This quantitative, descriptive, correlation study examined the relationships of the perceived levels of transformational and authentic leadership among Chief Nurse Executives (CNEs) of acute care U.S. hospitals with personal attributes and organizational context variables.
Transformational leadership ◦ Idealized attributes ◦ Idealized behaviors ◦ Inspirational motivation ◦ Intellectual stimulation ◦ Individual consideration Authentic leadership ◦ Transparency ◦ Moral/Ethical ◦ Balanced Processing ◦ Self-awareness Organizational Context Variables ◦ Licensed bed size ◦ Profit status ◦ Religious affiliation ◦ Magnet® status ◦ Healthy Work Environment® ◦ Nursing professional practice culture Personal Attributes ◦ Age ◦ Leadership tenure ◦ Level of Education ◦ Type of Education
No consistent definition of “success” for nursing leadership was evident within the literature reviewed. Successful nurse executives must possess strong communication, management, and business skills. ( Corning, 2002; Dunham & Fisher, 1990; Kirk, 2008; Poulin, 1984; Upenieks, 2002, 2003)
Preliminary work confirms that transformational and transactional leadership form a meaningful framework in which to assess self and staff perceptions of leadership style. (Avolio & Bass, 2004; Bass & Riggio, 2006; Burns, 1978; Dunham-Taylor & Klafehn, 1995; Judge & Piccolo, 2004; Walumbwa et al., 2007) ANCC describes transformational leadership as a component of success in Magnet Recognized® facilities. (Aiken et al., 2008; ANCC, 2008; McClure & Hinshaw, 2002)
Authentic leadership has captured the interest of social and behavioral scientists as a basis for other forms of leadership. (Avolio & Gardner, 2005, Gardner et al., 2005; George, 2003) Authentic leadership is based upon positive psychology, is evident in genuine, ethical, and optimistic individuals, and develops through self-reflection of trigger events and meaning within the leadership role. (Michie & Gooty, 2005; Shamir & Eilam, 2005; Sparrowe, 2005) AACN identifies authentic leadership as a key component of a Healthy Work Environment®. (AACN, 2005; Shirey, 2006)
Full Range of Leadership Model Effective Contingent Reward Ineffective Laissez-Faire PassiveActive Management By Exception Passive Management By Exception Active Transformational Figure 2. Full-Range of Leadership Model. Bass, B.M., & Avolio, B.J. (1990). Manual for the Multifactor Leadership Questionnaire. Menlo Park, CA: Mind Garden, Inc. Copyright 1990 by Bruce Avolio. Used with permission.
Population ◦ Active CNE members of the American Organization of Nurse Executives (AONE) Hosted CSM webpage linking to ◦ Online survey at Mind Garden, Inc. website Multifactorial Leadership Questionnaire (MLQ) Authentic Leadership Questionnaire (ALQ) Demographic Data Survey Data spreadsheet ◦.csv file uploaded to PASW and compatible with Excel
Multifactorial Leadership Questionnaire ◦ 45 items ◦ Nine subscales total, 5 subscales for Transformational Leadership (idealized attributes, idealized behaviors, inspirational motivation, intellectual stimulation, and individualized consideration) Authentic Leadership Questionnaire ◦ 16 items ◦ Four subscales (transparency, moral/ethical, balanced processing, self-awareness) Demographic Data Survey ◦ 12 items
184 completed surveys ◦ 1 subject eliminated for substantial missing data ◦ 39 subjects eliminated for failure to meet study inclusion criteria 144 subjects included in study data analysis ◦ Sample size differed by variable based upon the number of responses to individual questions
◦ Represent 38 states ◦ Mean age of participants was 53.8 years (range 33 – 69 years) ◦ Mean years within their role was 9.8 years (range 0 – 38 years) ◦ 80.6% were educated at a masters degree level (35% of these had nursing administration focus) and 8.3% were educated at a doctoral level ◦ 88.5% work in organizations aspiring to or having achieved Magnet Recognition® status ◦ 64.6% were implementing the AACN Healthy Work Environment ®standards ◦ 71.5% were not for profit or identified their organization as not religiously affiliated ◦ Mean bed size was 302.91 beds (range 14 – 2,200 beds)
The age distribution of the participants represented a non-normal distribution, skewed to the older end of the range Figure 4. Chief Nurse Executive Age Distribution by Decade
Transformational Leadership Authentic Leadership PERSONAL ATTRIBUTES Age Tenure in Executive Role Level of Education Type of Education ORGANIZATIONAL CONTEXT Bed Size Profit Status Religious Affiliation Nursing Professional Practice Culture Magnet® Status Healthy Work Environment®
What are the relationships between the perceived levels of transformational leadership (TL) and authentic leadership (AL) of chief nurse executives (CNEs) in U.S. acute care hospitals? The research question was fully supported ◦ There were statistically significant positive relationships between TL and AL on all subscales as analyzed by Spearman Rho Correlations (between the five TL subscales and the four AL subscales)
VariableTransparency Moral/ Ethical Balanced Processing Self Awareness Idealized Attributes(A)0.36**0.28**0.35**0.41** Idealized Influence (B)0.32**0.41**0.39**0.33** Inspirational Motivation0.41**0.35**0.38**0.42** Intellectual Stimulation0.28** 0.47**0.51** Individual Consideration0.34**0.36**0.52**0.48** Note. *p <.05, **p <.01 Associations were all significant at p <.01 with effect size ranging from small to large. Cohen (1988) defines significance:.10 -.29 = small;.30 -.49 = medium; >.50 = large.
Research variable Study M Normative M MLQ Idealized Influence (Attributes) 3.472.95 Idealized Influence (Behaviors) 3.602.99 Inspirational Motivation 3.643.04 Intellectual Stimulation 3.452.96 Individual Consideration3.643.16 Normative Mean Database maintained by Mind Garden, Inc.
What are the relationships between the perceived levels of transformational and authentic leadership of CNEs in U.S. acute care hospitals and the organizational context variables of the setting in which the chief nurse executive is employed? Demonstrated mixed findings and the research question was only partially supported ◦ Bed size, profit status, religious affiliation, and Healthy Work Environment showed no association ◦ Magnet Status and NPPC demonstrated positive associations with only two leadership subscales (Idealized Behaviors and Ethical/Moral)
There was only one significant relationship between transformational leadership (TL) and the organizational context variables: ◦ The Idealized Behaviors subscale was positively associated with having an active Magnet Recognition® application. (Mann Whitney U-test: U = 364.50, p <.009) There was only one significant relationship between authentic leadership (AL) and the organizational context variables: ◦ The Ethical/Moral subscale demonstrated a small positive association with the presence of a Nursing Professional Practice Culture (Spearman Rho Correlation: 0.20, p <.05)
What are the relationships between the perceived levels of transformational and authentic leadership of CNEs in U.S. acute care hospitals and the personal attribute variables of the chief nurse executives? Demonstrated mixed findings and the research question was partially supported
Specific Findings: Transformational Leadership subscale positive correlations included: ◦ Intellectual Stimulation and Individual Consideration with age ◦ Intellectual Stimulation, Inspirational Motivation, and Idealized Behaviors with level of education Idealized Attributes showed no associations
Specific Findings: Authentic Leadership subscale positive correlations include: ◦ Moral/Ethical, Balanced Processing, and Self-Awareness with age ◦ Moral/Ethical with tenure and level of education Transparency showed no associations. Type of education could not be analyzed fully due to excessive stratification of the findings; however, ancillary analyses were conducted relative to master’s education in nursing administration, with no significant findings.
Are there statistically significant differences in MLQ and ALQ sub-scores by level of education (Diploma, ASN, BSN degrees vs. Master’s degree vs. Doctoral degree) of chief nurse executives (CNEs) in US acute care hospitals? ◦ The TL subscale Intellectual Stimulation revealed significant differences by education level (master’s and doctoral higher) ◦ The AL subscale Moral/Ethical revealed significant differences by education level (master’s higher)
U TestUp Mean Rank Sum of Ranks Intellectual Stimulation Diploma/ASN/BSN509.05.00340.34645.50 Master’s degree70.118132.50 Diploma/ASN/BSN43.50.01311.22179.50 Doctoral degree18.88226.50 Moral/Ethical Diploma/ASN/BSN458.00.00037.13594.00 Master’s degree70.028052.00 Diploma/ASN/BSN53.00.04711.81189.00 Doctoral degree18.08217.00 The significance value of p was determined to be at.025 (.050/2) for the pair-wise comparison.
All statistical associations were in a positive direction; as one variable increased so did the other Transformational and authentic leadership were significantly associated with each other
Transformational and authentic leadership were only minimally associated with organizational context variables Transformational and authentic leadership were positively associated with personal attributes more often than with organizational context variables
Positive Psychology Ethical Moral Individualized Consideration Inspirational Motivation Intellectual Stimulation Self Awareness Transparency Balanced Processing ANCC Magnet Recognition® No Intent No Application Active Application Magnet Status AACN Healthy Work Environment® Idealized Attributes Transformational Leadership Authentic Leadership Idealized Behaviors Age Level of Education Type of Education Tenure Profit Status Religious Affiliation Licensed Bed Size NPPC Organizational Context Personal Attributes Figure 5. Anderson Nursing Executive Leadership Conceptual Model. Arrows represent statistically significant associations between variables. NOTE: All associations were positive
Research Question 1 CNEs who perceive themselves as transformational leaders, also perceive themselves as authentic leaders ◦ authentic leadership as a basis for other forms of leadership (Avolio & Gardner, 2005) Although associated, transformational and authentic leadership are two distinctly different leadership styles (Walumbwa et al., 2008) Transformational and authentic leadership are strongly related, which might have implications for ◦ screening and selection of future leaders ◦ education and development of future leaders
Research Question 2 The relationships between transformational and authentic leadership and organizational context were not consistent with the results of previous studies (AACN, 2005; ANCC, 2008; Bass & Riggio, 2006; Dirks & Ferrin, 2002; Drenkard, 2009; Dunham-Taylor, 2000; McClure & Hinshaw, 2002; Shirey, 2006; Upenieks, 2003) suggesting ◦ the need for further study in this area The moral/ethical component of authentic leadership did not associate with religious affiliation as suggested by positive psychology findings (Dirks & Ferrin, 2002; Dunham & Fisher, 1990; Gardner, Avolio, Luthans, May, & Walumbwa, 2005; Michie & Gooty, 2005; Upenieks, 2002, 2003)
Research Question 2 The relationship between transformational leadership and the ANCC Magnet Recognition Program® was minimal, which ◦ does not validate or negate this leadership style as critical to building an excellent nursing practice environment (ANCC, 2008) The relationship between authentic leadership and the implementation of the AACN Healthy Work Environment was not significant, which ◦ suggests the need for further research to validate this leadership style as a key component of a healthy work environment (AACN, 2005)
Research Question 3 The mean age of CNEs in the study was 53.8 years (median 55 years), and 80.5% were over the age of 50 years, which may impact ◦ turnover and vacancy of CNEs nationally within the next 10 – 15 years ◦ conscious attention to CNE succession planning is needed now The relationship between age and authentic leadership suggests ◦ support for findings related to conscious self-reflection and trigger events over time (Avolio & Gardner, 2005; Ilies et al., 2005)
Research Question 3 The relationship of education level and transformational leadership ◦ supports the findings of others (Dunham & Klafehn, 1990) ◦ could be impacted by Magnet Program® eligibility requirements The mean tenure of Chief Nurse Executives is 9.8 years suggesting that ◦ CNEs seek advancement within different facilities, or experience dissatisfaction or burn-out in the role (Jones, Havens, Thompson, & Knodel, 2008) ◦ mobility of chief nurse executives may mediate the impact of setting or organizational context ◦ CNE tenure may implicate experience as a factor in leadership success (Henderson, 1995; Linton & Farrell, 2009)
Education Availability of nursing administration master’s programs ◦ Declined between 2004 and 2008 (Institute of Medicine, 2011) Impact of DNP programs on educational preparation of CNEs (Institute of Medicine, 2011) Competition between academia and practice for highly qualified nurses to fill openings ◦ 54.5% vacancies, and 20.1% additional faculty needed (Tracy & Fang, 2010) ◦ Flexibility of curricula ◦ Creative solutions – dual roles or subsidized faculty positions
Practice Transformational leadership may develop as a result of authenticity (self-awareness, balanced processing, moral/ethical, and transparency) or concurrently with it Authenticity develops as a result of reflection upon the events of one’s life over time, which suggests ◦ a possible connection to age, experience and level of education Further analysis of relationships between authentic leadership and the other forms of leadership within the Full Range of Leadership Model is needed (Bass & Avolio, 1990)
Laissez-Faire Management by Exception - Passive Management by Exception - Active Contingent Reward Transformational Leadership Authentic Leadership ? +
Findings suggest a positive relationship between transformational and authentic leadership as perceived by CNEs The relationship between age, level of education, tenure, and leadership style suggests that personal attributes are important determinants of leadership style and may possibly mediate success The impact of personal attributes, leadership style, and the development of leaders will be critical as the majority of nurse executive incumbents retire over the next 10 – 15 years
Transformational leadership and authenticity may provide leaders with the means to channel their “passion” for the nursing executive role into strategic vision and operational success. Next steps… Analysis of remaining data Chief Nurse Executive Life Stories
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