Role of Leadership in the Healthcare Setting: Qualitative Study of Nurse "On-the-Job" Satisfaction

As Correlated With Supervisor Leadership Style

Leadership style is perceived to be an important factor in hiring, retention, and job satisfaction for nursing staff in healthcare facilities. Modern healthcare organizations may have issues with retention of nursing staff that may be ameliorated via appropriate leadership styles that enhance staff satisfaction.

This study aimed to explore the impact of nursing supervisor leadership style upon the job satisfaction of nursing staff in the Kind Saud University Medical City, Riyadh, Saudi Arabia.

The Multifactor Leadership Questionnaire (MLQ) Leader Form (5x-Short) was used to assess Leadership style for the supervisors. The Minnesota Satisfaction Questionnaire (MSQ) short form -- 1967 revision, was used to assess 'job satisfaction' for the nursing staff.

Results

The results of these studies indicate that managers or supervisors explore and utilize various leadership behaviors and combinations that would create a positive impact on their followers "on-the-Job" attitudes and Performance.

Conclusions

On the basis of the findings of this study, it is concluded that the leadership behaviors of the supervisor/heads of department based on the MultiFactor Leadership Questionairre had little influence on the overall satisfaction of nurses in this setting. The supervisors/heads of departments were instrumental and successful in shaping the work ethic among the staff nurses in this hospital setting through leading by example, as evidenced by the significant association of Idealized Influence (Behavior) with job satisfaction of the staff nurses.

CHAPTER ONE: INTRODUCTION

1.1 Preface:

Various leadership styles have been advanced and have provided leaders with choices concerning what they feel would match their needs, those of their followers, and those of the organization as a whole. The Full Range Leadership Model developed by Avolio and Bass in 1991 presents behaviors that can be used by managers/supervisors/leaders in leading their followers to attain unit level and organizational goals. The model consists of three umbrella leadership styles: transformational, transactional, and Laissez-faire leadership (Antonakis, Avolio and Sivasubramaniam, 2003). Transformational leadership has been associated with job satisfaction among nurses (Abualrub and Alghamdi, 2012). Studies linking leadership styles as perceived by leaders, with job satisfaction as perceived by followers, appeared to be scarce. Hence, this study aimed to explore the influence of leadership style, as perceived by supervisors, based on the Full Range Leadership Model on job satisfaction, as perceived by nurses in King Saud University Medical City, Riyadh, Saudi Arabia.

1.2 Background

In healthcare organizations, leadership effectiveness is assessed in terms of its outcomes in patient care (Wong, Cummings and Ducharme, 2013), patient safety, patient satisfaction, quality of hospital care, and more importantly staff job satisfaction (Aiken et al., 2012). In view of the shortage of nurses in various parts of the world (WHO, 2006), job satisfaction among nurses is an important issue to be studied because it can impact both turnover and retention of nursing staff, as well as patient care outcomes (Hunt, 2009).

In Saudi Arabia, the shortage of nurses is brought about by the following factors: increasing population and healthcare service needs (MOH-KSA, 2013); preference by Saudi nursing graduates to work in other high (or higher) paying jobs; job dissatisfaction and burnout among nurses; insufficient number of Saudi nursing graduates to cope up with the needs of the nation; and turn-over of nurses due to migration (Al-Homayan, et al., 2013). Hunt (2009) asserts that turnover is costly and stressful not only to the organization but to the remaining staff as well. Hence, improving the management of nurses after they are hired may prevent unnecessary turnover (Hunt, 2009).

In view of the prevailing shortage of nurses in Saudi Arabia, it is important that current nurse population be trained, motivated, and retained in the healthcare system, because turnover is costly. It is therefore important to conduct this exploratory research on the correlation between leadership styles of nurse managers/supervisors and job satisfaction of staff nurses in this large tertiary hospital in Riyadh, Saudi Arabia. These data will provide useful information for hospital administrators to formulate strategies to address and/or resolve issues that may be identified from the findings.

1.3 Research Problem:

The current study is different in its methodological approach. It aimed to determine the influence of supervisors' perceived leadership styles, as measured by the Multifactor Leadership Questionnaire Leader Form (5x-Short), on the staff nurses' perceived level of job satisfaction, as measured by the Minnesota Satisfaction Questionnaire (Short version).
1.4 Research Questions:

This study specifically aimed to answer the following questions:

1. How do supervisors perceive their own leadership styles?

2. What is the level of job satisfaction among the staff nurses in this hospital setting?

3. Is there a significant relationship between the supervisor's perceived leadership styles and the staff nurses' perceived job satisfaction?

1.5 Objectives of Study

The study specifically aimed to explore the:

1. Perceived leadership styles of supervisors.

2. Level of job satisfaction among the staff nurses.

3. Presence of significant relationship between the perceived leadership styles of the supervisors and the perceived job satisfaction of the staff nurses.

1.6 Statement of hypotheses

The following hypotheses were advanced in this study:

1. There is no significant relationship between the perceived leadership styles of the supervisors and the perceived job satisfaction of the staff nurses.

1.7 Importance of study

Studies revealed that there are correlations between leadership styles and level of job satisfaction of employees (Malloy and Penprase, 2010; Negussie and Demissie, 2013). The results of this study are therefore important to the following:

The administrators, so that they will be able to review their personnel policies and integrate the findings to formulate plans aimed not only at enhancing job satisfaction but also staff retention as well.

The supervisors and/or department head, so that they will be able to recognize their leadership strengths and weaknesses and be able to work in enhancing their leadership skills.

The staff nurses, so that they will be able to recognize the value of job satisfaction in enhancing their work life as well as personal life.

The future researchers, that they will be able to use the findings as basis in pursuing further studies aimed at understanding the role of leadership and followership in organizational success.

1.8 Conceptual framework

The conceptual framework (Figure 1.1) examines the supervisors' perceived leadership styles and its influence towards the perceived job satisfaction of the nurses. The unidirectional arrow linking supervisors' leadership styles suggests that the influence of the leadership style is one-way. This indicates that the staff nurses have no idea that the supervisors conducted self-appraisal of their own leadership styles. Hence, the perceived job satisfaction of the nursing staff should in no way be considered an offshoot of the potential staff nurses' biases that they may have with their supervisors.

According to Burns (1979), "leadership is exercised when persons with certain motives and purposes mobilize, in competition or conflict with others, institutional, political, psychological, and other resources so as to arouse, engage, and satisfy the motives of followers." This concept is used in this study in interpreting the conceptual framework. Supervisors have responsibilities to the organization, co-workers, followers, and to themselves. In this study, supervisors are tasked to lead their followers in attaining the organization's goals by using organizational resources. Supervisors are given a free hand to employ leadership styles in order to arouse, engage, and satisfy the motives of the followers. An inferred motive of the followers (nursing staff) is job satisfaction. In this study, transformational leadership, transactional leadership, and laissez-faire leadership styles were assumed to be used by the supervisors and were expected to influence the job satisfaction of their staff nurses.

Figure 1.1 Schematic diagram of conceptual framework

1.9 Definition of terms

The following terms were conceptually and operationally defined in this study: Leadership style is conceptually defined as the "set of behaviours that leaders employ to influence the behaviours of subordinates" (Bass, 1990). It is operationally defined as the set of behaviors represented as transformational leadership, transactional leadership, and laissez-faire leadership as measured using the MLQ (5x-Short).

Transformational leadership is conceptually defined as a leadership style that "occurs when leaders broaden and elevate the interests of their employees, when they generate awareness and acceptance of the purposes and mission of the group, and when they stir their employees to look beyond their own self-interest for the good of the group" (Bass, 1990). It is operationally defined as the set of behaviors represented by Idealized Influence (Attributed), Idealized Influence (Behavior), Inspirational Motivation, Intellectual Stimulation, and Individualized Consideration as measured by MLQ (5x-Short).

Transactional leadership is conceptually defined as a leadership style wherein "leaders get things done by making, and fulfilling, promises of recognition, pay increases, and advancement for employees who perform well while penalizing those who do not do good work" (Bass, 1990). It is operationally defined as the set of behaviors represented by Contingent Reward, Management-by-Exception (Active) and Management-by-Exception (Passive) as measured using the MLQ (5x-Short).

Laissez-faire leadership is conceptually defined as style wherein leaders "relinquish their responsibilities, and avoid making decisions" (Bass, 1990). It is operationally defined as the set of behaviors as measured using MLQ (5x-Short).

Job satisfaction is conceptually defined as a "pleasurable emotional state resulting from the appraisal of…