Every day nurses have the responsibility for the health as well as the well being of their patients and therefore to ensure a continuity of the patient care each every nurses on a unit work tougher to ensure that they achieve the shared goals. The cohesive team thus work diligently to promote then patent health, safety and recovery and to achieve such unity nursing manager coordinates and supervises all the interactions that go on between all the team members he is in charge of (Longerich, et al 2003).Nurse leaders may be nurses mangers who are responsible for one nursing unite or a nurse executive held responsible for all the in-patient nursing units. Nurse steam leaders achieve their roles by applying the various nursing leadership style which include: transformational, transactional as well as dynamic leadership. A combination of more than one leadership style is often considered more effective but a single type also serves the intended purpose depending on the situation that the leader is in (Mahoney, 2001).
Background
The nursing professionals faces one of the greatest challenges of developing future leaders as powerful leadership skills are required all nurses i.e. those responsible for providing direct acre to those in the top management position for example anyone looked upon as an authority ranging from a nurses taking care of a patient to those responsible for giving assistance to others. All of them are considered s leaders. Another difficult that faces leadership for health care professionals is that most of the leadership theories were not developed based on the healthcare context but rather with in the business context then applied to healthcare.
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A clinical nursing leader is involved in direct patient care as well as offers a continuous improvement of the care by influencing others. Leaders have skills, task which they utilize to as an attitude that inform behavior leading to consistent superior performance with long-term benefits to all those involved. Leader s not alloy control other but are more of visionaries who serve to helping employees to lead, plan, organize and control their activities (Jooste, 2004).
In the past decade shelf life of leaders in the health service has halved and instead of working in environments that encourage creative thinking especially about the future of health care there is one that consists of vast paper trails that are characterized by motions masquerading as activity. Thus the luxuries of personal lives for the senior staff are tumbled upon especially in some of the healthcare organizations where 60- hours working in a week has become quite normal. This situation has made some health care staff to no longer work for patients but rather to be motivated by pronouncements from government representatives , media expose an even on the latest scandal regarding misuse of public money (Woolnough, 2002).
Health care system has witnessed different parts of the health organization focus on different things which is often marred with poor coordination across the various departments with objectives being sandwiched between keeping costs down with efforts to increasing patient services. Such in-coordination as been felt by the hospital administrators especially at times when demands for administrative services increases and thus administrative jobs are cut.
Making choices require certain amounts of freedom, thought, actions, time for weighing options, as well as time for reviews of such decision, unfortunately in health cares leaders lack such luxuries as the reliable, easily accessible and relevant information they require to make decision is often not unavailable. Further more resources and time that is essential for such responsibilities is missing and this affects much of the health care leaders who are driven by gut feeling which is linked to strong sense of personal values regarding what is right, just and reasonable(Outhwaite, 2003).
Irrespective of the countries which healthcare leaders operate they are always expected to fulfill the following roles: being a diplomat, a visionary, politician, conflict resolver, coach, figure head as well as a human being failure to which no leader can claim to the title. as a matter of fact most leaders face the pressures of sharing a little pieces of themselves with anyone that ask for it, in addition to that healthcare leaders face real dilemmas regarding several issues like ways of radically changing their organizations without any guarantees of success despite the well planned changes and being able to accept the consequences of their actions, working with political agendas or legislations which they disagree with and also accept the consequences, apportioning of resources of the available as fairly as possible while also accepting the consequences, saying no when they want to say yes and also accept the consequences ,trying to act ethically yet sometimes leading to failures and knowing that despite their selfless effort someone some how cries foul. In addition to that healthcare leaders are faced with challenges of making decision like making choices regarding decisions on acting on absolute principle or creative several flexible responses, to keep particular services or to discard them, having a open organization and developing closer ties with the service users yet at same time having little or no control over the eventual outcomes, to continue to lead or not (Outhwaite, 2003).
Failure to act in decisive manner by healthcare leaders may lead to general delay action for instance lack of medical and nursing action in the review of requested treatment in admission leads to inaction on the part of delivering the treatment. The pivotal role of the leader may be overshadowed by fear of unjust critism which result to delayed decision which its ultimate consequence of having to deal with sense of failure and guilt.
Leadership
Leadership can be defined as the process of influencing others, meeting goals by obtaining the co-operation from those around them and acquiring the resources to achieve their goal. To be a leader you must make a decision to act; doing so requires skill, knowledge, energy, vision and self-confidence (Tappen, 2001). On the other hand, leadership may not be obvious or visible process of influencing others, but the very leadership features within the individual may trigger other people to act according the leading person. Carney (1999) defines leadership as persuading others to pursue a common goal by setting aside individual concerns, while Marquis & Huston (2000) states that “leadership is made up of authority and accountability.” They define authority as the power one has to direct the work of others and accountability as well as the moral responsibility that comes with the position of leadership. Majority of existent theories pays attention to leadership as a personal feature which is more or less helpful when achieving goals within the organization and not for individual goals. However, this paper work would focus on both parts as leadership in nursing field requires the same amount of attention to the work of organization and the individual as well. In other words, if adding all definitions together, we get the idea that leadership involve influence on others, authority, achievement of goals through command work and the leader’s moral responsibility. The basic question is how the leader arranges his / her priorities, the job of staff, atmosphere, etc.
Leadership theories
Trait theory
Much has been written about the differing leadership styles and theories over the last seventy years. Many leadership theories have evolved over the last century starting with ‘Trait theory’. It is based on the assumption that some people possess personality traits which single them out as natural leaders and those who possess such traits should be nurtured into leadership positions (Marquis& Huston, 2000). However, this theory was abandoned by the 1940’s as no set of consistent traits could be identified and thus research focused on the behavior and attitudes of managers based on the assumption that leadership styles are based on specific behavior. (Sellgren et al, 2006) Nowadays, many ideas of trait theory are rejected as psychology studies provided evidence that leadership though appears as every individual’s feature is not that helpful when trying to nurture it so this theory now has only historical rather than practical importance.
Behavioral theory
Research on leadership has shifted focus from leadership traits to leadership behavior (Bass, 1981 cited in McNeese-Smith, 1996). Behavioral theories particularly focus on what a leader does (Whitehead et al, 2007). This approach was adopted from the 1950’s onwards following two major studies by American universities. It looked at what a leader does and what he / she should do, what is leader’s role when facing certain problems, the behavior exhibited by leaders and the influence of leadership style on a group’s performance. Research into behavioral theory was based on the premise that each leader has a style based on their personality, they experience and education (Ekvall, 1992 cited in Sellgren et al, 2006). Also, the theory was interested on leader’s interaction in group work, and how members of the group react to each other and especially, the leading figure. For further analysis, the leader’s behavior can be separated into three main leadership styles – Authoritarian, democratic and Laissez-faire (Tappen, 2001). Leadership style is related to the amount of control or freedom which the leader affords to the group (McCarthy, 1998).
Authoritarian
Authoritarian leaders keep most of the authority and make most of the decisions without much consultation with the group. Autocratic leadership style does not allow group participation and does not nurture creativity. This may have the effect of de-motivating the team members in the long term (Whitehead et al, 2007). In some cases it can even be said that autocratic leader does not even ‘need’ a group work; all what matters is group’s ability to follow the ‘orders’. Authoritarian style can however, be useful in situations where group participation would be counter-productive or where rapid decisions need to be made. Still, rapid decisions do not guarantee success, so this type of leadership in many cases is rarely acceptable.
There are certain researchers nowadays who examine the leadership and leader’s behavior of important historical figures. They draw a conclusion that many presidents, politicians and generals of the past were good authoritarian leaders as the very lifestyle back then were based on social status and the power within the society (Whitehead et al, 2007). Education also played an important role and the good leader was the one who could lead the whole nation to success by making decisions on his own. Fortunately or not, nowadays this type of leadership is often treated as unacceptable behavior rather than type of leadership.
Democratic
This style of leadership takes the opinions of the group into account. The decision making is shared with the group paying attention to every single critique and comment from other members of the group. This style encourages group participation and exercises general, rather than close supervision. (Carney, 1999) In other words, it is all seen in the very word ‘democratic’; the leader within the group is seen as more important figure than everyone else, but the leader himself / herself is responsible for creating a feeling of equality; work in such group usually would be followed by friendly and positive atmosphere as every individual in the group would be seen in many cases as more important figure than the very problem they are solving. Possible drawbacks may be that democratic leaders are only strong when every individual feels strong in the group, but some leaders are not capable of withstanding their opinion if it may damage the atmosphere within the group. Despite that, these cases are rarely discussed as after such incidents the authority of the leader may be ‘diminished’ and the group would be searching for other leading figure.
Laissez – faire
In this style the leader allows the group to determine their own way of working and does not provide much direction, feedback or decision making. This type of leader is passive and non-directive; he / she provide little support for the group and in fact may turn requests for help and support back to the group in general (Tappen, 2001). Some groups require ‘passive’ leader, who in a way will took all responsibility, but actions and decisions would be made by other people in the group. It does not necessarily suggest that this kind of leadership is provoked by group members; the leader should be conscious about the situation and accept that. Some behavior researchers and psychologists even points out that this type of leadership requires more psychological knowledge and personal strength than others; not many people would allow such freedom for the group without being afraid to accept full responsibility of their actions (Tappen, 2001).
In more recent times, research carried out by Kouzes & Posner (1988) and Bass (1995) showed interesting results about leadership behaviors. They studied over 1,300 leaders and have identified five different leadership behaviors:
Challenging the process: these are leaders who are innovative and experimental; their work should be a challenge.
Inspiring a shared vision: Intuitive leaders who picture the future and enlist others to become involved;
Enabling others to act: these are empowered and supportive leaders who build trust and team work;
Modeling the way: Leaders who act as role models, setting a good example and practicing what they preach;
Encouraging the heart: Leaders, who support their followers, recognize and reward their accomplishments, though some researchers nowadays questions methods of leading the group through rewards (especially material).
These leadership behaviors are very useful and can be used as independent variables to measure both the manager’s opinion of their style of leadership and that which is perceived by those they manage. This in turn can be used as an indication of employee’s satisfaction with their manager’s style.
Situational leadership theory
This leadership theory is based on the premise that leadership style should be determined by the situation or the individuals involved (Marquis & Huston, 2009). The differing leadership styles of situational leadership proposed by Hersey et al (1997) are based on the maturity or readiness of the follower. They set out four levels of readiness ranging from low (unable or unwilling) to high (able, willing and competent) and depending on the level of the follower the leader’s style is directive, coaching, supportive or delegate in approach. There would be helpful to present an example which would illustrate this theory better. For example, the leader who is working with group of people which is known to him / her would follow absolutely different steps or provide different behavior when working with other group of people which he / she has not met before. That is because new people would consciously or not question presented leader’s authority, their working methods may contradict the methods by which leader chooses to act, etc. In other words, this theory focuses on the new direction which was not discussed before – the conflict between group members and leader when facing certain new issues, or anything at all what is innovative and not known how to deal with. Situational leadership stresses out the importance of leader’s actions in new situations where group work has to be organized very carefully (Hersey, 1997).
Charismatic Theory (Transactional and Transformational leadership styles)
New leadership styles have developed in more recent times and that involves the transactional leadership and transformational leadership, both of which are part of Charismatic theory (Rafferty, 1993). In rapidly growing health sector, these kinds of leadership are especially notable up to the present day. Transactional leadership is characterized by bargaining, it emphasizes the organizations goals while recognizing the rewards that people value. Once goals have been achieved the leader rewards those who helped to achieve them (Lindholm et al 2000, Carney 1999). It seems as a very fair method – to focus on goals rather than rewards; the sequence of actions is very strict, showing that efforts would be rewarded only if they were effective. Transformational leadership has charisma as its focus. The leader provides the vision, instilling a sense of pride in achievements, while gaining trust and respect from the group. Transformational leadership raises both leader and follower to a high level of motivation and morality as both shares a common value according to Burns (1978) who coined the term. In other words, both leader and the follower are on the same level, the main distinction is who leaded who to such level. To shortly sum up, this theory basically was called charismatic as leader must be able to build up the strategy consciously and think ways of how group can effectively be included into achievement of necessary goals.
Servant leadership
One of the more recent leadership concepts is Servant leadership. This style is very different to traditional views of management where the organizations needs take precedence. Servant leadership is concerned with service to the follower as opposed to engaging followers to support organizational goals (Stone et al, 2004). Servant leaders take into account their followers needs first and this in turn empowers them to achieve organization’s goal. This also sometimes brings problem of inequality in light as the leader’s needs and the follower’s would be of very different level. Thus, one side could feel in a way ‘used’ but in many cases feelings would not be considered that important as many problems are solved in formal style and achievement of goals is the only satisfactory solution. This theory was called servant for various reasons very few literature provides the origin of such concept, as the fact that organization’s word is always the last, is quite natural itself (Carney, 1999).
To sum up these kinds of leadership theories, the short evolution of leadership studies it is seen that analysis provides numbers of exceptions, and ambiguities. Every theory and every type of leadership can be understood and interpreted differently considering every individual. Leadership is necessary in group work to achieve certain goals, but nothing can guarantee or provide an easy pattern to do so. However, after this discussion we now would be focusing on another part of this paper analysis; in what forms leadership appears in nursing field and how leadership styles can help to achieve personal or institutional goals and bring satisfaction for the job.
Leadership styles in Nursing
What is clear from the literature is that no one style of management and leadership is consciously used within nursing as a specific method to cope with certain issues that nurses and ward managers are facing. However, what emerges is that predominantly health care has moved away for the traditional autocratic style and towards a combination of transactional and transformational leadership. A study of 71 Irish Health Managers carried out by Armstrong (1999) found that over half used transactional and transformational leadership. The reasons are quite obvious. The period of time shows that the research is quite new and nowadays autocratic leadership is usually interpreted negatively. Transactional and transformational leadership, however are more effective in nursing field as such kind of leadership showed great success in institutional work (Avolio, 1988). Nurses in general, aims to helping people, and these two styles of leadership are emphasize the co-operation with other people; group work and care for others is extremely important to get successful results. Nowadays in nursing field other models are rarely seen as effective and though it can be said that democratic leadership is also very common, it usually appears in the group of nurses excluding their direct leader – the employer. Democratic leadership often occurs where leader is not the one with higher status, but the one which is ‘chosen’ by the group as the most reliable or so on (Bass, 1995).
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In a study carried out by Lindholm et al (2000) he found that more than half of managers interviewed exhibited a combination of both transactional and transformational leadership styles and these managers appeared to experience fewer management problems, less resistance to change and greater support from other professional groups within health care. What is not really acceptable is that these studies do not provide enough information about minorities, who are using different leadership styles. Although, it is only natural to state that leaders who uses different methods or have mixed qualities, often are said to be better than those who can be applied only to one pattern.
The Hay group, an international management consultancy firm which carried out a study of leadership styles in seven NHS trusts in Brittan sets out six leadership styles which are prevalent in nursing (Kenmore, 2008):
Directive: A leader who instructs staff on what to do without consultation, this often seems as autocratic style, though also can be the transactional or transformational leadership style leader;
Visionary: The leader who provides long term guidance and vision for the future, the team work is important and especially the trust for a leader;
Affiliative: This leader creates harmony within the team as other way the achievement of goals would be not as effective as needed; this style is especially good if the certain group is going to co-operate in the future, they would find ways to achieve goals effectively together as a team;
Participative: A leader who generates ideas and develops staff commitment; it is an active leader who also works in a group though he / she clearly ‘states’ who is the leader;
Pace-setting: This leader promotes high standards and task accomplishments as he / she finds the reward as the best way to motivate his group; statistics show that money as motivation is not the most important part for job satisfactory, but still this kind of leaders are quite common;
Coaching: A leader who promotes self-development and further education; it is a sort of investment in group for facing future tasks; also very effective if the team would work together for a long period of time.
The Hay group found that the most effective ward managers are flexible in their approach and used a variety of these leadership styles in order to get the best performance from their staff (Kenmore, 2008). However there is no comparative study of leadership styles carried out within Irish nursing on this scale which identifies an opportunity for further research in order to gain better understanding in the Irish context.
In Ireland the National Clinical Leadership Programme (2008) was set up by the Office of the Nursing & Midwifery Services Directory (ONMSD) to assist nurse managers to develop leadership skills which support the new and expanded ways of delivering quality patient care. This programme was adopted from the Royal College of Nursing’s (RCN) Clinical Leadership Programme framework which aims to develop transformational leadership qualities in participants (Clinical Leadership Pilot Evaluation Report, 2008). The theoretical framework focuses on:
Learning to self manage
Developing effective relationships
Patient focus
Networking
Political Awareness
This leadership programme has since been developed further by the ONMSD to become the National Leadership Development Project. This project has developed competencies which promote clinical leaders. These, the ONMSD believe, are the key to providing better care and developing leadership within nursing. This pilot project commenced in March 2011 with the completion date set for 2012. (NLDP, 2010). So far, this project received positive reviews by many researchers of health care studies and the nurses themselves.
Defining Job satisfaction – history and current thoughts
Job satisfaction is defined by Locke (1969) as: “a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experience.” It is described as a positive affective orientation towards employment by Muller & McCloskey (1990). Job satisfactory is a crucial factor which influences individual’s personal appearance in his / her work sphere which can result in increasing or decreasing effectiveness in job duties.
As a formal area of research, job satisfaction did not really exist until the mid 1930’s although there was a good deal of qualitative research and theorizing about the concept of job satisfaction. These included Freud (1922) who felt that morale acted to suppress negative tendencies, encouraging personal sacrifice and commitment to group goals. Janet (1907) theorized that repetitive work encouraged one to dwell on negative thoughts and cause obsessive thinking. Historically, researchers were interested in job satisfaction as a means of increasing productivity. Scientific management theory assumed that above all things, workers value economic incentives and would be willing to work harder for economic incentives. Taken these two opinions into account it is seen that the lack of personal or moral satisfaction still was not discussed widely.
This led to the Hawthorne studies which were carried out by Professor Elton Mayo from the Harvard Business School between 1927 and 1932. This study began by examining the effect of physical conditions on productivity, however in the course of his investigations he became convinced that factors of a social nature were affecting job satisfaction and productivity. This study revealed that the feelings and attitudes of workers affected production rates and this led to him introducing an interview programme to assess the nature of the relationship between methods of supervision and workers attitudes. As a result of these interviews it became apparent that small changes in work conditions temporarily increase productivity but further investigations reveled that this increase resulted, not from the changes in conditions, but from the knowledge that workers were being observed. In other words when interest was shown in workers their productivity increased but when this interest was withdrawn, the productivity fell. This later became known as the Hawthorne effect. This research provided strong evidence that people work for other purposes than pay as well and sparked a wave in research into other factors which affect job satisfaction.
After these studies and thoughts about job satisfactory, numbers of tools for measuring job satisfaction appear. One of the most commonly used is Maslow’s theory of human needs (1954). Maslow asserted that human needs emerge sequentially according to a hierarchy of five need levels: physiological, safety, affiliation, achievement and esteem and self-actualization. Maslow argued that the satisfied need was not a motivator of behavior and therefore the importance of higher needs increases as lower needs are satisfied. This was followed by Herzberg et al (1959) who went on to develop a theory of job satisfaction based on Maslow’s hierarchy and concluded that not all factors increase satisfaction. They conclude that there was a relationship between job satisfaction and certain work behaviors as well as between job dissatisfaction and other work behaviors. Hertzberg concluded that satisfaction and dissatisfaction were two totally different phenomena which develop from distinct sources and had differing initial and long term effects on behavior. Hertzberg also found that the factors related to good feelings towards one’s job were achievement and recognition, the nature of the work itself, responsibility, advancement and salary. The bad feelings towards the job stemmed from company policy and administration, technical supervision, the question of payment, interpersonal relationships with supervisors and working conditions. Hertzberg’s basic proposition is that workers are driven by two different factors; hygiene and motivation factors. Hygiene needs related to the physical and psychological environment in which the work is done while motivational factors relate to the nature and the challenge of the work itself. However, there has been severe criticism of Hertzberg’s theory due to its lack of empirical support as well as the very idea of job satisfactory did not provide examples of fairly different job spheres.
The job satisfaction of nurses
There is a wealth of literature relating to job satisfaction in general management literature and to a lesser extent, in nursing literature. From the moment when job satisfaction became a field of psychological interest, numbers of considerable researches has been done on various aspects of job satisfaction. One of the most notable studies was carried out by the Hay group and it would be mentioned further.
Job satisfaction is not easily defined mostly because it means different things to different people. Job satisfaction is multifaceted and can be affected by both internal and external factors. Atchison (2003) lists pay as the most important external factor but states that internal factors such as a good boss, professional development and a nurturing work environment are even more important. This is borne out by the extensive study carried out by the Hay group (1999) of over 500,000 employees in 300 locations where they found that employees rated pay and benefits in only 10th position in the reasons for employee satisfaction. According to Atchison (2003), pay checks are entitlements and not motivators. The only time a pay check is motivating is when there is a threat of loss of the pay check. Atchison (2003) states, that job satisfaction to nurses is unique as what motivates nurses is not so much pay and conditions but rather the well-being of the patient and a sense of “a job well done”. What is more, not payment, but the patient is one of the most important figures in nurses’ job. Even when the patient outcome is not positive a nurse may feel a sense of satisfaction having met the patients needs spiritually, physically and psychologically. This is defined by the Hay group (1999) as “Meaningful work, making a difference” and is cited as the 3rd most common reason given by employees for wanting to stay with a company. Pay ranked at only 10th place as a reason for staying, though this may vary in other countries depending on nursing conditions, economy, etc. This research lists ten reasons overall (Hay group, 1999):
- Career growth, learning and development
- Exciting work, challenging
- Meaningful work, making a difference
- Great people
- Being part of a team
- Good boss
- Recognition for job well done
- Autonomy, sense of control over one’s work
- Flexible work hours and dress code
- Fair pay and benefits
This is re-iterated by Lebbin (2007) who says that many people who work in health care are motivated by improving the health and well-being of their patients. He goes on to state that staff dissatisfaction cannot be fixed by increasing pay and benefits but by the organization addressing its primary goal which is ‘caring’.
Blegin (1993) found that factors affecting employee satisfaction were: employer commitment, communication with supervisors, autonomy, recognition, and peer communication. This study also found that stress and routinization negatively affected employees satisfaction. Basically, if an employee meets constant stress in work place or the job becomes as a routine, the changes are necessary, and the payment is rarely a sol
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