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Leadership Behaviour of Nurse Managers in Relation to Job Satisfaction and Work Climate

Leadership Behaviour of Nurse Managers in Relation to Job Satisfaction and Work Climate

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Leadership behaviour of nurse managers in relation to jobsatisfaction and work climate
STINA FRANSSON SELLGREN
MSc, RN, PhD
1
, GO ¨RAN EKVALL
PhD
2
and GO ¨RAN TOMSON
MD, PhD
31
PhD
 , Medical Management Centre, Karolinska Institutet and 
Deputy Nursing Director
 , Karolinska UniversityHospital, Stockholm
,
2
Professor Emeritus
 , Institution of Psychology, University of Lund, Lund and 
3
Professor
 , Medical Management Centre and Division of International Health, Karolinska Institutet, Stockholm,Sweden
Introduction
Staff turnover is a global and increasing problem forhealth care. There is a shortage of active nurses in theEuropean Union and this is projected to worsen over thenext 20 years (Hasselhorn
et al.
2003). In the US, staff turnover is estimated to reach a level of 29% in 2020(Health Resources and Services Administration, HRSA
Correspondence
Stina Fransson Sellgren
Department of Nursing Karolinska University Hospital 17176 StockholmSwedenE-mail: stina.sellgren@karolinska.se
SELLGREN S.F., EKVALL G. & TOMSON G.
(2008)
Journal of Nursing Management 
16
, 578–587
Leadership behaviour of nurse managers in relation to job satisfaction and work climate
Aim
This study examines how nurse managers
Õ
leadership behaviour relates tojob satisfaction and a creative work climate.
Background 
The nursing shortage is a challenge for managers all over the world.Leadership is a core element of management and it is important to elucidateleadership behaviour in order to increase knowledge about attracting andretaining talented staff.
Method 
We studied 770 subordinates at a large university hospital. Threequestionnaires for assessing perceived leadership behaviour, creative work climateand job satisfaction were used.
Results
Subordinates with a manager perceived as
Ô
super
Õ
have the highest rateson job satisfaction. The correlation between leadership and creative work climateis stronger than between leadership and job satisfaction. Between job satisfactionand work climate the correlation is strong.
Conclusions
The study shows that the relationship between a creative workclimate and job satisfaction is strong. A managers
Õ
ability to lead has a major affecton work climate.
Implication for nursing management 
Nurse managers must work on developingtheir leadership behaviour towards being an all-round leader that cares aboutpeople, is concerned about productivity and can handle changes. Support of ideasand initiatives are important in order to enable subordinates to perceive theirwork as challenging.
Keywords
: job satisfaction, leadership behaviour, work climate
Accepted for publication
: 31 October 2007
Journal of Nursing Management, 2008,
16,
578–587
DOI: 10.1111/j.1365-2934.2007.00837.x
578
ª
2008 The Authors. Journal compilation
ª
2008 Blackwell Publishing Ltd
 
2002). Job satisfaction is found to be an essential factorin staff turnover and is cited as a major contributoryfactor in the intention to stay in the nursing profession(Taunton
et al.
1997, Shader
et al.
2001). Dealing withthe nursing shortage is a huge challenge for managers inhealth care organizations all over the world, and qualitynursing leadership is an important determinant in itself as a predictor of job satisfaction (McNeese-Smith 1996,Taunton
et al.
1997). Consequently, it is very importantto elucidate the leadership behaviour of nurse managersin order to increase knowledge toward efficiency andeffectiveness in health care, as well as in attracting andretaining talented staff.
Management, leadership and leadership styles
The nurse manager, besides being the head and managerof the unit, is also a leader over part of the health carestaff. Kotter (1990) stated that management seeks toproduce predictability and order by: setting operationalgoals, establishing action plans, allocating resources,organizing and staffing, solving problems and moni-toring results. Leadership on the other hand seeks toproduce necessary changes by developing a vision of thefuture and strategies to reach that vision. This includescommunicating the vision and motivating and inspiringthe staff to attain the vision. In modern organizations,success as a manager necessarily involves leading (Yukl2002) and the manager
Õ
s role is more seen as a coach,considering relations to staff, high quality in nursingand efficiency (Collins 2001, Zimmerman
et al.
2001).The manager
Õ
s ability to lead affects the staff 
Õ
s ability toachieve stated visions and goals (Bass 1985, Yukl2002). Our study is focused on the leadership part of the manager
Õ
s work.Leadership style was described in early studies asconsisting of two broad and independent behaviouraldimensions, one production/task oriented, primarilyconcerned with accomplishing the task, utilizing staff and resources efficiently and maintaining reliableoperations. The other is employee oriented, with focuson improving relationships and helping people,increasing cooperation and teamwork and buildingidentification with the organization (Fleishman &Harris 1962, Hersey & Blanchard 1977).Today changes occur frequently in every organizationand to handle and motivate change is one of the leader
Õ
smain tasks. In leadership research, a new dimension of change orientation (Ekvall & Arvonen 1994, Yukl2002) has entered the arena. A change-orientated leaderis primarily concerned with development, increasingflexibility and innovation, gaining commitment to thechanges, and has a creative attitude and visionaryqualities (Kotter 1995, Yukl 2002).The transformational leadership style was describedin the 1980s (Bass 1985, Burns 1978) and can be de-scribed as having a focus on development and change inaddition to employee orientation (Bass 1985, Burns1978). The integrated leader who combines differentaspects of leadership for different situations is found tobe most effective today (Cook 2001).The importance of supportive leadership behaviourfor job satisfaction and the intention to stay in nursinghas been described previously (Blanchard & Waghorn1997, Taunton
et al.
1997, Albaugh 2003), as well asthe fact that poor supervision by nurse managers leadsto job dissatisfaction (Taylor
et al.
1999).
 Job satisfaction
 Job satisfaction has been described as the most impor-tant predictor for nurses
Õ
intention to remain employed(Shader
et al.
2001, Cowin 2002, Larrabee
et al.
2003). Job satisfaction can be considered from a global per-spective, such as the feelings and emotions perceived bythe individual employee based on work experiences(Price 2001, Spector 1997). It can also be exploredthrough a facet approach, studying employee attitudestowards various aspects (facets) of their jobs. Taris andFeij (2001) described two aspects of values, intrinsicand extrinsic where intrinsic values refer to immaterialaspects of the job such as job variety and autonomy andextrinsic values refer to material work aspects such assalary and opportunity for promotion. Job satisfactiondecreases when intrinsic work values are not met (Taris& Feij 2001, Hegney
et al.
2006).The main theme of these earlier studies is that job satisfaction is the resultof an evaluation of whether one
Õ
s job meets one
Õ
s needs;if one feels dissatisfied, searching for and acceptinganother place to work will likely occur. Recent studieswithin nursing have reported relationships between jobsatisfaction and specific components such as pay (Chan& Morrison 2000, Cowin 2002), control, autonomyand responsibility (Chan & Morrison 2000, Cowin2002, Larrabee
et al.
2003) and satisfaction with pro-fessional opportunities (Cowin 2002). Work groupcohesion is found to be important (Tourangeau &Cranley 2006) and McNeese-Smith (1996) found thatthe perceptions of staff nurses toward the leadershipbehaviour of their manager were significantly related totheir job satisfaction. Supportive leadership behaviourincludes creating opportunities that lead to staff per-ceiving their work as meaningful, stimulating and giv-ing a sense of coherence (Antonovsky 1979).
Leadership behaviour of nurse managers 
ª
2008 The Authors. Journal compilation
ª
2008 Blackwell Publishing Ltd,
Journal of Nursing Management 
,
16,
578–587
579
 
Work climate
Organizational climate has been discussed simulta-neously with organizational culture (Schneider 1990)and some writers argue that the two topics overlap andencompass each other (Denison 1996). Culture is de-fined as the normative beliefs, norms, values and sharedbehavioural expectations in the organization and is aproperty of the work unit (Ashforth 1985, Verbeke
et al.
1998); it affects the strategies for management.Our definition of climate, based on the work of Verbeke
et al.
(1998), is that climate is the way people perceivetheir work environment. The organizational climate isregarded as a conglomerate of the attitudes, feelings andbehaviours which characterize life in an organization(Glisson & James 2002, Isaksen & Ekvall 2006). Aclimate must be more innovative for the focus to be onrenewal and change. According to Ekvall
et al.
(1983),a climate that emulates innovativeness (creative workclimate) includes maintaining support for ideas, openrelationships, mutual trust and confidence; challengeand motivation, commitment to the goals and opera-tions of the organization; the freedom to seek infor-mation and show initiative; maintain pluralism inviews, knowledge and experiences; and having an openexchange of opinions and ideas.A study by Hellriegel and Slocum (2004) clearlyindicates the existence of a relationship between workclimate and job satisfaction. In a recent study of mental health service organizations, the results showthat both culture and climate impact work attitudesand subsequent staff turnover (Aarons & Sawitsky2006).The many previously quoted studies dealt with therelation between leadership behaviour and either jobsatisfaction or creative work climate. None studied therelation between all three. Because of the importance of providing high-quality health care and patient satisfac-tion (McNeese-Smith 1996, Newman
et al.
2002, Seo
et al.
2004), more knowledge is needed about thisrelationship.
Aim
The aim of the current study was to examine how nursemanagers leadership behaviour relates to job satisfac-tion and a creative work climate.
Method
The study was conducted at a large university hospitalin Sweden, in November 2003.
Study population
At the time of our study there were 92 nurse managersat the hospital, representing a wide variety of healthcare units; 77 of these met our inclusion criteria.Inclusion criteria for the managers were: responsibilityfor the budget of the unit and for recruiting staff,having 10 or more subordinates, having been in chargefor at least 6 months, and having not given notice toresign. Ten subordinates of each nurse manager wererequested to participate in the study, providing 770potential participants from a total population of about3000 subordinate staff. Included in the sample popu-lation were Registered Nurses, assistant nurses andvarious administrative staff. Only staff members actu-ally working at the time of the study were enrolled intothe randomization process; if a nurse manager had 10subordinates, all were asked to participate in the study.When a manager
Õ
s team consisted of more than 10subordinates, each subordinate received a number thatwas then randomly drawn from a box by an assistantindependent of the hospital and the study. Excludedfrom our sample were members of staff with time-based or temporary employment as these nurses pri-marily work nightshifts or weekends when the manageris not in charge and therefore would not be able torespond to the questionnaire on perceived leadershipbehaviour.
Questionnaires
The study is based on three validated questionnairesevaluating job satisfaction, leadership behaviour andwork climate (available from G.E.). These weredistributed at the same time to all 770 subordinates.Attached were questions regarding basic data onthe respondents, such as gender, age and profession.The questionnaires were distributed to the subordi-nates
Õ
home addresses and a reminder was distributedafter 2 weeks to those participants who had notresponded.
Questionnaire I: leadership behaviour
A questionnaire, based on the
Ô
change, production,employee
Õ
model (CPE), was used to assess perceivedleadership behaviour. This questionnaire was developedand validated by Ekvall and Arvonen (1991, 1994) andconsists of 30 items covering the three dimensions of change, production and employee (relations), with 10items for each dimension. These three fundamentaldimensions can then be combined into leadership
S. F. Sellgren
et al.
580
ª
2008 The Authors. Journal compilation
ª
2008 Blackwell Publishing Ltd,
Journal of Nursing Management 
,
16,
578–587

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