Introduction
With the advent of the knowledge age in the 21st century, new technologies and theories are constantly evolving, necessitating that nurses adapt and develop new knowledge on a continuous basis in order to cope with the rapidly changing healthcare environment and patients’ growing health needs [1]. However, processing a substantial amount of information within a limited timeframe can impose a significant burden on nurses, potentially leading to information overload, burnout, and negative emotional states, which can subsequently impair their capacity for clinical decision-making and ultimately affect the health and well-being of patients [2]. Studies have shown that healthcare professionals are at high risk of working alone and burnout, and 74.3% of them expect to be able to share information resources and achieve more collaboration and communication [3]. Knowledge sharing can facilitate the development of a culture of innovation and creativity, thereby providing nurses with novel avenues for addressing complex issues [4], effectively mitigating burnout and talent loss [5]. Knowledge sharing behavior refers to the behavior of knowledge owners to transfer professional knowledge and skills to others in various ways, thereby increasing the value of knowledge [6]. Studies have demonstrated that the knowledge sharing behavior of registered nurses is moderately lower than that of nurse specialists, and with considerable scope for enhancement in both [7, 8]. Nurse specialists are nurses who have undergone systematic theoretical and practical training in a specific field and obtained the professional qualifications [9]. As clinical experts with higher level of knowledge and skills in a specific field, nurse specialists typically assume multidimensional roles and functions, including those of nurses, nursing professional consultants and researchers [7], which can facilitate the comprehensive advancement of the nursing domain. Xu et al. indicated that the knowledge and skills of nurse specialists represent a significant resource for the nursing team, their knowledge sharing behavior are effective in enhancing the core competencies of nurses and improving patients’ clinical outcomes [8]. The National Nursing Career Development Plan (2021–2025) [10] states that it is necessary to fortify the construction of nurse specialist teams, promote exchanges and cooperation through the establishment of nursing specialty alliances and expert construction teams, draw fully on advanced concepts and experiences, and effectively assuming a pioneering and guiding role of high-quality nursing resources. Therefore, given the scarcity of nurse educators, nurse specialists are the optimal candidates for the dissemination of knowledge [11].
In healthcare, knowledge sharing is the cornerstone for organizations to create long-term competitive advantage and is essential to drive innovation, aid decision-making and solve problems. Clinical care is intensive, high-risk and highly specialized, requiring close collaboration between members of the organization, and the transfer and sharing of knowledge and skills is extremely important. Nurse specialists possess a high level of knowledge and skills and play a bridging role in knowledge sharing, if effective knowledge management is carried out, information barriers can be broken down and the value of knowledge can be maximized. Current research concerning knowledge sharing behaviors focuses on corporate employees, teachers, students, and so forth, with a paucity of attention to the group of nurse specialists. Therefore, exploring the mechanisms influencing knowledge sharing behaviors of nurse specialists is of great significance in enhancing the quality of healthcare services and improving people’s well-being.
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In 2009, Dutch scholars Mom et al. initially proposed the concept of ambidextrous managers [12], which subsequently evolved into “ambidextrous leadership”, whose core claim is to deal with dichotomous contradictions and achieve effective coordination and integration between tension elements and organizational contradictions through the flexible conversion of two leadership styles under the same spatio-temporal dimension [13, 14]. A substantial body of research have demonstrated that nurses’ knowledge sharing behavior is inextricably linked to leadership style, positive leadership style can be effective in promoting knowledge sharing behavior [15, 16]. This provides a novel perspective for analyzing the knowledge sharing behavior of nurse specialists from the vantage point of leadership style. Perceived organizational support stems from American psychologist Eisenberger’s organizational support hypothesis, it encompasses two dimensions: emotional support and instrumental support. A study showed that perceived organizational support is positively correlated with knowledge sharing behavior, when employees perceive support from the organization, they feel obliged to reciprocate and are motivated to contribute to the organization’s success, such as knowledge sharing [17].
Organizational commitment is a positive psychological resource that includes five dimensions: emotional commitment, economic commitment, opportunity commitment, normative commitment and ideal commitment. The extant literature indicates that organizational commitment plays a mediating role between organizational support and knowledge sharing behavior [18], which suggests that an increase in the level of organizational support can effectively increase the level of organizational commitment among employees, thereby enhancing their knowledge sharing behavior. Organizational support theory holds that employees determine their level of organizational commitment according to the level of perceived organizational support. This, in turn, influences their level of work engagement and inclination to contribute to the organization [19].
To sum up, previous studies have shown that ambidextrous leadership, perceived organizational support and organizational commitment can affect knowledge sharing behavior, but their specific pathways are unclear. The purpose of this study was to explore the relationship between ambidextrous leadership, perceived organizational support, organizational commitment and knowledge sharing behavior in nurse specialists, thus revealing the mechanism of the effect of ambidextrous leadership on knowledge sharing behavior among nurse specialists.
Theoretical background and research hypothesis
Social exchange theory
To structure the arguments on how ambidextrous leadership affects the knowledge sharing behavior of nurse specialists, we draw on social exchange theory [20]. According to social exchange theory, organizational relationships consist mainly of employee-manager relationships and employee-organization relationships. Individuals are guided by the principle of reciprocity when engaging in social exchanges, and their behavior can be governed by certain exchange activities in organizations that offer rewards, which are not limited to material benefits, but also include psychological wealth, such as emotional sustenance, reputation and status. Leaders act as agents of the organization and employees tend to interpret the agent’s actions as organizational wishes, therefore, leadership style may influence employees’ positive perceptions of organizational support. Organizational support can be viewed as a reward given to employees by the organization, when individuals perceive organizational support, they will reciprocate with higher levels of organizational commitment and engage in more extra-role behaviors for the organization, such as knowledge sharing. In this study, using ambidextrous leadership as an independent variable, knowledge sharing behavior as a dependent variable, and perceived organizational support and organizational commitment as mediating variables, a chain mediating model was drawn. (Fig. 1).
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Hypothesis 1(H1): ambidextrous leadership will significantly predict knowledge sharing behavior
In this study, ambidextrous leadership refers to the behavior of a head nurse who combines two apparently contradictory but interrelated leadership and continually adapts them in different contexts to cope with complex management environments, common combinations include transformational and transactional leadership. Evidence suggests that transformational leaders encourage innovation and creativity, create a highly autonomous work environment, facilitate knowledge transfer within the organization [21]. Transactional leaders motivate employees through generous rewards and punishments, take on the key role of knowledge sharing management in the organizational environment [22]. Effective leaders can switch between different leadership in a situationally appropriate way with facility [23], therefore, we predicted that the degree of ambidextrous leadership would positively predict the level of knowledge sharing behavior.
Hypothesis 2(H2): perceived organizational support mediates the relationship between ambidextrous leadership and knowledge sharing behavior
Perceived organizational support refers to nurse specialists’ overall perception of whether the organization values their contribution and cares about their well-being. It is positively correlated with willingness to share knowledge, the higher the perceived organizational support, the higher the sense of belonging to the organization and the stronger the willingness to share knowledge [24]. A systematic review reported 13 outcomes affected by leadership, the most common including organizational climate and organizational support [25]. One study found that ambidextrous leadership can positively predict students’ perceived organizational support and intrinsic motivation, serve as an important antecedent variable of perceived organizational support [26]. Therefore, we hypothesized that ambidextrous leadership improves knowledge sharing behavior by increasing perceived organizational support, which mediates ambidextrous leadership and knowledge sharing behavior.
Hypothesis 3(H3): organizational commitment mediates the relationship between ambidextrous leadership and knowledge sharing behavior
Organizational commitment can be defined as the degree of identification, involvement and loyalty that an individual feels towards the organization. The extant literature indicates that head nurses exert organizational influence through their leadership, which leads to increased work engagement of nurses and ultimately increased their job satisfaction and organizational commitment [27]. Asiri et al. found that leadership can directly and positively predict the level of organizational commitment [28]. Furthermore, relevant studies successively confirmed that organizational commitment and knowledge sharing behavior are highly correlated and organizational commitment can positively predict knowledge sharing behavior [29, 30]. These studies led us conjecture that organizational commitment will positively affect knowledge sharing behavior of nurse specialists.
Hypothesis 4(H4): perceived organizational support and organizational commitment mediate the relationship between ambidextrous leadership and knowledge sharing behavior
Studies have shown that organizational support can positively predict the level of organizational commitment [31]. A more direct result is that organizational support can indirectly affect knowledge sharing behavior through organizational commitment as a mediating variable [18]. This phenomenon is consistent with the social exchange theory, organizational support can be viewed as an incentive conferred by the organization on the nurse specialists, when they feel supported and valued by the organization, they will classify themselves as “insiders” of the organization, give more trust and commitment to the organization, develop a sense of obligation to return to the organization, and give back to the welfare of the organization through knowledge sharing. Combined with the above assumption, perceived organizational support and organizational commitment may have a chain mediating effect between ambidextrous leadership and knowledge sharing behavior.
Fig. 1
Hypothesized model of the interrelationships of ambidextrous leadership, perceived organizational support, and organizational commitment on knowledge sharing behavior
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Materials and methods
Study design and procedures
From July to September 2024, we organized three nurse specialist trainings at the College of Nursing, Anhui Medical University (Hefei, Anhui Province, China) for nurse specialists from all levels of hospitals in Anhui Province. Convenience sampling was used to recruit nurse specialists trained here for the study, all participants must meet the following inclusion criteria: (a) nurse specialists, (b) entry time was greater than 1 year, (c) voluntary participation in this study; and (d) without participating in other similar studies. The exclusion criteria were as follows: (a) sick, maternity, and personal leave nurses, (b) trained nurses, intern nurses, (c) major traumatic event within 6 months, such as divorce or bereavement, and (d) currently receive psychotropic medication or psychotherapy.
The electronic survey questionnaire was distributed to nurse specialists through the official channel based on Wechat (a widely used social media platform in China) and Questionnaire Star (a professional online survey platform). All participants were informed about and fully understood the research purposes, and a online informed consent form was obtained from all participants before the survey. This study obtained ethical approval from the Ethics Review Committee of Anhui Medical University (Ethics approval number: 83230280).
Sample size and sampling
In accordance with Kendall’s criteria, the sample size should be 5–10 times larger than the number of items [32]. In this research, the minimum sample size was calculated to be 125, with 25 items. Additionally, to ensure stable estimation of the structural model, a minimum of 200 participants is deemed necessary [33]. Furthermore, considering a potentially 10–20% rate of invalid response, a sample size of 220 participants was required.
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A total of 306 nurse specialists completed and returned questionnaires. However, invalid questionnaires that didn’t meet the inclusion criteria, filling time was less than 3 min and regular answers were excluded. Finally, 8 invalid questionnaires were eliminated, and 298 valid questionnaires were included, with an effective recovery rate of 96.75%.
Instruments
Sociodemographic information questionnaire
Demographic characteristic of nurse specialists included gender, age, hospital level, type of employment, monthly income (CNY), number of night shifts (per month), and position.
Multifactor leadership questionnaire
Multifactor leadership questionnaire developed by Bruee et al. [34] was used to evaluate nurse specialists’ perception of ambidextrous leadership, and has demonstrated appropriate reliability and validity. This study adopted the Chinese version of the scale revised by Pan et al., with a Cronbach’s α of 0.880 [35]. The scale comprises 32 items in seven dimensions, which are divided into leadership charm (5 items), intellectual stimulation (5 items), vision motivation (5 items), individualized consideration (5 items), contingent reward (4 items), proactive exception management (4 items) and passive exception management (4 items). Each item is scored on a 5-point Likert scale with scores ranging from 0 (never) to 4 (almost always). The total scores ranged from 0 to 128, higher scores indicating higher the level of the head nurse’s ambidextrous leadership style. In this study, Cronbach’s α for the scale was 0.915.
Perceived organizational support scale
Complied by Chen et al. in 2006 [36], the adjustment version of Perceived organizational Support Scale was revised by Zuo et al. in 2009 [37]. The scale was used to measure perception of organizational support among nurse specialists, it comprises 13 items in two dimensions: emotional support (10 items) and instrumental support (3 items). Each item is assessed on a 5-point Likert scale with scores ranging from 1 (strongly inconsistent) to 5 (strongly consistent). The total scores ranged from 13 to 65, with higher scores indicates higher level of perceived organizational support. The Cronbach’s α of the original scale was 0.853, the Cronbach’s α of the scale in this research was 0.957.
Chinese employees organizational commitment scale
Chinese Employees Organizational Commitment Scale developed by Ling et al. [38] was used to evaluated the level of organizational commitment of nurse specialists. The scale comprises 25 items in five dimensions, which are divided into affective commitment (5 items), normative commitment (5 items), ideal commitment (5 items), economic commitment (5 items) and opportunity commitment (5 items). Responses to each item were assessed on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), the range of total scores were between 25 and 125, the higher the score, the higher the standard of organizational commitment. The Cronbach’s α of the original scale was 0.908, in this study, the Cronbach’s α for the scale was 0.875.
Knowledge sharing behavior scale
Knowledge Sharing behavior Scale was developed by Yi et al. in 2009 [39], and it was translated into Chinese version by Chen et al. to assess the knowledge sharing behavior of clinical nurses [40]. The scale includes four dimensions with a total of 19 items, which were divided into written contribution (4 items), organizational contribution (5 items), personal interaction (5 items) and social practice (5 items). Items were scored on the Likert-5 scale ranging from 1 to 5, the range of possible scores were between 19 and 95, higher scores reflected a higher level of knowledge sharing behavior. The Cronbach’s α of the original scale was 0.923, in this research, the Cronbach’s α for the scale was 0.906.
Data collection
Twenty nurse specialists were invited to conduct a preliminary test prior to the commencement of the formal survey to assess the time taken to complete the questionnaire and to make adjustments to the questionnaire items to ensure validity. After preliminary testing, based on the Wechat and Questionnaire star platform (https://www.wjx.cn/), the questionnaire was distributed to nurse specialists in Anhui Province. Nurses who met the inclusion criteria were invited to complete the questionnaire and submitted it through a smartphone or computer. To ensure the validity and scientificity of the questionnaire, the instructions was set up in the preamble to explain the purpose and significance of the research, and the questionnaire was informed to be an anonymous survey to ensure the acquisition of real information. All questions were compulsory, and each IP address could only be filled in once, ensuring that the questionnaire was complete without repetition.
Data analysis
SPSS 23.0 and AMOS 26.0 was used to analyze the data collected. First, common method bias were tested using the Harman single-factor test. Second, categorical variables were described by frequencies and percentages. The normal distribution of the data was tested using the Kolmogorov-Smirnov test and QQ-plot, all continuous variables conformed to an approximately normal distribution and were described by means and standard deviations(SD). Third, comparisons between groups were made using independent samples t-test or one-way analysis of variance, and pearson’s correlation analysis was used to explore the correlations between ambidextrous leadership, perceived organizational support, organizational commitment and knowledge sharing behavior. Finally, structural equation modelling was constructed using AMOS 26.0, where ambidextrous leadership is the independent variable, knowledge sharing behavior is the dependent variable, both perceived organizational support and organizational commitment are the mediating variables, and age, monthly income and position are the control variables in this model. The model was adjusted and fitted through the maximum likelihood ratio method, 5000 bootstrap resamples method were conducted to test and validate the mediation effect with a 95% confidence interval(CI) excluding 0. The models’ goodness of fit was judged based on the following criteria: the chi-square/degree-of-freedom ratio (χ2/df) < 3, root mean square error of approximation(RMSEA) ≤ 0.80, comparative fit index(CFI) ≥ 0.90, goodness of fit index(GFI) ≥ 0.90, normed fit index(NFI) ≥ 0.90 [41, 42]. The inspection level was established at α = 0.05, and p<0.05 was considered statistically significant.
Results
Common method bias test
In this research, common method bias was controlled by filling in anonymously, hiding variable names, and balancing order effects of entries. In order to inspect the common method bias caused by self-reported scales, We performed Harman’s single factor test. The results showed that there were 17 factors with eigenvalues greater than 1, the first factor accounted for 28.00% of the total variation, which was less than the critical standard of 40%. It indicated that there is no serious common method bias in this study [43].
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Sociodemographic information of participants
Of the 298 participants, the mean age was 32.26 years old(SD = 3.56). Most of the participants were female(93.6%), contractual employees(62.1%), and from tertiary hospital(78.5%). No significant differences were found in knowledge sharing behavior scores when nurse specialists were grouped according to gender, hospital level, type of employment and night shift(per month). However, statistically significant differences were found in nurse specialists depending on age (F = 3.57, p = 0.03), Monthly Income (CNY) (F = 5.38, p = 0.01) and position (t = 5.68, p = 0.02) (Table 1).
Table 1
Sociodemographic characteristics of nurse specialists(N = 298)
Variables | N(%) | knowledge sharing behavior | t/F | P |
|---|---|---|---|---|
Gender | ||||
Male | 19(6.4) | 56.89 ± 6.51 | 1.24 | 0.23 |
Female | 279(93.6) | 54.87 ± 10.87 | ||
Age | ||||
≤30 | 101(33.9) | 53.65 ± 10.73 | 3.57 | 0.03 |
31–39 | 191(64.1) | 55.41 ± 10.43 | ||
≥40 | 6(2) | 64.83 ± 11.69 | ||
Hospital level | ||||
Grade III | 234(78.5) | 55.41 ± 10.80 | 1.26 | 0.21 |
Grade II | 64(21.5) | 53.52 ± 10.03 | ||
Type of employment | ||||
Contract | 185(62.1) | 54.84 ± 10.39 | 0.12 | 0.73 |
Formal | 113(37.9) | 55.27 ± 11.09 | ||
Monthly Income(CNY) | ||||
≤ 6000 | 104(34.9) | 52.48 ± 11.16 | 5.38 | 0 |
6001–7999 | 121(40.6) | 55.02 ± 9.05 | ||
8000–9999 | 41(13.8) | 59.88 ± 13.08 | ||
≥ 10000 | 32(10.7) | 56.91 ± 8.84 | ||
Night shift(per month) | ||||
None | 36(12.1) | 55.94 ± 9.41 | 0.91 | 0.44 |
≤3 | 37(12.4) | 52.49 ± 11.66 | ||
4–6 | 184(61.7) | 55.43 ± 10.64 | ||
≥7 | 41(13.8) | 54.54 ± 10.81 | ||
Position | ||||
Nurse | 16(5.4) | 61.13 ± 9.16 | 5.68 | 0.02 |
Head nurse | 282(94.6) | 54.66 ± 10.64 |
Correlation between knowledge sharing behavior and ambidextrous leadership, perceived organizational support, and organizational commitment
The average scores of nurse specialists were 55.00 (10.65) on knowledge sharing behavior, which was at a moderate level. Correlation analysis showed that knowledge sharing behavior was positively correlated with ambidextrous leadership (r = 0.562, p < 0.01), perceived organizational support (r = 0.575, p < 0.01), and organizational commitment (r = 0.413, p < 0.01), respectively. Ambidextrous leadership was positively associated with perceived organizational support (r = 0.554, p < 0.01) and organizational commitment (r = 0.407, p < 0.01). perceived organizational support also positively associated with organizational commitment (r = 0.446, p < 0.01). (Table 2)
Table 2
Pearson’s correlation analyses between ambidextrous leadership and perceived organizational support, organizational commitment and knowledge sharing behavior(N = 298)
Mean(SD) | AL | POS | OC | KSB | |
|---|---|---|---|---|---|
AL POS | 68.27(17.00) 39.32(8.94) | 1 0.554** | 1 | ||
OC KSB | 79.44(11.77) 55.00(10.65) | 0.407** 0.562** | 0.446** 0.575** | 1 0.413** | 1 |
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Structural model and mediating effect analysis
The structural model was initially tested, and correlations between error terms for the dimensions of organizational commitment and knowledge sharing behavior were added according to modification indices. The model fitting index of the corrected model is acceptable: χ2 = 309.890, df = 127, χ2/df = 2.440, RMSEA = 0.070, CFI = 0.949, GFI = 0.902, NFI = 0.917. The standardized path coefficients of the final model are shown in Fig. 2.
Table 3 showed the results of the mediation effect analysis. The study showed that the total indirect effect included three different pathways, all statistically significant and accounting for 49.6% of total effect, with a value of 0.315 (95%CI: [0.208,0.431], p<0.05). Indirect effects were observed via perceived organizational support and organizational commitment and chain mediation via perceived organizational support and organizational commitment. Ambidextrous leadership→perceived organizational support→knowledge sharing behavior, ambidextrous leadership→organizational commitment→knowledge sharing behavior and ambidextrous leadership→perceived organizational support→organizational commitment→knowledge sharing behavior explained 28.7% (95%CI: [0.090,0.316], p<0.05), 12.1% (95%CI: [0.028,0.166], p<0.05) and 8.8% (95%CI: [0.018,0.131], p<0.05) of the total effect.
Fig. 2
Final model for the effects of ambidextrous leadership, perceived organizational support and organizational commitment on knowledge sharing behavior. Notes**P < 0.01, ***P < 0.001
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Table 3
The chain mediating effect of perceived organizational support and organizational commitment in ambidextrous leadership and knowledge sharing behavior(N = 298)
Paths | β | BootSE | Bootstrap 95% CI (bias corrected) Lower Upper | P | Proportion of total effect(%) |
|---|---|---|---|---|---|
AL→POS→KSB AL→OC→KSB AL→POS→OC→KSB | 0.182 0.077 0.056 | 0.057 0.034 0.028 | 0.090 0.316 0.028 0.166 0.018 0.131 | 0.001 0.005 0.004 | 28.7 12.1 8.8 |
Direct effects(AL→KSB) Indirect effects(AL→KSB) Total effects | 0.320 0.315 0.635 | 0.076 0.056 0.044 | 0.174 0.471 0.208 0.431 0.540 0.714 | 0.000 0.000 0.001 | 50.4 49.6 100 |
Discussion
This study showed a positive relationship between ambidextrous leadership, perceived organizational support, organizational commitment and knowledge sharing behavior. The role of these variables on nurse specialists’ knowledge sharing behavior has been tested, all the hypotheses of this research were confirmed.
Direct effect of ambidextrous leadership on knowledge sharing behavior
This study found that ambidextrous leadership positively predicted knowledge sharing behavior among nurse specialists, confirming hypothesis 1, which was consistent with a previous study on employees of construction companies in Parkistan [44]. Contingency theory posits that effective leaders will utilize different leaderships depending on the situation, e.g. transformational leadership for dynamic environments and transactional leadership for stable environments [45]. Ambidextrous leaders possess the cognitive and behavioral flexibility to transition between divergent leaderships, thereby more efficaciously managing organizational tensions and management dilemmas. Furthermore, they encompass both exploration and exploitation attributes, encourage nurse specialists to think outside the box, and afford nurse specialists with a high degree of autonomy and flexibility in the workplace, foster a positive and open working atmosphere, and implement a generous reward system, which enhance the willingness of nurse specialists to share knowledge, establish a knowledge-oriented culture, thus facilitate knowledge dissemination, and further confirm the social exchange theory. This study provides empirical evidence of the positive impact of ambidextrous leadership on knowledge sharing behavior, which reflects the importance and necessity of developing ambidextrous leadership among nurse leaders in healthcare.
The mediating effect of perceived organizational support
Perceived organizational support had a mediating effect between ambidextrous leadership and knowledge sharing behavior among nurse specialists, validating hypothesis 2. As a positive external resource, organizational support can reinforce employees’ trust in the organization and the level of psychological empowerment, encourage a collective perspective in the management of organizational resources, and provide intrinsic motivation for knowledge sharing [24]. Social exchange theory states that external incentives have a stimulating effect on individual behavior, thereby promoting the transformation of motivation into behavior. Organizational support can be seen as a reward given by the organization to employees, which is a catalyst for positive employee performance, such as behaviour, attitude and performance. Individuals who perceive a high level of organizational support tend to demonstrate a stronger sense of organizational identity and belonging. They also perceive themselves as important members of the organization, and as a result, are more likely to invest in extra-work roles and engage in more pro-organizational behaviors [20]. Perceived organizational support can be effectively enhanced by organizational preferential treatment [46], nurse managers are instrumental in the provision of organizational resources and incentives for nurse specialists and thus are regarded as a pivotal source of organizational support [47]. Ambidextrous leadership capitalizes on the synergistic effect of two contradictory and complementary leaderships, fostering an organizational supportive climate by providing nurse specialists with adequate resources and emotional support, thus enhancing their perception of insider status and facilitating extra-role behaviors, such as knowledge sharing.
The mediating effect of organizational commitment
In this research, organizational commitment had a mediating effect between ambidextrous leadership and knowledge sharing behaviors among nurse specialists, hypothesis 3 was confirmed. A previous study demonstrated a positive correlation between leadership and organizational commitment, as well as a significant predictive relationship between them through psychological empowerment [28]. Organizational commitment is an attitude tendency that reflects the degree of identification and investment of nurse specialists to the organization. The evidence suggests that organizational commitment exerts a direct and positive effect on knowledge sharing behavior [30], moreover, it functions as a mediating and moderating variable between knowledge sharing behavior and its various influencing factors [18, 48]. Organizations with a high level of organizational commitment exhibit a high level of mutual trust among their members, which effectively mitigates the sense of crisis that may arise when individuals share knowledge. According to social exchange theory, ambidextrous leaders apply management strategies flexibly to meet the dynamic situational needs of the organization, build positive interpersonal relationships with nurse specialists, and contribute to the formation of high-quality leader-member exchange relationships, thereby enhancing organizational commitment among nurse specialists. Those with a strong organizational commitment display a higher level of work engagement, a more comprehensive knowledge structure and are more likely to engage in brainstorming and generate new ideas, as well as responding to organizational knowledge sharing initiatives through work innovation. Therefore, an emphasis on ambidextrous leadership in healthcare not only enhances the level of organizational commitment of nurse specialists, but also facilitates knowledge sharing and enhances organizational competitiveness.
The chain mediating effect of perceived organizational support and organizational commitment
The most important finding is the chain mediating effect of perceived organizational support and organizational commitment on the relationship between ambidextrous leadership and knowledge sharing behavior, hypothesis 4 was supported. A Korea study showed that perceived organizational support and organizational commitment can positively influence employees’ knowledge sharing behavior as chain mediating variables [18], and in this research, we corroborates that the results apply to the group of nurse specialists in the Chinese cultural context similarly. Head nurse is seen as representative of the organization, their leadership is an important indicator of the preferential treatment that nurse specialists receive from the organization. The stable and positive working environment created by the nurse managers based on ambidextrous leadership can provide resources for nurse specialists and ensure their organizational commitment, which in turn enhances their willingness to share knowledge [31, 49]. The willingness of nurse specialists to share knowledge does not contingent on a single independent antecedent condition, rather, it is the result of the complex interaction of multiple factors. In accordance with the principle of equivalence and reciprocity in social exchange, nurse specialists develop a sense of reciprocity when they feel the care and investment of the organization, receive sufficient emotional and instrumental support, and perceive the importance that the hospital and department place on knowledge. In return for high levels of organizational support, nurse specialists demonstrate organizational commitments, align themselves with the hospital and organizational development plans, and engage in high-level knowledge sharing behaviors. Taken together, these factors promote knowledge-sharing behaviors, and managers can develop measures to facilitate knowledge sharing and contribute to the quality of healthcare services.
Implications
Based on social exchange theory, this study considers the organization(department), organizational members (nurse specialists), and leaders (nurse managers) as a whole, and explores the mechanism by which ambidextrous leadership affects the knowledge sharing behavior of nurse specialists in the Chinese context, which provides a new perspective on facilitating knowledge sharing, and is of great theoretical and practical significance. Theoretically, this study reveals complex mechanisms behind knowledge sharing behavior among nurse specialists by introducing organizational support and organizational commitment and constructed a chain mediation model, enriching and expanding the application of social exchange theory in healthcare. Practically, we make the following recommendations based on our findings. First, for individual nurse specialists, they should maintain a positive and optimistic mindset, enhance their perception of organizational support, adopt an insider mentality in their daily work, and participate in professional learning activities or training on a regular basis, focusing on the cultivation of their own abilities. Second, nurse managers should apply management strategies flexibly, pay attention to the individual characteristics and needs of nurse specialists, provide adequate resource security for nurse specialists, improve the two-way reciprocal relationship between nurse specialists and the organization, enhance their sense of belonging to the organization, and stimulate the willingness of them to share knowledge. Finally, hospital management should focus on leadership training for nurse managers, recruiting and promoting nurse managers with ambidextrous leadership. Emphasis should be placed on the dual mediating roles of organizational support and organizational commitment, improving staff welfare, focusing on the career development of nurse specialists, providing diversified training and development programs, constructing a good platform for knowledge exchange for nurse specialists in order to ensure the sharing of information resources and the sustainable development of the healthcare system.
Limitations
This study had some limitations. First, the study was conducted in Anhui province, east China, which may limit the generalization of the results to other healthcare settings or cultural contexts, future study could consider expanding the sample to cover participants from diverse regions and cultural backgrounds to ensure the overall validity of the study. Second, this study relied on self-reported data, which may not reflect the true feelings of nurse specialists. In the future, it may be considered to conduct qualitative interviews, collect data from multiple sources, such as hospital chief nurses and workmates of nurse specialists, to verify the accuracy of self-reported data. Third, the cross-sectional study excluded the inference of causality. In order to gain a more comprehensive understanding of the relationship between ambidextrous leadership, organizational support, organizational commitment, and knowledge sharing behavior, a longitudinal research design can be adopted in the future to reveal changes in variables over time and potential causal relationships. Finally, this study focused on the impact of ambidextrous leadership on knowledge sharing behavior, but there may be other relationships between these variables. Future research could further explore their relationships and gain a more nuanced understanding of the complex interactions between them.
Conclusions
In conclusion, our study found a significant chain mediation role of perceived organizational support and organizational commitment in the relationship between ambidextrous leadership and knowledge sharing behavior among nurse specialists. The implementation of strategies designed to enhance perceived organizational support and organizational commitment among nurse specialists has the potential to facilitate more active knowledge sharing behaviors. The findings of the research have enhanced the comprehension of the theory of association and furnished practical implications for healthcare system practitioners, which can develop targeted intervention strategies to facilitate the advancement of the nursing field and enhance patient well-being.
Acknowledgements
The authors would like to thank all the nurse specialists who participated in this study.
Declarations
Ethics approval and consent to participate
We confirmed that all experiment were performed in accordance with relevant guidelines and regulations, and this research obtained ethical approval from the Ethics Review Committee of Anhui Medical University(ethics approval number: 83230280), informed consent was obtained from all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
Not applicable.
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