Nurse Job Satisfaction and Supervisor Leadership Style Study

Introduction and Background

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, and leaders in guiding 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 and based on the Full Range Leadership Model — on job satisfaction as perceived by nurses at King Saud University Medical City, Riyadh, Saudi Arabia.

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 — most importantly — staff job satisfaction (Aiken et al., 2012). In view of the global shortage of nurses (WHO, 2006), job satisfaction among nurses is an important issue because it can affect both turnover and retention of nursing staff, as well as patient care outcomes (Hunt, 2009).

In Saudi Arabia, the shortage of nurses is driven by several factors: increasing population and healthcare service needs (MOH-KSA, 2013); a preference among Saudi nursing graduates to seek higher-paying positions elsewhere; job dissatisfaction and burnout among nurses; an insufficient number of Saudi nursing graduates to meet national demand; and nurse turnover due to migration (Al-Homayan et al., 2013). Hunt (2009) asserts that turnover is costly and stressful not only for the organization but also for the remaining staff. Improving the management of nurses after they are hired may therefore prevent unnecessary turnover (Hunt, 2009).

Given the prevailing nursing shortage in Saudi Arabia, it is critical that the current nurse population be trained, motivated, and retained within the healthcare system, because turnover carries substantial costs. This exploratory research therefore examines the correlation between the leadership styles of nurse managers and supervisors and the job satisfaction of staff nurses in a large tertiary hospital in Riyadh. The findings are intended to provide useful information for hospital administrators to formulate strategies addressing issues identified through the research.

In the hospital setting, department managers — through their supervisory functions — are directly responsible for their subordinates, the front-liners in patient care. The current study is distinctive in its methodological approach: it aimed to determine the influence of supervisors' perceived leadership styles, as measured by the Multifactor Leadership Questionnaire (MLQ) Leader Form (5x-Short), on the staff nurses' perceived level of job satisfaction, as measured by the Minnesota Satisfaction Questionnaire (MSQ) Short Form.

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 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?

Correspondingly, the study aimed to explore the perceived leadership styles of supervisors, the level of job satisfaction among staff nurses, and the presence of any significant relationship between the two.

The conceptual framework examines the supervisors' perceived leadership styles and their influence on the perceived job satisfaction of nurses. A unidirectional relationship is assumed: staff nurses had no knowledge that supervisors were conducting a self-appraisal of their leadership styles. Therefore, the nurses' perceived job satisfaction should not be considered an outgrowth of any biases they may hold toward 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." In this study, supervisors are tasked with leading their followers toward organizational goals using available resources, with job satisfaction as an inferred motive of the nursing staff.

Leadership style is defined as the "set of behaviours that leaders employ to influence the behaviours of subordinates" (Bass, 1990), operationalized here as transformational, transactional, and laissez-faire leadership as measured using the MLQ (5x-Short).

Transformational leadership "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 by the behaviors of Idealized Influence (Attributed), Idealized Influence (Behavior), Inspirational Motivation, Intellectual Stimulation, and Individualized Consideration.

Transactional leadership is defined as a 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 operationalized by Contingent Reward, Management-by-Exception (Active), and Management-by-Exception (Passive).

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

Job satisfaction is 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, p. 316), operationalized as the feeling toward job-related factors as measured by the MSQ Short Form.

Literature Review: Leadership Models and Nurse Satisfaction

The Full Range Leadership Model (FRLM) 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 incorporated charisma, inspirational motivation, intellectual stimulation, individualized consideration, contingent reward, management-by-exception, and laissez-faire leadership (Avolio, Bass, and Jung, 1999).

Following psychometric reviews and revisions, the MLQ (5x) was developed with nine factors (Antonakis et al., 2003). Under this model, charisma was disaggregated into two distinct components:

Idealized Influence (Attributed) (IIA) is the socialized dimension of the leader's charisma, wherein the leader is perceived as confident, powerful, ethical, and as setting higher standards — in short, the leader builds trust.

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

Inspirational Motivation (IM) energizes followers by projecting optimism, stressing ambitious goals, and articulating a realistic and clearly understood vision.

Intellectual Stimulation (IS) encourages followers to question established methods and improve upon them.

Individualized Consideration (IC) involves leaders focusing on the individual needs of each follower and working to develop their full potential.

Transactional leadership is comprised of Contingent Reward (CR), Management-by-Exception (Active) (MBEA), and Management-by-Exception (Passive) (MBEP). MBEA involves vigilant monitoring to ensure performance standards are met; MBEP involves intervention only after mistakes or noncompliance occur. Laissez-faire leadership involves the avoidance of decisions and responsibilities altogether.

Negussie and Demissie (2013) examined the relationship between leadership styles and job satisfaction among 175 registered nurses at Jimma University Specialized Hospital, Ethiopia, using the MLQ Rater Form (5x-Short) and the Minnesota Satisfaction Questionnaire (MSQ) Short Form. Nurses rated the leadership styles of their managers. Results of regression analysis indicated that IIA, IIB, IM, IS, and IC had significant, positive, and moderate-to-strong associations with both intrinsic (r ranging between .29 and .49; p<.01) and extrinsic job satisfaction (r ranging between .17 and .42; p<.05 and p<.01). Contingent Reward had a weak positive association with intrinsic satisfaction (r=.15, p<.01) and a moderate positive association with extrinsic satisfaction (r=.39, p<.01). Laissez-faire had negative weak correlations with both intrinsic (r=-.19, p<.05) and extrinsic (r=-.15, p<.05) job satisfaction. Overall, nurses in this study had moderate intrinsic job satisfaction and low extrinsic job satisfaction.

Malloy and Penprase (2010) examined the relationship between leadership styles and the psychosocial work environment of 122 registered nurses using the MLQ (5x-Short) and the Copenhagen Psychosocial Work Environment Questionnaire. IIA, IIB, IM, IC, IS, and CR all demonstrated significant, positive, and moderate-to-strong correlations with job satisfaction (r ranging between .39 and .48; p<.01). MBEA, MBEP, and laissez-faire leadership showed significant negative and moderate-to-strong correlations with job satisfaction (r ranging between -.21 and -.53; p between <.05 and <.01). The results suggest that leaders using transformational leadership behaviors are more likely to foster a positive work environment, increased job satisfaction, commitment, and motivation.

Abualrub and Alghamdi (2012) examined the impact of nurse manager leadership styles on Saudi nurses' job satisfaction and intention to stay. Results indicated that Saudi nurses perceived their managers as transformational rather than transactional leaders. Transformational leadership was associated with job satisfaction, whereas transactional leadership was associated with job dissatisfaction. Nurses who were satisfied with their jobs intended to stay longer. Hierarchical regression analysis indicated that background variables, transformational leadership, and transactional leadership explained 32% of the variance in job satisfaction and 5% of the variance in intention to stay.

Bahnassy et al. (2014) assessed overall job satisfaction of nurses in a tertiary hospital in Riyadh. No statistically significant differences in job satisfaction were found when participants were grouped by age, gender, nationality, marital status, or years of experience (p>.05). However, statistically significant differences emerged by position, work unit, educational attainment, country of education, and salary. Higher salary was positively and significantly associated with higher job satisfaction.

Al-Dossary, Vail, and Macfarlane (2012) measured job satisfaction of nurses in a teaching hospital and found 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. More years of experience were associated with better job satisfaction.

A study among nurses in primary health care centers in the Jazan region of Saudi Arabia showed that male nurses were less satisfied than females, and those with four or fewer years of tenure were less satisfied than those with five or more. Overall, nurses in this study were dissatisfied with their work lives (Almalki, FitzGerald, and Clark, 2012).

The reviewed literature suggests that leadership is vital to individual, organizational, and patient care outcomes. Results across these studies indicate that managers and supervisors employ various combinations of leadership behaviors that create positive impacts on their followers. No single leadership style provides all expected outcomes; rather, combinations of leadership behaviors yield positive results in varying situations. These studies provide a foundation for exploring leadership–satisfaction relationships in the current study's context.

Methodology

The study employed a quantitative descriptive design. Bivariate correlations between the independent variable (leadership styles) and the dependent variable (job satisfaction) were examined. The study was conducted at King Saud University Medical City (KSUMC), Riyadh, during the first quarter of 2014.

Fifty supervisors and department heads and 220 staff nurses from KSUMC were recruited using a non-probability, convenience sampling method. Inclusion criteria required full-time employment at KSUMC. Nursing students and nursing interns were excluded.

Two instruments were used. 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 measuring leadership behaviors as perceived by supervisors and/or department heads were rated on a 5-point Likert-type scale ranging from 0 ("not at all") to 4 ("frequently, if not always"). The MLQ (5x-Short) has been found to have satisfactory discriminant validity, with inter-item correlation coefficients (Cronbach's alpha) of subscales ranging between .64 and .92, and an overall alpha of .70 (Avolio, Bass, and Jung, 1999). In the current study, the Cronbach's alpha of leadership styles was ≥.79, confirming instrument reliability.

The second instrument was the Minnesota Satisfaction Questionnaire (MSQ) Short Form — 1967 revision (Weiss, Dawis, England, and Lofquist, 1967). This 20-item instrument measures employee satisfaction across different aspects of their work and work environment using a 5-point Likert-type scale from 1 ("very dissatisfied") to 5 ("very satisfied"). Two scoring models were employed: an overall satisfaction percentage score (scores of 75% or above indicate high satisfaction; 26–74% indicate average satisfaction; 25% or below indicate low satisfaction), and mean ratings for intrinsic, extrinsic, and general satisfaction. Hoyt reliability coefficients for the MSQ ranged from .84 to .92 for intrinsic satisfaction, .77 to .82 for extrinsic satisfaction, and .90 for general satisfaction. Test-retest reliability of the MSQ was .89 over one week and .70 over one year (Weiss et al., 1967). In the current study, Cronbach's alphas were .76 for intrinsic, .85 for extrinsic, and .88 for general satisfaction.

After obtaining official permission from higher administration, a pretest was conducted on samples not included in the final study to ensure clarity of the instruments and estimate completion time. The MLQ required between 12 and 15 minutes; the MSQ required between 8 and 10 minutes. No issues were raised by pretest participants. Final participants dropped completed questionnaires into a drop box near their department office to ensure anonymity.

Data were processed and analyzed using SPSS 17 (Chicago, IL). Descriptive statistics were used to characterize participants, perceived leadership styles, and satisfaction levels. Bivariate analysis using the Pearson product-moment correlation coefficient was used to test significant relationships between leadership styles and job satisfaction scores. The Spearman rank correlation coefficient was used to analyze relationships between leadership styles and satisfaction ratings. Significant correlations were inferred at p<.05.

Ethical approval was obtained from the Institutional Review Board, and administrative permission was secured from KSUMC prior to the study. Participants were informed of the study's objectives. Anonymity and confidentiality were assured, and implied consent was obtained when participants returned completed questionnaires.