Background <p>Innovation is vital in high-acuity healthcare settings, yet engagement in innovative work behavior (IWB) among nurses remains limited. Ambidextrous leadership, which integrates explorative and exploitative styles, may enhance nurses’ innovation capacity.</p> Aim <p>To examine the influence of ambidextrous leadership behaviors on innovative work behavior among critical care nurses.</p> Methods <p>A cross-sectional correlational study was conducted with 360 nurses in critical care units at a major educational hospital in Egypt. Data was collected over 2 months in 2024 using the Ambidextrous Leadership Questionnaire and the Innovative Behavior Inventory. Descriptive statistics, Pearson correlation, and regression analyses were used to assess relationships between study variables.</p> Results <p>The mean score for nurses’ perception of ambidextrous leadership was 40.10 ± 5.69, and for innovative work behavior was 66.03 ± 8.35. Both values reflect moderate levels. Ambidextrous leadership was positively correlated with IWB (<i>r</i> = 0.483, <i>p</i> &lt; 0.001). Exploitative leadership showed a stronger correlation with IWB (<i>r</i> = 0.466) compared with explorative leadership (<i>r</i> = 0.381). Regression analysis further confirmed that ambidextrous leadership significantly predicted IWB (β = 0.304, R² = 0.625, <i>p</i> &lt; 0.001).</p> Conclusion <p>Ambidextrous leadership is a significant driver of innovative behavior among critical care nurses. By balancing creativity with clinical discipline, nurse leaders can foster innovation without compromising care quality. These findings highlight the importance of developing ambidextrous leadership skills to promote innovation in critical care practice.</p> Clinical trial number <p>Not applicable.</p>