Review
Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

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Abstract

Context

Numerous policy and research reports call for leadership to build quality work environments, implement new models of care, and bring health and wellbeing to an exhausted and stretched nursing workforce. Rarely do they indicate how leadership should be enacted, or examine whether some forms of leadership may lead to negative outcomes. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

Methods

The search strategy of this multidisciplinary systematic review included 10 electronic databases. Published, quantitative studies that examined leadership behaviours and outcomes for nurses and organizations were included. Quality assessments, data extractions and analysis were completed on all included studies.

Findings

34,664 titles and abstracts were screened resulting in 53 included studies. Using content analysis, 64 outcomes were grouped into five categories: staff satisfaction with work, role and pay, staff relationships with work, staff health and wellbeing, work environment factors, and productivity and effectiveness. Distinctive patterns between relational and task focused leadership styles and their outcomes for nurses and their work environments emerged from our analysis. For example, 24 studies reported that leadership styles focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with higher nurse job satisfaction, whereas 10 studies found that leadership styles focused on tasks (dissonant, instrumental and management by exception) were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

Conclusion

Our results document evidence of various forms of leadership and their differential effects on the nursing workforce and work environments. Leadership focused on task completion alone is not sufficient to achieve optimum outcomes for the nursing workforce. Efforts by organizations and individuals to encourage and develop transformational and relational leadership are needed to enhance nurse satisfaction, recruitment, retention, and healthy work environments, particularly in this current and worsening nursing shortage.

Section snippets

What is already known about the topic?

  • Nursing leadership is called for repeatedly to manage challenging healthcare workplace and workforce issues.

  • Considerable research has examined the relationships between specific leadership styles and practices of nursing leaders and outcomes for the nursing workforce.

What this paper adds

  • Our results point to outcomes patterns that support claims that relationship or people focused leadership practices contribute to improving outcomes for the nursing workforce, work environments and for productivity and effectiveness of healthcare organizations.

  • With little exception, relationally focused leadership practices led to much more frequent and positive outcomes for the nursing workforce and nursing work environments than did other more task focused leadership styles, which included

Search strategy, data sources, and screening

The search strategy included 10 electronic databases CINAHL, Medline, PsychInfo, ABI, ERIC, Sociological Abstracts, Embase, Cochrane, Health Star and Academic Search Premier. Searches included the following keywords – leadership, research, evaluation and measurement – to locate studies published between 1985 and December 2006 (and then updated to May 2009) that examined the outcomes of various styles of nursing leadership. See Table 1 for search strategy.

Inclusion criteria

Titles, abstracts and manuscripts were

Search results

The electronic database search yielded over 34,664 titles and abstracts. Following removal of duplicates, 18,963 titles and abstracts were screened using the inclusion criteria and 1357 manuscripts were retrieved for screening. Of these, 150 manuscripts were specific to nursing leadership and were further sorted into factors associated with developing leadership, outcomes associated with leadership, and the measurement of leadership. Following quality assessment of the 150 nursing studies, 23

Discussion

The findings of this comprehensive review point to a trend in outcomes patterns that support claims that relationship or people focused leadership practices contribute to improving outcomes for the nursing workforce, work environments and for productivity and effectiveness of healthcare organizations. Although similar to findings from Gilmartin and D’Aunno (Gilmartin and D’Aun, 2007), our review adds additional detailed analyses that examine the pattern of leadership styles, (relational or

Conclusion

The findings of this systematic review point to specific leadership approaches that are more effective at achieving positive outcomes for the nursing workforce and for healthcare organizations, than others. Combined with knowledge from other reviews that relational and transformational leadership skills can be learned (Cummings et al., 2008), these results present an important moral imperative to ensure that our healthcare organizations are led by individuals and teams who display relational

Conflict of interest

None declared.

Acknowledgements

Supported by a New Investigator Award, Canadian Institutes of Health Research (CIHR), and a Population Health Investigator award, Alberta Heritage Foundation for Medical Research (AHFMR) to Dr. Greta Cummings.

References (221)

  • R. Aldag et al.

    Measurement of perceived task characteristics

    Psychological Bulletin

    (1981)
  • J.A. Algera

    Task Characteristics

    (1981)
  • N.J. Allen et al.

    The measurement and antecedents of affective, continuance and normative commitment to the organization

    Journal of Applied Psychology

    (1990)
  • D. Ancona et al.

    Bridging the boundary: external activity and performance in organizational teams

    Administrative Science Quarterly

    (1992)
  • J. Antonakis et al.

    An analysis of the full-range leadership theory: the way forward

  • B.B. Arnetz

    Physicians’ view of their work environment and organisation

    Psychotherapy and Psychosomatics

    (1997)
  • B.B. Arnetz et al.

    An instrument for strategic development of the working environment in health care. Practical application defined the problems

    Läkartidningen

    (1995)
  • J.E. Arnetz et al.

    The development and application of a patient satisfaction measurement system for hospital-wide quality improvement

    International Journal of Qualitative Health Care

    (1996)
  • B.J. Avolio et al.

    Re-examining the components of transformational and transactional leadership using the multifactor leadership questionnaire

    Journal of Occupational and Organizational Psychology

    (1999)
  • B.J. Avolio et al.

    Multifactor Leadership Questionnaire Manual and Sampler Set

    (2004)
  • B.J. Avolio et al.

    Transformational leadership and organizational commitment: mediating role of psychological empowerment and moderating role of structural distance

    Journal of Organizational Behaviour

    (2004)
  • J.G. Baggs et al.

    The association between interdisciplinary collaboration and patient outcomes in medical intensive care

    Heart Lung

    (1992)
  • G.R. Baker et al.

    The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada

    Canadian Medical Association Journal

    (2004)
  • B.M. Bass

    Leadership and Performance Beyond Expectations

    (1985)
  • B.M. Bass

    Multifactor Leadership Questionnaire Manual

    (1987)
  • B.M. Bass
    (1994)
  • B.M. Bass et al.

    Multifactor leadership questionnaire (Form 5X)

    (1991)
  • B.M. Bass et al.

    Multifactor Leadership Questionnaire (Short Form 6S)

    (1992)
  • B.M. Bass et al.

    Improving Organizational Effectiveness through Transformational Leadership

    (1994)
  • B.M. Bass et al.

    The Multifactor Leadership Questionnaire

    (1995)
  • B.M. Bass et al.

    Multifactor Leadership Questionnaire (MLQ): Sampler Set Manual

    (1995)
  • B.M. Bass et al.

    Full Range of Leadership: Manual for the Multifactor Leadership Questionnaire

    (1997)
  • B.M. Bass et al.

    Multifactor Leadership Questionnaire. Technical Report

    (2000)
  • B.M. Bass et al.

    Applied Psychology

    (2003)
  • P. Benner et al.

    Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics

    (1996)
  • L.G. Boleman et al.

    Leadership and management effectiveness: a multi-frame, multi-sector analysis

    Human Resource Management

    (1991)
  • Borrevik, B., 1972. The construction of an OCDQ for academic departments in colleges and universities. Unpublished...
  • A.M. Boström et al.

    Evidence-based practice and determinants of research use in elderly care in Sweden

    Journal of Evaluation in Clinical Practice

    (2007)
  • Boumans, N.P.G., 1990. The work of nurses in general hospitals a study of work aspects and their influence on nurses....
  • N.P.G. Boumans et al.

    Leadership in the nursing unit: relationships with nurses’ well-being

    Journal of Advanced Nursing

    (1993)
  • N.P.G. Boumans et al.

    Working in an intensive or non-intensive care unit: does it make any difference?

    Heart & Lung: Journal of Acute & Critical Care

    (1994)
  • R. Boyatzis et al.

    Resonant Leadership

    (2005)
  • D.K. Boyle et al.

    Managers’ leadership and critical care nurses’ intent to stay

    American Journal of Critical Care

    (1999)
  • A. Brayfield et al.

    An index of job satisfaction

    Journal of Applied Psychology

    (1951)
  • P. Bycio et al.

    Further assessments of Bass's (1985) conceptualization of transactional and transformational leadership

    Journal of Applied Psychology

    (1995)
  • C. Camman et al.

    Assessing the attitudes and perceptions of organization members

  • Canadian Nursing Advisory Committee, 2002. Our health, our future: creating quality workplaces for Canadian nurses....
  • R. Caplan et al.

    Job Demands and Worker Health

    (1975)
  • T. Capuano et al.

    Use of a validated model to evaluate the impact of the work environment on outcomes at a magnet hospital

    Health Care Management Review

    (2005)
  • S. Carless et al.

    A short measure of transformational leadership

    Journal of Business and Psychology

    (2000)
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