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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Nurs . 2026 Feb 4;25:341. doi: 10.1186/s12912-026-04334-3 Search in PMC Search in PubMed View in NLM Catalog Add to search The relationships between clinical nurse leadership and emotional labor, psychological detachment, and perceived organizational support: a cross-sectional study Rongsai Wei Rongsai Wei 1 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China Find articles by Rongsai Wei 1, # , Qiaomei Zhang Qiaomei Zhang 2 Department of Cardiovascular Medicine, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China Find articles by Qiaomei Zhang 2, # , Xumiao Li Xumiao Li 1 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China Find articles by Xumiao Li 1 , Zhuolin Liang Zhuolin Liang 1 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China Find articles by Zhuolin Liang 1 , Jingying Liu Jingying Liu 1 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China Find articles by Jingying Liu 1, ✉ , Hongwen Ma Hongwen Ma 3 Department of Nursing, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China Find articles by Hongwen Ma 3, ✉ Author information Article notes Copyright and License information 1 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China 2 Department of Cardiovascular Medicine, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China 3 Department of Nursing, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China ✉ Corresponding author. # Contributed equally. Received 2024 Jun 24; Accepted 2026 Jan 14; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13067667 PMID: 41639861 Abstract Background Clinical leadership is crucial for healthcare quality, but its predictors among nurses in China are not well understood. This study investigated the independent predictive power of emotional labor, psychological detachment, and perceived organizational support on clinical nurse leadership, guided by Conservation of Resources theory. Method Using a convenience sampling method, 212 registered nurses from three tertiary hospitals in Tianjin were recruited for a cross-sectional survey. Data were collected using a set of standardized questionnaires, which assessed demographic characteristics, emotional labor, psychological detachment, perceived organizational support, and clinical leadership. Descriptive statistics and linear regression analysis were employed to analyze the data. Results The average leadership score of the clinical nurses was 4.53 ± 0.54 points. Clinical leadership was positively correlated with emotional labor ( r = 0.432, p < 0.01) and perceived organizational support ( r = 0.538, p < 0.01). Clinical leadership is negatively correlated with psychological detachment ( r =-0.186, p < 0.01). However, in the hierarchical regression model controlling for demographic variables, only emotional labor ( β = 0.304, p < 0.001) and perceived organizational support ( β = 0.439, p < 0.001) remained significant predictors, collectively explaining 44.5% of the variance in leadership scores (adjusted R² =0.445). The initially observed association with psychological detachment became non-significant in the final model ( p = 0.063). Conclusion Emotional labor and Perceived Organizational Support are critical, modifiable factors that significantly predict clinical nurse leadership. Healthcare organizations should prioritize fostering a supportive environment and providing emotion regulation training to cultivate nursing leadership. Keywords: Nurses, Leadership, Emotional labor, Relationship, Conservation of resources theory Introduction Nursing constitutes a foundational component of the global healthcare system, essential for achieving Universal Health Coverage and the Sustainable Development Goals [ 1 ]. As the largest segment of the health workforce, nurses are indispensable in disease prevention, treatment, and rehabilitation [ 2 ]. Yet, the sector faces critical challenges, including workforce shortages, widespread burnout, and escalating patient care complexity [ 3 ]. Strengthening the nursing workforce from within is therefore a pressing priority. In this context, the concept of clinical nurse leadership—defined as the demonstration of influence, decision-making, and responsibility by every nurse in daily practice to enhance care quality and safety—has been recognized as a pivotal driver of healthcare improvement and innovation [ 4 , 5 ]. Unlike formal, position-based leadership, this model emphasizes leadership as a set of observable behaviors accessible to all clinicians, which is critical for direct care outcomes. Its significance is well-documented: it enhances patient safety through robust teamwork and clear communication [ 6 ], fosters effective interdisciplinary collaboration by bridging professional divides [ 7 ], and directly cultivates a supportive and efficient practice environment, which in turn reduces turnover intent [ 8 ]. The manifestation of clinical leadership is not automatic; it is heavily dependent on the interplay between workplace conditions and nurses’ finite psychological resources. The high-stakes clinical environment demands significant emotional labor [ 9 ], wherein nurses must manage their emotional expressions according to professional norms, often suppressing their true feelings. This sustained self-regulation is inherently resource-intensive and, without adequate recovery, can lead to depletion and undermine leadership effectiveness [ 10 ]. Conversely, perceived organizational support—the belief that the organization values one’s contributions and cares about well-being—can mitigate this strain. When nurses feel supported, they experience greater psychological safety and commitment, thereby strengthening their capacity and willingness to undertake leadership behaviors such as advocacy and initiative-taking [ 5 , 11 ]. Furthermore, psychological detachment from work during off-hours is considered a vital recovery experience that may replenish the cognitive and emotional resources necessary to engage with the challenges of the next day, including those requiring leadership [ 12 , 13 ]. However, the current understanding of these factors remains fragmented. To cohesively explain their dynamic interplay, this study employs the Conservation of Resources (COR) theory as its overarching theoretical framework [ 14 ]. A cornerstone of occupational stress research, COR theory posits that individuals are motivated to acquire, retain, and protect valued resources, and that the threat or actual loss of these resources is disproportionately salient compared to resource gains [ 15 ]. Within this framework, we conceptualize clinical leadership as a set of resource-demanding behaviors. From this perspective, emotional labor acts primarily as a resource depletion process [ 16 ], perceived organizational support functions as a vital external resource reservoir that can offset losses and facilitate gains [ 17 ], and psychological detachment represents a key internal resource recovery mechanism [ 13 ]. This theoretical integration provides a parsimonious yet powerful model for hypothesizing how these variables might collectively govern a nurse’s ability to engage in leadership, moving beyond simple direct effects to consider a resource-based economy. While emotional labor, psychological detachment, and organizational support have been independently linked to nurse leadership in various studies, a critical gap persists: the literature lacks a systematic comparison of their relative predictive strength within a single, coherent theoretical model. Most studies examine these variables in isolation, failing to answer a pressing practical question: For a hospital administrator with limited resources, which factor—addressing the burdens of emotional labor, bolstering organizational support, or promoting recovery—should be prioritized to most effectively cultivate leadership? The absence of such comparative evidence leaves leadership development strategies scattered and potentially inefficient. To address this decisive gap, the present study aims to quantitatively evaluate and compare the independent predictive power of emotional labor, psychological detachment, and perceived organizational support on clinical nurse leadership in Tianjin, China. Grounded in the resource dynamics of COR theory, we hypothesize that: H1 Emotional labor will significantly and positively predict clinical nurse leadership. H2 Perceived organizational support will significantly and positively predict clinical nurse leadership. H3 Psychological detachment will significantly and positively predict clinical nurse leadership. The findings are expected to extend the theoretical application of COR theory in nursing by testing a comparative model of resource dynamics. More importantly, the results will yield an evidence-based hierarchy of intervention targets, providing healthcare organizations with actionable and prioritized strategies to efficiently cultivate a stronger clinical leadership workforce. Methods Study design and setting This cross-sectional study was conducted in April 2024 across three public hospitals in Tianjin, China, utilizing a convenience sampling approach. To capture a diverse spectrum of clinical environments within the city’s healthcare system, the participating institutions were strategically selected to vary in level and specialty: a premier tertiary care academic medical center (> 1500 beds), a major tertiary care specialized hospital (approx. 800 beds), and a secondary general hospital (approx. 500 beds) serving the local community. This design enabled the investigation of the research variables across different organizational contexts, thereby enhancing the representativeness of the findings for the municipal level. Participant and sampling A convenience sample of clinical nurses was recruited. Eligible participants were registered nurses with at least one year of direct patient care experience. The sample size was estimated using Kendall’s method [ 18 ], which recommends 5–10 times the number of variables for regression analysis. The planned regression model included 21 predictor variables (10 demographic items, 3 dimensions of emotional labor, 1 dimension of psychological detachment, 2 dimensions of organizational support, and 5 dimensions of clinical leadership). Therefore, the minimum required sample size was 21 × 10 = 210. Accounting for a potential 20% non-response rate, the target sample size was 252. Recruitment involved obtaining administrative approvals from the three hospitals. Department liaisons assisted in distributing the survey invitation. To mitigate selection bias and enhance representativeness across departments, approximately 30% of eligible nurses from each major clinical department (including internal medicine, surgery, critical care, and other specialties) were randomly selected using a random number table to receive the survey invitation. Non-response mitigation strategies, such as follow-up reminders and the provision of small appreciation gifts, were employed. Data collection An online questionnaire was developed using the Questionnaire Star platform. The first page of the survey detailed the study purpose, estimated completion time, confidentiality measures, and the voluntary nature of participation. Informed consent was obtained electronically from all participants; proceeding to the questionnaire items was contingent upon confirming consent. To ensure data quality, invalid responses were excluded based on predefined criteria: (1) questionnaires with more than 10% missing items on key scales; (2) responses exhibiting uniform patterns (e.g., straight-lining); and (3) logical inconsistencies. Automated reminders were sent via the platform after 24 and 48 h of inactivity to minimize missing data. Of the 270 questionnaires distributed, 263 were returned. After excluding 51 invalid responses, 212 questionnaires were retained for analysis, yielding an effective response rate of 78.5%. Measurements Demographic information We surveyed the demographic information of the participants through a series of questions, including gender, age, marital status, working years, educational degree, titles, teaching experience, labor relations, duties, and monthly income. Clinical leadership survey Clinical leadership was assessed using the Chinese version of the Clinical Leadership Survey, which was translated and cross-culturally adapted by Li Quan [ 19 ] from the original scale developed by Patrick et al. [ 20 ]. The scale is designed to measure five dimensions of leadership behavior: challenging the process, inspiring a shared vision, enabling others to act, modeling the way, and encouraging the heart. It comprises 15 items, and responses are captured on a 5-point Likert scale ranging from 1 (almost never) to 5 (always). Higher scores indicate a greater frequency of leadership behaviors. In the original Chinese validation study, the scale demonstrated acceptable internal consistency (Cronbach’s α = 0.78) and a confirmed five-factor structure through confirmatory factor analysis (χ²/df = 2.413, RMSEA = 0.079, CFI = 0.941) [ 19 ]. In the present study, the overall scale’s Cronbach’s alpha was 0.97. Emotional labor scale This study used a Chinese version of the Emotional Labor Scale to assess the emotional labor of nurses. The scale was translated by Yao Ying [ 21 ] in 2021 and was drawn from the original scale developed by the Korean scholar Hong [ 22 ] in 2019. This scale includes three dimensions—emotional control effort in profession, patient-focused emotional suppression, and emotional pretense by norms—for a total of 16 items. It was rated on a 5-point Likert scale, with one point indicating “strongly disagree” and five points indicating “strongly agree”, for a total possible score of 16–80 points. All items are scored positively. The Cronbach’s alpha of this scale is 0.76 ~ 0.88, and factorial validity is good (χ²/df = 1.670, RMSEA = 0.049, CFI = 0.965), indicating that it has good reliability and validity when used in the nursing population in China. The Cronbach’s alpha in this study is 0.93. Psychological detachment scale This study used the Chinese version of the Psychological Detachment Scale to measure the level of psychological detachment among nurses. The scale was translated by Lu [ 23 ] in 2018 and was drawn from the original scale developed by Sonnentag and Fritz (2007) [ 24 ]. The scale is a single-dimensional scale consisting of 4 items. Scores were rated on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree” and ranged from 1 to 5 points in sequence. The total score ranges from 4 to 20 points. All items are scored positively. The higher the score is, the greater the degree of psychological detachment. This scale is widely used in research on psychological detachment, with a Cronbach’s alpha of 0.84. All items showed factor loadings > 0.50. The Cronbach’s alpha in this study is 0.89. Perceived organizational support scale Perceived organizational support was measured using the Perceived Organizational Support Scale, which was developed specifically for the nursing population in China. The scale was initially developed by Chen [ 25 ] and later revised by Zuo [ 26 ]. It consists of 13 items loading onto two dimensions: emotional support (10 items) and instrumental support (3 items). Participants rated their agreement on a 5-point Likert scale from 1 (very noncompliant) to 5 (very compliant), with higher total scores indicating a stronger perception of organizational support. The scale’s development involved interviews with nurses and reviews by nursing management and human resources experts, which established its content validity [ 26 ]. The original validation study reported good reliability for the total scale (Cronbach’s α = 0.90) and its subscales [44]. In this study, the scale exhibited exceptionally high internal consistency, with a Cronbach’s alpha of 0.983 for the total score. Data analysis Data were analyzed using IBM SPSS Statistics (Version 26.0). Descriptive statistics (frequencies, means, and standard deviations) were used to summarize participant characteristics and study variables. The normality of the residuals for the regression model was assessed and confirmed via histogram and normal probability plot (P-P plot). Pearson correlation coefficient is used to test the correlation between clinical leadership and variables. To identify demographic variables for control in subsequent regression analyses, independent samples t-tests or one-way ANOVA were performed, comparing clinical leadership scores across all demographic categories (e.g., age, gender, education level, years of experience, marital status). A two-step hierarchical multiple regression was then conducted to examine the relationships between the core predictors and clinical leadership. Only demographic variables that showed a statistically significant association with clinical leadership in the aforementioned univariate analyses were included as controls in the first step (Model 1). The core theoretical variables (emotional labor, psychological detachment, and perceived organizational support) were entered in the second step (Model 2) to determine their explanatory power beyond the controlled demographics. Effect sizes for significant predictors in the final model were evaluated using Cohen’s f² [ 27 ], with values of 0.02, 0.15, and 0.35 representing small, medium, and large effects, respectively. Results Common method deviation test Since the data for all variables were collected from the same participants through a self-reported questionnaire at a single time point, common method variance (CMV) could be a potential concern. To address this, we performed Harman’s single-factor test. All items from the key measures (emotional labor, psychological detachment, perceived organizational support, and clinical leadership) were subjected to an exploratory factor analysis using principal component analysis. The unrotated solution revealed the presence of multiple factors, with the first factor accounting for 41.12% of the total variance, which is below the critical threshold of 50%. This indicates that common method bias is unlikely to be a serious problem in this study. Factor structure of key scales To address the discriminant validity of the key scales and the concern regarding their high internal consistency, confirmatory factor analyses (CFA) were conducted. For Clinical Leadership Survey and Perceived Organizational Support Scale, the hypothesized multidimensional model was compared against a single-factor model. For the Clinical Leadership Scale, the hypothesized five-factor model demonstrated a significantly better fit to the data (χ²/df = 6.063, CFI = 0.907, TLI = 0.877, RMSEA = 0.155) than a single-factor model (χ²/df = 10.392, CFI = 0.805, TLI = 0.773, RMSEA = 0.211). The substantial improvement in fit indices (e.g., ΔCFI = 0.102) supports the discriminant validity of the five leadership dimensions. Similarly, for the Perceived Organizational Support Scale, the two-factor model yielded a better fit (χ²/df = 8.487, CFI = 0.895, TLI = 0.872, RMSEA = 0.188) compared to a single-factor model (χ²/df = 11.486, CFI = 0.851, TLI = 0.821, RMSEA = 0.223). The consistent improvement in model fit (ΔCFI = 0.044) provides evidence for the two-factor structure. Although the absolute fit indices for the multidimensional models were not optimal, the consistent and significant superiority over the simpler single-factor models robustly indicates that the theoretical multidimensional structures are more tenable than unidimensional alternatives in representing the data. Descriptive statistics of variables Table 1 presents the descriptive statistics for all study variables, reported as mean scores per item to allow for direct comparison across scales. Emotional Labor was reported at a high frequency (M = 4.30/5, SD = 0.65). The subdimension “effort to control emotions in profession” scored the highest (M = 4.58/5, SD = 0.74). Psychological Detachment was at a moderate level (M = 2.58/5, SD = 1.00). Perceived Organizational Support was high (M = 4.14/5, SD = 0.80). Instrumental support (M = 4.22/5, SD = 0.78) was slightly more prevalent than emotional support (M = 4.09/5, SD = 0.82). Clinical Leadership was strong overall (M = 4.53/5, SD = 0.54). Among the subdimensions, “modeling the way” scored highest (M = 4.59/5, SD = 0.56), while “challenging the process” and “inspiring a shared vision” were comparatively lower (both M = 4.47/5). Table 1. Descriptive statistics of the variables Variable No. of Items Scale Range M SD Emotional Labor 16 1–5 4.30 0.65 Emotional control effort in profession 3 1–5 4.58 0.74 Patient-focused emotional suppression 5 1–5 4.36 0.74 Emotional pretense by norms 8 1–5 3.73 0.85 Psychological Detachment 4 1–5 2.58 1.00 Perceived Organizational Support 13 1–5 4.14 0.80 Emotional support 5 1–5 4.09 0.82 Instrumental support 8 1–5 4.22 0.78 Clinical Leadership 15 1–5 4.53 0.54 Challenging the process 3 1–5 4.47 0.63 Inspiring a shared vision 3 1–5 4.47 0.62 Enabling others to act 3 1–5 4.58 0.54 Modeling the way 3 1–5 4.59 0.56 Encouraging the heart 3 1–5 4.53 0.60 Open in a new tab Note: M = Mean; SD = Standard Deviation. The means for subdimensions are calculated based on their own set of items. All scores are reported as mean values per item based on a 5-point Likert scale Demographic characteristics and comparison of the study variables A total of 212 questionnaires were included in the research. The main participants in our study were nurses (91.1%), and most were 30–39 years old (36.3%). More than half of them were married (75.5%) and had a bachelor’s degree (75.5%). Seventy-five nurses (35.4%) had worked in the hospital for more than 15 years. Most of them were primary nurses (55.2%) or public institution staff (67.0%). In our research, 153 nurses did not have teaching experience (72.2%). More than half of the nurses earned between 6000 and 10,000 yuan per month (64.1%) (Table 2 ). As shown in Table 2 , there was a significant difference between clinical leadership and marital status ( t = 10.497, p < 0.01). No significant differences were found in the demographic information of the other participants. Table 2. Demographic characteristics and comparison of the study variables Category n (%) Mean (SD) F P Gender -0.71 a 0.474 Male 19 (8.90) 66.68 (9.52) Female 193 (91.10) 68.09 (8.00) Age(years) 0.41 0.743 20–29 63 (29.70) 68.52 (7.93) 30–39 77 (36.30) 67.86 (8.11) 40–49 37 (17.50) 66.76 (8.61) ≥ 50 35 (16.50) 68.46 (8.26) Marital Status 10.49 < 0.001 Unmarried 47 (22.10) 69.11 (7.67) Married 160 (75.50) 68.11 (7.65) Divorced 5 (2.40) 52.40 (12.99) Working Years 1.69 0.170 1–5 years 40 (18.90) 66.93 (8.17) 6–10 years 58 (27.30) 69.98 (7.40) 11–15 years 39 (18.40) 67.08 (8.53) More than 15 years 75 (35.40) 67.41 (8.33) Educational Degree 2.66 0.072 Diploma or lower 50 (23.60) 66.02 (8.94) Bachelor 160 (75.50) 68.65 (7.81) Master or above 2 (0.90) 61.50 (3.53) Job title 0.53 0.584 Primary Nurse 117 (55.20) 67.91 (8.30) Nurse-in-Charge 87 (41.00) 67.76 (7.87) Associate-Chief-Nurse 8 (3.80) 70.88 (8.99) Teaching Experience -0.03 a 0.973 Yes 59 (27.80) 67.93 (8.70) No 153 (72.20) 67.97 (7.94) Labor Relations 1.09 0.337 Contract System 64 (30.20) 69.20 (7.32) Public Institution Staffing 142 (67.00) 67.39 (8.33) Others 6 (2.80) 68.17 (11.53) Duties 2.84 0.061 Nurse 203 (95.80) 67.68 (8.20) Head Nurse 7 (3.30) 74.00 (1.82) Department Head Nurse 2 (0.90) 75.00 (0.00) Monthly Income(yuan) 1.46 0.233 ≤ 6000 15 (7.10) 69.00 (9.18) 6000–10,000 136 (64.10) 67.25 (8.45) ≥ 10,000 61 (28.80) 69.30 (7.01) Open in a new tab Note: a: a t-test for two independent samples Correlation between clinical leadership and variables The correlation analysis revealed significant bivariate relationships between the core study variables and clinical leadership. Emotional labor showed a significant positive correlation with clinical leadership ( r = 0.432, p < 0.01). Perceived organizational support was also positively correlated with clinical leadership ( r = 0.538, p < 0.01). Psychological detachment demonstrated a significant negative correlation with clinical leadership ( r = –0.186, p < 0.01) (Table 3 ). Table 3. Correlations between clinical leadership and variables Emotional Labor Psycholo-gical Detachment Perceived Organizational Support Clinical Leadership Emotional Labor 1 Psychological Detachment -0.092 1 Perceived Organizational Support 0.251 ** -0.105 1 Clinical Leadership 0.432 ** − 0.186 ** 0.538 ** 1 Open in a new tab Note. **. p < 0.01 Factors affecting clinical leadership Multiple regression analysis identified factors influencing nurses’ clinical leadership. Model 1 (demographics-only) explained 8.3% of variance (adjusted R² = 0.083), with divorced marital status showing significant negative effects ( β = -0.312, p < 0.001). Model 2 added emotional labor, psychological detachment, and perceived organizational support, explaining 44.5% of variance (adjusted R² = 0.445), indicating these organizational and psychological factors collectively account for substantial leadership variability beyond demographics. Key predictors in Model 2 included emotional labor ( β = 0.304, p < 0.001) and perceived organizational support ( β = 0.439, p < 0.001), with a large overall effect size ( Cohen’s f² = 0.84). The Durbin-Watson statistic (1.882) confirmed independent errors, and VIF values (1.02–1.10) ruled out multicollinearity concerns (Table 4 ). Table 4. Factors affecting clinical leadership Model 1 Model 2 B SE β t p B SE β t p Constant 69.106 1.137 60.768 0.000 34.847 3.710 9.393 0.000 Married -0.994 1.294 -0.053 -0.768 0.443 0.680 1.016 0.036 0.670 0.504 Divorced -16.706 3.667 -0.312 -4.555 0.000 -12.743 2.875 -0.238 -4.432 0.000 Emotional Labor 0.240 0.042 0.304 5.718 0.000 Psychological Detachment -0.198 0.106 -0.097 -1.869 0.063 Perceived Organizational Support 0.343 0.042 0.439 8.213 0.000 R 2 0.091 0.458 Adj- R 2 0.083 0.445 F(p) 10.497(< 0.001) 34.829(< 0.001) Cohen’s f² 0.100 0.844 Open in a new tab Note: Model 1 controlled for significant demographic variables (marital status). Model 2 added the core theoretical predictors Discussion Profile of clinical leadership and core findings This study not only assessed the current state of clinical leadership among nurses in Tianjin but, more importantly, quantified the relative predictive strength of its key influencing factors guided by COR theory. The surveyed nurses reported a generally high level of clinical leadership (Overall M = 4.53/5.00). A nuanced examination revealed a distinctive profile: the sub-dimension of “modeling the way” scored the highest, whereas “challenging the process” and “inspiring a shared vision” were comparatively lower [ 28 , 29 ]. This pattern suggests that while nurses excel in leading by example and upholding professional standards, there may be cultural or organizational barriers that inhibit innovative practice and the effective communication of a shared vision [ 30 , 31 ]. Beyond this descriptive profile, our hierarchical regression analysis yielded two principal findings that refine our theoretical understanding: first, perceived organizational support and emotional labor emerged as the most powerful and significant predictors, supporting H1 and H2; second, contrary to H3, psychological detachment did not demonstrate a significant independent effect. This hierarchy of predictors provides critical insights into the resource dynamics that underpin leadership behaviors in the nursing context. The enabling role of perceived organizational support Our finding that perceived organizational support was the strongest predictor (β = 0.439) underscores its role as a critical external resource reservoir [ 9 , 32 ]. According to COR theory, valuable resources are not only used to cope with demands but also enable individuals to invest in extra-role behaviors [ 33 ]. In the demanding clinical environment, POS—comprising both instrumental and emotional support [ 6 ]—functions as a buffer against resource depletion from job demands like emotional labor [ 1 ]. More importantly, it provides a stable foundation of security and value, empowering nurses to confidently invest their personal resources in leadership behaviors such as mentoring colleagues and initiating change [ 10 , 17 ]. This aligns with the “resource gain spiral” principle, where the possession of key resources facilitates the acquisition of further resources [ 34 ]. Our results suggest that organizational support is not merely a “hygiene factor” but a fundamental enabler that allows nurses to translate their competencies and intentions into tangible leadership actions. The dual nature of emotional labor The significant positive prediction of emotional labor on leadership ( β = 0.304) presents an intriguing nuance to the conventional view of it as purely depleting [ 16 ]. While emotional labor undoubtedly consumes psychological resources, our finding suggests it can also be reinterpreted as a strategic resource investment. The highest-scoring dimension, “effort to control the emotional environment,” can be seen as an active process of building relational and social capital. By skillfully managing emotions, nurses foster trust, enhance team cohesion [ 12 ], and maintain a positive clinical atmosphere [ 35 ], all of which are valuable resource gains. These gains, in turn, provide the social influence and stable platform necessary to exercise clinical leadership effectively. This creates a dynamic where the initial investment of emotional resources yields returns that facilitate leadership, embodying a COR-based “gain spiral” [ 34 ]. Therefore, the relationship is not paradoxical but rather indicative of a complex process where well-managed emotional labor transitions from a cost to an investment. The non-significance of psychological detachment The non-significant association between psychological detachment and leadership (H3 not supported) requires careful interpretation within the specific context of nursing. Several COR-theory-aligned explanations may account for this. First, the “loss paradox” of COR theory posits that individuals facing resource threat may prioritize protecting remaining resources over acquiring new ones [ 15 ]. In a high-stakes clinical setting, mentally disengaging from work might be perceived as risky, leading nurses to maintain a state of “attentive readiness” to prevent potential resource losses (e.g., missing critical patient changes), thereby negating the restorative benefits of detachment [ 36 ]. Second, the resource-providing effect of a strong perceived organizational support (as found in our study) might have superseded the effect of individual recovery strategies [ 37 ]. When the organization provides substantial support, the relative importance of individual efforts like psychological detachment for sustaining leadership may diminish. Finally, standard measures of detachment may not capture the nature of off-work mental engagement in nursing, which could range from ruminative worry (depleting) to constructive problem-solving (which could be a form of resource investment) [ 38 ]. Synthesis, implications, and unexplored demographics Collectively, our findings offer a nuanced COR perspective on nursing leadership. They demonstrate that resource dynamics are not simplistic: some seemingly depleting activities (emotional labor) can be investment vehicles, and some theoretically restorative activities (detachment) may not yield expected returns in high-demand contexts. The key theoretical contribution is the quantitative establishment of a resource hierarchy, identifying perceived organizational support as the most potent leverage point, followed by emotional labor. In addition to these core relationships, our analysis revealed marital status as a significant demographic predictor, with divorced nurses reporting substantially lower leadership scores. While this finding, based on a small subgroup ( n = 5), requires cautious interpretation and replication, it aligns with the COR principle that major life stressors can act as significant resource drains, depleting the energy necessary for work-related roles like leadership [ 39 , 40 ]. This suggests that nurses undergoing significant personal transitions may constitute a vulnerable group warranting targeted attention. For nursing management, these insights provide a clear, evidence-based roadmap for intervention. Efforts should prioritize: Strengthening perceived organizational support through systemic initiatives such as supportive leadership training [ 33 ], equitable resource distribution [ 41 ], and ensuring nurses feel valued and heard [ 32 ]. Reframing emotional labor from a mere cost to be managed to a skill to be honed. Implementing emotion regulation training can help nurses perform emotional labor more efficiently, maximizing its return as a leadership resource. Providing targeted support for nurses facing major life challenges, such as through accessible employee assistance programs and flexible scheduling policies, to help mitigate personal resource depletion [ 42 , 43 ]. This multi-faceted approach—systemically building organizational resources, cultivating personal resource investment skills, and offering targeted support—is essential for fostering a resilient and leaderful nursing workforce. Limitations This study is subject to several limitations. First, the cross-sectional design and self-reported data from a single source prevent definitive causal inferences and may introduce common method variance, although statistical tests indicated this was not a critical issue. Second, the generalizability of the findings is constrained by the sample. The convenience sampling from three hospitals in one city, coupled with a sample size calculation that lacked strong theoretical justification, limits the population to which results can be confidently applied. Although the response rate was acceptable, potential non-response bias remains a consideration. Third, the focus on aggregate-level constructs represents a deliberate trade-off. The high internal consistency and model fit challenges with certain scales suggested potential redundancy in their sub-dimensions within our cultural context. Consequently, we prioritized a robust analysis of the core constructs’ relationships. However, this means the potentially distinct effects of sub-variables (e.g., different types of emotional labor) were not explored. Future research should seek to validate these findings in more diverse and larger samples using longitudinal designs. It should also employ culturally refined instruments to better distinguish between theoretical sub-dimensions, enabling a more nuanced investigation into the specific mechanisms linking these psychological and organizational factors to leadership. Conclusion This study, conducted among 212 clinical nurses from three hospitals in Tianjin, identified emotional labor and perceived organizational support as significant positive predictors of clinical nurse leadership, thereby supporting H1 and H2. In contrast, psychological detachment was not a significant predictor, leading to the rejection of H3. The findings underscore that leadership development in this specific context is influenced more strongly by work-related psychological experiences and organizational resources than by recovery activities outside of work. This highlights the critical role of hospital management in fostering a supportive environment that acknowledges nurses’ emotional efforts. Implications for nursing management The findings of this study provide a clear, actionable framework for healthcare administrators aiming to cultivate clinical nurse leadership. Based on the established resource hierarchy, the most strategic investment is to cultivate a robust culture of perceived organizational support. This can be achieved through initiatives such as supportive leadership training for managers, ensuring equitable resource distribution, and fostering transparent communication that makes nurses feel genuinely valued. Concurrently, organizations should reframe emotional labor from a psychological risk to a developable competency. Implementing targeted emotion regulation training can empower nurses to manage this demand more effectively, transforming it from a potential source of depletion into a strategic investment that builds the relational capital necessary for leadership. Finally, a proactive approach involves providing targeted support for nurses facing significant personal resource drains, such as those undergoing divorce or severe work-life conflict. Offering flexible scheduling options and accessible counseling services can help conserve these individuals’ personal resources, thereby enabling their capacity for leadership. This multi-pronged strategy ensures that interventions are not only evidence-based but also efficiently targeted at the most impactful leverage points revealed by this research. Acknowledgements We thank all the nurses who participated in this study. Author contributions Jingying Liu and Hongwen Ma conducted the literature searches, determined the research theme, designed the research, and revised the manuscript. Qiaomei Zhang collected the data and led critical revisions during peer review. Zhuolin Liang and Xumiao Li analyzed the data. Rongsai Wei and Qiaomei Zhang wrote the manuscript and translated the article. All the authors have approved the final version for submission. Jingying Liu and Hongwen Ma contributed equally to this work. Rongsai Wei and Qiaomei Zhang contributed equally to this work. Funding No funding was received for this research. Data availability The datasets used and/or analyzed during the study are available from the corresponding author upon reasonable request. Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Institutional Review Board of the Tianjin People’s Hospital (access number: 20240409C07). Before participation, all participants were presented with the study information online. Electronic informed consent was obtained from all participants prior to their enrollment in the study. Participants were asked to complete the online questionnaires independently and anonymously. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rongsai Wei and Qiaomei Zhang contributed equally to this study and should be considered co-first authors. Contributor Information Jingying Liu, Email: [email protected]. Hongwen Ma, Email: [email protected]. References 1. Perlman S, Shamian J, Catton H, Ellen M. Assessing the country-level involvement of nurses in COVID-19 vaccination campaigns: A qualitative study. Int J Nurs Stud. 2023;146:104569. [ DOI ] [ PubMed ] [ Google Scholar ] 2. Cummings GG, Lee S, Tate K, Penconek T, Micaroni S, Paananen T, Chatterjee GE. The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. Int J Nurs Stud. 2021;115:103842. [ DOI ] [ PubMed ] [ Google Scholar ] 3. 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