Abstract
Long-term care (LTC) facilities confront persistent workforce challenges characterized by high turnover, compassion fatigue, and complex resident care demands, which directly compromise clinical outcomes. This cross-sectional correlational study evaluated the relationship between nurse managers' transformational leadership behaviors, staff morale, and objective quality of care metrics across 28 licensed long-term care facilities. A sample of 418 nursing personnel (comprising Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants) completed the Multifactor Leadership Questionnaire (MLQ-5X) and the McCloskey/Mueller Satisfaction Scale (MMSS), while unit-level quality metrics—including facility-acquired pressure injury (FAPI) rates, fall incidence with injury, and medication administration error rates—were extracted from institutional quality assurance databases over a six-month window. Hierarchical linear regression analyses indicated that transformational leadership styles accounted for significant variance in nursing staff morale (β = 0.542, p < 0.001). Furthermore, aggregate staff morale served as a robust mediator between leadership behavior and objective clinical safety indicators, explaining notable reductions in fall rates (β = -0.381, p < 0.01) and FAPI occurrence (β = -0.415, p < 0.001). Findings suggest that administrative investment in relational, transformational leadership paradigms significantly bolsters nursing workforce stabilization while simultaneously elevating safety and healthcare outcomes for vulnerable geriatric populations.
