Examining the relationship between nursing staff demographics, work characteristics, and toxic leadership in Saudi Arabia: a cross-section approach

Nada Alqarawi, Ibrahim Alasqah, Awadh Shaman Al Harbi, Cris S. Adolfo, Joseph U. Almazan

BMC Nursing, 2025

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.1186/s12912-025-03065-1
Data confidence 85 high
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Abstract

BACKGROUND: Toxic leadership contributes significantly to nursing turnover and workplace dissatisfaction in healthcare settings. Understanding what drives nurses' toxic leadership is critical in formulating interventions that improve workplace conditions and foster a healthier work environment. This study examined the relationship between demographics, work characteristics, and perceived toxic leadership among nurses in working in healthcare settings in Saudi Arabia. METHODS: A descriptive cross-sectional survey was conducted with 691 nurses working in various healthcare settings across Saudi Arabia using a convenience sampling method. Data were collected using demographic characteristics and the Toxic Leadership Scale (TLS). Descriptive statistics, t-tests, one-way ANOVA, and multiple regression analysis were used to examine the relationships between demographic factors and toxic leadership ratings. RESULTS: The mean Toxic Leadership Scale score was 103.21, with narcissism scoring highest (71.68), followed by unpredictability (59.42) and self-promotion (59.39). Younger nurses reported higher levels of toxic leadership (p < 0.001), females reported more abusive supervision (p < 0.05), and single nurses reported higher self-promotion (p < 0.05). Nurses with postgraduate education had higher TLS scores (p < 0.001), and those with less than 10 years of experience in emergency and medical departments also reported higher scores (p < 0.001). Indian nurses had the highest TLS scores (p < 0.001), while there were no significant differences based on weekly working hours (p > 0.05). Multiple regression analysis (R² = 0.099, p < 0.001) found that non-reference hospital work (B = 2.894, p < 0.001), younger age (B = -5.227, p = 0.045), postgraduate education (B = 6.015, p = 0.005), and non-Saudi nationality (B = 5.009, p = 0.004) were significant predictors of higher TLS scores. CONCLUSION: This study highlights the necessity of implementing specific strategies aimed at mitigating toxic leadership behaviors in hospital settings. Perceived toxic leadership was higher among non-Saudi, younger, educated nurses, staff employed, and those working in specific hospital types. Implementing leadership training, organizational reforms, and supportive workplace policies can help reduce the toxic leadership and ultimately improve retention and job satisfaction among nurses.