{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:00:41Z","timestamp":1790834441330,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To describe agile leadership, ambidextrous leadership, organizational agility, and innovation behaviors among nurse managers and explore how these practices are experienced in clinical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Agile leadership, organizational responsiveness, and innovation are increasingly relevant to nursing management. However, these concepts may overlap substantially when measured through same-source self-report, making qualitative contextualization important for understanding how they are experienced in practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory sequential explanatory mixed-methods study was conducted in a tertiary Saudi hospital. Forty-four nurse managers completed measures of agile leadership, ambidextrous leadership, organizational agility, and innovation behaviors. Thirty-two nurse managers then participated in semi-structured interviews analyzed thematically. Quantitative data were analyzed descriptively and exploratorily, and qualitative data were analyzed thematically. Greater interpretive weight was given to the qualitative phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nurse managers reported moderate agile and ambidextrous leadership and high organizational agility and innovation behaviors. The four measures showed near-unity correlations, limiting construct-specific interpretation. Qualitative analysis generated five themes: agile leadership as flexibility and human-centered responsiveness; ambidextrous leadership as balancing opening and closing behaviors; organizational agility as adaptive unit functioning; innovation as problem-driven practice; and contextual challenges influencing leadership effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings indicate a highly interrelated agile leadership\u2013organizational functioning profile. The primary contribution lies in the qualitative findings, which show how nurse managers described flexibility, delegation, balancing operational and improvement work, problem-driven innovation, and contextual constraints within Saudi clinical management. Larger multisite and multi-source studies are needed to determine whether the measured constructs are empirically distinct.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1950319","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:40:56Z","timestamp":1790833256000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring agile leadership, ambidextrous leadership, organizational agility, and innovation behaviors among nurse managers: an explanatory mixed-methods study"],"prefix":"10.3389","volume":"6","author":[{"given":"Ebtsam Aly","family":"Abou Hashish","sequence":"first","affiliation":[{"name":"College of Nursing - Jeddah, King Saud bin Abdul-Aziz University for Health Sciences","place":["Jeddah, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Jeddah, Saudi Arabia"]},{"name":"Ministry of National Guard Health Affairs","place":["Jeddah, Saudi Arabia"]},{"name":"Faculty of Nursing, Alexandria University","place":["Alexandria, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hend","family":"Alnajjar","sequence":"additional","affiliation":[{"name":"College of Nursing - Jeddah, King Saud bin Abdul-Aziz University for Health Sciences","place":["Jeddah, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Jeddah, Saudi Arabia"]},{"name":"Ministry of National Guard Health Affairs","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8178924","DOI":"10.1155\/jonm\/8178924","article-title":"Nurse managers\u2019 perspectives on digital transformation and informatics competencies in e-leadership: a qualitative study","volume":"2025","author":"Abou Hashish","year":"2025","journal-title":"J Nurs Manag"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e70458","DOI":"10.1002\/nop2.70458","article-title":"Technostress creators and inhibitors: dual impacts on nurses\u2019 psychological and work outcomes","volume":"13","author":"Abou Hashish","year":"2026","journal-title":"Nurs Open"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12912-024-02084-8","article-title":"Nurse managers\u2019 managerial innovation and its relation to proactivity behavior and locus of control among intensive care nurses","volume":"23","author":"Elbus","year":"2024","journal-title":"BMC Nurs"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/14604582261440411","article-title":"Nurses\u2019 adaptation to digital transformation in healthcare: a grounded theory of progressive digital adaptation","volume":"32","author":"Abou Hashish","year":"2026","journal-title":"Health Informatics J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"7935435","DOI":"10.1155\/nuf\/7935435","article-title":"Effect of organizational agility and ambidextrous leadership on nurses\u2019 readiness for change","volume":"2025","author":"Hossny","year":"2025","journal-title":"Nurs Forum"},{"key":"B6","doi-asserted-by":"publisher","first-page":"4248","DOI":"10.3390\/su16104248","article-title":"The synergy of ambidextrous leadership, agility, and entrepreneurial orientation to achieve sustainable AI product innovation","volume":"16","author":"Zhang","year":"2024","journal-title":"Sustainability"},{"key":"B7","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.leaqua.2011.07.014","article-title":"Explaining the heterogeneity of the leadership-innovation relationship: ambidextrous leadership","volume":"22","author":"Rosing","year":"2011","journal-title":"Leadersh Q"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12912-024-02277-1","article-title":"Sparking nurses\u2019 creativity: the roles of ambidextrous leadership and psychological safety","volume":"23","author":"El-Gazar","year":"2024","journal-title":"BMC Nurs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"4834","DOI":"10.3390\/ijerph19084834","article-title":"Agile leadership and perceived career success: the mediating role of job embeddedness","volume":"19","author":"Akkaya","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B10","volume-title":"Doing Agile Right: Transformation Without Chaos","author":"Rigby","year":"2020"},{"key":"B11","doi-asserted-by":"publisher","first-page":"687","DOI":"10.21608\/jnsbu.2023.310299","article-title":"Agile leadership training program for head nurses and its effect on their innovative behavior","volume":"4","author":"Amr","year":"2023","journal-title":"J Nurs Sci Benha Univ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"365","DOI":"10.29228\/joh.41492","article-title":"Development, validity and reliability of the marmara agile leadership scale study","volume":"44","author":"\u00d6zgenel","year":"2020","journal-title":"J Hist Sch"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/23779608231160463","article-title":"The relationship between coping strategies, compassion satisfaction, and compassion fatigue during the COVID-19 pandemic","volume":"9","author":"Abou Hashish","year":"2023","journal-title":"SAGE Open Nurs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s12912-025-04232-0","article-title":"The impact of ambidextrous leadership on innovative work behavior among critical care nurses: a cross-sectional study","volume":"25","author":"El-Sayed","year":"2025","journal-title":"BMC Nurs"},{"key":"B15","unstructured":"Wasilewski\n              J\n            \n          \n          MN\n          Minneapolis\n          Walden University\n          Ambidexterity and innovation in chief nursing officers in the healthcare setting\n          \n          2019"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2588514","DOI":"10.1080\/23311975.2025.2588514","article-title":"Multi-level analysis of ambidextrous leadership and its impact on innovative work behavior: a systematic literature review approach","volume":"12","author":"Muhammad","year":"2025","journal-title":"Cogent Bus Manag"},{"key":"B17","doi-asserted-by":"publisher","first-page":"6624868","DOI":"10.1155\/jonm\/6624868","article-title":"Assessing the impact of ambidextrous leadership on nurses\u2019 presenteeism: a latent profile and mediation analysis study","volume":"2026","author":"Zhou","year":"2026","journal-title":"J Nurs Manag"},{"key":"B18","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0925-5273(98)00217-5","article-title":"A methodology for achieving agility in manufacturing organisations: an introduction","volume":"62","author":"Sharifi","year":"1999","journal-title":"Int J Prod Econ"},{"key":"B19","doi-asserted-by":"publisher","first-page":"261","DOI":"10.4103\/enj.enj_21_25","article-title":"Relationship between organizational agility and nursing staff\u2019s well-being and readiness for change","volume":"22","author":"Hussien","year":"2025","journal-title":"Egypt Nurs J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1002\/nop2.1080","article-title":"Effectiveness of a nursing innovation workshop at enhancing nurses\u2019 innovation abilities","volume":"9","author":"Gao","year":"2022","journal-title":"Nurs Open"},{"key":"B21","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1108\/IJEBR-11-2015-0262","article-title":"Measuring employee innovation: a review of existing scales and the development of the innovative behavior and innovation support inventories across cultures","volume":"23","author":"Lukes","year":"2017","journal-title":"Int J Entrep Behav Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1111\/nuf.12323","article-title":"Turkish psychometric properties of the innovative behavior inventory and innovation support inventory: a model analysis on nurses","volume":"54","author":"Labrague","year":"2019","journal-title":"Nurs Forum"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10999922.2026.2638672","article-title":"Organizational citizenship behavior model in improving public service management mediated by integrity","author":"Syamsir","year":"2026","journal-title":"Public Integrity"},{"key":"B24","volume-title":"The Agile Leader: How to Create an Agile Business in the Digital Age","author":"Hayward","year":"2021"},{"key":"B25","doi-asserted-by":"publisher","first-page":"117","DOI":"10.7341\/20242026","article-title":"The effectiveness of agile leadership in practice: a comprehensive meta-analysis of empirical studies on organizational outcomes","volume":"20","author":"Porkodi","year":"2024","journal-title":"J Entrep Manag Innov"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/23779608221078158","article-title":"Occupational fatigue and associated factors among Saudi nurses working 8-hour shifts at public hospitals","volume":"8","author":"Alsayed","year":"2022","journal-title":"SAGE Open Nurs"},{"key":"B27","volume-title":"Designing and Conducting Mixed Methods Research","author":"Creswell","year":"2018"},{"key":"B28","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1108\/LODJ-11-2012-0141","article-title":"Ambidextrous leadership and team innovation","volume":"36","author":"Zacher","year":"2015","journal-title":"Leadersh Organ Dev J"},{"key":"B29","volume-title":"Psychometric Theory","author":"Nunnally","year":"1978"},{"key":"B30","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol"},{"key":"B31","volume-title":"Multivariate Data Analysis","author":"Hair","year":"2019"},{"key":"B32","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B33","doi-asserted-by":"crossref","DOI":"10.1016\/0147-1767(85)90062-8","volume-title":"Naturalistic Inquiry","author":"Lincoln","year":"1985"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4018\/ijec.2015100101","article-title":"Common method bias in PLS-SEM: a full collinearity assessment approach","volume":"11","author":"Kock","year":"2015","journal-title":"Int J e-Collab"},{"key":"B35","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1186\/s12913-024-10641-9","article-title":"Driving innovation in health care: exploring the impact of ambidextrous leadership on creative performance among frontline health professionals in Norway","volume":"24","author":"Mutonyi","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1177\/2394964319868321","article-title":"Leadership agility for organizational agility","volume":"5","author":"Joiner","year":"2019","journal-title":"J Creat Value"},{"key":"B37","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1186\/s12912-025-03467-1","article-title":"The effect of transformational leadership on nurses\u2019 innovative behaviors: the mediating effect of psychological empowerment","volume":"24","author":"Bekti\u015f","year":"2025","journal-title":"BMC Nurs"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1742276","DOI":"10.3389\/fpsyg.2026.1742276","article-title":"Current status of innovative behaviors among nurses in public hospitals and its influencing factors: a cross-sectional study","volume":"17","author":"Zhu","year":"2026","journal-title":"Front Psychol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e70051","DOI":"10.1111\/wvn.70051","article-title":"Exploring the impact of leadership, organizational support, and knowledge management in evidence-based practice implementation among nurse managers through SEM","volume":"22","author":"Abou Hashish","year":"2025","journal-title":"Worldviews Evid Based Nurs"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1560726","DOI":"10.3389\/fpsyg.2025.1560726","article-title":"Exploring how ambidextrous leadership influences knowledge workers\u2019 innovative behavior: a two-stage SEM-ANN analysis","volume":"16","author":"Liu","year":"2025","journal-title":"Front Psychol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/23779608261436185","article-title":"Nurses\u2019 perceptions of climate change and attitudes toward sustainability practices: the mediating role of nurse managers\u2019 sustainable management behaviors","volume":"12","author":"Elbassal","year":"2026","journal-title":"SAGE Open Nurs"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12912-024-02134-1","article-title":"The relationship between organizational justice and bullying behaviors among nurses: the role of nurse managers\u2019 caring behaviors","volume":"23","author":"Abou Hashish","year":"2024","journal-title":"BMC Nurs"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/23779608251413844","article-title":"The roles of transformational leadership in nurses\u2019 retention and the quality of nursing care: a cross-sectional study","volume":"12","author":"Alhusban","year":"2026","journal-title":"SAGE Open Nurs"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1812663","DOI":"10.3389\/frsus.2026.1812663","article-title":"Institutional capacity, organizational performance and multi-stakeholder collaboration in local disaster risk reduction: evidence from west sumatra, Indonesia","volume":"7","author":"Saputra","year":"2026","journal-title":"Front Sustain"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.18280\/ijsse.160512","article-title":"Institutionalizing risk-oriented collaborative governance for preventive landslide mitigation in sawahlunto city","volume":"16","author":"Purnama","year":"2026","journal-title":"Int J Saf Secur Eng"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1950319\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:40:59Z","timestamp":1790833259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1950319\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":45,"alternative-id":["10.3389\/frhs.2026.1950319"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1950319","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"1950319"}}