Effect of authoritative leadership on innovation performance of specialist nurses: the chain mediation effect of self-efficacy and training transfer

Effect of authoritative leadership on innovation performance of specialist nurses: the chain mediation effect of self-efficacy and training transfer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of authoritative leadership on innovation performance of specialist nurses: the chain mediation effect of self-efficacy and training transfer yu WANG, cuiping XU, lili BAO This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8162255/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To explore the chain-mediated roles of self-efficacy and training transfer between empowering leadership and innovative performance of specialized nurses, with a view to providing suggestions and guidance for nursing managers to improve innovative performance of specialized nurses and to promote the development of high quality of specialized nurses. Methods Employing a cross - sectional research approach, 330 specialist nurses from four Class - A tertiary hospitals in Jinan were recruited via convenience sampling from June to November 2023 as the research subjects. The investigation was implemented using a General Information Questionnaire, an Empowering Leadership Questionnaire, a Self - Efficacy Scale, a Training Transfer Scale, and an Innovation Performance Scale. A structural equation model for the mediating effect was constructed, and the mediating effect was examined using the Bootstrap method. Results A total of 325 specialized nurses were ultimately included in the survey. The total scores of the Empowering Leadership Questionnaire, Self - Efficacy Scale, Training Transfer Scale, and Innovation Performance Scale for specialist nurses were (51.38±7.93), (29.74±5.81), (52.9±6.35) and (47.17±8.95) points respectively, all of which were at a moderately high level. The mediating effect analysis revealed that empowering leadership had a significant direct effect on innovation performance. The effect size was 0.120, accounting for 26.97% of the total effect. Self - efficacy, training transfer and the chain mediating effect of the two factors indirectly influenced innovation performance. The mediating effect sizes were 0.160, 0.116 and 0.049 respectively, accounting for 35.96%, 26.07%and 11.01% of the total effect. Conclusion The innovation performance of specialized nurses requires improvement. Empowering leadership not only directly influences innovation performance but also indirectly affects it through the mediating roles of training transfer and self-efficacy, as well as the chain mediating effect between training transfer and self - efficacy. Nursing administrators should emphasize the management strategy of empowerment, exploring approaches to enhance training transfer and self-efficacy within the development programs for specialized nurses, thereby further elevating their levels of innovation performance. Specialist nurse Authoritative leadership Self-efficacy Training transfer Innovative performance Chain mediation Nursing management research Figures Figure 1 Figure 2 Background The National Nursing Development Plan (2021–2025) sets forth new requirements for the high-quality development of specialist nursing, underscoring the urgent need to strengthen the specialist nursing workforce and enhance quality nursing services [ 1 ]. Faced with challenges arising from accelerated population ageing, shifts in disease patterns, and escalating public health demands, specialist nurses represent a vital resource for improving nursing quality and patient health outcomes, establishing themselves as a core force within the healthcare system. Specialist nurses are registered nurses possessing experience in specific domains who, after completing specialised training and education encompassing theoretical and practical learning, obtain corresponding qualification certificates and apply their expertise proficiently in clinical nursing [ 2 ]. They play a pivotal role in accelerating the professionalisation, safety, and individualisation of nursing, with their innovative performance directly influencing the quality development of specialist nursing. Within healthcare, innovation performance forms the bedrock of organisational core competitiveness. It is vital for enhancing nursing service quality, elevating patient satisfaction, optimising care processes, and driving the intrinsic development of nursing practice [ 3 ]. A favourable organisational environment is pivotal to boosting innovation performance. Authoritative leadership, an organisational style centred on empowerment and trust, encourages staff to realise their potential through delegation. This enhances employee empowerment and self-management capabilities, thereby increasing innovation output [ 4 ]. Self-efficacy represents a vital psychological resource, denoting an individual's confidence and conviction in successfully executing required actions within specific domains or tasks [ 5 ]. Training transfer refers to the extent to which individuals apply acquired learning outcomes (knowledge, skills, attitudes, and behaviours) from training to their work environment, thereby positively influencing job performance or organisational objectives [ 6 ]. Research indicates that positive psychological and resource support, such as elevated self-efficacy or training transfer, enhances innovation performance [ 7 – 8 ]. Presently, issues including an imperfect specialist nurse training system, inadequate utilisation mechanisms, and insufficient policy support may result in low training transfer and self-efficacy among specialist nurses, thereby impacting their innovation performance. According to social cognitive theory, organisational environment, training transfer, self-efficacy, and innovation performance interact reciprocally [ 9 ]. When individuals receive organisational resource support, it stimulates their self-efficacy, prompting training transfer behaviours that subsequently enhance innovation performance. However, the precise mechanisms of this influence remain unclear, and relevant domestic research is still in its infancy. Consequently, this study adopts a social cognitive theory framework to investigate the current state of innovation performance among specialist nurses. In sum, we built a structural equation model to explore the relationship between empowering leadership, self-efficacy, training transfer, and innovative performance of specialist nurses. This study proposes the following hypotheses: (1) empowering leadership is significantly associated with innovative performance; (2) empowering leadership influences innovative performance through the mediating effect of self-efficacy; (3) empowering leadership influences innovative performance through the mediating effect of training transfer; (4) self-efficacy and training transfer play a chain mediating role in the influence of empowering leadership on innovative performance. The hypothetical model is shown in Fig. 1 . Method Study design The study followed the STROBE cross-sectional study guidelines and used a descriptive cross-sectional design. Settings and samples Convenience sampling was employed to select specialist nurses from four Grade A tertiary hospitals in Jinan City, Shandong Province, as research subjects between June and November 2023. Inclusion criteria: ① Practising registered nurses who had obtained specialist nurse certification following successful completion of specialist nurse training and assessment; ② Individuals who had held specialist nurse certification for ≥1 year while engaged in clinical nursing practice; ③ Informed consent and voluntary participation in this research study. Exclusion criteria: ① Specialist nurses on external placements; ② Absent due to sick leave, annual leave, further training, etc.; ③ Individuals who had undergone psychological or pharmacological treatment within the preceding three months. Exclusion standards: Questionnaires deemed invalid due to missing items, incomplete responses, or ambiguous answers. According to Kendall's sample size estimation method, the sample size should be 5 to 10 times the number of variables. This study involved 54 variables, yielding a calculated sample size of 270 to 540 cases. Considering an estimated loss to follow-up rate of 10% to 20%, a sample size of 300 to 600 cases was required. After weighing multiple factors, the study ultimately included 325 cases. Instruments Demographic characteristics A general information questionnaire was independently compiled, comprising 11 basic items: gender, age, department, rank, professional title, years of service, educational attainment, marital status, childbearing status, employment status, and average monthly income. A total of 325 valid questionnaires were ultimately collected, yielding a response rate of 98.48%. Among these, 47 respondents were male, accounting for 14.5% of the sample, while 278 were female, representing 85.5% of the sample. Outcome variable ： Innovative performance The Nurses Innovation Performance Scale [14], revised by Wei Xin based on Janssen (2004), was used to measure the level of nurses' innovative behavior. The scale includes three dimensions: idea generation, idea promotion, and idea realization, with a total of nine items. The Likert 7 scoring method was used, ranging from 1 = "strongly disagree" to 7 = "strongly agree", with a total score of 9 to 63. The higher the score, the higher the nurse's own innovative performance. In this study, the Cronbach's α coefficient of the scale was measured to be 0.968. Independent variables: Authoritative leadership The Empowering Leadership Scale was developed by Ahearne et al. [10] and has been introduced to many countries and translated into multiple languages to reflect the degree to which employees perceive empowering leadership. The scale includes four dimensions: meaning of work, emphasis on participation in decision-making, confidence in performance, and increased autonomy, with a total of 12 items. The Likert 5-point rating method was used, with 1 to 5 representing “strongly disagree,” “somewhat disagree,” “uncertain,” “somewhat agree,” and “strongly agree,” respectively, and the total score is 12 to 60 points. The higher the score, the higher the subject’s perceived level of empowering leadership. The Cronbach’s α coefficient of this scale was measured to be 0.955 in this study. Mediator variable: Self-efficacy Schwarzer[11] developed the scale in 1997, and Wang Caikang[12] translated and revised it to assess an individual's level of self-efficacy. The scale contains 10 items and is a single-dimensional scale. The Likert 4-point rating method is used, with 1 point for "completely incorrect" and 4 points for "completely correct", for a total score of 10 to 40. The higher the score, the stronger the individual's self-efficacy. In this study, the Cronbach's α coefficient of the scale was 0.931. Mediator variable: Training transfer Based on the theoretical foundation of the training transfer model, Zuo Niuyan [13] developed a training transfer scale in 2014 to evaluate the behavioral performance of trainees after participating in training. It includes two dimensions, "maintenance" and "promotion", with a total of 12 items, which are universal. The Likert 5-point rating method was used, with scores ranging from 1 to 5 from "strongly disagree" to "strongly agree", and a total score of 12 to 60. The higher the score, the better the training transfer effect. The Cronbach's α coefficient of this scale was measured to be 0.948 in this study. Data analysis Data analysis was conducted using SPSS 26.0 software. Count data were described using frequency and percentage (%). Normally distributed continuous data were described using mean and standard deviation. Univariate analysis employed t-tests or F-tests. The correlations between authoritative leadership, self-efficacy, training transfer, and innovation performance among specialist nurses were assessed using Pearson correlation analysis. Structural equation modelling was constructed using AMOS 26.0, with Bootstrap sampling employed to test mediating effects. The significance level was set at α=0.05. Ethical issue This study has been approved by the Ethics Committee of the School of Nursing, Shandong University of Traditional Chinese Medicine (Ethics Approval Number: SZYHL2023006). All procedures were conducted in accordance with relevant guidelines and regulations. Following explanation of the study objectives and data confidentiality to participating specialist nurses, their informed consent was obtained. Specialist nurses were given the option to participate in this study; completion of the questionnaire constituted their willingness to participate. The questionnaire was completed anonymously. Results A total of 330 questionnaires were returned, with 325 valid responses ( 325 ). The valid response rate was 98.48%. General demographic characteristics of the participants are presented in Table 1 . Table 1 General demographic data of the study subjects (n = 325 ) project Grouping Number of examples (n) Composition ratio (%) project Grouping Number of examples (n) Composition ratio (%) Age (years) 4 0 40 12.3 Is he a mentor? yes 106 32.6 gender female 278 85.5 no 219 67.4 male 47 14.5 Is he/she the head of the specialty group? yes 52 16.0 Years of service 1–5 53 16.3 no 273 84.0 6–10 105 32.3 Job position charge nurse 260 80.0 1 1–15 100 30.8 Tutoring 1 0.3 > 15 67 20.6 Treatment Class 5 1.5 Years of work experience after obtaining a college diploma 1–5​ 2 20 6 7.7 day shift 59 18.2 6–10 78 24.0 Marital status unmarried 67 20.6 1 1–15 19 5.8 Married 250 76.9 > 15 8 2.5 Divorced or widowed 8 2.5 Specialist Nurse Level National level 91 28.0 Fertility status With children 240 73.8 provincial 178 54.8 No children 85 26.2 College level 56 17.2 Employment Method Formal establishment 100 30.8 Education level Junior college 5 1.5 Contractual 204 62.8 Undergraduate 278 85.5 Personnel outsourcing 20 6.2 postgraduate 42 12.9 Labor dispatch 1 0.3 Technical title Nurse 19 5.8 Average monthly income (RMB) < 4000 3 0.9 nurse 87 26.8 4,000–6,000​​​ 38 11.7 Head Nurse 197 60.6 6 00 1–8 000 84 25.8 Associate Chief Nurse and above twenty two 6.8 8 00 1–10000 119 36.6 Table 2 shows the levels of empowering leadership, self-efficacy, training transfer, and innovation performance. The specialized nurse empowerment leadership score was (51.38 ± 7.93) points, self-efficacy score was (29.74 ± 5.81) points, training transfer score was (52.97 ± 6.35) points, and innovation performance score was (47.17 ± 8.95) points. Table 2 Specialist nurses' scores on empowering leadership, self-efficacy, training transfer, and innovative performance (scores, ‾x ± s, n = 325 ) project Total Score Item Score empowering leadership 51.38 ± 7.93​ 4.28 ± 0.66 Work intention 13.04 ± 2.10 4.35 ± 0.70 Emphasis on Participation in Decision-Making 12.85 ± 2.33 4.28 ± 0.7 8 Confidence in performance 12.69 ± 2.1 1 4.23 ± 0.70 Enhance autonomy 12.79 ± 2.18 4.27 ± 0.73​ Self-efficacy 29.74 ± 5.8 1 2.97 ± 0.58 Training transfer 52.97 ± 6.35​ 4.41 ± 0.5 3 maintain 17.71 ± 2.2 5 4.43 ± 0.56 Promotion 35.26 ± 4.42​ 4.4 1 ± 0.55 Innovation Performance 47.17 ± 8.95​ 5.24 ± 0.99 Creative generation 21.01 ± 4.02 5.25 ± 1.0 1 Creative Promotion 15.66 ± 3.11​​ 5.2 2 ± 1.0 4 Creative realization 10.5 1 ± 2.18 5.25 ± 1.09 Pearson correlation analysis showed that empowering leadership, self-efficacy, training transfer, and innovative performance were all positively correlated pairwise, with r values ranging from 0.389 to 0.617 and p < 0.01. Detailed results are shown in Table 3 . Table 3 Correlation analysis of various dimensions of empowering leadership, self-efficacy, training transfer behavior, and innovative performance for specialist nurses (n = 325, r value) variable Significance of work Emphasis on Participation in Decision-Making Confidence in performance Enhance autonomy Self-efficacy maintain Promotion Creative generation Creative Promotion Creative realization Significance of work 1.00 Emphasis on Participation in Decision-Making 0.810 a 1.00 Confidence in performance 0.720 a 0.760 a 1.00 Enhance autonomy 0.754 a 0.759 a 0.800 a 1.00 Self-efficacy 0.308 a 0.295 a 0.423 a 0.394 a 1.00 maintain 0.405 a 0.379 a 0.429 a 0.398 a 0.453 a 1.00 Promotion 0.397 a 0.380 a 0.426 a 0.378 a 0.468 a 0.793 a 1.00 Creative generation 0.355 a 0.348 a 0.425 a 0.385 a 0.596 a 0.481 a 0.552 a 1.00 Creative Promotion 0.360 a 0.350 a 0.427 a 0.402 a 0.589 a 0.485 a 0.545 a 0.909 a 1.00 Creative realization 0.329 a 0.289 a 0.348 a 0.351 a 0.591 a 0.385 a 0.459 a 0.829 a 0.894 a 1.00 Note: a p < 0.01. Using specialist nurses' innovative performance as the dependent variable, empowering leadership as the independent variable, and self-efficacy and training transfer as mediating variables, a structural equation model was constructed. The model was then modified, fitted, and tested using the maximum likelihood method. The fit indices were χ²/df = 3.050, RMSEA = 0.079, GFI = 0.946, NFI = 0.969, IFI = 0.979, CFI = 0.979, TLI = 0.968, and SRMR = 0.018, indicating a good structural model fit. The structural model is shown in Fig. 2 . The bootstrap method was used to test the mediating effects. The results showed that the direct effect of empowering leadership on innovative performance was 0.120, accounting for 26.97% of the total effect. The total indirect effect of self-efficacy and training transfer between empowering leadership and innovative performance was 0.325, accounting for 73.03% of the total effect. (See Table 4 for details.) Table 4 Testing the chained mediating effects of self-efficacy and training transfer between specialized nurse empowerment leadership and innovation performance Path Indirect Effect 95% CI LLCI UCI →Self-efficacy→Innovation performance 0.160 0.089 0.242 →Training Transfer→Innovative Performance 0.116 0.051 0.205 →Self-Efficacy→Training Transfer→Innovative Performance 0.049 0.024 0.087 Total Indirect Effect 0.325 0.181 0.467 Direct effect 0.120 0.064 0.337 Total Effect 0.445 0.335 0.548 Discussion 1.Status of empowering leadership, self-efficacy, training transfer and innovative performance of 325 specialist nurses The results showed that the average score of empowering leadership of specialist nurses was (51.38±7.93) points and the average score of items was (4.28±0.66) points, which was at a slightly higher level overall. Among them, the work meaning dimension scored the highest, which was higher than the results of Li C [15]. This indicates that specialist nurses can perceive more power in the work environment. The reason for this may be that the subjects of this study all came from tertiary grade A hospitals. The advanced modern management concept, perfect system support and strong resource guarantee of the hospitals provided a platform support for the empowerment of specialist nurses. Nursing managers are committed to creating a positive and meaningful work environment. Specialist nurses are nursing talents with advanced professional abilities in specific fields. Their profound specialist knowledge, superb skills and advanced clinical decision-making ability are important foundations for obtaining empowerment. High-level empowering leadership is of great significance for reducing management costs and talent turnover rate [16]. Therefore, in nursing management practice, it is necessary to break the shackles of the traditional concept of centralized management. Leaders should appropriately delegate authority and give nurses certain powers and autonomy in order to improve nurses' self-worth and creativity. This study found that the total self-efficacy score of specialist nurses was (29.74±5.81), which is at a medium level and lower than the results of Li Renxia's study [17], suggesting that the self-efficacy of specialist nurses needs to be further improved. The reason for this is that the nursing work environment of tertiary hospitals is characterized by high intensity and overload. Being in a state of high pressure and high burnout for a long time will lead to emotional exhaustion [18], thereby weakening the individual's confidence in coping with work challenges. Secondly, there is a lack of external recognition and effective incentive system. Negative emotional experiences will reduce their affirmation of their own abilities [19]. This suggests that nursing managers should establish and improve performance management and incentive systems, provide specialist nurses with timely and specific positive social feedback, and enhance their professional identity and sense of meaning in their work. Hospitals should regularly conduct emotional intelligence training to create positive physical and mental experiences for specialist nurses, help them identify and manage negative emotions, and improve their self-efficacy level. This study shows that the transfer score of specialist nurses' training was (52.97±6.35) points, and the average score of each item was (4.41±0.53) points, which is at a relatively high level. The maintenance score was the highest, which is similar to the results of the study in references [20-21]. The possible reason is that most of the tertiary-level Class A hospitals are certified as specialist nurse training bases, with a positive training atmosphere, rich clinical resources and professional teaching staff, which provides a solid foundation for high-quality training. Secondly, the research subjects are specialist nurses with bachelor's degrees and head nurses, who have strong professional theoretical knowledge, clinical practice experience and motivation for continuous learning, which promotes the development of training transfer behavior. Therefore, nursing managers should fully consider the reasons affecting training transfer and explore training transfer behaviors with positive significance. The innovation performance score of specialist nurses in this study was (47.17±8.95) points, which is at a medium-to-high level, but there are certain differences in the innovation performance of specialist nurses, which is consistent with the study of Lin T [22]. The reasons for this may be that specialist nurses possess richer theoretical knowledge, clinical experience, and professional judgment than general nurses, enabling them to keenly identify clinical pain points and transform them into concrete innovative solutions. Secondly, effective teamwork promotes information sharing and innovative thinking, which is beneficial to improving the innovative performance level of specialist nurses. Therefore, how to reduce the differences in innovative performance among specialist nurses requires further research and necessary intervention strategies from nursing managers. 2.The Mediating Role of Self-Efficacy in Empowering Leadership and Innovative Performance of Specialist Nurses This study shows that empowering leadership has a positive effect on innovative performance (r=0.421, P<0.01), and self-efficacy is positively correlated with innovative performance (r=0.617, P<0.01). Self-efficacy partially mediates the relationship between empowering leadership and innovative performance (effect value 0.160), accounting for 35.96% of the total effect. Specialist nurses possess solid clinical judgment and experience in solving complex problems, enabling them to demonstrate higher empowering leadership, which is conducive to enhancing their autonomy and self-decision-making ability, thus promoting behaviors that generate self-efficacy. Self-efficacy, as an intrinsic driving force for employees' innovative intentions and behaviors, can significantly promote the improvement of innovative performance[23]. Therefore, nursing managers should not ignore the mediating role of self-efficacy, and should pay attention to the mental health and work pressure of specialist nurses in a timely manner, and provide more support and resources to stimulate more innovative thinking and abilities and generate higher innovative performance. The mediating role of training transfer between empowering leadership and innovative performance of specialist nurses This study found that empowering leadership, training transfer and innovative performance are all positively correlated. Training transfer plays a partial mediating role between empowering leadership and innovative performance (effect value of 0.116), and the mediating effect accounts for 26.07% of the total effect. Under the empowering leadership work situation, specialist nurses can perceive higher organizational support. The inclusive and open work environment helps to enhance employees' intrinsic motivation, improve their enthusiasm for participating in training, and thus promote the training transfer process[24]. Through training transfer, employees can better transform the skills learned in training into actual work behaviors and improve the organization's innovative performance[25]. This suggests that nursing leaders should not overlook the positive role of training transfer when improving the innovative performance of specialist nurses. Creating a favorable atmosphere and incentive mechanisms for training transfer can stimulate the work enthusiasm and creativity of specialist nurses, promote the transfer of training effects, and thus improve innovative performance. 4.The Chain Mediating Effect of Empowering Leadership, Self-Efficacy, Training Transfer, and Innovative Performance of Specialist Nurses This study shows that self-efficacy and training transfer have a chain mediating effect on empowering leadership and the innovative performance of specialist nurses, accounting for 11.01% of the total effect. This indicates that empowering leadership can stimulate self-efficacy, improve the effectiveness of training transfer, and thus enhance the innovative performance of specialist nurses. This suggests that nursing managers can enhance the empowering leadership ability of specialist nurses by establishing open and trusting communication channels and listening and feedback mechanisms, and providing more career development opportunities. Simultaneously, measures should be taken to enhance the work motivation and innovative enthusiasm of specialist nurses to improve self-efficacy and training transfer, thereby improving innovative performance and laying a solid foundation for high-quality development of nursing. Limitations and further studies The participants in this study were all from tertiary-level hospitals, which limits the generalization of the results. Secondly, this study was a cross-sectional survey and lacks information on the dynamic impacts of empowering leadership, self-efficacy, and training transfer on innovative performance. Future longitudinal studies could explore other potentially modifiable mediating variables to provide new perspectives for improving the innovative performance of specialist nurses and promoting high-quality development in nursing. Conclusion In conclusion, the innovative performance level of specialist nurses needs improvement. Empowering leadership not only directly influences their innovative performance but also affects it through the chain-mediating effect of self-efficacy and training transfer. This suggests that nursing managers should focus on empowering nurses to participate in decision-making, exploring ways to generate self-efficacy and training transfer, and fully affirming the value of specialist nurses to improve their innovative performance, thereby enhancing the quality of nursing services and the patient experience. Declarations Acknowledgments We thank the research team members and all participants for their contributions. Authorship contribution statement Yu Wang: Writing – original draft, Resources, Methodology, Investigation. Cuiping Xu: Resources. LiLi Bao:Writing – review & editing, Supervision, Project administration. Funding This research was not funded. Data availability The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy reasons. Declarations Ethics approval and consent to participate This study has been approved by the Ethics Committee of the School of Nursing, Shandong University of Traditional Chinese Medicine (Ethics Approval Number: SZYHL2023006). All procedures were conducted in accordance with relevant guidelines and regulations. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All participants have provided informed consent before the data collection. Participating Specialist nurses were promised that the information provided would remain anonymous. Competing interests policy We declare that we have no conflict of interest. We declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Expressing agreement If accepted, we agree to publish it in your journal.And we will pay APC in full. References National Health Commission. Notice on Issuing the National Nursing Development Plan (2021-2025) [J]. Gazette of the State Council of the People's Republic of China, 2022(23):57-63. Ding Yanming, Wu Xinjuan, Tian Junye, et al. Survey on the Current Status of Specialist Nurse Training and Management in Tertiary Hospitals Across 31 Provinces in China [J]. Chinese Journal of Nursing, 2021, 56(9):1357-1362. Nassani A A, Javed A, Rosak-Szyrocka J, et al. 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Chinese Journal of Nursing Education, 2025, 22(05):580-585. Mwadzingeni L, Dandira M, Kutywayo D, et al. Impact of capacity building through learning, training, and coaching on agricultural innovation[J]. PloS one, 2025, 20(1): e0314004. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8162255","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563325401,"identity":"04cd09c3-6d25-49c7-a708-58c19e37af9d","order_by":0,"name":"yu WANG","email":"","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital)","correspondingAuthor":false,"prefix":"","firstName":"yu","middleName":"","lastName":"WANG","suffix":""},{"id":563325402,"identity":"78b0385d-d978-4152-98fe-47b50571eef3","order_by":1,"name":"cuiping XU","email":"","orcid":"","institution":"First Affiliated Hospital of Shandong First Medical University (Shandong Qianfushan Hospital)","correspondingAuthor":false,"prefix":"","firstName":"cuiping","middleName":"","lastName":"XU","suffix":""},{"id":563325403,"identity":"cd049f57-2ccf-4a77-87de-fc31a898aebb","order_by":2,"name":"lili BAO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACNvnDBx9+MPgnx8be//BBQkUNYS18EmzJxhIFB4z5ec4wGzw4c4ywFjkJHjMBng8HEmfOyGGTfNjCTITDpNvSGCQM7hgb3Mg9VpHYwMbA396dgF+LzOFjDwoMnskZnHmXdiNxhwyDxJmzG/BrYUhLN5AwYDY2OJ5gdiPxDBuDgUQuIS05ZhI8BsyJGw4kmBUktjEToUUCrOVw4syOHDMG4rTwHAMGskEaMJCPJUsknDnGQ9Av8u3NwKj8YwOMyuaDH39U1Mjxt/fi14IBeEhTPgpGwSgYBaMAKwAAKhtMqeMDJQYAAAAASUVORK5CYII=","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial 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08:34:30","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103575,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8162255/v1/0d3c5e72a0c1e614393150e6.html"},{"id":98744820,"identity":"35d2666f-3843-43de-8128-6eccce4d6659","added_by":"auto","created_at":"2025-12-22 08:34:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44398,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe theoretical model of this study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8162255/v1/a102f098df8333312c210896.png"},{"id":98778279,"identity":"ead623f5-f509-472f-adb3-399c59262369","added_by":"auto","created_at":"2025-12-22 12:29:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113929,"visible":true,"origin":"","legend":"\u003cp\u003eChain-mediating model of self-efficacy and training transfer between empowering leadership and innovative performance in specialist nurses.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8162255/v1/6028b44c9bbf10c0d996b65d.png"},{"id":100360287,"identity":"12f889d7-6ee1-45b4-a42c-ec8703d17d74","added_by":"auto","created_at":"2026-01-16 07:38:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1082907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8162255/v1/9ff7cee3-13a8-429e-90b1-1dc248bf7168.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of authoritative leadership on innovation performance of specialist nurses: the chain mediation effect of self-efficacy and training transfer","fulltext":[{"header":"Background","content":"\u003cp\u003eThe National Nursing Development Plan (2021\u0026ndash;2025) sets forth new requirements for the high-quality development of specialist nursing, underscoring the urgent need to strengthen the specialist nursing workforce and enhance quality nursing services [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Faced with challenges arising from accelerated population ageing, shifts in disease patterns, and escalating public health demands, specialist nurses represent a vital resource for improving nursing quality and patient health outcomes, establishing themselves as a core force within the healthcare system. Specialist nurses are registered nurses possessing experience in specific domains who, after completing specialised training and education encompassing theoretical and practical learning, obtain corresponding qualification certificates and apply their expertise proficiently in clinical nursing [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. They play a pivotal role in accelerating the professionalisation, safety, and individualisation of nursing, with their innovative performance directly influencing the quality development of specialist nursing. Within healthcare, innovation performance forms the bedrock of organisational core competitiveness. It is vital for enhancing nursing service quality, elevating patient satisfaction, optimising care processes, and driving the intrinsic development of nursing practice [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A favourable organisational environment is pivotal to boosting innovation performance. Authoritative leadership, an organisational style centred on empowerment and trust, encourages staff to realise their potential through delegation. This enhances employee empowerment and self-management capabilities, thereby increasing innovation output [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Self-efficacy represents a vital psychological resource, denoting an individual's confidence and conviction in successfully executing required actions within specific domains or tasks [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Training transfer refers to the extent to which individuals apply acquired learning outcomes (knowledge, skills, attitudes, and behaviours) from training to their work environment, thereby positively influencing job performance or organisational objectives [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Research indicates that positive psychological and resource support, such as elevated self-efficacy or training transfer, enhances innovation performance [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Presently, issues including an imperfect specialist nurse training system, inadequate utilisation mechanisms, and insufficient policy support may result in low training transfer and self-efficacy among specialist nurses, thereby impacting their innovation performance. According to social cognitive theory, organisational environment, training transfer, self-efficacy, and innovation performance interact reciprocally [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. When individuals receive organisational resource support, it stimulates their self-efficacy, prompting training transfer behaviours that subsequently enhance innovation performance. However, the precise mechanisms of this influence remain unclear, and relevant domestic research is still in its infancy. Consequently, this study adopts a social cognitive theory framework to investigate the current state of innovation performance among specialist nurses. In sum, we built a structural equation model to explore the relationship between empowering leadership, self-efficacy, training transfer, and innovative performance of specialist nurses. This study proposes the following hypotheses: (1) empowering leadership is significantly associated with innovative performance; (2) empowering leadership influences innovative performance through the mediating effect of self-efficacy; (3) empowering leadership influences innovative performance through the mediating effect of training transfer; (4) self-efficacy and training transfer play a chain mediating role in the influence of empowering leadership on innovative performance. The hypothetical model is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study followed the STROBE cross-sectional study guidelines and used a descriptive cross-sectional design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSettings and\u0026nbsp;samples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConvenience sampling was employed to select specialist nurses from four Grade A tertiary hospitals in Jinan City, Shandong Province, as research subjects between June and November 2023. Inclusion criteria: ① Practising registered nurses who had obtained specialist nurse certification following successful completion of specialist nurse training and assessment; ② Individuals who had held specialist nurse certification for ≥1 year while engaged in clinical nursing practice; ③ Informed consent and voluntary participation in this research study. Exclusion criteria: ① Specialist nurses on external placements; ② Absent due to sick leave, annual leave, further training, etc.; ③ Individuals who had undergone psychological or pharmacological treatment within the preceding three months. Exclusion standards: Questionnaires deemed invalid due to missing items, incomplete responses, or ambiguous answers. According to Kendall's sample size estimation method, the sample size should be 5 to 10 times the number of variables. This study involved 54 variables, yielding a calculated sample size of 270 to 540 cases. Considering an estimated loss to follow-up rate of 10% to 20%, a sample size of 300 to 600 cases was required. After weighing multiple factors, the study ultimately included 325 cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA general information questionnaire was independently compiled, comprising 11 basic items: gender, age, department, rank, professional title, years of service, educational attainment, marital status, childbearing status, employment status, and average monthly income. A total of 325 valid questionnaires were ultimately collected, yielding a response rate of 98.48%. Among these, 47 respondents were male, accounting for 14.5% of the sample, while 278 were female, representing 85.5% of the sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome variable\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eInnovative performance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Nurses Innovation Performance Scale [14], revised by Wei Xin based on Janssen (2004), was used to measure the level of nurses' innovative behavior. The scale includes three dimensions: idea generation, idea promotion, and idea realization, with a total of nine items. The Likert 7 scoring method was used, ranging from 1 = \"strongly disagree\" to 7 = \"strongly agree\", with a total score of 9 to 63. The higher the score, the higher the nurse's own innovative performance. In this study, the Cronbach's\u0026nbsp;α\u0026nbsp;coefficient of the scale was measured to be 0.968.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables: Authoritative leadership\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Empowering Leadership Scale was developed by Ahearne et al. [10] and has been introduced to many countries and translated into multiple languages\u0026nbsp;to reflect the degree to which employees perceive empowering leadership. The scale includes four dimensions: meaning of work, emphasis on participation in decision-making, confidence in performance, and increased autonomy, with a total of 12 items. The Likert 5-point rating method was used, with 1 to 5 representing\u0026nbsp;“strongly disagree,”\u0026nbsp;“somewhat disagree,”\u0026nbsp;“uncertain,”\u0026nbsp;“somewhat agree,”\u0026nbsp;and\u0026nbsp;“strongly agree,”\u0026nbsp;respectively, and the total score is 12 to 60 points. The higher the score, the higher the subject’s perceived level of empowering leadership. The Cronbach’s\u0026nbsp;α\u0026nbsp;coefficient of this scale was measured to be 0.955 in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediator variable: Self-efficacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSchwarzer[11] developed the scale in 1997, and Wang Caikang[12] translated and revised it to assess an individual's level of self-efficacy. The scale contains 10 items and is a single-dimensional scale. The Likert 4-point rating method is used, with 1 point for \"completely incorrect\" and 4 points for \"completely correct\", for a total score of 10 to 40. The higher the score, the stronger the individual's self-efficacy. In this study, the Cronbach's\u0026nbsp;α\u0026nbsp;coefficient of the scale was 0.931.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediator variable: Training transfer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the theoretical foundation of the training transfer model, Zuo Niuyan [13] developed a training transfer scale in 2014 to evaluate the behavioral performance of trainees after participating in training. It includes two dimensions, \"maintenance\" and \"promotion\", with a total of 12 items, which are universal. The Likert 5-point rating method was used, with scores ranging from 1 to 5 from \"strongly disagree\" to \"strongly agree\", and a total score of 12 to 60. The higher the score, the better the training transfer effect. The Cronbach's\u0026nbsp;α\u0026nbsp;coefficient of this scale was measured to be 0.948 in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using SPSS 26.0 software. Count data were described using frequency and percentage (%). Normally distributed continuous data were described using mean and standard deviation. Univariate analysis employed t-tests or F-tests. The correlations between authoritative leadership, self-efficacy, training transfer, and innovation performance among specialist nurses were assessed using Pearson correlation analysis. Structural equation modelling was constructed using AMOS 26.0, with Bootstrap sampling employed to test mediating effects. The significance level was set at α=0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical issue\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee of the School of Nursing, Shandong University of Traditional Chinese Medicine (Ethics Approval Number: SZYHL2023006). All procedures were conducted in accordance with relevant guidelines and regulations. Following explanation of the study objectives and data confidentiality to participating specialist nurses, their informed consent was obtained. Specialist nurses were given the option to participate in this study; completion of the questionnaire constituted their willingness to participate. The questionnaire was completed anonymously.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 330 questionnaires were returned, with 325 valid responses ( 325 ). The valid response rate was 98.48%. General demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral demographic data of the study subjects (n\u0026thinsp;=\u0026thinsp;325 )\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eproject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of examples (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComposition ratio (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eproject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNumber of examples (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eComposition ratio (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdministrative positions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e85.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDeputy Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 6\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDeputy Director of Nursing Department and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIs he a mentor?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIs he/she the head of the specialty group?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJob position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003echarge nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 1\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTutoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTreatment Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of work experience after obtaining a college diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eday shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eunmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 1\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDivorced or widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist Nurse Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFertility status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWith children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e73.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eprovincial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmployment Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFormal establishment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContractual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePersonnel outsourcing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLabor dispatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAverage monthly income (RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,000\u0026ndash;6,000​​​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 00 1\u0026ndash;8 000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate Chief Nurse and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etwenty two\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 00 1\u0026ndash;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e36.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the levels of empowering leadership, self-efficacy, training transfer, and innovation performance. The specialized nurse empowerment leadership score was (51.38\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93) points, self-efficacy score was (29.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81) points, training transfer score was (52.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35) points, and innovation performance score was (47.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.95) points.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecialist nurses' scores on empowering leadership, self-efficacy, training transfer, and innovative performance (scores, \u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;325 )\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eproject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eempowering leadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.38\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasis on Participation in Decision-Making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence in performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhance autonomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73​\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e52.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emaintain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePromotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e35.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.4 1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInnovation Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e47.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.95​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreative generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreative Promotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11​​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.2 2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreative realization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.5 1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePearson correlation analysis showed that empowering leadership, self-efficacy, training transfer, and innovative performance were all positively correlated pairwise, with r values ranging from 0.389 to 0.617 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.01. Detailed results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis of various dimensions of empowering leadership, self-efficacy, training transfer behavior, and innovative performance for specialist nurses (n\u0026thinsp;=\u0026thinsp;325, r value)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance of work\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmphasis on Participation in Decision-Making\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConfidence in performance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEnhance autonomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003emaintain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePromotion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCreative generation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCreative Promotion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCreative realization\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance of work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasis on Participation in Decision-Making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.810 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence in performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.720 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.760 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhance autonomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.754 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.759 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.800 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.308 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.295 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.423 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.394 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emaintain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.405 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.379 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.429 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.398 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.453 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePromotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.397 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.380 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.426 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.378 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.468 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.793 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreative generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.355 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.348 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.425 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.385 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.596 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.481 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.552 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreative Promotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.360 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.350 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.427 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.402 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.589 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.485 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.545 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.909 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreative realization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.329 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.289 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.348 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.351 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.591 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.385 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.459 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.829 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.894 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eNote: \u003csup\u003ea\u003c/sup\u003e p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUsing specialist nurses' innovative performance as the dependent variable, empowering leadership as the independent variable, and self-efficacy and training transfer as mediating variables, a structural equation model was constructed. The model was then modified, fitted, and tested using the maximum likelihood method. The fit indices were χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.050, RMSEA\u0026thinsp;=\u0026thinsp;0.079, GFI\u0026thinsp;=\u0026thinsp;0.946, NFI\u0026thinsp;=\u0026thinsp;0.969, IFI\u0026thinsp;=\u0026thinsp;0.979, CFI\u0026thinsp;=\u0026thinsp;0.979, TLI\u0026thinsp;=\u0026thinsp;0.968, and SRMR\u0026thinsp;=\u0026thinsp;0.018, indicating a good structural model fit. The structural model is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe bootstrap method was used to test the mediating effects. The results showed that the direct effect of empowering leadership on innovative performance was 0.120, accounting for 26.97% of the total effect. The total indirect effect of self-efficacy and training transfer between empowering leadership and innovative performance was 0.325, accounting for 73.03% of the total effect. (See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for details.)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTesting the chained mediating effects of self-efficacy and training transfer between specialized nurse empowerment leadership and innovation performance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePath\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIndirect Effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026rarr;Self-efficacy\u0026rarr;Innovation performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026rarr;Training Transfer\u0026rarr;Innovative Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026rarr;Self-Efficacy\u0026rarr;Training Transfer\u0026rarr;Innovative Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Indirect Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e1.Status of empowering leadership, self-efficacy, training transfer and innovative performance of 325 specialist nurses\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results showed that the average score of empowering leadership of specialist nurses was (51.38±7.93) points and the average score of items was (4.28±0.66) points, which was at a slightly higher level overall. Among them, the work meaning dimension scored the highest, which was higher than the results of Li C [15]. This indicates that specialist nurses can perceive more power in the work environment. The reason for this may be that the subjects of this study all came from tertiary grade A hospitals. The advanced modern management concept, perfect system support and strong resource guarantee of the hospitals provided a platform support for the empowerment of specialist nurses. Nursing managers are committed to creating a positive and meaningful work environment. Specialist nurses are nursing talents with advanced professional abilities in specific fields. Their profound specialist knowledge, superb skills and advanced clinical decision-making ability are important foundations for obtaining empowerment. High-level empowering leadership is of great significance for reducing management costs and talent turnover rate [16]. Therefore, in nursing management practice, it is necessary to break the shackles of the traditional concept of centralized management. Leaders should appropriately delegate authority and give nurses certain powers and autonomy in order to improve nurses' self-worth and creativity. This study found that the total self-efficacy score of specialist nurses was (29.74±5.81), which is at a medium level and lower than the results of Li Renxia's study [17], suggesting that the self-efficacy of specialist nurses needs to be further improved. The reason for this is that the nursing work environment of tertiary hospitals is characterized by high intensity and overload. Being in a state of high pressure and high burnout for a long time will lead to emotional exhaustion [18], thereby weakening the individual's confidence in coping with work challenges. Secondly, there is a lack of external recognition and effective incentive system. Negative emotional experiences will reduce their affirmation of their own abilities [19]. This suggests that nursing managers should establish and improve performance management and incentive systems, provide specialist nurses with timely and specific positive social feedback, and enhance their professional identity and sense of meaning in their work. Hospitals should regularly conduct emotional intelligence training to create positive physical and mental experiences for specialist nurses, help them identify and manage negative emotions, and improve their self-efficacy level. This study shows that the transfer score of specialist nurses' training was (52.97±6.35) points, and the average score of each item was (4.41±0.53) points, which is at a relatively high level. The maintenance score was the highest, which is similar to the results of the study in references [20-21]. The possible reason is that most of the tertiary-level Class A hospitals are certified as specialist nurse training bases, with a positive training atmosphere, rich clinical resources and professional teaching staff, which provides a solid foundation for high-quality training. Secondly, the research subjects are specialist nurses with bachelor's degrees and head nurses, who have strong professional theoretical knowledge, clinical practice experience and motivation for continuous learning, which promotes the development of training transfer behavior. Therefore, nursing managers should fully consider the reasons affecting training transfer and explore training transfer behaviors with positive significance. The innovation performance score of specialist nurses in this study was (47.17±8.95) points, which is at a medium-to-high level, but there are certain differences in the innovation performance of specialist nurses, which is consistent with the study of Lin T [22]. The reasons for this may be that specialist nurses possess richer theoretical knowledge, clinical experience, and professional judgment than general nurses, enabling them to keenly identify clinical pain points and transform them into concrete innovative solutions. Secondly, effective teamwork promotes information sharing and innovative thinking, which is beneficial to improving the innovative performance level of specialist nurses. Therefore, how to reduce the differences in innovative performance among specialist nurses requires further research and necessary intervention strategies from nursing managers.\u003c/p\u003e\n\u003cp\u003e2.The Mediating Role of Self-Efficacy in Empowering Leadership and Innovative Performance of Specialist Nurses\u003c/p\u003e\n\u003cp\u003eThis study shows that empowering leadership has a positive effect on innovative performance (r=0.421, P\u0026lt;0.01), and self-efficacy is positively correlated with innovative performance (r=0.617, P\u0026lt;0.01). Self-efficacy partially mediates the relationship between empowering leadership and innovative performance (effect value 0.160), accounting for 35.96% of the total effect. Specialist nurses possess solid clinical judgment and experience in solving complex problems, enabling them to demonstrate higher empowering leadership, which is conducive to enhancing their autonomy and self-decision-making ability, thus promoting behaviors that generate self-efficacy. Self-efficacy, as an intrinsic driving force for employees' innovative intentions and behaviors, can significantly promote the improvement of innovative performance[23]. Therefore, nursing managers should not ignore the mediating role of self-efficacy, and should pay attention to the mental health and work pressure of specialist nurses in a timely manner, and provide more support and resources to stimulate more innovative thinking and abilities and generate higher innovative performance.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eThe mediating role of training transfer between empowering leadership and innovative performance of specialist nurses\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThis study found that empowering leadership, training transfer and innovative performance are all positively correlated. Training transfer plays a partial mediating role between empowering leadership and innovative performance (effect value of 0.116), and the mediating effect accounts for 26.07% of the total effect. Under the empowering leadership work situation, specialist nurses can perceive higher organizational support. The inclusive and open work environment helps to enhance employees' intrinsic motivation, improve their enthusiasm for participating in training, and thus promote the training transfer process[24]. Through training transfer, employees can better transform the skills learned in training into actual work behaviors and improve the organization's innovative performance[25]. This suggests that nursing leaders should not overlook the positive role of training transfer when improving the innovative performance of specialist nurses. Creating a favorable atmosphere and incentive mechanisms for training transfer can stimulate the work enthusiasm and creativity of specialist nurses, promote the transfer of training effects, and thus improve innovative performance.\u003c/p\u003e\n\u003cp\u003e4.The Chain Mediating Effect of Empowering Leadership, Self-Efficacy, Training Transfer, and Innovative Performance of Specialist Nurses\u003c/p\u003e\n\u003cp\u003eThis study shows that self-efficacy and training transfer have a chain mediating effect on empowering leadership and the innovative performance of specialist nurses, accounting for 11.01% of the total effect. This indicates that empowering leadership can stimulate self-efficacy, improve the effectiveness of training transfer, and thus enhance the innovative performance of specialist nurses. This suggests that nursing managers can enhance the empowering leadership ability of specialist nurses by establishing open and trusting communication channels and listening and feedback mechanisms, and providing more career development opportunities. Simultaneously, measures should be taken to enhance the work motivation and innovative enthusiasm of specialist nurses to improve self-efficacy and training transfer, thereby improving innovative performance and laying a solid foundation for high-quality development of nursing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and further studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants in this study were all from tertiary-level hospitals, which limits the generalization of the results. Secondly, this study was a cross-sectional survey and lacks information on the dynamic impacts of empowering leadership, self-efficacy, and training transfer on innovative performance. Future longitudinal studies could explore other potentially modifiable mediating variables to provide new perspectives for improving the innovative performance of specialist nurses and promoting high-quality development in nursing.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the innovative performance level of specialist nurses needs improvement. Empowering leadership not only directly influences their innovative performance but also affects it through the chain-mediating effect of self-efficacy and training transfer. This suggests that nursing managers should focus on empowering nurses to participate in decision-making, exploring ways to generate self-efficacy and training transfer, and fully affirming the value of specialist nurses to improve their innovative performance, thereby enhancing the quality of nursing services and the patient experience.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the research team members and all participants for their contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYu Wang: Writing – original draft, Resources, Methodology, Investigation. Cuiping Xu: Resources. LiLi Bao:Writing – review \u0026amp; editing, Supervision, Project administration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy reasons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee of the School of Nursing, Shandong University of Traditional Chinese Medicine (Ethics Approval Number: SZYHL2023006). All procedures were conducted in accordance with relevant guidelines and regulations. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All participants have provided informed consent before the data collection. Participating Specialist nurses were promised that the information provided would remain anonymous.\u003c/p\u003e\n\u003ch2\u003eCompeting interests policy\u003c/h2\u003e\n\u003cp\u003eWe declare that we have no conflict of interest. We declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpressing agreement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIf accepted, we agree to publish it in your journal.And we will pay APC in full.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNational Health Commission. Notice on Issuing the National Nursing Development Plan (2021-2025) [J]. Gazette of the State Council of the People\u0026apos;s Republic of China, 2022(23):57-63.\u003c/li\u003e\n\u003cli\u003eDing Yanming, Wu Xinjuan, Tian Junye, et al. Survey on the Current Status of Specialist Nurse Training and Management in Tertiary Hospitals Across 31 Provinces in China [J]. Chinese Journal of Nursing, 2021, 56(9):1357-1362.\u003c/li\u003e\n\u003cli\u003eNassani A A, Javed A, Rosak-Szyrocka J, et al. Major determinants of innovation performance in the context of healthcare sector[J]. International Journal of Environmental Research and Public Health, 2023, 20(6): 5007.\u003c/li\u003e\n\u003cli\u003eUdin U, Fitriani K, Dananjoyo R. Linking empowering leadership and work environment with employee performance: The mediating role of job stress[J]. WORK, 2025, 81(1): 2415-2424. \u003c/li\u003e\n\u003cli\u003eLocke E A. Self-efficacy: The exercise of control[J]. Personnel psychology, 1997, 50(3): 801.\u003c/li\u003e\n\u003cli\u003eNewstrom J W. Leveraging management development through the management of transfer[J]. Journal of Management Development, 1986, 5(5):33-45.\u003c/li\u003e\n\u003cli\u003eRen L, Shen H. The relationship between servant leadership and team innovation performance: Mediating effect of self-efficacy[J]. Heliyon, 2024, 10(6).\u003c/li\u003e\n\u003cli\u003eYun J, Kim D H, Park Y. The influence of informal learning and learning transfer on nurses\u0026apos; clinical performance: a descriptive cross-sectional study[J]. Nurse education today, 2019, 80: 85-90.\u003c/li\u003e\n\u003cli\u003eBandura A. Human agency in social cognitive theory[J]. American Psychologist, 1989, 44(9):1175.\u003c/li\u003e\n\u003cli\u003eAhearne M, Mathieu J, Rapp A. To empower or not to empower your sales force? An empirical examination of the influence of leadership empowerment behavior on customer satisfaction and performance[J]. Journal of Applied Psychology, 2005, 90(5):945.\u003c/li\u003e\n\u003cli\u003eSchwarzer R, B\u0026auml;\u0026szlig;ler J, Kwiatek P, et al. The assessment of optimistic self‐beliefs: comparison of the German, Spanish, and Chinese versions of the general self‐efficacy scale[J]. Applied Psychology, 1997, 46(1):69-88.\u003c/li\u003e\n\u003cli\u003eWANG, C. K., HU, Z. F., \u0026amp; LIU, Y. (2001). Reliability and validity study of the General Self-Efficacy Scale[J]. Applied Psychology, 1(1):37-40.\u003c/li\u003e\n\u003cli\u003eZuo, N. Y. (2014). The influence of personality traits and psychological contracts on training transfer [D]. Jiangsu University of Science and Technology.\u003c/li\u003e\n\u003cli\u003eWei Xin. The influence of patient gratitude on nurses\u0026apos; innovation performance [D]. Shandong University, 2021.\u003c/li\u003e\n\u003cli\u003eLi C, Niu Y, **n Y, et al. Emergency department nurses\u0026rsquo; intrinsic motivation: A bridge between empowering leadership and thriving at work[J]. International Emergency Nursing, 2024, 77: 101526.\u003c/li\u003e\n\u003cli\u003eYeh T P, Lin Y K, Lu H Y, et al. Impact of Empowering Leadership Training Through Flipped Learning Approach on the Well‐Being of Nursing Staff and Residents in Long‐Term Care Settings[J]. Journal of Nursing Management, 2025, 2025(1): 5815383.\u003c/li\u003e\n\u003cli\u003eLixia Li. Correlation between Nurses\u0026apos; Work Engagement, Self-Efficacy, and Implicit Attitudes[J]. Nursing Research, 2021, 35(11):2054-2057.\u003c/li\u003e\n\u003cli\u003eFriganović A, Selič P. Levels of burnout syndrome in Croatian critical care nurses: a cross-sectional study[J]. Psychiatria Danubina, 2020, 32(suppl. 4): 478-483.\u003c/li\u003e\n\u003cli\u003eTzafilkou K, Perifanou M, Economides A A. Negative emotions, cognitive load, acceptance, and self-perceived learning outcome in emergency remote education during COVID-19[J]. Education and information technologies, 2021, 26(6): 7497-7521.\u003c/li\u003e\n\u003cli\u003eL\u0026uuml;, F. F., \u0026amp; Zhang, Y. Analysis of the current status and influencing factors of training transfer among stroke specialty nurses[J]. Contemporary Nurse (First Half), 2022, 29(1):39-42.\u003c/li\u003e\n\u003cli\u003eWang Qiu-ting, Lin Mei-zhen, Wei Lin, et al. Survey on the Current Status and Related Factors of Training Transfer in Traditional Chinese Medicine Specialist Nurses [J]. Chinese Journal of Nursing Education, 2025, 22(06): 718-724.\u003c/li\u003e\n\u003cli\u003eLin T, Gao Y, Feng X. Relationship between information literacy and innovative behavior of emergency specialist nurses: A cross-sectional study in southwest China[J]. International Emergency Nursing, 2023, 71: 101356.\u003c/li\u003e\n\u003cli\u003eLiang Z, Suntrayuth S, Sun X, et al. Positive verbal rewards, creative self-efficacy, and creative behavior: A perspective of cognitive appraisal theory[J]. Behavioral Sciences, 2023, 13(3): 229.\u003c/li\u003e\n\u003cli\u003eLin WQ, Zhang PP, Li SY, et al. Mediating effect of job redesign on the relationship between work environment and training transfer in stroke specialty nurses[J]. Chinese Journal of Nursing Education, 2025, 22(05):580-585.\u003c/li\u003e\n\u003cli\u003eMwadzingeni L, Dandira M, Kutywayo D, et al. Impact of capacity building through learning, training, and coaching on agricultural innovation[J]. PloS one, 2025, 20(1): e0314004.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Specialist nurse, Authoritative leadership, Self-efficacy, Training transfer, Innovative performance, Chain mediation, Nursing management research","lastPublishedDoi":"10.21203/rs.3.rs-8162255/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8162255/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e To explore the chain-mediated roles of self-efficacy and training transfer between empowering leadership and innovative performance of specialized nurses, with a view to providing suggestions and guidance for nursing managers to improve innovative performance of specialized nurses and to promote the development of high quality of specialized nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e Employing a cross - sectional research approach, 330 specialist nurses from four Class - A tertiary hospitals in Jinan were recruited via convenience sampling from June to November 2023 as the research subjects. The investigation was implemented using a General Information Questionnaire, an Empowering Leadership Questionnaire, a Self - Efficacy Scale, a Training Transfer Scale, and an Innovation Performance Scale. A structural equation model for the mediating effect was constructed, and the mediating effect was examined using the Bootstrap method.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 325 specialized nurses were ultimately included in the survey. The total scores of the Empowering Leadership Questionnaire, Self - Efficacy Scale, Training Transfer Scale, and Innovation Performance Scale for specialist nurses were (51.38±7.93), (29.74±5.81), (52.9±6.35) and (47.17±8.95) points respectively, all of which were at a moderately high level. The mediating effect analysis revealed that empowering leadership had a significant direct effect on innovation performance. The effect size was 0.120, accounting for 26.97% of the total effect. Self - efficacy, training transfer and the chain mediating effect of the two factors indirectly influenced innovation performance. The mediating effect sizes were 0.160, 0.116 and 0.049 respectively, accounting for 35.96%, 26.07%and 11.01% of the total effect.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The innovation performance of specialized nurses requires improvement. Empowering leadership not only directly influences innovation performance but also indirectly affects it through the mediating roles of training transfer and self-efficacy, as well as the chain mediating effect between training transfer and self - efficacy. Nursing administrators should emphasize the management strategy of empowerment, exploring approaches to enhance training transfer and self-efficacy within the development programs for specialized nurses, thereby further elevating their levels of innovation performance.\u003c/p\u003e","manuscriptTitle":"Effect of authoritative leadership on innovation performance of specialist nurses: the chain mediation effect of self-efficacy and training transfer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 08:34:21","doi":"10.21203/rs.3.rs-8162255/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"112c393f-5130-4a5d-a1e7-5907e5045142","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-11T19:08:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 08:34:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8162255","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8162255","identity":"rs-8162255","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}