Understanding the role nurse manager (NM) leadership behavior plays in achieving staff nurse job satisfaction and retention provides potentially valuable information to hospitals in the process of applying for Magnet® designation and represents a gap in the current literature. This information would be helpful to inform NMs and leaders as they seek to improve nurse satisfaction scores and retention rates while on the Magnet journey. Existing research addressing job satisfaction among nurses has focused primarily on nurse leader characteristics without an in-depth examination of the influence of NM leadership behaviors on staff nurse satisfaction. A primary role of the nurse leader is to plan for retention strategies.1 Previous studies have identified aspects of leadership as a factor in influencing staff nurse satisfaction and retention.2,3 This research study expanded upon those findings and examined the relationship between staff nurse perception of their NM’s leadership behavior and staff nurse job satisfaction in a hospital that was seeking Magnet designation. Hospitals that have achieved Magnet designation, sponsored by the American Nurses Credentialing Center®, demonstrate excellent outcomes in both patient care and the ability to attract and retain nurses.4,5 Job satisfaction, defined as a nurse’s affective attachment to the job or aspects of the job,6 is a critical aspect of attracting and retaining well-qualified personnel.2 Factors that influence the job satisfaction of staff nurses include work on present job, pay, opportunities for promotion, supervision, and coworkers.7 Job dissatisfaction is a problem in acute care environments, and up to 40% of nurses working in hospitals express dissatisfaction with their staff nurse positions.8 Leaders are an important factor in why employees remain with or exit an organization.9 Decreased job satisfaction can lead to intent to depart the organization and actual turnover.10
A descriptive, correlational design was used to examine the relationship between staff nurse perception of their NM leadership behaviors and their job satisfaction in a hospital on the Magnet journey. The distributed survey mode was chosen for the study because it was an accessible means of acquiring the perceptions of a large sample of nurses. The hospital and staff nurses were selected for the study because they had begun the Magnet journey and had not achieved designation. Before the study was conducted, survey materials and research methods were approved by the institutional review board from the hospital site and the supporting university. Staff nurses participating in the study completed the Multifactor Leadership Questionnaire (MLQ) 5X Short Form,12 the Abridged Job Descriptive Index (aJDI) survey,7 and a demographic questionnaire.
1. What is the relationship between staff nurse perception of their NM leadership behaviors and their staff nurse job satisfaction in a hospital applying for Magnet designation?
2. What is the influence of NM leadership style on staff nurse overall job satisfaction?
Nurse managers are in a position to influence staff nurse job satisfaction and retention through their leadership behaviors. The 5 components, on which Magnet hospitals are evaluated, include transformational leadership (TL); structural empowerment; exemplary professional practice; new knowledge, innovation, and improvements; and empirical outcomes.11 Three leadership styles may be particularly pertinent to NMs in Magnet environments and include (1) transformational, (2) transactional, and (3) passive-avoidant. Transformational leadership behavior works to influence employees to see opportunities, challenges, and themselves in new and different ways.12 Transformational leaders seek to transform the paradigm or world view of the workplace environment. Transactional leadership behavior works to actively bring together employees in constructive and positive ways to problem solve and innovate.12 Passive-avoidant leadership behavior tends to react or respond to situations, often in a way that is not systematic, as opposed to proactive leadership methods.12 Magnet hospitals strive for and are recognized for patterns of TL. Passive-avoidant leadership is contrary to Magnet standards.11 For this reason, it is essential to identify the leadership behavior of NMs that impact staff nurse job satisfaction during the Magnet journey.
To measure perceptions of NM leadership behavior, the survey instrument included the MLQ 5X Short Form.12 The MLQ 5X Short Form is the abbreviated form of the MLQ.12 The MLQ identifies the most common leadership characteristics and is the benchmark measure of TL.12 The MLQ has well-established reliability and validity as a leadership measurement instrument in both industry and service settings.12 The MLQ has been used in more than 200 research studies within the past 40 years.12 Prior confirmatory factor analysis, the goodness-of-fit index, and reliability scores indicate that the MLQ is both a reliable and valid instrument for measuring TL, transactional, and passive-avoidant leadership behavior characteristics.12 The Cronbach’s α coefficient for each of the MLQ subscales varied between .69 and .83.12 The MLQ places leadership behaviors on a continuum and defines stages of leadership between the transactional, transformational, and passive-avoidant leadership styles. The MLQ 5X Short Form measured NM leader style (transformational, transactional, and passive-avoidant) and outcomes of leadership through the 12 MLQ subscales: TL (idealized attributes, idealized behaviors, inspirational motivation, intellectual stimulation, individual consideration), transactional leadership (contingency reward, active management by exception), passive-avoidant (passive management by exception, laissez faire), and outcomes of leadership (extra effort, effectiveness, satisfaction). Questions were presented to participants using a frequency scale ranging from 0, not at all, to 4, frequently, if not always.
The aJDI7 was included in the survey instrument to assess the relationship between staff nurse perception of their NM leadership behaviors and their staff nurse job satisfaction. The aJDI is the abbreviated version of the Job Descriptive Index.13 The aJDI is a multifaceted self-report instrument that has been extensively used for over 50 years to measure job satisfaction and was last revised in 2010.13 The aJDI instrument had established validity and reliability.7 The Cronbach’s α coefficient for each of the aJDI subscales varied between .88 and .92.7 The 38-item aJDI instrument included 5 six-item subscales (satisfaction with work on present job, satisfaction with pay, satisfaction with opportunities for promotion, satisfaction with supervision, and satisfaction with coworkers). The aJDI included a subscale, Abridged Job in General (aJIG), which is a global measure of overall job satisfaction that was composed of 8 items. The aJDI score was calculated by summing the values, separately, for each subscale. The range of possible scores on each scale was 0 to 18.7
A researcher-developed demographic questionnaire was utilized to collect characteristics of the participants and included variables such as age in 5-year increments, years of clinical experience, highest nursing degree, number of years in the organization, number of years in current position, primary work shift, and current employment status. The demographic data were the independent variables used to identify factors that may influence facets of staff nurse job satisfaction that were independent of the NM leadership behaviors.
The sample for the research study was staff nurses in 1 nonprofit acute care hospital in the southern United States. The sample was purposive because of its convenience, availability, and timeliness. The hospital site for the research study consisted of a large staff nurse sample size and adequate NM pool. The hospital nursing administration supported the research study as it aligned with their mission to seek Magnet designation. With the permission of nursing administration, the 1st author attended the research council meeting and 3 monthly shared governance meetings to provide surveys and to address any of the research study questions or concerns. Survey packets (including cover letter, survey questionnaire, and return envelope) were distributed to the nursing units within the hospital inviting more than 500 staff nurses to participate in the research study. The cover letter to each study participant explained the purpose and relevance of the voluntary study and included the risks and benefits of participation, provisions regarding strict confidentiality and anonymity, and that responses would be reported only in aggregate. The consent to participate in the study was the completed survey questionnaire.
Staff nurse was defined as an RN who had completed nursing orientation and worked at least 90 days total and more than 2 days per month on their current nursing unit. The staff nurses were provided the definition of their NM as having primary responsibility for the unit 24 hours a day and 7 days a week. To protect the anonymity of study participants and to reduce inflation of the scores, survey data were not included in the study for NMs with less than 5 staff nurses participating in the study.12 Each staff nurse involved with the research study was asked to refer his/her responses regarding NM leader behaviors to the 1 NM who had primary responsibility for his/her unit. Nurse managers demonstrate a range of leadership behaviors in the day-to-day operation of their unit. The MLQ 5X Short Form12 asked the staff nurse questions about their perceptions regarding their NM leadership behaviors. Staff nurse surveys were linked to NMs through the participant’s identification of unit and manager. The aJDI survey form7 asked staff nurses to rate how well a series of statements related to satisfaction with their current work environment with yes/no responses.
As each staff nurse participant completed his/her survey, he/she placed the survey in a sealed envelope that was provided by the researchers and then deposited the sealed survey envelope into a closed collection box that was located in the main nursing office. No one in the organization, including the NMs, had access to any survey data completed by the staff nurses.
Over a 3-month period, a total of 117 staff nurses completed the survey (23.4%), and 115 surveys met the inclusion criteria for the study for a response rate of approximately 23% (n = 115). An exact response rate could not be accurately calculated because it was not known how many of the 500 staff nurses actually received the survey packet or did not meet the inclusion criteria and declined to participate. Responses were analyzed using the Statistical Package for the Social Sciences (SPSS 19.0; IBM Corp, Armonk, New York).
Description of the Sample
Among the 115 staff nurse participants in the research study, the mean age was 42.0 years (range, <26 to >60 years), which is comparable to the national nurse average of 47 years of age.14 The majority of staff nurses had more than 15 years of clinical experience (n = 45, 39.1%) and held an ADN (n = 67, 58.3%) as their highest level of academic preparation. Staff nurses reported employment at the hospital under study for less than 5 years (n = 34, 29.6%), 6 to 10 years (n = 38, 33.0%), and more than 10 years (n = 41, 35.7%). Most staff nurses worked 12-hour shifts from 7:00 AM to 7:00 PM (n = 48, 41.7%) compared with 7:00 PM to 7:00 AM (n = 35, 30.4%). Full-time employment was reported by the majority of staff nurses (n = 101, 87.8%).
Pearson correlations were calculated between the 3 MLQ 5X Short leadership style scales (TL, transactional leadership, and passive-avoidant behavior) and participant scores on the aJDI measures of job satisfaction. Pearson correlations were then calculated between each subscale of the aJDI and the global measure of job satisfaction as provided by the aJIG. Next, regression analyses were completed to explore the influence of each MLQ 5X Short leadership style scale (transformational, transactional, passive-avoidant) on the aJDI satisfaction with supervision score. Subsequently, regression analyses were specified to assess the influence of each MLQ 5X Short identified leadership style scale on the global measure of job satisfaction (aJIG) while controlling for the influence of the aJDI satisfaction with supervision score to estimate the unique effects of NM leadership style and satisfaction with supervision on overall staff nurse job satisfaction.
Scale means and SDs revealed that this sample of staff nurses did not view their NMs as strongly possessing any one of the characteristics of transformational, transactional, or passive-avoidant leadership styles. Means surrounded the midrange score of 2 (range, 0-4) for the MLQ 5X Short. The means of the aJDI subscales indicated that the sampled staff nurses were most satisfied with the subscale of satisfaction with coworkers (14.71 mean with a 0- to 18-point scale range) and least satisfied in the area of satisfaction with opportunities for promotion (6.95 mean with a 0- to 18-point scale range). Means and SDs for the MLQ 5X Short and the aJDI subscales are displayed in Table 1.
Pearson correlations demonstrated that a perception of TL behaviors on the part of the NM was positively related to staff nurse satisfaction with opportunities for promotion (r = 0.396, P < .01) and satisfaction with supervision (r = 0.686, P < .01). Opportunities for promotion (r = 0.322, P < .01) and satisfaction with supervision (r = 0.484, P < .01) were also positively correlated with a perception of transactional leadership behaviors. Interestingly, a staff nurse perception of passive-avoidant leadership behaviors on the part of their NM was significantly negatively correlated to 4 of the nurse satisfaction subscales: satisfaction with current work (r = −0.258, P < .05), satisfaction with opportunities for promotion (r = −0.277, P < .05), satisfaction with supervision (r = −0.664, P < .01, and satisfaction with coworkers (r = −0.314, P < .01). The global measure of job satisfaction (aJIG) was significantly and positively related to a perception of TL behaviors (r = 0.296, P < .01) and negatively related to passive-avoidant leadership (r = −0.413, P < .01). Each of the subscales of the aJDI was significantly and positively related to the aJIG global measure of satisfaction. Pearson correlations are reported in Table 2.
In this study, there were statistically significant differences between staff nurses employed with the hospital for 5 or less years (n = 34, 29.6%) and staff nurses employed with the hospital 11 or more years (n = 41, 35.7%). Pearson correlations were performed, and the results indicate that staff nurses with 5 or less years of employment with the hospital had positive relationships with transformational (r = 0.564, P < .01) and transactional leadership style (r = 0.419, P < .05), a negative relationship with passive-avoidant leadership style (r = −0.687, P < .01), whereas staff nurses employed for 11 or more years did not have a statistically significant relationship with any leadership style. These results suggest that the overall job satisfaction of staff nurses employed with the hospital for 5 or less years was greatly influenced by NM leadership behaviors, but not for staff nurses employed with the hospital for 11 or more years. Further correlational analysis found staff nurses employed with the hospital 5 or less years had the strongest correlation with satisfaction with opportunity for promotion with transformational (r = 0.575, P < .01) and transactional leadership style (r = 0.560, P < .01) and dissatisfaction with passive-avoidant leadership style (r = −0.464, P < .01) of their NM. Staff nurses employed with the hospital for 11 or more years had the strongest correlations with satisfaction of supervision with transformational (r = 0.676, P < .01) and transactional leadership style (r = 0.598, P < .01) and dissatisfaction with passive-avoidant leadership style (r = −0.542, P < .01). These results indicate that staff nurses employed in the hospital for 5 or less years had a greater relationship between leadership behaviors and satisfaction with opportunity for promotion, whereas the staff nurses employed in the hospital 11 or more years had a greater relationship between leadership behaviors and satisfaction with supervision. Other differences between the groups found 91.2% of the staff nurses employed 5 or less years worked full time compared with 85.4% of the group employed for 11 or more years. Of the group of staff nurses employed in the current hospital for 5 or less years, 23.5% worked 7:00 AM to 7:00 PM compared with 46.3% of the group employed for 11 or more years.
Hierarchical regression specified to assess the influence of staff nurse perception of NM leadership behaviors on the aJDI supervision subscale revealed a significant positive influence of transformational and transactional leadership on satisfaction with current workplace supervision. Perception that the NM behaved in a passive-avoidant manner resulted in significantly lower nurse satisfaction with supervision scores. Separate regression equations predicting the influence of each leadership behavior construct on the global aJIG score indicated that only TL had a significantly positive influence on overall staff nurse job satisfaction. The passive-avoidant style exerted a significantly negative response on overall nurse satisfaction, and the influence of transactional behaviors was insignificant. Equations specified with both leadership behavior scales and the aJDI satisfaction with supervision scale predicting overall job satisfaction (aJIG) demonstrated that satisfaction with supervision was a positive influence on overall satisfaction when separately controlling for the influence of each leadership behavior style (transformational, transactional, and passive-avoidant), and while controlling for satisfaction for supervision, none of the 3 leadership behavior styles remained significant. In summary, staff nurses who perceived that their NM behaved in a manner consistent with transformational and transactional leadership styles were more satisfied with their current workplace supervision, and staff nurses who perceived that their NM behaved in a manner consistent with the passive-avoidant style were less satisfied. Only TL influenced overall job satisfaction in a positive manner, and the influence of passive-avoidant behavior was negative. When each of the 3 leadership behavior styles was introduced as a control variable into separate models predicting the influence of satisfaction with supervision on overall satisfaction, the influence of satisfaction was positive and significant, whereas none of the 3 leadership behavior styles remained significant. Results of the regression analyses are reported in Table 3.
The literature indicates that leadership behaviors that are suitable for healthcare organizations had been poorly explored.15 Describing the staff nurse perception of their NM leadership behaviors gives additional insight into the NM leadership behaviors that were related to facets of staff nurse job satisfaction (work, pay, promotion, supervision, and coworkers) and staff nurse overall job satisfaction. The results of the research study indicate that staff nurses at this hospital, in the process of working toward achieving Magnet designation, were relatively satisfied in the areas of work on current job, pay, supervision, coworkers, and overall job satisfaction. Staff nurses at this facility were moderately dissatisfied in the area of opportunities for promotion (mean, 6.95 [SD, 5.54]). Similarly, descriptive findings indicated that staff nurses perceived their NMs to be less transformational and less transactional than the national norm.12 These findings raise concerns that must be addressed by any facility attempting to exemplify the Magnet hospital commitment to behaviors consistent with TL. Our finding that TL has a positive influence on the nursing workplace substantiates previous research. The Institute of Medicine16 has urged that attention be paid to organizational designs that promote TL and evidence-based management into the practice settings and work environments of direct care nurses.
There were a number of limitations to this study. First, our survey was administered to nurses working in 1 facility. While this was purposefully done to investigate the environment of a hospital currently working toward Magnet designation, our results were likely biased by situations or events occurring that were unique to this facility environment. Our response rate to the survey was lower than is optimal to generalize findings to the larger population of staff nurses. Low response rate limited our ability to use multilevel or mixed-effects modeling to address the nested nature of our data. This low participation rate may indicate future challenges as the hospital develops a plan for meeting the Magnet designation expectations for research in practice.17 While the mean age of staff nurses in the sample was 42.0 years (range, <26 to >60 years) and was comparable to the national nurse average of 47 years of age,14 the predominate number of staff nurses with an ADN (n = 67, 58.3%) compared with the baccalaureate degree in nursing (n = 44, 38.3%) was a limitation to the study.
Future research would benefit from similar studies that address the relationship between leadership behavior and nurse job satisfaction using a national sample of hospitals that are working toward Magnet designation. In addition, research conducted using a mixed-methods design would illuminate survey findings and provide guidance regarding the factors driving dissatisfaction in certain areas or continued use of particular leadership behaviors.
Implications for Nurse Leaders
This research measured staff nurse perception of their NM leadership behaviors in an effort to determine if there was an impact on staff nurse satisfaction. Transformational and transactional leadership behaviors of NMs are positively related to staff nurse job satisfaction. Conversely, passive-avoidant leadership behaviors of NMs are related to staff nurse job dissatisfaction. The results of this study are pertinent to hospital and nursing leadership, particularly for hospitals who are in the process of applying for Magnet designation. Staff nurses are often promoted into leadership roles including those as a NM based on clinical expertise and tenure and may not have leadership competency.19
Studies show that managers perceive their leadership behaviors different than those who report to them.9 This study asked staff nurses about their perceptions of their NM’s leader behaviors. In an effort to analyze NM leader behaviors, the MLQ can be used to measure a full range of leadership styles and allows for NMs to rate themselves. Having NMs explore their perception of their own leadership behaviors as compared with the staff nurse perception of their NM leadership behaviors would provide valuable information for developing leader competencies. Quality improvement initiatives and leadership training could aim to develop more TL behaviors and reduce the influence of passive-avoidant leader behavior to improve staff nurse job satisfaction and retention. This research study did not survey the NM and is an opportunity for further research.
Studies report the largest majority of nurses who planned to retire were NMs followed by a large percentage of staff nurses.18 At a time when fewer nurses are seeking NM positions,19 it is imperative to identify and to support nurses for leadership development. The Institute of Medicine, in collaboration with the Robert Wood Johnson Foundation, has called for the transformation of the nursing profession through the development of competent leaders.20 Bachelor’s degree–prepared nurses have exposure to leadership and management competencies through their academic and clinical experiences but require additional clinical experience and leadership training before acquiring these leader positions.
This transformation begins with a change in organizational culture that implements shared decision making and empowers nurse leaders to create environments that increase staff nurse autonomy and satisfaction.21,22 The low response rate from the staff nurses in this study was an early indicator that evidence-based research and staff involvement were not a high priority that you would expect to see in a hospital on the Magnet journey. Nurse leaders are faced with an ever-changing environment, and the application process for Magnet designation is in itself a change process. The change process includes recognition of a need for change, empirical data collection, selection from possible alternative choices, development of sustainable plans, consistent implementation of the plan, evaluation using multimodal methods, and stabilization of the changes.23 Hospitals on the Magnet journey need to include evidence-based management in making management decisions.24 Results from this study suggest the importance of additional assessment to reveal any gaps in opportunity for promotion, shared decision making, lack of transformational behaviors, and too many passive-avoidant behaviors. Nurse managers utilize a variety of leadership behaviors to manage the day-to-day activities in the hospital but have a tendency to exhibit more of 1 leadership style. Competencies for NMs must include TL skills that are necessary to excite and motivate staff nurses as well as a healthy balance of transactional leadership skills that are required for meeting the detailed aspects required to address the complexities in the healthcare delivery environment and not simply focus on assessing technical skills.25
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