Role of leadership in nurses' job satisfaction

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:

In the hospital setting, the department managers, through their supervisory functions, are directly responsible for their subordinates -- the front-liners in providing patient care services. 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 one's job as achieving or facilitating the achievement of one's values" (Locke, 1969, p316). It is operationally defined as the feeling towards job-related factors as measured by the Minnesota Satisfaction Questionnaire (Short).

CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction

This chapter presents related literature and studies that contributed to the conceptualization of the current study.

2.2 Previous Studies

The Full Range Leadership Model (FRLM)

The Full Range Leadership Model developed by Bass and Avolio in 1991 (Antonakis, Avolio, and Sivasubramaniam, 2003) evolved from Burns' (1978) concept of transforming leadership (Avolio, Bass and Jung, 1999). The conceptualization of transactional and transformational leadership included charisma, inspirational, intellectual stimulation, individualized consideration, contingent reward, management-by-exception, and laissez-faire leadership (Avolio, Bass and Jung, 1999). The following operational definitions were provided (Avolio, Bass and Jung, 1999):

Charisma: Originally, charisma and inspirational were merged as one and was defined as a leadership style that provides followers with clear sense of purpose that is energizing, a role model for ethical conduct, and builds identification with the leader and his or her articulated vision.

Intellectual Stimulation (IS) - leaders encourage followers to question the tried and true ways of solving problems and to question the methods they use in order to improve upon them.

Individualized Consideration (IC) - leaders focus on understanding the needs of each follower and work continuously to get them to develop to their full potential.

Contingent Reward (CR) -- leaders clarify what is expected from followers and what they will receive if they meet expected levels of performance.

Active Management-by-Exception -- leaders focus on monitoring task execution for any problem that might arise and correcting those problems to maintain current performance levels

Passive-Avoidant - leadership tends to react only after problems have become serious to take corrective action and often avoids making any decisions at all.

Based on the results of studies, reviews, and feedback from various scholars concerning the need to revise the components of the model, psychometric tests were undertaken again on the original MLQ instrument until the MLQ (5x) was finally developed with nine factors (Antonakis et al., 2003). Transformational leadership (TFL) refers to the 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). Five leadership behaviors characterize Transformational Leadership style namely: Idealized Influence (Attributed), Idealized Influence (Behavior), Inspirational Motivation, Intellectual Stimulation, and Individualized Consideration. Charisma in the previous version is broken down in the MLQ (5x-Short) version into (Antonakis et al., 2003):

Idealized Influence (Attributed) (IIA) is the socialized version of charisma of the leader, wherein the leader is perceived as confident, powerful, ethical, and as being the initiator of higher standards. In short, the leader builds trust.

Idealized Influence (Behavior) (IIB) is the charismatic manifestation of leader's values, beliefs, and sense of mission that is aligned with organizational goals. In short the leader acts with integrity.

Inspirational Motivation (IM) energizes their followers by viewing the future with optimism, stressing ambitious goals, and projecting and idealizing a realistic vision that is clearly understood by the followers. In short, the leader inspires his/her followers.

Transactional leadership (TSL) refers to the 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). The Transactional Leadership style is comprised of Contingent Reward, Management-by-Exception (Active), and Management-by-Exception (Passive). Active Management-by-Exception in the old version was broken down in the Multifactor Leadership Questionnaire [MLQ] (5x-Short) version as follows (Antonakis et al., 2003):

Management-by-Exception (Active) (MBEA) leads by using vigilance to ensure that performance standards are met. Leader monitors mistakes.

Management-by-Exception (Passive) (MBEP) leaders intervene only when mistakes are committed or noncompliance is committed. Leader's role is compared to a firefighter, wherein actions are initiated only when issues or concerns arise.

Laissez-faire leadership refers to the style wherein leaders "relinquish their responsibilities, and avoid making decisions" (Bass, 1990).

Full Range Leadership Model and job satisfaction of nurses

Negussie and Demissie, (2013) examined the relationship between leadership styles using the MLQ Rater Form (5x-Short) and job satisfaction of 175 registered nurses from Jimma University Specialized Hospital, Ethiopia, using the Minnesota Satisfaction Questionnaire [MSQ] (Short). Nurses rated the leadership styles of their nurse managers. Results of the regression analysis indicated that IIA, IIB, IM, IS, and IC have significant, positive and moderate to strong association with intrinsic (r range between .29 and .49; p

In this study, it appeared that the various leadership behaviors in the Full Range Leadership Model were demonstrated by the nurse managers. Leadership behaviors under the transformational banner appeared to contribute to the job satisfaction of the staff nurses. It also appeared from the results that IS had the strongest association with both intrinsic and extrinsic job satisfaction of the nurses.

In another study, the relationship between leadership styles and psychosocial work environment of 122 registered nurses were examined by Malloy and Penprase (2010) using MLQ (5x-Short) and Copenhagen Psychosocial Work Environment Questionnaire (COSOQ). Nurses rated the leadership styles of their managers. IIA, IIB, IM, IC, IS, CR, were found to have significant, positive and moderate to strong correlations with job satisfaction (r range between .39 and .48; p

The results apparently indicated that the various leadership behaviors of the FRLM were demonstrated by the managers. Leadership behaviors under the transformational leadership model contributed significantly not only to the job satisfaction of the nurses, but also contributed to a positive work environment, commitment and motivation.

Leadership and job satisfaction studies in Saudi Arabia

Abualrub and Alghamdi (2012) examined the impact of leadership styles of nurse managers on Saudi nurses' job satisfaction and intention to stay on the job. The results indicated that Saudi nurses perceived their managers as transformational rather than transactional leaders. The results further showed that transformational leadership was associated with job satisfaction. Transactional leadership on the other hand was found to be associated with job dissatisfaction. Nurses who were satisfied with their jobs intended to stay longer. The hierarchical regression analysis indicated that background variables, transformational leadership, and transactional leadership styles explained 32% of the variance in job satisfaction. The hierarchical regression analysis also indicated that background variables, transformational leadership, and transactional leadership styles explained 5% of the variance in nurses' intention to stay.

Bahnassy et al. (2014) determined the overall job satisfaction of nurses in a tertiary hospital in Riyadh. The results indicated that there were no statistically significant differences found in job satisfaction of nurses when grouped according to age group, gender, nationality, marital status, and years of experience (p>.05). This suggests that the participants were more or less similar in their perceived job satisfaction. Statistically significant differences in job satisfaction were found in position, place of work, educational attainment, country where educational degree was obtained, and salary. Those who have a rank of staff nurse 2, were assigned in women's hospitals, were non-PhD degree holders, had obtained education in Australia, and had high salaries had higher satisfaction scores. Salary had a statistically significant positive association with job satisfaction, meaning, the higher the salary, the more satisfied was the nurse.

Al-Dossary, Vail, and Macfarlane (2012) measured the job satisfaction of nurses in a teaching hospital. The findings indicated that pay, supervision, contingent rewards, co-workers, nature of work, and on-the-job communication had statistically significant and strong positive correlations with job satisfaction. Promotions, operating conditions, and fringe benefits had statistically significant and moderate positive correlations with job satisfaction. More years of experience were associated with better job satisfaction. No statistically significant differences were found in job satisfaction when grouped according to age group, gender, number of assigned patients, position level, and education level (p>.05).

A study among nurses working in primary health care centers in Jazan region, Saudi Arabia, showed that male nurses were less satisfied than females. Those who were between 20 and 29 years old were less satisfied than those who were 30 years and older. Those who had tenure of four years or less, were less satisfied than those who had five years of more of tenure. Overall, nurses in this study were dissatisfied with their work life (Almalki, FitzGerald and Clark, 2012).

2.3 Summary

The various studies that were reviewed suggested that leadership is vital to the attainment of individual, organizational, and patient care outcomes. Apparently, the attainment of various individual, organizational, and patient care outcomes was made possible with the use of various combinations of leadership styles by nurse manager(s) in disposing of their responsibilities and in leading their followers. The results of these studies seemingly suggest that managers or supervisors explore and utilize various leadership behaviors and combinations that would create positive impacts on their followers and subordinates. This would facilitate attainment of personal and organizational goals, especially given the fast-paced nature of changes affecting healthcare organizations and patient care. The various studies indicated varying degrees of evidence concerning the extent to which leadership behaviors correlated with the job satisfaction of nurses. Taken as a whole, this author asserts that there is no single leadership style that can provide all expected outcomes. It requires a combination of leadership behaviors to result in positive outcomes in varying situations.

The various literature studies that were reviewed are very important because they provided insights that may add up to the improvement in the setting of this study.

CHAPTER THREE: Methodology

3.1 Introduction

This chapter presents the study design, setting, participants and sampling design, research instruments used, data collection, data collection, data analysis and ethical considerations.

3.2 Study Design

The study employed a quantitative descriptive design. Bivariate correlations between the independent variable (leadership styles) and the dependent variable (job satisfaction) were examined.

3.3 Setting of the study

The study was conducted at King Saud University Medical City (KSUMC), Riyadh during the first quarter of 2014.

3.4 Participants and sampling design

Fifty supervisors and department heads and 220 staff nurses from KSUMC were recruited to participate in this study that was conducted during the first quarter of 2014. The non-probability, convenience sampling method was used to select the participants in the present study. Inclusion criteria included those who were employed full time at KSUMC. Nursing students and nursing interns were excluded in this study.

3.5 Research instrument

Two instruments were used in this study. The Multifactor Leadership Questionnaire (MLQ) Leader Form (5x-Short) by Avolio and Bass (1995) was used with permission (communication from Mind Garden, 01 December 2013). The 36 items that measure leadership behaviors as perceived by the supervisors and/or heads of the department (self-evaluation) were used. The supervisors/department heads rated their perceived leadership style by choosing a response from a 5-point Likert-type scale that were coded from "0" for not at all, to "4" for frequently, if not always. The scores were aggregated, and the mean score was interpreted according to the leadership style that was perceived to be used. The MLQ (5x-Short) underwent rigorous validation studies and has been found to have satisfactory discriminate validity (Avolio, Bass and Jung, 1999). The inter-item correlation coefficient (Cronbach's alpha) of the subscales ranged between .64 and .92 and overall, .70 suggesting that the reliabilities were consistent over time (Avolio, Bass and Jung, 1999). In the current study, the inter-item correlation coefficient (Cronbach's alpha at.05 significance level) of the leadership styles was ? .79. The results indicated that the MLQ (5x-Short) used in this study measured what it intended to measure.

The second instrument used was the Minnesota Satisfaction Questionnaire (MSQ) short form -- 1967 revision. This instrument is designed to measure an employee's satisfaction with the different aspects of their work and work environment (Weiss, Dawis, England and Lofquist, 1967). The instrument is comprised of 20 items taken from the long-form MSQ that best represents each of the 20 scales. Participants of the study rates individual satisfaction level using a 5-point Likert-type scale, where very dissatisfied is coded 1, and very satisfied is coded 5. Two score interpretation models were adopted in this study. One is to determine the overall satisfaction score by summing the scores in each item and converting these scores into a percentage score. Interpretation is made based on the range of scores: scores from 75% and above represent a high degree of satisfaction; scores between 26 and 74 represent an average satisfaction; and scores of 25 and lower represent a low level of satisfaction (Weiss, Dawis, England and Lofquist, 1967). The second interpretation model was to formulate a range of the mean ratings based on the Likert-type scale responses to enable interpretation of intrinsic, extrinsic, and general job satisfaction rating. The instrument underwent extensive evaluation and was found out to have satisfactory construct validity. Three scales were identified (Weiss, Dawis, England and Lofquist, 1967). Hoyt reliability coefficient yielded coefficients ranging between .84 and .92 for the intrinsic satisfaction scale, .77 and .82 for extrinsic satisfaction scale, and .90 for the overall general satisfaction. Test-retest correlation of the MSQ as a whole was .89 over a period of one week, and .70 over one-year interval; this suggests that the instrument is stable and reliable over time (Weiss, Dawis, England and Lofquist, 1967). In this study, the original three scales (intrinsic, extrinsic, and general satisfaction) were adopted. The inter-item correlation coefficient of MSQ in this study is .76 for intrinsic satisfaction, .85 for extrinsic satisfaction, and .88 for general satisfaction. The results showed that MSQ measured the satisfaction factors indicating reliability of the instrument.

3.6 Data collection

After obtaining official permission for this study from higher administration, a pretest was carried out, in order to ensure clarity of tools and time needed for filling the questionnaire. The pretest was conducted on samples not included in the final study in order not to contaminate the sample. The duration for the MLQ was between 12 minutes and 15 minutes; while the duration for the MSQ was between eight minutes and ten minutes. There were no issues raised by participants in either group. The participants were advised to drop the questionnaires in a drop box placed near their department office to facilitate gathering of returned questionnaires and ensure anonymity.

3.7 Data analysis

Data were processed and analysed using SPSS 17 (Chicago, Ill.). In determining the characteristics of the participants, perceived leadership styles of supervisors, and level of satisfaction of the staff, descriptive statistics was used. The items with high satisfaction levels were ranked. To explore the presence of significant relationships between the leadership styles of the supervisors and the job satisfaction scores, bivariate analysis using the Pearson product moment correlation coefficient was used. The Spearman rank correlation coefficient was used to analyse presence of significant relationships between the leadership styles of supervisors and the job satisfaction ratings of staff nurses. Significant correlations were inferred if the p-value is less than .05.

3.8 Ethical considerations

Approval from the Institutional Review Board and permissions from the Administration of KSUMC were obtained prior to the conduct of the study. Participants' were informed about the objectives of the study. The anonymity of identities and confidentiality of responses were assured. Implied consents were provided by the participants when they returned the completed questionnaires.

CHAPTER FOUR: Results, interpretation, and discussion of findings

4.1 Introduction:

This section presents the results, interpretation and discussion of findings.

4.2 Profile of the participants

The response rate for this study is 100% (50/50) among supervisors/department heads. The response rate for the nurses is 87.7% (193/220). This study includes the participation of 50 supervisors and 193 staff nurses (Table 4. 1). Most (174/193; 90.16%) of the staff nurses were female. More than half (127/193; 65.80%) were between 26 years old and 45 years old. The age structure of the participants appeared to be chronologically mature insofar as age is concerned. Almost two-thirds (128/193; 66.32%) have worked with KSUMC for more than five years. The tenure structure of the staff nurses appeared to be balanced.

Table 4.1. Profile of participants (N=193)

f %

Supervisors

50

Staff nurses

Sex

Male

19

9.84

Female

90.16

Age range

25 years old and below

17

8.81

26 to 35 years old

76

39.38

36 to 45 years old

51

26.42

46 to 55 years old

35

18.13

56 years old and over

14

7.25

Tenure

1- to less than 5

65

33.67

5- to less than 10

37

19.17

10- to less than 15

40

20.73

15- to less than 20

23

11.92

20+

28

14.51

4.2 Perceived leadership styles

Most of the supervisors perceived that they used Inspirational Motivation, Individualized Consideration, Intellectual Stimulation, Contingent Reward, and Idealized Influence (Behavior) frequently, if not always (range of Mean between 3.28 and 3.50) as shown in Table 4.2. Transformational Leadership as a whole was demonstrated frequently, if not always (M=3.31; SD=.46) while Transactional Leadership is used often (M=2.28; SD=.39).

The results also showed that the FRLM is practiced by the nurse managers/supervisors in the setting of this study. This finding adds to the existing body of evidence for the utilization of the various leadership behaviors in the FRLM, especially transformational and contingent reward approaches, under transactional leadership styles. Inspirational motivation is the most frequently demonstrated leadership behavior in the current study. This finding is supported by the work of Abualrub and Alghamdi, 2012 and of Negussie and Demissie, 2013. These studies found inspirational motivation to be the most frequently practiced leadership behavior; this leadership style was also found to be moderately associated with job satisfaction among staff nurses (Abualrub and Alghamdi, 2012; Negussie and Demissie, 2013). Taken as a whole, these similar findings confirm the evidence that leaders who demonstrate the leadership behaviors in the FRLM, and particularly those who share personal and organizational goals clearly with conviction, inspire their followers.

Table 4. 2. Perceived Leadership styles by supervisors (N=55)

Mean

Median

SD

Interpretation

Inspirational Motivation

3.50

3.50

0.53

Frequently, if not always

Individualized Consideration

3.50

3.50

0.50

Frequently, if not always

Intellectual Stimulation

3.31

3.50

0.69

Frequently, if not always

Transformational Leadership

3.31

3.40

0.46

Frequently, if not always

Contingent Reward

3.29

3.25

0.50

Frequently, if not always

Idealized Influence (Behavior)

3.28

3.25

0.53

Frequently, if not always

Management-by-Exception (Active)

3.05

3.00

0.75

Fairly often

Idealized Influence (Attributed)

2.95

3.00

0.69

Fairly often

Transactional Leadership

2.28

2.25

0.39

Often

Laissez-faire Leadership

0.53

0.50

0.62

Not at all

Management-by-Exception (Passive)

0.51

0.25

0.63

Not at all

Mean range interpretation: 4.00-3.21 = Frequently, if not always; 3.20-2.41 = Fairly often; 2.40-1.61 = Sometimes; 1.60-0.81 = Once in a while; 0.80-.0.00 = Not at all.4.3 Perceived level of job satisfaction

Nurses in the current study rated intrinsic, extrinsic, and general job satisfaction as satisfactory (M=3.91, SD=0.41; M=3.66, SD=.55; M=3.83, SD=.84 respectively) as shown in (Table 4.3). Taken as a whole, the staff nurses have high level of general satisfaction scores (M=75.68, SD=8.68; range between 49 and 98). The general satisfaction score range indicates that the staff nurses are either averagely or highly satisfied in this hospital setting. The top five items that were rated either satisfied or very satisfied (range between 80.83% and 90.16%) by the staff nurses were all intrinsic satisfaction-related. Ranked number one is 'the chance to do something that makes use of my abilities' (174/193; M=4.09; SD=0.643).