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Workplace Gaslighting and Occupational Outcomes Among Hospital Nurses: Associations with Job Satisfaction and Self-Rated Performance

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27 October 2026

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28 October 2026

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Abstract
Purpose: To examine associations of workplace gaslighting with job satisfaction and self-rated performance among hospital nurses. Design/methodology/approach: A cross-sectional online survey was conducted among 448 hospital nurses in Greece between October and December 2025. Workplace gaslighting was assessed with the 11-item Gaslighting at Work Scale. Job satisfaction and self-rated performance were assessed using global single-item measures. Pearson correlations and linear regression models adjusted for age, gender, postgraduate education, work experience, shift work, and perceived understaffing were used. Findings: Higher workplace gaslighting was associated with lower job satisfaction (r = −0.339, p < .001) and lower self-rated performance (r = −0.153, p = .001). After adjustment, each 1-point higher gaslighting score was associated with a 0.523-point lower job satisfaction score (95% CI, −0.659 to −0.388; p < .001) and a 0.241-point lower self-rated performance score (95% CI, −0.376 to −0.106; p < .001). Adjusted models explained 17.9% and 6.0% of variance, respectively. Practical implications: Workplace gaslighting warrants attention as a potentially important marker of dysfunctional leadership in nursing workforce research and management. Originality: The study addressed the relationship between supervisor gaslighting and two occupational outcomes among hospital nurses. Gaslighting was more strongly associated with job satisfaction than with self-rated performance. The findings are relevant to hospital nurses, nurse managers and nursing workforce researchers.
Keywords: 
workplace gaslighting
;  
job satisfaction
;  
nursing staff
;  
hospital
;  
leadership
;  
work performance
Subject: 
Public Health and Healthcare  -   Nursing
What does this paper contribute to the wider global clinical community?
  • Workplace gaslighting was associated with lower job satisfaction and lower self-rated performance among hospital nurses.
  • The association was stronger for job satisfaction than for self-rated performance after adjustment for demographic and work-related characteristics.
  • The findings identify supervisor gaslighting as a potentially relevant issue for nursing workforce research and management.

Introduction

Nursing work is highly complex, as it requires the simultaneous combination of physical, emotional, cognitive, and organizational activities. These demands are met within work environments that can either support or constrain nurses' ability to function effectively (Jackson et al., 2021). Consequently, the psychosocial and organizational conditions of nursing work are not secondary factors regarding workforce outcomes, but rather part of the context in which nurses experience and evaluate their work. Among these factors, job satisfaction is particularly significant; existing literature indicates that it is inextricably linked to key aspects of the hospital environment, such as the work environment, management, organizational climate, and leadership, and significantly influences staff turnover as well as the quality and safety of care (Broetje et al., 2020; Zhao et al., 2025). Similarly, studies based on the "Job Demands-Resources" framework have identified supervisor support, fair and authentic management, transformational leadership, interpersonal relationships, autonomy, and professional resources as key resources for nurses (Hudays et al., 2024; Montenegro Méndez et al., 2025). Consequently, the relationship between nurses and their supervisors can serve as a significant organizational resource or, when that relationship becomes detrimental, as an additional source of occupational stress.
Nurses' job satisfaction constitutes not merely an indicator of individual well-being but a system-level determinant of organizational sustainability and care quality. Successive reviews of the international literature converge on the conclusion that satisfaction operates as a proximal antecedent of retention, with higher levels consistently associated with lower turnover and, by extension, with the mitigation of the chronic staffing shortages that constrain contemporary health systems (Zhao et al., 2025). The implications, however, extend well beyond workforce stability. Dissatisfaction has been linked to diminished psychological well-being and quality of life among nurses, as well as to heightened intention to leave the profession (Yasin et al., 2024), while the broader evidence base on nurse well-being indicates that such individual-level strain is transmitted directly to those receiving care: a recent meta-analysis established that nurse burnout is significantly associated with compromised patient safety, lower nurse-assessed quality of care, and reduced patient satisfaction, with these associations remaining consistent across nurses' age, sex, professional experience, and geographical context (Li et al., 2024). Critically, job satisfaction should not be conceived as an exogenous or purely dispositional attribute, since it is substantially shaped by the behaviour of those who lead clinical units. A meta-analysis of 57 studies documented a moderate positive association between leadership and nurses' job satisfaction, with the magnitude and direction of this association contingent upon leadership style: transformational and authentic leadership exhibited the strongest positive correlations, whereas toxic and task-oriented styles were negatively associated with satisfaction (Ozen and Kantek, 2026). Taken together, this body of evidence positions job satisfaction at the intersection of workforce sustainability and patient outcomes and identifies the relational conduct of nurse leaders as a proximal, modifiable determinant of that satisfaction, thereby establishing the phenomenon as a legitimate object of nursing management rather than a peripheral human-resources concern.
Nurse job performance warrants comparable attention, since it constitutes the behavioural channel through which workforce capacity is ultimately translated into delivered care, and has been linked to care quality, teamwork, patient safety, and organizational effectiveness (Krijgsheld et al., 2022). As with satisfaction, performance is not reducible to individual competence but is partly contingent upon leadership. A recent structural equation model among 460 hospital nurses, framed within the Job Demands–Resources perspective, found transformational leadership to be positively associated with job performance both directly and indirectly through nurse self-efficacy, with the indirect pathway accounting for 46.3% of the total effect (Jiang, 2026). Converging evidence indicates that inclusive leadership is likewise associated with performance, although this association was fully transmitted through grit and work engagement rather than operating directly (Wen et al., 2026). Leadership therefore appears to shape performance principally by cultivating the personal and motivational resources on which effective clinical functioning depends.

Background

One increasingly recognized form of harmful supervisory behavior is "gaslighting," which refers to psychological manipulation aimed at undermining a person's perception of reality in the workplace. Gaslighting involves a pattern of psychological manipulation in which another person's perceptions, memories, interpretation of events, or judgment are repeatedly challenged, dismissed, distorted, or belittled (Christensen and Evans-Murray, 2021; Gougjehyaran et al., 2026). A recent analysis of the concept characterized workplace gaslighting as a covert, process-oriented phenomenon rooted in the exercise of power; its defining features include the distortion or denial of reality, the instilling of cognitive doubt, persistent and repetitive behavior, a power imbalance, victim-blaming, and a subtle nature that avoids direct confrontation (Gougjehyaran et al., 2026). These characteristics are significant because they distinguish gaslighting from related forms of workplace mistreatment, such as bullying, mobbing, incivility, or overt psychological aggression: the distinguishing element is not merely hostility, but the gradual undermining of the target’s confidence in their own perceptions and judgment (Christensen and Evans-Murray, 2021; Katsiroumpa et al., 2026b; Kukreja and Pandey, 2023).
Hospital nurses are a particularly relevant population in which to examine workplace gaslighting because nursing care is delivered in highly interdependent and hierarchical environments, where supervisors influence work allocation, scheduling, feedback, performance appraisal, access to resources, and professional development. At the same time, nurses commonly work under substantial workload and staffing pressures, making the quality of supervisory relationships especially important to day-to-day work experience and professional functioning (Broetje et al., 2020; Hudays et al., 2024; Montenegro Méndez et al., 2025; Zhao et al., 2025). As a result, the repeated invalidation, distortion, or manipulation by a supervisor may have implications beyond the interpersonal relationship by undermining confidence in professional judgment, psychological safety, and willingness to raise concerns. A growing body of research conducted among nursing populations has associated exposure to workplace gaslighting with a broad constellation of adverse professional and organizational outcomes, including occupational burnout, heightened turnover intention, career entrenchment, diminished work engagement, and the pattern of withdrawal increasingly described as "quiet quitting." Critically, these consequences do not appear to remain confined to the individual level, as gaslighting has likewise been linked to poorer perceived quality of care and to compromised patient safety outcomes. Taken together, this evidence indicates that gaslighting warrants consideration not merely as one further manifestation of generic workplace mistreatment, but as a distinct relational phenomenon with direct implications for the sustainability of the nursing workforce and for nursing management practice (Atta et al., 2025; El-Sayed et al., 2025; Katsiroumpa et al., 2026a; Kaya Soylu et al., 2026; Moisoglou et al., 2025; Moisoglou et al., 2026).
The "Job Demands-Resources" (JD-R) model provides a coherent theoretical framework and an explanation for why such supervisory behavior might be linked to nurses' occupational outcomes. The model distinguishes between job demands and job resources, the latter facilitating goal achievement, mitigating the costs associated with demands, and fostering motivation and growth, with supervision typically functioning as a resource (Demerouti et al., 2001; Tiryaki Sen and Yildirim, 2023). Consequently, workplace gaslighting can be understood as a relational job demand that simultaneously undermines a potential job resource; interactions that ought to provide guidance, validation, and feedback instead generate uncertainty, self-doubt, and psychological strain (Demerouti et al., 2001; Gougjehyaran et al., 2026; Katsiroumpa et al., 2026b). This interpretation has been applied in recent research, where gaslighting has been conceptualized as a job demand and psychological well-being as a resource, with psychological well-being partially mediating the relationship between gaslighting and burnout (Kaya Soylu et al., 2026).
Existing literature supports this theoretical explanation, although research has focused on a heterogeneous set of outcomes (Kaya Soylu et al., 2026). In the nursing profession, workplace gaslighting has been linked to career entrenchment in a multicenter study (Atta et al., 2025), while higher gaslighting scores have been associated with increased burnout and turnover intention (Moisoglou et al., 2025). Other studies have broadened the scope of findings beyond psychological distress and staff retention-related outcomes. Workplace gaslighting has been negatively associated with workforce flexibility (El-Sayed et al., 2025), symptoms of anxiety and depression, "quiet quitting" and reduced work engagement (Katsiroumpa et al., 2026a), as well as lower quality of care and patient safety, as assessed by the nurses themselves (Moisoglou et al., 2026). Consequently, gaslighting may play a role in various aspects of nursing work, including psychological well-being, attitudes toward staying in or leaving the job, professional functioning, and perceptions of care delivery (Atta et al., 2025; El-Sayed et al., 2025; Katsiroumpa et al., 2026a; Kaya Soylu et al., 2026; Moisoglou et al., 2025; Moisoglou et al., 2026). However, it remains unclear whether supervisor-perpetrated gaslighting is independently associated with two key professional outcomes for hospital nurses: how they evaluate their work experience and how they perceive their own job performance. This knowledge gap is noteworthy, given that workplace gaslighting has already been linked to job satisfaction among non-nursing employees in a longitudinal study (Kukreja and Pandey, 2023), while contemporary nursing research highlights leadership and management as significant factors related to job satisfaction, and supervisor support as a factor influencing job performance (Hudays et al., 2024; Tiryaki Sen and Yildirim, 2023; Zhao et al., 2025). Therefore, simultaneously examining job satisfaction and self-assessed performance may help determine whether workplace gaslighting is more strongly associated with an evaluative attitude toward the job or whether its associations extend to perceived professional functioning.

Aim and Hypotheses

The present study examined the associations of workplace gaslighting with job satisfaction and self-rated performance among hospital nurses. We hypothesized that higher workplace gaslighting would be associated with lower job satisfaction and lower self-rated performance after adjustment for relevant demographic and work-related characteristics.
To the best of our knowledge, this is the first study to examine the associations of workplace gaslighting with job satisfaction and self-rated performance among nurses, and the first to examine both outcomes simultaneously in any occupational population.

Methods

Design and Reporting

We conducted a cross-sectional, open online survey of hospital nurses in Greece between October and December 2025. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (von Elm et al., 2007). Reporting of the web-based survey procedures was additionally informed by the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Eysenbach, 2004)

Study Setting and Sampling

The questionnaire was administered using Google Forms and disseminated through nursing-focused professional and social media networks on Facebook, Instagram, and LinkedIn, including networks of nursing professional associations and institutions. This recruitment approach generated a nonprobability convenience sample. Because the invitation was circulated through open online networks and the number of individuals exposed to the invitation was not known, a conventional response rate could not be calculated.

Eligibility Criteria

Eligible participants were clinical nurses who (1) were employed in a hospital, (2) worked in a subordinate/nonmanagerial role, (3) had remained in the same position for at least 1 year, and (4) provided informed consent.

Survey Administration and Data Quality

The study information and electronic informed-consent statement were presented before the questionnaire items, and only participants who provided consent proceeded to the survey. Google Forms was configured with the “Limit to 1 response” setting as the primary technical safeguard against duplicate participation; this setting restricts each signed-in Google account to a single submission. The responses available to the investigators did not contain directly identifying information, and no email addresses were included in the analytic data set. No additional investigator-level IP-address, cookie-based, or CAPTCHA-based duplicate-screening procedures were documented beyond the platform-level one-response restriction. Because recruitment used an openly distributed survey link, the number of unique individuals who viewed the invitation or accessed the survey could not be established, precluding calculation of view, participation, or completion rates. The final analytic data set contained no missing observations for the variables included in the present analyses.

Sample Size

The minimum sample size was estimated a priori using G*Power version 3.1.9.2 (Faul et al., 2009). The calculation was based on a linear multiple regression model testing the incremental contribution of workplace gaslighting (1 tested predictor) after accounting for 6 prespecified covariates (7 predictors in the full model). Assuming a small incremental effect size (f² = 0.03), 95% statistical power, and a 2-sided α level of .05, the required sample size was 436 participants. The final analytic sample exceeded this requirement.

Variables and Measurements

Demographic and work-related variables included gender (male/female), age in years, postgraduate education (MSc and/or PhD degree: yes/no), years of work experience, shift work (yes/no), and self-reported employment in an understaffed department (yes/no). These covariates were specified a priori for the regression analyses based on their potential relevance to workplace experience and occupational outcomes; selection was not based on univariable statistical significance.
Workplace gaslighting was assessed using the 11-item Gaslighting at Work Scale (GWS), previously developed and psychometrically validated by Katsiroumpa et al. in a sample of 400 employees in Greece (Katsiroumpa et al., 2026b). The GWS comprises 2 dimensions: loss of self-trust (5 items) and abuse of power (6 items). Items assess supervisor gaslighting behaviors during the previous 6 months and are rated on a 5-point scale ranging from 1 (never) to 5 (always). Total and subscale scores are calculated as the mean of the corresponding items, yielding scores from 1 to 5, with higher scores indicating more frequent perceived supervisor gaslighting behaviors. The initial validation study demonstrated a 2-factor structure and excellent psychometric properties. In the present sample, internal consistency was excellent for the total GWS (Cronbach α = .955), loss of self-trust (α = .932), and abuse of power (α = .923).
Job satisfaction was assessed using the single-item question, “How satisfied are you with your job overall?”, rated from 1 (not at all) to 7 (absolutely). Single-item global job-satisfaction measures have demonstrated acceptable reliability and validity in occupational research (Dolbier et al., 2005). Higher scores indicate greater overall job satisfaction.
Self-rated performance was assessed with the single-item question, “How would you rate your performance?”, using an 11-point numerical rating scale from 0 (very poor) to 10 (excellent). Higher scores indicate more favorable perceived work performance. Single-item global self-ratings have been used in occupational-health and work-performance research; however, the present measure should be interpreted as perceived rather than objectively measured performance (Ahlstrom et al., 2010; Kessler et al., 2003).

Data Analysis

Categorical variables are presented as number (percentage). Continuous variables are summarized using mean (SD) and median (IQR) to characterize both central tendency and distribution. Distributional features were assessed using the Kolmogorov-Smirnov test together with visual inspection of Q-Q plots; regression model adequacy was evaluated separately using residual diagnostics.
The primary exposure variable for regression analyses was the total GWS score. Job satisfaction and self-rated performance were evaluated as separate prespecified continuous outcomes. Pearson correlation coefficients were used to describe pairwise associations among the GWS total score, its 2 subscales, job satisfaction, and self-rated performance. Because the total GWS score is mathematically derived from its subscales and the corresponding correlations were high, the subscales were not entered simultaneously with the total score in the multivariable regression models. Correlation analyses involving the subscales were treated as secondary and exploratory.
For each outcome, an unadjusted linear regression model first estimated the association with the total GWS score. A prespecified multivariable linear regression model then adjusted for age, gender, postgraduate education, years of work experience, shift work, and working in an understaffed department. Covariates were retained irrespective of their univariable P values. Regression results are reported as unstandardized coefficients (B), 95% CIs, and 2-sided P values; B represents the expected change in the outcome score for each 1-point higher GWS score. Model explanatory performance is summarized using R2. No formal multiplicity adjustment was prespecified; therefore, inference emphasizes effect estimates, 95% CIs, and consistency of the observed associations rather than statistical significance alone.
Multicollinearity was assessed using variance inflation factors (VIFs), with values greater than 5 considered indicative of potentially important multicollinearity (Kim, 2019). For each adjusted outcome model, regression assumptions were evaluated by visual inspection of a residual histogram and a residual-versus-predicted-value plot for approximate residual normality, linearity, and homoscedasticity. Because the analytic data set contained no missing observations for the variables included in these analyses, no imputation was performed. Statistical significance was defined as a 2-sided P < .05. Analyses were performed using IBM SPSS Statistics for Windows, version 28.0 (IBM Corp).

Ethical Considerations

The study was conducted in accordance with the ethical principles of the World Medical Association Declaration of Helsinki (World Medical Association, 2025). The Ethics Committee of the Faculty of Nursing at the National and Kapodistrian University of Athens approved our study protocol (approval number: 08, 23 September 2025). Participation was voluntary, and responses were anonymous to the research team. Before accessing the questionnaire, participants were informed about the study objectives and procedures and provided informed consent.

Results

Participant Characteristics

The analytic sample comprised 448 hospital nurses, exceeding the prespecified minimum sample size of 436. Of the 448 participants, 391 (87.3%) were women. The mean (SD) age was 38.04 (10.27) years, and the mean (SD) duration of work experience was 11.61 (9.97) years. Overall, 189 participants (42.2%) held an MSc and/or PhD degree, 343 (76.6%) worked shifts, and 362 (80.8%) reported working in an understaffed department (Table I).
Table I. Participant demographic and work-related characteristics (N = 448). 
Table I. Participant demographic and work-related characteristics (N = 448). 
Characteristic Value
Gender, No. (%)
Women 391 (87.3)
Men 57 (12.7)
Age, mean (SD), y 38.04 (10.27)
Postgraduate degree (MSc and/or PhD), No. (%) 189 (42.2)
Work experience, mean (SD), y 11.61 (9.97)
Shift work, No. (%) 343 (76.6)
Working in an understaffed department, No. (%) 362 (80.8)

Scale Scores, Internal Consistency, and Correlations

The mean (SD) total GWS score was 2.37 (1.04). Mean (SD) scores were 2.11 (1.02) for loss of self-trust and 2.59 (1.13) for abuse of power. Mean (SD) job satisfaction was 4.60 (1.60) and mean (SD) self-rated performance was 7.79 (1.48). Descriptive statistics, score ranges, and internal-consistency estimates are presented in Table II.
Table II. Descriptive statistics and internal consistency of study measures (N = 448). 
Table II. Descriptive statistics and internal consistency of study measures (N = 448). 
Measure Possible range Mean (SD) Median (IQR) Cronbach α
Gaslighting at Work Scale, total 1-5 2.37 (1.04) 2.27 (1.91) .955
Loss of self-trust 1-5 2.11 (1.02) 2.00 (1.80) .932
Abuse of power 1-5 2.59 (1.13) 2.50 (1.83) .923
Job satisfaction 1-7 4.60 (1.60) 5.00 (2.00) NA
Self-rated performance 0-10 7.79 (1.48) 8.00 (2.00) NA
Abbreviation: NA, not applicable. Cronbach α is not applicable to single-item measures.
Workplace gaslighting was inversely correlated with job satisfaction (r = -0.339, p < .001) and self-rated performance (r = -0.153, p = .001). Both GWS subscales were also inversely correlated with job satisfaction (loss of self-trust: r = -0.290, p < .001; abuse of power: r = -0.352, p < .001) and self-rated performance (loss of self-trust: r = -0.128, p = .007; abuse of power: r = -0.161, p < .001). Job satisfaction was positively correlated with self-rated performance (r = 0.304, p< .001). Table III depicts the Pearson correlation coefficients between study scales.
Table III. Pearson’s correlation coefficients for the study scales (n=448). 
Table III. Pearson’s correlation coefficients for the study scales (n=448). 
Scale 2 3 4 5
1. Gaslighting at Work Scale 0.948** 0.971** -0.339** -0.153**
2. Loss of self-trust 0.844** -0.290** -0.128**
3. Abuse of power -0.352** -0.161**
4. Job satisfaction 0.304**
5. Self-rated performance
** p-value < 0.01.

Associations of Workplace Gaslighting with Occupational Outcomes

In the unadjusted model, each 1-point higher GWS score was associated with a 0.521-point lower job-satisfaction score (B = -0.521; 95% CI, -0.656 to -0.386; P < .001). Adjustment for age, gender, postgraduate education, years of work experience, shift work, and working in an understaffed department produced an essentially unchanged estimate (adjusted B = -0.523; 95% CI, -0.659 to -0.388; p < .001). The adjusted model explained 17.9% of the variance in job satisfaction (R2 = 0.179) (Table IV).
Table IV. Linear regression models with job satisfaction as the dependent variable (n = 448). 
Table IV. Linear regression models with job satisfaction as the dependent variable (n = 448). 
Univariate models Multivariable modela
Unadjusted coefficient beta 95% CI for beta P-value Adjusted coefficient beta 95% CI for beta P-value
Workplace gaslighting -0.521 -0.656 to -0.386 <0.001 -0.523 -0.659 to -0.388 <0.001
a Multivariable model is adjusted for age, gender, MSc/PhD degree, years of work experience, working in shifts and working at an understaffed department. R2 for the multivariable model = 17.9%, p-value for ANOVA < 0.001. CI: Confidence Interval.
For self-rated performance, each 1-point higher GWS score was associated with a 0.219-point lower performance score in the unadjusted model (B = -0.219; 95% CI, -0.350 to -0.087; p = .001). After multivariable adjustment, the association remained similar in direction and magnitude (adjusted B = -0.241; 95% CI, -0.376 to -0.106; p < .001). The adjusted model explained 6.0% of the variance in self-rated performance (R2 = 0.060) (Table V).
Table V. Linear regression models with self-rated performance as the dependent variable (n = 448). 
Table V. Linear regression models with self-rated performance as the dependent variable (n = 448). 
Univariate models Multivariable modela
Unadjusted coefficient beta 95% CI for beta P-value Adjusted coefficient beta 95% CI for beta P-value
Workplace gaslighting -0.219 -0.35 to -0.087 0.001 -0.241 -0.376 to -0.106 <0.001
a Multivariable model is adjusted for age, gender, MSc/PhD degree, years of work experience, working in shifts and working at an understaffed department. R2 for the multivariable model = 6%, p-value for ANOVA < 0.001. CI: Confidence Interval.
VIFs in the adjusted models ranged from 1.029 to 1.206, providing no evidence of important multicollinearity according to the prespecified threshold. Visual inspection of residual histograms and residual-versus-predicted-value plots did not identify major departures from approximate residual normality, linearity, or homoscedasticity (Supplementary Figures S1-S4).

Discussion

The present study examined whether workplace gaslighting was associated with job satisfaction and self-rated performance among hospital nurses. The main finding was a clear inverse association between workplace gaslighting and job satisfaction, which remained essentially unchanged after adjusting for demographic and job characteristics. A second, weaker but statistically significant association was observed between gaslighting and self-rated performance. Exploratory analyses further indicated that both dimensions of gaslighting were inversely associated with both occupational outcomes, with abuse of power showing numerically stronger associations than loss of self-trust.
The association with job satisfaction represents the most important finding of this study. Each 1-point increase in workplace gaslighting was associated with a job satisfaction score that was approximately 0.52 points lower on a 7-point scale, and adjustment caused almost no attenuation of this estimate. Although causality cannot be inferred due to the study design, the consistency between the unadjusted and adjusted estimates suggests that the association was not easily explained by differences in age, gender, graduate education, professional experience, shift work, or perceived understaffing. The results align with the existing literature that has identified leadership, supervisory support, management practices, and interpersonal relationships as major determinants of nurses’ job satisfaction (Broetje et al., 2020; Hudays et al., 2024; Montenegro Méndez et al., 2025; Zhao et al., 2025). A recent multilevel study has similarly shown that more supportive unit manager leadership is associated with higher job satisfaction among nurses (Choi and Cho, 2026). Similar results are reported by studies outside the nursing field, linking workplace gaslighting to lower job satisfaction (Kukreja and Pandey, 2023) and by studies of nurses showing associations between gaslighting and burnout and intention to leave (Moisoglou et al., 2025).
The "Job Demands-Resources" model offers an explanatory approach to this issue, highlighting the relationship with supportive supervision as a significant job resource; such supervision provides guidance, recognition, feedback, predictability, and assistance in managing demanding clinical work (Broetje et al., 2020; Demerouti et al., 2001; Tiryaki Sen and Yildirim, 2023). The phenomenon of "gaslighting" presents unique characteristics, as it can function simultaneously as a relational job demand and as a factor that erodes an existing job resource. The repeated distortion, denial, questioning of validity, or manipulation of an employee's perceptions can induce uncertainty and psychological strain; furthermore, the fact that these behaviors originate from the supervisor undermines a relationship that, under normal circumstances, would provide professional support. Previous studies support this theory, conceptualizing gaslighting as a job demand and psychological well-being as a resource, with psychological well-being acting as a partial mediator in the association between the phenomenon and professional burnout (Kaya Soylu et al., 2026). Consequently, the relatively strong correlation with job satisfaction observed in the present study is considered theoretically sound, as satisfaction reflects the employee's assessment of the work environment and the employment relationship, while potentially being directly influenced by a supervisory relationship characterized by a lack of trust, a lack of predictability, and an abuse of power.
The mechanism through which leadership shapes job satisfaction clarifies why gaslighting should be associated with this outcome in particular. Job satisfaction is less a direct function of objective working conditions than an appraisal of the employment relationship, and the immediate supervisor is the most proximal figure through which nurses read the organisation's stance towards them (Choi and Cho, 2026; Zhao et al., 2025). Meta-analytic evidence indicates that this influence is graded by leadership style, with relational and people-oriented styles showing the strongest positive associations with satisfaction and toxic or task-oriented styles associating with it negatively (Ozen and Kantek, 2026). Two conduits appear to carry that influence. The first is structural: supervisors govern access to information, feedback, developmental opportunity and support, and structural empowerment is more consistently associated with nurses' job satisfaction than psychological empowerment is (Li et al., 2026), consistent with the conceptualisation of supportive supervision as a core job resource (Broetje et al., 2020; Demerouti et al., 2001; Montenegro Méndez et al., 2025). The second is relational: the quality of the leader–member exchange conditions how supervisory conduct is experienced, and a recent multilevel study of nursing teams found abusive supervision to predict lower job satisfaction, with shared perceptions of exchange quality attenuating that association (Caputo et al., 2025). Relational leadership, moreover, operates on the nurse's own self-appraisal as well as on the work environment, as perceived authentic leadership has been found to correlate positively with nurses' general self-efficacy alongside job satisfaction and intent to stay (AbuAlRub et al., 2026). Workplace gaslighting engages both conduits in reverse, and this is what distinguishes it from the mere absence of constructive leadership: passive supervision withholds a resource, whereas gaslighting corrupts the relationship through which that resource would be interpreted. Where authentic leadership builds the subordinate's confidence in their own judgement through transparency and balanced processing, gaslighting systematically dismantles it (AbuAlRub et al., 2026; Christensen and Evans-Murray, 2021; Gougjehyaran et al., 2026; Katsiroumpa et al., 2026b; Kukreja and Pandey, 2023). The consequence for satisfaction is direct, since the supervisory relationship that ordinarily supplies the evidence on which a favourable appraisal rests becomes itself the source of uncertainty about what has occurred and whether one's perception of it can be trusted. Targets of abusive supervision already face a hierarchy of societal, organisational, supervisor-imposed and individual barriers that impede escape or redress (Breevaart et al., 2022); where the mistreatment consists precisely in denying that anything occurred, such barriers are likely to be more formidable still, and the resulting dissatisfaction correspondingly more durable. Read in this light, our observation that abuse of power was more strongly associated with job satisfaction than loss of self-trust is coherent, since it is the structural conduit that the empowerment literature identifies as the stronger determinant of satisfaction (Li et al., 2026).
The association with self-rated performance was considerably weaker and requires a more nuanced interpretation. The adjusted model explained 6.0% of the variance in self-rated performance, compared with 17.9% for job satisfaction. Performance is multiply determined, by clinical competence, professional experience, team functioning, workload, staffing, organisational resources and motivation, so a single supervisory exposure would not be expected to account for a large share of its variance. A parallel reading of the leadership–performance literature, however, offers a more specific explanation for this gradient. Whereas leadership reaches job satisfaction directly, because satisfaction is itself an appraisal of the supervisory relationship, its association with nurses' job performance appears to be carried largely by intervening personal and motivational resources. A structural equation model of hospital nurses found that self-efficacy accounted for nearly half of the total association between transformational leadership and job performance (Jiang, 2026), while a study of inclusive leadership reported that its direct association with performance ceased to be significant once grit and work engagement were entered as mediators, leaving the relationship wholly indirect (Wen et al., 2026). A further model traced a serial pathway running from team psychological safety through occupational coping self-efficacy and job satisfaction to job performance (Liu et al., 2026). Within this architecture, performance lies several links downstream of the supervisory relationship, with attenuation expected at each transition, and job satisfaction operates as a mediator of performance rather than as a parallel outcome, an ordering consistent with the positive correlation observed between the two outcomes in our sample.
The same architecture indicates why gaslighting should nonetheless reach performance. The mediator that carries leadership to performance is precisely the one gaslighting is theorized to attack, since confidence in one's professional capability presupposes confidence in one's own perception and judgement (Christensen and Evans-Murray, 2021; Gougjehyaran et al., 2026; Katsiroumpa et al., 2026b; Kukreja and Pandey, 2023). The expected route is therefore indirect, a conclusion convergent with evidence that abusive supervision affects professional functioning through intervening psychological states rather than through a simple direct pathway, having been linked to service-sabotage behaviours via workplace alienation (El-Gazar et al., 2024). Evidence on workplace bullying points in the same direction, associating persistent interpersonal mistreatment with heightened work-related stress, burnout and lower quality of working life (Galanis et al., 2024). These constructs should not, however, be treated as synonymous with gaslighting, whose distinctive feature is the repeated undermining of an individual's confidence in their own perceptions and judgement (Christensen and Evans-Murray, 2021; Gougjehyaran et al., 2026; Katsiroumpa et al., 2026b; Kukreja and Pandey, 2023). That feature carries a methodological corollary: because self-efficacy operates simultaneously as the theorized mediator and as a determinant of how nurses appraise their own functioning, self-rated performance cannot readily distinguish diminished capability from diminished confidence in judging it. Our findings therefore demonstrate an association with perceived performance and cannot establish an effect on objective clinical performance. It is also plausible that clinical functioning is comparatively buffered, since nursing work is scaffolded by protocols, team structures, professional standards and an immediate obligation to patients, such that nurses may protect patient-facing performance even as their appraisal of the supervisory relationship deteriorates. Finally, that abuse of power was again more strongly associated with the outcome than loss of self-trust is intelligible on this account, since supervisory control over scheduling, workload allocation and access to resources constrains the material conditions of performance directly rather than only through psychological mediation (Bashir and Oetzel, 2026; Yürür et al., 2025).

Strengths and Limitations

The study possesses several notable strengths. First, the sample size exceeded the pre-determined requirement; the GWS scale demonstrated excellent internal consistency; covariates were selected on a consistent basis rather than through univariate statistical significance; and regression diagnostics revealed no significant violations of model assumptions. Furthermore, the simultaneous assessment of job satisfaction and perceived performance allowed for the identification of a significant difference in the magnitude of their respective associations with gaslighting.
However, several limitations are important. First, the cross-sectional design does not establish temporal relationship or causality, and inverse or reciprocal relationships cannot be ruled out. Therefore, we interpret the findings throughout as associations rather than effects. Second, the open online recruitment resulted in a non-probability convenience sample and precluded the calculation of a conventional response rate, potentially limiting representativeness. To enhance the transparency of the survey, the study followed STROBE and was additionally informed by CHERRIES, while limiting a response at the platform level reduced the risk of duplicate submissions. Third, exposure and outcomes were self-reported within the same survey, creating the potential for common method bias. This is particularly important for self-reported performance and therefore the outcome should not be interpreted as objective clinical performance. Finally, job satisfaction and performance were assessed using global measures of a single item. Although such measures have precedent in occupational research, future studies should replicate the findings using multidimensional and independently assessed outcomes.

Recommendations for Further Research

Longitudinal and multilevel research that incorporates independent performance and patient outcomes is now needed to establish temporal pathways and determine whether gaslighting contributes information beyond established notions of harmful workplace behavior.

Implications for Policy and Practice

The findings of this study suggest that workplace gaslighting may represent a relevant but under-examined component of the psychosocial work environment of nursing. Its association was significantly stronger with job satisfaction than with self-rated performance, supporting the possibility that gaslighting first affects nurses' evaluations of their work and supervisory environments, while the consequences for professional functioning may be more distal or mediated by other psychological and organizational processes.

Conclusion

Workplace gaslighting was associated with poorer occupational outcomes among hospital nurses, with a markedly stronger relationship with job satisfaction than with self-rated performance. This pattern suggests that gaslighting may be particularly relevant to nurses’ appraisal of their work environment and supervisory relationship. These findings position workplace gaslighting as a potentially important marker of dysfunctional leadership and an organizational issue that warrants attention in nursing workforce research and management.

Supplementary Materials

The following supporting information can be downloaded at the website of this paper posted on Preprints.org.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request, subject to applicable ethical and data-protection requirements.

No Patient or Public Contribution

No patients, service users, caregivers or members of the public were involved in the research process.

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