In hospital corridors and patient rooms, nurses form the core of care delivery. Their performance and creativity often determine whether a health system runs smoothly. Yet many nurses report that leadership dynamics at their workplaces can make their jobs more stressful than healing.
A study by Dalia Khalid Faeq, published in BMC Nursing, investigates one such dynamic: how narcissistic leadership affects nurses’ experiences of workplace bullying, their intention to leave their jobs, and their creativity at work. The research finds that bullying serves as a key link between self-centered leadership styles and negative outcomes for nurses, suggesting that leadership behavior can quietly shape whether nurses stay inspired or feel driven away.
Understanding the Problem
Health systems around the world face growing challenges in retaining nurses. High turnover disrupts care continuity and can raise costs for hospitals that must constantly recruit and train new staff. In many cases, poor management practices have been cited as a major influence on job dissatisfaction.
Faeq, based in the Kurdistan region of Iraq, set out to examine the impact of a specific leadership style—narcissistic leadership—on nurses working in Sulaimania’s private hospitals. The concept of narcissistic leadership describes managers who are guided by self-interest and a desire for power or admiration. Such individuals often show arrogance, ignore feedback, and put their own accomplishments ahead of the team’s well-being.
Previous research had linked narcissistic leaders to workplace conflict and disengagement across sectors such as business and hospitality, yet relatively few studies explored how this pattern plays out in healthcare—especially in developing regions. Nursing involves continuous collaboration and empathy; introducing self-centered leadership into that setting could have far-reaching effects on morale and creativity.
The Kurdistan region’s unique political and economic context gave additional significance to the study, offering insight into how leadership theories developed elsewhere might apply in a different cultural environment.
The Research Question
The study sought to answer three interconnected questions. First, does narcissistic leadership directly affect workplace bullying, nurses’ intentions to leave, and their creative performance? Second, how does workplace bullying itself influence turnover intention and creativity? Third, might bullying act as the bridge connecting narcissistic leaders to these outcomes?
To interpret these relationships, Faeq used two frameworks common in organizational psychology. The Conservation of Resources (COR) theory holds that people seek to preserve emotional and physical resources, such as energy, time, and confidence. When workplace pressures exceed what employees can handle, they experience stress and begin to lose these resources. Similarly, the Job Demands-Resources (JD-R) model proposes that employers create both “demands” (sources of strain like workload or bad leadership) and “resources” (supports that help staff cope and thrive).
Together, these theories suggested that narcissistic leadership could be a stressor that drains nurses’ resources, triggering bullying and ultimately reducing creativity and retention.
How the Study Was Conducted
The investigation relied on a quantitative survey distributed among nurses working in private hospitals in Sulaimania, Iraq. Out of 435 invited participants, 374 returned completed questionnaires, producing a response rate of nearly 80 percent.
The survey included established scales to measure four key variables:
- Narcissistic leadership, using statements like “My leader is exceedingly self-centered.”
- Workplace bullying, assessed through experiences such as being ridiculed or deliberately excluded.
- Turnover intention, measured by items such as “I often think about quitting my job.”
- Creative performance, based on supervisors’ evaluations of how resourceful or innovative their nurses were.
To ensure bilingual accuracy, the questionnaire was translated from English into Kurdish and back-translated before distribution. Data collection was done anonymously, with participants submitting completed forms in sealed envelopes.
Analytically, Faeq used a statistical method called structural equation modeling, which allows researchers to test how multiple variables relate to one another simultaneously. The software packages SPSS and AMOS were used to assess the validity of the measurement items and the strength of the relationships proposed in the hypotheses.
What the Data Revealed
The results showed a strong positive association between narcissistic leadership and workplace bullying. In other words, teams led by narcissistic supervisors reported more frequent experiences of bullying.
Narcissistic leadership was also linked to two other outcomes: higher turnover intention and lower creative performance. Nurses who described their managers as self-centered were more likely to think about leaving their organization and less likely to demonstrate innovative problem-solving in their daily roles.
Workplace bullying itself played an important role in this picture. Nurses who experienced more bullying were more inclined to consider quitting and showed less creativity in their work. Statistical modeling indicated that bullying acted as a mediator—it explained part of the path between leadership behavior and nurses’ responses.
Together, these findings formed a network of relationships: narcissistic leadership promoted bullying, bullying increased turnover intention, and both factors reduced creativity. The data fit the researchers’ proposed model well, suggesting that bullying operates as a mechanism through which damaging leadership behaviors affect broader organizational outcomes.
What the Findings Mean in Context
The results align with established psychological theories. From the COR perspective, narcissistic leaders represent a source of “resource loss.” Their domineering or insensitive behavior drains the emotional energy that nurses rely on to handle demanding work environments. As resources diminish, employees may adopt self-protective behaviors such as psychological withdrawal or the intention to quit.
The JD-R model provides a complementary lens: both narcissistic leadership and bullying act as “job demands” that heighten stress and reduce the availability of resources necessary for creativity and engagement. Without adequate support, the cycle can perpetuate itself—tense workplaces become less innovative, which in turn may frustrate leaders and reinforce negative behaviors.
Beyond theoretical models, the study contributes data from a region where few empirical investigations of leadership have been conducted. It shows that toxic leadership patterns and their effects are not confined to Western or corporate settings; they can emerge in any workplace where interpersonal power is unevenly distributed.
Limitations of the Study
While the study presents a structured picture of how narcissistic leadership relates to bullying and its outcomes, it also has limits. All data came from self-reported surveys within one metropolitan area and one type of hospital (private institutions). Public hospitals or rural facilities might show different dynamics due to organizational size, resources, or cultural norms. Additionally, because the study used a cross-sectional design—data collected at one moment—it cannot confirm cause and effect.
The sample’s voluntary nature may also influence the findings. Nurses who felt particularly affected by leadership behaviors could have been more likely to participate, potentially amplifying negative experiences in the dataset.
Future research could address these issues by following nurses over time or comparing leadership styles between public and private hospitals. Studies might also include interviews or observational methods to capture how narcissistic behaviors manifest in day-to-day interactions.
Emerging Questions
Faeq’s research raises several new questions for healthcare management. How do organizational cultures either tolerate or counteract narcissistic leadership? What types of leadership training could help managers avoid behaviors that contribute to bullying? Can hospital systems develop resource-based support programs that protect staff well-being and maintain creativity even under stress?
Exploring these questions may reveal interventions that balance authority and empathy in health workplaces. Since creativity among nurses often means finding quick and effective solutions to patient needs, understanding what stifles that creativity has practical consequences for patient care as well as employee retention.
As hospitals continue to grapple with staffing shortages and burnout, the study provides an analytical look at a human factor often discussed but less frequently measured—the influence of leaders who prioritize self-image over team health. The findings do not judge individuals but rather highlight a pattern: when leadership becomes self-focused, the workplace can turn inward too, making it harder for creativity, cooperation, and commitment to thrive.
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