Nursing leadership and management have gained increasing relevance in recent decades, driven by the need to ensure more effective, safer, and patient-centered health systems. The World Health Organization highlights the strengthening of nursing leadership as a strategic priority to achieve universal health coverage, reduce inequalities, and improve the quality of care.1,2 In line with this vision, the International Council of Nurses affirms that nurse managers and leaders must be empowered to participate in decision-making at all levels of the healthcare system, promoting efficiency, ethical integrity, and sustainability.3

Historically, nursing management focused on staff supervision and the organization of care-related tasks.4 However, this role has evolved towards a more strategic vision, encompassing resource planning, coordination of multidisciplinary teams, continuous quality improvement, patient safety, and the implementation of healthcare policies.5 This shift has positioned nursing leadership as a key competency that directly impacts clinical outcomes, team satisfaction, talent retention, and workplace climate.4–6Numerous studies have shown that transformational and participative leadership styles in nursing are associated with higher care quality, lower staff turnover, and increased organizational commitment.4,7,8 However, developing and reinforcing these competencies requires valid and reliable tools that allow for their objective and ongoing assessment.4,9

Despite growing international recognition of the importance of evaluating nursing leadership and managerial performance, few validated instruments are currently available. Filomeno et al.,10 in their recent systematic review identified ten instruments to measure nurse manager competencies at different hierarchical levels. However, none of them were validated for Spanish-speaking contexts. This gap limits the implementation of evidence-based strategies for leadership development and hinders the design of targeted management training programmes.5,10,11

In this context, and according to Orts-Cortés et al.12 reflections, there remains an urgent need for culturally adapted tools to assess nurse managerial roles from a professional, ethical, and organizational perspective within the Spanish healthcare system.

The Nursing Managers’ Work Perception Scale (EPTGE), developed in Portugal, by Martins and Gonçalves,9 provides a robust framework for assessing performance in key management domains. The original scale includes 42 items across eight dimensions and has demonstrated strong psychometric properties in Portuguese healthcare settings.9 Its adaptation to the Spanish context is essential to align leadership evaluation with both international standards and local realities.

The translation and cultural adaptation of tools such as the EPTGE help to address this gap by ensuring not only linguistic equivalence but also cultural relevance. Psychometric validation is necessary to confirm that the scale retains its statistical integrity and theoretical structure in the new setting.

Therefore, the aim of this study was to translate, culturally adapt, and validate the EPTGE scale for the Spanish context, providing a rigorous and specific tool to assess nurse managers’ performance, promote quality improvement, and support alignment with institutional policy and international benchmarks.

The Spanish version of the EPTGE demonstrated excellent internal consistency (Cronbach's alpha=0.961), consistent with the psychometric properties of the original Portuguese scale, which also reported alpha coefficients above 0.90.9 This confirms the internal homogeneity of the instrument and supports its reliability, capturing the multidimensional nature of nurse management activities.

Construct validity was supported through EFA, which extracted eight components accounting for 66.86% of the total variance. This structure aligns with the original factor configuration,9 suggesting conceptual equivalence and structural robustness in the Spanish adaptation. The strong communalities and factor loadings further confirm the adequacy of the internal structure.

At the item level, the highest mean score was observed for “Cares about nursing and patient values” (mean: 3.54; SD: 0.541), reflecting a strong ethical commitment among Spanish nurse managers. Similar trends were found in the scoping review of managerial competences, in which “caring for people” and “being visionary” emerged as key leadership attributes.11 Similarly, items related to professional development and team motivation, such as “Motivates the nursing team to self-training” and “Promotes team commitment and motivation”, also scored highly, reflecting the integration of transformational leadership traits in daily nurse management.6

Conversely, the lowest mean score was associated with the item “Take part in the definition and implementation of the institutional health policies” (mean: 2.70; SD: 0.862), suggesting limited engagement of nurse managers in higher-level strategic decision-making. This gap reflects broader challenges in healthcare governance, where nurses are often excluded from policymaking processes. Trend documented in previous literature, who identified a lack of time, knowledge, and organisational support as barriers to nurses’ participation in policy development.16 Similarly, an Ethiopian study reported that 58% of nurse managers were excluded from strategic decision, largely due to inadequate managerial support and poor feedback mechanisms.17

Moderate variability was observed across several items, with “Participates in shift handover” (SD: 0.981), possibly reflecting variations in institutional practices or expectations, and organisational culture, and underscores the need to contextualise managerial roles based on local operational structures, and care delivery models.

Nursing leadership competency have been strongly associated with job satisfaction and retention. Mirzaei et al.18 reported that resource allocation, support, and quality control explained 87.3% of the variance in job satisfaction and 81.3% in intention to leave. Furthermore, some studies found that nurse manager turnover is associated with the increases of adverse events, such as pressure ulcers and falls,19 proving the managerial stability and competence impact on care outcomes.18,19 These findings reinforce the value of measuring and strengthening leadership competencies to improve retention and quality of care.

The validated Spanish EPTGE version, offers a reliable and valid tool for assessing nurse manager competencies across multiple domains. It offers a foundation for targeted training, performance evaluation, and leadership development strategies aligned with the needs of the Spanish healthcare system. The strong ethical and motivational dimensions observed suggest a solid foundation upon which to build, although structural barriers to policy involvement remain a key area for improvement.

The Spanish EPTGE version demonstrates adequate psychometric properties providing a useful tool to measure, compare and enhance nurse managers’ performance. Providing a structured instrument for leadership assessment, talent development, and strategic workforce planning, in the Spanish healthcare context.

Findings highlight the ethical and transformational leadership traits among nurse managers exposing a persistent gap in in policy involvement and strategic decision-making. This underscores the need to strengthen the governance role of nurse leaders within healthcare system, to promote safe, more effective, and person-centered care.

The validated EPTGE scale has broad potential applications in research, education, and clinical practice. Informing leadership development curricula, supporting performance evaluation systems, and facilitating national or international comparisons. Future research should include confirmatory factor analyses, and longitudinal designs, are encouraged to consolidate its utility across diverse healthcare settings.

There is no online material available for replication. For additional content, please contact the author.

Salvador Peiró.

The corresponding author, on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described.

E. Coello Gonçalves Canedo: resources, conceptualization, investigation, methodology, data curation, formal analysis, supervision, validation, writing - original draft, writing, review and editing. P. San Martín González: conceptualization, investigation, methodology, data curation, writing original draft. N. Quintero Flórez: conceptualization, investigation, methodology, data curation, writing original draft. M.M. Ferreira Pereira da Silva Martins: conceptualization, methodology, data curation, software, formal analysis, supervision, validation, writing, review and editing.

None.

Open access funding provided by Universidad de Salamanca.