Head nurse leadership style with staff nurse burnout and job satisfaction in neonatal intensive care units

Leadership style has been defined as a two-factor construct composed of "consideration" and "initiating structure." Research has suggested that these factors affect the behavior and attitude of subordinates. This study's purpose was to quantify the relationships of head nurse leadership style with self-reported staff nurse burnout and job satisfaction in Neonatal Intensive Care Units (NICUs). Three instruments--the Minnesota Satisfaction Questionnaire, the Tedium Scale, and the Leadership Opinion Questionnaire--were voluntarily completed by 283 registered nurses employed by 14 level-III NICUs in the United States. The leadership dimensions of consideration and structure were distinct (r = -.10). Staff nurse satisfaction and burnout were related (r = -.41). Head nurse consideration was clearly related to staff nurse satisfaction (r = -.55) and to a lesser extent to burnout (r = -.29). Initiating structure alone was not related to satisfaction or burnout. Aggregate perceptions of head nurse leadership were ranked across NICUs in order to classify the head nurses on consideration and structure. The 14 head nurses were separated into four groups: high consideration-high structure, high consideration-low structure, low consideration-high structure, and low consideration-low structure. Satisfaction and burnout of staff nurses in each of the leadership-style groups were then compared. Analysis of variance for satisfaction (F(3,279) = 3.10, p = .03) and burnout (F(3,279) = 3.90, p = .01) were both significant. For both satisfaction and burnout, the head nurse leadership classification of low consideration-high structure was most deviant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Charge nurses as front-line leaders: development through transformative learning

Based on the results of a staff satisfaction survey, nurse leaders recognized that the role of charge nurse was a significant source of dissatisfaction. Little attention had been paid to how the charge nurse role was learned, and no organizational support was offered to develop nurses for this role. Collaborating with a nurse educator consultant, nurse managers developed and implemented a three-part educational program to reframe staff perceptions of the charge nurse role. Centered on principles of transformational learning, the program evaluation demonstrated that concerted efforts to improve staff satisfaction and effectiveness could be accomplished if staff were given new information and guided through focused discussion and reflection. Eighty-two percent of the attendees noted that they appreciated the time allocated for the sessions and acknowledged that this gave them an opportunity to examine their thoughts and feelings. Seventy-five percent said that they learned new words to describe and explain their experiences. After the sessions, staff described a new sense of professional pride and nurse managers observed greater confidence in nurses' decision making and assertive communication.     

The influence of staff nurse perception of leadership style on satisfaction with leadership: A cross-sectional survey of pediatric nurses

BackgroundThere is evidence that transformational leadership style promotes nursing excellence. Differences in how supervisees and supervisors perceive the supervisor's leadership style may also be related to satisfaction with leadership. Research demonstrates that satisfaction with leadership is a critical element in the retention of nurses.ObjectiveTo evaluate staff nurse and nurse leader perceptions of leadership style.Methods16 supervisors and 179 supervisees completed the Multifactor Leadership Questionnaire and a demographic survey. Data were analyzed using parametric statistical techniques.ResultsAlthough staff perceived leaders as employing largely transformative leadership strategies, differences existed in leader-staff congruence in interpretation of leadership style and as related to the role of the leader.ConclusionsDifferences in interpretation of leadership style between supervisors and supervisees were associated with diminished satisfaction with leadership. In addition, those serving in a direct operational role (assistant nurse manager) were viewed as less transformative than leaders who maintained broader administrative responsibilities.     

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BackgroundLeadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.MethodsThe search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.ResultsA total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.ConclusionsThe findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.     

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

Context

Numerous policy and research reports call for leadership to build quality work environments, implement new models of care, and bring health and wellbeing to an exhausted and stretched nursing workforce. Rarely do they indicate how leadership should be enacted, or examine whether some forms of leadership may lead to negative outcomes. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

Methods

The search strategy of this multidisciplinary systematic review included 10 electronic databases. Published, quantitative studies that examined leadership behaviours and outcomes for nurses and organizations were included. Quality assessments, data extractions and analysis were completed on all included studies.

Findings

34,664 titles and abstracts were screened resulting in 53 included studies. Using content analysis, 64 outcomes were grouped into five categories: staffsatisfaction with work, role and pay, staff relationships with work, staff health and wellbeing, work environment factors, and productivity and effectiveness. Distinctive patterns between relational and task focused leadership styles and their outcomes for nurses and their work environments emerged from our analysis. For example, 24 studies reported that leadership styles focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with higher nurse job satisfaction, whereas 10 studies found that leadership styles focused on tasks (dissonant, instrumental and management by exception) were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

Conclusion

Our results document evidence of various forms of leadership and their differential effects on the nursing workforce and work environments. Leadership focused on task completion alone is not sufficient to achieve optimum outcomes for the nursing workforce. Efforts by organizations and individuals to encourage and develop transformational and relational leadership are needed to enhance nurse satisfaction, recruitment, retention, and healthy work environments, particularly in this current and worsening nursing shortage.     

Leadership behaviours: effects on job satisfaction, productivity and organizational commitment

BACKGROUND: Research in the west has shown that job satisfaction, productivity and organizational commitment are affected by leadership behaviours. The purpose of this study is to determine the effect of leadership behaviours on employee outcomes in Singapore. Very little research related to this subject has been done in health care settings in this country. The comparison of the results of the different types of settings and samples will allow a better understanding of the relationship between leadership behaviours and employee outcomes and thus help to determine if leadership is worth the extra effort. METHOD: The study explored the relationships between five leadership behaviours identified by Kouzes and Posner and the employee outcomes of registered nurses practising in the general wards, intensive care units and the coronary care unit in an acute hospital. Survey questionnaires were used to elicit responses from 100 registered nurses and 20 managers belonging to the organization. Data collected included demographic characteristics and the degree to which the five types of leadership behaviours were used as perceived by the nurse managers and the registered nurses. In addition, the level of nurse job satisfaction, the degree of productivity and the extent of organizational commitment are described. FINDINGS: The findings show a similar trend to the original studies in the United States of America. Use of leadership behaviours and employee outcomes were significantly correlated. The regression results indicate that 29% of job satisfaction, 22% of organizational commitment and 9% of productivity were explained by the use of leadership behaviours. Recommendations are made in the light of these findings.     

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey

Patrick A., Laschinger H.K.S., Wong C. & Finegan J. (2011) Journal of Nursing Management 19 , 449–460
Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey Aim To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner’s model of transformational leadership. Background While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. Methods A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. Results Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. Conclusion The results provide encouraging evidence for the construct validity of the CLS. Implications for nursing management Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.     

The nature of leadership style in nursing management

The purpose of this study was to explore the nature of leadership styles used by nurse managers, and describe staff nurses' perceptions of leadership styles. Effective leadership among nurse managers has been associated with staff nurse job satisfaction and retention. Twenty staff nurses from two hospitals in Ghana responded to tape-recorded interview questions. Four themes emerged from inductive analysis of the data. Findings suggest that nurse managers employed intimidation and minimal consultation to control their employees. The study further indicated that nurse managers were perceived as 'figure-heads', who are weak and inarticulate at the level of policy planning and implementation. It was therefore concluded that staff nurses in the study site hospitals lack confidence, trust and satisfaction with the current style of leadership. Staff nurses preferred a more proactive, articulate and independent nursing leadership at the top level. It is recommended that effective leadership training be instituted for prospective nurse managers before appointments are made into management and administrative positions.     

Supplemental nurse staffing in hospitals and quality of care

OBJECTIVE: To promote evidence-based decision making regarding hospital staffing, the authors examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events. BACKGROUND: The use of supplemental nurses to bolster permanent nursing staff in hospitals is widespread but controversial. Quality concerns have been raised regarding the use of supplemental staff. METHODS: Data from the 2000 National Sample Survey of Registered Nurses were used to determine whether the qualifications of supplemental nurses working in hospitals differed from permanent staff nurses. Data from Pennsylvania nurse surveys were analyzed to examine whether nurse outcomes and adverse events differed in hospitals with varying proportions of nonpermanent nurses. RESULTS: Temporary nurses have qualifications similar to permanent staff nurses. Deficits in patient care environments in hospitals employing more temporary nurses explain the association between poorer quality and temporary nurses. CONCLUSION: Negative perceptions of temporary nurses may be unfounded.     

A clinical advancement program: evaluating 10 years of progressive change

OBJECTIVE: To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time. BACKGROUND: The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benner's Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change. METHODS: Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets. RESULTS: Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results. CONCLUSIONS: Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.     

Enhancing collaborative communication of nurse and physician leadership in two intensive care units

OBJECTIVE: To test an intervention to enhance collaborative communication among nurse and physician leaders (eg, nurse manager, medical director, clinical nurse specialist) in two diverse intensive care units (ICUs). BACKGROUND: Collaborative communication is associated with positive patient, nurse, and physician outcomes. However, to date, intervention-focused research that seeks to improve collaborative communication is lacking. METHODS: A pretest-posttest repeated measures design incorporated baseline data collection, implementation of the intervention over 8 months, and immediate and 6-months-post data collection. FINDINGS: Communication skills of ICU nurse and physician leaders improved significantly. Leaders also reported increased satisfaction with their own communication and leadership skills. In addition, staff nurse and physician perceptions of nursing leadership and problem solving between groups increased. Staff nurses reported lower personal stress (eg, more respect from co-workers, physicians, and managers), even though they perceived significantly more situational stress (eg, less staffing and time). CONCLUSION: Study findings provide evidence that nurse-physician collaborative communication can be improved.     

Nurse executive and staff nurse perceptions of the effects of reorganization in Veterans Health Administration hospitals

OBJECTIVE: To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities. BACKGROUND: Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff. METHODS: Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities. RESULTS: Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.     

Making the transition: staff nurse to front-line nurse leader

This paper discusses the challenges that staff nurses face when moving into formal Leadership positions. Current transition strategies for nurses are presented, including a critical analysis of organizational and individual factors that enhance or impede the transition to front-line nurse leadership positions. Recommendations outline essential practices, resources available and support networks that enable a smooth transition into these positions. Reflections on the author's personal transition to a front-line nurse leadership position are included.     

护理管理者变革型领导行为与护理人员工作满意度的相关性研究

目的调查目前护理管理者变革型领导水平及护理人员工作满意度的现状,分析变革型领导对工作满意度的影响,并探索两者的相关性。方法采用问卷调查法对哈尔滨市一所三级甲等医院中的238名护理人员进行调查。结果护理管理者的变革型领导和护士的工作满意度都处于中等水平,两者之间呈正相关（P〈0.01）。结论通过提高护理管理人员变革型领导的知识和技能,可以提高护理人员的工作满意度。     

The influence of nursing leadership on nurse performance: a systematic literature review

brady germain p. & cummings g.g. (2010) Journal of Nursing Management 18, 425–439
The influence of nursing leadership on nurse performance: a systematic literature review Aim The aim was to explore leadership factors that influence nurse performance and particularly, the role that nursing leadership behaviors play in nurses’ perceptions of performance motivation. Background Nurse performance is vital to quality patient care outcomes and nursing leadership behaviors have been linked to nurse performance. Evaluations A review of research articles that examined the factors that nurses perceived as influencing their motivation and performance was conducted. Eight studies were included in the final analysis. Key issues Nurses’ perceptions of factors that affect their motivation and ability to perform were grouped into five categories using content analysis: autonomy, work relationships, resource accessibility, nurse factors, and leadership practices. Nursing leadership behaviors were found to influence both nurses’ motivations directly and indirectly via other factors. Conclusion The review suggests that nurse performance may be improved by addressing nurse autonomy, relationships among nurses, their colleagues and leaders, and resource accessibility. Implications for nursing management Nursing managers and leaders may enhance their nurses’ performance by understanding and addressing the factors that affect their ability and motivation to perform.