2 - Nurse Managers As Transformational And Transactional Leaders 3p3b4y

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ONTINUING DUCATION SERIES

CE Objectives and Evaluation Form appear on page 186.

Elaine McGuire Susan M. Kennerly

Nurse Managers as Transformational and Transactional Leaders Executive Summary 䊳 In an era when nurse managers are both critical to and responsible for retention and performance, leadership style is critical to achieve both outcomes. 䊳 Transformational leaders move beyond the management of transaction to motivate performance beyond expectations through the ability to influence attitudes. 䊳 In a comparison of nurse manager and staff nurse assessments of leadership style, nurse managers rated themselves as more transformational than their staff perceived. 䊳 Staff nurses who perceived their manager as more transformational also demonstrated a higher organizational commitment. 䊳 While transformational leaders are more effective, nurse manager performance standards are often rooted in transactional characteristics. 䊳 Nurse managers can be taught transformational leadership skills including establishing clear expectations, creating a shared vision, and ultimately inspiring stronger organizational commitment.

LEADERSHIP SKILLS and abilities of nurse managers have long been recognized as making a critical contribution to the smooth operation of inpatient units and the success of acute care hospitals. Their leadership role is increasingly gaining attention in relation to their contributions to staff attitudes and relationships. The first-line nurse manager is positioned in close proximity to the work itself and to the nursing staff engaged in patient care. Thus, the way the manager implements the leadership role can have a significant impact on the work environment and organizational commitment. The nurse manager who positively influences the work environment and fosters the staff’s organizational commitment stimulates greater achievement at the unit level and enhances the organization’s competitive advantage. Exactly how this occurs and the nature of the leadership behaviors exercised by the nurse manager is not welldefined. This research clarifies the link between the nurse manager’s use of transformational and transactional leader behaviors and the development of organizational commitment by ed nurse staff. Many of the complex demands faced by today’s health care leaders at the top of the organization are

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also present at the unit manager level. As organizations grow, the distance between the chief nursing officer and the RN staff widens. Nursing staff must increasingly rely on the nurse manager’s clinical expertise and leadership abilities, making the leadership role of the unit manager pivotal to unit performance. The “falling dominoes effect” discovered by Bass, Waldman, Avolio, and Bebb, (1987) s the notion that leadership style and abilities cascade from one level to another in an organization. Acute care hospital nurse staffs experience organizational and unit-based benefits from the cascading effects of leadership at the top. However, the unit-based nurse manager’s close proximity to the work of patient care and day-to-day leadership intervenes in this transaction. This dual leadership influence raises questions about organizational commitment and the role and placement of the leader. How does organizational commitment ELAINE McGUIRE, PhD, MBA, RN, CNAABC, is Vice President, Patient Care Services, and Chief Nursing Officer, TriHealth, Cincinnati, OH. SUSAN M. KENNERLY, PhD, RN, is an Associate Professor, College of Nursing, University of Cincinnati, Cincinnati, OH.

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develop? Where is the leader best positioned in the organization to have an optimal impact on RN staff commitment? What is the influence of nurse manager’s transformational and transactional leadership behaviors on the degree of organizational commitment held by staff?

Review of Literature Most of the research conducted to date has focused on the role of nurse leaders in upper-level positions in the health care organization (McDaniel & Wolf, 1992; Stordeur, Vandenberghe, & D’hoore, 2000). A decrease in the availability of RNs needed to sustain and replenish the current workforce has triggered a new look at the nurse leader’s role throughout the organization. Most recently, the role of nurse managers and executives has been re-examined to better understand which leader is best positioned in the organization to exert the most positive influence on nursing staff relationships (Ohman, 1999). Organizations turn to the leader for solutions to workforce and other resource issues that will help the organization achieve and maintain a competitive advantage. Nursing’s current interests in organizational leadership are focused on recruiting, retaining, and motivating staff and ensuring patient safety. The nurse leader’s role is pivotal to achieving these outcomes and to rebuilding the trust and respect that staff must have in managers at all levels of the organization (Laschinger & Finegan, 2005). Maintaining a positive work environment and building a team effort are key to achieving patient safety (Institute of Medicine, 2004). Positive health care work environments must be in place to attract and retain staff (Walters, 2005). The current shortage of RNs at the bedside magnifies the importance of having strong, clear, ive, and inspirational leadership across the health care organization. The interdependence of man-

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agerial leadership and staff organizational commitment has been documented in the literature since as early as the mid-1950s. The exact nature of this interdependence is still not well understood even though it has been studied from a variety of perspectives in industry, education, and health care situations. As more has been learned about the characteristics of leadership, leadership theory has evolved from Trait Theory in the 1930s to the Contingency and Situational Theories of the 1960s and to Transformational Theory in the 1980s. The early work of Burns (1978), Bennis and Nanus (1985), and Bass (1985) stimulated interest in the concepts of transformational and transactional leadership and the relationship that emerges between leader and follower. The theory of Transformational and Transactional Leadership (Bass, 1985) offers a framework through which managers can further develop their own knowledge and abilities about leading others and provides the model needed for shaping staff commitment and the work environment. Bass’ Model of the Full Range of Leadership (1998) implies that all leaders display both transformational and transactional characteristics, only in differing amounts. Transformational leaders use ideals, inspiration, intellectual stimulation, and individual consideration to influence the behaviors and attitudes of others (Bass & Avolio, 2000). Hater and Bass (1988) were intrigued with the potential impact such a leader could have on the competitive positioning of the organization. The ability of transformational leaders to move followers beyond their own self-interest was particularly noteworthy in their study of 54 top-performing managers. Transformational leaders stimulated follower commitment to a shared vision and goals. Followers were stimulated to approach old problems in new ways. Followers were especially influenced by

leaders who were ired and trusted and expended specific effort to meet the follower’s needs and wants. Figure 1 depicts the relationship that develops between follower and organization when a particular leadership style predominates (McGuire, 2003). For example, when a transformational leader demonstrates charismatic behaviors and uses inspirational motivation to persuade others, that leader is also capable of rousing followers to exert additional effort on behalf of the organization (Bass, 1985). The follower’s positive sense of self-worth and value leads to enhanced job satisfaction, job performance, and organizational commitment. Leaders who can provide intellectual stimulation can engage followers in more creative problem solving and “out of the box” thinking to produce results that are more likely to provide the organization a competitive advantage. When transactional components are predominantly used in leading individuals, followers are more likely to engage in behaviors that fulfill contract requirements and place limits on organizational commitment and job satisfaction such that the status quo is maintained. Unlike transformational leadership, transactional leadership is a style of leadership focused on contingent reward of followers. The transactional leader sets goals, gives directions, and uses rewards to reinforce employee behaviors associated with meeting or exceeding established goals. Transactional leaders emphasize process in setting goals and giving directions and strive to compromise, manipulate, and control the situation and followers. According to Bass (1985), the rewards used by the transactional leader include praise and recognition, merit increases, promotions, bonuses, or honors. These rewards can be given or withheld according to employee performance. The ultimate outcome of such contingent reward behavior is enhanced role clarity, job satisfac-

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Figure 1. The Relationship Between Primary Leadership Style and Organizational Outcome

Leader

Follower Behaviors

• Charismatic • Inspirational motivation • Intellectual stimulation • Individualized consideration

• Shared vision • Increased self-worth/ self-esteem • Challenging/ meaningful work • Coached/mentored • Feels valued

Transactional Leadership

• Contingent reward • Management-byexception (active) • Management-byexception (ive)

• Fulfills the contract • I work/you pay me • Errors are corrected reactive/retrospective

Laissez-faire Leadership

• A non-transaction

• Nothing happens • No followers because there is no leader

Transformational Leadership

Organizational Outcome

Results in a Competitive Advantage

• Increased loyalty • Increased organizational commitment • Increased job satisfaction • Increased morale • Increased job performance

Maintains the Status Quo

• Work is supervised and completed according to specifications • Deadlines are met • Limited job satisfaction for employees • Low to stable levels of organizational commitment

Contributes to Organizational Demise

• No decisions made • Responsibilities ignored • No purposeful interactions

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tion, and improved performance. Laissez faire leadership, as reflected in Figure 1, indicates an absence of leadership. When this leadership style is used, literally nothing happens. Decisions are not made, actions are not carried out, and responsibilities are ignored (Bass, 1998). There is no significant purposeful interaction between the leader and employees, so a group of followers does not form. Laissez faire leadership is ineffective in promoting purposeful interaction and contributes to the organization’s demise. The effective leader achieves a balance between transformational and transactional behaviors, thus creating a leadership style that matches the needs of followers. The leader can then help followers to realize greater individual and organizational achievements (Bass, 1998). Followers who feel more self-confident and involved, have a sense of belonging, and share a common sense of direction tend to emerge as committed and loyal employees of the organization. The strength or degree of this commitment is reflected by a strong value in and acceptance of the organization’s goals and values. There is a readiness to expend considerable effort on behalf of the organization and a strong desire to remain a member of the organization.

Purpose The purpose of this study was to explore the transformational and transactional leadership characteristics of nurse managers in relation to the organizational commitment of RNs working on their respective unit(s). Each manager’s predominant leadership style was self-identified and then re-examined in contrast to staff’s perceptions of the leadership style used.

Research Questions 1. What is the relationship between the nurse manager’s selfassessment and the RNs’ assessment of the manager as it relates to transformational and

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transactional leadership characteristics? 2. What is the relationship between the RNs’ perception of the nurse manager’s transformational and transactional leadership characteristics and the degree of organizational commitment demonstrated by the same RNs? 3. What is the relationship between the self-assessed transformational and transactional leadership characteristics of the nurse manager and the degree of organizational commitment demonstrated by the RNs reporting to that nurse manager? This descriptive correlational study examined the relationship between two key variables: the leadership style of nurse managers and the organizational commitment of staff nurses. Similarities and differences in nurse manager and staff nurse perceptions of leadership characteristics were also explored.

tion. The sample was predominantly female (94%) and between the ages of 36 and 55. The managerial experience of the group showed a wider variation ranging from as few as 6 months to as long as 33 years. The majority of nurse managers (76%) held either a baccalaureate or master’s degree in nursing. Over half (59%) of the nurse managers had operational responsibility for more than one nursing unit and supervised an average of 64 employees. The nurse managers often managed multiple specialty areas and multiple cost centers. The staff nurse sample consisted of 500 RNs who had worked at least 6 months on their current nursing unit. Similarly, this sample was predominantly female (94%) with more than two-thirds of the staff nurses between 36 and 55 years of age. Unlike the nurse manager sample, the majority of the staff nurses (57%) held either a diploma or associate degree in nursing. Seventy-percent worked on the day shift generally in fulltime (68%) positions.

Sample

Data Collection

The chief nursing officers of 21 not-for-profit hospitals with greater than 150 beds located in the Midwest region of the country were ed to obtain permission to include nurse managers of their respective acute care nursing units in the study. Eleven of the 21 eligible hospitals agreed to participate. A convenience sample comprised 63 nurse managers who had been in their current position for at least 6 months. Each manager had 24-hour ability and directed, planned, coordinated, and controlled the operational activities and personnel for one or more patient care areas. For a nurse manager to be a participant in this research, at least 5 of their 15 or more direct-report RN staff also had to agree to participate. The nurse manager sample’s demographic characteristics reflected the general nursing popula-

The chief nursing officers of 21 nonprofit hospitals were provided an abstract of the proposed study and a letter requesting their hospital’s participation. Once each chief nurse agreed that the study could be conducted in their hospital all requirements of the respective facility’s institutional review board were met prior to data collection at 11 participating hospitals. The data collection period extended over 4 months. Local meetings were held with nurse managers to ask them to participate and to invite their staff nurses to do likewise. To become an actual study participant a nurse manager also had to have a minimum of five staff nurses participating in this study. Of the 119 nurse managers originally agreeing to the study, only 63 (53%) met the staff nurse participation requirement.

Methodology

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All materials, such as cover letters, demographic forms, and questionnaires were prepared in advance of site meetings and distributed to the nurse managers. Similar packets were also given to the nurse managers for distribution to their staff nurses who agreed to participate. Each study participant received a cover letter that provided an overview of the study, including the risks and benefits of participation and provisions regarding confidentiality and anonymity. Completion and return of the survey questionnaire indicated consent to participate. A coding system was employed to preserve anonymity and permit the grouping of data in the aggregate.

Measurement Instruments All participants completed a demographic form that included specific questions related to work and organizational factors. The Multifactor Leadership Questionnaire (MLQ) Form 5X (Bass & Avolio, 2000) was used to measure transformational and transactional leadership characteristics. This 45item questionnaire with 12 subscales uses a frequency rating with scoring that ranges, for this study, from 1 (not at all) to 5 (frequently, if not always). Prior confirmatory factor analysis, the goodness of fit index, and reliability scores (Bass & Avolio, 2000) indicated that the MLQ is both a reliable and valid instrument for measuring transformational and transactional leadership characteristics. When scored, the resulting values indicate the leadership characteristics most frequently used and the predominant leadership style. Two versions of the MLQ were used in this study. The leader form was completed by the nurse managers as a self-assessment, while the staff nurses used the rater form to assess the leadership characteristics of their managers. The organizational commitment of the staff nurse participants was measured using the Organizational Commitment Questionnaire

(OCQ) developed by Porter and Smith (Mowday, Steers, & Porter, 1979). The OCQ is a 15-item, easyto-complete survey that uses a seven-point Likert-like response scale (strongly disagree to strongly agree) (Cook, Hepworth, Wall, & Warr, 1989). A higher score indicates greater organizational commitment. Internal consistency reliability, test-retest reliability, convergent validity, discriminant validity, and predictive validity the OCQ as a reliable and valid tool. Reliability scores generally ranged from 0.82 to 0.93 (Mowday et al., 1979).

Findings and Results Research Question 1. This research question addressed the relationship between the nurse managers’ self-assessed leadership characteristics and the staff nurses’ assessment of their manager’s leadership characteristics. Table 1 presents the descriptive statistics for the MLQ by group. As might be expected, nurse managers rated themselves higher on transformational leadership than did their staff nurses. Managers’ mean scores on the MLQ’s transformational subscales ranged from 3.89 to 4.28, indicating their self-perceptions of being highly transformational. Conversely, staff nurses rated their managers to be somewhat more transactional than did the managers themselves. It should be acknowledged, however, that this type of self-report bias is known to sometimes occur in correlational studies. Findings suggest that nurse managers may struggle somewhat with the concept of transformational leadership. Also, the work environment itself may affect the nurse manager’s ability to fully exercise transformational leadership behaviors. Hospitals and health care organizations, by nature, tend to be bureaucratic organizations where transformational leadership may not be fostered to the greatest degree possible. Philosophically, nurse managers

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may be strong proponents of Transformational Leadership Theory, but are unable to demonstrate such leadership characteristics in actual practice. If an organization rewards managers for performance measures of a transactional nature, such as productivity, cost management, and policy compliance, there is little, if any, motivation for exerting the efforts necessary to develop transformational characteristics. Conducting research in highly structured military settings led Masi and Cooke (2000) to similar conclusions. Their research indicated that the cultural climate found in bureaucracies may inhibit leadership style from influencing unit-level norms (Masi & Cooke, 2000). Research Question 2. Significant correlations, ranging from r = 0.393 to -0.202 (p<0.01), were found between the staff nurses’ scores on the MLQ and the OCQ. All subscales on the MLQ demonstrated statistically significant correlations except for the transactional subscale labeled managementby-exception (active). These results were consistent with Transformational Leadership Theory except for the positive correlation (r=0.370) between contingent reward, a transactional characteristic, and organizational commitment. Idealized influence, also called charismatic leadership, was the transformational leadership characteristic to show the strongest positive correlation (r=0.393, p<0.01) with organizational commitment. Such leaders are ired and respected by their followers, and above all are trusted by others (Bass, 1998). Staff nurses are more likely to respond favorably to role models that demonstrate integrity and strong ethical and moral values. Nurses are also more likely to commit to organizations that espouse similar values and have exhibited these values in actions and not just words. Contingent reward was noted in a similar fashion in other research studies (Ohman, 2000; Stordeur, D’hoore, &

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Table 1. Descriptive Statistics for Measurement Instruments by Group Nurse Manager Group (n=63) Instrument

Staff Nurse Group (n=500)

M

SD

Range *

M

SD

Range *

Idealized Influence (A)

3.89

0.59

1.00-4.75

2.90

0.72

0.75-3.75

Idealized Influence (B)

4.12

0.55

2.50-5.00

3.73

0.91

0.50-5.00

Inspirational Motivation

4.13

0.53

2.25-5.00

3.97

0.87

0.75-5.00

Intellectual Stimulation

4.12

0.53

2.25-5.00

3.47

0.99

0.75-5.00

Individualized Consideration

4.28

0.44

3.00-5.00

3.58

1.06

0.00-5.00

Contingent Reward

3.92

0.44

2.75-5.00

3.73

0.99

0.75-5.00

Management-by-Exception (A)

2.67

0.62

1.25-4.25

2.87

0.93

0.50-5.00

Management-by-Exception (P)

2.01

0.58

1.00-3.25

2.14

0.92

0.00-5.00

Laissez-faire

1.80

0.63

1.00-3.25

1.80

0.86

0.50-4.75

Extra Effort

3.86

0.64

1.00-5.00

3.61

1.17

0.00-5.00

Effectiveness

4.13

0.47

2.50-5.00

3.87

1.03

0.00-5.00

Satisfaction

4.18

0.56

1.50-5.00

3.97

1.09

0.00-5.00

MLQ Total Score

160.13

11.88

119.0-180.0

150.98

26.93

63.0-198.0

MLQ Transformational Subscales:

MLQ Transactional Subscales:

Additional Subscales:

* Possible range of scores = 1 (lowest) – 5 (highest)

Vandenberghe, 2001; Stordeur et al., 2000). Given the current emphasis health care organizations place on rewards and recognition as a means for retaining staff nurses, it is not surprising that contingent reward would be positively correlated with staff nurse organizational commitment. Research Question 3. Pearson’s product-moment correlation revealed no significant correlation between the nurse manager’s selfassessed leadership characteristics and the degree of organizational commitment demonstrated by their staff nurses. Although some transformational characteristics, notably inspirational motivation and intellectual stimulation, showed statistically significant (p<0.05) results, the correlations were too weak to draw any inferences (r = 0.0306 and 0.0133 respectively). This lack of correlation s the concept that although some managers may believe them-

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selves to demonstrate certain leadership characteristics, if this belief is not shared by their staff nurses, a difference in perception occurs. This disparity may result from a number of things, including role differences, past work experiences, and previous interactions with other management personnel. Such findings might suggest that when leadership characteristics are identified through selfassessment versus observation, little can be deduced from this selfexamination as it relates to organizational commitment of others. Perceptions of one’s own managerial strengths, talents, or in this case, leadership characteristics, may have little or no relationship to the behaviors demonstrated by those who are direct reports. Although the correlations were too weak to draw any substantive conclusions, the positive direction of the correlation between inspirational motivation and organiza-

tional commitment is in keeping with Transformational Leadership Theory. Followers tend to be drawn to leaders who are naturally enthusiastic, optimistic, and can envision a more attractive future state (Bass, 1998). Intellectual stimulation showed statistically significant results but was negatively correlated with staff nurse organizational commitment (r = -0.111, p<0.01). This finding is not in keeping with Transformational Leadership Theory. The leader who possesses this leadership characteristic would likely challenge direct reports to “think out of the box,” and to use creative problem-solving techniques when confronted with the need to find solutions (Bass, 1998). Given the hectic pace found on most nursing units today, nurse managers may be forced to move from problem to problem with little time for identifying long-term solutions. This scenario may suggest that nurse man-

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agers have become more adept at “putting out fires” on their own rather than engaging staff in reframing questions and approaching problems from a new perspective.

Nursing Management Implications Performance standards for nurse managers require them to be able for transactional processes such as budgets, productivity, and quality monitoring, while at the same time displaying transformational characteristics by acting as coach, mentor, and leader. On the best of days, these job expectations are challenging for even the most experienced nurse managers. To maintain stability in an uncertain health care environment, nurse managers who can effectively handle the transformational/transactional duality of their role are vitally important to the smooth operation of any nursing unit. Since transformational leadership characteristics can be taught and learned (Bass, 1998), organizations have a significant opportunity to develop the type of leaders who can positively interact with first-line employees. Nurse executives must be advocates for leadership education that emphasizes the four main components of transformational leadership to provide nurse managers with a solid foundation for professional growth and development. Nurse managers can be taught how to establish clear expectations and how to challenge staff in a meaningful fashion. By creating a shared vision for the nursing unit, staff nurses become committed to pursuing common goals and interests. Staff nurses will follow the leadership of nurse managers who can inspire and motivate them to perform beyond basic expectations and can engender a sense of team spirit across the nursing unit on all shifts. Nurse manager job responsibilities have traditionally included directing, planning, coordinating, and controlling the activities and personnel on one or more nursing

units. However, today’s hospital environment calls for managers who have the ability and desire to coach and mentor staff (Shiparski, 2005). Transformational leaders prefer to coach staff rather than control their behaviors (Bass, 1998). In doing so, they create a ive climate where individual differences are recognized, two-way communication is promoted, and effective listening skills are valued (Bass, 1998). Nurse executives can play a significant role in guiding and ing nurse managers as their coaching skills develop and mature. This study’s findings validate that transformational nurse leaders promote a higher sense of commitment in their followers. To develop a committed nursing staff, nurse executives should develop, promote, and hire individuals into nurse manager positions who demonstrate a balance of leadership characteristics which are more transformational than transactional. Employing charismatic nurse managers who have high ethical and moral character and integrity and exhibit risk-taking behaviors is an absolute plus at a time when corporate compliance, conflict of interest, and unethical business practices are scrutinized closely. Nurse executives who recruit and retain a committed workforce bring a competitive advantage to their organizations, foster a healthier work environment, and gain a personal sense of accomplishment and success. $ REFERENCES Bass, B.M. (1985). Leadership and performance beyond expectation. New York: The Free Press. Bass, B.M. (1998). Transformational leadership. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. Bass, B.M., & Avolio, B. (2000). Multifactor leadership questionnaire: Technical report. Redwood City, CA: Mind Garden, Inc. Bass, B.M., Waldman, D.A., Avolio, B.J., & Bebb, M. (1987). Transformational leadership and the falling dominoes effect. Group & Organization Studies, 12(1), 73-87.

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Bennis, W., & Nanus, B. (1985). Leaders: Strategies for taking charge. New York: Harper Collins Publishers, Inc. Burns, J.M. (1978). Leadership. New York: Harper & Row Publishers. Cook, J.D., Hepworth, S.J., Wall, T.D., & Warr, P.B. (1989). The experience of work: A compendium and review of 249 measures and their use. New York: Academic Press. Hater, J.J., & Bass, B.M. (1988). Superiors’ evaluations and subordinates’ perceptions of transformational and transactional leadership. Journal of Applied Psychology, 73(4), 695-702. Institute of Medicine (IOM). (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: Author. Laschinger, H., & Finegan, J. (2005). Using empowerment to build trust and respect in the workplace: A strategy for addressing the nursing shortage. Nursing Economic$, 23(1), 6-13. Masi, R.J., & Cooke, R.A. (2000). Effects of transformational leadership on subordinate motivation, empowering norms, and organizational productivity. The International Journal of Organizational Analysis, 8(1), 16-47. McDaniel, C., & Wolf, G.A. (1992). Transformational leadership in nursing service: A test of theory. Journal of Nursing istration, 22(2), 60-65. McGuire, E. (2003). Transformational and transactional leadership characteristics of nurse managers in relationship to the organizational commitment of ed nurse followers. Unpublished doctoral dissertation, University of Cincinnati, Cincinnati, OH. Mowday, R.T., Steers, R.M., & Porter, L.W. (1979). The measurement of organizational commitment. Journal of Vocational Behavior, 14, 224-247. Ohman, K.A. (1999). Nurse manager leadership. Journal of Nursing istration, 29(12), 16, 21. Ohman, K.A. (2000). The transformational leadership of critical care nurse-managers. Dimensions of Critical Care Nursing, 19(1), 46-54. Shiparski, L.A. (2005). Engaging in shared decision making: Leveraging staff and management expertise. Nurse Leader, 3(1), 36-41. Stordeur, S., D’hoore, W., & Vandenberghe, C. (2001). Leadership, organizational stress, and emotional exhaustion among hospital nursing staff. Journal of Advanced Nursing, 35(4), 533-542. Stordeur, S., Vandenberghe, C., & D’hoore, W. (2000). Leadership styles across hierarchical levels in nursing departments. Nursing Research, 49(1), 37-43. Walters, J. (2005). Creating a culture of trust. EN, 102, 18-23.

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