Emerging Nurse Manager’s Resilience and Their Empowering Behavior during COVID-19

Abstract

Background: The COVID-19 pandemic exacerbated tensions and tested the resiliency of many nursing leaders. Resilience enables head nurses to cope with their work environment challenges, and maintain healthy psychological activity. Moreover, their empowering behavior represents the vehicle to transform traumatic events such as the COVID-19 pandemic to create a high-quality work environment. Aim: To explore the relationship between nurse manager resilience and empowering leader behavior during COVID-19. Method: This is a descriptive correlational study. The study subjects consisted of two groups: head nurses (44) and staff nurses (284). The study was conducted at Benisuef University Hospital. Two tools were used for collecting data; nurse managers’ resilience scale, and staff nurses’ perceived empowering behavior during the COVID-19 pandemic via questionnaire. Results: In total, 50% of nurse managers had high resilience skills levels, about one-third of them (34.1%) had moderate levels and only 15.9% had low resilience skills levels. Furthermore, with regard to empowering leadership behavior levels as perceived by staff nurses during COVID-19; 66.9% of them perceived it high, 29.2% reported a moderate level of empowering behavior, and only 3.9% perceived low levels. Finally, there was a highly statistically significant positive correlation between nurse manager’s resilience skills levels and staff nurses’ perception of empowering behavior during COVID-19. Conclusions: Half of the nurse managers had high resilience skills, and only 15.9% had low levels. Two-thirds of staff nurses perceived high levels of their nurse manager’s empowering behavior during COVID-19, in comparison to only 3.9% who perceived low levels. There was a highly statistically significant positive correlation between nurse manager’s resilience skills levels and perceived empowering behavior during COVID-19.

1. Introduction

The nursing profession, as one of the most valuable, noble, and respectable professions, requires nurses to play a crucial part in a variety of difficult scenarios facing modern and developed societies [1]. Nurse leaders at all levels respond to large and small crises on a daily basis, both internal and external, planned and unexpected, by participating in clinical decision-making, delegation, engagement in innovative problem solving and assisting with clarifying judgments, empowering their staff members with adequate autonomy and upholding system and property standards [2]. The COVID-19 pandemic has caused damage to health systems worldwide. Despite the instability and unpredictability, healthcare workers continue to deliver care under physically and emotionally demanding conditions that are evolving in tandem with the pandemic’s changing landscape [3]. Nurses who deal closely with COVID-19 patients on the front lines often see patients in distress, which can increase their stress and worry. This extraordinary circumstance has a tremendous influence on their mental and emotional health [4]. The complex COVID-19 pandemic presents extraordinary challenges. Among these challenges is the conspicuous tension between nurses. Therefore, nurse managers should step up their support to nurses in the fight against COVID-19 [5,6]. All nurse managers in practice today face a problem as complex as the COVID-19 pandemic. Such a crisis would be an impactful event for all nurses of today and tomorrow. None of them have experienced this level of confusion, difficulty, and uncertainty while striving to navigate this crisis with minimal losses [7,8].

Resilience is a critical necessity for nurses [9]. Resilience is a positive concept that allows nurses to overcome stressful situations and adapt positively, resulting in the maintenance of their psychological well-being and mental health [10]. Resilience is a personality trait that enables individuals to bounce back from disappointment or difficulties and to live in and adjust to stressful situations. Consequently, resilience can compromise the impacts of multiple job stressors on job performance consequences. However, these stressors were stated in the context of work requirements in less harmful environments [11]. Nurse resilience details a complex and dynamic process that changes over time and according to the situation, embodying both personal attributes and external resources, and describes a nurse’s ability to adapt positively to stress and adversity [12].

The concept of leadership presents a hot spot in the field of management science. The earliest research using the scientific method dates back to leadership trait theory in the early 20th century. In recent years, companies have faced a profound technological and commercial revolution. These changes flatten and focus on organizational design, flexibility, customer orientation, quality improvement, and efficiency. In addition, the nature of work also changed significantly becoming increasingly complex and requiring more awareness. “Knowledge workers” have become the core of a rapidly growing workforce. In such a changing context, empowered leadership emerges as a particular type of leadership. The concept of empowering leadership was proposed in the 1990s. Manz originally referred to empowered leadership as “super leaders.” Power functions as a control mechanism. Those who hold power can lead others to help them achieve their goals. In other words, power is the ability not to be influenced by others. A person will submit to others when there is no power and will be relatively free from power. A source of energy can be an individual’s ability to provide valuable resources to the organization. It could also be their position in the organizational structure, specialized skills and access to specific knowledge or information, etc. From this perspective, empowerment is a resource allocation strategy that can reduce dependence on high power. Empowering leadership behavior can be defined as a range of management practices, including decentralization, participation, information sharing, and training [13,14,15].

Empowering leadership, defined as leader behavior that stimulates team self-direction through a mixture of actions designed to give the team autonomy and to motivate and lead the team in using that autonomy, presents a perfect match with the reasons for team-based organizational structures that recognize the potential for greater harmony in self-directed teams [14]. Empowering leader behavior is a leadership style that focuses on and intends to empower employees. Empowering leader behavior refers to the specific leader behaviors that result in employee empowerment through the power-sharing between superiors and subordinates. Shared power occurs when leaders delegate responsibility and authority to staff members who are qualified to make decisions at the level of an organization where business occurs. Establishing trust in employees can be achieved by; encouraging employee engagement in decision-making; increasing autonomy by lowering organizational barriers, and establishing motivating or important goals [15]. Sonal J et al., 2019 [14] stated that empowering leader behavior is a process in which head nurses share power to improve motivation of their nurses and involvement in their work by creating an environment that makes it possible to share the power with nurses through drawing attention to the importance of their role. Empowering behavior gives head nurses the opportunity to autonomy, showing trust in nurses’ potential and giving them the freedom to act and perform according to the current situation.

Nursing leaders are important in the workplace because they have the ability to influence the environment by providing nurses with the resources needed to meet their job demands or by preventing potential resource loss. As a result, having an effective supervisor is particularly important during times of big resource loss and greater demands, as in the case of the COVID-19 catastrophe. Because of the unpredictable and disordered nature of crises, a manager’s flexibility and willingness to adjust are critical, as such situations are marked by constricted reasoning, uncertainty, time pressure, and life and death risks [16]. The COVID-19 pandemic exacerbated these tensions and tested the resilience of many nursing leaders. While achieving productive goals, nurse managers must acquire empowering skills and resilience. Where resilient leaders inspire employees by involving them in the discussion of potential barriers to achieving the new reality [17]. Therefore, the positive leadership qualities and strong enabling leadership behaviors of head nurses play an extremely important role in creating an environment that increases job satisfaction. Moreover, resilience gives the head nurse the strength to recover quickly and face challenges, and fight them with flexibility and strength. It can be seen that they are the one who goes above and beyond to overcome adversity; adapt and adjust, and has the ability to return [10]. Resilience enables head nurses to cope with their work environment challenges, and maintain healthy psychological activity, while their empowering behavior is the vehicle to transform traumatic events such as the COVID-19 pandemic to create a high-quality work environment [18].

To better cope with the disruption caused by the COVID-19 pandemic, first, resilient empowering healthcare managers should demonstrate openness to healthcare service production innovation and adaptation to the new demands and ensure strong support for customers and communities. Second, their efforts should be directed toward ensuring the efficiency of their internal operational management and healthcare team protection. Third, priority should be given to workplace safety measures and healthy working conditions as well as supply chain stabilization, and finally to broadening access to relevant information to craft high-performance work groups, provide a common vocabulary for leaders and followers as well as tools and techniques to achieve mission-critical objectives [17]. Bearing resilience and empowering leadership behavior at the center is essential to sustain the complex political, social, and economic balance of adopting containment measures to reduce the impact of the pandemic while ensuring the provision of essential services, giving nurses the strength to recover quickly and face challenges. Resilience enables nurses to cope with their work environment challenges, and maintain healthy psychological activity. Meanwhile, the empowering behavior of nursing leaders represents the vehicle to transform traumatic events such as the COVID-19 pandemic to create a high-quality work environment [18].

2. Aim of the Study

The present study aimed to explore the relationship between nurse manager’s resilience skills levels and empowering leader behavior during COVID-19 through:

• Assess nurse manager’s resilience level.
• Identify empowering leader behavior as perceived by staff nurses during COVID-19.
• Find out the relationship between nurse manager’s resilience skills levels and empowering leader behavior during COVID-19.

3. Materials and Methods

3.1. Research Design

This was a descriptive correlational study employing a scientific method that described the behavior of objects without affecting them in any way. Researchers described two variables, namely nurse managers’ resilience level and empowering leadership behavior of nurse managers as perceived by staff nurses in the study setting.

3.2. Study Setting

The study was conducted in Benisuef University Hospital, in Benisuef governorate. It is a governmental hospital affiliated with the Ministry of Health and Population in Egypt.

4. Participants

The study subjects consisted of two groups:

First group nurse managers: This group consists of all head nurses in the selected hospital; including head nurses of both genders with at least one year of experience in the current hospital were included in the study (n = 44). Those who had attended any previous training on resilience were excluded.

Researchers excluded four head nurses who had less than one year of experience and two head nurses who attended previous training about resilience. All of the head nurses with the required inclusion criteria were accepted to participate in the study and there was no drop-out.

Second group staff nurses: All staff nurses who were working in the previously mentioned hospital at the time of data collection and accepted to participate in the study. Both genders had experienced at least six months in the hospital before the onset of pandemic COVID-19 (n = 284). Researchers excluded twelve staff nurses who had less than six months of experience before the onset of pandemic COVID-19. All of the staff nurses with the required inclusion criteria were accepted to participate in the study and there was no drop-out.

4.1. Study Instruments

4.1.1. Nurse Manager’s Resilience Scale

This scale was designed by Wagnild, GM. 1993 [19] and modified by Tau, B. et al., 2018 [18]. It is used to assess levels of resiliency for head nurses.

It is composed of two parts:

Part I: Demographic data of head nurses: This part included: age, gender, level of education in nursing, years of experience, etc.

Part II: Nurse Manager’s Resilience Levels: This section consisted of 25 items, divided into five main dimensions: purposeful life, perseverance, self-reliance, existential aloneness and equanimity. Each dimension included 5 items.

Scoring system: Head nurses’ responses were measured using a five-point Likert Scale ranging from 1–5 where (1) Strongly Agree to (5) Strongly Disagree. Total score (125), on the cut-off point (75) as follows:

High Level of resilience skills >75% = (>94).

Moderate level of resilience skills 60–75% = (75–94).

Low level of resilience skills <60% = (<75).

Validity and reliability testing for this study showed a Cronbach Alpha coefficient of the instrument at 0.85 for the study sample. A panel of experts reviewed the face and content validity of the tool.

4.1.2. Staff Nurses’ Perception regarding Nurse Manager’s Empowering Behavior during COVID-19 Questionnaire

This tool was designed by Arnold, J.A. et al., 2000 [20] and modified by the researcher based on recent related literature [18,21]. It is used to assess the empowering behavior of head nurses as perceived by staff nurses during COVID-19.

It was composed of two parts:

Part I: Demographic data of staff nurses: This part included: age, gender, level of education in nursing, years of experience, etc.

Part II: Empowering Behavior of Nurse Manager’s during COVID-19: This part consisted of 38 items classified into five dimensions: leading by example (5 items), coaching (11 items), showing concern and interacting with the team (10 items), informing (6 items) and participative decision-making (6 items).

Scoring system: Staff nurses’ responses were measured on a five-point Likert Scale ranging from 5–1 where (5) denoted always and (1) denoted never. Total score (190), on the cut-off point (75) as follows:

High level of empowering behavior >75% = (>143).

Moderate level of empowering behavior 60–75% = (114–143).

Low level of empowering behavior <60% = (<114).

The Cronbach Alpha coefficient of the questionnaire was 0.93 for the study sample. A panel of experts reviewed the face and content validity of the tool.

4.2. Procedure

To carry out the study in the predetermined hospital, a letter containing the aim of the study was directed from the researcher’s faculty of nursing to the hospital general manager to obtain his permission and help conduct the study at his facility. Researchers obtained approval from the scientific research ethical board at the faculty of nursing. Then, informed consent was obtained from all subjects involved in the study after explaining the purpose and method of data collection. Confidentiality, anonymity and the right to withdraw from the study at any time were guaranteed.

Researchers randomly selected 10 head nurses from the hospital. In addition, 40 staff nurses were recruited for the pilot study. Based on the pilot study, no modifications were required. Therefore, all of these subjects were included in the main study sample.

This study began at the start of February 2021 and was completed by the end of June 2022. Researchers started by assessing head nurses’ resilience levels followed by assessing empowering leader behavior as perceived by staff nurses during COVID-19. The time needed to fulfill both the resilience scale and the empowering leader behavior questionnaire ranged between 10–15 min. Data were collected two days per week in the presence of the researchers. The method of filling out the sheet was explained prior to data collection. The researchers collected data by meeting head nurses and staff nurses in groups at the workplace, at different times.

4.3. Statistical Analysis

The collected data were organized, categorized, computerized, tabulated and analyzed using the Microsoft Excel program and SPSS software version 24. Pearson’s correlation coefficient was used to determine significant correlations between different quantitative variables Cronbach alpha coefficient was used to determine the reliability of the tool. For all the above mentioned statistical tests performed, the threshold of significance was fixed at 5% level (p value). A p value of ≤0.05 indicates a significant result, while a p value of ≤0.01 indicates a highly significant result.

5. Results

Table 1. Demographic data of studied head nurses (n = 44).

Demographic Data	Head Nurses (n = 44)
	n	%
Age (years)
<25	0	0
25–<35	37	84.1
35–<45	5	11.4
>45	2	4.5
Mean ± SD	30.98 ± 6.30
Educational level in nursing
Technical Nursing Institute	3	6.8
Bachelor’s degree	11	25
Master’s degree	30	68.2
Years of experience
<1 year	0	0
1–<5 years	35	79.5
5–<10 years	2	4.5
>10 years	7	15.9
Mean ± SD	7.20 ± 7.83

describes the demographic data of studied head nurses. It illustrates that the majority, 84.1%, are aged between 25 and 35, while no one is aged less than 25 with a mean 30.98 ± 6. Regarding their educational level in nursing, more than two-thirds, 68.2%, of them had a master’s degree in nursing, while only 6.8% graduated from the technical nursing institute. Regarding the head nurses’ years of experience; the highest percentage of them, 79.5%, ranged from 1 to less than five years of experience with a mean 7.20 ± 7.83.

Table 2. Demographic data of studied staff nurses (n = 284).

Demographic Data	Staff Nurses (n = 284)
	n	%
Age (years)
<25	159	56
25–<35	116	40.8
35–<45	7	2.5
>45	2	0.7
Mean ± SD	24.76 ± 3.88
Educational level in nursing
Technical Nursing Institute	10	3.5
Bachelor’s degree	232	81.7
Master’s degree	42	14.8
Years of experience
1 year	48	16.9
1–<5 years	199	70.1
5–<10 years	30	10.6
>10 years	7	2.5
Mean ± SD	3.80 ± 3.91

shows that more than half (56%) of staff nurses were less than 25 years old and only two of them (0.7%) were aged 45 years old or more; with a mean 24.76 ± 3.88. Regarding their level of education in nursing, the highest percentage (81.7%) of them had a bachelor’s degree in nursing. In comparison, only 3.5% of them graduated from the technical nursing institute with a mean 3.80 ± 3.91. Regarding their years of experience, 70.1% of them ranged between one and less than five years of experience, with a mean 3.80 ± 3.91.

Note that in

Table 3. Percentage distribution of nurse manager’s resilience skills levels (n = 44).

Resilience Skills Dimensions	Nurse Manager’s Resilience Levels (n = 44)						Mean ± SD
	High > 75%		Moderate 60–75%		Low < 60%
	N	%	N	%	N	%
Purposeful life	22	50	15	34.1	7	15.9	17.52 ± 4.75
Perseverance and persistence	20	45.5	13	29.5	11	25	15.30 ± 4.22
Self-reliance	24	54.5	14	31.8	6	13.7	15.55 ± 3.97
Existential aloneness	23	52.3	16	36.4	5	7.7	16.48 ± 3.82
Equanimity	21	47.7	14	31.8	9	20.5	18.84 ± 3.29
Total	22	50	15	34.1	7	15.9	28.58 ± 7.97

almost half 54.5%; 52.3% and 50% of nurse managers had high levels of self-reliance, existential aloneness, and purposeful life dimensions, respectively, with mean values of 15.55 ± 3.97, 16.48 ± 3.82 and 17.52 ± 4.75. Moreover, less than half 47.7% and 45.5% had high levels of equanimity and perseverance, and persistence dimensions, respectively, with mean values of 18.84 ± 3.29 and 15.30 ± 4.22. Meanwhile, at the moderate level, the existential aloneness dimension was the highest percentage at 36.4%. In addition, the perseverance and persistence dimension was the highest percentage in the low nurse manager resilience levels.

Figure 1 reveals that half 50% of the nurse managers had high resilience skills. Meanwhile, more than one-third 34.1% had moderate levels and only 15.9% had low resilience skills levels.

In

Table 4. Percentage distribution of staff nurses’ perception regarding levels of nurse manger’s empowering behavior during COVID-19 (n = 284).

Domains of Empowering Behavior	Perceived Empowering Behavior Levels						Mean ± SD
	High ≥ 75%		Moderate 60–75%		Low < 60%
	N	%	N	%	N	%
Leading By Example	203	71.5	41	14.4	40	14.1	15.79±3.58
Participative Decision-Making	193	68.0	51	18.0	40	14.1	18.65±3.93
Coaching	188	66.2	65	22.9	31	10.9	34.16±6.16
Informing	181	63.7	62	21.8	41	14.4	18.04±3.42
Showing Concern/Interacting with the Team	193	68.0	75	26.4	16	5.6	30.65±4.40
Total	190	66.9	83	29.2	11	3.9	23.46±4.29

, one can observe that 71.5% of staff nurses reported their head nurses had a high level of leading by example of empowering behavior with a mean value of 15.79 ± 3.58. More than two-thirds 68% and 66% of them perceived that their head nurses had a high level of participative decision-making, showing concern and interacting with their team in addition to the coaching of empowering behavior, respectively, during COVID-19 with mean values of 18.65 ± 3.93, 30.65 ± 4.40 and 34.16 ± 6.16.

Figure 2 demonstrates that two-thirds of 66.9% of staff nurses perceived high levels of their nurse manager’s empowering behavior during COVID-19. Comparatively, 29.2% of them reported that their nurse manager had a moderate level of empowering behavior and only 3.9% perceived them as having a low level of empowering behavior during COVID-19.

As evident from

Table 5. Correlation between nurse manager’s resilience skills levels and staff nurses’ perception of their empowering behavior level during COVID-19.

Nurse Manager’s Resilience Skills Levels		Staff Nurses’ Perception of the Nurse Manager’s Empowering Behavior during COVID-19
		Lead by Example	Participation in Making Decisions	Training	Explanation	Show Interest and Interact with Others
Purposeful life	r	0.603	0.54	0.43	0.52	0.439
	p	000 **	000 **	000 **	000 **	000 **
Perseverance and persistence	r	0.579	0.613	0.579	0.479	0.379
	p	000 **	000 **	000 **	000 **	000 **
Self-reliance	r	0.75	0.651	0.735	0.379	0.479
	p	000 **	000 **	000 **	000 **	000 **
Unique existence	r	0.423	0.593	0.477	0.57	0.58
	p	000 **	000 **	000 **	000 **	000 **
Equilibrium	r	0.235	0.511	0.463	0.357	0.704
	p	000 **	000 **	000 **	000 **	000 **

r: Pearson coefficient (**) Highly statistically significant at p < 0.001.

, all dimensions of the nurse manager’s resilience skills levels had a highly statistically significant correlation with all dimensions of the nurse manager’s empowering behavior as perceived by their staff nurses and r ranged between 0.235 and 0.750 at p < 0.001.

Both

Table 6. Pearson’s correlation coefficient between total nurse manager’s resilience skills levels and total staff nurses’ perception of empowering behavior during COVID-19.

	Total Staff Nurses’ Perception of Empowering Behavior during COVID-19
	r	p
Total Nurse Managers’ Resilience	0.311	0.001 **

r: Pearson coefficient (**) Highly statistically significant at p < 0.001.

and Figure 3 indicated a highly statistically significant positive correlation between total nurse manager’s resilience skills levels and total staff nurses’ perception of empowering behavior during COVID-19.

6. Discussion

Resilience is an individual’s response to significant threats or harmful situations by positively adapting to specific situations and coping with organizational challenges [10]. Empowering leadership behavior supports employee resilience by sharing authority, autonomy, and responsibility with them in order to enhance and encourage their adaption and responsiveness to the work environment [22]. Thus, participation enhances quality and increases productivity [1].

Regarding nurse managers’ resilience skills levels, it was noticed from the present study results that almost half of the nurse managers had high levels of self-reliance, existential aloneness, and purposeful life dimensions, respectively, with mean ± SD values of 15.55 ± 3.97, 16.48 ± 3.82 and 17.52 ± 4.75. Self-reliance from the researchers’ point of view implies that self-reliance is believing in ourselves and our abilities. It is the ability to rely on oneself and realize one’s own limits and personal strengths. This suggested that respondents agree that they can manage in some way, and showed that respondents agreed that they have been capable of controlling in one manner or another. In addition, the nurse manager role has always been considered difficult, even before the COVID-19 pandemic. Targeted efforts to increase their resilience have shown improvements in satisfaction and retention of their jobs, thereby increasing patient safety. In addition, Nimako, B. 2021 [23] stated that when nurses work as part of a larger care team, they can seek help from colleagues to deal with problems as they arise. This finding is an indication that nurse managers may need counseling about existential loneliness, and these respondents may therefore need to build resilience [24]. Lenzo, V. et al., 2020 [25] studied resilience among registered nurses in Ghana during the COVID-19 pandemic and presented findings that support the results of our study. Moreover, they found that the highest scored item was “my life has meaning,” in the purposeful life dimension. This implies that nurses have a high level of resilience during the COVID-19 pandemic, in addition to the study by [26] where nurses reported a high level of resilience in self-reliance, existential aloneness, and purposeful life dimensions. Nimako, B. 2021 [23] contrasted the present results and asserted that the lowest scored item was existential aloneness. Tau, Du Plessis, Koen and Ellis (2018) [18] studied the relationship between resilience and empowering leaders’ behavior in the South African mining healthcare sector. Their work findings support the present study results and found that purposeful life (meaning), the realization that life has a purpose and the sense of having something for which to live; had a mean value of 28.2, which was the highest sub-score. However, the contrasted present results which found that existential aloneness, the realization that a person’s life path is unique, with a mean value of 26.8, had the lowest sub-score. In addition, Yassin, N. M et al., 2021 [27] studied the relation between head nurses’ resilience level skill and their empowering behavior and found that head nurses reported that the majority (80.0%) of head nurses had a high level of purposeful life dimension. Moreover, high percentages of (75.0% and 70.0%) them had high levels of existential aloneness and self-reliance dimensions, respectively.

Present study results indicated that less than half (47.7% and 45.5%) had high levels of equanimity and perseverance and persistence dimensions, respectively. From the researchers’ perspective, whereby perseverance is the act of persisting despite adversity or discouragement; this demonstrates their will to continue forward with their life and stay engaged. Moreover, resilient nurses are more willing to stick with their careers, deal with stress at work, and give their patients high-quality and safe care. High resilience nurses are healthier, happier, and more able to control their emotions and deal with challenges, making them better able to deliver high-quality nursing care [28]. Thus, it was clear that around half of the respondents were determined and self-disciplined. Lenzo, V. et al., 2020 [25] carried out a study in Italy to investigate the role of resilience as a protective factor for negative psychopathological consequences. Their results supported and aligned with the results of this study. Tau, B. et al., 2018 [18] supported the present results and found equanimity ‘“ the balanced perspective of one’s life and experiences” was high with a mean value of 27.8. Moreover, they found perseverance described as the act of persistence despite adversity or discouragement, showing a willingness to continue to reconstruct one’s life and remain involved; was high with a mean value of 27.8. Moreover, findings from a study by Yassin, N. M et al., 2021 [27] supported ours and found that almost two-thirds (65.0%) of head nurses had a high level of the perseverance dimension and more than half (55.0%) had a high level of the equanimity dimension.

Interestingly, the current study findings revealed half (50%) of the nurse managers had high resilience skills. From the researchers’ point of view, this means that nurse managers face COVID-19 pandemic challenges in an adaptive way, showing great levels of feelings of freedom and a sense of uniqueness, a higher ability to believe in themselves and in their abilities, showing a balanced perspective concerning their own life and experiences, a higher persistence in the face of adversity or a threatening situation, and great ability in understanding the meaning of life and their contributions. In addition, [28] emphasized that resilient nurse leaders are not only able to survive hardship and adversity, but also have the ability to exhibit behaviors that enhance the growth of their peers. This result was supported by the researchers [9,18] in Saudi Arabia, where a high level of resilience was reported among head nurses with a mean value of 4.03. In addition, Juan, S.J. et al., 2021 [26] in China found the majority (83%) of head nurses had high resilience levels. Meanwhile, Afshari, D. et al., 2021 in Iran found that a low percentage (12%) of head nurses had high resilience levels.

This study also reveals that more than a third of them have moderate recovery skills. From the researchers’ point of view, the moderate level of recovery may also reflect the emotional and financial support nurses have received since the start of the pandemic. Moreover, these findings highlight the importance of developing interventions and increasing social support for nurses during these stressful times to promote their psychological well-being and resilience. Social support helps nurses achieve a positive emotional state, reduces stress and anxiety levels, protects their physical and mental health, and thus improves their recovery levels [27]. This agrees with findings from studies undertaken by Alameddine, M. et al., 2021, and Awano, N. et al., 2020 [1,4] who also reported similar results. Furthermore, R.G et al., 2021 [10] stated that the majority of head nurses 95% have moderate resilience. However, Afshari, A. et al., 2021 found that 16.2% of the samples were moderately resilient. In addition, the results of our study also indicate that only 15.9% of nurse managers have low-level recovery skills. From the researcher’s point of view, these nurse managers must have increased organizational support and flexibility and must have access to counseling services, especially in times of crisis. Such support holds the promise of a good return on investment as it improves the productivity and retention of nurses and will ultimately lead to improved patient experiences and outcomes. Results from research conducted by Alameddine, M. et al., 2021 [1] supported the present findings, while conversely Afshari, A. et al., 2021 [3] reported that a high proportion (88%) of the head nurses had low recovery skills.

The current study demonstrated that two-thirds (66.9%) of staff nurses perceived a high level of their nurse manager’s empowering behavior during COVID-19. In comparison, 29.2% of them reported that their nurse manager had a moderate level of empowering behavior and only 3.9% perceived them as had a low level of empowering behavior during COVID-19. From the researchers’ point of view, nurses feel empowered when their nurse leaders show confidence in their abilities to perform. Furthermore, [29] mentioned that when nurses feel important by being able to make decisions without seeking approval from their leaders, they feel empowered to perform. This result was supported by [18,30,31] and Yassin, N.M. et al., 2021 [27] who reported that nearly half (45.2%) of the staff nurses reported that their head nurses had a high level of overall empowering behavior, while more than one-fifth 22.8% of them reported that their head nurses had a moderate level of overall empowering behavior as perceived by staff nurses. Along with the present study, Mudallal et.al. 2017 and Kim et.al. 2018 [31,32] confirmed these results in their studies in which staff nurses perceived their head nurses had a high level of empowering behavior and reported their feeling of empowerment by their head nurses based on their interaction with them. Meanwhile, research by Rangachari and Woods 2020 [17] contrasted present study results and found that 82% of staff nurses perceived low levels of empowering leader behavior during COVID-19, and added that significant support for emotional grief during a pandemic can lead healthcare workers to believe that their organization puts their own employees first, which, in turn, can make them feel physically and psychologically safe and empowered to talk about safety issues and the solutions taken on the front lines.

In this study, 71.5% of staff nurses reported that their head nurses had a high level of leading by example of empowering behavior. From the researchers’ point of view, this means that head nurses emphasize their discretion in setting goals and determining work procedures, which helps staff nurses to understand and perform whole pieces of work and eventually makes it possible for staff nurses to derive meaning from the job. Moreover, Park, J. et al., 2017 [33] asserted that nurse managers realized that in order to manage the changes and challenges of the health system during COVID-19, nurse managers must move from the traditional management model of hierarchical power and control to a leadership model that shares power and control. These results were supported by Suryaningtyas, D. et al., 2019 [34] who assessed employee responses to empowering leadership and found the same results with a mean value of 61.75. Furthermore, the present results indicated that more than two-thirds (68% and 66%) of them perceived that their head nurses had a high level of participative decision-making, showing concern and interacting with their team in addition to the coaching of empowering behavior respectively during COVID-19. These results were consistent with the findings of [15] who emphasized staff nurses feel a high level of empowering behavior in the above-mentioned dimensions based on head nurses’ interactions with the patient, physicians, and educational team and working with their staff nurses as a team.

The last objective of this study was to find out the relationship between nurse managers’ resilience and empowering leader behavior in COVID-19. As evident from the present study results, all dimensions of nurse managers’ resilience skills levels had a highly statistically significant correlation with all dimensions of nurse managers’ empowering behavior as perceived by their staff nurses. From the researchers’ point of view, resilient head nurses are able to create an empowering work environment through their leadership behaviors, which provide their staff nurses care, resources, and organizational support, involve them in any decision and provide needed information, which creates an empowered work environment and also, empowered staff nurses and positive health outcomes. In the same vein, Yassin, N.M. et al., 2021 and Besuner 2017 [27,35] confirmed these results by discovering a positive significant statistical correlation was found between overall head nurses’ resilience skills and staff nurses’ perception regarding head nurses’ empowering behavior (r = 0.865) at (p < 0.001). Furthermore, Park, J. et al., 2017 [33] confirmed these results by discovering significant correlations between empowering leader behavior and resilience, in which head nurses who had a higher level of empowering leader behaviors, also had higher ability and skill to be resilient and overcome challenges.

Along with the present findings Suryaningtyas, D. et al., 2019 and Park, J. et al., 2017 [34,36] confirmed these results by discovering significant correlations between empowering leader behavior and resilience, where head nurses who had a higher level of empowering leader behaviors also had a higher ability and skill to be resilient and overcome challenges. Likewise, Besuner 2017 [35] found statistically significant positive associations among self-efficacy, psychological empowerment, personal resilience, and organizational resilience. Additionally, Zehir and Narcıkara 2016 [36] found a meaningful relationship between authentic leadership and resilience whereby authentic leaders can influence follower performance and empower staff nurses through demonstrating leading-by-example behaviors and commitment to work, in addition to work of Arshad, A. et al., 2021 [2] whose findings agreed with the present study results. Thus, from the researchers’ point of view, resilience in nursing is vital in enabling head nurses to cope with or manage work stress during their work and empowering their staff nurses to make positive changes and achieve the goals of the organization that can influence nurses’ ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes especially during COVID-19.

Limitations of the Study

COVID-19 waves (fourth and fifth) paused the study data collection procedure because hospitals in the study settings announced emergency situations as responses for the fourth and fifth COVID-19 waves.

7. Conclusions

The COVID-19 pandemic has posed additional challenges for nurse managers and these challenges are expected to persist in the future. This study explored the relationship between nurse manager’s resilience skills levels and empowering leader behavior during COVID-19. Based on the findings of the present study, it was concluded that around half of the head nurses had high resilience skills levels in self-reliance, existential aloneness, and purposeful life, equanimity and perseverance, and persistence dimensions. Meanwhile, at the moderate level, about one-third of them had the existential aloneness dimension as the highest dimension, and the perseverance and persistence dimension was the highest percentage in the low nurse manager resilience levels. Furthermore, with regard to empowering leadership behavior levels as perceived by staff nurses during COVID-19; two-thirds of them perceived it as high, more than one quarter reported a moderate level of empowering behavior and only 3.9% perceived it as low. Finally, a highly statistically significant positive correlation was found between total nurse managers’ resilience skills levels and total staff nurses’ perception of empowering behavior during COVID-19.

8. Recommendations

Based on the study findings, the following recommendations are suggested to promote nurse managers’ resilience skills and the staff nurses’ perception of empowering behavior during COVID-19.

8.1. Healthcare Organzations

• Organizations should introduce the coaching approach as a step to organizational change to bridge the gap between learning and practice.
• Conduct training and educational programs for nurse managers detailing how to be coaches.
• Involve resilience skills in performance evaluation for nurse managers.
• Empower nurses by providing adequate resources, educational preparation, training and development, decision-making policies, building relationships, and communication effectively.
• Foster organizational culture that supports nurse empowerment.

8.2. Nurse Managers

• Building resilience skills through participating in ongoing training and workshops on building resilience to become able to manage adverse working conditions in the intensive care unit.
• Build positive, nurturing professional relationships with staff nurses.
• Use coaching approach in guiding and evaluating their staff nurses.
• Use different leadership styles such as inclusive leadership especially during COVID-19 which establish high levels of trust, articulating a clear purpose, and exploring different perspectives to make better decisions.

8.3. Future Studies

Further studies need to be conducted in different healthcare settings to generalize the concept and correlations between resilience skills and empowering leader behaviors of nurse managers.