Transformational Leadership, Self-Efficacy, and Job Performance in Chinese Tertiary Hospital Nurses: A Cross-Sectional Structural Equation Model Study

Background: Nurse job performance is critical to healthcare quality, particularly in high-demand, hierarchical systems such as tertiary hospitals in China. While transformational leadership and self-efficacy are known to influence performance, their interaction remains underexplored in culturally structured healthcare contexts. Purpose: This study investigates how transformational leadership relates to nurse job performance, with self-efficacy examined as a mediating mechanism. The model is grounded in Bandura’s social cognitive theory and the Job Demands–Resources (JD-R) model. Methods: A cross-sectional survey was conducted with 460 registered nurses from three tertiary Grade-A hospitals in Shanghai, selected via stratified random sampling. Self-reported data were collected using validated instruments: the Multifactor Leadership Questionnaire (MLQ), the Nursing Profession Self-Efficacy Scale (NPSES2), and the Nurse Job Performance Scale. Structural equation modeling (SEM) and bootstrapping were used to test direct and indirect effects. Results: Transformational leadership was positively associated with both nurse self-efficacy (β = 0.33, p < .001) and job performance (β = 0.18, p < .001). Self-efficacy was the primary predictor of job performance (β = 0.47, p < .001) and partially mediated the leadership–performance relationship, accounting for 46.3% of the total effect. Conclusion: These findings support a dual-pathway model in which transformational leadership enhances performance both directly and through psychological empowerment. The results offer practical insights for leadership development and underscore the importance of fostering self-efficacy in demanding, hierarchical healthcare systems. Future research ought to explore longitudinal designs and cultural moderators to extend generalizability.