Entrepreneurial leadership, nurses’ proactive work behavior, and career adaptability: a structural equation model

The research paradigm is elucidated by Bandura’s social cognitive theory (SCT), which offers a theoretical framework for grasping the effect of entrepreneurial leadership on nurses’ proactive work practices and career adaptability. According to SCT, an individual’s beliefs, deeds, and perceptions impact how they engage with behavior. Social structures and environmental influences often play a role in the development and change of human beliefs and cognitive capacities in this interaction between an individual and their surroundings. An individual’s conduct influences the features of their environment, which in turn influences their behavior, constituting the ultimate interaction between the environment and behavior [5]. The proposed conceptual framework in this study is built using this theoretical framework as a guideline (Fig. 1).

EL is the conduct of a leader who captivates followers with a compelling vision, gains their loyalty, and dedicates themselves to identifying and generating strategic value. EL combines the management of start-ups’ leadership with their entrepreneurial drive, enabling new businesses to create the required diversity and navigate a complex, dynamic environment by identifying avenues for growth, taking calculated risks, pointing out directions, and putting ideas into action. By their distinctive offerings, leaders methodically and interpersonally lead, facilitate, and mobilize a group of followers toward achieving exceptional performance and fulfilling the corporate goal. Nurse Managers have the potential to invigorate work activities by formulating a novel vision that can profoundly impact nurses’ capacity for career flexibility and proactive work habits [6‐8].

EL comprises seven key components. Framing the challenge is the ability of entrepreneurial leaders to set extraordinarily lofty goals and standards for the competence of people and their work. Absorbing uncertainty refers to an entrepreneur’s ability to take risks, foresee potential future developments, accept responsibility, form a vision, see the possibilities, and instill confidence in the staff. Underwriting is a way for an entrepreneurial leader to show their engagement in interpersonal negotiations and use their persuasive skills to persuade others to accept their ideas while also providing direction and support to followers [9, 10].

Building commitment involves inspiring followers, fortifying the group’s dedication to achievement, and fostering a sense of cohesion and collaboration among teammates. Defining gravity is the capacity to develop unity and cohesion via mutual understanding and consensus over the goals that need to be accomplished. Identifying and exploiting opportunities is defined as the entrepreneurial leader’s capacity to assess the variables that influence the probability of success or failure and make informed decisions. Orientation towards learning is an attitude toward learning that emphasizes development programs, being current with developing trends, and having a sharp sense of where to find relevant information [9, 10].

It has been shown through studies that EL enhances both individual and organizational performance. It acts as a catalyst to boost an organization’s competitiveness by empowering it to successfully negotiate environmental and crisis-related challenges and achieve sustainable growth, holistic care, and preservation. Additionally, it had a major impact on the development of strategies and tactics that promote creativity and opportunity recognition as well as unrestricted behavior (proactive, inventive, and organizational citizenship behavior) by modifying, responding to, promoting, and utilizing opportunities in the workplace to improve enactment [6‐12].

PWB entails anticipation, planning, and action to influence the future. It is also characterized as predictive, self-generated activities aimed at the future to improve the situation at hand or one’s personal qualities. Furthermore, it was clarified that an individual’s aspirational conduct, which is typified by a proactive strategy incorporating a proactive mentality, eagerness, and inventiveness, can initiate a shift in the current circumstances or generate new chances inside the workplace. PWB differs from a reactive and passive mindset that entails waiting for uncontrollable outside events to occur [13‐15].

Four elements are integrated into PWB. Taking charge is an intentional, self-directed endeavor started by nurses who are actively working to bring about good change inside the enterprise. Voice is the intention of attaining a favorable result. Individual innovation is a practice that comprises creating and utilizing advantageous modern thoughts to support the organization’s strategic durability and productive work. Problem prevention involves identifying the root of the issue and taking action to stop it from happening again soon. These proactive, independent preventative efforts are crucial to preventing workplace problems from recurring [16, 17].

PWB is essential for fostering career adaptability (CA) and attaining positive adaption outcomes, such as task competency, individual inventiveness, lower turnover, improved performance, and enhanced productivity that benefits the business. It helps nurses deliberately become experts in their work environment, especially when faced with change and uncertainty. This can help them feel competent in their roles. To anticipate upcoming trends and chances for gaining a competitive edge, it also functions as issue-selling and proactive external milieu analysis [18, 19]..

CA is a psychosocial foundation and a concoction of attitudes, abilities, and behaviors that help people manage difficult situations in their line of work, such as disappointments, traumatic experiences, and upcoming or current job changes. It’s a capacity to handle the predictable duties involved in getting ready for and doing a job, as well as the erratic alterations brought on by changes in the workplace and its surroundings. Additionally, it enables nurses to make career decisions and handle workplace difficulties by understanding both themselves and their occupation. As a result, nurses must be prepared to learn novel talents and adopt new working styles to deal with advances [20, 21].

Concern, control, curiosity, and confidence are the four hallmarks that comprise career adaptability. The concern is a future-oriented dimension of CA and comprises the mental process of imagining prospective career paths and devising strategies to accomplish professional objectives. Control demonstrates how much nurses endorse self-control and accept responsibility for their future occupational success, establishing a feeling of autonomy and precision and facilitating an efficient performance of professional and developmental duties. Curiosity refers to the exploration of one’s potential professions. It arises from a curious attitude toward future work opportunities as well as a willingness to investigate scenarios when faced with career changes. Confidence is described as feelings of self-confidence and nurses’ belief in their capacities to pursue professional goals and aspirations in the face of threats [22].

CA improves career management and provides a better understanding of work-related concerns. It has a favorable impact on occupational and work outcomes, including job success, job performance, well-being, employability, entrepreneurial intentions, and professional fulfillment, as well as lower job stress and attrition [23, 24].

Nurses’ performance has been influenced by many factors, including their usage of the internet, telecommunications, and highly revolutionary technology like artificial intelligence. Furthermore, because of the current COVID-19 outbreak, nurses have faced increased work pressures, a work-life imbalance, and a nursing shortage, according to the ICN study report 2023. The nurse shortage has increased dramatically from 30.6 million in 2019 when the epidemic began. Furthermore, COVID-19 has altered the dynamic structure of contemporary organizations, forcing both practitioners and scholars to focus on establishing work behaviors that are change-oriented, future-focused, self-starting, and career-adapted. These variables are reflected in scholars’ findings and documented high levels of nurses’ turnover intentions, low percentage of career adaptability, and proactive work behaviors among nurses [25‐30].

Among several contextual factors, EL is an emerging leadership style that is still in its embryonic stages of empirical and theoretical development and has a considerable impact on the behaviors of followers [31]. Despite previous research demonstrating the importance of entrepreneurial leadership, less is known about the influence of nurse managers’ EL behaviors on nurses’ PWB and CA. Therefore, this study addresses this empirical knowledge gap theoretically and empirically and gives further exploration of the importance of EL for nurse managers in improving PWB and the CA of nurses.

What is the relationship between EL, nurses’ PWB, and CA?

Null H0: There is no significant relationship between EL, nurses’ PWB, and CA.

Alternative H1: EL as an independent variable will significantly correlate with both nurses’ PWB and CA.

Cronbach’s alpha correlation coefficient was utilized to assess the internal consistency of the study instruments. The results confirmed that the three instruments were reliable. Five academics in the field evaluated the translation’s fluency and content validity by translating tools into Arabic for Egyptian cultural relevance. As a result, several elements have been changed to improve clarity. Language experts then translated the tools back into English. The researchers and jury members assessed the back-translations to verify accuracy and reduce any threats to the research’s validity. We also conducted a test run on 45 nurses (10%) who were not study participants to verify that the tools were clear and applicable, as well as to estimate the amount of time it would take to complete the questions. Considering the pilot research findings, no amendments have been made to the final tools.

Having formal approval from the governing body for the designated environment enabled data collection to take place. Data was collected after the researchers described the purpose of the study and obtained subjects’ consent by delivering questionnaires personally to study participants. Each nurse completed the questionnaires in around 30 minutes. Data was collected over 4 months, from February to May of 2023. During data collection, the researchers tried to overcome the common method biases by ensuring confidentiality and anonymity of replies as they notified the participants that the information they provide will be safely stored, combined, and utilized exclusively for the study. Additionally, the researchers used various response forms to gather the required data, create surveys with items arranged in a random sequence, and gather data at various intervals.

Cronbach’s alpha was used to assess the tools’ dependability. The participant’s demographic data and study variables were analyzed using frequency and percent; the study variables were described using a mean score and standard deviation. Pearson’s correlation was used to study the associations between EL, PWB, and CA. AMOS Ver. 23 was utilized to investigate the impact of entrepreneurial leadership on nurses’ proactive work behavior and career adaptability through structural equation modeling (SEM). The model fit indices included the evaluation of; χ2/df = Chi Square/degree of freedom, CFI = Comparative fit index; IFI = Incremental Fit Index; RMSEA = Root Mean Square Error of Approximation; NFI = Normed fit index; RFI = Radio Frequency Interference; NNFI (Non-Normed Fit Index); SRMR (Standardized Root Mean Square Residual); GFI (Goodness of Fit Index); AGFI (Adjusted Goodness of Fit); TLI (Tucker-Lewis Index). The model can be judged for its fitness based on Schermelleh et al., (2003) [36] as follows;

The mean age of the staff nurses was 34.20 ± 7.72 years. Half of them were in the age group of 30–40 years old. Most of them (92%) were female, and more than two-thirds (66.7%) were married. Concerning educational qualifications, 43.5% of them had a bachelor’s degree in nursing science. The mean years of experience were 9.12 ± 5.24 years, with 30.9% of them having 5 to less than 10 years of experience.

Table 1 declared that nurses perceived a moderate mean score of overall EL (140.84 ± 11.94), which represented a moderate mean score of its related dimensions: framing the challenges (18.35 ± 1.77), absorbing uncertainty (14.08 ± 2.05), underwriting (19.25 ± 2.03), building commitment (17.17 ± 2.20), defining gravity (20.37 ± 1.80), opportunity identification and exploitation (32.17 ± 4.44), and orientation towards learning (19.45 ± 2.39).

Table 2 illustrates that nurses perceived a moderate frequency mean score of overall PWB (46.02 ± 5.85), which represented a moderate mean score of its related dimensions: problem prevention (10.63 ± 1.58), individual innovation (9.24 ± 1.54), voice (14.72 ± 2.02), and taking charge (11.43 ± 1.81).

Table 3 showed that nurses perceived a moderate mean score of overall CA (85.55 ± 10.35) which represented in moderate mean score of its related dimensions; concern (19.18 ± 3.13), control (23.30 ± 3.28), curiosity (21.00 ± 3.03) and confidence (22.07 ± 2.85).

Table 4 clarifies that there was a statistically significant positive moderate correlation between EL and PWB, EL and CA, and CA and PWB where (r = 0.449, p = 0.000**), (r = 0.359, p = 0.000**), (r = 0.319, p = 0.002**).

Table 5 and Fig. 2 Testing on construction models was done to confirm the suggested research hypothesis. According to the test results, the goodness of fit index is composed of the following values: CFI = 0.928; IFI = 0.930; RMSEA = 0.082; TLI = 0.910; RMR = 0.276; SRMR = 0.090; X² = 134.789; P = 0.000; df = 84 and χ2/df = 1.605. However, the values of NFI = 0.834; RFI = 0.793; GFI = 0.845; AGFI = 0.779; and NNFI = 0.7925 were slightly less than the acceptable level. It can be claimed that the structural the majority of model’s parameters revealed a good fit index. So, it can be said that this model presents that EL has a significant effect on nurses’ PWB with an estimated β of 0.785, coefficient of regression C.R. of 3.415, at P value < 0.001. Also, it significantly affects CA with an estimated β of 0.997, a coefficient of regression C.R. of 2.72 at P value < 0.001.

Table 6 Initial Model Values, Modified Model Values, and One Factor Model Values of EL, CA, and PWB demonstrate the validity and reliability of the study variables. Based on the test result of Confirmatory Factor Analysis (CFA) on the construct of EL, it is seen that the value of λ (loading factor) in every dimension is > 0.5. It means that all the indicators in the dimensions have been valid (first order). Likewise, the value of CR is ≥0.70, and VE is≥0.50. Thus, it can be concluded that all the indicators used in this study have good validity and reliability values. Considering CA, the value of λ (loading factor) in every dimension is > 0.5. It means that all the indicators in the dimensions have been valid (first order). Likewise, the value of CR is ≥0.70, and VE is ≥0.50. Thus, it can be concluded that all the indicators used in this study have good validity and reliability values. As regards PWB, the value of λ (loading factor) in every dimension is > 0.5. It means that all the indicators in the dimensions have been valid (first order). Likewise, the value of CR is ≥0.70, and VE is ≥0.50. Thus, it can be concluded that all the indicators used in this study have good validity and reliability values.

The limitations of the present research provide opportunities for further studies in the area. First, we concentrated on developing a structure equation model of EL, nurses’ PWB, and CA, and the limitations of this study can be illustrated as follows; the data was collected from only two private hospitals thus the generalization of findings might be restricted. Second, even though this study employed the SEM approach, the cross-sectional study design makes it impossible to demonstrate causality, which limits the evaluation of the influence of study factors. Finally, the data was collected through self-report measures that may be sensitive to subjectivity and response bias. To address these limitations, objective metrics will be required in the future through observational, longitudinal, qualitative, empirical, and multi-site research.

The research on the influence mechanism between EL and PWB and career adaptability has theoretically been enhanced and reinforced by this study. The practical ramifications of this study extend to staff nurses, nurse managers, and hospital human resources management practices. First, this study contributes to the body of knowledge on EL by creating and evaluating a novel model that explains how nurse managers’ EL fosters PWB and CA in nurses while also illuminating the relationship between these factors.

Second, there aren’t any studies evaluating the impact of EL on nurses’ PWB and CA that we are aware of in entrepreneurship literature. Additionally, this study offers novel insight that shows how entrepreneurial leaders enable staff members to create successful outcomes for nurses. Leaders can also utilize the study’s results to support EL as a means of fostering proactivity and CA. Thus, to enhance nurses’ PWB and CA as a proactive strategy for upgrading career success and outstanding organizational objectives and staying on top of the rapidly evolving healthcare industry, it is necessary to continuously update job knowledge and skills through additional training and educational programs.

Furthermore, managers can utilize the study’s results to support entrepreneurial leadership in fostering proactive environments that empower staff members to take initiative, feel self-assured, and develop their career flexibility. Also, these results inspire managers to create new healthcare business chances, and detecting market needs is a fundamental aspect of EL. Structuring a strategic, operational, and sustainable healthcare business plan that will be implemented by entrepreneurial leaders and proactive staff who are adaptable to their career opportunities. Additionally, hospital managers should recruit and retain top-talent staff to build EL with high-performing teams with enduring development opportunities. The research’s conclusions can also be used by academics through studying entrepreneurship in more research methodologies to better comprehend the additional tasks and duties that contemporary and aspiring business leaders must fulfill as well as to assist them hone their entrepreneurial leadership competencies.