Job satisfaction is vital to nurses' lives and can affect patient safety, productivity and performance, quality of care, retention and turnover, commitment to the organization and the profession, and the organization itself.1,2 Poor nurse satisfaction leads to negative consequences, such as overburdening workloads, poor quality of patient care, rising expenses associated with turnover and attrition, and nurses quitting their jobs and leaving the profession.3–5 Positive feelings toward leadership and work settings, including interpersonal relationships among nurses, increase overall nurse job satisfaction.6 And organizational empowerment was found to be directly associated with job satisfaction, particularly in areas where nurses feel they can impact policy.7
Studies suggest that leader behaviors can affect the work climate, which in turn affects financial results.8,9 Replacing a nurse is costly, so increasing critical care nurses' job satisfaction is beneficial to organizations. One way to improve leadership effectiveness is for organizations to implement development programs that enhance leadership practices. Healthcare organizations can contribute to nurses' overall professional development by identifying organizational activities that have the potential to increase job satisfaction. To sustain a competitive advantage and achieve organizational goals, leaders must implement strategies that attract, recognize, and retain the best critical care nurses.
Study participation, data collection
The purpose of this study was to explore the influence of managerial leadership on job satisfaction of critical care nurses. Inclusion criteria were intensive care nurses in the MICU, CCU, cardiothoracic ICU, surgical ICU, neuro, and burn unit; who work either full time, part time, or on a per diem basis; and have been employed by the organization for a minimum of 6 months. In total, 204 critical care nurses, excluding 52 invitations that were returned undelivered, from one U.S.-based, nonprofit healthcare organization were invited to participate in the study. Out of the 204 that were invited, 137 critical care nurses voluntarily participated in the study, resulting in a response rate of 67%. Of the 137 who responded, 81% (112) completed the survey in its entirety.
The nurses participated in the study by accessing a web site that linked them to an informed consent page and then to the 65-item survey and a demographic questionnaire. Five leadership practices were measured: enabling others to act, encouraging the heart, inspiring a shared vision, challenging the process, and modeling the way.
All completed responses were usable (112). Critical care nurses' demographic variables included age, gender, ethnicity, specialty certification, educational level, years with current employer, years with specialty area, title, shift, employment status, and job satisfaction. Of those who answered the demographic questions, 85 (77%) were women and 25 (23%) were men; the largest age distribution of participants (40.8%) was between age 29 and 38. (See Table 1.)
Based on the data collected, we found that job satisfaction is positively and significantly correlated with several perceived leadership practices. The results revealed that there's a positive, statistically significant relationship between job satisfaction and leaders who model the way. There was also a positive, statistically significant relationship between job satisfaction and leaders who inspire a shared vision. The analysis also revealed a weak significant correlation between job satisfaction and leaders who challenge the process. Finally, we found a positive, statistically significant relationship between job satisfaction and leaders who enable others to act. However, encouraging the heart wasn't significantly correlated with job satisfaction.
Implications for nurse managers
This study suggests that the top perceived leadership practices that influence critical care nurses' overall job satisfaction in a nonprofit organization in New York City are model the way, inspire a shared vision, challenge the process, and enable others to act.
“Model the way” encompasses role modeling, accountability, reliability, perception and sensitivity, commitment to basic beliefs, and demonstration of transparency. Leaders should establish patterns of interaction that help their followers work collaboratively to achieve sustainable, positive outcomes. Exemplary leaders model the way by making explicit that there are no gaps between “what they say they do and their explanations for their actions” and “what they actually do and the real reasons for their actions.”10
“Inspire a shared vision” reflects the nurses' passionate beliefs about the difference their leaders can make. It encompasses technical ability, vision, excitement, persuasion, strategy, and passion. This points to a leader who passionately leads his or her direct reports to achieve a high performance. The leader speaks of trends that affect the future performance of his or her direct reports and appeals to them to share their dream of the future and the achievement of their interests. The leader speaks with conviction and paints a “big picture” of the nurses' aspirations. Leaders can only inspire commitment; they can't command it. For a leader to gain support, he or she must have knowledge of the aspirations, visions, hopes, and values of his or her direct reports.11
“Challenge the process” entails the search for opportunities to change the status quo. In addition, it encompasses adventure, encouragement, intellectual curiosity, goal orientation, provocative encouragement, innovation, and risk taking. The leader challenges the process by exhibiting adventurous behavior, seeking opportunities to test the skills of direct reports, and challenging them to try new approaches. The leader searches outside of the organization for new trends and innovative approaches to improve. He or she exhibits intellectual curiosity by asking “What can we learn?” and ensuring that the organizational goals, plans, and strategies are met. He or she experiments and takes risks. Leaders must be committed to change and should support their direct reports as they deal with challenging situations.11
“Enable others to act” means building spirited teams. Leaders enable their direct reports to act by building trust, fostering collaborative relationships, and listening actively to differing points of view. Leaders enable others to act by showing empathy, treating others with respect and dignity, being supportive of the decisions others make, and building consensus by giving others choices about how to do their work, ensuring job growth. When nurses are trusted, have more discretion and authority, and are provided with more information, the outcome is extraordinary results.11 Effective leadership also involves being aware of others' self-perceptions.12
The findings of this study suggest that leadership behaviors are the primary factor in determining job satisfaction. To address the nursing shortage, hospital leaders must implement strategies to improve job satisfaction to retain critical care nurses. The complexities of interpersonal relationships within the clinical environment and the critical issues that nurses face on a daily basis indicate that morale, job satisfaction, and motivation are essential components of improving workplace efficiency, output, and communication among staff.13 Nurse leaders and healthcare administrators may use the results of this study to develop and implement strategies that will decrease critical care nurse turnover costs and improve patient safety, patient satisfaction, and cost reduction.
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