Accumulating evidence finds servant leadership is related to critical employee and organizational criteria, but only a limited amount of studies link servant leaders to both internal and external stakeholder outcomes. Moreover, there remains a great deal to learn regarding the conditions under which this influence is enhanced or diminished. We address these limitations in the literature by testing a multilevel model that hypothesizes servant leadership is related to nurse behavior and satisfaction as well as patient satisfaction. Further, drawing upon contingency theory, we test a contextual moderator, organizational structure, as a potential enhancer of the relationships between servant leadership and these outcomes. Using a sample of 1485 staff nurses and 105 nurse managers at nine hospitals, we demonstrated that servant leadership is directly related to more nurse helping and creative behavior, and it is related to patient satisfaction through nurse job satisfaction. Also, organizational structure acted as a moderator to enhance the influence of servant leadership on creative behavior as well as patient satisfaction through nurse job satisfaction. Limitations and future research directions are discussed.
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