To validate the Ethical Leadership Scale by Brown, Treviño and Harrison (2005) in Italian language, and assess, in healthcare setting, whether ethical leadership is related to leader-member exchange and also job satisfaction, work engagement, cynicism, and organizational service climate BACKGROUND: Ethics is a key component in healthcare professions, and leaders have to encourage ethical behaviour. Unfortunately, no instrument is currently validated in Italy and the associations between this construct and the proposed measures have been under-studied.A cross-sectional study was conducted in a large organization offering healthcare services. All employees were invited to fill an on-line survey. The answers of 637 respondents, working in 48 centres for elderly and disabled people, were examined with exploratory and confirmatory factor analyses and aggregated at the centre level to test the association among the examined measures.The 10 items on the ethical leadership scale load on a single factor, negatively related to cynicism and positively related to the other examined variables.The proposed scale is a reliable tool to assess the ethical leadership of Italian healthcare managers and nurse leaders. Supporting ethical leadership may stimulate employees' work attitudes and promote organizational service climate.