To explore mechanism of how nurse managers' transformational leadership affects patient satisfaction, and to examine the mediating role of nurses' psychological empowerment.

A total of 140 nurses and 310 patients in Sun Yat-sen University Cancer Center were surveyed. The Leadership Practice Inventory-other, the Psychological Empowerment Scale and two items from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (Chinese version) were used to measure nurse-perceived nurse managers' transformational leadership behaviors, nurses' psychological empowerment and patient satisfaction. The descriptive statistics and correlation analysis were performed using the SPSS 20.0. software package, and the structure equation modeling was performed using the MPlus 7.0.

Higher frequencies of nurse managers adopting transformational leadership were associated with higher level of nurses' psychological empowerment (β=0.665, P < 0.05); higher level of nurses' psychological empowerment was associated with higher overall patient satisfaction (β=0.243, P < 0.05); nurses' psychological empowerment mediated the relationship between nurse managers' transformational leadership and patients' overall satisfaction (β=0.162, P=0.014); the effects of nurse managers' transformational leadership and nurses' psychological empowerment on patients' recommendation of hospital were not statistically significant (P>0.05).

Nurse managers are encouraged to adopt transformational leadership, i.e., improving clinical and leadership skills, trying to be nurses' role model, solving problems at work, empowering and motivating nurses, thus to increase nurses' senses of empowerment, and to improve patient satisfaction eventually.

Nurse manager; Transformational leadership; Psychological empowerment; Patient satisfaction; Structural equation modeling