Head Nurse Digital Leadership and Staff Nurse-GenAI Collaboration in Chinese Hospitals: The Mediating Role of Digital Self-Efficacy and the Moderating Role of Nurse Perceived Job Autonomy.

AIMS: To examine how head nurse digital leadership is associated with staff nurse-generative artificial intelligence (GenAI) collaboration, specifically exploring the mediating role of digital self-efficacy and the moderating role of nurse perceived job autonomy.

BACKGROUND

GenAI is shifting nursing practice from solo task execution to active nurse-AI collaboration. While digital leadership is theorised to facilitate this transition, the specific mechanisms and boundary conditions, particularly in the context of Chinese tertiary hospitals, remain insufficiently explored.

METHODS

A time-lagged study design was employed, collecting data from 336 frontline nurses across 18 tertiary hospitals in China. The moderated mediation model was tested using PROCESS Model 4 and PROCESS Model 7 with 5000 bootstrap resamples.

RESULTS

Digital leadership was positively associated with nurse-GenAI collaboration. Digital self-efficacy served as a critical mediator in this relationship. Furthermore, perceived job autonomy significantly moderated the relationship between digital leadership and digital self-efficacy. The indirect effect of leadership on collaboration through self-efficacy was also significant when nurses reported higher levels of job autonomy.

CONCLUSION

Head nurses who demonstrate strong digital leadership are associated with more effective GenAI collaboration, potentially by nurturing nurses' digital confidence. However, the strength of this association appears contingent upon the structural resource of job autonomy, which may afford nurses greater freedom to experiment with and integrate AI tools into clinical practice.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders should move beyond top-down AI implementation towards distributed leadership models that prioritise the development of nurses' digital self-efficacy. To maximise the benefits of AI adoption, hospital administrators must foster autonomous work environments that empower nurses to act as proactive partners with technology, ultimately enhancing workflow efficiency and clinical resilience in high-workload settings.