Journal of Nursing Management, 2008, 16, 578–587

Leadership behaviour of nurse managers in relation to job satisfaction and work climate
STINA FRANSSON SELLGREN
1

MSc, RN, PhD

1

¨ , GORAN EKVALL

PhD

2

¨ and GORAN TOMSON

MD, PhD

3

PhD, Medical Management Centre, Karolinska Institutet and Deputy Nursing Director, Karolinska University Hospital, Stockholm, 2Professor Emeritus, Institution of Psychology, University of Lund, Lund and 3 Professor, Medical Management Centre and Division of International Health, Karolinska Institutet, Stockholm, Sweden

Correspondence Stina Fransson Sellgren Department of Nursing Karolinska University Hospital 17176 Stockholm Sweden E-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 managersÕ leadership behaviour relates to job 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 elucidate leadership behaviour in order to increase knowledge about attracting and retaining talented staff. Method We studied 770 subordinates at a large university hospital. Three questionnaires for assessing perceived leadership behaviour, creative work climate and job satisfaction were used. Results Subordinates with a manager perceived as ÔsuperÕ have the highest rates on job satisfaction. The correlation between leadership and creative work climate is stronger than between leadership and job satisfaction. Between job satisfaction and work climate the correlation is strong. Conclusions The study shows that the relationship between a creative work climate and job satisfaction is strong. A managersÕ ability to lead has a major affect on work climate. Implication for nursing management Nurse managers must work on developing their leadership behaviour towards being an all-round leader that cares about people, is concerned about productivity and can handle changes. Support of ideas and initiatives are important in order to enable subordinates to perceive their work as challenging. Keywords: job satisfaction, leadership behaviour, work climate
Accepted for publication: 31 October 2007

Introduction
Staff turnover is a global and increasing problem for health care. There is a shortage of active nurses in the
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European Union and this is projected to worsen over the next 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
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Leadership behaviour of nurse managers

2002). Job satisfaction is found to be an essential factor in staff turnover and is cited as a major contributory factor in the intention to stay in the nursing profession (Taunton et al. 1997, Shader et al. 2001). Dealing with the nursing shortage is a huge challenge for managers in health care organizations all over the world, and quality nursing leadership is an important determinant in itself as a predictor of job satisfaction (McNeese-Smith 1996, Taunton et al. 1997). Consequently, it is very important to elucidate the leadership behaviour of nurse managers in order to increase knowledge toward efficiency and effectiveness in health care, as well as in attracting and retaining talented staff.

Management, leadership and leadership styles
The nurse manager, besides being the head and manager of the unit, is also a leader over part of the health care staff. Kotter (1990) stated that management seeks to produce predictability and order by: setting operational goals, establishing action plans, allocating resources, organizing and staffing, solving problems and monitoring results. Leadership on the other hand seeks to produce necessary changes by developing a vision of the future and strategies to reach that vision. This includes communicating the vision and motivating and inspiring the staff to attain the vision. In modern organizations, success as a manager necessarily involves leading (Yukl 2002) and the managerÕs role is more seen as a coach, considering relations to staff, high quality in nursing and efficiency (Collins 2001, Zimmerman et al. 2001). The managerÕs ability to lead affects the staffÕs ability to achieve stated visions and goals (Bass 1985, Yukl 2002). Our study is focused on the leadership part of the managerÕs work. Leadership style was described in early studies as consisting of two broad and independent behavioural dimensions, one production/task oriented, primarily concerned with accomplishing the task, utilizing staff and resources efficiently and maintaining reliable operations. The other is employee oriented, with focus on improving relationships and helping people, increasing cooperation and teamwork and building identification with the organization (Fleishman & Harris 1962, Hersey & Blanchard 1977). Today changes occur frequently in every organization and to handle and motivate change is one of the leaderÕs main tasks. In leadership research, a new dimension of change orientation (Ekvall & Arvonen 1994, Yukl 2002) has entered the arena. A change-orientated leader is primarily concerned with development, increasing flexibility and innovation, gaining commitment to the

changes, and has a creative attitude and visionary qualities (Kotter 1995, Yukl 2002). The transformational leadership style was described in the 1980s (Bass 1985, Burns 1978) and can be described as having a focus on development and change in addition to employee orientation (Bass 1985, Burns 1978). The integrated leader who combines different aspects of leadership for different situations is found to be most effective today (Cook 2001). The importance of supportive leadership behaviour for job satisfaction and the intention to stay in nursing has been described previously (Blanchard & Waghorn 1997, Taunton et al. 1997, Albaugh 2003), as well as the fact that poor supervision by nurse managers leads to job dissatisfaction (Taylor et al. 1999).

Job satisfaction
Job satisfaction has been described as the most important predictor for nursesÕ intention to remain employed (Shader et al. 2001, Cowin 2002, Larrabee et al. 2003). Job satisfaction can be considered from a global perspective, such as the feelings and emotions perceived by the individual employee based on work experiences (Price 2001, Spector 1997). It can also be explored through a facet approach, studying employee attitudes towards various aspects (facets) of their jobs. Taris and Feij (2001) described two aspects of values, intrinsic and extrinsic where intrinsic values refer to immaterial aspects of the job such as job variety and autonomy and extrinsic values refer to material work aspects such as salary and opportunity for promotion. Job satisfaction decreases 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 result of an evaluation of whether oneÕs job meets oneÕs needs; if one feels dissatisfied, searching for and accepting another place to work will likely occur. Recent studies within nursing have reported relationships between job satisfaction and specific components such as pay (Chan & Morrison 2000, Cowin 2002), control, autonomy and responsibility (Chan & Morrison 2000, Cowin 2002, Larrabee et al. 2003) and satisfaction with professional opportunities (Cowin 2002). Work group cohesion is found to be important (Tourangeau & Cranley 2006) and McNeese-Smith (1996) found that the perceptions of staff nurses toward the leadership behaviour of their manager were significantly related to their job satisfaction. Supportive leadership behaviour includes creating opportunities that lead to staff perceiving their work as meaningful, stimulating and giving a sense of coherence (Antonovsky 1979). 579

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Work climate
Organizational climate has been discussed simultaneously with organizational culture (Schneider 1990) and some writers argue that the two topics overlap and encompass each other (Denison 1996). Culture is defined as the normative beliefs, norms, values and shared behavioural expectations in the organization and is a property 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 perceive their work environment. The organizational climate is regarded as a conglomerate of the attitudes, feelings and behaviours which characterize life in an organization (Glisson & James 2002, Isaksen & Ekvall 2006). A climate must be more innovative for the focus to be on renewal and change. According to Ekvall et al. (1983), a climate that emulates innovativeness (creative work climate) includes maintaining support for ideas, open relationships, mutual trust and confidence; challenge and motivation, commitment to the goals and operations of the organization; the freedom to seek information and show initiative; maintain pluralism in views, knowledge and experiences; and having an open exchange of opinions and ideas. A study by Hellriegel and Slocum (2004) clearly indicates the existence of a relationship between work climate and job satisfaction. In a recent study of mental health service organizations, the results show that both culture and climate impact work attitudes and subsequent staff turnover (Aarons & Sawitsky 2006). The many previously quoted studies dealt with the relation between leadership behaviour and either job satisfaction or creative work climate. None studied the relation between all three. Because of the importance of providing high-quality health care and patient satisfaction (McNeese-Smith 1996, Newman et al. 2002, Seo et al. 2004), more knowledge is needed about this relationship.

Study population
At the time of our study there were 92 nurse managers at the hospital, representing a wide variety of health care units; 77 of these met our inclusion criteria. Inclusion criteria for the managers were: responsibility for the budget of the unit and for recruiting staff, having 10 or more subordinates, having been in charge for at least 6 months, and having not given notice to resign. Ten subordinates of each nurse manager were requested to participate in the study, providing 770 potential participants from a total population of about 3000 subordinate staff. Included in the sample population were Registered Nurses, assistant nurses and various administrative staff. Only staff members actually working at the time of the study were enrolled into the randomization process; if a nurse manager had 10 subordinates, all were asked to participate in the study. When a managerÕs team consisted of more than 10 subordinates, each subordinate received a number that was then randomly drawn from a box by an assistant independent of the hospital and the study. Excluded from our sample were members of staff with timebased or temporary employment as these nurses primarily work nightshifts or weekends when the manager is not in charge and therefore would not be able to respond to the questionnaire on perceived leadership behaviour.

Questionnaires
The study is based on three validated questionnaires evaluating job satisfaction, leadership behaviour and work climate (available from G.E.). These were distributed at the same time to all 770 subordinates. Attached were questions regarding basic data on the respondents, such as gender, age and profession. The questionnaires were distributed to the subordinatesÕ home addresses and a reminder was distributed after 2 weeks to those participants who had not responded.

Aim
The aim of the current study was to examine how nurse managers leadership behaviour relates to job satisfaction and a creative work climate.

Questionnaire I: leadership behaviour
A questionnaire, based on the Ôchange, production, employeeÕ model (CPE), was used to assess perceived leadership behaviour. This questionnaire was developed and validated by Ekvall and Arvonen (1991, 1994) and consists of 30 items covering the three dimensions of change, production and employee (relations), with 10 items for each dimension. These three fundamental dimensions can then be combined into leadership

Method
The study was conducted at a large university hospital in Sweden, in November 2003. 580

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profiles (Yukl 2002). The questionnaire was reliability tested using CronbachÕs alpha with coefficients between 0.86 and 0.94 (Arvonen & Ekvall 1999), and its validity has been demonstrated in several large studies (Ekvall & Arvonen 1991, 1994). We choose to use the CPE tool because it is reliability tested and validated in Swedish and has been widely used both in Sweden and in other countries (Arvonen & Ekvall 1999). The respondentsÕ answers are rated 1–6 on a Likert scale (ranging from Ôdo not agree at allÕ to Ôagree totallyÕ). Example questions from this questionnaire include: My manager: • Ôinitiates new projectsÕ (change); • Ôgives clear orders and instructionsÕ (production); • Ôis friendlyÕ (relation). Questionnaire II: job satisfaction The tool used for self-assessing job satisfaction, the Job Satisfaction Questionnaire, was developed by one of the co-authors (GE) and consists of 20 items covering five different variables: competence (five items), feeling (five items), autonomy (three items), initiative (four items) and relation (three items). The questionnaire has been used earlier in studies of different companies and health organizations in Sweden (Arno & Tunving 2002); its ¨ reliability has been tested both by us and others, demonstrating a CronbachÕs alpha coefficient in the range 0.74–0.92 (Arno & Tunving 2002). ¨ Answers to the questionnaire were given on a Likert scale from Ômostly negativeÕ to Ôsomewhat more negative than positiveÕ and Ôsomewhat more positive than negativeÕ to Ômostly positiveÕ. There is no middle answer (neither/nor) so the respondent is required to take a standpoint. Example questions from this questionnaire: How do your work and the circumstances at work affect your possibility to: • Ôfeel secureÕ (feeling); • Ôfeel appreciatedÕ (relation); • Ôbe more competentÕ (competence). Questionnaire III: work climate The questionnaire used for self-assessing work climate, the Creative Climate Questionnaire (CCQ; Ekvall 1996), consists of 50 items, five in each of the following ten variables: challenge, freedom, idea support, trust, dynamism, playfulness, debate, conflict, risk taking, and idea time. The questionnaire is widely used both nationally and internationally for assessing creative climate (Talbot et al. 1992, Isaksen & Ekvall 2006).

The reliability test using CronbachÕs alpha shows coefficients between 0.66–0.90. Answers are rated 0–3 on a Likert scale (in terms of applicability, from Ônot at allÕ to Ôto some degreeÕ and ÔfairlyÕ to Ôto a high degreeÕ). Low rates indicate that the climate is perceived as stagnated and high rates indicate that the climate is perceived as creative. For the variable (ÔconflictsÕ) it is the opposite. Example questions from this questionnaire include: • Ônew ideas are supported and encouragedÕ (support for ideas); • Ôyou are allowed to make your own decisionsÕ (freedom); • ÔthereÕs always something going on hereÕ (dynamism). All three questionnaires are available from the second author G.E.

Statistical analyses
The distributions of the variables were assessed for askewness using traditional tests and no signs of severe askewness were found. For analysing the relationship between the leadership dimensions and job satisfaction, correlation analyses were employed. The relation between job satisfaction and leaders perceived as super (‡1 SD beyond the mean in all three dimensions), middle of the road (within 0.5 SD of the mean in all three dimensions), or invisible ( £ 1 SD below the mean in all three dimensions) was studied through analysis of variance, with DuncanÕs post-hoc test with a significance level of 0.05. Likewise, the relationship between job satisfaction and the quartiles of total work climate (mean value of all ten variables) was studied in the same manner. The relationships between the work climate variables and job satisfaction were explored with correlation analyses. A partial correlation analysis was done between the leadership dimensions and job satisfaction, controlling for total work climate.

Ethics
Participation in the study was voluntary and informed consent was obtained. Confidentiality and anonymity were guaranteed. If anyone did not want to be a part of the study, his or her name was immediately removed from the data list. Assurance of anonymity was especially important, considering that the first author was working at the same hospital as the nursing director at the time of the study. The study received ethical approval from Karolinska Institutet (KI, Dnr 03-348). 581

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Results Respondents
After a dropout of 344 invited respondents, the total number of participant respondents in the study was n = 426 (55%). Most of the non-participants (217) provided no explanation as to why they did not respond, whereas 127 gave some explanation, such as being on sick leave (6), on maternity leave or pregnant (10), or on leave for some other reason (15). Nine had resigned. Only six gave the explanation that the questionnaires were too extensive to go through. Of the 426 respondents, seven did not answer the questions on basic data attached to the questionnaires. When analysing the background variables, there is a statistically significant under-representation among the respondents of age 31–40 years as compared with the entire sample. There is a tendency toward over-representation of respondents in the age of 41–50 years, but this is not statistically significant. No other differences can be shown in comparison between the invited and the respondents (Table 1).
Table 1 Basic facts of the invited sample compared with facts of the responded Invited Gender Men Women Age (years) 20–30 31–40 41–50 51–60 >60 Profession Registered Nurse/midwife Nurse practitioner/child nurse Practitioner Secretary Administrative assistant Social worker Technician/transporters Others Internal dropout 43 727 139 259 196 148 28 464 261 20 12 7 2 4 Responded 28 391 73 121 121 88 16 272 126 7 6 2 2 4 7

Relationship between leadership behaviour and job satisfaction
The correlation rates between leadership dimensions and variables of job satisfaction ranged from 0.22 and 0.51 (Table 2). All of the correlations are significant (P £ 0.001). The strongest correlation is between the job satisfaction variable ÔfeelingÕ and the leadership dimension Ôemployee orientationÕ; the lowest correlation is between the variable ÔautonomyÕ and the dimension Ôchange orientationÕ. Overall, the correlations between the job satisfaction variable ÔautonomyÕ and all three leadership dimensions are lower than the other correlations. The correlations with employee orientation are somewhat stronger than the correlations with the other leadership dimensions. The strongest correlation with production orientation is the variable ÔfeelingÕ, and with Ôchange orientationÕ the strongest correlation is with ÔinitiativeÕ. The results of the analyses of variance (Table 3) show that the mean values of job satisfaction among staff with invisible managers were significantly lower than the mean values among those who had middle of the road or super managers. Further, the mean values between staff with middle of the road managers were lower and significantly different than those with super managers, with one exception, ÔautonomyÕ.

Relationship between leadership behaviour and work climate
Correlation analyses were done between the ten variables of creative work climate and the three leadership dimensions, and between the mean value of total creative work climate and the leadership dimensions. The correlations at the variable level showed a variance between 0.28 (ÔdebateÕ to Ôproduction orientationÕ) and 0.58 (Ôidea supportÕ to Ôchange orientationÕ). All of the correlations are significant (P £ 0.001). There are strong correlations between each of the three leadership dimensions and creative work climate (as a total mean value): Ôchange orientationÕ 0.54, Ôproduction orientationÕ 0.48, and Ôemployee orientationÕ

Leadership dimension Change orientation Production orientation Employee orientation ***P < 0.001.

Competence 0.38*** 0.33*** 0.39***

Feeling 0.41*** 0.45*** 0.51***

Autonomy 0.22*** 0.25*** .25***

Initiative 0.46*** 0.38*** 0.47***

Relation 0.38*** 0.42*** 0.48***

Table 2 Correlations between dimension and job (n = 426)

leadership satisfaction

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Leadership behaviour of nurse managers Table 3 Analysis of variance between job satisfaction of staff that perceived their managers as super (>1 SD beyond the mean, middle of the road within 0.5 SD of the mean, and vague £ 1 SD below the mean) Vague (n = 32) Competence Feeling Autonomy Initiative Relation 1.61 1.56 1.40 1.57 1.89 Middle (n = 53) 2.09 2.23 1.73 2.05 2.33 Super (n = 23) 2.78 2.85 2.33 2.77 2.77 P *** *** *** *** *** Post hoc* 1<2<3 1<2<3 1 < 2,3 1<2<3 1<2<3 Table 4 Correlations between creative work climate variables and job satisfaction (n = 426)* Variables of work climate Competence Feeling Autonomy Initiative Relation Challenge Freedom Idea support Trust Dynamism Playfulness Debate Conflict Risk taking Idea time 0.48*** 0.43*** 0.54*** 0.40*** 0.43*** 0.37*** 0.39*** )0.32*** 0.45*** 0.44*** 0.54*** 0.42*** 0.57*** 0.46*** 0.43*** 0.46*** 0.40*** )0.39*** 0.44*** 0.48*** 0.30*** 0.43*** 0.36*** 0.26*** 0.19*** 0.24*** 0.32*** )0.15** 0.35*** 0.54*** 0.47*** 0.51*** 0.68*** 0.46*** 0.44*** 0.44*** 0.53*** )0.36*** 0.54*** 0.53*** 0.56*** 0.39*** 0.55*** 0.56*** 0.54*** 0.63*** 0.44*** )0.47*** 0.40*** 0.40***

*The post hoc test is done as a result of Duncan with a significance level of 0. 05. ***P < 0.001.

0.56. The P-value is significant ( £ 0.001) in all of the variables.

**P < 0.005, ***P < 0.001.

Relationship between creative work climate and job satisfaction
Correlation analyses were performed both as correlations between each variable, ten of creative work climate and five of job satisfaction, and between the mean value of the total creative work climate and job satisfaction variables. The correlation analyses of variables showed a range from )0.15 (ÔconflictÕ to ÔautonomyÕ) to )0.68 (Ôidea supportÕ to ÔinitiativeÕ). All correlations apart from ÔconflictÕ to ÔautonomyÕ (P = 0.003) are significant at the 0.001 level (Table 4). The negative co-variation between ÔconflictsÕ and Ôjob satisfactionÕ is expected theoretically. Correlations between the total mean value of all creative work climate variables and the five variables of job satisfaction are strong: ÔcompetenceÕ 0.55, ÔfeelingÕ0 .60, ÔautonomyÕ 0.41, ÔinitiativeÕ 0.64, and ÔrelationÕ 0.65. All these correlations are significant (P £ 0.001). In Table 5, we divided the sample into four quartiles according to the mean values of total creative work climate and related these to the mean values of the five variables of job satisfaction. The differences in mean values between each of the four groups are significant (P £ 0.001) in all the variables except ÔautonomyÕ.

Correlations between leadership behaviour, job satisfaction and creative work climate
When taking mean values of correlations (based on total scores), it is clear that there is a stronger relationship between leadership behaviour and creative work climate and between creative work climate and job satisfaction than between leadership behaviours and job satisfaction. This indicates that the impact of leadership behaviour on job satisfaction most likely has an influence via a creative work climate (Figure 1). A partial correlation analysis controlling for total creative work climate resulted in less strong correlations, which confirms this hypothesis (Table 6 and Figure 1).

Discussion
This is one of few studies on leadership and creative work climate in a hospital setting and it contributes to the knowledge of the relationship between leadership behaviour, work climate and job satisfaction in nursing. There is to our knowledge no study published that explores leadership behaviour in nursing, including the dimension ÔchangeÕ, in relation to intrinsic factors of job satisfaction and creative work climate. Although nursing staff turnover has been a major problem for many

Table 5 Analysis of variance between job satisfaction of staff when perceived creative work climate is divided into quartiles

1 qu. (n = 109) Competence Feeling Autonomy Initiative Relation 1.72 1.71 1.40 1.61 1.85

2 qu. (n = 107) 1.99 2.09 1.54 2.01 2.30

3 qu. (n = 104) 2.26 2.34 1.88 2.26 2.51

4 qu. (n = 104) 2.65 2.70 2.18 2.67 2.83

Prob *** *** *** *** ***

Post hoc* 1<2<3<4 1<2<3<4 1< 2 < 3 < 4 1<2<3<4 1<2<3<4

*The post hoc test is done as a result of Duncan with a significance level of 0.05. ***P < 0.001.
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Leadership

0.52
Creative work

0.36 (0.12)
Job

0.57
Figure 1 Mean correlations between job satisfaction, leadership behaviour and creative work climate (n = 426). The mean partial correlation (controlling for climate) between leadership behaviour and job satisfaction is shown within parentheses.

years, focus in health care has been on effectiveness and productivity and less on what is important for developing job satisfaction. This is despite the fact that nursing staff are among the most important resources of health care. Staff that perceives job satisfaction is essential for the ability to give high-quality and safe care (Kramer & Schmalenberg 2004). The relationship between leadership behaviour and job satisfaction is significant (P < 0.001). Managers perceived as ÔsuperÕ leaders influences staff job satisfaction in a positive way. Staff working under a manager perceived as a Ômiddle of the road leaderÕ rate higher job satisfaction than staff supported by an Ôinvisible leaderÕ. A manager with an ÔinvisibleÕ leadership style affects job satisfaction in a negative way. These findings support earlier findings where poor management practices, including lack of support, feedback and supervision, have been associated with job dissatisfaction (Taunton et al. 1997, Taylor et al. 1999) and intention to leave (Wai Chi Tai et al. 1998). Newman et al. (2002) also found that poor management was one of the main reasons for dissatisfaction and intention to leave. All variables of job satisfaction explored in our study show significant correlations with both leadership behaviour and creative work climate. Ekvall (2001) obtained similar results for job satisfaction and work climate in a study of staff at a state-owned company that performs tests on motor cars all over Sweden. One of the variables in our study ÔautonomyÕ has a lower correlation with both leadership behaviour and to
Leadership dimension Change orientation Production orientation Employee orientation Competence 0.10* 0.07 ns 0.11* Feeling 0.11* 0.21*** 0.25*** Autonomy )0.02 ns 0.05 ns 0.02 ns

work climate than the rest of the variables. It seems from the results of this study that ÔautonomyÕ is least affected by the studied impact factors. According to Herzberg (1966) ÔautonomyÕ could be referred to as a ÔmotivatorÕ, while Taris and Feij (2001) discuss autonomy as an aspect of the job that allows for selfexpression. Autonomy seems to be more of a characteristic of the individual and less easy to influence. Kant (1784) defines autonomy as freedom from external authority and distinguishes between a person who is intellectually autonomous and one who keeps him/ herself in an intellectually heteronomous, i.e. dependent and immature, status. In our study, the correlations between variables of leadership behaviour and job satisfaction were significant, but that the correlation between job satisfaction and employee orientation was slightly stronger than for Ôproduction orientationÕ and Ôchange orientationÕ. Nursing as a profession relies on relations and caring for others, which affect the leadership and organization of nursing. If the manager leads with kindness and respect for the individual it is more likely that the staff show the same behaviour towards the patients. This is important today when there is an obvious risk of losing the aim to care properly for the patient, as a result of the pressure for increased staff productivity and the economic goals of the administrators (Bondas 2006). Positive leadership qualities and strong facilitative leadership behaviour of the first line manager are important in creating an environment that increases job satisfaction and the intention to stay (Blanchard & Waghorn 1997, Albaugh 2003). The command and control model of leadership is no longer appropriate (Laschinger et al. 1999). McDaniel and Wolf (1992) found that transformational leadership factors (e.g. individual consideration, charisma and intellectual stimulation) lead to low turnover (e.g. high job satisfaction). Nursing supervision is also shown to have a positive effect on nursesÕ physical symptoms and their perceptions of well-being and on the experience of having or not having control and motivation (Begat et al. 2005). On the other hand, the results of a recent study by Sellgren et al. (2006) showed that the staff preferred a more production-oriented leadership style than the leaders preferred to demonstrate.
Initiative 0.16** 0.12* 0.17** Relation 0.03 ns 0.16** 0.17*** Table 6 Partial correlation coefficients, controlling for total climate (mean of 10 variables) n = 396

*P < 0.05, **P < 0.005, ***P < 0.001.

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Our findings that increased creativity in the work climate results in higher job satisfaction are supported by the findings of Kramer (1990), who identified in magnet hospital studies that group climate within nursing is an important variable. Magnet hospitals are so named for their excellence in retaining and attracting nursing staff during periods of nurse shortage. The reputation of each of these hospitals was that they were good places to work and gave high quality of nursing care. The positive climate aided the institution in attracting and retaining their staff. A study from a university health centre showed that when the climate is perceived as stagnated, job satisfaction is low, while the more positive the perception of work climate, the less employees tend to stay away from work (Sounan & Gagnon 2005). Hemmingway and Smith (1999) also found in their study among 252 nurses in Canada that organizational climate predicted turnover. The importance of leadership behaviour for a creative work climate is obvious in the results of our study, as similar to a study of a state university college in Sweden (Ekvall & Ryhammar 1998). Their results indicated that the behavioural style of the manager affected organizational outcomes, such as creativity and productivity through influencing the creative work climate. The significant correlation between leadership behaviour and organizational outcomes disappeared when the influence of the third variable ÔclimateÕ was removed. In our study of health care staff, the findings are somewhat different. There are still significant correlations between leadership behaviour and variables of job satisfaction, but it is less strong than that of leadership behaviour mediated through work climate. It is important to be aware of the strong relationship between leadership behaviour and work climate because of the strong correlation between work climate and job satisfaction. This means that the manager in her leadership role is a key to nurse retention. This confirms reported findings (McNeese-Smith 1996, Taunton et al. 1997). While the individual characteristics of a human being may be difficult to change it is possible to adjust oneÕs leadership behaviour in a specific situation (Ekvall & Arvonen 1991). To lead does not only mean to go before, it also means to go with. The results of our study indicate that the managerÕs role as a climate builder is very important and has great impact on nursing staff job satisfaction.

compared with the respondents showed that there was a significant under- representation of age 31–40 among the respondents. The way this may have influenced results is difficult to say. The main criticism of questionnaires is that they do not measure real behaviour, only the attitudes of the subordinates towards the object. The CPE questionnaire has been tested for the influence of attitude (Ekvall & Arvonen 1994). The change and production dimensions showed no correlations with attitude while the dimension relation orientation showed a mediumsized coefficient (.40), which is logical, as being accepted is a psychological drive in relations-oriented behaviour. A further study with a more qualitative approach could however add a more in-depth understanding of the phenomenon.

Conclusions
This study provides evidence that leadership behaviour and work climate are essential for the feeling of job satisfaction in nursing. The study shows that a creative work climate has the strongest relationship to job satisfaction and that the manager is an important link in creating such a climate. According to this, in order to improve job satisfaction the manager has to work and develop her leadership behaviour towards being a ‘‘super’’ leader. This type of leader cares about people in the organization, considers productivity and knows how to handle changes. Training in these subjects should be arranged by the hospital management. When organizational changes occur and the work environment is unstable, it is the manager that should remain calm and motivate the staff. To know how to develop functional work groups is important as well as what individual needs that has to be met. In order to create an open-minded creative climate, the manager has to support new ideas and initiatives from subordinates. In small units where managers work with their staff and where work teams are stable it is easier to foster a creative work climate. People must be allowed to feel joy at work even if you are working in a very serious area. When this type of work climate is present it is more likely that subordinates will feel job satisfaction and remain in their jobs.

Acknowledgements Methodological considerations
The dropout rate was normal for this type of study (45%). Analysis of the base data for the total sample
The authors thank all the nurse managers and nursing staff that have participated in this study. We also thank Ola Andersson for assistance with the statistical analyses.

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