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JONA Volume 34, Number 3, pp 111-113 2004, Lippincott Williams & Wilkins, Inc.

Leadership and Retention


Research Needed
Carol S. Kleinman, PhD, RN
Numerous studies provide empirical support for the relationships between effective leadership style and job satisfaction, retention, and organizational productivity. The intent of this article is to provide a synthesis of data-based studies that have evaluated the relationship between the leadership behaviors of nurse administrators and staff nurse retention. Understanding the current state of knowledge regarding leadership and staff nurse retention provides a foundation for directing future research efforts. among nurse executives3-5 and nurse managers.4,6 These studies also reveal that nursing leaders use a combination of transformational and transactional leadership behaviors in their management roles. This combination of transformational and transactional leadership behaviors is consistent with observations by Bass7 about the styles of effective leaders. Other leadership styles that have been studied to a lesser extent in the nursing literature include laissezfaire5 and management by exception, which can be either active or passive.5,8 Laissez-faire leadership is characterized by avoidance behaviors, in which the leader does not actively participate in the leadership process, ie, the leader avoids making decisions and is not available to staff.9 Whereas active management by exception is characterized by behaviors that focus on negative staff performance as a motivator for improvement, passive management by exception embodies avoidance behaviors coupled with the impetus to respond only to negative staff performance issues.9 LEADERSHIP STYLE AND JOB SATISFACTION An enduring body of literature supports the relationship between the effective leadership styles of nurse executives and managers and staff nurse job satisfaction.4-6,10-12 Effective leadership characteristics that have long been identified as significant contributors to staff nurse job satisfaction include providing open discussion, considering the ideas of others, being available, maintaining high performance standards, and promoting strong employee relationships.10,13,14 As depicted in a causal model of staff nurses intentions to remain in their jobs, a leadership style providing consideration for staff had a direct effect on group cohesion. Group cohesion was then identified as having a direct effect on staff nurse job satisfaction.12 Within the context of assessing transformational and transactional leadership characteristics of nurse administrators, staff nurse job satisfaction has repeatedly been positively correlated with transformational leadership behaviors.4-6,11 As previously discussed, transformational leadership behaviors are the characteristics most predominantly embodied by effective leaders. JOB SATISFACTION AND RETENTION Lu et al15 provided impressive evidence from their large-scale study of job satisfaction and turnover in a sample of hospital staff nurses (N 2,197). Job satisfaction was found to be positively associated with professional commitment and negatively associated with job-change intentions. These findings were consistent with the work of Shader et al16 in their study to determine the factors that contribute to staff nurse job satisfaction and turnover in an academic medical cen-

RESEARCH REFLECTIONS

THE CONCEPT

OF

LEADERSHIP

During the past 20 years, nurses have studied leadership primarily in the context of the transformational and transactional behaviors of nurse executives and nurse managers. The concept of transformational leadership, developed by Burns,1 describes transformational leaders as instilling pride and motivation, sharing a vision of the direction of an organization, and demonstrating open consideration of employee ideas. In contrast to transformational leadership behaviors, transactional leadership characteristics are described as being centered on day-to-day operations,1 with employee motivation accomplished through economic rewards in exchange for services.2 Researchers have consistently identified the predominance of transformational leadership behaviors

RELATIONSHIPS AMONG LEADERSHIP STYLE, JOB SATISFACTION, AND RETENTION


Upon examining the data-based research studies assessing leadership behaviors and staff nurse retention, three related content areas emerged in the literature. The content areas include relationships between leadership style and job satisfaction, job satisfaction and staff nurse retention, and leadership style and staff nurse retention. These parallel investigations provide the foundation for understanding the impact of effective leadership in enhancing staff nurse job satisfaction and retention.

Author affiliation: Associate Professor and Director of Health Systems Administration Programs, Seton Hall University College of Nursing, South Orange, NJ. Correspondence: Seton Hall University College of Nursing, 400 South Orange Avenue, South Orange, NJ 07079 (drcsk@ optonline.net).

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ter. Results from that study reflected that job satisfaction was associated with lower anticipated staff nurse turnover. Predictors of anticipated turnover included lower job satisfaction, required weekend overtime, job stress, and lack of group cohesion among staff members. Interestingly, there were no predictors of anticipated turnover among staff nurses older than 51 years. Perhaps older nurses are less susceptible to the predictors that influence younger nurses. Alternatively, older nurses may be motivated more by factors that influence their desire to remain in their jobs, such as salary, seniority, pension, and unit assignment, than by those that may influence their desire to leave. In a comprehensive study funded by both the National Institute for Nursing Research and the Agency for Healthcare Research and Quality, Aiken et al17 surveyed more than 10,000 nurses in more than 300 hospitals in the United States, Canada, England, and Scotland. Compelling evidence was found that organizational and managerial support was strongly related to staff nurse satisfaction and retention. Perhaps the most accurate illustration of the relationship between job satisfaction and staff nurse intention to stay in the job was described by the causal modeling work of Boyle et al.12 Their work suggested that administrative leadership characteristics indirectly affected staff nurse job satisfaction. Based on further analyses, job satisfaction was found to explain 10% of the variance in staff nurse intention to stay. It is abundantly clear that, collectively, researchers have identified a consistent link between staff nurse job satisfaction and retention. LEADERSHIP STYLE AND RETENTION From a historical perspective, in the mid-1980s to the early 1990s, evidence demonstrated that effective leadership skills enhanced job satisfaction10,13,18 and that excellent nurse executives demonstrated a predominantly transformational leadership style.3 It was not until the work by Volk and Lucas19 that the relationship between management style and anticipated staff nurse turnover was examined by nurse researchers. Since that time, a strong body of evidence has been developing. The works of McDaniel and Wolf,4 Taunton et al,20 and Shobbrook and Fenton21 and research from magnet hospitals22 have all contributed to an understanding of the significant association of effective leadership characteristics and staff nurse retention. teristics than were those without advanced education.3,5 As evidenced in the 1990 study by Dunham and Klafehn,3 doctorally prepared subjects were perceived as having a significantly higher frequency of transformational leadership behaviors when compared with subjects without doctoral degrees. Interestingly, subjects with masters degrees in nursing were reported to demonstrate a significantly higher frequency of transformational leadership behaviors than were subjects with non-nursing masters degree preparation.

MEASURING LEADERSHIP
Nurse researchers studying the leadership behaviors of nurse executives and nurse managers have predominantly used the Multifactor Leadership Questionnaire (MLQ).9,23 The almost exclusive use of the MLQ in nursing research explains the rationale for the historical trend of examining leadership behaviors from a transformational and transactional perspective as the early work by Bass,2 Bass and Stodgill,24 and Bass and Avolio25 built on the work of Burns1 and examined the organizational impact of the two leadership styles. One particularly advantageous feature of the MLQ is that staff nurses are able to rate the leadership behaviors of their nurse managers and administrators while allowing nurse managers and administrators to rate themselves using the same scales. Based on a review of MLQ studies in nursing, two particularly revealing findings appear important in laying the groundwork for future leadership research. First, nurse managers and administrators self-rated the frequency of their own transformational and transactional leadership behaviors consistently higher than did staff nurses who were rating the frequency of leadership behaviors demonstrated by the nurse managers and administrators.3-5 Second, nurse administrators with graduate degrees were perceived as exhibiting more transformational leadership charac-

RECOMMENDATIONS FOR FUTURE RESEARCH


Additional research in this area is needed to increase understanding of how to develop and foster effective leadership styles among nursing executives and managers. Among several areas for potential research, the need for interventional study is of primary importance. Although the relationship between effective leadership styles and staff nurse retention has been widely studied, it remains unclear how to fully develop effective leadership characteristics among nurse executives and managers. The current state of knowledge does not reflect a systematic study of strategies for enhancing the leadership characteristics among those in nursing management. It is not clear how to intervene to further develop the leaders with positive leadership characteristics and how approaches should differ to develop the managers with ineffective styles. The current understanding of the relationship between graduate education and the higher frequency of transformational leadership characteristics3,5 suggests graduate education may contribute to the development of effective leadership characteristics. It may not be feasible to expect all nursing management personnel to obtain graduate degrees; therefore, studies are needed to ex-

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plore the effectiveness of various leadership training mechanisms. Leadership training and graduate education must be examined from a comparative approach to determine how to best prepare nursing leaders. Research is also needed that builds upon the work of Dunham and Klafehn.3 Are there differences in the leadership content taught in nursing and non-nursing graduate programs? If graduates of masters degree programs in nursing are more effective leaders, this may provide beneficial information regarding the development of graduate programs and the counseling of prospective students. Importantly, do differences in graduate degree preparation translate into different job satisfaction and retention outcomes among nursing staff under the leadership of nursing and nonnursing masters degree graduates? Predictors of the desire to leave their jobs have already been identified for younger nurses, although the predictors did not hold true for nurses older than 51 years. It would be both interesting and of importance to study older nurses to identify factors that are predictors of the desire to remain. Perhaps such conditions for older nurses may provide a direction for initiatives with younger nurses to decrease turnover in the younger group. A final recommendation would be for the use of other leadership measurement instruments. It is not clear which leadership measurement tools, beyond the ubiquitous MLQ, may provide a more comprehensive evaluation of the leadership concept and leadership styles and behaviors. Huber et al26 have developed a comprehensive evaluation of several types of instruments for use in nursing administration research. The instruments included in their evaluation provide several tools for the measurement of leadership and other aspects of nursing management.

SUMMARY
The evidence is clear that effective nursing leaders can enhance staff retention. Effective nurse administrators have often been described as more frequently demonstrating transformational leadership behaviors. From an interventional perspective, future research is needed to examine how to best develop effective leaders in nursing.

REFERENCES
1. Burns JM. Leadership. New York: Harper & Row; 1978. 2. Bass BM. Leadership and Performance: Beyond Expectations. New York: Free Press; 1985. 3. Dunham J, Klafehn KA. Transformational leadership and the nurse executive. J Nurs Adm. 1990;20(4):28-34. 4. McDaniel C, Wolf GA. Transformational leadership in nursing service: a test of theory. J Nurs Adm. 1992;22 (2):60-65. 5. Dunham-Taylor J. Nurse executive transformational leadership found in participative organizations. J Nurs Adm. 2000;30(5):241-250. 6. Medley F, Larochelle DR. Transformational leadership and job satisfaction. Nurs Manag. 1995;26(9):64jj-64mm. 7. Bass B. Transformational leadership: Industry, Military, and Educational Impact. Mahwah, NJ: Lawrence Erlbaum Associates; 1998. 8. Stordeur S, Dhoore W, Vandenberghe C. Leadership, organizational stress, and emotional exhaustion among hospital nursing staff. J Adv Nurs. 2001;35(4):533-542. 9. Bass B, Avolio B. MLQ Multifactor Leadership Questionnaire. 2nd ed. Redwood City, CA: Mind Garden, Inc; 2000. 10. Gray-Toft PA, Anderson JG. Organizational stress in the hospital: development of a model for diagnosis and prediction. Health Services Res. 1985;19(6):753-774. 11. Morrison RS, Jones L, Fuller B. The relations between leadership style and empowerment on job satisfaction of nurses. J Nurs Adm. 1997;27(5):27-34. 12. Boyle DK, Bott MJ, Hansen HE, et al. Managers leadership and critical care

nurses intent to stay. Am J Crit Care. 1999;8(6):361-371. 13. Kramer M, Schmalenberg C. Job satisfaction and retention. Insights for the 90s. Nursing 91. 1991;3:50-55. 14. Patrick S. Managers shoulder burden of retaining staff: turnover more common in a competitive market. [Electronic version]. Dallas Business Journal. August 11, 2000. 15. Lu KY, Lin PL, Wu CM, et al. The relationships among turnover intentions, professional commitment, and job satisfaction of hospital nurses. J Prof Nurs. 2002;18(4):214-219. 16. Shader K, Broome ME, Broome CD, et al. Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. J Nurs Adm. 2001;31(4):210-216. 17. Aiken LH, Clarke SP, Sloane DM. Hospital staffing, organization, and quality of care: cross-national findings. Int J Qual Health Care. 2002;14(1):5-13. 18. Kramer M. The magnet hospitals: excellence revisited. J Nurse Adm. 1990; 20(9):35-44. 19. Volk MC, Lucas MD. Relationship of management style and anticipated turnover. Dimensions of Critical Care. 1991;10(1):35-40. 20. Taunton RL, Boyle DK, Woods CQ, et al. Manager leadership and retention of hospital staff nurses. West J Nurs Res. 1997;19(2):205-226. 21. Shobbrook P, Fenton K. A strategy for improving nurse retention and recruitment levels. Prof Nurs. 2002;17(9): 534-536. 22. Scott JG, Sochalski J, Aiken L. Review of magnet hospital research. J Nurs Adm. 1990;29(1):9-19. 23. Bass BM, Avolio BJ. Developing Potential Across a Full Range of Leadership: Cases on Transactional and Transformational Leadership. Mahwah, NJ: Lawrence Erlbaum Assoc.; 1990. 24. Bass BM, Stodgill RM. Bass and Stodgills Handbook of Leadership: Theory, Research, and Managerial Applications. New York: Free Press; 1990. 25. Bass BM, Avolio BJ. Improving Organizational Effectiveness Through Transformational Leadership. Thousand Oaks, CA: 1993. 26. Huber DL, Maas M, McCloskey J, et al. Evaluating nursing administration instruments. J Nurs Adm. 2000;30(5): 251-272.

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