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Purpose

This study examines whether nurse middle managers’ proactive behavior mediates the relationship between cognitive motivational states (role breadth self-efficacy and positive emotions) and outcomes related to quality of work life (job satisfaction and job stress) and job effectiveness (innovative work behavior and job performance).

Design/methodology/approach

The study utilizes two-wave survey data from 152 nurse middle managers. Structural equation modeling was used to test whether proactive behavior mediates the effects of role breadth self-efficacy and positive emotions on both quality of work life and job effectiveness outcomes.

Findings

Findings indicate that cognitive motivational states (role breadth self-efficacy and positive emotions) significantly influence proactive behavior. Proactive behavior, in turn, enhances both quality of work life and job effectiveness. Additionally, proactive behavior was found to be the mechanism through which role breadth self-efficacy and positive emotions positively impact innovative work behavior.

Practical implications

These insights provide valuable guidance for hospital management and HR practitioners on how to foster nurse middle managers’ proactivity, ultimately improving job performance and enhancing the quality of work life within healthcare organizations.

Originality/value

The study identifies proactive behavior as a key mediator in the relationship between cognitive motivational states and both work life quality and job effectiveness, emphasizing its role in driving innovative work behavior among nurse middle managers.

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