Journal of nursing management · 2026
When and How Head Nurses' Ethical Leadership Shapes Nurses' Creative Patient Service: The Roles of Ethical Generative AI Usage and AI Compatibility.
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Liu Yi
Аннотация
AIMS: To investigate the impact of head nurses' ethical leadership on nurses' creative patient service, specifically examining the mediating role of ethical generative artificial intelligence (GenAI) usage and the moderating influence of perceived artificial intelligence (AI) compatibility.
BACKGROUND: The rapid integration of GenAI tools into clinical nursing offers opportunities for innovation. While ethical leadership is known to influence employee behaviour, its role in guiding ethical technology use to drive creative patient care remains under-explored in the digitalised healthcare environment.
METHODS: A multisource, dyadic study was conducted across 12 tertiary hospitals in four major Chinese cities. Using convenience sampling, we recruited 64 head nurses and 592 matched staff nurses. The target sample size was determined a priori through power analysis. Staff nurses rated their head nurse's ethical leadership, their own ethical GenAI usage and their perceived AI compatibility. Head nurses rated each staff nurse's creative patient service. Hypotheses were tested using path analysis in Mplus 8.3.
RESULTS: Ethical leadership from head nurses was positively related to nurses' creative patient service. This relationship was partially mediated by nurses' GenAI ethical usage. AI compatibility acted as a moderator; the indirect positive effect of ethical leadership on creative service via GenAI usage was stronger for nurses with higher levels of AI compatibility.
CONCLUSIONS: Head nurses play a central role in the AI era by modelling ethical standards that encourage the responsible use of GenAI. When nurses use these tools ethically and possess high technological compatibility, they are better equipped to provide creative solutions in patient care.
IMPLICATIONS FOR NURSING MANAGEMENT: Nursing administrators should prioritise ethical leadership training to guide the responsible adoption of AI technologies. Management should not only focus on the technical implementation of GenAI but also build a culture of ethical usage and assess individual AI compatibility. Tailored support for nurses with lower AI compatibility may be necessary to ensure equitable innovation in patient service across the workforce.
BACKGROUND: The rapid integration of GenAI tools into clinical nursing offers opportunities for innovation. While ethical leadership is known to influence employee behaviour, its role in guiding ethical technology use to drive creative patient care remains under-explored in the digitalised healthcare environment.
METHODS: A multisource, dyadic study was conducted across 12 tertiary hospitals in four major Chinese cities. Using convenience sampling, we recruited 64 head nurses and 592 matched staff nurses. The target sample size was determined a priori through power analysis. Staff nurses rated their head nurse's ethical leadership, their own ethical GenAI usage and their perceived AI compatibility. Head nurses rated each staff nurse's creative patient service. Hypotheses were tested using path analysis in Mplus 8.3.
RESULTS: Ethical leadership from head nurses was positively related to nurses' creative patient service. This relationship was partially mediated by nurses' GenAI ethical usage. AI compatibility acted as a moderator; the indirect positive effect of ethical leadership on creative service via GenAI usage was stronger for nurses with higher levels of AI compatibility.
CONCLUSIONS: Head nurses play a central role in the AI era by modelling ethical standards that encourage the responsible use of GenAI. When nurses use these tools ethically and possess high technological compatibility, they are better equipped to provide creative solutions in patient care.
IMPLICATIONS FOR NURSING MANAGEMENT: Nursing administrators should prioritise ethical leadership training to guide the responsible adoption of AI technologies. Management should not only focus on the technical implementation of GenAI but also build a culture of ethical usage and assess individual AI compatibility. Tailored support for nurses with lower AI compatibility may be necessary to ensure equitable innovation in patient service across the workforce.