Communication Competence and Nurse Managers’ Authentic Leadership in Relation to Nursing Performance Among Operating Room Nurses: The Role of Teamwork in a Cross-Sectional Study

Background/Objectives: Nursing performance in the operating room (OR) is associated with individual competencies, leadership, and teamwork. Based on McGrath’s Input–Process–Output model, this study examined the associations of OR nurses’ communication competence and nurses’ perceptions of nurse managers’ authentic leadership with nursing performance including indirect associations through teamwork. Methods: This cross-sectional study included 149 OR nurses working at three tertiary hospitals in Republic of Korea. Self-reported data were analyzed using PROCESS macro Model 4 with 5000 bootstrap resamples and 95% percentile bootstrap confidence intervals. Separate mediation models were supplemented by mutually adjusted models including both predictors and sensitivity analyses with modified teamwork scores. Results: OR nurses’ communication competence and nurses’ perceptions of nurse managers’ authentic leadership were each positively associated with teamwork and nursing performance. Their direct associations with nursing performance remained statistically significant across model specifications. Indirect associations through teamwork were significant in the separate models but not in the mutually adjusted model using the full teamwork measure. Both indirect associations were significant when the T-TPQ leadership subscale was excluded, with or without the communication subscale, although their estimates were smaller. Conclusions: Direct associations with nursing performance were consistent, whereas indirect associations through teamwork depended on model specification and teamwork measurement. These findings support considering teamwork alongside OR nurses’ communication competence and nurses’ perceptions of nurse managers’ authentic leadership without implying causal relationships.