Aim: This study aimed to investigate the relationship between toxic leadership and nurse followership effectiveness. Design: A quantitative cross-sectional study. Methods: This study was carried out in all medical and surgical inpatient care units at Alexandria Main University Hospital. In total, 343 nurses completed the toxic leadership scale and followership styles questionnaires. Frequencies and percentages were used to present demographic characteristics; means and standard deviations were used to present continuous variables. An independent sample t-test, Pearson correlation, and linear regression analysis were conducted to test the nature of the relationship between study variables. Results: The results indicated a slightly moderate mean percentage score for toxic leadership and a slightly high mean percentage score for nurse followership effectiveness. In addition, there was a significant negative weak correlation between toxic leadership and nurse followership effectiveness. Conclusion: Training programs should be designed for leaders and followers to develop self-insight / awareness, maintain self-control and accountability, and advance followership skills. Controlling systems should be developed for the immediate identification of ongoing toxic leadership behavior in the organization, and a whistleblower protection system should be established.

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Background:The uncertainty in the health care organizations, particularly in nursing, makes the new millennium an important time for nurses to develop leadership skills. One of the greatest challenges faced in the nursing profession is developing future nurse leader. Nurses must have leadership to move forward in harmony with changes in society and in health care. The leadership development program is a useful way for "unfreezing" views, ideas and opinions about leadership competence and, more importantly, for showing how the bedside nurses saw themselves as leaders; be empowered, have confidence in his/her abilities as a future leader and employ leadership practices. Objective: To determine the impact of implementing a leadership development training program for staff nurses on structural empowerment, leadership self-efficacy, and clinical leadership practices. Settings: This study was conducted in Inpatient Surgical Care Units at Alexandria Main University Hospital (N=15) Subjects: Nurses who are working in surgical units at morning and afternoon shift was selected randomly by simple random sample (N=40) were included in the study. Tools: Three tools were used in this study. The first tool was Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) to measure structural empowerment. The second tool was Clinical Nurse Leadership Self-Efficacy Scale (CNLSE)) to assess the nurse's confidence in performance of each of the 9 practice competencies of the clinical nurse leader. The third tool was Clinical Leadership Observation Scale to assess clinical leadership of staff nurses aligning with Kouzes and Posner (2007) model. In addition, demographic data sheet was developed by the researcher; and included questions related to gender, age, educational qualification, working unit, years of units and nursing experience Results: findings of the present study revealed that there was a highly significant improvement of overall structural empowerment and its dimensions, leadership self-efficacy and its dimensions as well as clinical leadership practices and its dimensions in the three phases of evaluation (before, immediately after and after 2 month of program implementation). The program also had moderate effect on structural empowerment and leadership self-efficacy and large effect on both clinical leadership practices and leadership knowledge. Conclusion: The study concluded that there was a highly positive significant correlation between leadership self-efficacy and structural empowerment and between clinical leadership practices and structural empowerment and leadership self-efficacy immediately after program implementation. Recommendations: Organization need to identify the essential leadership competencies required for bedside nursing staff and develop programs to enhance these competencies and should devote a minimum of two weeks per year to leadership training and education.