Psychometric properties of the Persian version of the Toxic Leadership Behaviors of Nursing Managers Scale

Persian ToxBH-NM Scale

Abstract

Background & Aim: Given the critical role of the nursing profession in healthcare delivery and social welfare, and the increasing recognition of toxic leadership behaviors in clinical environments, it is essential to assess such behaviors using valid and reliable instruments. This study aimed to assess the psychometric properties of the Persian version of the Toxic Leadership Behaviors of Nursing Managers Scale (ToxBH-NM).
Methods & Materials: This descriptive cross-sectional study was conducted in 2025 to translate and evaluate the psychometric properties of the Persian version of the Toxic Leadership Behaviors of Nursing Managers Scale (ToxBH-NM). The study included 282 nurses from five teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran. Participants were selected using a multistage sampling method and completed questionnaires on demographics, job satisfaction, turnover intention, and the ToxBH-NM. Of the 300 distributed questionnaires, 18 were excluded due to incomplete responses and missing data, resulting in a final analysis performed on 282 nurses with complete and valid questionnaires. A methodological psychometric validation approach was used, including assessment of face, content, and construct validity, along with reliability analysis using Cronbach's alpha and the intraclass correlation coefficient (ICC).
Results: Face and content validity were confirmed (CVR = 0.96; S-CVI/Ave = 0.92). Confirmatory factor analysis supported the original four-factor, 30-item structure of the Persian ToxBH-NM Scale, with satisfactory model fit indices (χ²/df = 2.61, RMSEA = 0.079, SRMR = 0.048, CFI = 0.98, IFI = 0.98, TLI = 0.98, NFI = 0.97, and GFI = 0.91).
Cronbach's alpha coefficients ranged from 0.848 to 0.943 across the four dimensions and reached 0.967 for the total scale. Test–retest reliability showed high temporal stability (ICC = 0.98 for the total scale). Concurrent validity was supported by a significant negative correlation between the total toxic leadership score and job satisfaction (r = −0.189, p = 0.001), whereas no significant correlation was observed with turnover intention (r = −0.002, p = 0.974).
Conclusion: This instrument may support the assessment of toxic leadership behaviors among nursing managers and provide a foundation for future research and leadership development initiatives in the Iranian healthcare system.