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Authentic leadership

Does it relate to job satisfaction and engagement?

Lindsay, Sandra L. DHSc, MBA, MSN, CCRN-K, NE-BC; Mathieson, Kathleen M. PhD, CIP

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Nursing Management (Springhouse): June 2022 - Volume 53 - Issue 6 - p 24-30
doi: 10.1097/01.NUMA.0000831416.21965.e2
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In Brief

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Figure

Authentic leadership (AL) has been linked to positive team performance and outcomes within and outside the healthcare industry.1,2 Authentic leaders are inclusive and inspiring, and they prioritize the interests and needs of employees over their own.1 Studies indicate that clinical nurses who perceive AL characteristics among their leaders report higher levels of job satisfaction and organizational commitment and remain with their employer longer.3 The purpose of this quantitative correlational study was to examine the association between nurses' perceptions of AL and their satisfaction and engagement. We hypothesized that job satisfaction and engagement would be positively influenced by nurses' perceptions of AL.

Background

Job satisfaction is a key factor that influences nurses' decisions to continue their employment in an organization.4 Challenging patient-care assignments, increasing patient volume relative to the number of staff members available to care for patients, ineffective communication among the healthcare team, and lack of leadership support have been associated with nurse burnout.5 Job dissatisfaction and disengagement are associated with errors of omission in nursing care, poor quality patient care and outcomes, low organizational commitment, and increased nurse turnover.6 In contrast, environments that are supportive and empowering have been associated with increased job satisfaction among nurses, lower turnover rates, increased productivity, and better patient outcomes.4 Nurses who are satisfied with their responsibilities, practice settings, and treatment by employers are more likely to develop a greater bond to their organization and, subsequently, increase their engagement.6

Authentic leaders create supportive environments, which foster employee autonomy and enthusiasm for work, and employees who are supported by their leaders are more likely to demonstrate proactive behaviors.7 In a recent study, Raso and colleagues examined the relationship between clinical nurses' perceptions of AL behaviors among their managers and the effects on their work environment.2 The authors found a moderate association between nurses' perceptions of AL behaviors and a healthy work environment.2

Improved job satisfaction, engagement, and retention are more important than ever as the profession faces a global nursing shortage that will only increase as members of the aging nursing workforce retire from practice.8 Individuals in healthcare are more prone to burnout from ongoing psychological distress than those in many other professions.9 Stephanie and Gustomo suggested that strengthening engagement may result in employees going above and beyond the call of duty.10 Performing above the call of duty is particularly important during a crisis such as the COVID-19 pandemic, when an increased volume of patients and clinical needs stretches the critical care nursing workforce beyond their capabilities.11 AL has been shown to positively influence desired employee outcomes such as job satisfaction, engagement, psychological capital, and burnout prevention. Studies have demonstrated the need for a supportive and relational style of leadership, such as AL, to help mitigate unfavorable employee outcomes and foster supportive, healthy work environments, which are best suited to yield desirable patient outcomes.2

Methods

A nonexperimental, quantitative, correlational design was used to answer the question, “What is the association between nurses' perceptions of authentic leadership and their satisfaction and engagement?” Ethical approval for the study was received from the A.T. Still University Institutional Review Board. Critical care nurses were recruited through the American Association of Critical-Care Nurses (AACN). Participants met inclusion criteria if they were registered clinical nurses with more than 6 months' experience, worked full-time or part-time, and provided direct patient care. Nurses who served in leadership or management roles, advanced practice nurses, and nurse educators were excluded.

Data were collected over a 10-week period beginning in March 2020 in the early and peak stages of the COVID-19 pandemic. The survey included demographic questions and three validated instruments: The Authentic Leadership Questionnaire (ALQ), Utrecht Work Engagement Scale (UWES), and Global Job Satisfaction Survey.12-15

The 16-item ALQ uses a five-point scale, ranging from 0 (not at all) to 4 (frequently, if not always), and measures the leader's self-awareness, transparency, ethical moral standards, and balanced processing.16 The values of all the characteristics were averaged to obtain the raw score. Higher scores signified higher levels of authenticity.16

The UWES requires participants to rate how often they experienced feelings of vigor, dedication, and absorption in their job using a seven-point Likert scale of frequency, ranging from 0 (never) to 6 (always/everyday). The overall engagement score is the total of all 17 items.13,14 Scores for the items measuring each subscale (vigor, dedication, and absorption) were averaged to obtain the raw score. Higher scores represented higher levels of engagement.13,14

The six-item Global Job Satisfaction Survey measures how employees feel about their job overall, without referring to any specific part of the job.16 Participants' responses were measured on a five-point Likert-model scale, ranging from 1 (not at all) to 5 (a great deal). Higher scores are consistent with higher levels of job satisfaction.16

Data were analyzed using the IBM Statistical Package for Social Sciences (SPSS) version 26. AL, job satisfaction, and engagement variables were tested for normality using the Kolmogorov-Smirnov test. Due to abnormal distribution of some study variables, researchers examined relationships between all principal study variables using Spearman's correlation coefficient. The minimal level of significance used in all analyses for rejecting the null hypothesis was .05.

Results

Personal and professional characteristics of the sample are presented in Table 1 and Table 2. The study consisted of 259 participants, of whom 155 met the inclusion criteria. The final sample included 89% female and 11% male RNs who worked throughout the US, with the majority from the South followed by the Northeast, Midwest, and West (Table 1). Most participants were age 39 or younger (Table 1). Nurses in the sample worked across several clinical units, with the largest percentage working in neurologic intensive care settings, followed by medical intensive care, intensive care stepdown, cardiothoracic intensive care, surgical intensive care and other units, trauma intensive care, and coronary care (Table 2). Most nurses worked full-time, had greater than 4 to 20 years of nursing experience, and worked in their organization longer than 4 to 20 years (Table 2). Nearly three-quarters of the nurses were baccalaureate-prepared, and more than half held a nursing certification (Table 2).

Table 1: - Personal demographic characteristics of the sample
Demographic Frequency Percent (%)
Sex
   Female 138 89
   Male 17 11
Age (years)
   <30-39 90 58
   >39-59 60 38.7
   >59 5 3.2
US region of practice
   West 8 4.9
   Midwest 19 12.1
   Northeast 61 39.2
   South 66 42.4

Table 2: - Professional demographic characteristics of the sample
Demographic Frequency Percent (%)
Employment status
   Full-time 127 82.5
   Part-time 21 13.6
   Per diem 2 1.3
   Other 4 2.6
Type of hospital
   Acute care 98 63.2
   Community 41 26.5
   Teaching 62 40
   Rural 24 15.5
   Urban 31 20
   Private 31 20
   Public 42 27.1
Specialty area
   Medical ICU 37 23.9
   Surgical ICU 9 5.8
   Stepdown ICU 21 13.5
   Cardiothoracic ICU 13 8.4
   Coronary care 2 1.3
   Trauma ICU 3 1.9
   Neurologic ICU 61 39.4
   Other 9 5.8
Years in nursing
   <2-4 31 20
   >4-20 98 63.3
   >20 26 16.7
Years on current unit
   <2-4 82 52.9
   >4-20 63 40.6
   >20 10 6.5
Years at current organization
   <2-4 53 34.2
   >4-20 86 55.5
   >20 16 10.3
Education/degree
   Associate/diploma 22 14.2
   Bachelor's 116 74.8
   Master's 15 9.7
   Doctorate 2 1.3
Certification
   Yes 94 60.6
   No 61 39.4
Note: Type of hospital total is greater than 100% because respondents could mark all that apply.

Clinical nurses perceived their leaders to have a moderate level of AL. Similar to Wong and Laschinger, the ethical/moral perspective dimension of the ALQ was ranked the highest, and self-awareness the lowest among the four subscales. Nurses reported high levels of overall engagement. The highest score was on the dedication Utrecht Work Engagement subscale, followed by the subscales for vigor and absorption. Overall, clinical nurses in this study reported a moderate job satisfaction level.

A statistically significant (P < .001) positive correlation was demonstrated between AL and job satisfaction (Spearman's ρ =.474, P < .001). Figure 1 illustrates the correlation between AL and job satisfaction. Similarly, Spearman's correlation coefficient showed a statistically significant positive correlation between nurses' perceptions of AL and their engagement (Spearman's ρ = .314, P = .005). Figure 2 illustrates the positive relationship between AL and engagement. Thus, the research hypothesis was supported.

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Figure 1::
Personal demographic characteristics of the sample
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Figure 2::
Correlation between perceptions of authentic leadership and engagement

Discussion

The goal of this study was to understand the association between nurses' perceptions of AL and how it influences their satisfaction and engagement at work. As predicted in the hypothesis, there was a positive, high, and statistically significant correlation between AL and job satisfaction. Similarly, Spearman's correlation coefficient showed a positive, high, and statistically significant correlation between nurses' perceptions of AL and their engagement.

The findings of this study are consistent with past studies that have examined the influence of AL on staff behaviors. Wong and Laschinger found that authentic leaders fostered an empowering environment that increased nurses' job satisfaction and performance.16 AL was supported as a more desirable style of leadership by Raso et al. who found a moderate correlation between AL and a healthy work environment.2 The importance of addressing other factors such as burnout, resources, and the environment in addition to developing authentic leaders should be emphasized. Lee and colleagues found that although AL positively influenced nurses' intent to leave, work environment and burnout played a crucial role in their decision.4

Practical implications

Over the years, AL has emerged as a model for effective nursing leadership development.2 The data generated by this study add to the existing body of knowledge that shows positive relationships between nurses' perceptions of AL and their job satisfaction and engagement. The AACN identified AL as a critical pillar in the development of healthy and safe work environments.17

Healthcare is facing extraordinary challenges that can leave nurses feeling mentally and physically exhausted, especially in a pandemic year. As a result, safe and quality patient care and nursing self-care may be compromised. Healthcare organizations need nurse leaders who are visible, lead with integrity, effectively balance regulatory obligations in a constantly changing environment, empower staff to achieve desirable patient outcomes, and foster caring and healthy work environments where nurses feel valued.2,18

Limitations and recommendations for future study

The cross-sectional design of the present study prevents determination of causality. Because the survey was administered through the AACN, generalizability of the results is limited to nurses in the critical care field and nurses who are AACN members. Some of the survey responses were incomplete. Results were calculated based on an 80% or higher response rate to individual questions.

The study should be replicated in other settings outside of critical care to increase the generalizability of the findings. It may also be valuable to conduct a longitudinal study to see if nurses' perceptions of their leaders improve over time with leadership training and experience in the role.

Embracing authentic leadership

AL is a fundamental pillar of a healthy work environment, which fosters higher levels of staff satisfaction and engagement. This study's findings suggested that perceptions of AL nurtured engaged and moderately satisfied nurses. These findings can provide support for a relational style of leadership, such as AL, to be taught in evidence-based training programs for existing nurse leaders, novice, and future nurse leaders. Introducing AL in nursing curricula may be a good strategy to increase the number of formal and informal leaders in the nursing profession and provide a good foundation for nursing students who aspire to pursue nursing leadership in the future. Leaders can prioritize self-reflection, moral courage, and building relationships, and foster shared decision-making to promote higher levels of engagement and job satisfaction among their team members

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