Korean Version of Toxic Nurse Leadership Scale Validated in Hospital Study

A cross-sectional validation study has provided preliminary empirical support for the reliability and validity of the Korean version of the Toxic Leadership Behaviors of Nurse Managers Scale, designated as the K-ToxBH-NM Scale. The research, which utilized a methodological framework, evaluated the instrument’s performance among hospital nurses in South Korea to determine whether the translated scale can effectively capture destructive managerial behaviors in local healthcare environments.

The original Toxic Leadership Behaviors of Nurse Managers Scale was established to measure toxic leadership dynamics specifically within nursing settings and had previously established its measurement validity across diverse cultural environments. The researchers noted that creating and validating a Korean adaptation could enhance the empirical understanding of toxic managerial leadership within the Korean nursing context while potentially contributing to the broader improvement of workplace culture across the country’s healthcare institutions.

To evaluate the psychometric properties of the translated instrument, the researchers executed a secondary analysis utilizing data obtained from hospital nurses practicing in South Korea. The analytic cohort comprised 311 hospital nurses derived from an initial sample of 319 nurses who had completed the parent investigation’s survey between November and December 2024. The investigative protocol encompassed comprehensive assessments of content validity, construct validity, convergent validity, and multiple indices of measurement reliability.

Construct validity was examined through both exploratory and confirmatory analytic procedures, comparing several competing measurement structures including a single-factor model, the original four-factor model, and a bifactor model. An initial principal component analysis resolved the items into three underlying behavioral components, identified as intemperate–authoritarian, deceptive–abusive, and self-serving–opportunistic behaviors. When tested via confirmatory factor analysis, a three-factor model specifying six correlated residuals demonstrated acceptable goodness-of-fit indices across most statistical metrics.

Subsequent structural evaluations indicated that the original four-factor configuration exhibited a slightly better statistical fit than the three-factor solution, although the four factors demonstrated exceptionally strong inter-factor correlations ranging between 0.87 and 0.94. Additionally, evaluation of a bifactor model revealed the presence of a dominant general factor, providing statistical justification for calculating and interpreting the total instrument score rather than relying solely on isolated subscale scores.

Convergent validity of the K-ToxBH-NM Scale was substantiated by a statistically significant, strong positive correlation with scores from the Workplace Incivility Scale (r = 0.79, p < 0.001). Evaluation of scale reliability via Cronbach’s alpha and intraclass correlation coefficients demonstrated high internal consistency across items, alongside good test–retest reliability in a designated subsample of 60 participants who completed repeat testing.

The investigators concluded that their findings offer preliminary support for the psychometric integrity, reliability, and validity of the K-ToxBH-NM Scale for evaluating toxic managerial conduct. However, they explicitly noted that further replication in independent and more demographically representative samples will be necessary before the tool is broadly generalized, recommending that the instrument currently be utilized as a research measure with the total composite score serving as the primary metric of assessment.

Subject of Research: Validation of the Korean Toxic Leadership Behaviors of Nurse Managers Scale

Article Title: Validation of the Korean version of the toxic leadership behaviors of nurse managers scale: a cross-sectional study

Article References: Lee, H., Chung, S. J., Oh, Y. H., & Jang, S. J. (2026). Validation of the Korean version of the toxic leadership behaviors of nurse managers scale: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05619-3

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05619-3

Keywords: toxic leadership, nurse managers, nursing research, scale validation, cross-sectional study, workplace incivility, South Korea, psychometrics, Validation, Korean, version, toxic