Do nurses on inpatient nursing units (P) who work with transformational leaders (I) versus other styles of leadership, bureaucratic or laissez-faire (C) have higher nurse engagement, retention, and team member satisfaction scores (O) over the course of one year (T)?
Literature Review on the Effect of Leadership Styles
Organizational effectiveness is significantly influenced by the type of leadership. According to Shim (2016), the relationship between healthcare providers and leaders determine the quality of services and patient outcome. There are different leadership styles whose impacts depend on the founding concepts. These include transformational, transactional, bureaucratic, and laissez-faire. This paper, therefore, examines the current literature on different leadership styles and how they impact nurse engagement, retention, and team member satisfaction. The literature is centered on the PICOT question: Do nurses on inpatient nursing units (P) who work with transformational leaders (I) versus other styles of leadership, bureaucratic or laissez-faire (C) have higher nurse engagement, retention, and team member satisfaction scores (O) over the course of one year (T)?
Different Leadership Styles
Prior to examining the impacts of the different leadership styles, it is critical to understand their constructs, merits, and pitfalls. Nanjundeswaraswamy and Swamy (2014), while distinguishing leadership styles define an effective leader as one with the ability to influence the followers towards a desirable outcome. In a transformational leadership style, these authors note that it focuses on the development of employees and their needs. Transformational leaders concentrate on the development of employees’ value system through inspiration. In bureaucratic leadership, Rouzbahani, Alibakhishi, Ataie, Koulivand, and Goudarzi (2013) argue that the leader follows the normative rules and adhere to the authority lines. Bureaucratic leaders are empowered by their offices and impose strict discipline on the employees while demanding the business-like conduct at the organization. In Laissez-faire leadership style, which is also defined as delegative, the leaders allow the followers or team members to make decisions. Across the three leadership styles, their effectiveness is based on the impacts on the employees and influencing the achievement of organizational goals.
Review of Current Evidence-Based Literature
The impact of transformational leadership is described by organizational commitment and job satisfaction, which reduces nurse turnover. In a cross-sectional study by Lin, MacLennan, Hunt, and Cox (2015) conducted in Taiwan, it was revealed that supervisor support is influenced greatly by transformational leadership approach. This study further showed that transformational leaders are supportive of employees, which promotes job satisfaction and commitment. A concept analysis by Fischer (2016) concurs with these findings and posit that transformational leaders are associated with enhanced patient care and high-performing teams. However, this leadership style required further empirical research to understand the constructs and specific mechanisms through which it influences healthcare outcomes. A key disadvantage of this study is that it did not focus on a specific context such as mental health unit. The difference between transformational and laissez-faire leadership can be explained on the emotional intelligence context. In a descriptive exploratory study by Spano-Szekely, Griffin, Clavelle, and Fitzpatrick (2016), a positive correlation between transformational leadership and emotional intelligence was shown. However, the correlation is negative in Laissez-faire leadership. The negative correlation is associated with a deficiency in employee satisfaction and teamwork, which further determine the rate of turnover among nurses. This study concluded that emotional intelligence is vital in an organization that should be considered when hiring nurse managers.
There is a difference in the relationship between leadership style and a supportive working environment which determines nurse retention. This was revealed in a descriptive correlational study by Merrill (2015), who concluded that nursing leaders should focus on enhancing the transformational leadership competencies while reducing the negative ones such as abusive. These authors revealed that transformational leadership style promotes the safety of working climate, which results in staff motivation and satisfaction. This was not the same as the laissez-faire style, which negatively contributes to socialization at the workplace. Important to note is that unsupportive working climate causes a high turnover rate among nurses. A key merit of transformational leadership that lacks in laissez-faire style or bureaucratic is employee empowerment. In a descriptive correlational study by Khan, Griffin, and Fitzpatrick (2018), transformational leadership style was linked to reduced nurse turnover and workload. A descriptive analysis study by Alghamdi, Topp, and AlYami (2018) conducted in Saudi Arabia demonstrated the relationship between transformational leadership style and job satisfaction. Through an anonymous questionnaire and post-hoc analysis, this study concluded that transformational leaders demonstrate high competence in their work and are independent with regards to gender, which enhances the level of teamwork.
Organizations are struggling with establishing effective leadership styles, thus result in developing a mixture of approaches. Joshi (2019) in a quantitative design using a survey on ten leadership styles revealed that bureaucratic leadership style which involves following the organizational rules is characterized by the weakness of authority and workers being obliged to follow the company’s rules and regulations. This author, therefore, recommends comprehensive training for leaders at both the top and middle levels to develop their competencies. The merits and challenges associated with bureaucratic leadership are further explained Andreasson, Ljungar, Ahlstrom, Hermansson, and Dellve (2018) in a study on Swedish hospitals. According to these authors, creating change in a hospital requires the leaders to examine all the preconditions related to the specific issue that requires adjustment. Following the governance principles and professional bureaucracies ensures that the change is effected profoundly. On the other hand, bureaucratic leadership style may be perceived as authoritarian, which affects teamwork and one’s competence and satisfaction. Teamwork among nurses can be explained by the level of socialization and incivility. Kaiser (2017) in a survey of different leadership styles, revealed a strong correlation between transformational leadership style with low incivility level, staff input, and satisfaction. This author, therefore, recommended comprehensive training to employees on interpersonal dynamics and relationships which foster socialization. Notably, these aspects are contained in transformational leadership, which comprise of enhanced relationships among the healthcare providers.
The satisfaction of team members in nursing practice is dependent on the structural empowerment, professional working environment, and authentic leadership. In a predictive non-experimental design by Regan, Laschinger, and Wong (2016) in Canada, it was shown that enhanced interprofessional collaboration (IPC) is significantly influenced by authentic leadership and having a suitable nursing working environment. Although this study did not specify the type of leadership, the specific elements promoting interprofessional collaboration can be used to describe the leadership styles. These elements describe transformational leadership. This was established in a cross-sectional study in Uganda by Musinguzi et al. (2018) on the difference between transformational and transactional or laissez-faire styles in teamwork, job satisfaction, and motivation. The findings revealed that the majority (62%) of health workers prefer transformational leaders while 42% and 14% prefer transactional or laissez-faire leadership styles respectively. Based on these findings, it is apparent that transformational leaders focus on employee empowerment and achieving a suitable working environment which promotes interprofessional collaboration. It is, therefore, the role of organizations to ensure a culture and structure that is supportive of transformational leaders. Musinguzi et al. (2018) outline some of the key merits of transformational leaders, which include maintaining cohesion among the healthcare providers and motivation which are not present in transactional or laissez-faire leadership model.
There is a relationship between job satisfaction, teamwork, and nurse retention. Notably, this relationship is dependent on the quality and type of leadership and the working environment. This was established in a study by Bawafaa, Wong, and Laschinger (2015) through a secondary analysis of data obtained from a cross-sectional survey in Canada. According to this research, resonant leaders and structural empowerment in the healthcare sector ensure a supportive environment, which results in high satisfaction among nurses. In addition, these leaders are instrumental in fostering motivation and skill development among employees, which promotes one intention to stay at the organization. Besides nurse retention, the importance of effective leadership is to attract new workers to address the increasing shortage. Through secondary data analysis, Fallatah and Laschinger (2016) revealed that managers with authentic leadership qualities had the ability to attract new nurses and retain them based on job satisfaction. The relationship between nurse retention, teamwork, and job satisfaction is centered on establishing a supportive working environment for every nurse, regardless of diversity affiliation. In transformational leadership theory, the manager should demonstrate competence in attracting new workers to meet the healthcare organization needs and objectives. However, retaining such workers remains a critical challenge which is addressed by the quality of leadership.
Organizational commitment is dependent on job satisfaction, teamwork, and leader’s behaviour. In a study by Lorber, Treven, and Mumel (2018), a Spearman correlation analysis revealed that the leadership characteristics, style, emotional intelligence, and profound teamwork significantly influence the commitment of nurse to the organization. In this study, bureaucratic leadership was characterized by following all the organizational norms, culture and structure. Although this leadership style was identified to be effective in implementing organizational change, it was faulted for limited worker’s empowerment and the relationship between the leaders and employees which may negatively impact the growth and development of a medical facility. The relationship between organizational commitment and interprofessional teamwork in medical facilities is supported by the organizational culture and transformational leadership. This was revealed in a multi-centre cross-sectional study by Korner, Wirtz, Bengel, and Goritz (2015) which established that organizational managers should enhance their awareness regarding the effectiveness of interprofessional teamwork and organizational culture. Notably, these aspects reflect on quality leadership and although the bureaucratic style of leadership entails managing an organization according to its culture, transformational leadership ensures sustainability in the relationship between the managers and workers which fosters job satisfaction and organizational commitment.
Application of Evidence-Based Literature
The implications of the findings above are reflected in understanding the types of leadership in an organization and their merits. For instance, the study by Kaiser (2017) demonstrates the importance of transformational leadership in promoting civility, teamwork, and employees’ satisfaction, which determines the retention rate. Boamah, Laschinger, Wong, and Clarke (2018) in a cross-sectional survey examined the impacts of transformational leadership on patient safety outcome and job satisfaction and revealed that the use of this leadership style is vital in achieving a work environment that empowers the nurses and promotes the workers’ satisfaction. One of the key insights from the literature analysis above is the importance of educating nursing leaders on different leadership approaches and their implications. Al-Yami, Galdas, and Watson (2018) while using the organizational commitment and multifactor leadership questionnaires revealed that transformational leadership style is both dominant and effective in promoting the organizational goals and objectives compared to transactional approaches such as bureaucratic. These authors, therefore, recommend the introduction of a full-range leadership approach in the nursing workforce, which will promote the nursing managers competence as future leaders. Also, a wide leadership approach influences positive change.
The intention of a nurse to leave an organization is influenced by the leadership style. Applying the theory of reasoned action and organizational commitment model, the intention of a nurse to leave an organization is affected by the working environment and relationship between workers and managers (Alha & Mat, 2015). In addition, the intention of a nurse to stay or leave an organization is determined by performance management, which further defines the leadership style and quality. Transformational leadership, according to Lavoie-Tremblay, Fernet, Lavigne, and Austin (2016), is associated with a supportive environment which promotes nurses’ satisfaction and motivation to stay in an organization. This introduces the importance of having an effective organizational culture. Through a cross-sectional design, these authors recommend supportive leadership approaches while eliminating authoritarian or abusive management. To achieve a supportive environment, training nursing managers on different leadership styles, their constructs, merits, and challenges is vital. Spano-Szekely et al. (2016), on the other hand, recommend the importance of considering emotional intelligence while hiring nursing managers. According to these authors, the transformational leadership style has a positive correlation with emotional intelligence, which promotes the quality of management and patient outcome as compared to the laissez-faire style.
Understanding the constructs of a leadership style is the foundation of its effective application. In the study by Merrill (2015), the different leadership styles were noted to have diverse implications for the workers. Joshi (2019) agrees with this argument and adds that organizations are facing vital challenges in selecting the most effective leadership approach that suits the company. This author further recommends the application of a multi-leadership approach that considers diverse styles. Although it is important for organizational leaders to ensure employees follow the bureaucracies, protocols, and guidelines outlined in the hospital’s structure and culture, establishing a supportive environment that empowers nurses is vital. While examining staff nurses’ perception of their managers, Khan et al. (2018) revealed that transformational leadership style is associated with structural empowerment. For bureaucratic and laissez-faire leadership styles, they are characterized by poor teamwork and high turnover. Nurse engagement is examined based on socialization, which is high in transformational leadership compared to bureaucratic or laissez-faire.
Different leadership styles determine organizational commitment, teamwork, and nursing satisfaction. According to Korner et al. (2015), it is imperative for organizations to conduct an effective assessment of leadership competencies with regards to promoting teamwork and service delivery. This aids in developing profound interventions to educate nurse leaders on good organizational cultures which promote job satisfaction and organizational commitment. One of the key findings from the literature analysis is the importance of interpersonal and communication skills in one’s commitment and nurse retention. Regan et al. (2016) note that effective leadership should be authentic, which focuses on building legitimate management. Fallatah and Laschinger (2016), while defining authentic leadership adds that honest relationships between leaders and followers should value one’s inputs and built on ethical frameworks. Drawing from these three studies, it is apparent that the transformational leadership approach is characterized as authentic, openness, and profound relationship between workers and leaders, which fosters job satisfaction. Also, transformational leaders are characterized by competence in interpersonal and communication skills, which are vital in achieving organizational goals and objectives. Bawafaa et al. (2015) therefore, recommend continuous education of leaders on transformational leadership style to promote job satisfaction and worker motivation.
Leadership styles significantly determine turnover rates, teamwork, satisfaction, and individual engagement. Nanjundeswaraswamy and Swamy (2014) while evaluating leadership styles based on the two broad categories of transformational and transactional, revealed that the management approach determines the individual’s commitment and satisfaction, which are interrelated. Although this study did not distinguish the bureaucratic and laissez-faire leadership styles individually, it is apparent that the transformational model is widely applicable and empowers workers to promote their output. Engaging nurses in hospitals is critical in fostering the relationship among healthcare providers, which ensures a supportive working environment. In bureaucratic leadership, Andreasson et al. (2018) posit that workers are required to follow management methods and professional protocols in fostering organizational change. However, this study was limited in examining the implications of the bureaucratic leadership approach from the nurses’ perspective and in a specific context such as acute care units. This limitation affects the external validity of the study.
A key finding from the literature evaluation is the significance of transformational leadership with regards to job satisfaction, organizational commitment, and socialization. Boamah et al. (2018) demonstrate other merits of this leadership style such as promoting the quality of care and interaction between various stakeholders. Another key finding is the need for healthcare administrators to alter policies to enhance the working environment (Al-Yami et al., 2018; Lavoie-Tremblay et al., 2016; Merrill, 2015). Drawing from the theory of reasoned action, the intention of a nurse to leave or stay in an organization is influenced by the working environment. In a quantitative, comparative, and descriptive study by Abdelhafiz, Alloubani, and Almatari (2016) in Jordan, it was shown that there is a strong and positive correlation between leadership style and job satisfaction which is dependent on the working environment. These authors, however, do not provide the significance between laissez-faire or bureaucratic leadership and nurse retention, thus the importance of considering different styles in the future in one study population. In addition, the development of leadership competencies is not provided, which is a major recommendation for future studies.
Nurse retention is influenced by organizational culture and structure. These aspects further influence the attraction of new and competent nurses. Halter et al. (2017) in a literature review on nurse turnover established that the intention by a worker to leave or stay in an organization is based on two core elements of satisfaction and motivation at the workplace. Notably, these aspects further determine organizational commitment. Bawafaa et al. (2015) mention that structural empowerment among registered nurses should be factored in the type of leadership. Bureaucratic leadership style ensures that every activity is carried out according to the structure and culture of the medical facility. Although this promotes commitment by an employee to the organizational norms, there are also challenges with regards to these leaders being perceived as authoritarian. In a laissez-faire leadership style, the delegation of activities has a low correlation with job satisfaction and an individual’s commitment. Musinguzi et al. (2018) contend that few healthcare providers recognize this leadership style as effective. Transformational leadership approach, on the other hand, is related to high commitment, nurse retention, satisfaction, and teamwork (Regan et al., 2016; Lorber et al., 2018). In these two studies, transformational leadership should be encouraged to promote an individual’s commitment and outcome.
Although transformational leadership is described as significant in achieving the organizational goals and objectives, it is evident that skill development and ensuring a profound case for change are challenging. Cheng, Bartram, Karimi, and Leggat (2016) in a cross-sectional study, revealed that human resources managers are required to demonstrate quality transformational leadership skills which determines employee outcome. However, this leadership approach is challenged by promoting change in the organization as compared to the bureaucratic style. Compared to the laissez-faire leadership style, the transformational approach is characterized by poor skill development but is credited by high motivation and employee satisfaction, which promote nurse retention (Crowne et al., 2017). A key gap, however, in the above analysis is the limitation of exploring the three leadership styles using the same population depending on the outcomes of nurse engagement, teamwork, and retention. This provides a foundation for future research.
In summary, leadership style determines the organizational outcome and employee satisfaction, which influences employee retention rate. Transformational leadership style is characterized by workers’ empowerment and inspiration while bureaucratic is described by following the organizational normative rules and guidelines. Laissez-faire style, on the other hand, entails delegation with minimal supervision. Drawing from the literature analysis above, transformational leadership has significant influence on employee output and organizational effectiveness based on aspects such as emotional intelligence, promoting the working environment, and employee satisfaction. However, it is essential to compare the different leadership styles further using one study population based on the three outcome variables of nurse engagement, team satisfaction, and retention.
Abdelhafiz, I. M., Alloubani, A. M. D., & Almatari, M. (2016). Impact of leadership styles adopted by head nurses on job satisfaction: a comparative study between governmental and private hospitals in Jordan. Journal of nursing management, 24(3), 384-392.