Servant Leadership and Secondary Traumatic Stress in Critical Care Nurses and Emergency Medical Personnel

<title>Abstract</title> <p> Background Emergency medical personnel frequently face trauma, emotional challenges, high-acuity patients, and high-pressure decision-making. These factors put emergency and critical care nurses, paramedics, and emergency medical technicians at greater risk of secondary traumatic stress and diminished psychological health. Servant leadership may be an organizational resource that bolsters resilience and lowers trauma stress, but little is known about whether these psychological outcomes lead to job performance. Methods This quantitative, cross-sectional, correlational study examined servant leadership, resilience, secondary traumatic stress, and job performance in 376 US-based emergency and critical care nurses and emergency medical personnel. Respondents were nurses from emergency rooms, operating rooms, pediatric and intensive care units, emergency medical technicians and paramedics. They completed the Servant Leadership Behavior Scale-6, Response to Stressful Experiences Scale-4, Secondary Traumatic Stress Scale, and Individual Work Performance Questionnaire. PROCESS Model 4 with 5,000 bootstrapped samples analyzed resilience and secondary traumatic stress as parallel mediators. Results Servant leadership was positively related to resilience and negatively associated with secondary traumatic stress. Servant leadership significantly predicted resilience ( <italic>b</italic>  = 0.971, <italic>p</italic> &lt; .001) and lower secondary traumatic stress ( <italic>b</italic> = -2.474, <italic>p</italic> = .008) but was not associated with job performance ( <italic>b</italic>  = 0.01, <italic>p</italic> = .672). Neither resilience nor secondary traumatic stress significantly mediated the servant leadership-job performance relationship. Additionally, resilience and secondary traumatic stress were not significant predictors of job performance. Conclusions Servant leadership can be important for psychological support in trauma-exposed health professionals even when psychological gains do not translate to job performance gains. Nurse managers and health leaders should view servant leadership as a well-being and retention initiative for employees while considering that job performance may be limited by operational factors in emergency healthcare. </p>