ArticleInternational journal of nursing studies advances2026
When violence meets leadership: Leadership climate as a buffer in the link between violence, harmful alcohol use, and burnout among healthcare workers in Sweden.
Article in International journal of nursing studies advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Healthcare workers are frequently exposed to workplace violence (including threats and physical aggression), which may increase the risk of burnout complaints through maladaptive coping behaviours such as harmful alcohol use. Leadership climate may buffer these adverse effects by fostering psychological safety and supportive supervisor-employee interactions. This study examined whether leadership climate moderates the association between violence and harmful alcohol use, whether the indirect association between violence and subsequent burnout via harmful alcohol use depends on leadership climate, and whether these pathways differ between physicians and nurses. Methods: Two-wave panel data were drawn from the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS). The sample included 2446 healthcare workers. Violence, harmful alcohol use, and leadership climate were assessed at Time 1, while burnout was measured at Time 2. Moderated mediation analyses were conducted using the PROCESS macro. Results: Violence was positively associated with harmful alcohol use, with this association weakened under stronger leadership climate. The conditional indirect prospective association between violence and later burnout through harmful alcohol use was evident primarily under weaker leadership conditions (b = 0.007, 95% CI [0.001, 0.016]) and nonsignificant under moderate or strong leadership. Formal tests did not indicate statistically significant differences between professional groups. Conclusions: A supportive leadership climate may play a modest protective role in the associations between violence and harmful alcohol use and subsequent burnout. Despite small effect sizes and limited causal inference, consistency with theory suggests that leadership climate may play a meaningful protective role in violence-exposed healthcare environments. Registration: Swedish Occupational and Education Registries.
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