Cross-level effects of health-promoting leadership on nurse presenteeism: The mediation and moderation effect of workload and performance pressure

Abstract This study examines the cross-level influence mechanism of leaders’ health-promoting leadership on subordinates’ presenteeism among nursing industry. A multilevel mediated moderation model was hypothesized to explore whether health-promoting leadership is associated with subordinates’ presenteeism via the workload of subordinates, and how leader’s performance pressure plays the role in the model. Questionnaires were distributed to 110 nursing teams, which including 110 chief nurses and 660 subordinate nurses. Our findings showed that although health-promoting leadership has no direct impact on presenteeism, health-promoting leadership has an indirect impact on presenteeism via workload, and workload acts as a complete mediator. Meanwhile, performance pressure moderated the relationship between health-promoting leadership and workload. With an increase in performance pressure of leaders, the negative impact of health-promoting leadership on nurse workload gradually weakened. In this multilevel mediated moderation model, the mediated moderating effect of performance pressure was significant and the moderating effect was completely mediated, which means that the interaction between health-promoting leadership and performance pressure can affect presenteeism through workload. When leaders were under high performance pressure, the protective effect of health-promoting leadership on workload would be inhibited. These findings contribute to enriching the research on presenteeism, providing insight into how the health development of employees and performance demands of leaders may be balanced, and affording fresh thoughts for effective prevention and treatment of nurse presenteeism.