Authentic leadership and nurse-assessed adverse patient outcomes


  • Carol A. Wong RN, PhD,

    Associate Professor, Ontario Ministry of Health and Long-Term Care Nursing Early Career Research Award Recipient, Corresponding author
    • Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Health Sciences Addition (HSA), The University of Western Ontario, London, ON, Canada
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  • Lisa M. Giallonardo RN MScN

    Doctoral Student, Professor
    1. The University of Western Ontario, Toronto, ON, Canada
    2. UNB-Humber Collaborative Bachelor of Nursing Program, Humber Institute of Technology and Advanced Learning, Toronto, ON, Canada
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Dr Carol A. Wong

Arthur Labatt Family School of Nursing

Faculty of Health Sciences

Room H27, Health Sciences Addition (HSA)

The University of Western Ontario

1151 Richmond Street

N6A 5C1 London






Our purpose was to test a model examining relationships among authentic leadership, nurses' trust in their manager, areas of work life and nurse-assessed adverse patient outcomes.


Although several work environment factors have been cited as critical to patient outcomes, studies linking nursing leadership styles with patient outcomes are limited suggesting the need for additional research to investigate the mechanisms by which leadership may influence patient outcomes.


Secondary analysis of data collected in a cross-sectional survey of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario was conducted using structural equation modelling.


The final model fit the data acceptably (χ2 = 1.30, df = 2, P = 0.52, IFI = 0.99, CFI = 1.00, RMSEA = 0.00). Authentic leadership was significantly associated with decreased adverse patient outcomes through trust in the manager and areas of work life.


The findings suggest that nurses who see their managers as demonstrating high levels of authentic leadership report increased trust, greater congruence in the areas of work life and lower frequencies of adverse patient outcomes.

Implications for nursing management

Managers who emphasize transparency, balanced processing, self-awareness and high ethical standards in their interactions with nurses may contribute to safer work environments for patients and nurses.