# Impact of Leadership Style on Professional Ethics and Moral Courage of Perioperative Nurses: A Cross‐Sectional Study in Southern Iran

## TL;DR

This study shows that active leadership styles, especially transformational leadership, improve ethical behavior and moral courage in perioperative nurses in high-pressure surgical environments.

## Contribution

The study identifies transformational leadership as a key predictor of professional ethics and moral courage in perioperative nursing.

## Key findings

- Transformational leadership strongly predicts professional ethics and moral courage in perioperative nurses.
- Transactional leadership is linked to professional ethics but not moral courage.
- Leadership styles explain a large portion of the variance in ethical behavior and moral courage.

## Abstract

This study aimed to investigate the association between leadership styles and professional ethics and moral courage among perioperative nurses in southern Iran.

Operating rooms are high‐pressure environments where leadership behaviors and ethical decision‐making are critical for safe surgical care.

A cross‐sectional study was conducted with 251 perioperative nurses in Shiraz hospitals (June–August 2024). Standardized instruments were used: the Multifactor Leadership Questionnaire (MLQ), the Cadozier Professional Ethics Questionnaire, and the Sekerka Moral Courage Scale. Data were analyzed using Spearman’s correlation and robust multiple regression (bootstrapping) due to non‐normal data distribution.

Active leadership styles demonstrated strong positive correlations with both professional ethics (r = 0.852) and moral courage (r = 0.868). Robust multiple regression analysis confirmed that transformational leadership was the primary positive predictor of both outcomes (β
PE = 0.754; β
MC = 0.824). Transactional leadership was also a significant predictor of professional ethics (β
PE = 0.197) but not of moral courage (p = 0.330). The models explained a substantial portion of the variance for professional ethics (adjusted R
2 = 0.842) and moral courage (adjusted R
2 = 0.704).

Active leadership is significantly associated with enhanced professional ethics and moral courage in perioperative nurses. Fostering transformational and transactional leadership is therefore recommended to improve the ethical climate in high‐pressure clinical settings.