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Aim. We investigated the impact of empowering leadership on both perceived stress and salivary cortisol, a commonly utilized biological indicator for stress assessment. Background. Empowering leadership is gaining increasing interest in companies. However, the impact of empowering leadership on stress is still insufficiently explored, with conflicting findings within the literature on this topic. While certain studies indicate that empowering leadership reduces perceived stress, other studies have suggested that empowering leadership could be stressful. Methods. We conducted a cross-sectional study using a questionnaire among a sample of 397 participants working in a French hospital. Participants' salivary cortisol was assessed. All analyses exploring the relationships between empowering leadership, perceived stress, and salivary cortisol were performed using multiple imputation methods. Results. Empowering leadership could simultaneously increase and decrease perceived stress. Specifically, although the empowering leadership global factor showed a negative correlation with perceived stress, some specific empowering leadership behaviors were positively associated with perceived stress. However, salivary cortisol was positively related to perceived stress and strictly negatively related to empowering leadership. Furthermore, salivary cortisol could be explained by a significant interaction effect between perceived stress and empowering leadership, indicating that empowering leadership enables employees to cope with perceived stress. Conclusions. Although empowering leadership was an ambiguous antecedent of perceived stress, our findings suggested that empowering leadership was a protective factor against increased salivary cortisol. These results suggest that empowering leadership behaviors could prevent biological stress. Implications for Nursing Management. While empowering leadership showed a protective effect on salivary cortisol, it is essential for managers to adopt the full set of empowering leadership practices to guarantee protective effects on perceived stress. This trial is registered with NCT04010773. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to assess the effect of a systemic intervention on the evolution of empowering leadership and emotional exhaustion in a university hospital sub‐centre compared to a control sub‐centre, both being part of a large French university hospital complex. Background: Empowering leadership is a promising strategy for developing hospital team engagement and performance. However, the bureaucratic functioning of large hospitals, characterized by a managerial culture of control and a stratified organization, can be a barrier to empowering leadership. Methods: The intervention included empowering leadership training, direct field experimentation of empowering leadership and coaching, involving all the sub‐centre hierarchical levels for 12 months. Data were collected before and after the intervention. A total of 441 and 310 participants were, respectively, included in the intervention and control sub‐centres. Results: Empowering leadership was decreased, and emotional exhaustion was increased in the control sub‐centre, while the scores remained stable in the intervention sub‐centre. The increased emotional exhaustion in the control sub‐centre could partially be explained by the change in empowering leadership. Conclusion: In a context of decreased empowering leadership and increased emotional exhaustion, the intervention had a protective effect. Implications for the design of future interventions were discussed. Implications for Nursing Management: This study unequivocally showed the benefit of transforming hospital management towards empowering leadership, to prevent increased emotional exhaustion. Registration number: This study is registered on ClinicalTrials.gov on 4 July 2019 (NCT04010773). [ABSTRACT FROM AUTHOR]