Leadership style and organisational commitment among nursing staff in Saudi Arabia

Impact of Nursing Leadership Styles on the Staff Turnover Intention in Saudi Arabia: A Cross-Sectional Study

Background and objectives The efficiency of healthcare systems and nursing care depends on appropriate leadership. The purpose of this study was to determine the association between leadership styles of nurse managers and the staff turnover intention in Saudi Arabia. The nurses' intention to quit their jobs was considered as indicative of staff turnover intention. Methods A quantitative cross-sectional questionnaire-based study was conducted among 279 nurses, employed in three hospitals in Hafar Al-Batin City, Saudi Arabia. The questionnaire comprised three parts to determine the association between leadership styles of nurse managers and staff turnover intention, and how they related to participants' demographic variables (gender/age/education/income/marital status/experience). The first part collected demographic data, and the second part was an adapted and validated version of the multifactor leadership questionnaire (MLQ-6S) used to assess the perceived leadership styles of nurse managers, based on 21 items. The third part, comprising seven items, was used to assess nurses' turnover based on intention to quit. The second and third parts of the questionnaire were scored using a five-point Likert scale. Collected data were tabulated and analyzed using a statistical software package for descriptive and inferential statistics (t-test, one-way analysis of variance (ANOVA), and correlation), comparing dependent outcome variables against independent demographic variables. Statistical significance was assumed when p-value was less than 0.05. Results Based on leadership style scores, transactional (13.32 out of a maximum of 24; 55.48%) and transformational (26.58 out of a maximum of 48; 55.37%) leadership were the most frequently perceived leadership styles among nurse managers. Laissez-faire leadership (6.31 out of a maximum of 12; 52.57%) was the least frequently perceived style. Upon comparing perceived leadership styles of nurse managers against demographic variables, no significant differences were observed for transformational leadership. However, income and experience of nurses showed significant relationship with the perceived transactional and laissez-faire leadership style scores, respectively. Based on perceived "intention to quit" scores, majority of the nurses expressed uncertain intention to quit (n = 193; 69.2%) and there was a significant yet weak negative correlation between the perceived leadership styles and intention to quit. The correlation coefficient (Pearson's-r) was lowest for laissez-faire leadership (-0.258) followed by transactional (-0.295) and transformational styles of leadership (-0.348). Conclusions The present study indicated a greater degree of transactional and transformational leadership styles among nurse managers than laissez-faire leadership style. While most of the nurses mentioned an uncertain intention to quit, correlating it with the perceived leadership styles it was found that transformational leadership among nurse managers indicated greater retention of nurses within their present jobs. The present research findings underline the importance of prioritizing and fostering healthy workplace environment by the nurse managers, through inculcation of transformational leadership practices. Furthermore, focused, multi-centric studies from around the world can help understand the leadership practices of nursing leaders and its relationship with the intention of nurses to quit their respective roles.

Exploring the relationship between patient safety culture and the full-range leadership theory in primary care settings: a conceptual analysis

PURPOSE

This study aims to investigate the conceptual relationship between full-range leadership theory (FRLT) and patient safety culture in primary care settings, aiming to understand how leadership styles influence the development and sustainability of a culture prioritizing patient safety.

DESIGN/METHODOLOGY/APPROACH

Using a conceptual analysis approach, the study builds a theoretical framework that integrates FRLT - which includes transformational, transactional and laissez-faire leadership styles - with the elements of patient safety culture. This framework serves as the basis for a comprehensive literature review, allowing for the formulation of hypotheses regarding the impact of each leadership style on patient safety culture.

FINDINGS

The analysis demonstrates that transformational leadership bolsters patient safety culture by fostering open communication, encouraging error reporting and facilitating continuous improvement. Transactional leadership yields mixed effects, effectively supporting compliance and operational outcomes but showing limitations in promoting a proactive safety culture. Conversely, laissez-faire leadership is associated with negative outcomes for patient safety culture, mainly due to its passive and detached approach.

ORIGINALITY/VALUE

The originality of this study is rooted in its focused examination of FRLT's impact on patient safety culture within primary care settings, the development of a unique conceptual framework and its contribution of actionable insights for health-care leadership. These elements collectively advance the understanding of how leadership can enhance patient safety culture, providing a solid foundation for future research and practical application in primary care environments.

Impact of Nurse Manager's Attributes on Multi-Cultural Nursing Teams: A Scoping Review

BACKGROUND

As global migration increases, nurse managers' effectiveness in multi-cultural nursing work environments is crucial due to the rising cultural diversity within healthcare teams. Despite the increasing international recruitment of qualified nurses to address the worldwide nursing shortage, no studies have synthesised the impact of nurse managers' attributes on nurses in multi-cultural nursing teams. Therefore, it was conducted a literature review aimed to synthesise the available literature on how nurse managers' personality traits, competencies, behaviours, and leadership styles influence nurse outcomes in multi-cultural nursing teams.

METHODS

Scoping review conducted according to the Joanna Briggs Institute guidelines to map the relationship or influence of nurse managers' personality traits, competencies, behaviours, and leadership styles on the outcomes of nurses in multi-cultural settings across various clinical environments. Searches were conducted across electronic databases such as CINAHL and MEDLINE, along with grey literature.

RESULTS

This review included 39 studies, highlighting 29 personality traits, 9 competencies, 115 behaviours, and 5 leadership styles that impact nurses' outcomes. Key findings emphasise the importance of nurse managers being supportive, culturally competent, and effective communicators, with transformational leadership style being particularly beneficial.

CONCLUSIONS

These findings provide insights for planning and developing training programmes to equip current and future nurse managers with skills to effectively lead in multi-cultural care settings.

Clinical nurse managers' leadership styles and staff nurses' work engagement in Saudi Arabia: A cross-sectional study

BACKGROUND

Effective nurse leadership enhances nurse welfare, improves patient care, and increases organisational success. A lack of adequate, supportive leadership significantly contributes to many nurses leaving the profession. Nurse managers need to prioritise engagement and retention as significant focus areas to address the nursing shortage in Saudi Arabia and accomplish the national program's objectives.

AIM

To examine the correlation between the leadership styles of clinical nurse managers and staff engagement.

METHOD

This study used a descriptive, cross-sectional, correlational design. The leadership styles of clinical nurse managers were evaluated using the Multifactor Leadership Questionnaire (MLQ-5X). Work engagement was assessed using the Utrecht Work Engagement Scale (UWES). Questionnaires were distributed to 450 nurses in four public hospitals in western Saudi Arabia. Non-probability convenience sampling was used to collect the data.

RESULTS

A total of 278 nurses from a range of clinical areas participated in the survey, which revealed that the leadership styles of clinical nurse managers positively or negatively impact nurse work engagement. Most clinical nurse managers exhibit transformational leadership, followed by transactional, then passive-avoidant styles. Respondents displayed a high level of work engagement, emphasising the positive impact of transformational and transactional leadership on work engagement outcomes. The findings showed significant differences in leadership styles and work engagement levels between Saudi and non-Saudi nurses across various dimensions.

CONCLUSION

Understanding the effect of leadership styles employed by nurse managers on work engagement can positively impact staff retention rates and the quality of patient care. Nurse managers should participate in training programs to enhance their practical leadership skills to enhance the work engagement levels of nurses.

IMPLICATION

Nurse work engagement can be improved by establishing training programs that promote effective leadership and highlight the significance of various leadership styles and their subsequent impact on nurse work engagement. Nursing students should receive education on leadership styles. Nursing leaders should be given access to mentoring programs and opportunities for career advancement to support the introduction of effective leadership styles.

Illness Anxiety Disorder and Distress among Female Medical and Nursing Students

Objective

This study aims to compare the prevalence of illness anxiety disorder (IAD) and distress between medical and nursing students and examine their associations with students' characteristics.

Methods

Cross-sectional data were collected using the Short Health Anxiety Inventory (SHAI, for measuring IAD) and the Medical Students' Disease (MSD) Perception and Distress Scales.

Results

Two hundred and sixteen Medical students and 250 Nursing students were recruited from a public female university in Saudi Arabia. Their mean age was 21.27 years. The findings showed that the overall prevalence of IAD (SHAI scores ≥18) among the total sample was 38.8%, with a significantly lower prevalence in medical students compared to the prevalence in nursing students (57.2% vs 17.6%, respectively, X2=45.26, p<.001). Nursing students had significantly higher SHAI scores and lower MSD Perception scores than medical college students, but there were no significant differences among them in the MSD Distress scale. Significant differences in the main study variables scores were reported among nursing students but not among medical students, with the fourth-year level nursing students having higher SHAI and lower MSD Perception and perception scores than other nursing students.

Conclusion

The highlights that medical and nursing students are susceptible to developing anxiety-related disorders and distress that may have negative impacts on their academic achievements and future careers. Both nursing and medical faculty should help in identifying strategies to support the students' mental health and well-being.

A leadership-based framework for improving Saudi Arabian female participation in sports

Study purpose

To analyze the relationship between the leadership styles and sports engagement among female sport persons in Saudi Arabia and proposes a framework model for improving Saudi Arabian female participation in sports.

Methods

This study adopted an online cross-sectional survey design for achieving the research aim. Survey instruments included multi-factor leadership questionnaire (MLQ) and Utrecht Work Engagement Scale (UWES). The study participants included adult female sports persons from various sports clubs in Saudi Arabia. A total of 329 responses were received, out of which 35 were incomplete; therefore, a total of 294 responses were considered for the data analysis.

Results

Transformational leadership style was identified to be the most preferred style compared to transactional and laissez-fare leadership styles. Older participants (>25 years) perceived transformational leadership scales including inspirational motivation, intellectual stimulation, and individual consideration to be more effective (p < 0.05) compared to younger participants. Transformational leadership has strong positive correlation with all engagement scales (as correlation coefficient "r" was greater than 0.7, p < 0.01).

Conclusion

Inspirational motivation could be an effective approach in increasing the female participation in Saudi Arabia, as they are mentally unprepared due to the experience of socio-cultural restrictions for decades.

Toxic leadership behaviour of nurse managers and turnover intentions: the mediating role of job satisfaction

INTRODUCTION

Globally, hospitals are confronted with major challenges of turnover of nurses. Knowledge of the factors that account for the turnover of nurses will aid in creating strategies that will enhance nurse managers' leadership behaviour and job satisfaction to reduce turnover. The study, therefore, investigated the mediating role of job satisfaction on toxic leadership and turnover intentions of nurses.

METHODS

A multi-centre cross-sectional study was undertaken to assess 943 nurses using the Toxic-leadership Behaviour of Nurse Managers scale, Minnesota Satisfaction Questionnaire and Turnover Intention scale. Descriptive statistics was used to assess the prevalence of toxic leadership, job satisfaction and turnover and Pearson's correlation examined the relationships between the variables. Hayes' PROCESS macro approach of mediation was used to determine the effect of toxic leadership behaviour on the turnover intention on the possible influence of job satisfaction.

RESULTS

The response rate for the study was 76.0%. Mean scores for turnover intentions and toxic leadership behaviour were 3.71 and 2.42 respectively. Nurses who work with toxic managers showed a higher propensity to leave their jobs. Job satisfaction acted as a mediator between the toxic leadership practices of managers and turnover intentions. The total effect of toxic leadership behaviour on turnover intention comprised its direct effect (β = 0.238, SE = 0.017, 95% CI [0.205, 0.271]) and its indirect effect (β = -0.020, SE = 0.017).

CONCLUSIONS

Job satisfaction acted as a mediating factor for toxic leadership behaviour and nurses' turnover intentions. As part of nurse retention initiatives, avoiding toxic leadership behaviours will be the ultimate agenda. Nurse administrators should recognize the value of excellent leadership and develop a structured training programme through the use of evidence-based professional development plans for nurse managers.

Understanding registered nurses' career choices in home care services: a qualitative study

BACKGROUND

The anticipated growth in number of older people with long-term health problems is associated with a greater need for registered nurses. Home care services needs enough nurses that can deliver high quality services in patients' homes. This article improves our understanding of nurses' career choices in home care services.

METHODS

A qualitative study using individual semi-structured interviews with 20 registered nurses working in home care services. The interviews were audio-recorded, transcribed and thematically analyzed.

RESULTS

The analysis resulted in three themes emphasizing the importance of multiple stakeholders and contextual factors, fit with nurses' private life, and meaning of work. The results offer important insights that can be used to improve organizational policy and HR practices to sustain a workforce of registered nurses in home care services.

CONCLUSION

The results illustrate the importance of having a whole life perspective to understand nurses' career choices, and how nurses' career preferences changes over time.

Perceived Utilization of Leadership Styles Among Nurses

Background

Nurses´ perceptions of leaders´ leadership styles has a significant impact on their well-being. Effective leadership in health care is crucial for improving and enhancing the effectiveness of health care systems. This study aimed to assess the perceived utilization of leadership styles among nurses at Jimma town public health facilities, Ethiopia.

Methods

This facility-based cross-sectional study was conducted with 403 nurses. Data were collected through a self-administered structured questionnaire. Data were entered into Epi-Data version 4.6 and then exported to SPSS version 25. The strength of association was described using unstandardized adjusted β with a 95% confidence interval (CI) and p-value <0.05.

Results

Of the 422 participants, 403 completed and returned the questionnaire correctly, thus achieving a response rate of 95.5%. Staff nurses perceived that their head nurses fairly often or commonly used transformational leadership styles, with a mean of 2.77±0.60. The multivariable linear regression analysis model indicated that there was a positive relationship between perceived leadership style and gender, overall organizational commitment, overall job-related stress, overall innovative work behavior, and overall leadership practice. However, there was a negative relationship between perceived leadership style and nurses who had not received previous training on leadership.

Conclusion

This study highlights that transformational leadership is a commonly utilized leadership style by leader nurses. Effective and balanced use of various leadership styles requires knowledge (training), organizational commitment, and innovative work behavior from both leaders and staff nurses. Therefore, a transformational leadership style is key to achieving organizational goals and increasing staff nurses' productivity.

The Impact of Transformational Leadership Style on Nurses' Job Satisfaction: An Integrative Review

Introduction

The argument about whether leadership style affects nurses' job satisfaction is centered around the impact of different leadership styles on the work environment and the quality of care provided by nurses. Therefore, this review was primarily aimed at assessing the impact of transformational leadership style on the job satisfaction of hospital nurses.

Methods

This is an integrative review conducted according to the Whittemore and Knafl's framework. Comprehensive literature searches were conducted in PubMed, MEDLINE, CINAHL, Web of Science, Research4Life, and APA PsychInfo. In addition, studies were included through hand-searching from different sources of grey literature and a reference list of identified articles. All English articles published between 2012 and 2023 reporting the impact of transformational leadership style on nurses' job satisfaction were eligible for inclusion.

Results

Seventeen articles were included in the review, of which 16 were cross-sectional studies, while one was mixed. The majority (n = 12) of the studies were conducted in at least two or more healthcare settings, with a total of 5841 nurses. Almost all (n = 16) articles reported the positive influence of transformational leadership on nurses' job satisfaction. In addition, the transformational leadership style was reported to have a positive impact on nurses' intentions to stay at work, quality care, and patient outcomes.

Conclusion

By adopting a transformational leadership approach within clinical environments, there is a potential to boost nurses' job satisfaction.

The influence of authentic leadership on nurses' turnover intentions and satisfaction with quality of care in Saudi Arabia: A structural equation modelling study

AIM(S)

The study aimed to test a model that examined the relationships between authentic leadership, psychological safety, work engagement and team effectiveness and subsequent effects of team effectiveness on job turnover intentions and nurse satisfaction with quality of care.

BACKGROUND

Nurse leaders who exhibit authentic leadership have been shown to contribute to the development of healthy work environments. In workplaces with demonstrated authentic leadership, nurses are more engaged and have lower job turnover intentions.

METHOD(S)

A non-experimental, cross-sectional design was used to test the hypothesized model via structural equation modelling. A total of 456 nurses were included.

RESULTS

Structural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership had a positive, significant and direct relationship with team effectiveness, nurses' work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care.

CONCLUSION(S)

Results of this study may help nursing leaders have a better understanding of the essential role of leadership style in increasing healthy work environments.

IMPLICATIONS FOR NURSING MANAGEMENT

Applying authentic leadership style in nursing practice could help to reduce the shortage of nurses stemming from the high turnover intentions of nurses.

Digitization in Everyday Nursing Care: A Vignette Study in German Hospitals

(1) Background: Digitization in hospital nursing promises to transform the organization of care processes and, therefore, provide relief to nurse staffing shortages. While technological solutions are advanced and application fields numerous, comprehensive implementation remains challenging. Nursing leadership is crucial to digital change processes. This vignette study examined the effects of the motives and values on nurses' motivation to use innovative technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess a fictitious situation about the introduction of digital technology. We varied the devices on the degree of novelty (tablet/smart glasses), addressed motives (intrinsic/extrinsic), and values (efficiency/patient orientation). (3) Results: The analysis included 299 responses. The tablet vignettes caused more motivation than those of the smart glasses (Z = -6.653, p < 0.001). The dataset did not show significant differences between intrinsic and extrinsic motives. The nursing leader was more motivating when emphasizing efficiency rather than patient orientation (Z = -2.995, p = 0.003). (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. The nursing staff's willingness to use digital technology is generally high. Management actions can provide a structural framework and training so that nursing leaders can ensure their staff's engagement in using also unknown devices.

The Relationship Between Nurses' Quality of Work-Life on Organizational Loyalty and Job Performance in Saudi Arabian Hospitals: A Cross-Sectional Study

Purpose

The purpose of this study is to analyze the relationship between quality of work-life on the organizational loyalty and job performance in Saudi Arabia.

Methods

This study used a cross-sectional design for collecting the data related to the nurses' quality of work-life, organizational loyalty, and job performance from nursing staff in Saudi Arabian hospitals. Three questionnaires were used in this study, which includes Quality of Work Life Scale (QWLS), Organizational Commitment Questionnaire (OCQ), and Individual Work Performance Questionnaire (IWPQ). An online version of the survey questionnaire was generated using the Google survey, to which a link is generated for collecting data. At the end of the survey, 243 responses were received. After removing the incomplete responses, 209 responses were considered for the data analysis. The statistical techniques including t-tests and Pearson's correlation were used in the data analysis.

Results

Nurse managers reflected good quality of life, and high loyalty toward their employers, and also reflected good job performance levels. However, staff nurses reflected poor quality of work-life, organizational loyalty, and job performance. Training and development had strong positive correlation with continuance commitment (r = 0.628, p < 0.01). Job satisfaction and job security held strong positive correlation with task performance (r = 0.601, p < 0.01) and contextual performance (r = 0.601, p < 0.01).

Conclusion

Quality of work-life, organization loyalty, and job performance are positively correlated, and poor quality of work-life can negatively impact job performance and organizational loyalty of nurses.

Leadership Style, Work Engagement and Organizational Commitment Among Nurses in Saudi Arabian Hospitals

Purpose

The purpose of this paper is to examine how nurse managers’ leadership styles, work engagement, and nurses’ organizational commitment are related in Saudi Arabia.

Methods

This study used a cross-sectional design using an online survey instrument targeted at nurse managers and nurses working in Saudi Arabian hospitals. Multi-factor leadership questionnaire (MLQ), organizational commitment questionnaire (OCQ), and Utrecht Work Engagement Scale (UWES) were used in the Questionnaire. The survey link is forwarded to HR administrators of 71 hospitals, which includes public, private, and public–private partnership hospitals. The survey link was active from 27th November 2021 to 18th December 2021, and at the end of the survey, 394 responses were received. After removing the incomplete responses, 390 participant responses are considered for data analysis. t-tests and correlation analysis are used to analyze the data.

Results

Among the participants, 84.4% of the participants were nurses and 15.6% were nurse managers. Significant difference (p < 0.05) of opinions is observed among nurse managers in relation to transformational and transactional leadership styles and engagement. Transformational and transactional leaderships are positively correlated with organizational commitment and nurses’ engagement.

Conclusion

Differences in leadership style perceptions among nurses and nurse managers reflected issues in nursing management, which have to be addressed in light of rapid infrastructural changes owing to Saudi vision 2030.

The Relationship between Empowerment and Organizational Commitment from Nurse’s Perspective in the Ministry of Health Hospitals

(1) Background: The nurse structure is the largest proportion of the healthcare team in hospitals and Primary Healthcare Centers (PHCs). Empowerment is considered a vital component in strategic planning implementation and plays an important role in enhancing job commitment, motivation and employee satisfaction. (2) Aim: The aim of this study is to examine the relationship between the empowerment and organizational commitment from a nurse’s perspective in the MOH in Makkah city in Saudi Arabia. (3) Methods: A descriptive, correlational design was utilized. The study was conducted at three hospitals affiliated with the Ministry of Health in Makkah. A random stratified sampling of 318 nurses voluntarily participated. Data were collected using two tools; Conditions for Workplace Effectiveness Questionnaire-II (CWEQ-II) to measure nurses’ empowerment, and the Organizational Commitment Questionnaire (OCQ). (4) Results: This study revealed that the nurses in Makkah city have a moderate degree of empowerment. Moreover, the level of organizational commitment among nurses was moderate. In addition, this study showed that there is a significant positive relationship between nurses’ empowerment and their organizational commitment. (5) Conclusion: By conducting this study, it seems that nurse’s empowerment is considered an important healthcare organizational strategy and nurses feel empowered by several factors, such as having access to power through informal and formal means and having access to organizational opportunity, access to support, access to information and access to resources. Access to sources of empowerment influences a nurse’s organizational commitment.

Effect of Hierarchical Nursing Management in Patients with Hypertension Complicated with Cardiovascular and Cerebrovascular Risk Factors

Hierarchical management is an essential component of nurse post management and an unavoidable tendency in nursing education. According to their existing condition, various hospitals around the country have actively tested the hierarchical usage and management model of clinical nurses, with some success. The application impact of hierarchical nursing care in patients with hypertension complicated by cardiovascular and cerebrovascular risk factors is the focus of this research. In a hospital, 300 patients with hypertension complicated by cardiovascular and cerebrovascular risk factors were chosen. All patients were split into two groups using the coin-throwing random method: the observation group received hierarchical nurse management and the control group received regular nursing management, with 150 cases in each group. The two groups' blood pressure, blood lipids, blood glucose, poor habits, rehospitalization rate, and cardiovascular and cerebrovascular problems were also examined. At the same time, the patients' poor mood and quality of life were assessed before and after the intervention. In the control group followed up for 1 year, the blood pressure compliance rate was 44.88%, the blood lipid compliance rate was 28.65%, the blood glucose compliance rate was 45.00%, the smokers with bad lifestyle habits were 26.57%, the overweight and obese were 23.5%, the high sodium was 31.67%, the rehospitalization rate was 15.48%, and the incidence of cardiovascular and cerebrovascular complications was 43.00%. The observation group's blood pressure, blood lipids, and blood sugar compliance rates rose substantially (P = 0.05) as compared to the control group. The occurrence of poor luck living habits, the rate of rehospitalization, and the incidence of cardiovascular and cerebrovascular complications were significantly reduced (P < 0.05). Before nursing intervention, there was no significant difference in the bad mood scores SAS, SDS, and quality of life between the two groups of patients (P > 0.05); after nursing intervention, compared with the control group, the observation group's bad mood scores were significantly reduced, physical factors, psychological factors, and total scores all increased significantly, and the difference was statistically significant (P < 0.05).

An integrative review of nursing leadership in Saudi Arabia

Aims

The aims of this integrative review were to describe leadership styles from the nursing literature in Saudi Arabia and to identify the current state of evidence about relationships between leadership styles and nurse, patient and organization outcomes in Saudi Arabia.

Design

Integrative review was used as a design for this study.

Methods

The following search terms were used with databases: ‘Saudi Arabia’, ‘leadership theory*’, ‘leadership style*’, ‘leadership model*’, ‘management style’ and ‘nurse*’. Methodological quality was assessed using two different quality rating tools for quantitative and qualitative studies. Databases used for this review included Nursing & Allied Health Database, Cochrane Database of Systematic Reviews, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science and ProQuest Dissertations & Theses.

Results

Nine manuscripts representing eight studies were included in this review. The papers reviewed included quantitative (n = 6), qualitative (n = 2) and mixed methods studies (n = 1). Results were grouped into different themes, identified as nursing leadership styles in Saudi Arabia, leadership styles and nurses' outcomes, and demographics and leadership styles.

Patient safety and leadership style in the government general hospitals in Kuwait: a multi-method study

Purpose

This study aims to evaluate the relationships between leadership style and reported incidents, reporting practices and patient safety initiatives in Kuwaiti hospitals.

Design/methodology/approach

This cross-sectional and retrospective quantitative multi-centre study was conducted in a secondary care setting. The multifactor leadership questionnaire and the patient safety questionnaire were distributed in six general hospitals to a sample of physicians, nurses and pharmacists. Incident reports were reviewed in each hospital to assess reporting practices.

Findings

The hospital with the most safety incident reports scored the highest on good reporting practices, whereas the hospital with the lowest score of poor reporting practices had reported fewer incidents. Reporting was better if an error reached the patient but caused no harm. Overall, reporting practices and implementation of patient safety initiatives in the hospitals were suboptimal. Nevertheless, a transformational leadership style had a positive effect on patient safety and reporting practices.

Practical implications

This study represents a baseline for researchers to assess the relationship between leadership style and patient safety. Moreover, it highlights significant considerations to be addressed when planning patient safety improvement programmes. More investment is needed to understand how to raise transformational leaders who are more effective on patient safety. Further studies that include primary and tertiary health-care settings and the private sector are required.

Originality/value

To the best of the authors’ knowledge, this study is the first in Kuwait to report on the relationship between transformational leadership and safety practices.

Organizational Culture, Quality of Care and Leadership Style in Government General Hospitals in Kuwait: A Multimethod Study

Purpose

To investigate the organizational culture, assess the quality of care, and measure their association with a transformational/transactional leadership style in six hospitals.

Materials and Methods

We used cross-sectional and retrospective quantitative approaches in government-sponsored secondary-care hospitals. A sample of 1626 was drawn from a frame of 9863 healthcare workers in six hospitals. Followers were surveyed using the Multifactor Leadership Questionnaire and the Organizational Description Questionnaire. We reviewed and analyzed one year (2012) of quarterly and annual quality indicators from the hospitals. Data were analyzed using suitable statistical analyses.

Results

We collected 1626 responses from six hospitals. 66.4% to 87.1% of participants in each hospital identified their hospital's organizational culture as transformational, whereas 41 out of 48 departments were identified as having a transformational culture. The percentage of participants at each hospital rating their leader and organizational culture as transformational ranged from 60.5% to 80.4%. The differences between leadership style and organizational culture were statistically significant for four of the hospitals. For most of the quality indicators, there was a positive, but nonsignificant, correlation with leadership style.

Conclusion

Leaders define and influence organizational culture. The prevailing transformational leadership style creates and maintains a transformational organizational culture. The effect of transformational leadership on the quality of care delivered by the organization was measured in this study, and showed a positive and nonsignificant relationship between generic quality indicators and the transformational style.

Differences between professionals' views on patient safety culture in long-term and acute care? A cross-sectional study

Purpose

This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey On Patient Safety Culture (HSPOSC) questionnaire was used to assess patient safety culture. Data from the organizations’ incident reporting system was also used to determine the number of reported patient safety incidents.

Design/methodology/approach

Patient safety culture is part of the organizational culture and is associated for example to rate of pressure ulcers, hospital-acquired infections and falls. Managers in health-care organizations have the important and challenging responsibility of promoting patient safety culture. Managers generally think that patient safety culture is better than it is.

Findings

Based on statistical analysis, acute care professionals’ views were significantly positive in 8 out of 12 composites. Managers assessed patient safety culture at a higher level than other professional groups. There were statistically significant differences (p = 0.021) in frequency of events reported between professional groups and between long-term and acute care (p = 0.050). Staff felt they did not get enough feedback about reported incidents.

Originality/value

The study reveals differences in safety culture between acute care and long-term care settings, and between professionals and managers. The staff felt that they did not get enough feedback about reported incidents. In the future, education should take these factors into consideration.

Nursing Leadership, Associated Sociodemographic and Professional Factors: The Perception of Leaders and Evaluators

Objective: To assess the leadership styles of the assistance Nursing professionals and their associated sociodemographic and professional factors. Materials and methods: An analytical and cross-sectional study. The sample comprised 75 Nursing professionals and 170 Nursing assistants selected for convenience. The Multifactorial Leadership Questionnaire was applied to assess leadership and the organizational result variables. Results: The predominant leadership styles were as follows: transformational (mean of 3.43) and transactional (3.40), which presented high correlation rates with satisfaction, efficacy and additional effort. The leadership style least perceived by the staff was corrective/avoidance (2.10). In transformational leadership, behavioral influence and inspirational motivation presented better scores in the leaders’ self-perception. Age, marital status and having children evidenced statistically significant differences with the transformational and transactional leadership styles; work experience was significant with transactional leadership. Conclusions: In their work, Nursing professionals denote encouraging practices that are inherent to transformational leadership, which is related to changes in the organizational culture, leads to motivating and inspiring the subordinates to transcend the routines and increases their satisfaction and commitment to their duties, thus being an important factor in health institutions.

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.

Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.

Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.

Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.

Clinical nurse managers' leadership practices in Saudi Arabian hospitals: A descriptive cross-sectional study

AIM

To understand the situational profiles of clinical nurse managers' transformational leadership practices in Saudi hospitals.

BACKGROUND

Clinical nurse managers' effective leadership may enable registered nurses to provide safe patient care.

METHODS

This included 29 clinical nurse managers and 318 registered nurses from three Saudi hospitals. Data were collected using the leadership practice inventory-self and the leadership practice inventory-observer.

RESULTS

A significant difference between self- and observer-assessed transformational leadership practices of clinical nurse managers was found. There was also a significant difference in transformational leadership practice between Saudi and non-Saudi clinical nurse managers. Ward experience of clinical nurse managers was statistically positively associated with higher ratings of "enabling others to act". Length of clinical nurse managers' experience was associated with "enabling others to act" and "encouraging the heart" practices.

CONCLUSION

Clinical nurse managers rated their transformational leadership performance higher than that reported by registered nurses. Further, non-Saudi clinical nurse managers working in Saudi hospitals overestimated the extent of their transformational leadership practices.

IMPLICATIONS FOR NURSING MANAGEMENT

Clinical nurse managers should gather feedback about their leadership performance regularly and implement required changes. Hospital administrations should provide additional support to clinical nurse managers through effective leadership programmes, enculturation and team-building strategies, to create a shared vision regarding the execution of optimal leadership.

Predictors of toxic leadership behaviour among nurse managers: A cross-sectional study

AIM

To identify the predictors of toxic leadership behaviour in nurse managers.

BACKGROUND

Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers.

METHODS

A descriptive, cross-sectional design was used. Two hundred and forty nurse managers from ten hospitals in the Central Philippines were included in the study. Data were collected using the Nurse Information Form and the Toxic Leadership Behaviours of Nurse Managers Scale (ToxBH-NM). Hierarchical multiple regression was used to analyse the data collected.

RESULTS

The mean of average item score of the ToxBH-NM was 1.250 (SD = 0.470). Multiple regression analyses identified the years of experience in a managerial role (β = -0.165, p = .031), job status (part time) (β = 0.177, p = .002), ward census (30 patients, 40 patients and above 40 patients) ([β = 0.231, p = .005]; [β = 0.345, p < .004]; [β = 0.262, p = .012]), number of units managed (2 units and > 3 units) ([β = 0.292, p < .001]; [β = 0.235, p < .001]), hospital type (private hospital) (β = 0.271, p = .007) and hospital level (secondary hospitals) (β = 0.226, p = .036) predicted toxic leadership behaviour in nurse managers.

CONCLUSIONS

Overall, nurse managers were appraised as non-toxic leaders. Nurse managers who held a part-time job status, those who had lower experience in the managerial role and those who were assigned to wards or units with high patient admission numbers reported increased toxic leadership behaviours. Further, nurse managers who managed more than 2 units, those who were employed in private hospitals and those who worked in secondary hospitals reported increased toxic leadership behaviours.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators can consider the different predictors identified when planning and developing leadership interventions and organisational strategies (e.g. limiting the number of units per nurse manager, provision of full-time job employment, assignment of assistant nurse managers, formulation of policy specific to managing toxic behaviours), which may assist in the determent of toxic behaviours in nurse managers.

The association between supervisor support and ethical dilemmas on Nurses' intention to leave: The mediating role of the meaning of work

AIM

To examine the association between supervisor support and ethical dilemmas on nurses' intention to leave health care organisations, both directly and through the mediating role of the meaning of work.

BACKGROUND

The shortage of nurses makes it vital that organisations retain nurses and so reduce the costs associated with replacing experienced nurses.

METHODS

This cross-sectional study samples 2,946 registered nurses from a selected health region in Norway. Structural equation modelling was used to test a hypothesized model.

RESULTS

Social support from the supervisor and ethical dilemmas is associated with nurses' intention to leave, both directly and indirectly through the mediating role of the meaning of work.

CONCLUSION

Health care organisations should enhance social support from supervisors and the meaning of work, and reduce the level of ethical dilemmas in hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Health care organisations should continuously develop and offer training in nurse manager skills, such as being empathic, understanding employees' needs and how to communicate and handle ethical dilemmas. Managers should value staff contributions, encourage staff involvement in ethical questions and highlight the impact of nurses' work on improving the welfare of others.

Frontline nurse managers' visions for their units: A qualitative study

AIMS

To elucidate frontline nurse managers' visions of their units.

BACKGROUND

Managers have the opportunity to imagine and share their visions for effective unit management.

METHODS

Semi-structured interviews were conducted with 12 frontline nurse managers working at inpatient units in two hospitals between 2016 and 2017. Data were qualitatively analysed using an inductive approach, focusing on participants' intents.

RESULTS

Although participants showed four types of difficulties in verbalizing visions, five categories and 18 subcategories were extracted through analysis of their descriptions about actual cases reflecting their visions. The categories were (a) provide excellent care to ensure patient recovery based on reliable knowledge and skills, (b) make efforts to broaden patients' futures, (c) create a climate for pursuing better practice, (d) all staff continuously pursue professional development and (e) provide nursing care that responds to external changes. All categories were common to all participants' images of the future and linked together to form each manager's vision.

CONCLUSION

Frontline managers experienced difficulty in articulating their visions. However, through episodes, they represented images of visions. The managers' visions comprised five categories reflecting various perspectives.

IMPLICATIONS FOR NURSING MANAGEMENT

Using a conceptualized vision framework, and identifying difficulties in verbalizing their images, can help managers articulate their visions.

Factors Affecting the Organizational Commitment of Nurses in Comprehensive Health Services: A Systematic Review

Introduction: Organization commitment is an important variable in understanding employee behavior that has a serious effect on organizational performance. Employees not only have to have expertise, empowerment and competence, but they also have to have organizational commitment. Therefore, the level of attachment and commitment of the nurses to their organization can influence their clinical competence. The research was conducted to identify the factors that influence nursing organizational commitment.Methods: The literature review employed the Scopus, ScienceDirect, Pubmed, Ebsco and CINAHL databases to retrieve original articles published between 1999 and 2017. The method used to arrange the literature review started with the topic selection and then the reviewer determined the following keywords: organization commitment, commitment, nursing, health and factors of commitment. Out of the 2.134 articles found, there were 15 journals with a cross-sectional study design that discussed the organizational commitment of nurses.Results: The organizational commitment of care is influenced by many factors, both internal and external. These factors include leadership style, compensation, career development, organizational culture /climate, spiritual health and learning organizations.Conclusion: The factors found above can increase the commitment of nurse organizations in comprehensive health services.

Reflecting on Leadership Development through Community Based Participatory Action Research

The need for leadership in nursing is well-documented and Domain Six of the doctoral section of the National Nursing Education Framework of the Canadian Association of Schools of Nursing (CASN) is Leadership. While there are likely many paths to achievement of these leadership components, the intent of this paper is to share my journey through iteration of and reflection on my PhD dissertation research focused on a four-cycle community-based participatory action research study (CBPR) related to clinical teaching in Ghana. The focus of CBPR is to engage the researcher and the participant group (community) in collaborative, and egalitarian processes to assess and problem solve an issue in the community. Similarly, leadership promotes collaborative interpersonal relationships among leaders and followers to address issues and institutes change strategies in policies. This paper presents my experiences in building leadership capacity through this scholarly endeavor (PhD thesis) in relation to the CASN guideline.

Liderança transformacional na prática dos enfermeiros em um hospital universitário

Resumo Objetivo Analisar o exercício da liderança transformacional na prática dos enfermeiros em um hospital universitário. Métodos Estudo de métodos mistos explanatório sequencial. Na etapa quantitativa, com amostra não probabilística por conveniência, aplicou-se um questionário de atitudes frente a estilos de liderança adaptado para a frequência de adoção dos comportamentos de liderança transformacional a 152 enfermeiros do referido hospital. Estes dados passaram por testes estatísticos descritivos e analíticos. Na etapa qualitativa, 25 participantes da primeira etapa foram sorteados e responderam a uma entrevista semiestruturada, analisadas mediante análise temática de conteúdo. Resultados Identificou-se a prática da liderança transformacional de forma frequente entre os enfermeiros. Entretanto, eles apresentam dificuldades para exercer esse modelo de liderança, devido a carência de apoio da instituição que, majoritariamente adota uma liderança verticalizada, pela falta de capacitação para os enfermeiros assistenciais, e fragilidades na comunicação e discussão dos problemas antes das tomadas de decisões. Conclusão A prática da liderança transformacional encontra resistências pelo maior exercícios da liderança verticalizada pelos gestores, entretanto os enfermeiros acreditam que uma liderança com comportamento horizontalizado pode favorecer mudanças estruturais e comportamentais da instituição.