Operationalizing integrative holistic leadership in nursing management: Psychometric validation of a higher-order competency model

Integrative nursing requires leadership that unites relational care, systems literacy, and safety governance within complex hospital environments. However, validated instruments that operationalize integrative holistic leadership in frontline nursing management remain limited, particularly in resource-constrained settings. This study aimed to develop and psychometrically validate the First-Line Nurse Manager Competencies Scale grounded in integrative holistic and systems leadership theory. A methodological instrument development design was employed. Item generation was informed by integrative holistic leadership theory and competency mapping. Content validity was evaluated by expert panel review. Data were collected from 315 nurse managers across six general hospitals. Exploratory factor analysis using principal axis factoring with oblique rotation identified the underlying structure. Confirmatory factor analysis tested model fit and higher-order construct validity. Reliability and construct validity were examined using Cronbach’s alpha, composite reliability, average variance extracted, and inter-factor correlations. A five-factor structure emerged comprising leadership and professionalism, communication and relationship management, healthcare environment knowledge, business and resource management, and quality and safety oversight. The model demonstrated excellent sampling adequacy and explained 72.6% of total variance. Confirmatory analysis supported a coherent higher-order integrative leadership construct with acceptable model fit indices. Internal consistency ranged from 0.92 to 0.97 across domains. Descriptive findings indicated high self-reported competency with balanced domain dispersion. This study moves integrative holistic leadership from normative discourse to empirically testable architecture. The validated model provides a structural foundation for competency-based leadership development, cross-national validation, and advancement of integrative nursing management science.