Journal of Nursing Research Vol. 16, No.

4, 2008

The Effect of Leader-Member Exchange, Trust,

Supervisor Support on Organizational Citizenship
Behavior in Nurses
Chun-Hsi Vivian Chen · Shih-Jon Wang* · Wei-Chieh Chang** · Chin-Shin Hu***

ABSTRACT: This study examined from a social exchange perspective the influence of leader-member exchange
(LMX) on the trust of subordinates in their supervisors as well as their perception of support received
from their medical organization supervisors and the subsequent effect of such on organizational
citizenship behavior (OCB) in subordinates. Two hundred valid supervisor-subordinate (head
nurses-nurses) dyads from 3 medical centers and 3 regional hospitals took part in this study, which
found that the quality of leader-member exchange affects nurse trust in their supervisors as well as
their perception of supervisor support, which consequently promotes OCB on the part of nurses.
Findings imply that a higher level of LMX can enhance nurses’ commitment, significantly reduce
turnover, and promote their OCB, resulting in greater organizational effectiveness.
Key Words: leader-member exchange, trust, supervisor support, organizational citizenship behavior.

Introduction the same degree of affection. The leader-member exchange

A comprehensive system design is often key to a
well-operated organization. Nevertheless, great stress is
likely to be placed on the management framework, inter-
unit design and inter-departmental arrangements, while
neglecting critical human factors in organizational opera-
tions. In fact, the methods by which supervisors lead and
employees interact within constructed systems are
extremely crucial to organizational performance and
success.
In terms of the social exchange process, “leadership”
is characterized by the dyadic relationship between
supervisor and subordinate (Martin, Thomas, Charles,
Epitropaki, & McNamara, 2005). In order to obtain recog-
nition, reward, and conversance from the supervisor, the
subordinate will adjust or continue his/her own behavior in
accordance with supervisor expectations. Likewise, in
order to earn subordinate loyalty, enthusiasm, praise, and
contributions, the supervisor will treat subordinates with
(LMX) is built upon this reciprocal relationship. The rela-
tionship between LMX and employee perceptions was ver-
ified by Dunegan (2003). Using nursing staff as samples,
Tangirala, Green, and Ramanujam (2007) investigated the
effect of LMX on subordinate work attitudes and found
that good LMX resulted in better work attitudes. The
degree of success to which relationships between super-
visors and subordinates could be adjusted and developed
was found to be contingent on the level of mutual respect,
influence, and trust (Wech, 2002). It has been argued that
enhanced mutual support and trust between supervisors
and subordinates can elevate the relationship and inter-
action between supervisors and subordinates (Lo, Ramayah,
& Hui, 2006).
Organizations tend to rely on objective productivity
or the profit index as their criteria for employee evaluation.
As a matter of fact, employee organizational citizenship
behavior (OCB) must also be taken into consideration by
supervisors when conducting performance evaluations.

PhD, Assistant Professor, Department of Business Administration, National Central University; *PhD, Assistant Professor, Department of
Bioscience Technology, Chang-Jung Christian University; **MHA, Doctoral Student, Department of Business Administration, National
Central University; ***MBA, Senior Sales Representative, Sales Department, Silicon Motion Inc.
Received: June 2, 2008 Revised: August 1, 2008 Accepted: September 23, 2008
Address correspondence to: Chun-Hsi Vivian Chen, No. 300, Jhongda Rd., Jhongli City, Taoyuan County 32001, Taiwan, ROC.
Tel: +886 (3) 422-7151 ext. 66182; Fax: +886 (3) 422-2891; E-mail: cvchen@mgt.ncu.edu.tw

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J. Nursing Research Vol. 16, No. 4, 2008
Due to the importance of OCB, many researchers have
endeavored to investigate the phenomenon of OCB with
regard to employees. It has been confirmed that OCB leads
to tangible benefits for employees and organizations in
many industries (Ackfeldt & Leonard, 2005; Schlechter &
Engelbrecht, 2006). Although not officially included in
organizations’ reward systems as one of the evaluation cri-
teria, OCB is beneficial to organizations’ operations and
will definitely play a decisive role in determining the effec-
tiveness of long-term organizational performance. If the
organization can promote its employees’ OCB, great
benefits in human resource management can be expected.
In general, studies investigating the influence of LMX
on employee OCB rarely involved the non-profit medical
industry. Instead, the focus of prior research has mainly
been on corporate organizations. As mentioned above, the
management of medical institutions resembles that of
many corporate organizations. A majority of personnel in
medical institutions are nurses. As their workload (whether
it be medical care or administration) is substantial and they
often encounter emergencies, mutual assistance in terms of
workforce is especially critical. For this reason, nurses
were selected as the target group in this study to investigate
the influence of LMX on the trust of subordinates in their
supervisors as well as their perception of supervisor sup-
port within the medical organization and the subsequent
effect on subordinate OCB.
Literature Review and Hypotheses
Leader-member exchange, trust, and supervisor
support
Blau (1964) argued that the establishment of a social
exchange relationship is based on a situation in which one
party contributes and the corresponding beneficial party
reciprocates (i.e., provides feedback). Wech (2002) indi-
cated that different relationships between supervisors and
subordinates (i.e., LMX) would develop to reflect the
attained level of mutual respect and trust. Referencing reci-
procity as used in role theory and social exchange theory,
Dienesch and Liden (1986) maintained that a member’s
role in an organization is determined by the interpersonal
exchange relationship established between the member
and the supervisor. The development of LMX is affected
by emotion, loyalty, and contribution. A good relationship
is comprised of trust, mutual appreciation, and respect
(Wat & Shaffer, 2005). Based on the LMX theory, Sanders
322
Chun-Hsi Vivian Chen et al.
and Schyns (2006) maintained that when a supervisor
trusts his/her subordinates, subordinates in turn trust their
supervisor. Hence, a good relationship between subor-
dinate and supervisor can be expected to engender a high
level of mutual trust.
Perceived supervisor support refers to the positive
feedback and benefits that subordinates receive from their
supervisors for their contributions (Kottke & Sahrainski,
1988). The supervisors are hard-pressed to treat each of
their subordinates the same way due to managerial con-
straints that result from limited organizational resources.
Thus, different types of relationships or exchange relation-
ships invariably develop. When a good exchange relation-
ship exists, subordinates will have a higher level of trust in
their supervisors and supervisors will also actively con-
sider the future career development of subordinates (Chen,
Lam, & Zhong, 2007).
Trust, supervisor support, and organizational
citizenship behaviors
OCB consists of work behaviors that are defined as
discretionary, unrelated to the formal organizational
reward system, and in aggregate will promote organiza-
tional effectiveness (Moorman, 1991). Jones and George
(1998) contend that the role of the members in the organi-
zation would be broadened at the point when “uncondi-
tional trust” develops within the organization. As a result,
employees are willing to establish “communal relation-
ships.” In this case, they believe that helping each other is
not only an obligation, but a responsibility. It was con-
firmed that as the quality of LMX improves, the level of
trust and loyalty between supervisors and subordinates rises,
which consequently leads to more OCB from the sub-
ordinate (Lapierre & Hackett, 2007). Lo et al. (2006)
argued that when a member of the organization realizes that
a social exchange relationship exists between him/her and
the organization, he/she would return with OCB based on
the rule of reciprocity. In addition, managerial support from
the supervisor can have a reciprocal effect on subordinates,
which can be expected to lead, eventually, to more OCB
from subordinates. Furthermore, when mutual trust is culti-
vated between subordinates and supervisors, subordinates
are more likely to perform OCB (Wat & Shaffer, 2005).
Using nursing staff as their example, Spence-
Laschinger, Finegan, and Shamian (2001) confirmed that if
supervisors provide a supportive working environment,
subordinates will demonstrate better work attitudes. As a
Leadership, Trust, and Nurses’ OCB
result, organizational effectiveness will improve. There-
fore, when subordinates interact well with supervisors,
they tend to feel that supervisors are supportive. Conse-
quently, they will contribute additional extra-role behav-
iors out of reciprocity (Lapierre & Hackett, 2007; Lo et al.,
2006). It was found that the perceived managerial support
among employees has a positive effect on their OCB
(Ehigie & Otukoya, 2005). In other words, subordinates
will demonstrate greater OCB as they gain more support
from their supervisors.
Mediating role of trust and support in LMX and
OCB
From the aforementioned studies, it can be inferred
that the quality of LMX will affect the level of subordinates’
trust in supervisors as well as their perception of support
from supervisors, which further affects subordinates’ OCB.
Based on previous findings, six hypotheses were
developed and tested as follows:
H1: LMX quality will have a positive effect on the
level of subordinate trust in their supervisors.
H2: LMX quality will have a positive effect on the
level of supervisor support perceived by the sub-
ordinate.
H3: Subordinate trust in their supervisor will have a
positive effect on their OCB.
H4: Perceived support from supervisors will have a
positive effect on subordinate OCB.
H5: Trust will mediate the relationship between LMX
and subordinate OCB.
H6: Perceived support from supervisors will mediate
the relationship between LMX and OCB.
Methods
Sample
Convenient sampling was adopted by this study to
collect data from nursing staff in 3 medical centers and 3
regional hospitals. Nurses and head nurses in 19 nursing
stations were drawn as sample participants. Nurses at dif-
ferent levels of hospital are in charge with different tasks
and work load that might affect their behaviors at work. In
order to improve data reliability, nurses in district hospitals
and primary medical agencies were excluded from con-
sideration in this study. Sample data included 280 dyads
(19 head nurses - 280 nurses). Questionnaires with exces-
sive missing data or which could not be accurately matched
J. Nursing Research Vol. 16, No. 4, 2008
as dyads were disqualified from consideration. After delet-
ing invalid responses, 200 valid supervisor-subordinate
(14 head nurses - 200 nurses) dyads (i.e., 400 question-
naires) were received, yielding a response rate of 71.4%.
Data and Procedure
An in-dyad research method was adopted for this
study. Separate questionnaires were distributed to nurses
and head nurses. The nurses’ questionnaire was comprised
of four parts: (1) demographics (including gender, educa-
tion, date of birth, work experience, marital status, and type
of hospital; (2) LMX; (3) level of trust in supervisor; and
(4) perceived supervisor support. In order to minimize
potential bias and avoid problems with common method
variance, OCB evaluations for each nurse were completed
by their immediate supervisor (head nurse). That is, each
head nurse would take the responsibility of evaluating
OCB for a number of subordinate nurses.
Questionnaires and stamped self-addressed envelopes
were sent to nurses and head nurses, respectively. As the
study was conducted within the dyad, each questionnaire was
coded with a researcher-assigned identification number to
match nurses’ responses with their immediate supervisors’
evaluations. To ensure confidentiality, respondents were
instructed to seal completed questionnaires in the self-ad-
dressed envelopes and send them directly to the researchers.
Measurements
After following Brislin’s (1986) recommendations
with regard to ensuring the accuracy and conceptual
equivalence of both the Chinese and English versions, all
question items in this study were translated and back-
translated by bilingual native speakers of both languages.
Leader-member exchange
The 11 items on the “LMX Questionnaire” developed
by Liden and Maslyn (1998) were adopted for use in this
study. A 5-point rating scale was used to evaluate nurses’
perceptions of LMX quality.
Organizational citizenship behavior
The 20-item organizational citizenship behavior
questionnaire developed by Farh, Podsakoff, and Lin
(1997) was adopted for this study. This questionnaire was
designed specifically for participants in ethnic Chinese
societies. A 5-point rating scale was used to evaluate the
frequency of nurses demonstrating OCB.
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J. Nursing Research Vol. 16, No. 4, 2008 Chun-Hsi Vivian Chen et al.

Trust of the questionnaire in this study and Cronbach’s a value

The 6-item trust questionnaire developed by Podsakoff,
MacKenzie, Moorman, and Fetter (1990) was adopted for
this study. A 5-point rating scale was used to evaluate the
level of nurses’ trust in their head nurses.
Supervisor support
The 7-item questionnaire for evaluating perceived
supervisor support developed by Tsui, Pearce, Porter, and
Tripoli (1997) was adopted for this study. A 5-point rating
scale was used to evaluate nurses’ level of perceived head
nurse support.
Reliability
Cronbach’s a value was adopted to verify collected
data reliability. Result are regarded as highly reliable when
Cronbach’s a values range from .70 to .98. Values lower
than .35 imply that results are unacceptable (Wortzel, 1979).
The Cronbach’s a for each variable in the current study
ranged from .84 to .91, indicating that data is highly reliable.
Cronbach’s a values for variables are presented in Table 1.
was used to examine the reliability. Based on the GFI, CFA
was conducted to test questionnaire validity. In order to
understand relationships between variables, Pearson’s pro-
duct-moment correlation was utilized to evaluate the cor-
relations between variables in this study. Finally, LISREL
8.0 path analysis was used to verify study hypotheses.
Results
Sample Structural Characteristics
A survey was adopted in this study for data collection
in accordance with the aforementioned research objectives
and hypotheses. The majority of participants were nurses
from medical centers and regional hospitals. Respondents
were all female and most were single (66.5%), held a college
degree (56%), and were between 20 and 30 years of age
(62.5%). Most had less than 10 years of work experience
(77%) and presently served in a medical center (72.5%).
Descriptive demographic data are illustrated in Table 2.

Validity
Confirmatory factor analysis (CFA) was adopted to Table 2.
Tabulated Statistics for Nurses (N = 200)
examine the goodness-of-fit index (GFI) value for each con-
struct. It has been argued that GFI values from .80 to .89 indi- Item n %
cate a fair fit, while values over .90 indicate a good fit (Jöreskog Education
& Sörbom, 1988). In this study, the GFI for each construct High school or below 29 14.5
College 1120 56.0
ranged from .86 to .94, indicating good convergent validity Bachelor or above 59 29.5
for each construct. GFI values are presented in Table 1.
Age
< 30 years 1250 62.5
30-39 years 59 29.5
Table 1.
40-49 years 09 04.5
Reliability and Validity Among Latent Variables
³ 50 years 05 02.5
Variables Items Cronbach’s a GFI Missing 02 01.0
LMX 11 .91 .89 Marital Status
Trust 06 .90 .94 Single 1330 66.5
Support 07 .86 .91 Cohabitating 02 01.0
Married 61 30.5
OCB 20 .84 .86
Widowed 04 02.0
Note. LMX = leader-member exchange; OCB = organizational Tenure
citizenship behavior. < 10 years 1540 77.0
10-19 years 33 16.5
20-29 years 11 05.5
Data Analysis ³ 30 years 01 00.5
The population distribution of variables for samples missing 01 00.5
in this study was first analyzed and presented in terms of Associated Hospital
percentage, mean, and standard deviation. In addition, Medical center 1450 72.5
Regional hospital 55 27.5
internal consistency analysis was performed for each facet

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Leadership, Trust, and Nurses’ OCB J. Nursing Research Vol. 16, No. 4, 2008

Correlation Analysis Trust

To understand correlations among LMX quality, the .393** .372**
level of trust nurses have in their supervisors, perceived LMX OCB
supervisor support, and OCB, a matrix of correlation coef-
ficients in this study was produced (see Table 3). Accord- .611** Supervisor .312**
ing to Kerlinger and Lee (2000), a perfect positive relation Support
is present when r = +1.0. That is, the correlation between
-.041
variables is rather significant when the r value approxi-
mates 1.0. In this study, all correlation coefficients were Figure 1. Estimated path coefficients of the hypothesized
model. LMX = leader-member exchange; OCB = organiza-
less than .7, indicating that collinearity was not a problem
tional citizenship behavior. **p < .01.
among these variables.

Structural Equation Modeling Discussion

In this study, tests for the goodness-of-fit index
conformed to the criterion suggested by researchers. The first key finding of this study is that the quality of
Therefore, the model proposed in this study had a good LMX has an apparent effect on level of nurse trust in their
fit (Table 4). Path analysis results for proposed hypothe- immediate supervisors. As argued by Dienesch and Liden
ses are illustrated in Figure 1. It was found that LMX has (1986), supervisors will categorize their subordinates into
a significant and positive effect on the level of nurses’ either an “out-group” or “in-group” based on mutual
trust in and perceived support from their head nurse. understanding and the level of mutual trust and contribu-
Such a finding supported both H1 and H2. In addition, tion. Brower, Schoorman, and Tan (2000) also maintained
both had significant and positive effects on nurse OCB, that a good LMX is related to a high level of trust, support,
which supported H3 and H4. Moreover, it was found that and relatively frequent interaction among supervisors and
LMX has an indirect effect on nurse OCB through the subordinates. This study confirmed that high LMX quality
mediation of nurses’ trust in and perceived support from can lead to greater nurse trust in their head nurse. Due to
head nurses. Therefore, H5 and H6 were supported as limited managerial resources and time, immediate super-
well. visors typically will select certain subordinates as “trusted
aides” to foster better exchange relationships. Whether
assisting the work of subordinates or balancing their
Table 3. work-life conflicts, these “trusted aides” or “in-group”
Intercorrelations Between Latent Variables (N = 200) members perceive more supervisor support than those
Variables M SD 1 2 3 4 from the “out-group.” According to Murphy, Wayne,
1.LMX 3.91 0.45 1
Liden, and Erdogan (2003), subordinates who are in good
2.Trust 4.21 0.49 .532** 1 exchange relationships tend to receive more desirable
3.Support 4.23 0.45 .637** .671** 1 assignments, rewards, and greater support from their
4.OCB 4.40 0.25 .076** .544** .546** 1 supervisors. This study verified that the quality of exchange
**p < .01. relationship between head nurse and nurses affects per-
ceived supervisor support for nurses.

Table 4.
Overall Model Fit
Index Cited Admissibility Result yes/no
c /df
2
Schumacker & Lomax (1996) 1.00-5.00 2.45 yes
GFI Jöreskog & Sörbom (1988) > .80 0.88 yes
CFI Bentler (1990) > .90 0.90 yes
RMSEA Browne & Cudeck (1993) < .10 0.08 yes
Note. GFI = Goodness-of-fit index; CFI = Comparative-fit index; RMSEA = Root mean square error of approximation.

325
J. Nursing Research Vol. 16, No. 4, 2008
Little was known about the underlying psychological
process regarding the positive outcomes resulting from the
exchange process between supervisor and subordinate
(Dam, Oreg, & Schyns, 2008). This study helped to fill this
void by extending the understanding of the effects of the
social exchange process and norms of reciprocity on orga-
nizational citizenship behavior. We verified that LMX
indirectly affects nurse OCB through their trust in the head
nurse and perceived supervisor support. Ehigie and
Otukoya (2005) argued that employees’ perceived mana-
gerial support has a positive effect on their OCB. That is,
subordinates engage in more OCB as they gain more sup-
port from their supervisors. Rather than being affected
directly by the exchange relationship, nurse OCB is pro-
moted through the elevation of trust in their head nurse and
support from them. Despite the fact that nurse work-shift
schedules are arranged by their supervisor, nurses typically
have little opportunity to share a shift with the head nurse
(due to the three-shift system). Because of such, it is rather
difficult for nurses to have a high quality exchange rela-
tionship with their head nurse. Also, the tasks of nurses in
different departments differ, as do their respective work
loads. As a result, the work load of nurses also affects their
interactions with head nurses, which in turn affects the
exchange relationship.
Implications and Conclusions
Study findings offer some useful tips on perfor-
mance improvement for nursing practitioners. Supervi-
sors should do their best to maintain a high quality
exchange relationship with their nurses. This can be
accomplished by sharing emotions, loyalty, and contri-
butions with their nurses, which will eventually improve
nurse trust and perceptions of supervisory support.
Moreover, trust is an essential bond for organizations in
order to have members respond promptly to all situa-
tions in a changing environment driven by service
demands and technology (Lauren, 2005). In fact, super-
visors must endeavor to cultivate organizational trust
and a supportive climate that will enhance reciprocity
among nurses to voluntarily take on extra-role responsi-
bilities. Therefore, with good interaction, a benign cycle
will be formed, which will not only enhance nurse com-
mitment to the medical institution and reduce turnover,
but also promote their organizational citizenship behav-
ior by taking on extra-role responsibilities to improve
collective effectiveness.
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Chun-Hsi Vivian Chen et al.
Limitations and Future Research
The findings of this study are subject to several limita-
tions. First, study samples were limited to nurses in three
medical centers and three regional hospitals. The generaliza-
tion of the findings thus might be limited. In addition, to avoid
common method variance, we requested that head nurses
evaluate nurses’ OCBs. However, the different scales of each
medical institution mean that nursing staff management prac-
tices may differ, which would affect head nurse evaluation
results. Based on the law of large numbers and the central
limit theorem, this research tried to minimize the potential
interference of evaluators’subjectivity by making head nurses
responsible for evaluating OCBs for multiple nurses under
their authority. Hence, evaluation results may differ slightly
from those done using the traditional one-on-one method.
Several suggestions recommended for future research
include: (1) leadership accounts for a significant portion of
the variance in subordinate work-related behavior and
organizational effectiveness. Different leadership concepts
might be explored in future research to broaden and enrich
our knowledge of leadership; (2) investigations could also
be conducted with subjects from different fields for further
verifications; and (3) this study was conducted in a cross-
sectional fashion. Longitudinal studies for future research
would be conducive to our further understanding of the
leadership dynamics in organizations.
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領導、信任與護理人員之組織公民行為 J. Nursing Research Vol. 16, No. 4

領導−部屬交換關係、信任、主管支持對
護理人員組織公民行為之影響
陳春希 王世融* 張緯杰** 胡清信***

摘 要： 本研究主要由社會交換理論的觀點探討醫療產業組織中，護理人員之領導−部屬交換
關係（leader-member exchange, LMX）是否會提升部屬對直屬上司的信任與知覺支
持的程度，進而促使部屬在組織公民行為（organizational citizenship behavior, OCB）
上的展現。本研究以 3 家醫學中心和 3 家區域教學醫院之護理長與護理人員為主要
研究對象，總共回收 200 對（主管−部屬）有效問卷。研究結果發現護理長和護理人
員兩者的交換關係品質，與護理人員對護理長的信任與所知覺的主管支持程度皆呈
現正向關係。此外，護理長和護理人員兩者的交換關係品質，會透過護理人員對於
護理長的信任與知覺主管支持程度的提升，進而促使其展現組織公民行為。本研究
的管理意涵顯示良好的主管與部屬的交換關係品質，不僅會增強護理人員對於組織
的承諾，降低其離職意願，並且使之主動展現組織公民行為，進而改善組織的整體
效能。

關鍵詞： 領導−部屬交換關係、信任、主管支持、組織公民行為。

國立中央大學企業管理學研究所助理教授 *長榮大學生物科技學系助理教授 **國立中央大學企業管理學

研究所博士生 ***慧榮科技股份有限公司業務部主任
受文日期：97 年 6 月 2 日 修改日期：97 年 8 月 1 日 接受刊載：97 年 9 月 23 日
通訊作者地址：陳春希 32001 桃園縣中壢市中大路 300 號

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