How are empowering leadership, self-efficacy and innovative behavior related to nurses' agency in distributed leadership in Denmark, Italy and Israel?

Aim The purpose of the study was to introduce the concept of distributed leadership to international nursing management by conducting a cross-national investigation of its relationships with empowering nursing leadership, nurses' work self-efficacy and nurses' innovative behaviour. Background Distributed leadership theory suggests that when more people lead processes together, innovation will be superior to solo leadership. However, we need knowledge about how nurse managers may enhance nurses' distributed leadership agency (DLA), and whether such results are generalizable across countries. Method The cross-national survey with an overall purposeful sampling method used questionnaire data from hospital nurses from Israel (n = 239), Italy (n = 226) and Denmark (n = 709). We used validated scales measuring Empowering Leadership, Self-efficacy, Innovative Work Behavior and DLA. Results The results from all three countries showed that empowering leadership and work self-efficacy were positively related to DLA, which, in turn, was also related to more innovation. Conclusion The results may imply that nursing managers can increase workplace innovativeness by adopting an empowering leadership style that supports nurses' self-efficacy and distributes leadership tasks. Implications for Nursing Management The cross-country robustness of the results may encourage further research in distributed leadership in nurse management, notably with a focus on causal mechanisms.