Leadership competencies and managerial competencies of nurse managers in Kuala Lumpur Hospital, Malaysia

Introduction: The roles of nurse managers are crucial to the success of healthcare organizations, requiring specific skills and competencies. Accordingly, nurse managers are expected to possess leadership and management skills. Therefore, it is essential to investigate the relationship between leadership and managerial competencies among hospital nurse managers. This study seeks to determine the impact of three different leadership competencies, namely administrative skill, interpersonal skill, and conceptual skill, on the managerial competencies of nurse managers at Kuala Lumpur Hospital. Methods: This cross-sectional quantitative study adopted Northouse’s (2019) leadership competencies questionnaires and Mind Tool’s (2018) management skills assessment tool. A total of 247 participants, all of whom were nurse managers at the Kuala Lumpur Hospital, Malaysia, were recruited for this study. Multiple regression analysis was used to test the hypothesis. Results: The findings revealed that nurse managers at Kuala Lumpur Hospital possessed high levels of all three leadership skills and managerial competencies. However, the only significant predictor of managerial competencies among the respondents is the conceptual skill of leadership (beta = 0.820, p < 0.01). Conclusions: This study emphasizes conceptual skills (cognitive abilities, analytical reasoning, and decision-making) in predicting managerial competencies among nurse managers. Developing these skills is critical for effective leadership and smooth healthcare organization operations.


Introduction
The healthcare environment and nursing facilities are continually evolving, presenting nurse managers with the challenge of equipping themselves with critical managerial competencies to provide high-quality and secure patient services (Chua et al., 2022;Paarima et al., 2020).Increased workloads and the necessity for effective leadership and management skills create significant challenges (Nazari et al., 2018).Poor healthcare organizational leadership can lead to increased operating costs, decreased productivity, and lower effectiveness of nursing care, ultimately resulting in employee dissatisfaction and decreased patient satisfaction and health status in society (Ghiasipour et al., 2017).Effective nurse leaders are crucial in healthcare organizations, as they must excel in both clinical and administrative roles, managing resources, communication, negotiation, motivation, and influence (Moghaddam et al., 2019).
Nurse managers are vital in daily healthcare operations, impacting the organization's performance through close interactions with patients, families, and other healthcare team members (Goktepe et al., 2018).Studies indicate poor communication and leadership are the primary causes of issues within healthcare systems, leading to inadequate management (Ghiasipour et al., 2017).Effective leadership fosters a quality-focused organizational culture, reduces conflicts, enhances team efficiency and productivity, boosts staff satisfaction, and improves hospital performance.
In recent decades, technological advancements, a multigenerational workforce, management accountability, performance measurement, resource limitations, the growth of inter-and intra-professional teams, and increased consumer expectations have significantly impacted healthcare (Jiang et al., 2023;Li et al., 2020).Leadership is vital for nurses, especially in overcrowding, bed shortages, material resource scarcity, and insufficient staffing (Ferreira et al., 2020).This study seeks to address gaps in the literature by examining the predictors of managerial competencies among nurse managers in Kuala Lumpur Hospital.It focuses on administrative, interpersonal, and conceptual skills, aiming to provide insights into the qualities necessary for effective leadership in today's healthcare landscape (Dewald & Reddy, 2020).

Managerial Competencies
Effective management roles involve designing and implementing strategic priorities that prioritize patient safety (Pathmanathan et al., 2022;Weiss et al., 2019).Nurse managers play a crucial role in strategy framing, development, execution, and embedding to demonstrate efficiency.As such, a nurse manager must possess a variety of skills and abilities that allow them to make strategic decisions effectively (Arsat et al., 2022;García et al., 2020).They must possess cognitive abilities, self-awareness, emotional resilience, and personal motivation to make strategic decisions.Nurse managers must monitor the delivery of consistent and high-quality patient care within the constraints of human, financial, and material resources.However, the success or failure of nurse managers is directly related to overall organizational efficiency and productivity (Wang et al., 2021).
Nurse leadership success is determined by leaders who recognize and hold themselves accountable for creating vibrant practice environments.Successful managerial positions allow nurse managers to contribute to the organization's agenda and objectives while following its values in their actions (Little et al., 2018).Evidence shows that effective nurse leadership has a positive impact on patient safety, the development of a safe environment, lower patient mortality and patient satisfaction, and safe medication practices (Farag et al., 2017).Furthermore, different nursing leadership styles have been shown to improve nurse job satisfaction, nurses' intention to stay, nurse commitment, and nurse creativity and incivility (Hall et al., 2022;Specchia et al., 2021).Nonetheless, ineffective nurse leadership has led to lower nurse satisfaction, efficiency, and productivity, as well as an increase in complaints (Hughes, 2018).In today's complex, everchanging healthcare system, effective nurse leaders are critical.Therefore, nurse managers need to understand the relationship between leadership and managerial competencies, which may be more important now than ever in history.
The nurse managers in the health system are expected to possess eight core abilities, which include decision-making, relationship management, communication skills, active listening, leadership, conflict management, adherence to ethical standards, cooperation, and team management skills (García et al., 2020).First, they need to understand team dynamics and foster healthy interactions.Understanding how teams operate is critical to successful management.It is worth mentioning that teams often follow a predetermined pattern of creation: developing, norming, storming, and executing.During this transition, it is vital to encourage and promote individuals so that the team can become fully functioning as quickly as feasible (Thapa et al., 2022).Second, nurse managers need to identify and develop the appropriate personnel.Finding and developing new team members, as well as cultivating the abilities required for the team's success, is a crucial component of team building (Rahman, 2022).Efficient delegation is crucial for team success, as simply having the right personnel and knowledge is not enough.Managers must also understand how to delegate tasks efficiently, as some managers, especially those with technical skills, may attempt to complete most tasks themselves, believing they can do them correctly and efficiently.Motivation is a crucial management skill, as it is a personal process that varies among individuals.Nurse managers can inspire their staff by getting to know them on a personal level and providing daily input.This keeps them informed about individual team members' status.Nurses who know what to expect from their nurse managers are happier and have faith in their abilities (Ellis, 2021).As a manager, it is crucial to promptly deal with individual performance difficulties to prevent any negative influence on the rest of the workforce and customers.Inadequate performance has a detrimental effect on customer service, team accomplishments, and overall performance.As such, the manager's inability to consistently achieve targets may lead to demotivation and negatively impact the whole team (Chirwa et al., 2023).
Effective communication is a crucial management skill, especially in nursing management.Nurse managers must keep their staff informed about their roles and practices, such as through team briefings.Communication styles significantly impact their ability to contribute to a high-functioning team, improving business and educational outcomes (Kerr et al., 2020).Nurse managers should also possess intelligence, cognitive and functional abilities, beliefs, attitudes, experiences, and behaviors that are effective in managing organizational performance (Wei et al., 2020).They should also have management abilities to cooperate with others and contribute to a highperforming team.Overall, effective communication is essential for nurse managers to contribute to a successful healthcare environment.Nurse managers often excel in planning, decision-making, and problemsolving due to their experience and analytical skills.However, they often neglect their people and team management skills, highlighting the importance of selfdevelopment in their professional development (Cummings et al., 2021).Nurse managers should avoid common managerial mistakes by enhancing their facilitation abilities and preventing management challenges (McCauley et al., 2020).Common mistakes include relying solely on technical expertise and asking superiors to solve problems.Effective organizations prioritize internal improvements and change, with nurse managers serving as role models for change and providing encouragement and coordination (Maurya & Sharma, 2017).

Leadership Competencies
Leadership is essential for managing resources, which is one of the most difficult challenges for any manager whose resources include staff, time, facilities, and access to care (Ellis, 2021;Tang et al., 2024).Leadership in this way is exercised by examining the strengths and weaknesses of a wide variety of theories as they relate to public, private, and non-profit organizations (Northouse, 2019).Leadership is a highly valued asset for individuals in positions of authority who wish to increase the effectiveness of their businesses (Zhao et al., 2024).This study examines leadership through the lens of trait theory and concludes with an exploration of transformational process theory (Teoh et al., 2022).It also addresses the advantages of situational, contingency, path-goal, and leader-member interaction theories, devoting significant time to explaining the implications of the merging and more modern psychodynamic leadership approaches.Administrative skill, interpersonal skill, and conceptual skill are outlined as the three perspectives for leadership that were proposed.In this new era, nursing leadership competencies enable the transformation of nursing and play a vital role in caring for patients, and families, and promoting healthy communities, with a focus on reducing health disparities (Arsat et al., 2023;Morse et al., 2021).
The provision of high-quality healthcare, characterized by assurance, empathy, responsiveness, tangibility, and dependability, is directly correlated with patient satisfaction throughout their hospital stay (Magfiroh et al., 2023).The strategic priorities that need to be addressed must be defined transparently and tactfully.The issue of medical care quality at work is highlighted, with a particular emphasis on nursing services and the role of the nurse, who is a representative of the highest management body and who significantly contributes to improving the quality of nursing services (Wasik, 2020).According to Ballantyne (2019), identifying contexts for change and taking the time to evaluate and benchmark the nursing care provided through measurement and audit within a professional environment can contribute to a team's clinical governance and is a strong leadership skill.Nurses will play a key role in the management of these audits and in the critical implementation of any substantive changes required as a result of the audit results.The nurse who leads the audit and review of the root cause acts to encourage an operational approach implemented to support both patient outcomes and hospital financial planning.The nurse faces the difficulty of conducting an audit and learning root cause analysis skills as well as the complexities of working with a diverse range of stakeholders, many of whom may hold opposing viewpoints.These are all excellent leadership qualities and nurse leaders' insights (Ballantyne, 2019).
Interpersonal skills encompass a wide range of abilities related to interacting with others.Failure to establish interpersonal relationships is the most cited cause of derailment by nurse managers, preventing them from establishing relationships with bosses, colleagues, individuals who report directly to them, patients, and their relatives (Martens et al., 2018).Healthcare practitioners must collaborate effectively within the team in order to provide continuous quality healthcare that aligns with organisation mission (Wei, 2022).Successful interprofessional teamwork relies on effective communication, which includes team coordination, active listening, and clear communication to ensure a shared understanding of decisions, establishing common goals, and distributing responsibilities (Brown et al., 2021).Other communication and teamwork challenges have been linked to a varied skill mix, a lack of familiarity with ward procedures and assigned patients, as well as busy, pressured working environments.Such findings demonstrate that improvements in the nursing team can benefit both patients and staff (Oldham et al., 2020).Effective communication requires a nurse manager to possess precise speaking and writing skills, as well as attentive listening abilities.Listening is a crucial talent for a nurse manager to possess to properly engage with others, assign tasks efficiently, and make clear decisions.
Conceptual skills facilitate comprehension of complex scenarios and are further enhanced by cognitive capabilities, analytical reasoning, and decisionmaking, which eventually lead to cognitive problemsolving and critical thinking with innovative solutions (Ahmady & Shahbazi, 2020).These skills are valuable in management because those who possess them can deal with difficult workplace situations in a variety of ways.Leaders with conceptual abilities are regarded as strategic leaders due to their ability to strategize about future situations and how to overcome them.The ability to approach a problem creatively and abstractly is highly valued at higher levels of management.Nurse managers must demonstrate success in creating and shaping the organization's vision, as well as in communicating and embodying the vision.For example, nurse managers serve as role models by acting in ways that represent the ideals and values inherent in the vision, demonstrating trust, self-belief, tenacity, and dignity in the pursuit of the vision, challenging actions that do not comply with the vision, defining organizational symbols, and avoiding rituals and routines that are incompatible with the vision (Ballantyne, 2019).

Present Study
While numerous studies have explored various facets of nurse leadership, there is a noted deficiency in a comprehensive analysis that distinguishes the direct impact of distinct leadership competenciesadministrative, interpersonal, and conceptual-on managerial capabilities within hospital settings.This identified gap is significant, as understanding the differential impact of these competencies may facilitate targeted developmental programs for nurse managers, ensuring they are effectively equipped to handle the multifaceted challenges of modern healthcare environments.
The primary purpose of this study is to examine the relationship between leadership competencies (administrative, interpersonal, and conceptual) and managerial competencies among nurse managers at Kuala Lumpur Hospital.The investigation seeks to determine which competencies significantly predict managerial effectiveness, providing empirical evidence to support targeted training and development initiatives.This research aims to deepen the understanding of how varied leadership skills contribute to effective management in healthcare, ultimately aiming to enhance patient care and organizational efficiency through more competent leadership.
Several hypotheses were formulated.Firstly, it is hypothesized that administrative leadership skills positively affect managerial competencies among nurse managers.Secondly, interpersonal skills are also expected to positively impact managerial competencies.Lastly, conceptual leadership skills are anticipated to significantly influence managerial competencies, highlighting their importance in the effective leadership of nurse managers.

Study design and setting
The relationship between leadership and managerial competencies among nurse managers at Kuala Lumpur Hospital was investigated using a quantitative method with a cross-sectional design.The Kuala Lumpur Hospital, also known as Hospital Kuala Lumpur (HKL), has 53 departments and units.Hospital Kuala Lumpur is the Malaysian Ministry of Health's largest hospital and a tertiary referral hospital.Over 7,000 people work at HKL, representing nearly 100 professions in a wide range of fields and disciplines.Out of the total number of staff, there are 32 matrons and 221 charge nurses, both referred to as nurse managers (Devex, n.d).All matrons and nurses were recruited as samples in this study via purposive sampling.
This study focuses on Kuala Lumpur Hospital in Malaysia with nurse managers categorized under specific job grades, including U32, U36, U41, U42, and U44.These grades represent different levels of managerial responsibility and expertise within the Malaysian public healthcare system.Grades U32 and U36 typically indicate entry-level management positions.Grade U41 denotes a mid-level management role.The higher grades, U42 and U44, reflect senior managerial positions.Nurse managers on study leave, maternal leave, medical leave, or who had been a nurse manager for less than six months were excluded from the study.

Instruments
A questionnaire set comprised of three parts was created.Part A contains social demographic items, Part B contains leadership competencies items and Part C contains managerial competencies items.

Social Demographic Data
The first part, consisting of seven questions, is to identify the baseline data of the nurse managers' sociodemographic characteristics and management experience, which include age, gender, educational background, working experience, and current working area.

Leadership Skills
The researcher uses and adapts Northouse's (2019) Leadership Skills Questionnaire, which contains a total of 18 items.It is designed to assess the participants' professional knowledge and competencies in the context of the objectives and content of the leadership skills.The Leadership Skills Questionnaire is intended to assess three types of leadership skills: administrative, interpersonal, and conceptual.A higher score indicates a broad skill set, whereas a lower score indicates a limited skill set.All items were scored on a 5-point Likert scale, with 1 indicating not true and 5 indicating very true.Cronbach's alpha values range between 0.660 and 0.833.

Managerial Competencies
For managerial competencies, the researcher used Mind Tools' (2018) management skills assessment tool, which contains 20 items in total.It is designed to assess the participants' professional knowledge and competencies in the context of the objectives and content of the managerial skills.The assessment tool is based on eight essential skill areas where managers should concentrate their efforts.The nurse manager's score of 20-46 indicates that she urgently needs to improve her management skills.If the nurse manager receives a score of 47-73, she is well on her way to becoming a good manager.If the nurse manager receives a score of 74-100, she is doing an excellent job managing her team.All items were scored on a 5-point Likert scale, with 1 indicating not at all and 5 indicating very often.The Cronbach's alpha coefficient is 0.830.

Research Instrument
This study used self-administered questionnaires via Google Forms, with the researcher sending the link to the Google Form to all respondents via WhatsApp.The hospital director and the head matron of Kuala Lumpur Hospital both gave their approval for this study.The data were collected over three weeks in August 2021.The researcher obtained the list of respondents from the head matron of Kuala Lumpur Hospital, and she assisted in providing the link to them.Prior to completing the questionnaires, respondents were given an explanation of the study's design, purpose, and methodology.Each respondent gave their consent after receiving appropriate information.

Statistic Analysis
Statistical Packages for the Social Sciences (SPSS) 28.0 was utilized for the data analysis.Multiple types of statistical testing were performed to ensure that the study's goals were met.The data were subjected to descriptive analyses to determine the prevalence of each respondent's demographic and each research variable.The correlations between administrative skill, interpersonal skill, conceptual skill, and managerial competencies were then investigated using Pearson correlation analysis.The final step was to use multiple regression analysis to look at the specific factors that predict competencies.All statistical tests were performed at the 0.05 level of significance.

Ethical Consideration
Before conducting the study, the researcher obtained ethical approval from the Ministry of Health's Medical Research and Ethics Committee (MREC) through the National Medical Research Register (NMRR) [Approval code: KKM/NIHSEC/ P21-1255(3)].
Participants were informed about the study and consented to participate voluntarily.The participant information sheet stated their right to participate or withdraw from the study at any time without fear of harm, retaliation, or prejudice.Personal data collected during the research were treated as highly confidential and used solely for analysis by the researcher.The researcher upheld professional etiquette to ensure participants did not feel vulnerable or offended by their participation in the study.All participants gave their written consent before completing the questionnaires.They were instructed not to write their names to protect their confidentiality and ensure complete anonymity.

Results
Data analysis reveals that all 247 respondents were female.The majority of respondents (66.4%) fell within the age range of 41 to 50, followed by 25.1% aged 51 to 60, and 8.5% aged 31 to 40.There is a significant concentration of respondents in the middle age group.Most respondents held a diploma (55.9%), followed by bachelor's degrees (32.0%), and a smaller proportion held master's degrees (12.1%).There were no respondents with PhD qualifications.Respondents varied widely in terms of their experience as nurse managers, with the largest proportion (37.2%) having 1 to 5 years of experience, followed by 6 to 10 years (29.1%),11 to 20 years (23.5%), and the smallest proportion (10.1%) having 21 to 30 years of experience.The respondents were distributed across various working areas, with the highest proportion (22.3%) working in medical wards, followed by surgical wards, orthopedic wards, administration, pediatric wards, obstetrics and gynecology wards, and nephrology wards, each accounting for smaller percentages.
Table 2 displays the leadership competencies, including three skills: administrative skills (mean = 23.77),interpersonal skills (mean = 22.38), and conceptual skills (mean = 22.92).According to the study's findings, nurse managers at Kuala Lumpur Hospital exhibited a high level of leadership skills, with each competence falling within the range of 21 to 25.Additionally, Table 2 indicates a high level of managerial competency (mean = 75.42).Nurse managers at Kuala Lumpur Hospital received scores ranging from 74 to 100, showcasing their skills and experience for their positions.Furthermore, Table 2 presents the Pearson correlation findings between administrative skills, interpersonal skills, conceptual skills, and managerial competencies.There is a positive relationship between administrative skill (r = 0.579, p < 0.01), interpersonal skill (r = 0.485, p < 0.01), and conceptual skill (r = 0.680, p < 0.01) in leadership and managerial competencies among nurse managers at Kuala Lumpur Hospital.This reveals that nurse managers at Kuala Lumpur Hospital possess strong administrative, interpersonal, and conceptual skills, indicating a well-rounded skill set for effective leadership in healthcare settings.Their managerial competency scores confirm their expertise in their roles.The positive correlations between administrative, interpersonal, and conceptual skills with managerial competency suggest that higher proficiency in these areas correlates with greater managerial effectiveness.Overall, the findings suggest that nurse managers at Kuala Lumpur Hospital possess a robust set of leadership and managerial skills, enhancing their effectiveness in managing healthcare units.
Table 3 below shows the results of the multiple regression analysis used to investigate the predictors of managerial competencies.According to the findings, the combination of administrative skills, interpersonal skills, and conceptual skills accounted for 46.7% of the variance in managerial competencies.The only significant predictor of managerial competencies was discovered to be conceptual skill (beta = 0.820, p < 0.01).Administrative skill (beta = -0.167,p > 0.05) and interpersonal skill (beta = 0.013, p > 0.05) were found to be non-significant predictors of managerial competencies.Hypothesis H3 is thus supported, but hypotheses H1 and H2 are not.
This study reveals that administrative, interpersonal, and conceptual skills collectively account for 46.7% of managerial competencies among nurse managers.Conceptual skill was found to be the most significant predictor, with higher skills indicating greater managerial abilities.Administrative and interpersonal skills were found to be non-significant predictors.The findings suggest that, while administrative and interpersonal skills are important, conceptual thinking is more crucial for effective managerial performance.

Discussions
This study aims to determine the influence of leadership competencies (administrative skill, interpersonal skill, and conceptual skill) on the managerial competencies of nurse managers at Kuala Lumpur Hospital.The descriptive findings indicate that the leadership abilities, namely administrative skills, interpersonal skills, and conceptual skills, were all rated highly, with conceptual skills being the most prominent among the three.This study also discovered the significance of managerial competencies among nurse managers at Kuala Lumpur Hospital.The correlation analysis results show that all three leadership skills among Kuala Lumpur Hospital nurse managers, which were administrative skills, interpersonal skills, and conceptual skills in leadership competencies, had significant positive relationships with managerial competencies.However, regression analysis revealed that only conceptual skills in leadership competencies were significant in predicting managerial competencies among Kuala Lumpur Hospital nurse managers.The findings of this study emphasize the importance of leadership and managerial skills for nurse managers.The importance and instillation of these skills necessitate the support of the nurse manager and the organisation.
The three skills that comprise the leadership competencies are administrative skills (mean = 23.77),interpersonal skills (mean = 22.38), and conceptual skills (mean = 22.22).The findings of the study revealed that all of the skills were at a high level (the score ranged from 21 to 25) among nurse managers at Kuala Lumpur Hospital.As a result, nurse managers are considered leaders because they exhibit leadership qualities in their nursing roles and influence other nurses and communities to envision high-quality healthcare (Zaghini et al., 2020).In addition, this study's findings indicate that the level of managerial competencies is high (mean = 75.42).The nurse managers at Kuala Lumpur Hospital received scores ranging from 74 to 100, indicating that they were capable of fulfilling their roles as nurse managers.Some studies also found that managerial competencies are critical in an organisation, which is consistent with the findings in this study (Fanelli et al., 2020;Said & Chiang, 2020).This study's findings indicate that conceptual leadership skill is the only predictor of managerial competencies among nurse managers at Kuala Lumpur Hospital, thus confirming hypothesis 3. Team coordination and active listening, communication to ensure a shared understanding of decisions, defining common goals, and sharing accountability are critical components that serve as the foundation for effective teamwork (Ellis, 2021).The data findings of the conceptual skills within the leadership competencies revealed all of the traits described.Furthermore, conceptual skills enable people to respond to complex ideas, concepts, and themes (Paarima et al., 2020).Critical thinking and problem-solving skills are essential to solving daily challenges faced in healthcare settings (Ahmady & Shahbazi, 2020).This allows healthcare professionals to dissect complex issues, identify underlying factors, and formulate effective strategies for resolution.The choices made in healthcare environments have a direct influence on the safety of patients and the quality of treatment provided (Molina-Mula et al., 2020).Therefore, conceptual skills empower healthcare workers to assess information, predict possible risks, and make appropriate choices that prioritize the well-being of patients.Patients' negative feedback often arises from communication and comprehension issues (Marca-Frances et al., 2020).Therefore, it is crucial to provide patients with guidance and prepare them in advance for potential outcomes in order to alleviate any uncertainties and anxieties they may have.
According to Jasim (2019), leaders' conceptual skills influence the value and degree of constructive, selfregulation, sense-making, consolidative, and innovative leadership in the public sector.These leaders use highlevel conceptual abilities to drive public sector transformation, absorb conceptual skills uniquely and distinctly, and effectively lead change.Furthermore, conceptual skills are required for managers at all levels of an organization to analyze and conceptualize the actions taken as part of the organization's strategy, objectives, and policies.Conceptual thinking allows for accurate and timely feedback, which also promotes organizational agility.Visionary, inventive, valuesbased, and strategic leadership, on the other hand, represents the "creation of a shared vision" (Major, 2019).A nurse manager should be able to see the "bigger picture" while focusing on individuals.A leader should be able to "envision the future" and then "enlist people" to help that vision come true, in order to inspire others to share in that vision (Khan et al., 2020).As a result, leaders who inspire a shared vision take the time to solicit feedback from their team members in order to identify needs, challenges, difficulties, and triumphs, as well as to create goals.Furthermore, leaders must be educated how to enlist employees' support in moving the organisation toward an inspiring goal by being visible, communicating with them in a timely and consistent manner, and understanding what is important to them.
Furthermore, the findings of this study support that an effective nurse leader understands resource management, has commercial and media skills, is an excellent communicator, and can influence, stimulate, and negotiate with others (Zaghini et al., 2020).This frequently requires an understanding of the system's operational flow, as well as embracing emerging variations and changes, both of which are conceptual skills in leadership competencies (Wu, 2022).In this study, nurse managers construct a declaration that defines the position and core values of an organization.Nurse managers can enhance individuals' focus and cultivate a more accurate understanding of purpose and dedication.This strengthens an organization's overarching objectives and integrates them into day-today choices and tasks.Values are a fundamental aspect of corporate culture, providing a reliable point of reference that remains unchanged even throughout times of transition.Examples of values in healthcare include Patient First, Integrity, Empathy, Teamwork, and Excellence.
The study's findings have important implications for organizational leadership and the development of effective leadership and managerial competency relationships.First, the study's findings can inform nurse managers at Kuala Lumpur Hospital about the critical role of conceptual skills in terms of their strengths and weaknesses, as well as what to improve, maintain, or reinforce.Second, the findings of this study suggest a link between managerial and leadership competencies, particularly conceptual skills.This is extremely important for the newly appointed nurse managers.These three leadership competency components are embedded in the training or workshop where they will be embedded as nurse managers.Nurses should also discuss potential leadership development opportunities with their line managers, such as mentorship, coaching, and action learning.Nurse managers must also be taught that conceptual skills in leadership competencies are linked to staff nurses, who are instilled by being noticeable, providing prompt and efficient interaction, and recognizing what is important to the nurses in order to enlist their participation in moving the organization toward an inspired goal.Competent leadership is one of the most important factors that positively affects organizational transformation and assists organizations in successfully adapting to a new competitive environment (Chatzoglou et al., 2017).The organization must reemphasize and promote effective leadership, as well as focus on developing the skills of potential nurse managers and assisting the nurse managers in achieving their goal.From society's perspective, nurse managers play a major role in the healthcare unit's daily operations and have a major impact on the organization's performance because they work closely with patients, families, and other healthcare team members (Goktepe et al., 2018).

Conclusion
The current study has some limitations, such as the fact that it only included nurse managers from Kuala Lumpur Hospital.The study's findings cannot be applied uniformly to all organizational sectors.Furthermore, the sample consisted solely of females; additional research in various domains could be conducted by including male nurse managers.As a result of the findings, it may be expanded to include more nurse managers in other Malaysian public and private hospitals, where the results will be stronger, more representative, and have a significant impact on the hypothesis, as well as lead to an accurate conclusion.Aside that, given the scarcity of research on the relationships between leadership and managerial competencies among nurse managers, more research on leadership and management in various contexts among nurse managers, particularly in Malaysia, is needed.
In conclusion, the findings of this study demonstrate the essential importance of conceptual skills in leadership for nurse managers.The cultivation and reinforcement of these skills necessitate the support of the nurse manager and the organization.Leadership competencies, administrative skills, interpersonal skills, and conceptual skills are important to be nurtured among nurse managers.These competencies undoubtedly elevate the performance of nurse managers and the organization.The goal of developing these skills in nurse managers is to project the organization's vision and mission, ultimately leading to enhanced patient care quality.
This study can be expanded to other public and private hospitals in Malaysia to include more nurse managers and larger samples, because a larger sample will be a more accurate representation of the population, implying additional accurate outcomes and having a significant impact on the hypothesis as well as reaching an accurate conclusion (Andrade, 2020).It is critical to include qualitative research in this study because it can examine how language and behavior convey information and can be used to express expressive information about ideas, values, sentiments, and motivations that support behaviors that are not expressed in quantitative data.To put it another way, qualitative research allows the researcher to ask difficult-to-answer numerical questions in order to better understand human experience.The study's results indicate that nurse managers must possess management and leadership capabilities in order to fulfil their roles.These may include nurses working in both the private and public sectors.Further investigation is required in many contexts to ascertain the significance of conceptual skills in leadership capabilities, their correlation with management capabilities, and their influence on the quality of nursing.Moreover, there is a lack of comprehensive empirical research on the influence of competences on skills.This area of study is still in its early stages and demands the attention of nursing researchers.

Table 1 .
Demographic Characteristics of the Respondents (N=247)