Joost Hoedemakers

DUTCH SUMMARY (TRANSLATED)

Introduction
The aging of the population is exerting increasing pressure on healthcare systems worldwide, with particularly acute consequences for elderly care. Healthcare institutions must respond to the increasingly complex care needs of older adults while continuing to provide equitable, high-quality care to a growing group of care recipients. Simultaneously, rapidly evolving digital technologies are transforming healthcare work and the organization of care. These developments place higher demands on the leadership of managers in healthcare. They are increasingly expected to apply relational forms of leadership, in which soft skills, such as empathy, play a crucial role.

Research into leadership within nursing contexts has increased significantly over the past ten years. This highlights the importance of leadership approaches that support the continuous competence development of nurses, and thus their competence-based employability. Against this background, these developments have important implications for the role of nurses in elderly care. They emphasize that strengthening nurses' competence-based employability requires continuous investment in professional development, largely facilitated by the daily leadership of managers.

Prior research further shows that competence-based employability is essential for coping with contemporary work-related challenges and for maintaining and improving the quality of care. At the same time, the development of employability is context-dependent. From a relational perspective, employability is likely fostered when a high degree of complementary fit is achieved between supervisors and nurses in their daily work relationship. Consequently, employability has become a central topic within Human Resource Management (HRM) research.

Key Findings

Study 1 provided a synthesis of empirical evidence on managerial leadership as an antecedent of employability. The systematic literature review included 17 articles and showed predominantly positive links between managerial leadership—such as transformational leadership, Leader-Member eXchange (LMX), servant leadership, and perceived support—and employee employability.

Study 2 investigated the hypothesized links between relational leadership, perceived supervisory support for development, and perceived opportunities for professional competence development. The results showed that supervisors' relational leadership was not directly related to nurses' competence-based employability. However, the empowerment dimension of relational leadership was positively related to perceived supervisory support for development, which in turn was linked to development opportunities. These opportunities were positively associated with the anticipation, optimization, corporate sense, and balance dimensions of employability.

Study 3 focused on how people management—specifically relational leadership combined with the application of both generic and tailored HR practices—is related to nurses' competence-based employability. The findings show that supervisors support employability by building high-quality dyadic relationships. It also appeared that relational leadership supports psychological safety, which helps explain how leadership relates to employability.

Study 4 examined how age and gender similarity within supervisor-nurse dyads are related to Self-Other Agreement (SOA) on various dimensions of relational leadership. The results show that non-directional age similarity was associated with higher SOA for empowerment and caring. It also appeared that SOA for caring, ethicalality, and vision decreased when supervisors were older than their nurses.

Theoretical Implications
This dissertation contributes to research at the intersection of relational leadership and competence-based employability. Overall, the findings underline that competence-based employability is a relational and context-sensitive process that unfolds through daily social exchanges. The work refines theory development by taking a multidimensional approach to leadership and identifying psychological safety as a crucial mechanism.

Practical Implications
HRM departments in elderly care should invest specifically in the development of relational leadership. This can be done through regular development tracks with intervision and coaching. In addition, the use of 360-degree feedback (SOA) can help clarify how leadership is perceived and where areas for improvement lie. Creating a psychologically safe climate is essential to stimulate learning behavior and reflection in the workplace.