Exploring the Associations Between Empowering Leadership, Work Environment and Moral Injury Among Nurses: A Cross-Sectional Study

Background: Leadership is vital for fostering work environments that support nurses' well-being, job satisfaction and high-quality patient care. This study examined the role of empowering leadership in shaping nurses' perceptions of a healthy work environment (HWE) and moral injury. Methods: A cross-sectional design was used with a convenience sample of nurses from an Italian public healthcare organization. Data were collected through an online survey, incorporating the Empowering Leadership Questionnaire (ELQ), the N2N-HWE and the Moral Injury Events Scale (MIES). Pearson's correlations and a multivariable linear regression model analyzed the relationship between ELQ, N2N-HWE and MIES. Results: Of the 155 nurses who participated (78.1% females, mean age = 34.06 ± 10.03 years), 92.9% perceived their work environment as unhealthy, and 31.6% reported high levels of moral injury. No direct association was found between HWE and moral injury (β = 0.03; 95% CI: -0.46, 0.53). However, a statistically significant interaction between HWE and empowering leadership on moral injury was observed (β = -0.08; 95% CI: -0.16, 0.002). Conclusions: Empowering leadership may buffer the negative impact of unhealthy work environments on nurses' moral injury, highlighting its protective role and the need for leadership-focused interventions in high-demand healthcare settings.