Kohnen et al.

Human Resources for Health (2024) 22:8 Human Resources for Health
https://doi.org/10.1186/s12960-023-00886-6

RESEARCH Open Access

Engaging leadership and nurse well‑being:

the role of the work environment and work
motivation—a cross‑sectional study
Dorothea Kohnen1,4* , Hans De Witte1,2 , Wilmar B. Schaufeli1,3 , Simon Dello4 , Luk Bruyneel4    and
Walter Sermeus4   

Abstract
Background Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related
well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership
and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Deter-
mination and Job Demands-Resources theory, this study aims to investigate the association between engaging lead-
ership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived
job characteristics (job demands and resources) and intrinsic motivation.
Methods A cross-sectional survey of 1117 direct care nurses (response rate = 25%) from 13 general acute care hos-
pitals in Belgium. Validated instruments were used to measure nurses’ perceptions of engaging leadership, burnout,
work engagement, intrinsic motivation and job demands and job resources. Structural equation modeling was per-
formed to test the hypothesised model which assumed a serial mediation of job characteristics and intrinsic motiva-
tion in the relationship of engaging leadership with nurse work-related well-being.
Results Confirmatory factor analysis indicated a good fit of the measurement model. The findings offer support
for the hypothesized model, indicating that engaging leadership is linked to enhanced well-being, as reflected
in increased work engagement, and reduced burnout. The results further showed that this association is mediated
by nurses’ perceptions of job resources and intrinsic motivation. Notably, while job demands mediated the relation-
ship between EL and nurses’ well-being, the relationship became unsignificant when including intrinsic motivation
as second mediator.
Conclusions Engaging leaders foster a favourable work environment for nursing staff which is not only benefi-
cial for their work motivation but also for their work-related well-being. Engaging leadership and job resources are
modifiable aspects of healthcare organisations. Interventions aimed at developing engaging leadership behaviours
among nursing leaders and building job resources will help healthcare organisations to create favourable working
conditions for their nurses.
Trial Registration: The study described herein is funded under the European Union’s Horizon 2020 Research and Inno-
vation programme from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered
in the ISRCTN registry (ISRCTN10196901).

*Correspondence:
Dorothea Kohnen
dorothea.kohnen@kuleuven.be
Full list of author information is available at the end of the article

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Kohnen et al. Human Resources for Health (2024) 22:8 Page 2 of 12

Keywords Leadership, Well-being, Motivation, Work environment

Introduction perceived by employees is not only beneficial for their

The nursing profession is under increased pressure due health but also for their work motivation. By inspiring,
to a global staff shortage and high turnover rates [1, 2]. strengthening, connecting, and empowering employ-
Nurses have to cope with high workload that, combined ees, engaging leaders are supposed to balance their fol-
with other work-related demands, may have severe con- lower’s job demands and resources in such a way that
sequences not only for their own physical and psycho- they remain healthy, motivated, productive, and satis-
logical health but also for their patients’ safety [3–5]. fied [11]. This resonates with research indicating that
Empirical evidence suggests that leadership behavior leaders, including engaging leaders, indirectly influence
has a profound impact on nurses’ perceived work-related their followers’ well-being by shaping their perceptions of
strain and psychological well-being [6, 7]. For instance, their work environment (i.e., in the form of reduced job
poor leadership and lack of autonomy may contribute demands and improved job resources) [6, 7, 11]. SDT fur-
to nurse burnout, whereas recognition, rewards, and ther posits that employees perform and feel better when
acknowledgement may enhance work-related well-being their motivation is autonomous in nature (i.e., intrinsic).
[8–10]. A recent systematic review on nursing leadership A workplace where employees experience sufficient sup-
concluded that positive leadership styles (e.g., transfor- port, receive high-quality feedback, and have opportuni-
mational leadership) and empowerment of staff foster ties for professional development, therefore, provides the
nurses’ well-being at work [10]. fuel required for optimal motivation and leads to optimal
Despite the widely acknowledged importance of lead- functioning and well-being [20, 21].
ership in creating healthy workplaces, the majority of The overall aim of this study is to address the afore-
leadership studies have largely neglected its impact on mentioned conceptual and theoretical shortcomings
health-related outcomes, such as burnout and work of current leadership research by (1) using a new com-
engagement, mostly in favour of job performance or job prehensive measure of burnout, namely, the Burnout
satisfaction [7]. Even more, previous research has under- Assessment Tool [13, 22], (2) focusing on the concept
estimated (inadequate) leadership as a driving factor in of Engaging Leadership (EL) that is rooted in SDT, a
the development of employee well-being and ill-health, well-established theory of human motivation, and (3)
partly because of poor conceptualization, measurement, focusing on two explanatory mechanisms: perceived
or analysis of leadership and burnout [11]. For instance, job characteristics (i.e., job resources and job demands)
earlier studies assessed burnout rather as a one-dimen- and intrinsic motivation in the relationship of leadership
sional construct by solely focusing on the emotional with nurse well-being. Drawing on the Job Demands–
exhaustion dimension of the Maslach Burnout Inventory Resource (JD–R) leadership model and SDT, we propose
(MBI) [12]. The MBI is the most widely used instrument an integrative model which links EL with nurses’ per-
to assess occupational burnout; however, it has been fre- ceived work-related well-being (i.e., burnout and work
quently criticized because of conceptual, practical and engagement) through two explanatory mechanisms: per-
psychometric shortcomings [13]. Similarly, most burnout ceived job characteristics (job demands and resources)
research considered leadership behavior as rather narrow and intrinsic motivation.
(e.g., by social support) instead of a comprehensive, mul-
tidimensional concept [14]. In relation to leadership, pre-
vious leadership concepts, particularly transformational Theoretical background and study hypotheses
leadership, have been criticized, because they lack a theo- The JD–R leadership model
retical foundation and detailed description of the under- To explain the link between leadership behavior and
lying processes [15, 16]. Accordingly, there is still much nurse well-being, we use the JD–R leadership model
debate in the literature about the (motivational) underly- as conceptual model, an extension of the original
ing processes through which leaders influence employee JD–R model [11, 23, 24]. At its core, the JD–R model
well-being [10, 17]. proposes two psychological processes by which exces-
In the present study, the focus is on the concept of sive job demands and lacking job resources are asso-
engaging leadership (EL) [11, 18] which is measured and ciated with well-being. First, job demands foster—via
understood through the perceptions of nurses. Rooted burnout—negative outcomes (i.e., health impairment
in Self-Determination theory (SDT, [19]), our research process). Second, job resources yield—via work engage-
builds on the premise that a resourceful workplace as ment—positive outcomes (i.e., motivational process).
Job demands describe “aspects of the job that require
Kohnen et al. Human Resources for Health (2024) 22:8 Page 3 of 12

sustained physical or mental effort” [23] and, therefore, overload, emotional demands). These results were fur-
are said to drain employees’ energy. By contrast, job ther supported in a study among nursing staff [32].
resources are considered as the positive aspects of the
job “that are either/or (1) functional in achieving work Intrinsic motivation in the JD–R leadership model
goals, (2) reduce job demands and the associated physi- Another focus of the present study is to examine the
ological and psychological costs, (3) stimulate personal mediating role of work motivation in the JD-R leader-
growth, learning, and development’’ [23]. Job resources ship model by drawing on the main premises of SDT.
are assumed to have motivational potential as they may The focus is on one specific facet of motivation, namely,
not only promote work engagement but also reduce intrinsic motivation (as a form of autonomous motiva-
burnout. In this study, the focus is on both the nega- tion), which is defined as “the doing of an activity for
tive aspect (burnout) and positive aspect (work engage- its inherent satisfactions rather than for some separable
ment) of job-related well-being as leadership behaviour consequence” [33]. If people are intrinsically motivated
shows to have differential relationships with these con- to perform a task, they do so for its own sake, because
structs [7, 25]. Burnout is defined as a work-related they perceive the task as interesting and pleasurable [33].
state of mental exhaustion, which is characterized by Following the premises of SDT, nurses will feel intrinsi-
extreme tiredness, reduced ability to regulate cognitive cally motivated and healthier when they find themselves
and emotional processes, and mental distancing [13]. in a work environment providing them with sufficient
Being repeatedly confronted with heavy levels of work- job resources, such as autonomy, skill use, opportunities
load and other work-related stressors, nurses are con- for growth and development, performance feedback. On
sidered at a high risk of burnout [26]. In contrast, work the other hand, a demanding work environment in which
engagement refers to a positive, fulfilling, work-related nurses experience excessive job demands such as high
state of mind that is characterized by vigor (i.e., high workloads, emotional demands and a lot of bureaucracy
level of energy and mental resilience while working), might not only reduce their work motivation but also put
dedication (referring to a sense of significance, enthusi- them at a higher risk for burnout.
asm, and challenge), and absorption (being focused and Engaging leaders are expected to behave in such a way
happily engrossed in one’s work) [24, 27]. A large-scale that they fulfil their followers’ work-related basic needs
prevalence study of work engagement in 30 European [11] which, in turn, is expected to fuel intrinsic motiva-
countries revealed that employees in human service tion [34]. Schaufeli [11] proposes four components of
jobs such as health care reported higher levels of work EL, namely, empowering, strengthening, inspiring, and
engagement than employees in other types of indus- connecting. These may shape nurses’ perceptions of
tries [28]. their work environment, thereby nurturing their work
Following the JD–R leadership model, leadership is motivation. First, engaging leaders empower nurses by
one of the unique antecedents and plays a decisive role giving them a voice and by recognizing their ownership.
in both the health impairment and motivational pro- As a result, they will experience more autonomy and
cess [11, 29]. In other words, leaders who encourage control over their own job which is likely to foster their
and give supportive feedback, and who show recogni- intrinsic motivation. Second, nurses are strengthened,
tion, may provide nurses with sufficient resources and because engaging leaders assign them challenging tasks
thereby positively influence their health and well-being stimulating their talents and skills. Through strengthen-
(i.e., the motivational process) [9, 30]. In contrast, lead- ing, leaders foster nurses’ feeling of mastery and compe-
ers who fail to provide constructive feedback, who show tence, particularly through positive feedback, which are
less support, or who exert undue control and pressure on considered as one of the prerequisites for the develop-
their staff may—due to reduced resources and increased ment of intrinsic motivation. Third, nurses are inspired to
demands—contribute substantially to feelings of stress work towards an overall goal of the team or organization
reducing individual well-being (i.e., the health impair- driven by a commitment to a vision and encouraged by
ment process) [31]. Empirical research supports this their leader. The leader further acknowledges each mem-
assumption. For instance, Nielsen et al. [17] found that ber’s individual contribution towards the overall goal,
various work characteristics (e.g., role clarity, opportuni- which will increase nurses’ experience that their work is
ties for development) mediated the relationship between meaningful, and their contribution makes a difference.
leadership and health professionals’ well-being. In a As a result, they are likely to become intrinsically moti-
similar vein, Schaufeli [11] reported that EL is positively vated. Finally, engaging leaders connect their followers,
associated with work engagement through job resources for example, by fostering collaboration and a strong team
(e.g., task variation, role clarity) and negatively associated spirit. In doing so, they promote a work environment
with burnout through reduced job demands (e.g., work characterized by a sense of security and relatedness in
Kohnen et al. Human Resources for Health (2024) 22:8 Page 4 of 12

which nurses’ intrinsic motivation is expected to flour- leaders (a) support nurses to balance their job resources
ish. Hence, by empowering, strengthening, inspiring, and job demands and (b) nurture their intrinsic moti-
and connecting, engaging leaders are considered to cre- vation through improved working conditions, it is
ate favourable working conditions characterized by feel- expected that engaging leaders influence nurses’ work-
ings of autonomy, competence, meaning, and relatedness related perceived strain and well-being (i.e., reduced
which in turn will increase nurses’ intrinsic motivation. levels of burnout and increased work engagement). The
This experience is likely to result in higher levels of work proposed model is shown in Fig. 1. The hypotheses are
engagement and well-being. Previous studies have mainly as follows:
focused on the concept of transformational leadership.
Research on EL is, however, relatively new and has not H1 Job demands mediate the relationship of EL with
widely been researched yet. Nevertheless, SDT-based 1a) burnout and 1b) work engagement.
research generally supports this assumption [35, 36].
For instance, a meta-analytic review shows that a work H2 Job resources mediate the relationship of EL with
environment where leaders support their employees to 2a) work engagement and 2b) burnout.
work autonomously is not only beneficial for the satisfac-
tion of employees’ basic needs but also for their (intrin- H3 The relationship of EL with intrinsic motivation is
sic) motivation [37]. While the researchers found that mediated by 3a) job demands and 3b) job resources.
leader autonomy support was positively related to intrin-
sic motivation, it showed, on the other hand, negative H4 Job demands and intrinsic motivation mediate
associations with employees’ distress (i.e., burnout and the relationship of EL with 4a) burnout and 4b) work
work stress). These findings find support by Slemp et al. engagement.
[38] who conducted a meta-analytic review of 72 stud-
ies on the motivational processes and consequences of H5 Job resources and intrinsic motivation mediate the
leader autonomy support in the workplace—behaviours relationship of EL with 5a) work engagement and 5b)
that may be also typical of EL. Furthermore, Fernet et al. burnout.
[36] showed that (transformational) leadership was sig-
nificantly related to nurse well-being by contributing to
favourable working conditions and intrinsic motivation.
Methods
Objective and hypotheses Design and setting
We propose that engaging leaders indirectly influence The present study employed a cross-sectional data set
nurse well-being and intrinsic motivation by provid- of 1117 direct care nurses from 13 general acute care
ing more job resources and by reducing job demands. hospitals in the Flemish (i.e., Dutch speaking) region of
Focusing on the mediating role of job characteristics Belgium.
and intrinsic motivation, considering that engaging

Fig. 1 Hypothesised model

Kohnen et al. Human Resources for Health (2024) 22:8 Page 5 of 12

Data collection (inspiring). The value of Cronbach’s alpha for the total
The data used for this study were collected between May scale of EL was 0.96.
2022 and August 2022 in the context of the Horizon 2020
funded Magnet4Europe project [39]. The project aims Job demands and resources
to investigates doctors’ and nurses’ perceptions towards The questionnaire captured a set of five job demands
leadership, their working environment, motivation, and and seven job resources which were mostly derived from
well-being. In the present study, we report only on the the Energy Compass psychometric instrument [42].
data collected from the nurses that participated in the Job resources included autonomy (4-items), role clar-
survey. Data were processed in line with the General ity (2-items), performance feedback (3-items), skill use
Data Protection Regulation 2016/679 of the European (1-item), opportunities for growth and development
Union (EU, [40]). More information on the data collec- (1-item), task variety (1-item), and value congruence
tion process in general can be found in Kohnen et al. [21]. (1-item). Job demands included role conflicts (3-items),
workload (4-items), red tape (1-item), emotional dis-
Participants sonance (1-item), and emotional demands (1-item). For
A total of 5889 registered nurses were invited to par- every respondent, composite scores of all job demands
ticipate in the survey. Registered nurses were eligible to and job resource measures were generated, i.e., scores on
participate if they had direct patient contact and worked the seven job resources as well as on the five job demands
on adult inpatient units, including intensive care units were each combined into one mean value. The value of
(ICU) and the emergency room (ER). Of the 5445 ques- Cronbach’s alpha for both scales were 0.84.
tionnaires sent, 1374 were filled in and returned, which
yielded a response rate of 25%. To keep the work situa- Intrinsic motivation
tion rather constant and comparable, the target popula- Intrinsic motivation was assessed with three items
tion for this study included nursing professionals in the from the Work Extrinsic and Intrinsic Motivation Scale
same job level, i.e., direct care nurses [41]. Accordingly, (WEIMS, [43]), rated on a five-point Likert scale ranging
the final data set consisted of 1117 observations. Regard- from completely disagree (1) to completely agree (5). The
ing the demographic characteristics, 82% of the nursing header for the scale was: “Please indicate to what extent
staff were female, the average age was 40 years (sd = 12) each of the following items corresponds to the reasons
and they had been working in their current hospital for why you are presently involved in your work.” An exam-
15 years on average (sd = 11). Direct care nurses from ple item was “Because I derive much pleasure from learn-
all types of departments were included in the study. The ing new things.”. The value of Cronbach’s alpha for this
majority was working in intensive care (25.3%), followed scale was 0.83.
by nurses active on surgical (18.5%), internal (17.5%), and
geriatric (12.5%) units. Burnout
Burnout was measured using the short version of the
Measures Burnout Assessment Tool (BAT), a novel self-report
A description of all measures, based on existing scales questionnaire [13]. The short version of the BAT [44]
available in Dutch, and their internal consistencies consists of 12-items that assess the presence of the four
(Cronbach’s alpha) are described below. Unless stated core burnout syndromes, with three items each: “At work,
otherwise, all variables were scored on a five-point Likert I feel mentally exhausted” (exhaustion), “I feel a strong
scale ranging from 1 (never) to 5 (always). aversion towards my job” (mental distance), “At work, I
may overreact unintentionally” (emotional impairment),
Engaging leadership and “When I’m working, I have trouble concentrating”
Employees perception of engaging leadership was meas- (cognitive impairment). The value of Cronbach’s alpha for
ured with the 12-item Engaging Leadership scale [11, the total burnout scale was 0.90.
29]. The instrument assesses the four core dimensions
of EL with three items each. In the Dutch version of the Work engagement
survey instrument, the term ’leidinggevende’ was used Work engagement was measured using three items from
to refer to ’supervisor.’ Example items were: “My super- the Dutch version of the Utrecht Work Engagement
visor delegates tasks and responsibilities to team mem- Scale (UWES, [45]). The UWES-3 assesses the three core
bers” (strengthening), “My supervisor encourages among dimensions of work engagement, with one item each.
team members to cooperate” (connecting), “My super- An example item was: “At my work, I feel bursting with
visor encourages team members to voice their opin- energy” (vigor). The value of Cronbach’s alpha for this
ions” (empowering), and “My supervisor is inspiring” scale was 0.84.
Kohnen et al. Human Resources for Health (2024) 22:8 Page 6 of 12

Covariates engagement. Rather, it was assumed that these relation-

To rule out the possibility that the associations can be ships are explained through job demands and resources.
explained by relevant third variables, we controlled for Following Hayes [51], a significant association between
the impact of the hospital, gender, and age. the predictor and the outcome is neither a necessary nor
a sufficient condition of mediation. Yet, the direct paths
Data analysis from EL to each outcome variable were also added in
Data analysis was done using SPSS Version 28 [46] and the SEM. Any direct associations among the variables
Mplus Version 8.6 [47]. To estimate our model, we per- included in this study are documented in the supplemen-
formed structural equation modeling (SEM) with maxi- tary material of this study (Additional file 1: Appendix 1).
mum likelihood estimation methods. In line with the
two-stage approach proposed by Anderson and Gerb- Results
ing [48], we first tested the measurement model and in Table 1 provides information on the means, standard
a second step the hypothesised structural model. The deviations, and correlations for all constructs. Corre-
measurement model was tested using Confirmatory Fac- lations among the variables included were statistically
tor Analysis (CFA). We considered a number of fit indi- significant and in the expected direction. In addition,
ces to assess how well the hypothesised measurement we used correlational analyses to verify the associations
model fits to the data [49, 50]: Comparative Fit Index between the sociodemographic variables (i.e., age and
(CFI), Tucker–Lewis Index (TLI), the Root Mean Square gender) and the variables of our model. Age significantly
Error of Approximation (RMSEA) and the Standardised correlated weakly with intrinsic motivation (− 0.139,
Root Mean Residual (SRMR). For the CFI and TLI, values p < 0.001), work engagement (0.086, p < 0.001), and burn-
above 0.90 indicated an adequate, values above 0.95 an out (− 0.104, p < 0.001), while gender showed no signifi-
even better model fit. For the RMSEA values should ide- cant correlations with any of the variables. In addition,
ally be below 0.06 and for SRMR below 0.08, respectively. when including these variables as controls, the hypoth-
Next, the hypothesised structural model was evaluated. esised associations did not change substantially. The
Bootstrapping was applied with a resample procedure of same was observed when including hospitals as covariate.
1000 bootstrap samples to determine the point estimate Therefore, to aid clarity, we report the most parsimoni-
and bias-corrected and accelerated 95% confidence inter- ous analysis without including hospitals, age and gender
val (CI) of the total and specific indirect effect [51, 52]. as control variables [54].
Bootstrapping is recommended as the indirect effect (the
product of the coefficients of the predictor and mediator Confirmatory factor analysis
variable) is not normally distributed [53]. A bootstrapped A CFA was conducted to evaluate the measurement
confidence interval (lower level of confidence inter- model which consisted of six correlated latent vari-
val − upper level of confidence interval, LLCI − ULCI) ables: engaging leadership (a second-order factor
that does not include the null value is indicated as sta- represented by its four dimensions strengthening, con-
tistically significant. As shown in Fig. 1, we did not necting, empowering, and inspiring; each represented
hypothesise direct relationships between EL and intrin- by their three corresponding items), job demands
sic motivation, or between EL and burnout and work (a first-order factor represented by items assessing

Table 1 Means, standard deviations, and Pearson correlations among study variables
Concept (# of items) Mean SD Correlations
1 2 3 4 5 6 7 8

1. Gender – – 1
2. Age 40 12 − 0.059* 1
3. Engaging Leadership (12) 3.49 0.81 0.018 0.011 1
4. Job Demands (10) 3.30 0.48 − 0.039 − 0.009 − 0.302** 1
5. Job Resources (13) 3.40 0.48 0.039 0.032 0.565** − 0.405** 1
6. Intrinsic Motivation (3) 3.80 0.62 0.047 − 0.139** 0.247** − 0.213** 0.456** 1
7. Work Engagement (3) 3.49 0.67 0.061 0.086** 0.341** − 0.348** 0.527** 0.497** 1
8. Burnout (12) 2.18 0.57 0.023 − 0.104** − 0.315** 0.589** − 0.468** − 0.347** − 0.591** 1
**Correlation is significant at the 0.01 level (two-tailed), gender was coded 1 = male and 2 = female. The range of scale for all variables is 1–5
Kohnen et al. Human Resources for Health (2024) 22:8 Page 7 of 12

workload, role conflicts, emotional demands, bureau- Results of the mediation analysis
cracy, and emotional dissonance), job resources (a First, we tested the main premises of the JD-R model (cfr.
first-order factor represented by items assessing auton- Fig. 2). Our results indicted a positive relationship of job
omy, performance feedback, role clarity, task variety, demands with burnout (β = 0.576, p < 0.001) as well as a
skill use, opportunities for growth and development, positive relationship of job resources with work engage-
and value congruence), intrinsic motivation (a first- ment (β = 0.444, p < 0.001). In addition, job resources
order factor represented by its three items), burnout were negatively related to burnout (β = − 0.311, p < 0.001).
(a second-order factor represented by its four dimen- Table 2 provides information on the indirect relation-
sions exhaustion, mental distance, cognitive impair- ships and mediating effects. Our first set of hypotheses
ment, and emotional impairment; each represented aimed at testing the main assumptions of the JD-R lead-
by their three corresponding items), and, finally, work ership model, i.e., job demands and job resources are
engagement (a first-order factor represented by its expected to mediate the relationship of EL with nurse
three items). The results of the CFA indicated a good well-being (burnout and work engagement). In relation
fit of our hypothesised measurement model, with χ2 to H1a, we observed an indirect effect of EL on burn-
(797) = 2566.703, CFI = 0.93, TLI = 0.93, RMSEA = 0.05, out via job demands (β = − 0.218) which was statistically
and SRMR = 0.06. All indicators showed significant fac- significant according to the bootstrap CI 95% (− 0.272,
tor loadings on their respective latent factors (p < 0.001) − 0.176). With regard to H1b, our results showed an indi-
with λ values ranging from 0.38 to 0.93. A reliable rect effect of EL on work engagement via job demands
measurement model was, therefore, obtained. (β = 0.064) which was statistically significant according

Fig. 2 Structural model of intrinsic motivation in the JD-R leadership model. Coefficients represent standardized estimates. **p < 0.001

Table 2 Indirect effect of engaging leadership on burnout and work engagement through job demands, job resources, and intrinsic
motivation
Hypothesis Predictor Mediator Outcome β ρ LLCI ULCI

1a Engaging Leadership Job demands Burnout − 0.218 0.000 − 0.272 − 0.176

1b Engaging Leadership Job demands Work engagement 0.064 0.000 0.035 0.100
2a Engaging Leadership Job resources Work engagement 0.260 0.000 0.192 0.342
2b Engaging Leadership Job resources Burnout − 0.183 0.000 − 0.262 − 0.121
3a Engaging Leadership Job demands Intrinsic motivation 0.011 0.457 − 0.018 0.040
3b Engaging Leadership Job resources Intrinsic motivation 0.368 0.000 0.286 0.457
4a Engaging Leadership Job demands and intrinsic motivation Burnout − 0.002 0.461 − 0.007 0.003
4b Engaging Leadership Job demands and Intrinsic motivation Work engagement 0.003 0.462 − 0.005 0.012
5a Engaging Leadership Job resources and intrinsic motivation Work engagement 0.104 0.000 0.070 0.144
5b Engaging Leadership Job resources and intrinsic motivation Burnout − 0.058 0.000 − 0.095 − 0.032
β = Standardized beta, LLCI = lower level of bootstrap confidence interval, ULCI = upper level of bootstrap confidence interval
Kohnen et al. Human Resources for Health (2024) 22:8 Page 8 of 12

to the bootstrap CI 95% (0.035, 0.100). These results con- results from the structural equation modeling largely
firm H1a and H1b. support this model: engaging leaders can shape nurses’
With regard to H2a, our results showed an indi- perceptions of their work and create a work environ-
rect effect of EL on work engagement via job resources ment that is characterized by more resources and fewer
(β = 0.260), which was statistically significant according demands. Particularly, by providing nurses with suffi-
to the bootstrap CI 95% (0.192, 0.342). In relation to H2b, cient job resources such leaders do not only nurture their
the results further indicated an indirect effect of EL on intrinsic motivation but also foster their perceived well-
burnout via job resources (β = − 0.183). This effect was being (i.e., reduced levels of burnout and increased work
statistically significant according to the bootstrap CI 95% engagement).
(− 0.262, − 0.121). Accordingly, these results support Overall, our results are in line with what has been sug-
H2 and, therefore—taken together with H1a—the main gested by previous studies: job resources appear to be a
assumptions of the JD-R leadership model. crucial factor for nurse work engagement, whereas job
Next, it was hypothesised that the relationship of EL demands remain an essential driver of burnout. Con-
with intrinsic motivation is mediated by job demands sistent with the JD-R leadership model, we found that
(H3a) and job resources (H3b). The observed indirect job demands mediated the relationship between EL and
association between EL and intrinsic motivation via burnout (H1a). Similarly, job demands mediated the rela-
job demands (β = 0.011) was not statistically signifi- tionship between EL and work engagement (H1b) indi-
cant according to the bootstrap CI 95% (− 0.018, 0.040). cating that engaging leaders can rule out the detrimental
Regarding H3b, our results showed an indirect effect of effect of job demands on nurse well-being. Job resources,
EL on intrinsic motivation via job resources (β = 0.368) on the other hand, mediated the relationship of EL with
which was statistically significant according to the boot- work engagement (H2a) but also with burnout (H2b).
strap CI 95% (0.286, 0.457). In short, while the results do These results illustrate that engaging leaders indirectly
not support H3a, they do confirm H3b. influence nurses’ well-being by shaping their perceived
Our next set of hypotheses stated that job demands and job resources and job demands. By empowering, inspir-
intrinsic motivation mediate the relationship of EL with ing, strengthening, and connecting, engaging leaders
burnout (H4a) and work engagement (H4b). We found create a more favourable work environment for nurses
that the indirect effect of EL on burnout via job demands characterized by reduced demands (less workload, emo-
and intrinsic motivation (β = − 0.002) was not statistically tional demands, role conflicts) and increased resources
significant according to the bootstrap CI 95% (− 0.007, (sufficient autonomy, task variety, skill use and feedback).
0.003). In relation to work engagement, we observed As a result, nurses will not only experience higher levels
an indirect effect of EL on work engagement via job of work engagement, also, they are less likely to experi-
demands and intrinsic motivation (β = 0.003). This effect ence feelings of burnout. These results are in line with
was not statistically significant according to the bootstrap the findings reported in previous studies [11, 32]. For
CI 95% (− 0.005, 0.012). These results do not confirm H4. instance, by including a wide variety of job demands
Finally, it was hypothesised that job resources and (i.e., emotional demands, role conflict, work overload)
intrinsic motivation mediate the relationship of EL with and job resources (i.e., job control, task variety, skill use),
work engagement (H5a) and burnout (H5b). The results Schaufeli [11] found that followers’ perceptions of their
show that EL had an indirect on work engagement via work characteristics mediated the relationship between
job resources and intrinsic motivation (β = 0.104). This EL and employee well-being.
effect was statistically significant according to the boot- In addition, our findings underscore the impor-
strap CI 95% (0.070, 0.144). In addition, we found that EL tance of work motivation in the JD-R leadership model.
had an indirect effect on burnout via job resources and Through increased job resources, engaging leaders seem
intrinsic motivation (β = − 0.058), which was statistically to foster nurses’ intrinsic motivation (H3b). Particu-
significant according to the bootstrap CI 95% (− 0.095, larly, the results indicate that nurses who feel empow-
− 0.032). Consequently, these results support H5. ered, inspired, strengthened, and connected through EL
behavior are more likely to perceive sufficient autonomy
Discussion and a strong connection with their team. In addition,
Based on the JD-R leadership model and SDT, we tested they will believe in their ability to master their work and
an integrative model which links engaging leadership to contribute meaningfully to the workplace. Conse-
with nurses’ perceived work-related well-being (i.e., quently, they will find themselves in a work environment
burnout and work engagement) through two explana- in which their intrinsic motivation is expected to flour-
tory mechanisms: perceived job characteristics (job ish. Following SDT, these results suggest that engaging
demands and resources) and intrinsic motivation. The leaders foster—via job resources—an internalization
Kohnen et al. Human Resources for Health (2024) 22:8 Page 9 of 12

process in nurses, inducing a sense of enjoyment and sat- and more research is needed to fully understand employ-
isfaction while performing their job [55]. Even more, as ees’ motivation in the workplace [37].
illustrated in the current sample, nurses are likely to feel
more engaged at work (H5a), while they are less likely to
develop feelings of burnout (H5b). This study adds to the Limitations
accumulating evidence of the JD-R model and SDT by Some limitations of the present study need to be men-
showing that leadership behavior has a profound impact tioned. First, this study employed a cross-sectional design
on nurses’ perceptions of their work environment, their which precludes to establish definite conclusions about
work motivation, and work-related well-being. causal relationships between the variables. Future stud-
Contrary to our expectations, we found no mediat- ies could revalidate the model using longitudinal designs.
ing effect of job demands and intrinsic motivation in the Second, we observed a relatively low participation rate
relationship of EL with nurses’ burnout (H4a) and work (25%) in our sample which raises concerns around sam-
engagement (H4b). Although job demands mediated the pling bias. While the COVID-19 pandemic and the
relationship between EL and nurses’ well-being, the rela- associated survey fatigue among health professionals
tionship became unsignificant when including intrinsic might be an explanation for the low response rates [56],
motivation as second mediator. Overall, these findings research on nursing staff seems to report similar if not
align with a recent study by Kohnen et al. [21]. In a sam- even lower response rates of 10–15% [57]. Similarly, our
ple of 1729 direct care nurses in Belgium, the authors sample consisted of direct care nurses working in Bel-
investigated the mediating role of intrinsic motivation gian hospitals (n = 13), which puts some limitation on
in the relationship of job demands and job resources the generalization of our findings. While the homogene-
with nurse work-related well-being. The results showed ous sample minimizes the influence of contextual factors,
that intrinsic motivation did not mediate the relation- allowing for a straightforward test of our hypotheses, the
ship of job demands with nurse well-being. In a similar results should be interpreted with caution. A replica-
vein, intrinsic motivation showed no associations with tion of our study among other health professionals, such
job demands in general. In relation to the current study, as physicians, or in other countries that are part of the
our findings prompt further exploration into the specific Magnet4Europe study [39], as well as over time would
aspects of EL, as it may not be effectively predicting the strengthen the external validity of our findings. Third,
associations of job demands and intrinsic motivation several job demands and resources were measured using
with nurses’ work-related well-being. Yet, another pos- few or even single items scales from validated instru-
sible explanation is that the relationship between job ments. Internal consistencies of the scales, however, were
demands and nurse well-being is influenced by other beyond the usual criterion of 0.70, with a value of α = 0.84
types of motivation, such as external regulation, as a form for both scales. While scholars in occupational research
of controlled motivation. SDT arranges different forms seem to prefer multiple-item over single-measures, a
of motivation along a continuum of self-determination, recent study confirmed the validity of several single-item
ranging from more controlled to more autonomous measures, such as job control [58]. Another limitation in
motivation. While the most autonomous form of moti- relation to our measures is that employees’ perceptions of
vation, i.e., intrinsic motivation, is at one extreme of the EL have been measured instead of surveying supervisors
continuum, the most controlled form of motivation (i.e., themselves. Future research might benefit from assessing
external regulation) is at the other end of the spectrum. leadership behavior by surveying non-followers. Simi-
External regulation occurs when employees engage in a larly, all concepts included in this study were obtained
certain behavior or activity for purely instrumental rea- through self-reports. As such, the strength of the effects
sons, such as to obtain rewards, to avoid punishment, reported herein may have been biased due to common-
or simply because they are being pressured by demands. method variance or because of the wish to answer con-
Indeed, previous research and meta-analytic evidence sistently [59]. This may be resolved in future research by
demonstrated that external regulation, and particularly including “objective” indicators of work characteristics,
amotivation (i.e., lack of motivation, employees shows such as nurse staffing levels, nurse–patient ratios or aver-
no interest or engagement in performing a task), exerted age hours worked per week. Finally, while the quantita-
only negative influence on employee functioning, leading tive nature of this study offers limited insights into the
to distress and burnout [36, 37]. This may suggest that local context, future investigations could enhance under-
autonomous and controlled motivation or amotivation standing by incorporating qualitative research methods,
are inversely associated with employees’ psychological such as interviews and focus groups. Notably, in the con-
functioning. However, empirical evidence on the indi- text of the Magnet4Europe study, interviews and focus
vidual effects of the different motivational types is scarce groups have been performed among nursing staff which
Kohnen et al. Human Resources for Health (2024) 22:8 Page 10 of 12

might offer valuable insights into their perceptions of the Conclusion

clinical work environment. Drawing on the JD-R leadership model and SDT, the
present study tested an integrative model which links
EL with nurse work-related well-being (i.e., burnout
Implications for practice and work engagement) through two explanatory mech-
Despite the aforementioned limitations, our study has a anisms: perceived job characteristics (job demands
few practical implications for healthcare organizations. and resources) and intrinsic motivation. The findings
First, the results of this study confirm that EL indirectly provide support for the hypothesised model, suggest-
influences nurses’ well-being by shaping their percep- ing that EL is associated with increased well-being
tions of their working environment. In particular, when (i.e., work engagement and burnout) by contributing
leaders provide nurses with sufficient job resources, such to favourable perceptions of job characteristics (more
as autonomy, feedback, and opportunities for develop- resources and less demands) and intrinsic motivation in
ment, nurses are likely to become intrinsically, i.e., auton- nurses.
omously motivated at work which seem to be beneficial
in two ways: first, it will foster their work engagement,
Abbreviations
and second, it will prevent them from burning out. The CFA Confirmatory factor analysis
findings illustrate that engaging leaders are key agents EL Engaging leadership
in shaping the clinical work environment and in creat- JD–R model Job demands-resources model
SDT Self-determination theory
ing a resourceful atmosphere that is needed to improve SEM Structural equation modeling
nurses’ motivation and well-being. Accordingly, health-
care organizations may benefit from investing into train- Supplementary Information
ing programs that support nurse leaders in developing The online version contains supplementary material available at https://​doi.​
EL behavior. As a matter of fact, research on leadership org/​10.​1186/​s12960-​023-​00886-6.
training programs shows that leadership behavior pro-
moting favourable working conditions, autonomous Additional file 1: Appendix 1: Table S1. Direct effects.

motivation, and well-being can be learned [60–62]. For

instance, a recent intervention study proposed a 6-day Acknowledgements
The Magnet4Europe Consortium consists of Walter Sermeus (director), Luk
training program on EL designed in co-creation between
Bruyneel, Hans De Witte, Wilmar B. Schaufeli, Simon Dello, Dorothea Kohnen
senior leaderships and team leaders [61]. Peer consulta- (Belgium, Catholic University Leuven); Linda Aiken (codirector), Matthew
tion and personal coaching were offered between training McHugh, Colleen A. Pogue, Mary DelGuidice, Herbert Smith, Timothy
Cheney, Douglas Sloane (USA, University of Pennsylvania); Reinhard Busse,
days to support the integration of the program. The find-
Claudia Maier, Julia Köppen, Joan Kleine (Germany, Technical University
ings showed that training managers in EL behaviour was Berlin); Jonathan Drennan (Ireland, University College Dublin); Vera McCarthy,
associated with improved business results, lower absen- Elaine Lehane, Noeleen Brady, Anne Scott (Ireland, University College Cork);
Ingeborg Strømseng Sjetne (Norway, Norwegian Institute of Public Health);
teeism, and, most importantly, improved well-being [61].
Anners Lerdal (Norway, Lovisenberg Diaconal Hospital); Lars E. Eriksson, Rikard
Our findings further indicate that job demands (such as Lindqvist, Lisa Smeds Alenius, Ingrid Svensson, Ann Jacobsson (Sweden, Karo-
heavy workloads, emotional demands, and role conflict) linska Institute); Jane Ball, Peter Griffiths, Jackie Bridges, Sydney Anstee, Jaimie
Ellis (England, University of Southampton); Anne Marie Rafferty (England,
are an important antecedent of burnout, whereas job
King’s College London); Martin McKee (England, London School of Hygiene
resources (such as autonomy, performance feedback, and Tropical Medicine); Paul Van Aken, Danny Van Heusden, Kaat Siebens,
role clarity) are key predictors of nurse intrinsic motiva- Peter Van Bogaert (Belgium, University Hospital Antwerp), Oliver Sergeant
(Meplis NV).
tion and work engagement. Healthcare organizations are,
therefore, advised to invest in initiatives aimed at reduc- Author contributions
ing job demands and increasing job resources. Consistent DK: conceptualization, methodology, formal analysis, writing—original draft,
review and editing; HDW: conceptualization, methodology, writing—review
with the JD-R model, Bakker et al. [63] suggest a combi-
and editing; WBS: conceptualization, methodology, writing—review and edit-
nation of trainings and workshops, where participants ing; SD: data curation, validation, writing—review and editing; LB: validation,
learn about possible ways to actively modify job demands writing—review and editing, supervision; WS: validation, writing—review and
editing, supervision, project administration.
and resources in their job (i.e., job crafting). Research has
shown that such job crafting interventions can be very Funding
effective for employees in optimizing their perceptions of This study is funded by the European Union’s Horizon 2020 research and
innovation programme under the project Magnet4Europe: Improving Mental
their work environment [64]. To summarize, by promot-
Health and Wellbeing in the Health Care Workplace (Grant Agreement
ing EL, healthcare organizations may create resourceful Number 848031). The investigation presented here is the responsibility of the
environment for nursing staff which is not only benefi- authors only. The EU Commission takes no responsibility for any use made of
the information set out.
cial for their work motivation but also for their overall
well-being.
Kohnen et al. Human Resources for Health (2024) 22:8 Page 11 of 12

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1
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