# Constructing a Multidimensional Entrepreneurial Leadership Competency Model Amongst Nurse Leaders of New Hospitals in China: A Mixed-Methods Study

## TL;DR

This study creates a leadership model for nurse leaders in new Chinese hospitals to improve nursing management and innovation.

## Contribution

A novel multidimensional competency model for entrepreneurial leadership in nurse leaders of new hospitals in China.

## Key findings

- The model includes five dimensions and 21 competency elements with strong reliability and validity.
- The model is supported by exploratory and confirmatory factor analyses, showing practical applicability.
- The model emphasizes entrepreneurial leadership in dynamic healthcare environments.

## Abstract

This study aims to assess and enhance the multidimensional entrepreneurial leadership competency model amongst nurse leaders of new hospitals in China.

As dynamically developing healthcare organisations, new hospitals face a more turbulent and uncertain environment compared with mature hospitals and often encounter uncertainties resulting from the complexity and ambiguity of their development process. The nurse leader's management philosophy, skill level and leadership style can greatly influence the construction of nursing teams, thus playing a key role in the management of new hospitals. Constructing a multidimensional nurse leader job competency model that meets the developmental qualities of new hospitals is thus critical to creating strategic value, improving nursing effectiveness and forming a competitive advantage in nursing.

This study adopted a mixed-research methodology and was conducted in two distinct phases. In the first phase, two rounds of in-depth semistructured interviews were performed with nurses, nurse managers, doctors and department heads in newly established hospitals. Participants were required to have worked in the new hospital for at least 1 year and to have been directly involved in clinical practice, nursing leadership or hospital management. A purposive sampling strategy was used to ensure diversity of roles and departments. The interviews were conducted by trained qualitative researchers; one acted as the facilitator, and the other took notes and managed audio recordings. After each round, thematic analysis was performed independently by two researchers, followed by discussion to reach consensus. The themes from both rounds were used to construct a competency model and develop a questionnaire. Grounded theory was applied to construct the dimensions and elements of the competency model. The model considered not only the elements of leadership for nurse leaders in new hospitals but also the developmental qualities of new hospitals. The second phase involved the development of a questionnaire based on the competency model identified in the first stage. Participants were recruited by convenience sampling. The respondents were nurses, nurse leaders, doctors and department heads of 2 new hospitals in Guizhou Province, with a total of 411 participants. Data collected from the questionnaires were used to test the reliability and validity of the model, the fit of the model and the consistency, accuracy and stability of its dimensions and elements.

The multidimensional nurse leader job competency model comprises 5 dimensions and 21 competency elements. After item analysis and exploratory factor analysis (EFA), 21 items were retained. The dimensions are establishing a shared vision (4 items, Cronbach's α was 0.850), problem-solving ability (5 items, Cronbach's α was 0.865), decision-making ability (4 items, Cronbach's α was 0.848), assuming uncertainty and risk (4 items, Cronbach's α was 0.850) and stimulating strategic innovation in nursing (4 items, Cronbach's α was 0.848). The total Cronbach's α was 0.939. Meanwhile, the cumulative variance explained by the five common factors extracted in accordance with customised choices in the EFA was 68.53%. In the validation factor analysis, χ2/df=1.235, RMSEA = 0.024, GFI = 0.952, CFI = 0.991, IFI = 0.991 and TLI = 0.989.

The proposed multidimensional nurse leader job competency model shows good reliability, validity, fitness and scientificity and thus can be used for the assessment and training of nurse leaders in new hospitals. The five core dimensions were strongly supported by EFA and confirmatory factor analysis. These findings demonstrate that the model is theoretically sound and practically applicable for evaluating and developing nurse leadership competencies in clinical settings.

This study emphasises the importance of constructing a multidimensional job competency model for nurse leaders in new hospitals based on entrepreneurial leadership whilst considering the dynamic developmental qualities of new hospitals to facilitate the development of entrepreneurial leadership in the nursing field in China. The model shows strong applicability amongst nurse leaders in new hospitals, providing a structured approach to addressing diverse leadership challenges in evolving healthcare environments. Future assessment and training of nurse leaders should be guided by this model, with further research recommended to validate its effectiveness and refine its application in different nursing management contexts.