How Nursing Leadership Affects Staff Nurses
How Nursing Leadership Affects Staff Nurses’ Job Satisfaction
Rhonda Rychlik
Queens University
How Nursing Leadership Affects Staff Nurses’ Job Satisfaction
The constant and rapidly changing health care environment dramatically affects nursing practice today. Health care leaders are faced with the problem of achieving their strategic goals while balancing finances, productivity, quality outcomes and employee and patient satisfaction. The health care environment is competitive and chaotic which means constant organizational change to meet the challenges. Today’s changes occur frequently in every organization and to handle and motivate change is one of the leader’s main tasks (Sellgren, Ekvall, & Tomson, 2008, p. 579). The challenges in health care today place pressure on the relationship of nursing leader behavior and staff nurse job satisfaction. The style of the manager can be important for employees’ acceptance of change and in motivating them to achieve a high quality of care (Azaare & Gross, 2011, p. 672). …show more content…
In order to move forward and survive in the health care chaos, staff nurses and management must establish positive relationships that create increased efficiency, productivity, and job satisfaction.
Effective leadership of nurse managers has been associated with creating a healthy work environment leading to job satisfaction and retention. Health care managers need to address quality of work place issues in order to provide an environment conducive to staff making decisions to remain (Cowden, Cummings, & Profetto-McGrath, 2011, p. 471). Research analysis suggests that nursing leadership style contributes to the creation of a positive or negative work environment and therefore has an effect on nurses’ job
satisfaction.
Theoretical Findings
Leadership has been studied and defined in many ways within research literature. In 1990, Bruce Avolio and Bernard Bass developed the Full Range Leadership Model which offers a continuum of leadership styles. This model is used throughout the majority of the research. The Full Range Leadership Model attempts to conceptualize transactional and transformational leadership, consisting of seven dimensions. The seven factor conceptualization was translated into an instrument that measures the components of both transactional and transformational leadership, the Multifactor Leadership Questionnaire (Reuvers, Van Engen, Vinkenburg, & Wilson-Evered, 2008, p. 229). This tool is widely accepted in research for its validity.
Transformational leadership (TFL) refers to the leader’s ability to influence others towards achieving extraordinary goals by changing the followers’ beliefs, values and needs (Casida & Parker, 2011, p. 479). TFL is measured by five dimensions: idealized influence-attributes, idealized influence-behavior, intellectual stimulation, individualized consideration and inspirational motivation (Mallory & Penprase, 2010, p.716). TFL has been linked to increased nursing job satisfaction. Transactional leadership (TRL) refers to the exchange process based on the fulfillment of contractual obligations in which the leader typically sets objectives and monitors and controls outcomes (Casida & Parker, 2011, p. 479). TRL focuses on reward and punishment by the leader in exchange for follower compliance.
Previous research has identified correlations between leadership style and the nurses’ work environment. Research within six of the articles reviewed consistently supports the relationship between transformational leadership, commitment and satisfaction. Leadership effectiveness, satisfaction with leadership, motivation and satisfaction with the work environment is evident in all of the reviewed articles. As defined in the Full Range Leadership Model, important characteristics of leaders include visibility, accessibility, open discussion and support of nurses in the provision of quality care through high standards and strong relationships with staff (Duffield, Roche, Blay, & Stasa, 2010, p. 25). Transformational leadership throughout the articles has shown strong associations with staff satisfaction where nurses are engaged and empowered to make decisions about their practice. Nurse Managers are change agents and are constantly faced with the challenges of developing a vision of the future and strategies to reach that vision (Sellgren, Ekvall, & Tomson, 2008, p. 579). This includes communicating the vision, engaging, motivating and inspiring their staff to reach that vision.
Job satisfaction has been described as the most important predictor for nurses’ intention to remain loyal to their organization. Job satisfaction can be considered from a global perspective, such as feelings and emotions perceived by the individual employee based on work experiences (Sellgren et al., 2008, p. 579). Staff nurses’ perceptions of their nurse leader are related to their job satisfaction. With a nursing shortage predicted in the future, it is essential to develop nurse managers as effective leaders who can recruit and retain a high quality, engaged work force assuring positive patient outcomes. This is believed to be achieved more with a transformational style of leadership in which leaders enhance the motivation, morale and performance of their staff.
The positive relationship between effective leadership and staff satisfaction is supported by the research articles in this review. There is evidence in this literature that work environments are evaluated as more positive and staff retention is better when staff feel supported by their leader. Further research is needed in the relationship between leadership and job satisfaction and defining how leadership makes a difference.
Empirical Findings
Ten articles were chosen for this literature review that described studies that examined leadership styles of nurse managers, factors contributing to staff satisfaction, burnout and retention and how staff satisfaction was affected by leadership. Evidence within the studies shows that transformational leaders successfully shape a nursing unit’s culture to consist of trust, collaboration, confidence, autonomy, shared governance and organizational commitment (Casida & Parker, 2011), (Cowden et al., 2011), (Nielsen, Randall, Yarker, & Brenner, 2008). Transactional leaders place a greater focus on rewarding employees with verbal praise, financial incentives and public recognition to motivate employees.
Results of the studies show a positive, strong correlation between transformational leadership and staff nurse satisfaction and a positive, weak correlation between transactional leadership and staff nurse satisfaction. Most of the articles focus on the correlation between leadership styles and job satisfaction, burnout, work environment and/or retention. There is some mention of further correlation between patient outcomes as a result of improved job satisfaction, less burnout, positive work environments and retention of staff. Staff nurses’ perceived levels of job satisfaction, quality of work, job stress and organizational commitment are all influenced by nurse managers’ leadership behaviors (Cowden et al., 2011), (Eneh et al., 2012), (Duffield et al., 2010). In a study by Malloy and Penpranse (2010), the goal was to identify the components that are significantly correlated with a positive or negative work environment. The findings in their study revealed a strong, positive correlation between leadership style and work environment. Similar findings were apparent in the studies by Wong, Spence & Cummings (2010). A significant body of knowledge has been generated around job satisfaction and retention practices that can promote healthier work environments (Casida & Parker, 2011), (Duffield et al., 2010), (Kanste, 2008).
Measuring leadership was consistent across the studies. The Multi-Factor Leadership Questionnaire which is the most widely used and most comprehensive was used in all but two of the studies when measuring leadership. This provided consistent measurement of leadership traits. The other two studies utilized the Global Transformational Leadership scale under the design of a structural equation model that tested the variables between transformational leadership and staff satisfaction. Exhaustion, stress, intent to leave, burnout and turnover were measured by the Maslach Burnout Inventory scale and the Copenhagen psychological questionnaire and showed a direct correlation to job satisfaction. The majority of the studies measured staff satisfaction by tools such as the Nursing Work Index, Aston Team Performance Inventory and Urecht Work Engagement.
Across the studies, transformational leadership was shown to improve work environment and decrease burnout factors. One factor that has been identified as being crucial to a positive work environment is the role of nurse leaders (Duffield et al., 2010, p. 25). Staff satisfaction results were increased when managers utilized transformational leadership but when other leadership styles were used, it resulted in a decrease in staff satisfaction. The positive result of higher satisfaction with transformational leadership was seen throughout the studies across the world. Seven studies took place in large hospital settings in the Northeastern US, Finland, Australia, Sweden, Canada and Eastern Europe. Two studies were done within government departments and the other was the qualitative study that occurred in Africa. Differences were noted in leadership styles across the world. In all of the studies, the majority of the respondents were female, registered nurses with a mean age in the early 40’s. This shows the significance of the aging nursing population and offers support for further research due to the predicted upcoming shortage.
All of the studies except the qualitative study where interviewing was used, utilized questionnaires and surveys which had relatively small response rates. This could be seen as a limitation because either very happy or very unhappy staff may respond which can bias the findings. Another limitation is that the studies did not address variables such as world events, organizational factors or current health care issues that may have influenced the respondents. The final limitation identified is that the results may not be internationally transferrable although the positive results relating to transformational leadership were found across the studies. Consistently across variables and studies, transformational leadership decreased factors that lead to higher burnout and increased well-being and job satisfaction. Correlational and descriptive statistics were the most common used methods of measurement. All studies showed a positive correlation between work environment, satisfaction and leadership. There was statistical significance p < 0.01 or p < 0.05 in all studies showing the correlation between leadership style, work environment, and job satisfaction.
Several gaps exist that should be addressed by future research in the relationship between nurse manager leadership and employee satisfaction. The biggest gap today is tying burnout and job satisfaction directly to leadership. There is a gap in knowledge of how leadership makes a difference; that is we do not know the mechanisms involved in influencing the most effective and sustainable outcomes (Nielsen et al., 2008), (Wong et al., 2010). All of the studies show strong links between leadership, staff nurse satisfaction and retention but further investigation is needed to determine what nurse managers do to create a positive environment.
Summary
All of the studies also show that leadership can have either a positive or negative effect on employee satisfaction. It is clear through the studies that nurse leaders need training and education before beginning their roles in order to be prepared for the challenges they face. It is recommended that nurse managers be trained to give their staff adequate feedback, social support, individualized consideration and encouragement (Kanste, 2008, p. 7). A manager must have the ability to lead especially with the rapid cycle change occurring in healthcare. Nurse managers must work on developing their leadership behavior towards being an all around leader that cares about people, is concerned about productivity and can handle change (Sellgren et al., 2008), (Reuvers et al., 2008).
Understanding factors that influence job satisfaction is key to enhancing morale within the profession and creating a secure future to support the demands of the population. By examining the relationship of perceived leadership styles of nurse managers and job satisfaction of registered staff nurses, the nursing profession can begin to establish positive, mutually beneficial relationships leading to improvements in the work environment, efficiency, productivity, and job satisfaction for all nurses (Sellgren et al., 2008).
The research articles reviewed supported the idea that leadership styles of nurse mangers affect staff nurse satisfaction and that staff nurses report higher levels of job satisfaction when their leader is transformational. Healthcare systems should facilitate transformational leadership for the purpose of creating healthy work environments, improving job satisfaction and recruiting and retaining highly engaged staff who provide the highest quality care.
References
Azaare, J., & Gross, J. (2011). The nature of leadership style in nursing management. British Journal of Nursing, 20 (11), 672-680. Retrieved from EbsocHost
Casida, J., & Parker, J. (2011). Staff nurse perceptions of nurse manager leadership styles and outcomes. Journal of Nursing Management, 19, 478-486. doi:10.1111/j.1365-2834.2011.01252
Cowden, T., Cummings, G., & Profetto-McGrath, J. (2011). Leadership practices and staff nurses’ intent to stay: A systematic review. Journal of Nursing Management, 19, 461-477. doi:10.1111/j.1365-2834.2011.01209
Duffield, C. M., Roche, M. A., Blay, N., & Stasa, H. (2010). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20, 23-33. doi:10.1111/j.1365-2702.2010.03478
Kanste, O. (2008). The association between leadership behaviour and burnout among nursing personnel in health care. Nordic Journal of Nursing Research & Clinical Studies, 28 (3), 4-8. Retrieved from EbsocHost
Mallory, T., & Penprase, B. (2010). Nursing leadership style and psychosocial work environment. Journal of Nursing Management, 18, 715-725. doi:10.1111/j.1365-2834.2010.01094
Nielsen, K., Randall, R., Yarker, J., & Brenner, S. (2008). The effects of transformational leadership on followers’ perceived work characteristics and psychological well-being: A longitudinal study. Work & Stress, 22 (1), 16-32. doi: 10.1080/02678370801979430
Reuvers, M., Van Engen, M. L., Vinkenburg, C. J., & Wilson-Evered, E. (2008). Transformational leadership and innovative work behaviour: Exploring the relevance of gender differences. Leadership and Innovation, 17 (3), 227-243. doi:10.1111/j.1467-8691.2008.00487
Sellgren, S. F., Ekvall, G., & Tomson, G. (2008). Leadership behaviours of nurse managers in relation to job satisfaction and work climate. Journal of Nursing Management, 16, 578-587. doi:10.111/j.1365-2934.2007.00837
Wong, C. A., Spence Laschinger, H. K., & Cummings, G. G. (2010). Authentic leadership and nurses’ voice behaviour and perceptions of care quality. Journal of Nursing Management, 18, 889-900. doi:10.1111/j.135-2834.2010.01113
Rhonda Rychlik
Queens University
How Nursing Leadership Affects Staff Nurses’ Job Satisfaction
The constant and rapidly changing health care environment dramatically affects nursing practice today. Health care leaders are faced with the problem of achieving their strategic goals while balancing finances, productivity, quality outcomes and employee and patient satisfaction. The health care environment is competitive and chaotic which means constant organizational change to meet the challenges. Today’s changes occur frequently in every organization and to handle and motivate change is one of the leader’s main tasks (Sellgren, Ekvall, & Tomson, 2008, p. 579). The challenges in health care today place pressure on the relationship of nursing leader behavior and staff nurse job satisfaction. The style of the manager can be important for employees’ acceptance of change and in motivating them to achieve a high quality of care (Azaare & Gross, 2011, p. 672). …show more content…
In order to move forward and survive in the health care chaos, staff nurses and management must establish positive relationships that create increased efficiency, productivity, and job satisfaction.
Effective leadership of nurse managers has been associated with creating a healthy work environment leading to job satisfaction and retention. Health care managers need to address quality of work place issues in order to provide an environment conducive to staff making decisions to remain (Cowden, Cummings, & Profetto-McGrath, 2011, p. 471). Research analysis suggests that nursing leadership style contributes to the creation of a positive or negative work environment and therefore has an effect on nurses’ job
satisfaction.
Theoretical Findings
Leadership has been studied and defined in many ways within research literature. In 1990, Bruce Avolio and Bernard Bass developed the Full Range Leadership Model which offers a continuum of leadership styles. This model is used throughout the majority of the research. The Full Range Leadership Model attempts to conceptualize transactional and transformational leadership, consisting of seven dimensions. The seven factor conceptualization was translated into an instrument that measures the components of both transactional and transformational leadership, the Multifactor Leadership Questionnaire (Reuvers, Van Engen, Vinkenburg, & Wilson-Evered, 2008, p. 229). This tool is widely accepted in research for its validity.
Transformational leadership (TFL) refers to the leader’s ability to influence others towards achieving extraordinary goals by changing the followers’ beliefs, values and needs (Casida & Parker, 2011, p. 479). TFL is measured by five dimensions: idealized influence-attributes, idealized influence-behavior, intellectual stimulation, individualized consideration and inspirational motivation (Mallory & Penprase, 2010, p.716). TFL has been linked to increased nursing job satisfaction. Transactional leadership (TRL) refers to the exchange process based on the fulfillment of contractual obligations in which the leader typically sets objectives and monitors and controls outcomes (Casida & Parker, 2011, p. 479). TRL focuses on reward and punishment by the leader in exchange for follower compliance.
Previous research has identified correlations between leadership style and the nurses’ work environment. Research within six of the articles reviewed consistently supports the relationship between transformational leadership, commitment and satisfaction. Leadership effectiveness, satisfaction with leadership, motivation and satisfaction with the work environment is evident in all of the reviewed articles. As defined in the Full Range Leadership Model, important characteristics of leaders include visibility, accessibility, open discussion and support of nurses in the provision of quality care through high standards and strong relationships with staff (Duffield, Roche, Blay, & Stasa, 2010, p. 25). Transformational leadership throughout the articles has shown strong associations with staff satisfaction where nurses are engaged and empowered to make decisions about their practice. Nurse Managers are change agents and are constantly faced with the challenges of developing a vision of the future and strategies to reach that vision (Sellgren, Ekvall, & Tomson, 2008, p. 579). This includes communicating the vision, engaging, motivating and inspiring their staff to reach that vision.
Job satisfaction has been described as the most important predictor for nurses’ intention to remain loyal to their organization. Job satisfaction can be considered from a global perspective, such as feelings and emotions perceived by the individual employee based on work experiences (Sellgren et al., 2008, p. 579). Staff nurses’ perceptions of their nurse leader are related to their job satisfaction. With a nursing shortage predicted in the future, it is essential to develop nurse managers as effective leaders who can recruit and retain a high quality, engaged work force assuring positive patient outcomes. This is believed to be achieved more with a transformational style of leadership in which leaders enhance the motivation, morale and performance of their staff.
The positive relationship between effective leadership and staff satisfaction is supported by the research articles in this review. There is evidence in this literature that work environments are evaluated as more positive and staff retention is better when staff feel supported by their leader. Further research is needed in the relationship between leadership and job satisfaction and defining how leadership makes a difference.
Empirical Findings
Ten articles were chosen for this literature review that described studies that examined leadership styles of nurse managers, factors contributing to staff satisfaction, burnout and retention and how staff satisfaction was affected by leadership. Evidence within the studies shows that transformational leaders successfully shape a nursing unit’s culture to consist of trust, collaboration, confidence, autonomy, shared governance and organizational commitment (Casida & Parker, 2011), (Cowden et al., 2011), (Nielsen, Randall, Yarker, & Brenner, 2008). Transactional leaders place a greater focus on rewarding employees with verbal praise, financial incentives and public recognition to motivate employees.
Results of the studies show a positive, strong correlation between transformational leadership and staff nurse satisfaction and a positive, weak correlation between transactional leadership and staff nurse satisfaction. Most of the articles focus on the correlation between leadership styles and job satisfaction, burnout, work environment and/or retention. There is some mention of further correlation between patient outcomes as a result of improved job satisfaction, less burnout, positive work environments and retention of staff. Staff nurses’ perceived levels of job satisfaction, quality of work, job stress and organizational commitment are all influenced by nurse managers’ leadership behaviors (Cowden et al., 2011), (Eneh et al., 2012), (Duffield et al., 2010). In a study by Malloy and Penpranse (2010), the goal was to identify the components that are significantly correlated with a positive or negative work environment. The findings in their study revealed a strong, positive correlation between leadership style and work environment. Similar findings were apparent in the studies by Wong, Spence & Cummings (2010). A significant body of knowledge has been generated around job satisfaction and retention practices that can promote healthier work environments (Casida & Parker, 2011), (Duffield et al., 2010), (Kanste, 2008).
Measuring leadership was consistent across the studies. The Multi-Factor Leadership Questionnaire which is the most widely used and most comprehensive was used in all but two of the studies when measuring leadership. This provided consistent measurement of leadership traits. The other two studies utilized the Global Transformational Leadership scale under the design of a structural equation model that tested the variables between transformational leadership and staff satisfaction. Exhaustion, stress, intent to leave, burnout and turnover were measured by the Maslach Burnout Inventory scale and the Copenhagen psychological questionnaire and showed a direct correlation to job satisfaction. The majority of the studies measured staff satisfaction by tools such as the Nursing Work Index, Aston Team Performance Inventory and Urecht Work Engagement.
Across the studies, transformational leadership was shown to improve work environment and decrease burnout factors. One factor that has been identified as being crucial to a positive work environment is the role of nurse leaders (Duffield et al., 2010, p. 25). Staff satisfaction results were increased when managers utilized transformational leadership but when other leadership styles were used, it resulted in a decrease in staff satisfaction. The positive result of higher satisfaction with transformational leadership was seen throughout the studies across the world. Seven studies took place in large hospital settings in the Northeastern US, Finland, Australia, Sweden, Canada and Eastern Europe. Two studies were done within government departments and the other was the qualitative study that occurred in Africa. Differences were noted in leadership styles across the world. In all of the studies, the majority of the respondents were female, registered nurses with a mean age in the early 40’s. This shows the significance of the aging nursing population and offers support for further research due to the predicted upcoming shortage.
All of the studies except the qualitative study where interviewing was used, utilized questionnaires and surveys which had relatively small response rates. This could be seen as a limitation because either very happy or very unhappy staff may respond which can bias the findings. Another limitation is that the studies did not address variables such as world events, organizational factors or current health care issues that may have influenced the respondents. The final limitation identified is that the results may not be internationally transferrable although the positive results relating to transformational leadership were found across the studies. Consistently across variables and studies, transformational leadership decreased factors that lead to higher burnout and increased well-being and job satisfaction. Correlational and descriptive statistics were the most common used methods of measurement. All studies showed a positive correlation between work environment, satisfaction and leadership. There was statistical significance p < 0.01 or p < 0.05 in all studies showing the correlation between leadership style, work environment, and job satisfaction.
Several gaps exist that should be addressed by future research in the relationship between nurse manager leadership and employee satisfaction. The biggest gap today is tying burnout and job satisfaction directly to leadership. There is a gap in knowledge of how leadership makes a difference; that is we do not know the mechanisms involved in influencing the most effective and sustainable outcomes (Nielsen et al., 2008), (Wong et al., 2010). All of the studies show strong links between leadership, staff nurse satisfaction and retention but further investigation is needed to determine what nurse managers do to create a positive environment.
Summary
All of the studies also show that leadership can have either a positive or negative effect on employee satisfaction. It is clear through the studies that nurse leaders need training and education before beginning their roles in order to be prepared for the challenges they face. It is recommended that nurse managers be trained to give their staff adequate feedback, social support, individualized consideration and encouragement (Kanste, 2008, p. 7). A manager must have the ability to lead especially with the rapid cycle change occurring in healthcare. Nurse managers must work on developing their leadership behavior towards being an all around leader that cares about people, is concerned about productivity and can handle change (Sellgren et al., 2008), (Reuvers et al., 2008).
Understanding factors that influence job satisfaction is key to enhancing morale within the profession and creating a secure future to support the demands of the population. By examining the relationship of perceived leadership styles of nurse managers and job satisfaction of registered staff nurses, the nursing profession can begin to establish positive, mutually beneficial relationships leading to improvements in the work environment, efficiency, productivity, and job satisfaction for all nurses (Sellgren et al., 2008).
The research articles reviewed supported the idea that leadership styles of nurse mangers affect staff nurse satisfaction and that staff nurses report higher levels of job satisfaction when their leader is transformational. Healthcare systems should facilitate transformational leadership for the purpose of creating healthy work environments, improving job satisfaction and recruiting and retaining highly engaged staff who provide the highest quality care.
References
Azaare, J., & Gross, J. (2011). The nature of leadership style in nursing management. British Journal of Nursing, 20 (11), 672-680. Retrieved from EbsocHost
Casida, J., & Parker, J. (2011). Staff nurse perceptions of nurse manager leadership styles and outcomes. Journal of Nursing Management, 19, 478-486. doi:10.1111/j.1365-2834.2011.01252
Cowden, T., Cummings, G., & Profetto-McGrath, J. (2011). Leadership practices and staff nurses’ intent to stay: A systematic review. Journal of Nursing Management, 19, 461-477. doi:10.1111/j.1365-2834.2011.01209
Duffield, C. M., Roche, M. A., Blay, N., & Stasa, H. (2010). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20, 23-33. doi:10.1111/j.1365-2702.2010.03478
Kanste, O. (2008). The association between leadership behaviour and burnout among nursing personnel in health care. Nordic Journal of Nursing Research & Clinical Studies, 28 (3), 4-8. Retrieved from EbsocHost
Mallory, T., & Penprase, B. (2010). Nursing leadership style and psychosocial work environment. Journal of Nursing Management, 18, 715-725. doi:10.1111/j.1365-2834.2010.01094
Nielsen, K., Randall, R., Yarker, J., & Brenner, S. (2008). The effects of transformational leadership on followers’ perceived work characteristics and psychological well-being: A longitudinal study. Work & Stress, 22 (1), 16-32. doi: 10.1080/02678370801979430
Reuvers, M., Van Engen, M. L., Vinkenburg, C. J., & Wilson-Evered, E. (2008). Transformational leadership and innovative work behaviour: Exploring the relevance of gender differences. Leadership and Innovation, 17 (3), 227-243. doi:10.1111/j.1467-8691.2008.00487
Sellgren, S. F., Ekvall, G., & Tomson, G. (2008). Leadership behaviours of nurse managers in relation to job satisfaction and work climate. Journal of Nursing Management, 16, 578-587. doi:10.111/j.1365-2934.2007.00837
Wong, C. A., Spence Laschinger, H. K., & Cummings, G. G. (2010). Authentic leadership and nurses’ voice behaviour and perceptions of care quality. Journal of Nursing Management, 18, 889-900. doi:10.1111/j.135-2834.2010.01113