Toxic leadership and nurse outcomes in intensive care units: a cross-sectional analysis of emotional labor and occupational embeddedness
- 1Department of Hepatobiliary and Pancreatic Surgery, The Second Qilu Hospital of Shandong University
- 2Shandong University
- 3Director of Nursing, Nursing Department, The Second Qilu Hospital of Shandong University
Abstract
Aim: This study aimed to assess occupational embeddedness and examine the relationships among toxic leadership, emotional labor, and occupational embeddedness among intensive care unit (ICU) nurses.
Design: A cross-sectional design.
Methods: A cross-sectional survey was conducted among 339 ICU nurses using the Toxic Leadership Behaviors of Nurse Managers Scale, the Emotional Labor Scale, and the Occupational Embeddedness Scale. Descriptive statistics were used to assess variable prevalence. Univariate and multivariate analyses were conducted to identify factors associated with occupational embeddedness. Additionally, Pearson correlation analysis was used to examine the relationships among toxic leadership behaviors, emotional labor, and occupational embeddedness.
Results: ICU nurses reported low levels of toxic leadership, while occupational embeddedness was moderate. The monthly income ( p = 0.014) and working environment ( p < 0.05) were the predictors of occupational embeddedness. Pearson correlation analysis showed a positive correlation between toxic leadership and emotional labor ( r = 0.272, p < 0.01), as well as a moderate negative correlation between toxic leadership and occupational embeddedness ( r = −0.477, p < 0.01). In addition, deep acting was positively correlated with occupational embeddedness ( r = 0.273, p < 0.01).
Conclusion: This study clarified the relationship between toxic leadership behavior, emotional labor and occupational embeddedness among ICU nurses. Nursing managers may consider adopting supportive and constructive leadership practices and providing appropriate support for nurses' emotional demands, including strategies that may facilitate adaptive emotional regulation and deep acting.
Implications: Nursing managers should recognize toxic leadership issues and consider measures to minimize the potential transmission of negative emotions and behaviors to staff.
Patient or public contribution: No patient or public contribution.
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BibTeX
@article{zhao2026toxic,
title = {{Toxic leadership and nurse outcomes in intensive care units: a cross-sectional analysis of emotional labor and occupational embeddedness}},
author = {Shuqing Zhao and Haochen Wang and Qing Liu and Chongzhong Liu and Xiaoyun Wang},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1975548},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1975548/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Toxic leadership and nurse outcomes in intensive care units: a cross-sectional analysis of emotional labor and occupational embeddedness
AU - Shuqing Zhao
AU - Haochen Wang
AU - Qing Liu
AU - Chongzhong Liu
AU - Xiaoyun Wang
PY - 2026
DA - 2026/10/20
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1975548
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1975548/full
AB - Aim: This study aimed to assess occupational embeddedness and examine the relationships among toxic leadership, emotional labor, and occupational embeddedness among intensive care unit (ICU) nurses. Design: A cross-sectional design. Methods: A cross-sectional survey was conducted among 339 ICU nurses using the Toxic Leadership Behaviors of Nurse Managers Scale, the Emotional Labor Scale, and the Occupational Embeddedness Scale. Descriptive statistics were used to assess variable prevalence. Univariate and multivariate analyses were conducted to identify factors associated with occupational embeddedness. Additionally, Pearson correlation analysis was used to examine the relationships among toxic leadership behaviors, emotional labor, and occupational embeddedness. Results: ICU nurses reported low levels of toxic leadership, while occupational embeddedness was moderate. The monthly income ( p = 0.014) and working environment ( p < 0.05) were the predictors of occupational embeddedness. Pearson correlation analysis showed a positive correlation between toxic leadership and emotional labor ( r = 0.272, p < 0.01), as well as a moderate negative correlation between toxic leadership and occupational embeddedness ( r = −0.477, p < 0.01). In addition, deep acting was positively correlated with occupational embeddedness ( r = 0.273, p < 0.01). Conclusion: This study clarified the relationship between toxic leadership behavior, emotional labor and occupational embeddedness among ICU nurses. Nursing managers may consider adopting supportive and constructive leadership practices and providing appropriate support for nurses' emotional demands, including strategies that may facilitate adaptive emotional regulation and deep acting. Implications: Nursing managers should recognize toxic leadership issues and consider measures to minimize the potential transmission of negative emotions and behaviors to staff. Patient or public contribution: No patient or public contribution.
SN - 2296-2565
ER -