection
Procedures.Data collection began after IRB approvals were obtained.Te researcher visited all unit managers and explained to them the main ideas and purposes of the study and asked them to help in identifying nurses who met the criteria.Unit managers announced the details of the study to their staf nurses via WhatsApp group to save time and efort.A link explaining the purpose of the study and its procedure was sent to all participants.Te total number of eligible registered nurses for this study was 300.Te invitation was sent to a convenience sample of 260 nurses, 170 nurses from the frst hospital and 90 from the second one.Of them, 238 participants responded (response rate � 92%).For data analysis, questionnaire data were downloaded to the SPSS program version 26.
2.9.Ethical Considerations.Before collecting data, ofcial IRB approval was obtained from the institutional review board at the Faculty of Nursing, Zarqa University, and then from the Jordan Ministry of Health to access the selected setting.Te completion of the online survey and electronic cover letter refected the consent to participate in the study.Participants were given written information about the study's objectives, procedures, and implications of participating in the study via an electronic cover letter.Participation in the study was entirely voluntary, and no participant was coerced into participating against his or her will.Te collected data were kept on the researcher's password-protected personal computer, and no one except the research team had access to the data.Te participants were assured that all information gathered would be used solely for research purposes.Participants were reminded of their right to withdraw from the study at any time without penalty.In addition, the researcher's WhatsApp number was included in case participants had any questions.

Data Management and Analysis.
Te frst step was to review all collected responses to ensure that all the data were entered correctly and that no data were missing.Coding and data entry were performed before starting the data analysis process.IBM SPSS version 26 was used to analyze the data (SPSS 26).Descriptive statistics were used to present the characteristics of Jordanian registered nurses who participated in the study and to describe the study participants' scores on authentic leadership and work engagement.An independent samples t-test was used to examine diferences in work engagement based on the gender of participants, marital status, educational level, and type of the university from which participants earned their last degree.Diferences in work engagement based on other categorical demographics such as the current working unit in this study were examined by using one-way ANOVA because this categorical variable has more than two categories.Te relationship between work engagement and other continuous variables (age and years of experience) was examined by using the Pearson correlation.A hierarchical multiple regression analysis was conducted to investigate the distinct relationship between authentic leadership and work engagement while controlling for demographic variables.Age, educational level, total nursing experience, and total experience in the current unit were entered into the frst model of the regression analysis, while authentic leadership was entered into the second model.
Te assumptions for using parametric statistical tests were checked before conducting the principal analysis.Te normality assumption of the continuous variables was met for all parametric tests.In addition, the homogeneity of variances assumption of the independent samples t-test and the one-way ANOVA was examined by using Levene's test.Linearity and absence of multicollinearity assumptions of Pearson correlation and hierarchical multiple regression were also met before proceeding further in the analysis.A signifcance level of 0.05 (two-tailed) was chosen.
Te mean age of participants was 35.25 years (SD � 7.364), ranging from 22 years to 54 years.Te mean total experience in nursing was 12.26 years (SD � 7.11), ranging from 1 to 33 years.Te mean total years of experience in the current hospital was 7.75 (SD � 4.64), ranging from 1 to 18 years (Table 1).

Scores of the Main Study Variables.
Te overall mean score for the authentic leadership questionnaire was 2.16 (SD � 0.85).Te mean scores of subscales were 2.30 (SD � 0.90) for the moral-ethical domain, 2.09 (SD � 0.93) for the transparency domain, 2.15 (SD � 1.04) for the selfawareness domain, and 2.11 (SD � 1.05) for the balanced processing domain.Te moral-ethical domain has the highest mean score of all subscales, while the transparency domain has the lowest mean score of all subscales (Table 2).
Te overall mean score for the work engagement questionnaire was 4.09 (SD � 1.19).Te mean scores of subscales were 4.11 (SD � 1.27) for the vigor domain, 3.85 (SD � 1.46) for the dedication domain, and 4.26 (SD � 1.16) for the absorption domain.Te absorption domain has the highest mean score of all subscales, while the dedication domain has the lowest mean score of all subscales.

Te Relationship between Authentic Leadership and Nurses' Work Engagement.
A Pearson correlation was used to correlate each authentic leadership subscale with the nurses' work engagement subscales.All work engagement subscales, including vigor, dedication, and absorption, were signifcantly and positively correlated with ALS subscales and the overall score (r ranged from 0.25 to 0.40, p < 0.001).Furthermore, the overall work engagement score was signifcantly and positively correlated with all ALS subscales and with the overall ALS score (r ranged from 0.31 to 0.37, p < 0.001) (Table 3).

Diferences in the Scores of Work Engagement and Authentic Leadership Based on Nurses' Sociodemographic
Characteristics.An independent samples t-test was used to examine mean diferences in nursing work engagement and authentic leadership according to nurses' gender, marital status, educational level, and university of graduation.A one-way ANOVA test was conducted to examine work engagement and authentic leadership mean score diferences with respect to the current working unit.Results revealed that the mean scores of nursing work engagement signifcantly difered based on educational level (t (123) � 2.30, p � 0.023).Post hoc analysis indicated that the bachelor participants (4.21 ± 1.11) had signifcantly higher mean scores of nursing work engagement than higher studies participants (3.80 ± 1.30).No statistically signifcant diference was found in the mean scores of nursing work engagement according to gender (p � 0.717), marital status (p � 0.112), and university of graduation (p � 0.054).Results revealed no statistically signifcant diference in the mean nursing work engagement score according to the current working unit (p � 0.280) as shown in Table 4. Results revealed that the mean authentic leadership signifcantly difered based on gender, (t (221) � 3.15, p � 0.002), indicating that the male participants (2.36 ± 0.802) had signifcantly higher mean scores of authentic leadership than female participants (2.017 ± 0.863).No statistically signifcant diference was found in the mean scores of authentic leadership according to marital status (p � 0.102), educational level (p � 0.225), and university of graduation (p � 0.583).Results revealed no statistically signifcant diference in the mean authentic leadership score according to the current working unit (p � 0.767) (Table 4).

Te Relationship between Work Engagement, Authentic
Leadership, and Continuous Demographics.A Pearson correlation was performed to assess the relationship between continuous variables.Results show that nursing work engagement is signifcantly and positively correlated with participants' age (r � 0.14, p � 0.027), total experience in nursing (r � 0.13, p � 0.039), and experience in their current hospital (r � 0.15, p � 0.022).Results show that nursing authentic leadership is signifcantly and positively correlated with participants' age (r � 0.18, p � 0.004), total experience in nursing (r � 0.14, p � 0.028), and experience in their current hospital (r � 0.18, p � 0.005).

Discussion
Leadership is one of the most important factors in an organization's success.Authenticity is required in nursing practice to maximize healthcare outcomes and empower staf to provide safe and efective nursing practices [31].Te overall mean score for ALS in this study is consistent with authentic leadership scores reported in previous research [4,32,33].Regarding authentic leadership subscales, the   Nursing Forum moral-ethical domain has the highest mean score of all subscales, while the transparency domain has the lowest mean score.Tese results match those of a study conducted in Jordan [34] and a study conducted in Poland [35].In fact, there are variations across cultures in perceptions of what constitutes as a leader.Te perceptions of leadership could be infuenced by cultural background and organizational policies and practices.Te Arab culture emphasizes leadership and advocates practicing moral-ethical leadership through adherence to key principles such as honesty, justice, commitment, trust, and integrity [16].Te relatively low mean score of relational transparency could raise a concern related to cultural factors or organizational norms that impact the level of leaders' openness and willingness to share information with followers [25].Due to the scarce availability of relevant research, the data of Arab nurse leaders on authentic leadership could not be adequately benchmarked with other cohorts.However, this interesting area would require conducting more research studies to confrm our fndings.
Te mean score of participants' work engagement in this study was 4.09.Te highest mean score of the work engagement subscales was for absorption, while the lowest mean score of the subscales was for the dedication domain.Our results were consistent with those in some previous studies [36,37].However, the scores of work engagement in this study were higher than the scores reported by a previous study conducted in Jordan among healthcare professionals [38].Scores of work engagement could vary as per work settings, work environments, and psychological and physical demands that impact nurses' ambition, initiation, and commitment at work.
Nurses' work engagement was positively correlated with authentic leadership.Tis outcome suggests that nurses from the Arab culture are more likely to be engaged at work when their leaders inspire trust, cooperation, and enthusiasm.In general, positive leadership styles have been shown to improve and increase employee engagement in the workplace [20,[39][40][41].Tis study expanded these results from a sample of nurses from the Arab culture.Te relationship between authentic leadership and work engagement was signifcant and positive in all of the ALQ subscales suggesting that all of the four components of authentic leadership that characterize authentic nurse managers could play an important role in promoting nurses' work engagement.However, nurse managers' self-awareness dimension had the strongest correlation with work engagement in comparison with all four domains of authentic leadership.Tis suggests that self-awareness and recognizing the strengths and limitations of the nurse manager were important in facilitating nurses' work engagement.It is expected that nurse managers' self-awareness demonstrated in self-regulation and possession of stress management could support nurses to accomplish their work goals, engage in their work, and provide safe care to patients [42,43].
Contrary to the previous research, participants with a bachelor's degree had signifcantly higher mean scores of nursing work engagement than participants with a higher education degree.While some studies found that there was no statistically signifcant link between the level of education of nurses and how engaged they were at work [44], other studies revealed that higher education level is associated with more work engagement [45].In fact, higher education levels among Jordanian nurses could have little positive impact on their working conditions including salary, exposure to disciplinary actions, and position.
In contrast to the fndings of Kim et al. [46], who found a strong association between gender and work engagement and described low levels of job engagement among women, our study showed no diferences in work engagement based on gender.To date, few research studies have been conducted on work engagement among female nurses in Arab culture.However, this outcome contradicts the expectation of a patriarchal culture where men have underestimated women's abilities to succeed in workplace [47].Te link between total experience in nursing and work engagement is supported by Saito et al. [48].However, these fndings contradict a study conducted by Al-Hamdan and Bani Issa [49], who revealed no statistically signifcant diference in the level of work engagement among nurses based on their total years of nursing experience.
In the current study, there was an independent relationship between authentic leadership and work engagement for controlling participant's demographics.Alok and Israel [19] investigated a multiple regression model between

Study's Recommendations and Implications.
Te fndings of this study demonstrate to nurse managers the value of being authentic with their subordinates.Tis study could help nurse managers to be authentic role models by encouraging them to learn and teach the values and principles of authenticity to their staf.When true leadership is imposed in the workplace, it results in a healthier work environment and encourages a trusting relationship between the nursing team and their nursing manager.Tis could result in higher staf satisfaction a refection on staf practice, resulting in highquality care.In addition, decision-makers should take management capabilities in Jordanian Te availability and efective management of these capabilities and resources enable hospitals to achieve higher levels of engagement.
In nursing education, there should be a strong emphasis on integrating the concepts of authentic leadership and modern management methods into students' curricula.Tis could prepare students as future nurses who are ready to lead and be trusted.Employees, leaders, and the human resources department must all understand the impact of authentic leadership on work engagement outcomes.Te lack of ownership, strict rules and regulations, and other challenges in the health sector, such as workplace stress, may have an impact on leaders' willingness to display authentic behaviors, which may have an impact on nurses' feelings of engagement.

Conclusion
Tis study investigated the correlation between a nurse manager's authentic leadership and work engagement.Te fndings revealed a positive association between a nurse's manager's authentic leadership and work engagement among Jordanian nurses, which is consistent with studies conducted in Western countries.Te results of the current study provide insights into the importance of recruiting authentic leaders to improve work engagement.Finally, the results of the current study support the application of the theory of authentic leadership to nursing managers in health sectors, thereby increasing the work engagement of registered nurses.
gagement, while authentic leadership score accounted for 11% additional variance above and beyond the 5% accounted for the frst model.In the frst model, only educational level (t � −2.34, B � −0.39, p � 0.02) signifcantly predicted work engagement.In the second model, both educational level (t � −2.12, B � 0.48, p � 0.035) and

Table 3 :
Correlation between authentic leadership and work engagement.

Table 4 :
Diferences in the scores of work engagement and authentic leadership based on nurses' sociodemographic characteristics.

Table 5 :
Te unique relationship between authentic leadership and work engagement for controlling demographic variables.Limitations of the Study.Te current study employed a convenience sampling technique, which may limit the study's ability to generalize fndings.In addition, the study targeted the two largest public hospitals; private hospitals, charities, and other healthcare organizations were not included.