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179NURSING ECONOMIC$/July-August 2006/Vol. 24/No. 4

T HE LEADERSHIP SKILLS and abilities of nurse managers have long been recognized as making a critical contri-

bution to the smooth operation of inpatient units and the success of acute care hospitals. Their leader- ship role is increasingly gaining attention in relation to their contri- butions to staff attitudes and rela- tionships. The first-line nurse man- ager is positioned in close proximi- ty to the work itself and to the nurs- ing staff engaged in patient care. Thus, the way the manager imple- ments the leadership role can have a significant impact on the work envi- ronment and organizational com- mitment. The nurse manager who positively influences the work envi- ronment and fosters the staff’s orga- nizational 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 well- defined. This research clarifies the link between the nurse manager’s use of transformational and transac- tional leader behaviors and the development of organizational com- mitment by registered nurse staff.

Many of the complex demands faced by today’s health care leaders at the top of the organization are

Nurse Managers as Transformational and Transactional Leaders

ELAINE McGUIRE, PhD, MBA, RN, CNAA- BC, 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.

Executive Summary � In an era when nurse man-

agers are both critical to and responsible for retention and performance, leadership style is critical to achieve both out- comes.

� Transformational leaders move beyond the management of transaction to motivate per- formance beyond expecta- tions through the ability to influence attitudes.

� In a comparison of nurse man- ager and staff nurse assess- ments of leadership style, nurse managers rated them- selves as more transforma- tional than their staff per- ceived.

� Staff nurses who perceived their manager as more trans- formational also demonstrat- ed a higher organizational commitment.

� While transformational lead- ers are more effective, nurse manager performance stan- dards are often rooted in transactional characteristics.

� Nurse managers can be taught transformational lead- ership skills including estab- lishing clear expectations, cre- ating a shared vision, and ulti- mately inspiring stronger organizational commitment.

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 perfor- mance. The “falling dominoes effect” discovered by Bass, Waldman, Avolio, and Bebb, (1987) supports 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 cas- cading 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 trans- action. This dual leadership influ- ence raises questions about organi- zational commitment and the role and placement of the leader. How does organizational commitment

Elaine McGuire Susan M. Kennerly

C E ONTINUING

DUCATION SERIES CE Objectives and Evaluation Form appear on page 186.

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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 influ- ence of nurse manager’s transfor- mational and transactional leader- ship 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 posi- tions in the health care organiza- tion (McDaniel & Wolf, 1992; Stordeur, Vandenberghe, & D’hoore, 2000). A decrease in the availabili- ty 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 execu- tives has been re-examined to bet- ter 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 orga- nizational leadership are focused on recruiting, retaining, and moti- vating staff and ensuring patient safety. The nurse leader’s role is pivotal to achieving these out- comes and to rebuilding the trust and respect that staff must have in managers at all levels of the organi- zation (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 environ- ments must be in place to attract and retain staff (Walters, 2005). The current shortage of RNs at the bed- side magnifies the importance of having strong, clear, supportive, and inspirational leadership across the health care organization.

The interdependence of man-

leaders who were admired and trusted and expended specific effort to meet the follower’s needs and wants.

Figure 1 depicts the relation- ship that develops between follow- er and organization when a partic- ular leadership style predominates (McGuire, 2003). For example, when a transformational leader demonstrates charismatic behav- iors and uses inspirational motiva- tion 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 per- formance, and organizational com- mitment. Leaders who can provide intellectual stimulation can engage followers in more creative problem solving and “out of the box” think- ing to produce results that are more likely to provide the organization a competitive advantage. When transactional components are pre- dominantly used in leading indi- viduals, followers are more likely to engage in behaviors that fulfill contract requirements and place limits on organizational commit- ment and job satisfaction such that the status quo is maintained.

Unlike transformational lead- ership, transactional leadership is a style of leadership focused on con- tingent reward of followers. The transactional leader sets goals, gives directions, and uses rewards to reinforce employee behaviors associated with meeting or exceed- ing established goals. Transactional leaders emphasize process in set- ting goals and giving directions and strive to compromise, manipulate, and control the situation and fol- lowers. According to Bass (1985), the rewards used by the transac- tional leader include praise and recognition, merit increases, pro- motions, bonuses, or honors. These rewards can be given or withheld according to employee perfor- mance. The ultimate outcome of such contingent reward behavior is enhanced role clarity, job satisfac-

agerial leadership and staff organi- zational commitment has been documented in the literature since as early as the mid-1950s. The exact nature of this interdepen- dence 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 devel- op their own knowledge and abili- ties about leading others and pro- vides the model needed for shap- ing staff commitment and the work environment.

Bass’ Model of the Full Range of Leadership (1998) implies that all leaders display both transfor- mational and transactional charac- teristics, only in differing amounts. Transformational leaders use ideals, inspiration, intellectual stimulation, and individual con- sideration to influence the behav- iors 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 particu- larly noteworthy in their study of 54 top-performing managers.

Transformational leaders stim- ulated follower commitment to a shared vision and goals. Followers were stimulated to approach old problems in new ways. Followers were especially influenced by

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

Leader

Transformational Leadership

• 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-by-

exception (active) • Management-by-

exception (passive)

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

reactive/retrospective

Laissez-faire Leadership

Results in a Competitive Advantage

• Increased loyalty • Increased organizational

commitment • Increased job satisfaction • Increased morale • Increased job performance

Contributes to Organizational Demise

• No decisions made • Responsibilities ignored • No purposeful interactions

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

• A non-transaction • Nothing happens • No followers because

there is no leader

Behaviors

Organizational Outcome

Follower

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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 commit- ment is reflected by a strong value in and acceptance of the organiza- tion’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 character- istics of nurse managers in relation to the organizational commitment of RNs working on their respective unit(s). Each manager’s predomi- nant leadership style was self-iden- tified and then re-examined in con- trast to staff’s perceptions of the leadership style used.

Research Questions

1. What is the relationship be- tween the nurse manager’s self- assessment and the RNs’ assessment of the manager as it relates to transformational and

tion. The sample was predomi- nantly female (94%) and between the ages of 36 and 55. The manage- rial 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 bac- calaureate 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 consist- ed 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 man- ager 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 full- time (68%) positions.

Data Collection

The chief nursing officers of 21 nonprofit hospitals were provided an abstract of the proposed study and a letter requesting their hospi- tal’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 par- ticipate and to invite their staff nurses to do likewise. To become an actual study participant a nurse manager also had to have a mini- mum of five staff nurses participat- ing in this study. Of the 119 nurse managers originally agreeing to join the study, only 63 (53%) met the staff nurse participation requirement.

transactional leadership char- acteristics?

2. What is the relationship between the RNs’ perception of the nurse manager’s transfor- mational and transactional leadership characteristics and the degree of organizational commitment demonstrated by the same RNs?

3. What is the relationship be- tween the self-assessed trans- formational and transactional leadership characteristics of the nurse manager and the degree of organizational com- mitment demonstrated by the RNs reporting to that nurse manager?

Methodology

This descriptive correlational study examined the relationship between two key variables: the leadership style of nurse managers and the organizational commit- ment of staff nurses. Similarities and differences in nurse manager and staff nurse perceptions of leader- ship characteristics were also explored.

Sample

The chief nursing officers of 21 not-for-profit hospitals with greater than 150 beds located in the Midwest region of the country were contacted to obtain permis- sion to include nurse managers of their respective acute care nursing units in the study. Eleven of the 21 eligible hospitals agreed to partici- pate. A convenience sample com- prised 63 nurse managers who had been in their current position for at least 6 months. Each manager had 24-hour accountability and direct- ed, planned, coordinated, and con- trolled the operational activities and personnel for one or more patient care areas. For a nurse man- ager 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 re- flected the general nursing popula-

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All materials, such as cover let- ters, demographic forms, and ques- tionnaires were prepared in advance of site meetings and dis- tributed 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 provid- ed 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 indicat- ed consent to participate. A coding system was employed to preserve anonymity and permit the group- ing 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 Question- naire (MLQ) Form 5X (Bass & Avolio, 2000) was used to measure transformational and transactional leadership characteristics. This 45- item questionnaire with 12 sub- scales uses a frequency rating with scoring that ranges, for this study, from 1 (not at all) to 5 (frequently, if not always). Prior confirmatory fac- tor 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 transfor- mational and transactional leader- ship characteristics. When scored, the resulting values indicate the leadership characteristics most fre- quently 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-assess- ment, while the staff nurses used the rater form to assess the leader- ship characteristics of their man- agers.

The organizational commit- ment of the staff nurse participants was measured using the Organi- zational Commitment Questionnaire

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 mea- sures of a transactional nature, such as productivity, cost manage- ment, and policy compliance, there is little, if any, motivation for exert- ing the efforts necessary to develop transformational characteristics. Conducting research in highly structured military settings led Masi and Cooke (2000) to similar conclusions. Their research indi- cated that the cultural climate found in bureaucracies may inhibit leadership style from influencing unit-level norms (Masi & Cooke, 2000).

Research Question 2. Sig- nificant 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 demon- strated statistically significant cor- relations except for the transaction- al subscale labeled management- by-exception (active). These results were consistent with Transformational Leadership Theory except for the positive correlation (r=0.370) be- tween contingent reward, a trans- actional characteristic, and organi- zational commitment.

Idealized influence, also called charismatic leadership, was the transformational leadership char- acteristic to show the strongest pos- itive correlation (r=0.393, p<0.01) with organizational commitment. Such leaders are admired 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 val- ues. 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 fash- ion in other research studies (Ohman, 2000; Stordeur, D’hoore, &

(OCQ) developed by Porter and Smith (Mowday, Steers, & Porter, 1979). The OCQ is a 15-item, easy- to-complete survey that uses a seven-point Likert-like response scale (strongly disagree to strongly agree) (Cook, Hepworth, Wall, & Warr, 1989). A higher score indi- cates greater organizational com- mitment. Internal consistency reli- ability, test-retest reliability, con- vergent validity, discriminant validity, and predictive validity support the OCQ as a reliable and valid tool. Reliability scores gener- ally 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 lead- ership characteristics. Table 1 pre- sents the descriptive statistics for the MLQ by group. As might be expected, nurse managers rated themselves higher on transforma- tional leadership than did their staff nurses. Managers’ mean scores on the MLQ’s transforma- tional subscales ranged from 3.89 to 4.28, indicating their self-per- ceptions of being highly transfor- mational. Conversely, staff nurses rated their managers to be some- what 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 cor- relational studies.

Findings suggest that nurse managers may struggle somewhat with the concept of transforma- tional leadership. Also, the work environment itself may affect the nurse manager’s ability to fully exercise transformational leader- ship behaviors. Hospitals and health care organizations, by nature, tend to be bureaucratic organizations where transforma- tional leadership may not be fos- tered to the greatest degree possible. Philosophically, nurse managers

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Vandenberghe, 2001; Stordeur et al., 2000). Given the current em- phasis health care organizations place on rewards and recognition as a means for retaining staff nurs- es, it is not surprising that contin- gent reward would be positively correlated with staff nurse organi- zational commitment.

Research Question 3. Pearson’s product-moment correlation re- vealed no significant correlation between the nurse manager’s self- assessed leadership characteristics and the degree of organizational commitment demonstrated by their staff nurses. Although some trans- formational characteristics, notably inspirational motivation and intel- lectual stimulation, showed statis- tically 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 sup- ports the concept that although some managers may believe them-

tional commitment is in keeping with Transformational Leadership Theory. Followers tend to be drawn to leaders who are naturally enthu- siastic, optimistic, and can envi- sion 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 Transform- ational Leadership Theory. The leader who possesses this leader- ship 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 identify- ing long-term solutions. This sce- nario may suggest that nurse man-

selves to demonstrate certain lead- ership 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 characteris- tics are identified through self- assessment versus observation, lit- tle can be deduced from this self- examination as it relates to organi- zational commitment of others. Perceptions of one’s own manager- ial 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 inspira- tional motivation and organiza-

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

Table 1. Descriptive Statistics for Measurement Instruments by Group

Nurse Manager Group (n=63) Staff Nurse Group (n=500)

Instrument M SD Range * M SD Range *

MLQ Transformational Subscales:

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

MLQ Transactional Subscales:

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

Additional Subscales:

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

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

Nursing Management Implications

Performance standards for nurse managers require them to be accountable for transactional processes such as budgets, produc- tivity, 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 environ- ment, nurse managers who can effectively handle the transforma- tional/transactional duality of their role are vitally important to the smooth operation of any nursing unit. Since transformational lead- ership characteristics can be taught and learned (Bass, 1998), organiza- tions have a significant opportuni- ty to develop the type of leaders who can positively interact with first-line employees. Nurse execu- tives must be advocates for leader- ship education that emphasizes the four main components of transfor- mational leadership to provide nurse managers with a solid foun- dation 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 inter- ests. 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 responsibil- ities have traditionally included directing, planning, coordinating, and controlling the activities and personnel on one or more nursing

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