{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:56:45Z","timestamp":1790567805794,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007853","name":"Central ElectroChemical Research Institute","doi-asserted-by":"publisher","award":["3.24.9"],"award-info":[{"award-number":["3.24.9"]}],"id":[{"id":"10.13039\/501100007853","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Nursing Scholarship"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Middle Nurse Managers (MNMs) play a pivotal role in translating organizational strategy into operational practice, ensuring care quality, and fostering team performance. Despite their importance, limited research has examined the factors influencing MNMs' competencies, particularly the interplay between individual and organizational determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine the direct and moderating effects of self\u2010efficacy and other organizational and individual factors on MNMs' competence knowledge and competence application across Italy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional, multicenter study was conducted between September 2022 and December 2023 with the participation of 382 MNMs from public and private healthcare organizations. Data were collected using validated instruments, including the Chase Nurse Manager Competencies Scale, the Questionnaire on Experience and Work Evaluation (QEEW 2.0), and the Leadership Self\u2010Efficacy Scale. Structural equation modeling (SEM) tested direct effects of educational appropriateness, leadership training intentions, autonomy, role clarity, and work complexity, and the moderating role of self\u2010efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Educational appropriateness, autonomy, and role clarity were significantly associated with competence knowledge, while educational appropriateness and autonomy were associated with competence application. Self\u2010efficacy was directly associated with both competence outcomes and significantly moderated the relationship between educational appropriateness and autonomy with each competence dimension, with positive associations observed among individuals with higher self\u2010efficacy (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.456 for knowledge;\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.459 for application,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Self\u2010efficacy was associated with competence outcomes and moderated the associations between organizational factors and competence. High self\u2010efficacy may reduce reliance on perceived educational appropriateness, whereas lower self\u2010efficacy increases its importance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jnu.70121","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:13:22Z","timestamp":1787750002000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The moderating role of self\u2010efficacy in influencing the level of competencies among Middle Nurse Managers: A cross\u2010sectional study"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0091-7524","authenticated-orcid":false,"given":"Dhurata","family":"Ivziku","sequence":"first","affiliation":[{"name":"Department of Health Professions Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"},{"name":"Faculty of Medical Sciences AAB College  Pristina Kosovo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-1065","authenticated-orcid":false,"given":"Felice","family":"Curcio","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery University of Sassari  Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9867-9319","authenticated-orcid":false,"given":"Lucia","family":"Filomeno","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0764-0866","authenticated-orcid":false,"given":"Alessio","family":"Lachi","sequence":"additional","affiliation":[{"name":"Saint Camillus International University of Health Sciences  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4641-604X","authenticated-orcid":false,"given":"Fabio","family":"D'Agostino","sequence":"additional","affiliation":[{"name":"Saint Camillus International University of Health Sciences  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4575-1898","authenticated-orcid":false,"given":"Noemi","family":"Giannetta","sequence":"additional","affiliation":[{"name":"Saint Camillus International University of Health Sciences  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0112-7041","authenticated-orcid":false,"given":"Daniela","family":"Forte","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention University Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nexhmije","family":"Gori","sequence":"additional","affiliation":[{"name":"Office of Projects and International Relations, Chamber of Nurses, Midwives, and Other Health Professionals  Pristina Kosovo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1566-1974","authenticated-orcid":false,"given":"Cesar Ivan Aviles","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"University of Enna \u201cKore\u201d  Enna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Tartaglini","sequence":"additional","affiliation":[{"name":"Department of Health Professions Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"},{"name":"Research Unit of Nursing Science, Department of Medicine and Surgery Campus Bio\u2010Medico University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2016-005567"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1108\/IJPPM-02-2016-0038"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/23779608221127823"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-12.1.8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/feduc.2024.1385442"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1207\/S15327906Mb340203"},{"key":"e_1_2_12_8_1","volume-title":"Structural Equation Modelling With LISREL, PRELIS, and SIMPLIS: Basic Concepts, Applications, and Programming","author":"Byrne B. 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