Predictors of transformational leadership of nurse managers

Transcription

1 Journal of Nursing Management, 2017, 25, Predictors of transformational leadership of nurse managers ILIA M. ECHEVARRIA PhD, MS, RN, CCRN, NEA-BC, CENP, CHES 1, BARBARA J. PATTERSON RN, PhD, ANEF 2 and ANNE KROUSE PhD, MBA, RN-BC 3 1 Associate Chief Nursing Officer, NCH Healthcare System, Naples, Florida, 2 Distinguished Professor of Nursing, Associate Dean for Scholarship and Inquiry and 3 Professor of Nursing, Associate Provost for Learning Spaces and Strategic Initiatives, School of Nursing, Widener University, Chester, PA, USA Correspondence Ilia M. Echevarria 2776 Island Pond Ln Naples FL USA Iliarn@comcast.net ECHEVARRIA I.M., PATTERSON B.J. & KROUSE A. (2017) Journal of Nursing Management 25, Predictors of transformational leadership of nurse managers Aim The aim of this study was to examine the relationships among education, leadership experience, emotional intelligence and transformational leadership of nurse managers. Background Nursing leadership research provides limited evidence of predictors of transformational leadership style in nurse managers. Methods A predictive correlational design was used with a sample of nurse managers (n = 148) working in varied health care settings. Data were collected using the Genos Emotional Intelligence Inventory, the Multi-factor Leadership Questionnaire and a demographic questionnaire. Simple linear and multiple regression analyses were used to examine relationships. Results A statistically significant relationship was found between emotional intelligence and transformational leadership (r = 0.59, P < 0.001) explaining 34% variance in transformational leadership. Conclusions Nurse managers should be well informed of the predictors of transformational leadership in order to pursue continuing education and development opportunities related to those predictors. Implications for nursing management The results of this study emphasise the need for emotional intelligence continuing education, leadership development and leader assessment programmes. Keywords: education, emotional intelligence, nurse manager, transformational leadership Accepted for publication: 4 October 2016 Background Throughout the past 15 years, the Institute of Medicine (IOM) has released reports regarding issues of public health; quality and safety; health services coverage and access; and health outcomes, highlighting recommendations for the redesign or improvement of health care services (IOM 2003, 2006, IOM 2012). To respond to these issues, The IOM Future of Nursing report (2010) calls for a change in how leaders respond to health care issues and transform health care, emphasising the need for strong leadership if this vision of a transformed health care system is to be realised. Nurses are expected to assume leadership roles in various settings and are accountable for redesigning and improving health care environments (American Nurses Association 2009). The nurse manager role is one such role, and can be a challenging leadership position. Nurses functioning in this role have a significant impact on many aspects of health care (Shirey et al. 2010). These include establishing a healthy work DOI: /jonm

2 I. M. Echevarria et al. environment; improving staff retention; maintaining sound financial responsibility; and promoting patient safety and quality driven outcomes (American Nurses Association 2009, Zori et al. 2010). A position title alone does not make an individual a leader; it is an individual s behaviour that reflects leadership qualities. Leadership behaviours can make leaders more effective in their roles and can be learned and developed (Packard 2009). Transformational leadership, a component of Bass and Avolio s (1997) Full Range Leadership Model, is a leadership style that has been correlated with positive leadership outcomes and is a desirable leadership style for nurse managers (Robbins & Davidhizar 2007, ANA 2009). Transformational leadership is a process of influencing followers to see challenges in their environment in a new way (Bass & Riggio 2006). The major premise of transformational leadership theory is to motivate the follower to accomplish more than what the follower intended to accomplish (Bass 1999, Bass & Riggio 2006). Transformational leadership comprises five components: idealised attributes (IA), idealised behaviours (IB), inspirational motivation (IM), intellectual stimulation (IS) and individual consideration (IC) (Avolio & Bass 2004). Idealised attributes (IA) or idealised influence (attributes) refers to leaders acting in ways that build others respect, displaying a sense of power and confidence, instilling pride in others and going beyond their self-interest for the good of the group (Avolio & Bass 2004, Avolio 2011). Idealised behaviours (IB) or idealised influence (behaviours) refers to a leader discussing values and beliefs, specifying the importance of having a sense of purpose, and considering the moral and ethical consequence of decisions (Avolio & Bass 2004). Inspirational motivation (IM) is the process by which leaders behave in ways that motivate and inspire those around them (Avolio & Bass 2004, Avolio 2011). Intellectual stimulation (IS) refers to a leader s ability to stimulate their followers to be creative in generating new ideas and creative solutions (Avolio 2011). Individual consideration (IC) refers to a leader providing individual attention to the followers need for achievement and growth by acting as coach, mentor or counsellor (Avolio 2011). The Full Range Leadership Model (Bass & Avolio 1997) comprises two additional leadership styles: transactional leadership, where leaders focus on the day-to-day tasks and reward subordinates for tasks; and laissez-faire leadership which is the near avoidance of leadership. The Full Range Leadership Model purports that every leader displays a frequency of each of the three leadership styles with each leader s profile demonstrating more of one than the other. However, leaders who have been identified as more effective and satisfying to their subordinates possess greater frequency of transformational factors than transactional factors (Avolio 2011). In addition to effective leadership styles and practices, leaders must also possess formal educational preparation and leadership experiences (ANA 2009, O Connor 2011, Rich & Porter-O Grady 2011). Both the American Nurses Association (ANA) (2009) and the American Organization of Nurse Executives (AONE) (2010) have advocated for the formal educational preparation of nurse leaders. The ANA s Nursing Administration Scope and Standards of Practice (2009) suggests that a nurse administrator possess a graduate-level degree in a relevant field of management, nursing, policy or administration with nurses at the highest levels of executive leadership achieving doctoral educational preparation. The AONE (2010) states that nurse leaders should be minimally prepared at the Baccalaureate or Master s level in nursing. Emotional intelligence (EI) is another concept that has been empirically linked to leadership and has been described as a predictor of management and leadership success (Lopes & Salovey 2008, Parker & Sorensen 2008, Mills 2009). Akerjordet and Severinsson (2010) affirmed emotional intelligence as essential for both the science and practice of nursing leadership and suggested that emotional intelligence is a capacity acquired through learning and experience. The American Nurses Association (2009) also discussed the significance of emotional intelligence as an important skill for nurse leaders. Several researchers have found that leaders emotional intelligence explains a high proportion of variance in leadership effectiveness and organisational outcomes (Carmeli 2003, Ozcelik et al. 2008, Mills 2009) as well as in transformational leadership (Brown & Moshavi 2005, Daus & Ashkanasy 2005, Harms & Crede 2010). However, there are studies that contradict these findings, suggesting that emotional intelligence alone is not the sole predictor of transformational leadership. Researchers state additional research is needed to validate the link between emotional intelligence and leader effectiveness (Antonakis 2003, Walter et al. 2011). While transformational leadership has been noted to be linked to leader effectiveness (Bass & Avolio 1997, Bass & Riggio 2006), and identified as a desirable leadership style for nurse managers (Robbins & Davidhizar 2007, American Nurses Association 2009), limited findings in nursing leadership research have 168 Journal of Nursing Management, 2017, 25,

3 Predictors of transformational leadership failed to provide evidence for predictors of transformational leadership qualities of nurse managers (Drake 2010, Kelly et al. 2014). Several professional organisations, as well as researchers, have affirmed that education and experience are vital for how a leader behaves or performs (Barbuto et al. 2007, Cummings et al. 2008, American Nurses Association 2009, Hisar & Karadag 2010), while others argue the importance of emotional intelligence in predicting leader behaviours and performance (Leban & Zulauf 2004, Barbuto & Baurbach 2006, Hawkins & Dulewicz 2007). Further research was needed to explore relationships among empirically linked leadership factors and predictors of transformational leadership in nurse managers. Theoretical framework Imogene King s (1971) Conceptual System and the Theory of Goal Attainment (King 1981) were used to guide this study. Both the conceptual system and Theory of Goal Attainment have been used in nursing to guide decisions in nursing practice, nursing administration and nursing education (Fawcett 2005). The conceptual system was effective in explaining the transformational nurse manager s role within the dynamic system of health care, while major concepts that comprise the Theory of Goal Attainment appropriately link to components of Transformational Leadership Theory (Burns 1978) (Figure 1). Aim The purposes of this predictive correlational study were to examine the relationships among education, leadership experience, emotional intelligence and transformational leadership and to investigate whether education, leadership experience and emotional intelligence predicted transformational leadership of nurse managers. The study sought to explore which variable produced the most variance in transformational leadership. Methods Study design The research questions guiding this study were, what is the relationship between education and transformational leadership? what is the relationship between Nurse Manager Transformational Leadership Conceptual System: Social, Interpersonal, and Personal Systems Leadership experience Level of education Emotional intelligence Theory of Goal Attainment Transaction process concepts: Perception: shaped by education and past experiences (work & personal) Communication: human behaviour that relates person to person and person to environment; and the information component of interactions Interaction: process of perception and communication; influenced by knowledge, needs, goals, experiences, emotional intelligence Transaction: observable behaviours Transformational leadership TL components: Idealised Influence (attributed) Idealised Influence (behaviour) Inspirational Motivation Intellectual Stimulation Individualised Consideration Note: Bolded items are variables measured in the present study Figure 1 Nurse manager transformational leadership (Echevarria, 2015). Journal of Nursing Management, 2017, 25,

4 I. M. Echevarria et al. leadership experience and transformational leadership? what is the relationship between emotional intelligence and transformational leadership? and what are the relationships among education, leadership experience, emotional intelligence and transformational leadership of nurse managers? The hypothesis was that the linear combination of the predictor variables education, leadership experience, and emotional intelligence predict the outcome variable transformational leadership of nurse managers better than any one predictor variable alone. A predictive correlational design was used to explore these relationships. According to Grove et al. (2012), correlational research involves the investigation of relationships between or among two or more variables. Since this study investigated relationships among the variables, without manipulation of the variables, a predictive correlational design was an appropriate design for the study. Sample The target population for this study was nurse managers actively working in varied health care settings. Inclusion criteria were: working full-time, at least one year of nurse manager experience, and direct oversight of one or more departments. Exclusion criteria were: non-full-time, not actively working, less than one year of nurse manager experience, and no departmental oversight. Participants for this study were recruited from the AONE professional organisation using a convenience sampling method. Permission to gain access to AONE members was granted through the AONE Director of Professional Practice after respective research access documents were submitted and reviewed by the AONE. The projected sample size of 130 subjects was calculated using a priori power analysis with a power of 0.80, a medium effect size of 0.13 and a significance level of P < 0.05, and seven predictor variables. A total of 169 participant responses were received. This comprised 83 electronic surveys and 86 paper surveys. The surveys were screened for eligibility and missing data. Twenty-one surveys were eliminated resulting in 148 (87.6%) usable surveys providing an adequate sample size. Of the 21 surveys that were eliminated, 15 were electronic surveys (7 removed for not meeting eligibility, 7 removed for missing data, and 1 removed due to responder bias) and 6 were paper surveys (3 removed for not meeting eligibility and 3 removed for missing data). The final 148 surveys comprised 68 electronic surveys and 80 paper surveys. Data collection Institutional Review Board (IRB) approval was obtained prior to participant recruitment. Data were collected both electronically and through paper and pencil format using three research instruments. The first instrument was the Genos EI Inventory-concise version (Gignac 2010) and was used to measure participant emotional intelligence behaviours. The second instrument, the Multi-factor Leadership Questionnaire (MLQ) (Avolio & Bass 2004), measured the outcome variable, transformational leadership. The third instrument was a researcher developed questionnaire used to collect demographic information, including education and leadership experience from participants. The Genos EI Inventory and the MLQ have been used extensively in research and have acceptable reliability and validity (Avolio & Bass 2004, Palmer et al. 2009). In this study, internal consistency reliabilities for the Genos EI Inventory (a = 0.90, total EI; a = , sub-scales) and MLQ (a = 0.86, total transformational leadership; a = , subscales) were overall found to be acceptable. Two weeks prior to the start of data collection, three pre-survey notifications targeting nurse managers and asking for their participation in the study were disseminated. The first two pre-survey notifications were posted onto the weekly AONE Working for You and enews Update newsletters for members to view. These are electronic newsletters that are ed to all AONE members each Tuesday and Friday respectively by the AONE organisation. The third pre-survey notification was mailed by the researcher through the United States post office to 500 AONE nurse manager members in the form of a postcard. The electronic survey was administered to AONE members through a survey link that was accessible on AONE s Working for You and AONE enews Update newsletters over a 7 week period. One week after the survey was launched, the researcher disseminated a reminder notification through postal mail to the same 500 nurse manager members who received the initial pre-survey notification postcard. The reminder notification contained information highlighting the research study deadline and encouraging completion and submission of the survey. The survey was also administered through paper and pencil. The paper survey was mailed to 500 AONE nurse manager members, approximately 3 weeks after the electronic survey went live. The members who received the paper surveys were the same nurse manager members from the mailing list 170 Journal of Nursing Management, 2017, 25,

5 Predictors of transformational leadership who received pre-survey notification and reminder postcards. Therefore, these targeted members had an opportunity to complete the survey electronically or on paper. Participants were instructed on the informational letter to only take the survey once and return the survey in the enclosed pre-paid envelope provided. Statistical analyses Data were analysed using SPSS for Windows version 20.0 (IBM, Chicago, IL) and examined to determine if assumptions of statistical analyses were met. The statistical methods used to analyse demographic data and answer the research questions were descriptive statistics, Eta correlation, Pearson s correlation and stepwise multiple regression. Additional analyses included independent t-tests, one-way ANOVA and two-way ANOVA. Results The demographic data revealed that females accounted for 87.8% (n = 130) and men accounted for 11.5% (n = 17) of the sample. One participant did not answer the gender question. The ages of participants ranged from 30 to 68 years old (M = 48.86, SD = 8.75). Four participants did not disclose age. The greatest frequency of participants by race was White or Caucasian (n = 136, 91.9%). The majority of participants reported Master s degree as their highest level of education (n = 105, 70.9%) with a MSN in Nursing Administration, Administration or Healthcare Administration accounting for the greatest number in type of Master s degree (n = 43). The second most frequently reported highest level of education was a Bachelor s degree (n = 30, 20.3%). Only 4.7% (n = 7) of participants held a Doctorate, while 2.7% (n = 4) held Associate degrees and 1.4% (n = 2) held Diplomas in nursing. The majority of participants had received leadership training in the previous 2 years (n = 134, 90.5%) and held a professional certification in their specialty (n = 115, 77.7%) (Table 1). Years of experience in leadership and management ranged from 1 to 45 years with a mean of years (SD = 8.60). Participants reported practising in their current nurse manager roles for 1 31 years (M = 7.53, SD = 5.98) (Table 2). An Eta was computed to determine the relationship between education, measured on an ordinal level and transformational leadership, measured on an interval level. Eta, also called a correlation ratio, can be used to measure relationships with all variables, whether Table 1 Descriptive statistics of categorical demographic data (n = 148) Variable and categories Frequency Valid % Gender (n = 147) Female Male Ethnicity/Race (n = 148) White or Caucasian Hispanic or Latino Black or African American Asian American Indian or Alaska Native Other* Highest Level of Education (n = 148) Diploma in Nursing Associate Bachelor Master Doctorate Professional Certification (n = 148) Yes No Leadership Training or Development in the Past 2 Years (n = 148) Yes No Unit Specialty Managed (n = 147) Medical Surgical or Telemetry Other Critical Care Maternal Health Perioperative Behavioural Health *Filipino. Various specialties or specific areas within specialty reported by participants (i.e. neuro critical care, paediatric critical care). Table 2 Descriptive statistics of continuous demographic data (n = 148) Variable n M SD Range Age Years of RN experience Years in current nurse manager role Years worked in current organisation Years of leadership/management experience Number of units managed Number of employees managed nominal or continuous and has been called a universal relationship because it can be used regardless of the form of the relationship (Plichta & Kelvin 2013). Descriptive statistics of education on transformational leadership revealed little variability in mean scores among education groups (Table 3). The Eta 2 revealed no significant differences in transformational leadership among education level groups. Education was not related to transformational leadership (P = 0.738). In order to determine relationships between leadership experience and transformational leadership and emotional intelligence and transformational leadership, Pearson correlations (r) were computed Journal of Nursing Management, 2017, 25,

6 I. M. Echevarria et al. Table 3 Descriptive statistics of education on transformational leadership scores (n = 148) Education group n M SD Diploma in Nursing Associate Bachelor Master Doctorate Total Outcome Variable: Transformational Leadership. (Table 4). Statistical analysis between leadership experience and transformational leadership revealed no significant relationship between the predictor and outcome variable (P = 0.918). Leadership experience was not related to transformational leadership. Statistical analysis for emotional intelligence and transformational leadership revealed that the relationship between the predictor and outcome variable was positive and significant, with moderate correlational magnitude (r = 0.59; P < 0.001). Emotional intelligence was related to transformational leadership and explained 34.8% of variance in transformational leadership mean scores. Multiple regression analysis revealed only one model summary, as predicted based on Pearson correlations, revealing emotional intelligence as the only predictor of transformational leadership when examining all predictor variables (Table 5). Since emotional intelligence was the only predictor of transformational leadership, the null hypothesis was accepted and the research hypothesis was rejected. The linear combination of the predictor variables education, leadership experience and emotional intelligence did not predict the outcome variable Table 4 Correlations between research predictor variables and transformational leadership (n = 148) Variable n r P r 2 Leadership experience ns Emotional intelligence < Significance 2-tailed. Table 5 Stepwise multiple regression model summary of emotional intelligence on transformational leadership Model R R 2 R 2 D F df P Emotional intelligence , Predictors in Model: (constant), EI. transformational leadership better than any one predictor variable alone. Additional analyses were conducted and revealed that females had greater mean scores of EI (M = ) compared with males (M = ) as well as greater mean scores of transformational leadership (M = 69.10) compared with males (M = 63.88). These findings were not significant for mean scores of EI (P = 0.148) but significant for transformational leadership (P = 0.005). It is important to note, however, that the sample size for males (n = 17) compared with females (n = 130) was much lower. The gender imbalance in this study was reflective of the 2013 National Workforce Survey of Registered Nurses which comprised 93% (n = 37686) females and 7% (n = 2679) males, indicating male RNs are under-represented in the workforce (Budden et al. 2013). Pearson correlations revealed a significant relationship between the years of leadership experience and emotional intelligence (r = 0.19, P = 0.023) as well as a significant relationship between years of RN experience and emotional intelligence (r = 0.19, P = 0.024). However, the magnitude of the relationships was very low for both. Years of leadership experience and years of RN experience separately explain only 3.6% variance in EI scores. There was no relationship between age and transformational leadership, however, there was a relationship between age and EI (r = 0.20, r 2 = 0.04, P = 0.017). The magnitude of the relationship was low with age, only explaining 4% of variance in emotional intelligence. Limitations This study had limitations related to sample and instrumentation. All the nurse managers who participated in the study were members of the AONE, possibly skewing the data. The method of recruiting from a professional organisation was ideal in targeting a high volume of nurse managers who met the study criteria. However, the sampling method affected the heterogeneity of the group. The characteristics of the sample revealed a highly homogenous group, comprising White females educated at the Master s level, potentially affecting the findings as well as limiting the generalisability of findings. Additionally, while nurse managers who participated in the survey practised in varied regions and settings across the United States, the researcher was unable to determine practice regions and settings because the demographic questionnaire did not ask participants to disclose locations 172 Journal of Nursing Management, 2017, 25,

7 Predictors of transformational leadership or primary work settings. The ability to capture practice regions and settings may have been useful in providing additional information regarding the study findings. Another limitation to the study was the use of selfrater research instruments to measure emotional intelligence and transformational leadership. Response bias is a concern when using self-rating instruments (Mills 2009). In this study, when analysing descriptive statistics for the research variables, the mean of total scores for both emotional intelligence and transformational leadership were positively skewed for each variable potentially indicating response self-inflation. Conclusion Health care continues to operate in a state of flux that requires effective leadership practices. Transformational leadership has been identified as a desirable leadership style that contributes to employee effectiveness and desirable outcomes in health care environments. This study was conducted to determine the variables that predicted transformational leadership in nurse managers and found that EI produced a significant variance in transformational leadership. The findings in this study reflect past research that has found a statistically significant correlation between EI and transformational leadership (Brown & Moshavi 2005, Daus & Ashkanasy 2005, Parker & Sorensen 2008, Harms & Crede 2010). The findings also support the ANA position statement on the importance of emotional intelligence as a skill set for nurse managers (American Nurses Association 2009). It is incumbent for nurse managers who are in critical roles responsible for impacting many facets of health care to have knowledge regarding predictors of transformational leadership in order to further pursue continuing development opportunities related to those predictors. While leadership experience and education were not related to transformational leadership, caution should be employed in concluding that education and leadership experience are not important for the nurse manager role. Future research should incorporate a random sampling method with multi-rater measurement instruments to eliminate the potential for self-rater bias and to increase the generalisability of the findings. Implications for nursing management The results of this study added new knowledge to nursing science in the area of nursing administration as it specifically relates to transformational leadership in nurse managers. This is the first study to measure transformational leadership in nurse managers in relation to leadership experience, education, and emotional intelligence collectively. This begins to address a gap in the literature. Knowledge of variables that explain and do not explain transformational leadership are important for nurse managers who are accountable for transforming practice environments. One way for nurse managers to ensure they are capable of positively influencing the environments they manage is to remain current with their leadership practices by enhancing their knowledge of leadership styles that have been documented in the literature as effective. Transformational leadership has been documented as a desirable and effective leadership style for nurse managers and the findings of this study have revealed that emotional intelligence explains moderate variance in transformational leadership of nurse managers. Therefore, nurse managers should pursue emotional intelligence professional development programmes in order to gain an understanding of emotional intelligence and learn how to enhance their emotional intelligence skills. The findings of this study may also assist nurse administrators in making evidence-based decisions regarding continuing education and leadership development programmes for existing and prospective nurse managers. This study supports the integration of EI continuing education or development training programmes into the practice setting. Evaluation tools such as 360s can be conducted to gain an understanding of leadership development needs related to emotional intelligence. Knowledge regarding the predictors of transformational leadership in nurse managers could also impact hiring practices. Nursing and hospital executives responsible for recruiting nurse managers and making determinations of qualified candidates can incorporate EI screening tools or behavioural assessments during the interview process. Additionally, nurse manager job descriptions may be revised to include criteria that support emotional intelligence behaviours as a desirable skill set. The nurse manager sample in this study all belonged to a nursing professional organisation related to their nurse manager practice specialty. The majority of the sample had received leadership training in the previous 2 years in various forms, many reflective of opportunities offered through the professional organisation; and held professional certifications in their specialty. The characteristics of this sample may support that notion that belonging to a professional organisation has implications for nursing continuing education Journal of Nursing Management, 2017, 25,

8 I. M. Echevarria et al. and professional development. Therefore, student nurses and registered nurses should continue to be encouraged to join nursing professional organisations related to their specialty. Source of funding No sources of funding were received for this study. Ethical approval IRB #90-15 Widener University Institutional Review Board. References Akerjordet K. & Severinsson E. (2010) The state of the science of emotional intelligence related to nursing leadership: an integrative review. Journal of Nursing Management 18 (4), American Nurses Association (2009) Nursing Administration: Scope and Standards of Practice. Nursebooks.org, Silver Spring, MD. American Organization of Nurse Executives (2010) AONE Position Statement on the Educational Preparation of Nurse Leaders. Available at: accessed 15 January Antonakis J. (2003) Why emotional intelligence does not predict leadership effectiveness: a comment on Parti, Douglas, Ferris, Ammeter, and Buckley. 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