Background <p>The ineffective leadership style of passive-avoidance is consistently linked to detrimental outcomes, particularly in high-stress clinical settings like healthcare. Extensive research demonstrates a link between work-to-family conflict and heightened psychological distress. However, the specific mechanism and sequential pathway through which passive-avoidant leadership translates into psychological distress for nurses, particularly in the cultural context of Iranian healthcare, remains under-explored. This study addresses this gap by formally testing the mediating role of work-to-family conflict.</p> Methods <p>This was a cross-sectional, correlational study conducted among 326 official and contractual nurses working in a large hospital in Iran. Data were collected using validated self-report instruments for passive-avoidant leadership, work-to-family conflict, and psychological distress. Structural Equation Modeling (SEM) with the Maximum Likelihood Robust (MLR) method was employed using R software (version 4.5.0) to test the direct and indirect relationships between the variables.</p> Results <p>Passive-avoidant leadership was significantly associated with psychological distress, directly and indirectly, through work-to-family conflict. Although the effect size was relatively small, the association observed in this Iranian sample appeared somewhat stronger than that reported in several previous cross-sectional studies.</p> Conclusions <p>These finding suggests that healthcare leaders may benefit from training in active supervision and that hospital management should consider organizational strategies that help reduce work-to-family conflict and support nurses’ mental health and promote well-being.</p>