I, Sultana Alsharif, do grant permission for my ...€¦ · AN ASSESMENT OF MANAGERIAL STYLES AND HOW THEY DIRECTLY INFLUENCE NURSING JOB SATISFACTION AT HERA GENERAL HOSPITAL IN

I, Sultana Alsharif, do grant permission for my professional contribution to be copied.

NURSING SUPERVISORS AT HGH 2


AN ASSESMENT OF MANAGERIAL STYLES AND HOW THEY DIRECTLY

INFLUENCE NURSING JOB SATISFACTION AT HERA GENERAL HOSPITAL IN THE

KINGDOM OF SAUDI ARABIA

by

Sultana Alsharif

A Professional Contribution

Submitted to the Faculty of

Marywood University

In Partial Fulfillment of the Requirements for the Degree of

Master of Health Services Administration in Public Administration

Approved:

Mentor

Review Committee Member



(Date: Month and Year)

Department Chairperson


Table of Content

ABSTRACT ........................................................................................................................................... 8

INTRODUCTION ............................................................................................................................... 10

CHAPTER ONE .................................................................................................................................. 12

LITERATURE REVIEW .................................................................................................................... 12

MANAGERIAL STYLES .................................................................................................................... 17

CHAPTER TWO ................................................................................................................................. 21

HISTORICAL BACKGROUND OF HEALTHCARE IN SAUDI ARABIA ...................................... 21

DESCRIPTION OF HERA GENERAL HOSPITAL (HGH) FRAMEWORK ................................. 26

Distribution: ............................................................................................................................................................................ 27

Ground Floor ........................................................................................................................................................................... 27

First Floor ................................................................................................................................................................................. 27

Second Floor ............................................................................................................................................................................ 27

Medical Operation Line ...................................................................................................................................................... 32

Administrators and Managers ............................................................................................................................................................... 32

Physicians ..................................................................................................................................................................................................... 32

Nurses ............................................................................................................................................................................................................ 32

Technicians .................................................................................................................................................................................................. 33

CHAPTER THREE ............................................................................................................................. 35

HERA GENERAL HOSPITAL POLICY OF CONTINUING EDUCATION .................................... 36

HEALTHCARE PROFESSIONAL QUALIFICATIONS ................................................................... 36

EMPLOYEE GENERAL BEHAVIOR (CODE OF CONDUCT) ....................................................... 37

ORGANIZATIONAL STRUCTURE .................................................................................................. 38

HEALTHCARE PROFESSIONAL ROLES........................................................................................ 43

QUALITY OF THE RELATIONSHIP BETWEEN NURSING SUPERVISORS AND NURSES ... 50

CONNECTION BETWEEN NURSING SATISFACTION AND PATIENT SATISFACTION ....... 51

CHAPTER FOUR ............................................................................................................................... 53

RESEARCH QUESTION .................................................................................................................... 53


HYPOTHESES .................................................................................................................................... 54

METHODOLOGY ............................................................................................................................... 56

Nursing Staff ........................................................................................................................................................................... 56

Nursing Supervisors............................................................................................................................................................. 57

CHAPTER FIVE ................................................................................................................................. 63

RESULTS ............................................................................................................................................ 63

Age ................................................................................................................................................................................................................... 64

Years of Experience at HGH.................................................................................................................................................................... 64

Position at HGH........................................................................................................................................................................................... 64

Future Employment Plan ........................................................................................................................................................................ 65

Table 1 .......................................................................................................................................................................................................... 65

Frequency Counts and Relative Frequencies for Study Variables............................................................................................ 65

Table 2 .......................................................................................................................................................................................................... 67

ANOVA for Effect of Age and Employment Plan on Nursing Staff Perceptions of .............................................................. 67

Manageria Styles ........................................................................................................................................................................................ 67

Table 3 .......................................................................................................................................................................................................... 68

ANOVA for Effect of Experience and Position on Nursing Staff Perceptions of................................................................... 68

Managerial Styles ....................................................................................................................................................................................... 68

Table 4 .......................................................................................................................................................................................................... 69

ANOVA for the Effect of Age and Employment Plan on Nursing Staff ..................................................................................... 69

Satisfaction ................................................................................................................................................................................................... 69

_______________________________________________________________ ............................................................................................................. 69

Table 5 .......................................................................................................................................................................................................... 70

ANOVA for Effect of Experience and Position on Nursing Staff Satisfaction ........................................................................ 70

CHAPTER SIX .................................................................................................................................... 82

DISCUSSION ...................................................................................................................................... 82

Table 6 .......................................................................................................................................................................................................... 87

Item Means and Confidence Intervals (Descriptive) ..................................................................................................................... 87

ADMINISTRATIVE IMPLICATIONS .............................................................................................. 88

LIMITATION ...................................................................................................................................... 91

CONCLUSION ..................................................................................................................................... 92

REFERENCES ..................................................................................................................................... 94


APPENDIX A ....................................................................................................................................102

INTERVIEW INSTRUMENT FOR NURSING SUPERVISORS ...................................................102

APPENDIX B ....................................................................................................................................103

NURSING STAFF SATISFACTION SURVEY ................................................................................103


Acknowledgment

I would like first to thank my mother, for without her continuous support (taking care of my

daughter) and encouragement I never would have been able to pursue my higher education. This

one is for you mom! My father-you are a great father, with your support I have achieved my

goals, I will always make you proud of me! Of course thank you to my husband for his support

and encouragement throughout my study, he is always there for me.

Second, a special thank to you, my research project advisor and professor, Dr. Alice McDonnell.

Words cannot describe how lucky I am to have had such a great professor; thank you for your

patient guidance, enthusiastic encouragement and the knowledge I gained from working with

you.

Third, My grateful thanks are also extended to Professor Margot Vagliardo and Professor David

Rheinheimer for their help in doing the data analysis measurement, and their valuable support in

designing the methodology.

I would like to express my very great appreciation to Dr. Waleed Husain and Ms. Manal

Kareemh, for their valuable support at Hera General Hospital for their help in collecting the data.

Finally, thanks to the subjects who voluntarily participated in the study, none of this would have

been possible without them.


Abstract

The study focused on evaluation of managerial styles of nursing supervisors. It also explored and

measured those managerial styles Autocratic, Consultative, Democratic, Chaotic, and Laissez-

faire, and how they directly influence nursing staff job satisfaction. The research was conducted

at Hera General Hospital (HGH) in The Kingdom of Saudi Arabia. The research finding is nurses

were satisfied with their supervisors at HGH. Moreover, supervisory interpersonal skills,

communication, coordination, empowerment would affect more the nurse perception of their

supervisors. There are confirmed factors affecting nursing staff perceptions of managerial styles

and nursing staff overall work satisfaction such as future employment plan, employee’s age,

years of experience, or employee’s position. Hospitals are able to utilize these findings to make

future executive decisions that will increase nurses’ job satisfaction, thereby improving the

success of their medical facilities.

Keywords: Nursing supervisor, nursing job satisfaction, and nurse perception


Introduction

Many changes have occurred internationally in the healthcare environment over the last

decade (Sullivan & Decker, 2000). Primary challenges of effective healthcare management

include nursing shortages and the retention of qualified healthcare professionals.

Management styles are very complex and crafted differently by each supervisor

depending on the situation. Due to this fact, every level of management will have an influence on

their healthcare organization’s efficiency and productivity.

Management style was found to be the key variable in predicting and creating

professional workplaces, i.e. the ability of hospitals to attract and retain nurses (Nichols, 2003).

It has been discovered that hospitals that attract and retain more qualified nurses are those in

which the nurses perceived their managers’ leadership style to be more participative (Upenieks,

2003).

Various medical associations and accreditation agencies worldwide all require healthcare

systems to refocus their efforts on reducing medical errors, improving patient safety, and

guaranteeing that they will provide continuing education opportunities for all of their health care

professionals.

The skills of the supervisors and their level of effectiveness are crucial topics to be


observed and analyzed. Currently, limited research has been conducted in this area. –The

research reported here is a research study conducted in Hera General Hospital (HGH), which is

located in Saudi Arabia. This researcher used a mixed method approach based on personal

interviews of nursing supervisors (see appendix A). Additional qualitative data will be provided

in order to expand the research findings. Furthermore, a descriptive analysis of the survey

instrument given to nurses at HGH (see appendix B) will be interpreted.

The current international nursing shortage must be addressed if dire consequences are to

be avoided. Insufficient nursing staff levels are associated with many adverse patient outcomes,

which include higher rates of pneumonia, urinary tract infections, prolonged hospital stays, and

“failure to rescue” (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002).

This study will benefit hospital administrators and nurse supervisors because it will help

them to recognize the effects that their styles and behaviors have on their healthcare

environment, and it will encourage them to make any necessary changes that will increase

nursing staff job satisfaction and perception of the nursing profession.


Chapter One

This researcher will begin the present study by reviewing earlier facts and related studies.

Managerial styles in the healthcare field will also be discussed. The role of managerial styles as

the key to hospital success will be justified in this chapter.

Literature Review

Supervision

First of all, the reader needs to grasp the definition of supervision in general. Rosemary

Stewart, who received her Doctorate from the London School of Economics, wrote on

managerial work and behavior. In 1967, she defined a supervisor as: “someone who gets things

done with individuals’ assistance and the aid of other resources.” Others say that the general

meaning of “supervision” is concerned with ‘ keeping an eye on someone,’ and checking that

work is being done appropriately and effectively. The more context- specific application of the

term ‘supervision’ in nursing can result in its being tainted with a negative image (Kohner,

1994). In the researcher’s professional opinion, a supervisor is someone who supervises and

directs subordinates’ tasks towards reaching a successful outcome. In the clinical field,

supervision is “regular, protected time for facilitated, in-depth reflection on complex issues

influencing clinical practice,” (Bond, 2010).


The United Kingdom’s Department of Health (1993) defined clinical supervision

as:

Clinical supervision is the term used to describe a formal process of professional support

and learning which enables practitioners to develop knowledge and competence, assume

responsibility for their own practice and enhance consumer protection and the safety in

care complex clinical situations. It is central to the process of learning and to the

expansion of the scoop of practice and should be seen for the means for encouraging self

assessment and analytics and skills.”

Healthcare managers have a significant, external focus (to the world outside the unit),

whereas a healthcare supervisor has a more internally- focused responsibility of implementing

the manager’s decisions through the work of subordinate employees. Supervisors play the work

must be performed in order to achieve the objective established by the healthcare manager.

Supervisors often perform the same kind of work as their subordinates. Thus, some situations

demand individual-centered, task-centered, or a combination of the two managerial styles.

Focusing on management styles and behaviors that are driven by nurse supervisors will improve

the productivity and efficiency of the unit.


Definition of a Nursing Supervisor

Nursing supervisors, who are the first level of supervision in a healthcare setting, form

the main focus group in this research. Because supervisors are more closely in contact with the

patient than high-level managers, they are better able to determine specific recommendations and

to measure the hospital’s success at meeting strategic and improvement goals. The second group

on which this research focuses is nursing staff.

The supervision role can be sub-divided into three parts: Peer, individual, and team

supervision. The purpose of supervision is to enable the supervisee to achieve, sustain, and

creatively develop a high quality of practice through focused support and development. The

supervisee reflects on the part he or she plays as an individual in the complexities of the events

and the quality of the practice (Bond, 2010). For Platt-Koch (1986), the aims of supervision are:

to expand the knowledge base, develop clinical expertise and proficiency, and develop self-

esteem and autonomy.

Definition of Nurses

The concept of the nursing practice comes from the intertwining of flesh and spirit.

Florence Nightingale, the founder of modern nursing, believed that “nurses put the patient in the

best condition for nature to act upon him,” (Nightingale, 1946). Florence created the idea of

nursing in order to fill in the gap between physicians and patients.

http://en.wikipedia.org/wiki/Nursing


Nursing Satisfaction

The experts continue to look to the past for guidance in coping with management

problems today. In the 1930s, there was a development of human relations and motivation

theories made possible by the Hawthorne experiments conducted by Elton Mayo, the

psychologist, sociologist, and organizational theorist. Elton Mayo founded the concept of "A

satisfied worker is a good worker." The management styles that borrow from this theory would

concentrate on providing employees with greater communication abilities, building effective

teamwork, giving them a say in the decision-making process, and ensuring their safety, which all

contribute to employee satisfaction. In his studies, Mayo provided a favorable environment for

the employees in order to ensure target outcomes. One of Mayo’s key findings was that social

interaction is important and people work well if they feel valued, not just for money.

According to Linda, Aiken, Clarke et al. (2008), in 168 Pennsylvania hospitals, when

nurses were given additional patients to care for, the increase was associated with a 7% growth

in the likelihood of dying within 30 days of admission. Also, it was noted that there was a 7%

growth in the chances of failure-to-rescues. Each additional patient per nurse ratio was associated

with a 23% increase in the probability of nurses feeling more burdened and a 15% increase in the

odds of the nurses becoming dissatisfied with their jobs. Findings from previous studies also

illustrate that job satisfaction is a condition that nurses find essential. When nurses are satisfied


with their jobs, patients’ conditions improve greatly. Furthermore, if supervisors realize

what satisfies the nurses, they will then make future decisions with the nurses’ satisfaction in

mind. Thus, there is a clear relationship between successful management, nurses’ job

satisfaction, and better patient care.

Aiken and his colleagues also found that low nurse-to-patient ratios were correlated with

higher risk-adjusted 30-day mortality and “failure to rescue” rates. In addition, nurses practicing

in settings with lower nurse-to-patient ratios were less likely to experience burnout and job

dissatisfaction (Aiken, Clarke, Sloane, et. al., 2002).

Nursing supervisors should employ different managerial styles in dealing with their

supervisees. Management styles of the health organization play a vital role in promoting

workplace empowerment, organizational commitment, and job satisfaction amongst nurses in

management positions in hospital settings (Nassar, Abduo & Mohmoud, 2011). Another key

finding is that the closer the management style to the participative group management style, the

higher the level of staff nurse job satisfaction (Nakata & Saylor, 1994). Managerial styles, which

are based on managers’ behaviors, can form the foundation of hospital success. Managerial

behaviors that are utilized to influence beneficial changes make even the most basic, daily work

more effective. This researcher’s study exploring and revealing five common managerial styles

in the healthcare field: Autocratic, Consultative, Democratic, Chaotic, and Laissez-faire.


Managerial Styles

Autocratic (Directive): This style is often referred to as a “top down approach”. It is most

readily seen in hierarchical structures where the boss is clearly the boss and there are ‘little

bosses’ who pass on his instructions. The employees often feel the sensation of making little to

no contribution to any decision- making in the organization. In this model, responsibility clearly

lies with the boss (Scottish Qualification Authority, 2010).

Democratic or shared management (Participative): In this style, all employees are engaged in

a common aim, which often supports innovation. In the participative style, there is a shared

vision and good communication between individuals in different roles in the organization.

Everyone is expected to contribute and to take a degree of responsibility for the success of the

organization (Scottish Qualification Authority, 2010).

Consultative: This style is a combination of autocratic and democratic. The supervisor who uses

this style asks for his/her supervisees’ feedback and views, and also allows the nurses to be

involved during the decision-making process. Consultative management style requires that the

managers have substantial confidence, but not complete confidence in subordinates, as they are

allowed to make less important decisions on the lower hierarchy levels. All hierarchical levels

are incorporated into the decision making process (Nassar, Abduo & Mohmoud, 2011).


Chaotic: This is a modern management style that allows an employee to work on his/her

ideas. It enacts no management restrictions on the employees, which assists in creating new

innovations. Chaotic management style will be adopted by a lot of establishments in the

upcoming future as the management will need to go along with the fast-paced lifestyle of the

employees.

Laissez-faire or free reign (Non-directive): This style of management describes the non-

directive approach to management. This means that all levels of staff are given sovereignty, and

as a consequence there is often little respect for those in promoted functions (Scottish

Qualification Authority, 2010). Laissez-faire can be defined as the absence of direct supervision

of employees and failure to provide regular feedback to supervisees.

Those styles of management can handle various situations and behaviors depending on

the amount of support and task behaviors. These dictate the amount of supervision required.

Each style has its own distinct characteristics. Supervisors must adjust the style according to the

situation in order to get the job done. Some supervisors can utilize a combination of more than

three management styles. There may be other influences that affect supervisor behavior such as

age, occupancy, job satisfaction, organizational commitment, and perceived job possibilities,

(Tai, Bame, Robinson, 1998).


It is essential for professionals to understand why supervision skills are an

important provision in the healthcare field. Supervisor’ behaviors concentrate on achieving the

organization’s outcomes relating to productivity, effectiveness and efficiency by understanding

how to address quality control issues and ensure nurses’ work meets hospital standards (Royal

College of Nursing, 2003).

One study that found certain causes related nursing job satisfaction. There are seven

variables that had important correlations between communication with supervisor, autonomy,

recognition and communication with colleagues, fairness and locus of control. Pay and

supervisor support positively impacted upon nursing job satisfaction (Lu, While & Barriball,

2004).

The main point is that nursing supervisor’s responsibility to achieve the desired goals of

the department or organization rests solely he supervisor. However, the supervisors have a strong

sense of belonging to their organization and do not see themselves as separate from the

organization. They work as a team while following established policies and procedures in order

to achieve the organizational goals. Supervisors focus on tasks to accomplish a goal. Final

decisions are the result of following these policies and procedures. Due to the instinct for

survival, they will tolerate mundane tasks and practical work (Thomas, 2012).


Management style and nurses’ retention were significantly interrelated in terms of

exploitative/authoritative management style. The researcher recommended that hospital leaders

should plan and implement effective strategies to promote nurse retention by creating a work

environment that is caring and conducive for the nurse’s professional practice to increase the

quality of care (Nassar, Abduo & Mohmoud, 2011). Thus, not only is a nurse supervisor’s role to

develop the practice, there should also be a communication of the nursing supervisor with nurse

leader and direct of nurse to improve nursing practice and quality of care enhancement.

Hospital is the preferred choice of the study in Saudi Arabia due to the limited types of

settings in Saudi Arabia healthcare system such as doctors’ offices and hospital that can be

publically or privately funded.


Chapter Two

The function of this chapter is to introduce the background of the development of the

healthcare system in the Kingdom of Saudi Arabia (KSA). Many changes occurred in the

economic, social, and public health sectors. The purpose of this chapter is to give a clear

explanation of Hera General Hospital’s framework, classification (mission, vision, and value),

characteristics, strategies, and its workforce operation line. Hospital where the research was

conducted will be explained, which will help the reader to understand the unique circumstances

in another culture.

Historical Background of Healthcare in Saudi Arabia

Area of Saudi Arabia is measured about 2.27million m2; and includes 150 cities there are

also more than 2000 villages (Ahmed, 2012). Over the past 15 years, Saudi Arabia has

experienced unique economic growth, which mainly is due to powerful petroleum industry.

Saudi Arabia is experiencing rising life expectancy, fertility rates, per capita income, and all the

other benefits of transitioning to a first world nation. Over a ten -year period, the average

income has more than tripled [$8140 per capita per year in 2000 (World Bank Group, 2010),

compared with $25,700 per capita per year in 2012 (Central Intelligence Agency, 2013)]; that is


because of the differentiated its exports and produces. The federal government has also

become noticeably wealthier, with an extraordinary 80% of national revenue being offered by the

petroleum industry (Central Intelligence Agency, 2007). The Kingdom of Saudi Arabia has

decided to use this wealth to fund a public health care system, thus it is obvious that society and

the nation have met with a lot of changes within the past few years. Sixty percent of government

spending for healthcare goes to the Ministry of Health (MOH) and the remaining 40% goes to

other government institutions such as National Guard, Military, Security Forces and private

sector groups (Al Humaidan, Al Jaser, Alkudsi & et al, 2012; and Ahmed, 2012). Under the

MOH there are more than 2094 Primary Health Care PHC’s and 249 hospitals (Central

Department of Statistics & Information, 2010 and MOH, 2011). In 2012, Saudi Arabia also has a

total of 408 hospitals. Two hundred forty-four of the hospitals are part of the MOH network, 39

hospitals belong to governmental institutions, and 125 belong to the private sector (Al

Humaidan, Al Jaser, Alkudsi & et al, 2012). The main role of the MOH is to give policy and new

strategies, which also provides the healthcare and improves the quality of the lives or (the public

health) of the member of the community. The MOH health care organization has 20 Directorates

Including PHCs, Hospitals, Labs, Pharmacies, and Allied Health (Ahmed, 2012). MOH is

prodigiously responsible to manage, finance, operate, and control the public health sector. This


focuses on health has resulted in a Human Development Index ranking of 55 out of 194

countries (The Real Wealth of Nations: Pathways to Human Development, 2010).

The first formal training for nurses in Kingdom of Saudi Arabia (KSA) was established at

a Health Institute in Riyadh in 1958, but it was for the training of male nurses only (Tumulty,

2001). This training program was driven by a collaborative effort between the Saudi Arabian

Ministry of Health (MOH) and the World Health Organization (WHO). Only fifteen Saudi male

students were enrolled - in a one-year Nursing Program in this initial nursing program.

These students only had an elementary school level of preparation including six years of

schooling background. Subsequently in 1961, two more Health Institutes were established which

included Nursing Training Programs. One was in Riyadh and the other was in Jeddah. These

were permitted to enroll Saudi women into Nursing (Tumulty, 2001). Men and women who

graduated from these Health Institutes were appointed as Nurses’ Aides (Miller-Rose, Chapman

& Francis, 2006).

As female education progressed, nursing training was extended to admit only students

with nine years of high school education for a three-year course. The MOH continued to add new

institutes for women and men in various Saudi towns throughout the country, and by 1990 it had

a total of 17 Female and 16 Male Health Institutes (Tumulty, 2001). MOH will only hire nurses


who have graduated from these programs.

In Kingdom of Saudi Arabia (KSA), 67% of Saudi nurses graduated from Health

Institutes, 30% from Junior Colleges and 3% from Bachelor of Science in Nursing (BSN)

programs, while there are also 28 graduates with a Master’s degree and 7 with a doctorate (Abu-

Zinadah 2006). However, in HGH, some of the nursing staff are from the Philippines because of

a nation-wide shortage.

  The Ministry of Health has also continued to upgrade its nursing for the purpose of

improving the quality of Saudi Nurses entering the labor market. They have upgraded their

Health Institutes to Colleges of Health Science in order to enroll post-high school students whom

they train for three years. As a result, in 2008, only four Health Institutes remained, in contrast

with 33 Health Science Colleges including fifteen Colleges for male students and eighteen

Colleges for female students (Tumulty, 2001). Due to the stipulations of Islam, which are

precisely followed, men and women must be educated separately in order to prevent issues.

Additionally, if a graduate or undergraduate nursing student meets specific requirements

they are permitted to study abroad, being sponsored by Saudi Arabian Cultural Mission

(SACM). The SACM sponsors scholars enrolled in all academic levels of nursing such as BSN,

Master’s and Doctoral degrees.

The SACMs’ responsibilities include:


- Assisting and supporting scholars during their application process

- Establishing agreements with universities in the U.S. to facilitate the enrollment of the

scholars in the desired programs.

- Supporting Masters’ and Doctoral students’ research

- Encouraging scholars to publish their research in scientific journals, and to attend and

present their research at scientific conferences

- Advising scholars throughout the period of their study in the USA (SACM, 2013)

The healthcare system in Saudi Arabia continues to develop rapidly because of increasing

number of population, which results in changing healthcare needs. The population is adapting to

increasing wealthy (comfortable) lifestyles. There is evidence that there are threats arising from

obesity and some associated diseases such as, diabetes and cardiovascular diseases. Thus, The

pattern of service delivery is complex with a variety of funders underpinning the different care

delivery organizations. This may present challenges regarding effective cross-boundary working

and the development of expertise across the nursing workforce (Aldossary, While & Barriball,

2008).


Description of Hera General Hospital (HGH) Framework

The research target for this proposal was Hera General Hospital, Kingdom of Saudi

Arabia (KSA). In this facility, there are approximately thirteen departments and six nursing

supervisors. Each nursing supervisor is responsible for two departments.

HGH is located in an industrial area in the Holy capital city of Mecca, Saudi Arabia. The

hospital’s location allows it to serve all provinces and villages. The hospital also cooperates with

primary health centers and polyclinics in Holy Mecca.

The hospital was opened on the 25th Sha’aban 1404, under the supervision of the late His Royal

Highness (HRH) Prince Majed Bin Abdul Aziz Al Saud, Governor of Mecca region at that time.

All the information was provided by Hera General Hospital through documents as follows:

HGH Buildings

Hera General Hospital consists of two floors and the ground floor, which includes the

administrative and medical departments. The other medical buildings contain the Outpatient

departments, specialized departments along with Physiotherapy.

Department Geographic


Distribution:

Ground Floor

Includes administrative supervision, other administrative departments including

Laboratory, Radiology and Emergency departments.

First Floor

Male Surgical, Male Medical, Female Medical, Infertility, Operating Room and ICU.

Second Floor

Pediatrics, Female Surgical, Consultant Center, OB/Gyn

Administrative Building

Medical maintenance and non medical maintenance

Transportation Services

Housing Services

Educational Building

Postgraduate studies

Training and Continuous Education Center

Fellowship building

Local training

Temporary Training

Residential Area


The residential area contains 38 units including a Mosque with capacity of 150

people. There are also swimming pools, a children nursery, car parking, and a supermarket.

General Building

Medical and non-medical maintenance containing workshops, stores, electrical stations,

water treatment station, evacuation departure, and a medical waste room are found in this

building.

Hospital Classification

HGH Mission Statement

To support the mission of Ministry of Health in providing healthcare services to the

community of Holy Mecca and its visitors to the Holy Mosque, according to international

standards

To utilize of available resources to achieve quality and patient safety

To invest and continually develop human resources through an innovative environment

and continuing educational opportunities.

HGH Vision

To become a leading hospital in providing healthcare services through success work

procedures

To create a positive healthy environment through the use of an integrated and advanced

team to realize international recognition.


HGH Values

The hospital describes the following list of values:

1. Honesty

2. Empowerment and encouragement

3. Active participation in the society

4. Leadership and professionalism

5. Team work and dedication

6. Holistic approach to care

7. Consistency and continuous improvement

8. Attention to details

9. Respect for others

10. Excellence in medical care services

HGH Goals

1. To become a reference for healthcare facilities in the city of Holy Mecca through

achievement of regional, national, international accreditation.

2. To become a leading facility for skilled staff and outstanding students through a well

established human resource development program and postgraduate center

3. To optimally utilization available resources and to minimize any limitations


Hospital Characteristics

Total outpatient specialty clinics

Number refer to patients visiting the clinics

Morning Clinics

101, 450

Specialty Clinics 14, 619

Daily Average Outpatients 410

ER Annual Average Patients

226, 971

ER Daily Average Patients

650

Treatment and Discharges

19, 127

Admissions

19, 512

Bed Capacity

The hospital bed capacity is 280 distributed as follows:

Department Male Female Total

Medical 29 29 58

General Surgery 31 31 62

OBS/Gyn 0 58 58

Pediatric 0 0 30

NICU 0 0 41

ICU 0 0 15

SMCC 8 8 16

DPU 0 0 5

The hospital is providing the following main services:

Medicine, including subspecialties of Neurology, Cardiology, and Gastroenterology.


Obstetrics/Gynecology

General Surgery: Dentistry, ENT, OR

Pediatrics

Intensive care unit

Neonatal ICU

Dermatology

Ophthalmology

Emergency department

Anesthesia

Physiotherapy

There are also diagnostic and therapeutic services provided:

Medical Laboratory

Ultrasound

CT scan

MRI

Radiology

Endoscopy

Pharmacy


Medical Dietetics

Work Forces in HGH

Medical Operation Line

Based on the hospital statistics in 2010, the number of administrators, physicians, nurses,

and technicians are as follows:

Administrators and Managers

HGH administrative structure consists of 144 administrators and managers. They govern

the direction of the entire medical operation of the hospital. They also provide support and co-

operation with the medical operation line for achieving the desired goals. The nursing

supervisors would be included in this category.

Physicians

Total numbers of physicians are 263 from different specialties

Nurses

Total number of nurses is 408 who are distributed in different departments in the hospital

to provide complete medical care to their patients


Technicians

Total number of technicians is 197 who are distributed in the Laboratory, Pharmacy,

Radiology, and Physiotherapy (See Hera General Hospital Organizational Chart Chapter III)

HGH Projects

HGH has many plans for the future expansion and improvement of its health care

organization. They hope to establish and enlarge Emergency Department, to develop the Human

Resources Development Program, to extend facilities of Physiotherapy Department, to provide

the housing facilities and a preventive maintenance program, to increase the Labor and Delivery

ward, to develop postgraduate and continuing medical education center (See Health Education

Organizational Chart Chapter Three. Be consistent with the numbering of chapters

HGH Strategies

HGH will be using the following plans in order to achieve its actualization of its projects:

1. Establish a total quality management program by obtaining Central Board for

Accreditation of Healthcare Institutions (CBAHI) accreditation which will include

meeting functional and documentation requirements

2. Define and maintain the unique culture while continuing to improve procedures

3. Conduct continuous utilization reviews in clinical and non-clinical areas to ensure that

the best possible procedures are being upheld


4. Provide broader range of staff development activities

Currently, there is a Co-operate with government authorities to provide outreached public

and private community facilities in order to provide high quality of care to cover Saudi

population needs.


Chapter Three

In this chapter, essential factors affecting the hospital’s achievement are hospital

credentials, available educational programs, healthcare professional qualifications, and

employee’s general behavior, which will be discussed. Another important factor is a clear

organizational structure, which begins with the hospital administration director being sure that

supervisors are aware of their roles. Supervisors then must clearly establish responsibilities of the

nursing staff. This chapter will also illustrate the connection between nursing satisfaction and

patient satisfaction, while representing the educational programs that supervisors use to achieve

the hospital goals.

Hospital Credentials

HGH is one of the hospitals that seek high quality care for the patient because they

provide continuing education for overall nursing staff and require a very specific list of

qualifications for licenses that all employees must obtain to ensure that HGH maintains its

accreditation.


Hera General Hospital Policy of Continuing Education

HGH’s documents indicate that the educational programs that HGH offers to its

authorized staff are accredited by Saudi Association for Health Specialties to enrich theoretical

information and to develop practical skills of nursing staff (Hera General Hospital, 2010).

The hospital also actively participates in medical and academic activities from various

education governmental sectors.

Healthcare Professional Qualifications

The nursing supervisors are employed by signing a contract with HGH and certified by

the Saudi Counsel.

According to Raina A. Tungo, a nursing supervisor of ICU and NICU, all nursing

supervisors must complete their Bachelor’s Degree in any healthcare related field. Additionally,

the nursing supervisors and nurses including the head nurse, nurse aid, midwife, charge nurse

must be licensed in Basic Life Support (BLS) and Advanced Life Support including CPR,

bleeding control, splinting broken bones, artificial ventilation, and basic airway management.

That certification must be updated each year and is renewed by Saudi Counsel.


One proof of HGH’s achievements toward trustworthiness that can be used to

substantiate and verify competence and licensure, is that they were successful in obtaining the

Joint Commission International (JCI) accreditation a few years ago in order to achieve

excellence in provision of services through maintaining international standards in delivery of

patient care.

It is evident, therefore, that this accreditation gives the community a sense of HGH’s

professional level of healthcare that safeguards patients and confirms clinical competence. These

factors instill confidence in anyone in need of healthcare services.

Employee General Behavior (Code of Conduct)

In order to continue their high standards, HGH requires its employees to:

1. Keep all patient information confidential

2. Take care of the hospital property

3. Follow instructions of security and safety at all times

4. Refrain from smoking inside the hospital

5. Abstain from the use of narcotics and alcohol

6. Display their ID card to ensure security measures


7. Maintain their appearance according to Islamic Educational religion

8. Refrain from social contact with the opposite gender

Organizational Structure

The most effective organizational structure is one in which activities are grouped together

by common goals from the top level to lower levels of the organization. Generally, little

collaboration occurs across functional departments, and the whole organization is coordinated

and controlled through the vertical hierarchy, with decision-making authority residing with

upper-level managers. According to Richard Daft, Organization Theory and Design, (2009)

“This structure promotes efficient production and in-depth skill development, and the hierarchy

of authority provides a sensible mechanism for supervision and control in large organizations.

However, in a rapidly changing environment, the hierarchy becomes overloaded. Top executives

are not able to respond promptly to problems”.

One benefit of a solid organizational structure is that it allows hospitals to offer services

at a competitive price. Therefore, redesigning the organizational structures contributes to

increased efficiency.

Another benefit of the organizational structure is that it defines the channels of


supervision to resolve conflict. Obstacles are unavoidable in all workplace relationships,

including those in organizations. Some conflict can be healthy because it contributes to diverse

thinking and leads to change. If management and employments are afraid to disagree, there is

likely no growth and development.

In order to establish and illustrate its organizational structure, Hera General Hospital has

created the following:

Nursing Affairs Organizational Chart, which was updated in 2014

Nursing Affairs Organizational Chart, Neonatal Intensive Care Unit (NICU), which was

updated in 2014

Hera General Hospital Organizational Structure for the year 2013

Health Education Organizational Chart, which was updated in 2014

The three charts are provided to support the study in this research:


Nursing Affairs Organizational Chart


Hera General Hospital Organizational


Health Education Organizational Chart


Healthcare Professional Roles

The definition of the supervisor was described earlier Chapter one. Now the nursing

supervisor role will be discussed as follows:

Nursing Supervisor Role

Hospital supervisors are required to perform many functions in their organization and the

way they handle various situations will depend on their individual style of management (Nickels,

McHugh & McHugh, 1997; and Jardali, Mmehi, Jamal, Dumit & Mouro, 2009)

Supervisors are responsible for the daily activities of their staff. They also manage and

coordinate patient’s health indirectly by supervising the nurses (Harkreader & Hogan, 2000).

It is critical that supervisors possess the following crucial managerial skills to provide the

highest quality of care for patients: Controlling and accomplishing necessary tasks; assigning

employees specific tasks; guiding and supervising employees on daily basic activities; ensuring

quality and measuring productivity; implementing recommendations; and resolving conflicts as

they may arise.

Nursing supervisors must be important role models for their subordinates. They must be

able to provide basic clinical supervision, motivation, career planning, and performance

feedback. Based on the nursing managers’ expertise of improving the quality of patient care, the


patient mortality rate within the hospital will ultimately decrease. Hospitals can use this

information to make recruitment and retention decisions that will certainly increase nurses’ job

satisfaction while improving patient outcome.

Supervisors should use effective techniques in order to improve the work performance. It

is critical to convey the importance of empowerment-proper delegation- in terms of its value to

supervisors, employees, and organizations alike. Delegation is one of the management

techniques that the supervisor can implement; it is described as part of basic management

function of organizing. For example, a supervisor gives a nurse a set of instructions or a job

description for which the supervisor is ultimately responsible. Delegation is an effective

technique because the supervisor’s job description may also contain too many tasks for the

supervisor to perform alone (McConnell, 2007). Delegating certain tasks can give the supervisor

more time to concentrate on supervisory activities. Empowerment is one of the behaviors in

terms of modern management and, more specifically, part of the language of total quality

management (TQM), but it is often misunderstood. Empowerment is letting employees solve

their own problems as they decide what needs to be done and then going ahead and doing it

within the limits (outline) set by the supervisor. In both delegation and empowerment the

supervisor must give the employees authority and provide them with whatever other resources

they may need in order to accomplish the goal. Thus, there is no difference between


empowerment and delegation (McConnell, 2007). This management process will work as

planned only if the supervisor is committed in advance to accepting the decision of the employee

(e.g. Democratic and Chaotic).

Supervisors’ thinking, planning, and communicating with nursing staff are necessary to

maintain department’s effectiveness. Efforts must be made because healthcare professionals are

members of the organization and functioning to achieve organization’s success.

Qualifications of Nursing Supervisors at HGH

Nursing supervisors should be selected as senior staff having more than or equal to the

length of experience of the employees they will supervise. Supervisors should usually (although

not always) be from the same clinical area or have sufficient recent experience of relevant

clinical practice. These nursing supervisors need to undergo further training to learn supervisory

skills to equip them for this role (Bond, 2010).

In Saudi Arabia, supervisors often do not require any formal education on how they are to

perform their duties. However, they are most often given on-the-job training / symposium or

attend company-sponsored courses. The management styles might be taught or discussed at these

training sessions. HGH provides supervisor handbooks containing rules that need to be followed.

Supervisors must be aware of the country legal responsibilities to ensure that their employees


work securely /safely and that the workplace that they are responsible for meets

government standards.

Thomas’s (2012) study found the following supervisor principles

those are needed in the organization:

1. The effective supervisor is committed to nursing personal and

professional development. This enables the supervisor to lead and assist

others. Supervisors need to have integrity and deliver on commitments,

they must be technically competent, they must understand the required

tasks needed to accomplish a goal, and they must always be aware they are

a role model.

2. The second principle the supervisor should remember is that it is all

about those they lead (e.g. nursing staff). Employees have to be motivated

to action by an empowered supervisor. This means creating an

environment that motivates the employee to go beyond the basics of what

is expected. The supervisor should focus on helping people perform more

effectively and efficiently. This helps them become more productive and

advance in their occupations. It also shows them that as a supervisor

he/she respects and values them as people and as professionals.


3. Supervisors are a part of the organization, but they are not the

organization and as such must work with others to accomplish the

organizations short term and long-term mission, vision, values, and goals.

The effective supervisor is aware that he or she is an active member within

the team and always works to better the team. Effective leaders have a

forward-looking orientation and work to build the culture of their

organization. The insecure leader wants their successor to fail. Any leader

who fails to support an employee, for any reason, hurts the organization,

therefore violating Principle Number Three.

As explained above, those these principles take into consideration employees’

performance, organizational developments, and supervisor’s function, which all ultimately

influence their organization.

Nursing Staff Role

All types of nurses might be asked to care for their patients in the roles of:

1.) Healers; the initial reason the practice of nursing was created. Nurses are asked to

help the patient cope with their disease; to help the patient find meaning and purpose in their life,

to mobilize external and internal resources (Eliopoulos, 2003).


2.) Caregivers who promote of the highest degree of self-care of their patients

teaching them ways to care for themselves by restoring emotional and social well being of the

clients (Harkreader & Hogan, 2000).

3.) Advocators which aid older adults in asserting their rights and obtaining required

services to prevent chemical and physical injuries. They also assist in preserving human rights in

terms of health and illness, especially during the process of dying (Harkreader & Hogan, 2000).

4.) Educators that share their knowledge with formal or informal opportunities to explain

to the patient their particular medical routine such as, their medications, therapy and nutrition.

They also would make available to the patient resources such as normal aging, pathophysiology

or related informational brochures (Harkreader & Hogan, 2000).

5.) Communicators that are essential to patient overall health. Nurses must be effective

and posses excellent communication skills involving listening, interacting, clarifying, coaching,

validating, and finally evaluating the patient’s progress. They must be able to identify each

individual patient by utilizing their critical thinking skills, suggesting using new technologies,

modalities of care and assess the best course of care because all patient’s needs are diverse

(Harkreader & Hogan, 2000).

6.) Researchers investigate and conduct studies to improve the quality of nursing

practices. They share their findings with the healthcare community (Harkreader & Hogan, 2000).


7.) Rehabilitators perform activities administered by nurses to coordinate patients’

physical therapy. They will promote role the clients’ ability to cope with pain after surgery

(Eliopoulos, 2003), such as after a knee and hip replacement (Harkreader & Hogan, 2000).

Qualification of Nurses

There are four levels of nursing education, and professional nursing practices in the U.S.:

Diploma Nursing Programs, Associate Degree Programs, Baccalaureate Degree Programs, and

Graduate Degree Entry Programs. Nurses are also able to advance their education to obtain

Master’s Degree Programs two years such as nursing practitioners, nurse educators or

administrators. Also, nurses are able to obtain Doctoral Degree Programs requiring more depth,

inquiry and scientific research to become theorists, ethicists, nurse philosophers, and researchers

(Harkreader & Hogan, 2000). The professional role combines physical science, social science,

nursing theory and technology to care for the individuals in the community (McDonnell, 2012).

The authority that certifies the practice nursing is based on a social contract that delineates

professional rights and responsibilities, as well a measure of public accountability. In all

countries, nursing practices are governed by law on entrance into the profession and are

regulated at the national or state level (McDonnell, 2012).


Quality of the Relationship Between Nursing Supervisors and Nurses

Nursing Superiors should avoid structural discrimination issues. Bond (2010) urges nurse

supervisor to be alert to and honest about their own prejudices, negative attitudes towards each

other, any sensitivities that the other may trigger for them and their fears about clinical

supervision. They should seek to minimize their destructive influences on the clinical

supervision relationship.

Creating a healthy relationship with the nurses has more of an influence on the clinical

supervision than any other factor. There are critical skills that need to be developed in order to

increase the nurses’ satisfaction and quality of care provided to the patients.

The nursing supervisor ought to create an atmosphere of support and advocacy for the

nursing staff. The nursing supervisor shows genuine interest in the supervisee as a person, in

nurses and in the context in which they work. The supervisor ought to verify occasionally that

the supervisee is getting what they need. All of these strategies will contribute to positive energy

in the clinical supervision relationship (Bond, 2010).

Valuing employees is certainly essential in terms of letting them make decisions for

certain tasks. In the healthcare field, sometimes the nursing supervisors need to assign work that


is not provided in the nurse’s job description. Thus, this technique of management

supports supervisors to build trust relationship between them and their nursing staff. The more

supervisors appreciate their nurses the nurses will be more satisfied.

Connection between nursing satisfaction and patient satisfaction

Staffing involves hiring, orienting, and deploying qualified nurses to meet the demands

for client care. The individual unit has specific guidelines indicating the required staffing/patient

ratio. As an example, the intensive care unit requires an all registered nurse staff with a

maximum nurse to patient ratio depending on patient acuity of 1 nurse to 2 patients (Thomas,

2012).

Nurse staffing and the quality of the hospital work environment; e.g. managerial support

for nursing care, good relations, and nurse participation in decision-making; were significantly

connected with patient satisfaction, quality and safety of care, and nursing staff satisfaction

(Aiken, Sermeus, Heede, Sloane, Busse, Mckee, Bruyneel & et al., 2012).

This research does not directly connect with patient satisfaction. Emerging findings show

the importance of participative, transformational styles for safety performance at all levels of


management including supervisory position. To the researcher, clinical nurse supervisors’

performance usually connects to the safety for the patients and nurses as well. Humans begin to

seek security so that they do not feel threatened. In employment, individuals (e.g. nurses) are in a

dependent situation so they need to secure their position. A policy by a supervisor of deliberately

making staff feel insecure ‘to keep them motivated’ will be counterproductive, since if it works it

will prevent the employees from progressing to higher levels. Only at the higher levels is it

possible to develop a shared mission with the organization (Trofino, 1995).

To the researcher, transformational style, empowerment technique, patient nurse ratio,

supervisory support, and employee job satisfaction are factors, which are proven to affect patient

satisfaction and quality of care. Some of managerial styles would not used to solve all these

issues; however, the supervisors should consider different management theories and activities to

deal with those factors that will affect the patient safety.


Chapter Four

This mixed method study presents a more complete view for a more comprehensive point

of view than concentrating on only one point of view. This research uses quantitative findings to

measure nursing staff perceptions and their overall job satisfaction. The quantitative data will be

examined first followed by qualitative data analysis. In addition, this research addresses nursing

supervisors’ assessment of managerial styles and behavior using qualitative techniques.

Qualitative findings are a form of inquiry that analyzes information conveyed through language

and behavior in a hospital setting. They are used to capture expressive information not conveyed

in quantitative data about beliefs, values, feelings, and motivations. The function of the data is

also to provide the context necessary to understand quantitative findings and to identify

important variables for future clinical studies. Analysis of qualitative and quantitative data was

performed collectively.

Research Question

The intent of this study is to determine the managerial style of the nursing supervisors as

well as their perceptions of how these styles relate to nursing job satisfaction.

The researcher also measured specific variables: the relationship between management


styles, and nurses’ satisfaction at Hera General Hospital (HGH). The research question is

“What managerial style, based on supervisors’ perspectives, best relates to nursing staff

satisfaction?”

Hypotheses

The hypotheses of the study are: 1.) What are the factors affecting nursing staff

perceptions of managerial styles and behaviors at Hera General Hospital? In addition, 2.) What

are the factors affecting nursing staff overall work satisfaction at Hera General Hospital?

The null hypotheses that were tested are:

1. What are the factors affecting nursing staff perceptions of managerial styles and

behaviors at Hera General Hospital?

a.) H0: There is an effect for age on staff perception of the managerial styles and

behavior at HGH.

H1: There is not an effect for age on staff perception of the managerial styles and

behavior at HGH.

b.) H0: There is an effect for length of nursing staff employment (length of

experience) on staff perception of the managerial styles and behavior at HGH.


H1: There is not an effect for length of nurse staff employment (length of

experience) on staff perception of the managerial styles and behavior at HGH.

c.) H0: There is an effect for position on staff perception of the managerial styles

and behavior at the hospital.

H1: There is not an effect for position on staff perception of the managerial styles

and behavior at HGH.

d.) H0: There is an effect for the nurse future employment plans on staff

perception of the managerial styles and behavior at HGH.

H1: There is not an effect for the nurse future employment plans on staff

perception of the managerial styles and behavior at HGH.

2. What are the factors affecting nursing staff overall work satisfaction at Hera General

Hospital?

a.) H0: There is an effect for age on staff satisfaction at HGH.

H1: There is not an effect for age on staff satisfaction at HGH.

b.) H0: There is an effect for length of staff nursing employment (length of

experience) at HGH.

H1: There is not an effect for length of experience on staff satisfaction at HGH.

c.) H0: There is an effect for position on staff satisfaction at HGH.


H1: There is not an effect for position on staff perception of the managerial

styles and behavior at HGH.

d.) H0: There is an effect for the nurse future employment plans on staff

satisfaction at HGH.

H1: There is not an effect for the nurse future employment plan on staff

satisfaction at HGH.

Methodology

Participants

Participants included nursing staff and nursing supervisors. The supervisors who

participated in this study are from the Philippines (non-Saudi). Nursing staff is from different

countries (e.g. India or Philippine) and Saudi.

Nursing Staff

There are a total of 408 nurses who work in different departments of HGH; however the

number of the participants is (n= 191). Those nurses are representing both male and female and

different departments.


Nursing Supervisors

Purposeful sample of nursing supervisors were interviewed based on their availability

during their shifts. The sample (n= 4) was interviewed over the span of two days to Hera General

Hospital. In addition, the total number of administrators and managers is 144. There is a total of

6-nurse supervisor but only four of the six participated in the study (as two were on vacation).

Instruments

The study is descriptive and inferential. The research involves two instruments: Nursing

staff surveys and an interview instrument for nursing supervisors. In nursing staff surveys,

nursing perceptions were measured through eleven questions. Participants indicate the

supervisors’ behavior that the supervisor is: Encouraging nursing staff, making changes for

improvement, spending efforts for patients care, appreciating nursing inputs, supporting

continuing education, discussing issues, her/his availability, his/her reaction toward nurses’

errors, nurse’s recommendation at the hospital, and utilizing of resource (data) to improve the

work, finally, valuing and respecting nurse’s point of views. Nurse career satisfaction was

measured through one question developed by the researcher. Some factors might influence their

satisfaction and perception such as nurse age, years of working at HGH hospital, position, and

future employment plan will be examined to find out the correlation. Those statements were


asked based on what inspired the researcher and which was found to be good indicators

of supervisors’ behaviors.

The study was conducted between the periods of Dec 28th, 2013 until Jan 8th, 2014. The

researcher visited the hospital twice in order to administer the surveys.

A great deal of qualitative research uses semi-structured interview material. The

interview with nursing supervisors contains six questions (See Appendix A) relating to

managerial styles. These interview questions helped the researcher understand the supervisors’

perspectives and their different managerial styles; and to answer the research questions. All

nursing supervisors who participated in this study are non-Saudi.

There are two dimensions of measurement quality:

1) Reliability – do measures produce consist results?

2) Validity – are measures capturing the information we think they are?

A survey (See appendix B) with 16 questions was used as the quantitative component for

the nursing staff. It addressed the effects of independent variables (age, years of experience,

position, employment plan) on nursing staff satisfaction as well as their perceptions of their

supervisors’ managerial styles for the research hypotheses. Questions1, 2, 3, and 16 identified

independent factors and questions 4 to 14 indicated scenarios reflecting managerial styles.

Question 15 provided opportunity for nurses to describe their overall work satisfaction.


Data Collection and Data Analysis Procedures

The focused participants of this research were the nursing supervisors and the nursing

staff at Hera General Hospital in Kingdom of Saudi Arabia (KSA). The data, both qualitative and

quantitative, was gathered from one hospital (one database). The purpose of the research is to

look at whether differences in the independent variables (age, experience, position, and

employment plan) lead to variances in the dependent variable (nursing staff perceptions and

satisfaction) by applying ANOVA testing along with data findings from the nursing supervisors’

interviews. The consolidated data will impact the outcome of this study.

For the nurses’ survey, the study found the level of significance that is linked to the

sample size. Because this study has a large of nurses sample (n= 191), small correlations may

reach statistical significance. In the nursing staff survey, the nurses who are under each of the 4

supervisors were asked 16 questions; the first three questions were demographic variables about

the nurses’ age, length of experience, and their position. The next series of questions evaluated

the nurses’ perceptions of managerial styles on a Likert scale. The nurses were asked to circle a

number from 1 to 5, 1 = strongly agree and 5 = strongly disagree in response to the following

statements: “my supervisor encourages input for making changes to improve quality of care”,

“my supervisor allows time for discussing changes to improve patient care”, “my supervisor puts

great effort into important patient care”, “after making any changes, my supervisor asks our


opinions about what worked and what did not work”, “nursing supervisors support

continuing education efforts for staff”, “when there is a conflict or tension in my hospital, those

involved are encouraged to talk about it”, “my supervisor is available to discuss work related

problems”, “I feel that work-related mistakes are held against me”, “I would recommend

employment at my hospital to my colleague”, “my supervisor uses data and information to

improve the work of nurses”, and “supervisors in my hospital value nurses who have different

points of view”, consequently these items from 4 to 14.

Question 15 evaluated nurses’ overall satisfaction about their job. Nurses were asked

“how would you describe your overall work satisfaction”. Question 15 evaluates the nurses’ job

satisfaction on a scale from 1 to 5, 1 = Very satisfied and 5 = Very dissatisfied. Finally, question

16 assessed the nurses’ future employment plans.

For the nursing supervisor interview, there were no demographic variables, but it is of

note that they are all women and all non-Saudi.

The Interview Instrument given to the nursing supervisor was designed to measure their

skills, thinking, and abilities to identify their managerial styles and to give examples based on

their experiences. The Interview Instrument helped the researcher better comprehend the overall

level of nursing satisfaction in different departments.

The study used ANOVA, whose the purpose of analysis of variance (ANOVA) is to test for


significant differences between more than two groups. Post- hoc tests were used in the

study to find the group differences when the significance was found from the ANOVA analyses.

The techniques used for gathering these data are that the nursing survey, which was divided into

packets for each department supervisors to distribute to their nurses. Each survey had a small

envelope attached to it. Upon completion of the survey, the nurses inserted the survey into the

envelope for confidentiality reasons and returned it to their nursing supervisor. The survey

packets were distributed at the time of the interview, which was scheduled first with nursing

supervisors. Next, the nurses were questioned regarding their perceptions and job satisfaction

through the survey responses. The study used SPSS software version 18. ANOVA tests were

conducted in order to respond to what issues are affecting nursing staff perceptions of managerial

styles and behaviors at Hera General Hospital. In addition, what are the issues affecting nursing

staff satisfaction at Hera General Hospital? Their answers were then compared to the

supervisors’ interviews as well.

After the supervisors have been given the interview, they may select to use more than one

managerial style in order to achieve the highest degree of effectiveness of clinical supervision

responsibilities. The five most used managerial styles that this study examines are autocratic,

paternalistic, laissez-faire, democratic, chaotic, participatory, and consultative. The researcher

checked for comprehension before administering the interview instrument. One particular style

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might be more suitable for a certain type of business or employee group than another.

Many supervisors may combine styles to fit their individual employees’ needs. After the

supervisors gave their permission, the interview was recorded to avoid missing any information.

The interview instrument was returned upon completion of the interview, while the

survey for the nursing staff was returned in five days. Then, they were collected to be analyzed.

These qualitative data were analyzed by first transcribing the interviews, then rereading and re-

reading the interviewees said, noticing similarities and differences. This information was coded

and became the themes emerging from the data.

The purpose of this qualitative data is to determine the managerial style of the nursing

supervisors as well as their perceptions of how these styles relates to nursing satisfaction.

Together with the survey of nursing staff’s perceptions and satisfactions, these collective

research findings were able to answer the research questions. As it is discussed earlier that the

managerial styles as perceived by nursing supervisors will also be explored at Hera General

Hospital.

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Chapter Five

Qualitative and quantitative research findings will be discussed in this chapter. First, the

quantitative results will be reported and then followed by qualitative results.

Results

Quantitative Findings

Frequency counts for the descriptive statistics for demographic variables are given in

(Table 1). Frequency counts for each of the factors of demographic were examined to determine

the dominant factor by which the respondents were affected.

The results of selected data analyses are given in Tables 2, 3, 4, and 5. R2 is the

proportion of the variability in the dependent variable that is accounted for by the study model

(employment plan and experience).

At the beginning of the study the focus on findings related to the nursing supervisors’

managerial style through the Interview Instrument and then the nurses’ perspectives and their

satisfaction level about who supervises them was measured. The purpose of this practice was to


see both parties’ perspectives as well as information and the managerial skills,

experience, and knowledge that could support the nursing practice in the healthcare field.

Because some of the levels had small a number of values, the three levels of the independent

variable nursing position (License Practical Nurse (LPN), Registered Nurse (RN), and Other)

were collapsed into two new levels of RN and Other.

In Table 1, the Frequency Counts were examined to determine the frequencies and

relative frequencies for the levels of the demographic factors.

Age

The table shows that there are 111 nurses whose ages were between 20 and 30 working at

Hera General Hospital, while 56 indicated their age was 30 to 40, and 20 indicated their age was

40 or older.

Years of Experience at HGH

In demographic item two, which is the years of work experience, there were 52 nurses

who had worked less than two years, 47 nurses who had worked between 2 to 4 years, 46 nurses

who had worked between 5 to 7 years, and 42 nurses who had worked for 8 years or more.

Position at HGH

146 nurses working at HGH are Registered Nurses, while 35 nurses are LPNs or other


(e.g. staff nurse with a diploma).

Future Employment Plan

For the item16, how long the nurses plan to continue their employment at HGH, 118

nurses plan to continue working between1 to 5 years. Thirty-three nurses plan to work less than

1 year, and 19 nurses plan to continue working 6 to 10 years longer at HGH.

Table 1

Frequency Counts and Relative Frequencies for Study Variables

____________________________________________________________

VARIABLE Frequency Relative Frequency

_______________________________________________________________

Age Group

20 to 30 111 0.58

30 to 40 56 0.29

40 and older 20 0.10

Years Worked

Less than 2 years 52 0.28

2 to 4 years 47 0.25

5 to 7 years 46 0.24

8 or more years 42 0.22

Position

RN 146 1.80

Other 35 2.23

Work Plan

Less than 1 year 33 0.17

1 to 5 years 118 0.62


6 to 10 years 19 0.1

More than 10 years 20 0.10

______________________________________________________________

The study found significance for the results in Tables 2, 3, and 4 as follows:

1. The effect of employment plan on nursing staff perceptions on managerial styles

2. The effect of experience on nursing staff perceptions on managerial styles

3. The effect of employment plan on nursing staff satisfaction

For the analyses in Tables 2, 3, 4 and 5, the ANOVA procedure was conducted using an

overall alpha level of significance of .05 for rejection of the null hypotheses. The three levels of

the independent variable and the nursing staff perception on managerial style were tested after

collapsing the category levels, and then the significances were found.


Effect of Age and Future Employment Plan on Nursing Staff Perceptions of Managerial

Styles

Other significances were found for the effect of employment plan on nursing staff

perceptions of managerial styles and the effect of employment plan on nursing staff satisfaction.

Table 2

ANOVA for Effect of Age and Employment Plan on Nursing Staff Perceptions of

Manageria Styles

_______________________________________________________________

Numerator Denominator

Effect df df MS F-Ratio

_____________________________________________________________

Age 2 180 0.73 0.87

Employment Plan 3 180 2.25 2.71*

________________________________________________________________

Category Means for Employment Plan

________________________________________________________________

Level of Employment Plan N Level Mean

________________________________________________________________

Less than 1 year 32

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I, Sultana Alsharif, do grant permission for my ...€¦ · AN ASSESMENT OF MANAGERIAL STYLES AND HOW THEY DIRECTLY INFLUENCE NURSING JOB SATISFACTION AT HERA GENERAL HOSPITAL IN