Effect of nurse leadership on national survey and evaluation of inpatient satisfaction: a single-center correlation study

Nursing constitutes an essential element of contemporary healthcare and plays a crucial role in the current patient-centered healthcare framework [1‐3]. At present, the advancement of industrialization and urbanization, coupled with an aging population, and environmental and lifestyle changes, has led to a rise in chronic diseases, mental disorders, and major communicable diseases as increasingly prominent public health concerns [4]. So, the general public imposes greater demands on both the quantity and quality of nursing services [5]. Consequently, the nurse role has progressed beyond conventional positioning, with growing prominence on spearheading medical system reform, advocating for interdisciplinary collaboration, and actively engaging in policy-making [6‐8]. As the cornerstone of healthcare, clinical nurses not only ensure the smooth process of medical procedures and fulfill patient needs [9, 10], but also engage in close interactions with patients and their families across diverse healthcare settings [11, 12].

Nursing leadership refers to the ability of clinical nurses to organize and plan the delivery of safe and effective nursing practice activities and serves as a crucial determinant in improving quality and patient outcomes [12, 13]. The current understanding of nursing leadership emphasizes the capacity to inspire patients and their families, the nursing team, and the whole organization. Some reports have emphasized the necessity for general nursing professionals to cultivate nursing leadership [14, 15]. Increasing hospital managers focus on the cultivation of nursing leadership in frontline nurses, and a few studies have shifted their attention from nursing managers to clinical nurses to assess the impact of nursing leadership on nursing quality [16‐18]. It has been reported that the nursing leadership among clinical nurses is gradually improving, potentially resulting in a positive influence on facilitating nurse performance, providing quality care, and ensuring patient safety [19, 20].

Patient satisfaction plays a crucial role in assessing the quality of medical services and constitutes an essential component of the performance evaluation framework for tertiary public hospitals in China [21]. The clinical nursing staff at the frontline have the most frequent and prolonged contact with patients, thereby exerting a certain influence on patient evaluation of medical services [22]. However, current domestic and international studies on nursing leadership have primarily focused on nursing managers [12], with little attention paid to frontline nurses working in clinical settings. As the concept of nursing leadership extends to the essential abilities required in nurse-patient interactions, there are conflicting reports regarding the correlation between nursing leadership and patient satisfaction [23, 24]. Therefore, this study investigated the current status of nursing leadership in frontline nurses and explored its correlation with the national survey of inpatient satisfaction, aiming to provide evidence to cultivate nursing leadership of frontline nurses, and further improve patient satisfaction.

With the reform and advancement of the healthcare cause, nurses play a pivotal role within the medical framework. They are essential members of the healthcare team, custodians of medical quality and safety, and facilitators of seamless operations within the medical system [26, 27]. They contact patients directly in most medical services, and their responsibilities encompass executing physicians’ orders, monitoring patient conditions, and delivering health education, etc [28]. In various interactions with patients, their skills and competencies may potentially influence nursing quality and safety. This study suggests a close link between the leadership competencies of frontline nurses and patient satisfaction across various interactive dimensions. Specifically, the effective communication skills, problem-solving abilities, and nursing expertise assessed by the NLQ scale are identified as independent influential factors that significantly impact overall patient satisfaction, particularly about nurse-patient communication, pain management, and caregiver management satisfaction.

In 2007, Chinese scholars introduced the concept of nursing-team leadership competency, distinguishing it from manager leadership competency and highlighting the importance of fostering leadership competencies among frontline nurses [29]. Scholar Bard et al. proposed a novel interpretation of nursing leadership, defined as the capacity to anticipate developments in a rapidly evolving healthcare landscape, proactively address crises and challenges, and make meaningful contributions to global health [30, 31]. Thus, nursing leadership is no longer confined to managerial roles. Every nurse may exemplify nursing leadership by motivating and guiding the patients and their families, the healthcare team, and the whole organization.

At present, there remains a paucity of research examining the relationship between the leadership competencies of frontline nurses and their service recipients. International studies primarily concentrate on identifying the essential competencies required for effective nursing leadership, as well as delineating various leadership styles [32, 33]. It is a prevalent issue to conflate nursing leadership with nursing management, the nursing leadership was narrowly defined as the exclusive domain of nursing managers. This study also focuses on the relationship between nursing leadership and patient satisfaction. Unlike previous satisfaction surveys that employed percentage ratings, this study used the NHC-ISSE satisfaction survey issued by the National Health Commission, which evaluated nursing satisfaction from five dimensions through a Likert 4-point score. Furthermore, the focus shifted from the entire ward to individual nurses. Each nurse received an NHC-ISSE satisfaction survey from two to four patients. The average score was used as the satisfaction score for each nurse and then matched with the corresponding NLQ score one by one.

This study concentrated on general clinical nurses and categorized nursing leadership into seven dimensions according to the NLQ questionnaire developed by Hangzhou Normal University: interpersonal skill, communication skill, critical thinking ability, problem-solving ability, planning and organizing ability, nursing expertise, and self-protection ability—each emphasizing the nurses’ skills and competencies. This survey demonstrated an upper level of nursing leadership among the enrolled frontline nurses, similar to an investigation in China [34]. Among all average dimension scores of the NLQ scale, the critical thinking ability dimension scored the highest, and the nursing expertise dimension scored the next. This phenomenon may be attributed to the increasing number of nurses, elevated educational standards, and fine-sorted specialization in recent years. In comparison, the self-protection ability scored lower, suggesting the need for clinical nurses to enhance their self-protection training to handle potential disputes or conflicts with patients.

Our survey findings indicated a level of overall inpatient satisfaction with their responsible nurse, potentially attributable to the surveyed hospital’s status as a regional medical center and the nurses’ high standards of care and professional competence. Among all average dimension scores of inpatient satisfaction, patient satisfaction with caregiver management and discharge instruction was comparatively higher, reflecting a strong humanistic management concept of frontline nurses. Conversely, patient satisfaction with nursing-patient communication and pain management was comparatively lower, indicating that the surveyed nurses should enhance their expertise and competencies in these two domains. With the increasing patient needs for nursing services, effective nurse-patient communication serves as a cornerstone for establishing a good relationship [35]. In addition, the lack of effective integration between specialized knowledge and clinical practice in pain management among clinical nurses may lead to adverse effects on patients, triggering unnecessary physiological, psychological, and emotional responses [36]. Overall, patient satisfaction, an essential element of high-quality medical care, has garnered significant attention from healthcare providers, researchers, and policymakers [37]. In numerous countries, it has been institutionalized as a critical metric for assessing medical quality in hospitals [38, 39], and in the United States, it also serves as a vital reference for medical insurance and subsidies [40]. Relevant studies have shown that patient satisfaction is related to medical quality and efficiency, such as improving treatment compliance, reducing readmission rates and mortality rates, and shortening hospital stays [41]. Therefore, besides cultivating professional knowledge and skills, nurses should also pay attention to the cultivation of nursing leadership competencies.

Notably, this survey found minimal sociodemographic differences in NLQ scores of nurses and NHC-ISSE scores of patients, contrary to traditional expectations. In general, the leadership skills of frontline nurses are likely to develop progressively over time, particularly through engagement in roles such as preceptor, mentor, or charge nurse, which provide valuable experiential learning opportunities. Thus, nurses with higher education, senior titles, and more experience are generally expected to show stronger leadership abilities. The current results may stem from convenience sampling based on voluntary participation, likely overrepresenting nurses with leadership awareness. Future studies should use mandatory surveys covering all frontline nurses to improve representativeness and generalizability. Meanwhile, patients with higher education levels tend to have greater health awareness, while those with higher incomes may expect more from healthcare services, potentially leading to lower satisfaction. Therefore, the lack of sociodemographic differences in satisfaction scores requires further investigation, as current findings may be influenced by care provided by frontline nurses with leadership awareness, sampled via convenience sampling.

Up to now, the relationship between nurse leadership and patient satisfaction is rarely reported and remains controversial [24, 42]. This study revealed a positive correlation between NLQ and NHC-ISSE scales, along with their various dimensions, to differing extents. This finding implied that increasing nursing leadership of clinical nurses was associated with enhanced patient satisfaction. Furthermore, multivariate partial correlation analysis revealed the important role played by communication skills, problem-solving abilities, and nursing expertise of clinical nurses in influencing patient satisfaction. Effective nurse-patient communication constitutes a core factor of nursing practice, serving as a facilitator for fostering good relationships [43]. Through proactive communication and interaction, nurses can accurately evaluate patient needs, while patients can develop self-care competencies and adhere to treatment regimens. This mutual interaction can cultivate trust, thereby enhancing overall patient satisfaction [44]. Additionally, given the complexity and variability of patient conditions, nurses must possess strong adaptability [45]. A robust problem-solving ability is another core factor of nursing practice, facilitating the timely and effective resolution of medical and health problems, thereby enhancing the patient experience and satisfaction. Furthermore, nursing expertise serves as the essential foundation for effective care; it encompasses the requisite knowledge and skills, critical thinking abilities, and other personal attributes necessary for nurses to fulfill their responsibilities effectively [46]. The nursing expertise provides a direct impact on patient health and safety, which constitutes the most essential requirement and standard for ensuring patient satisfaction.

Nursing leadership ought to be an essential competency for every professional nurse. The survey findings indicate that nursing leadership and patient satisfaction within the hospital are positioned at a moderate-high level, yet there remains potential for enhancement. This survey has identified the communication skills, problem-solving abilities, and nursing expertise of clinical nurses as the primary factors influencing patient satisfaction. So, it is recommended to launch quality improvement initiatives to monitor the impact of nurse leadership on patient outcomes, with focused attention on the aforementioned leadership skills that significantly influence satisfaction levels. Additionally, future studies should consider conducting large-scale, multi-center investigations with enhanced control for potential confounding factors, as well as the application of regression analyses or longitudinal study designs. Definitizing the important impact of nursing leadership and the essential competencies on patient satisfaction can facilitate the training strategy adjustment of nursing competencies, potentially leading to improvements in nursing safety and quality.