ArticleMedicine2026
Toxic leadership and nurses' vengeful behaviors: mediating effects of organizational citizenship behavior and moderating effects of self-efficacy: A predictive correlational study.
Article in Medicine, 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
Toxic leadership represents a destructive phenomenon in healthcare settings that negatively affects nurses' well-being and may provoke vengeful behaviors. Identifying organizational mechanisms that mitigate these effects remains essential. This study aimed to examine the effect of toxic leadership on nurses' vengeful behaviors and to explore the mediating role of organizational citizenship behavior (OCB) and the moderating role of self-efficacy in this relationship. A predictive correlational design was conducted at Alexandria Main University Hospital, Egypt. A convenience sample of 352 nurses completed 4 validated instruments: the Toxic Leadership Questionnaire, Organizational Citizenship Behavior Questionnaire, General Self-Efficacy Scale, and Vengeful Behaviors Scale. Data were analyzed using Pearson correlation analysis and structural equation modeling to examine direct, mediating, and moderating relationships. Nurses reported moderate levels of toxic leadership (M = 87.13), OCB (M = 31.37), and self-efficacy (M = 28.71), along with low levels of vengeful behaviors (M = 19.00). Path analysis revealed that toxic leadership had a significant positive direct effect on vengeful behaviors (β = 0.42, P < .001) and a significant negative effect on OCB (β = -0.39, P < .001). OCB significantly mediated the relationship between toxic leadership and vengeful behaviors (indirect effect: β = -0.13, P < .001). Self-efficacy demonstrated a significant negative direct effect on vengeful behaviors (β = -0.29, P < .001) and significantly moderated the relationship between toxic leadership and vengeful behaviors, attenuating this effect (interaction: β = -0.18, P < .001). Toxic leadership was associated with higher levels of vengeful behaviors among nurses, whereas OCB and self-efficacy acted as protective mechanisms that reduced these negative effects. Healthcare organizations should prioritize leadership development strategies that promote positive and supportive leadership practices, strengthen nurses' self-efficacy, and foster OCB to reduce vengeful behaviors and improve nurses' well-being and the quality of patient care.
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