Leadership behaviour of nurse managers in relation to jobsatisfaction and work climate

STINA FRANSSON SELLGREN MS c , RN , P h D1, GORAN EKVALL P hD

2 and GORAN TOMSON MD , P h D3

1PhD, Medical Management Centre, Karolinska Institutet and Deputy Nursing Director, Karolinska UniversityHospital, Stockholm, 2Professor Emeritus, Institution of Psychology, University of Lund, Lund and3Professor, Medical Management Centre and Division of International Health, Karolinska Institutet, Stockholm,Sweden

Introduction

Staff turnover is a global and increasing problem forhealth care. There is a shortage of active nurses in the

European Union and this is projected to worsen over thenext 20 years (Hasselhorn et al. 2003). In the US, staffturnover is estimated to reach a level of 29% in 2020(Health Resources and Services Administration, HRSA

CorrespondenceStina Fransson Sellgren

Department of NursingKarolinska University Hospital17176 StockholmSwedenE-mail: stina.sellgren@karolinska.se

SELLGREN S . F . , EKVALL G . & TOMSON G. (2008) Journal of Nursing Management 16, 578–587Leadership behaviour of nurse managers in relation to job satisfaction and workclimate

Aim This study examines how nurse managers! leadership behaviour relates tojob satisfaction and a creative work climate.Background The nursing shortage is a challenge for managers all over the world.Leadership is a core element of management and it is important to elucidateleadership behaviour in order to increase knowledge about attracting andretaining talented staff.Method We studied 770 subordinates at a large university hospital. Threequestionnaires for assessing perceived leadership behaviour, creative work climateand job satisfaction were used.Results Subordinates with a manager perceived as "super! have the highest rateson job satisfaction. The correlation between leadership and creative work climateis stronger than between leadership and job satisfaction. Between job satisfactionand work climate the correlation is strong.Conclusions The study shows that the relationship between a creative workclimate and job satisfaction is strong. A managers! ability to lead has a major affecton work climate.Implication for nursing management Nurse managers must work on developingtheir leadership behaviour towards being an all-round leader that cares aboutpeople, is concerned about productivity and can handle changes. Support of ideasand initiatives are important in order to enable subordinates to perceive theirwork as challenging.

Keywords: job satisfaction, leadership behaviour, work climate

Accepted for publication: 31 October 2007

Journal of Nursing Management, 2008, 16, 578–587

DOI: 10.1111/j.1365-2934.2007.00837.x578 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd

2002). Job satisfaction is found to be an essential factorin staff turnover and is cited as a major contributoryfactor in the intention to stay in the nursing profession(Taunton et al. 1997, Shader et al. 2001). Dealing withthe nursing shortage is a huge challenge for managers inhealth care organizations all over the world, and qualitynursing leadership is an important determinant in itselfas a predictor of job satisfaction (McNeese-Smith 1996,Taunton et al. 1997). Consequently, it is very importantto elucidate the leadership behaviour of nurse managersin order to increase knowledge toward efficiency andeffectiveness in health care, as well as in attracting andretaining talented staff.

Management, leadership and leadership styles

The nurse manager, besides being the head and managerof the unit, is also a leader over part of the health carestaff. Kotter (1990) stated that management seeks toproduce predictability and order by: setting operationalgoals, establishing action plans, allocating resources,organizing and staffing, solving problems and moni-toring results. Leadership on the other hand seeks toproduce necessary changes by developing a vision of thefuture and strategies to reach that vision. This includescommunicating the vision and motivating and inspiringthe staff to attain the vision. In modern organizations,success as a manager necessarily involves leading (Yukl2002) and the manager!s role is more seen as a coach,considering relations to staff, high quality in nursingand efficiency (Collins 2001, Zimmerman et al. 2001).The manager!s ability to lead affects the staff!s ability toachieve stated visions and goals (Bass 1985, Yukl2002). Our study is focused on the leadership part ofthe manager!s work.Leadership style was described in early studies as

consisting of two broad and independent behaviouraldimensions, one production/task oriented, primarilyconcerned with accomplishing the task, utilizing staffand resources efficiently and maintaining reliableoperations. The other is employee oriented, with focuson improving relationships and helping people,increasing cooperation and teamwork and buildingidentification with the organization (Fleishman &Harris 1962, Hersey & Blanchard 1977).Today changes occur frequently in every organization

and to handle and motivate change is one of the leader!smain tasks. In leadership research, a new dimension ofchange orientation (Ekvall & Arvonen 1994, Yukl2002) has entered the arena. A change-orientated leaderis primarily concerned with development, increasingflexibility and innovation, gaining commitment to the

changes, and has a creative attitude and visionaryqualities (Kotter 1995, Yukl 2002).The transformational leadership style was described

in the 1980s (Bass 1985, Burns 1978) and can be de-scribed as having a focus on development and change inaddition to employee orientation (Bass 1985, Burns1978). The integrated leader who combines differentaspects of leadership for different situations is found tobe most effective today (Cook 2001).The importance of supportive leadership behaviour

for job satisfaction and the intention to stay in nursinghas been described previously (Blanchard & Waghorn1997, Taunton et al. 1997, Albaugh 2003), as well asthe fact that poor supervision by nurse managers leadsto job dissatisfaction (Taylor et al. 1999).

Job satisfaction

Job satisfaction has been described as the most impor-tant predictor for nurses! intention to remain employed(Shader et al. 2001, Cowin 2002, Larrabee et al. 2003).Job satisfaction can be considered from a global per-spective, such as the feelings and emotions perceived bythe individual employee based on work experiences(Price 2001, Spector 1997). It can also be exploredthrough a facet approach, studying employee attitudestowards various aspects (facets) of their jobs. Taris andFeij (2001) described two aspects of values, intrinsicand extrinsic where intrinsic values refer to immaterialaspects of the job such as job variety and autonomy andextrinsic values refer to material work aspects such assalary and opportunity for promotion. Job satisfactiondecreases when intrinsic work values are not met (Taris& Feij 2001, Hegney et al. 2006).The main theme ofthese earlier studies is that job satisfaction is the resultof an evaluation of whether one!s job meets one!s needs;if one feels dissatisfied, searching for and acceptinganother place to work will likely occur. Recent studieswithin nursing have reported relationships between jobsatisfaction and specific components such as pay (Chan& Morrison 2000, Cowin 2002), control, autonomyand responsibility (Chan & Morrison 2000, Cowin2002, Larrabee et al. 2003) and satisfaction with pro-fessional opportunities (Cowin 2002). Work groupcohesion is found to be important (Tourangeau &Cranley 2006) and McNeese-Smith (1996) found thatthe perceptions of staff nurses toward the leadershipbehaviour of their manager were significantly related totheir job satisfaction. Supportive leadership behaviourincludes creating opportunities that lead to staff per-ceiving their work as meaningful, stimulating and giv-ing a sense of coherence (Antonovsky 1979).

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Work climate

Organizational climate has been discussed simulta-neously with organizational culture (Schneider 1990)and some writers argue that the two topics overlap andencompass each other (Denison 1996). Culture is de-fined as the normative beliefs, norms, values and sharedbehavioural expectations in the organization and is aproperty of the work unit (Ashforth 1985, Verbekeet al. 1998); it affects the strategies for management.Our definition of climate, based on the work of Verbekeet al. (1998), is that climate is the way people perceivetheir work environment. The organizational climate isregarded as a conglomerate of the attitudes, feelings andbehaviours which characterize life in an organization(Glisson & James 2002, Isaksen & Ekvall 2006). Aclimate must be more innovative for the focus to be onrenewal and change. According to Ekvall et al. (1983),a climate that emulates innovativeness (creative workclimate) includes maintaining support for ideas, openrelationships, mutual trust and confidence; challengeand motivation, commitment to the goals and opera-tions of the organization; the freedom to seek infor-mation and show initiative; maintain pluralism inviews, knowledge and experiences; and having an openexchange of opinions and ideas.A study by Hellriegel and Slocum (2004) clearly

indicates the existence of a relationship between workclimate and job satisfaction. In a recent study ofmental health service organizations, the results showthat both culture and climate impact work attitudesand subsequent staff turnover (Aarons & Sawitsky2006).The many previously quoted studies dealt with the

relation between leadership behaviour and either jobsatisfaction or creative work climate. None studied therelation between all three. Because of the importance ofproviding high-quality health care and patient satisfac-tion (McNeese-Smith 1996, Newman et al. 2002, Seoet al. 2004), more knowledge is needed about thisrelationship.

Aim

The aim of the current study was to examine how nursemanagers leadership behaviour relates to job satisfac-tion and a creative work climate.

Method

The study was conducted at a large university hospitalin Sweden, in November 2003.

Study population

At the time of our study there were 92 nurse managersat the hospital, representing a wide variety of healthcare units; 77 of these met our inclusion criteria.Inclusion criteria for the managers were: responsibilityfor the budget of the unit and for recruiting staff,having 10 or more subordinates, having been in chargefor at least 6 months, and having not given notice toresign. Ten subordinates of each nurse manager wererequested to participate in the study, providing 770potential participants from a total population of about3000 subordinate staff. Included in the sample popu-lation were Registered Nurses, assistant nurses andvarious administrative staff. Only staff members actu-ally working at the time of the study were enrolled intothe randomization process; if a nurse manager had 10subordinates, all were asked to participate in the study.When a manager!s team consisted of more than 10subordinates, each subordinate received a number thatwas then randomly drawn from a box by an assistantindependent of the hospital and the study. Excludedfrom our sample were members of staff with time-based or temporary employment as these nurses pri-marily work nightshifts or weekends when the manageris not in charge and therefore would not be able torespond to the questionnaire on perceived leadershipbehaviour.

Questionnaires

The study is based on three validated questionnairesevaluating job satisfaction, leadership behaviour andwork climate (available from G.E.). These weredistributed at the same time to all 770 subordinates.Attached were questions regarding basic data onthe respondents, such as gender, age and profession.The questionnaires were distributed to the subordi-nates! home addresses and a reminder was distributedafter 2 weeks to those participants who had notresponded.

Questionnaire I: leadership behaviour

A questionnaire, based on the "change, production,employee! model (CPE), was used to assess perceivedleadership behaviour. This questionnaire was developedand validated by Ekvall and Arvonen (1991, 1994) andconsists of 30 items covering the three dimensions ofchange, production and employee (relations), with 10items for each dimension. These three fundamentaldimensions can then be combined into leadership

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profiles (Yukl 2002). The questionnaire was reliabilitytested using Cronbach!s alpha with coefficients between0.86 and 0.94 (Arvonen & Ekvall 1999), and its validityhas been demonstrated in several large studies (Ekvall& Arvonen 1991, 1994). We choose to use the CPE toolbecause it is reliability tested and validated in Swedishand has been widely used both in Sweden and in othercountries (Arvonen & Ekvall 1999).The respondents! answers are rated 1–6 on a Likert

scale (ranging from "do not agree at all! to "agree to-tally!).Example questions from this questionnaire include:My manager:

• "initiates new projects! (change);• "gives clear orders and instructions! (production);• "is friendly! (relation).

Questionnaire II: job satisfactionThe tool used for self-assessing job satisfaction, the JobSatisfaction Questionnaire, was developed by one of theco-authors (GE) and consists of 20 items covering fivedifferent variables: competence (five items), feeling (fiveitems), autonomy (three items), initiative (four items)and relation (three items). The questionnaire has beenused earlier in studies of different companies and healthorganizations in Sweden (Arno & Tunving 2002); itsreliability has been tested both by us and others, dem-onstrating a Cronbach!s alpha coefficient in the range0.74–0.92 (Arno & Tunving 2002).Answers to the questionnaire were given on a Likert

scale from "mostly negative! to "somewhat more negativethan positive! and "somewhat more positive than nega-tive! to "mostly positive!. There is no middle answer(neither/nor) so the respondent is required to take astandpoint.Example questions from this questionnaire:How do your work and the circumstances at work

affect your possibility to:

• "feel secure! (feeling);• "feel appreciated! (relation);• "be more competent! (competence).

Questionnaire III: work climateThe questionnaire used for self-assessing work climate,the Creative Climate Questionnaire (CCQ; Ekvall1996), consists of 50 items, five in each of the followingten variables: challenge, freedom, idea support, trust,dynamism, playfulness, debate, conflict, risk taking, andidea time. The questionnaire is widely used bothnationally and internationally for assessing creativeclimate (Talbot et al. 1992, Isaksen & Ekvall 2006).

The reliability test using Cronbach!s alpha shows coef-ficients between 0.66–0.90. Answers are rated 0–3 on aLikert scale (in terms of applicability, from "not at all! to"to some degree! and "fairly! to "to a high degree!).Low rates indicate that the climate is perceived as

stagnated and high rates indicate that the climate isperceived as creative. For the variable ("conflicts!) it isthe opposite.Example questions from this questionnaire include:

• "new ideas are supported and encouraged! (supportfor ideas);

• "you are allowed to make your own decisions!(freedom);

• "there!s always something going on here! (dynamism).

All three questionnaires are available from the secondauthor G.E.

Statistical analyses

The distributions of the variables were assessed foraskewness using traditional tests and no signs of severeaskewness were found. For analysing the relationshipbetween the leadership dimensions and job satisfaction,correlation analyses were employed. The relation be-tween job satisfaction and leaders perceived as super(‡1 SD beyond the mean in all three dimensions),middle of the road (within 0.5 SD of the mean in allthree dimensions), or invisible ( £ 1 SD below the meanin all three dimensions) was studied through analysis ofvariance, with Duncan!s post-hoc test with a signifi-cance level of 0.05. Likewise, the relationship betweenjob satisfaction and the quartiles of total work climate(mean value of all ten variables) was studied in the samemanner. The relationships between the work climatevariables and job satisfaction were explored with cor-relation analyses. A partial correlation analysis wasdone between the leadership dimensions and job satis-faction, controlling for total work climate.

Ethics

Participation in the study was voluntary and informedconsent was obtained. Confidentiality and anonymitywere guaranteed. If anyone did not want to be a partof the study, his or her name was immediately re-moved from the data list. Assurance of anonymity wasespecially important, considering that the first authorwas working at the same hospital as the nursingdirector at the time of the study. The study receivedethical approval from Karolinska Institutet (KI, Dnr03-348).

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Results

Respondents

After a dropout of 344 invited respondents, the totalnumber of participant respondents in the study wasn = 426 (55%). Most of the non-participants (217)provided no explanation as to why they did not re-spond, whereas 127 gave some explanation, such asbeing on sick leave (6), on maternity leave or pregnant(10), or on leave for some other reason (15). Nine hadresigned. Only six gave the explanation that the ques-tionnaires were too extensive to go through. Of the 426respondents, seven did not answer the questions onbasic data attached to the questionnaires.When analysing the background variables, there is a

statistically significant under-representation among therespondents of age 31–40 years as compared with theentire sample. There is a tendency toward over-repre-sentation of respondents in the age of 41–50 years, butthis is not statistically significant. No other differencescan be shown in comparison between the invited andthe respondents (Table 1).

Relationship between leadership behaviour andjob satisfaction

The correlation rates between leadership dimensionsand variables of job satisfaction ranged from 0.22 and0.51 (Table 2). All of the correlations are significant(P £ 0.001). The strongest correlation is between thejob satisfaction variable "feeling! and the leadershipdimension "employee orientation!; the lowest correla-tion is between the variable "autonomy! and thedimension "change orientation!. Overall, the correla-tions between the job satisfaction variable "autonomy!and all three leadership dimensions are lower than theother correlations. The correlations with employeeorientation are somewhat stronger than the correlationswith the other leadership dimensions. The strongestcorrelation with production orientation is the variable"feeling!, and with "change orientation! the strongestcorrelation is with "initiative!.The results of the analyses of variance (Table 3) show

that the mean values of job satisfaction among staffwith invisible managers were significantly lower thanthe mean values among those who had middle of theroad or super managers. Further, the mean valuesbetween staff with middle of the road managers werelower and significantly different than those with supermanagers, with one exception, "autonomy!.

Relationship between leadership behaviour andwork climate

Correlation analyses were done between the ten vari-ables of creative work climate and the three leadershipdimensions, and between the mean value of total crea-tive work climate and the leadership dimensions. Thecorrelations at the variable level showed a variancebetween 0.28 ("debate! to "production orientation!) and0.58 ("idea support! to "change orientation!). All of thecorrelations are significant (P £ 0.001).There are strong correlations between each of the

three leadership dimensions and creative work climate(as a total mean value): "change orientation! 0.54, "pro-duction orientation! 0.48, and "employee orientation!

Table 1Basic facts of the invited sample compared with facts of theresponded

Invited Responded

GenderMen 43 28Women 727 391

Age (years)20–30 139 7331–40 259 12141–50 196 12151–60 148 88>60 28 16

ProfessionRegistered Nurse/midwife 464 272

Nurse practitioner/child nursePractitioner 261 126Secretary 20 7Administrative assistant 12 6Social worker 7 2Technician/transporters 2 2Others 4 4

Internal dropout 7

Table 2Correlations between leadershipdimension and job satisfaction(n = 426)

Leadershipdimension Competence Feeling Autonomy Initiative Relation

Change orientation 0.38*** 0.41*** 0.22*** 0.46*** 0.38***Production orientation 0.33*** 0.45*** 0.25*** 0.38*** 0.42***Employee orientation 0.39*** 0.51*** .25*** 0.47*** 0.48***

***P < 0.001.

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0.56. The P-value is significant ( £ 0.001) in all of thevariables.

Relationship between creative work climate andjob satisfaction

Correlation analyses were performed both as corre-lations between each variable, ten of creative workclimate and five of job satisfaction, and between themean value of the total creative work climate and jobsatisfaction variables. The correlation analyses of vari-ables showed a range from )0.15 ("conflict! to "auton-omy!) to )0.68 ("idea support! to "initiative!). Allcorrelations apart from "conflict! to "autonomy!(P = 0.003) are significant at the 0.001 level (Table 4).The negative co-variation between "conflicts! and "jobsatisfaction! is expected theoretically.Correlations between the total mean value of all

creative work climate variables and the five variables ofjob satisfaction are strong: "competence! 0.55, "feeling!0.60, "autonomy! 0.41, "initiative! 0.64, and "relation!0.65. All these correlations are significant (P £ 0.001).In Table 5, we divided the sample into four quartiles

according to the mean values of total creative workclimate and related these to the mean values of the fivevariables of job satisfaction. The differences in meanvalues between each of the four groups are significant(P £ 0.001) in all the variables except "autonomy!.

Correlations between leadership behaviour, jobsatisfaction and creative work climate

When taking mean values of correlations (based ontotal scores), it is clear that there is a stronger rela-tionship between leadership behaviour and creativework climate and between creative work climate andjob satisfaction than between leadership behaviours andjob satisfaction. This indicates that the impact of lead-ership behaviour on job satisfaction most likely has aninfluence via a creative work climate (Figure 1). Apartial correlation analysis controlling for total creativework climate resulted in less strong correlations, whichconfirms this hypothesis (Table 6 and Figure 1).

Discussion

This is one of few studies on leadership and creativework climate in a hospital setting and it contributes tothe knowledge of the relationship between leadershipbehaviour, work climate and job satisfaction in nursing.There is to our knowledge no study published thatexplores leadership behaviour in nursing, including thedimension "change!, in relation to intrinsic factors of jobsatisfaction and creative work climate. Although nurs-ing staff turnover has been a major problem for many

Table 3Analysis of variance between job satisfaction of staff that perceivedtheir managers as super (>1 SD beyond the mean, middle of theroad within 0.5 SD of the mean, and vague £ 1 SD below the mean)

Vague(n = 32)

Middle(n = 53)

Super(n = 23) P Post hoc*

Competence 1.61 2.09 2.78 *** 1 < 2 < 3Feeling 1.56 2.23 2.85 *** 1 < 2 < 3Autonomy 1.40 1.73 2.33 *** 1 < 2,3Initiative 1.57 2.05 2.77 *** 1 < 2 < 3Relation 1.89 2.33 2.77 *** 1 < 2 < 3

*The post hoc test is done as a result of Duncan with a significancelevel of 0. 05. ***P < 0.001.

Table 4Correlations between creative work climate variables and job satis-faction (n = 426)*

Variables ofwork climate Competence Feeling Autonomy Initiative Relation

Challenge 0.48*** 0.54*** 0.30*** 0.47*** 0.56***Freedom 0.43*** 0.42*** 0.43*** 0.51*** 0.39***Idea support 0.54*** 0.57*** 0.36*** 0.68*** 0.55***Trust 0.40*** 0.46*** 0.26*** 0.46*** 0.56***Dynamism 0.43*** 0.43*** 0.19*** 0.44*** 0.54***Playfulness 0.37*** 0.46*** 0.24*** 0.44*** 0.63***Debate 0.39*** 0.40*** 0.32*** 0.53*** 0.44***Conflict )0.32*** )0.39*** )0.15** )0.36*** )0.47***Risk taking 0.45*** 0.44*** 0.35*** 0.54*** 0.40***Idea time 0.44*** 0.48*** 0.54*** 0.53*** 0.40***

**P < 0.005, ***P < 0.001.

Table 5Analysis of variance between jobsatisfaction of staff when perceivedcreative work climate is divided intoquartiles

1 qu.(n = 109)

2 qu.(n = 107)

3 qu.(n = 104)

4 qu.(n = 104) Prob Post hoc*

Competence 1.72 1.99 2.26 2.65 *** 1 < 2 < 3 < 4Feeling 1.71 2.09 2.34 2.70 *** 1 < 2 < 3 < 4Autonomy 1.40 1.54 1.88 2.18 *** 1< 2 < 3 < 4Initiative 1.61 2.01 2.26 2.67 *** 1 < 2 < 3 < 4Relation 1.85 2.30 2.51 2.83 *** 1 < 2 < 3 < 4

*The post hoc test is done as a result of Duncan with a significance level of 0.05. ***P < 0.001.

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years, focus in health care has been on effectiveness andproductivity and less on what is important for devel-oping job satisfaction. This is despite the fact thatnursing staff are among the most important resources ofhealth care. Staff that perceives job satisfaction isessential for the ability to give high-quality and safe care(Kramer & Schmalenberg 2004).The relationship between leadership behaviour and

job satisfaction is significant (P < 0.001). Managersperceived as "super! leaders influences staff job satis-faction in a positive way. Staff working under a man-ager perceived as a "middle of the road leader! ratehigher job satisfaction than staff supported by an"invisible leader!. A manager with an "invisible! leader-ship style affects job satisfaction in a negative way.These findings support earlier findings where poormanagement practices, including lack of support, feed-back and supervision, have been associated with jobdissatisfaction (Taunton et al. 1997, Taylor et al. 1999)and intention to leave (Wai Chi Tai et al. 1998).Newman et al. (2002) also found that poor manage-ment was one of the main reasons for dissatisfactionand intention to leave.All variables of job satisfaction explored in our study

show significant correlations with both leadershipbehaviour and creative work climate. Ekvall (2001)obtained similar results for job satisfaction and workclimate in a study of staff at a state-owned companythat performs tests on motor cars all over Sweden.One of the variables in our study "autonomy! has a

lower correlation with both leadership behaviour and to

work climate than the rest of the variables. It seemsfrom the results of this study that "autonomy! is leastaffected by the studied impact factors. According toHerzberg (1966) "autonomy! could be referred to as a"motivator!, while Taris and Feij (2001) discuss auton-omy as an aspect of the job that allows for self-expression. Autonomy seems to be more of a charac-teristic of the individual and less easy to influence. Kant(1784) defines autonomy as freedom from externalauthority and distinguishes between a person who isintellectually autonomous and one who keeps him/herself in an intellectually heteronomous, i.e. dependentand immature, status.In our study, the correlations between variables of

leadership behaviour and job satisfaction were signifi-cant, but that the correlation between job satisfactionand employee orientation was slightly stronger than for"production orientation! and "change orientation!.Nursing as a profession relies on relations and caringfor others, which affect the leadership and organizationof nursing. If the manager leads with kindness and re-spect for the individual it is more likely that the staffshow the same behaviour towards the patients. This isimportant today when there is an obvious risk of losingthe aim to care properly for the patient, as a result of thepressure for increased staff productivity and theeconomic goals of the administrators (Bondas 2006).Positive leadership qualities and strong facilitativeleadership behaviour of the first line manager areimportant in creating an environment that increases jobsatisfaction and the intention to stay (Blanchard &Waghorn 1997, Albaugh 2003). The command andcontrol model of leadership is no longer appropriate(Laschinger et al. 1999). McDaniel and Wolf (1992)found that transformational leadership factors (e.g.individual consideration, charisma and intellectualstimulation) lead to low turnover (e.g. high job satis-faction). Nursing supervision is also shown to have apositive effect on nurses! physical symptoms and theirperceptions of well-being and on the experience ofhaving or not having control and motivation (Begatet al. 2005). On the other hand, the results of a recentstudy by Sellgren et al. (2006) showed that the staffpreferred a more production-oriented leadership stylethan the leaders preferred to demonstrate.

Leadership

Creative work Job

0.36 (0.12)

0.57

0.52

Figure 1Mean correlations between job satisfaction, leadership behaviourand creative work climate (n = 426). The mean partial correlation(controlling for climate) between leadership behaviour and job sat-isfaction is shown within parentheses.

Table 6Partial correlation coefficients, con-trolling for total climate (mean of 10variables) n = 396

Leadership dimension Competence Feeling Autonomy Initiative Relation

Change orientation 0.10* 0.11* )0.02 ns 0.16** 0.03 nsProduction orientation 0.07 ns 0.21*** 0.05 ns 0.12* 0.16**Employee orientation 0.11* 0.25*** 0.02 ns 0.17** 0.17***

*P < 0.05, **P < 0.005, ***P < 0.001.

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Our findings that increased creativity in the workclimate results in higher job satisfaction are supportedby the findings of Kramer (1990), who identified inmagnet hospital studies that group climate withinnursing is an important variable. Magnet hospitals areso named for their excellence in retaining and attractingnursing staff during periods of nurse shortage. Thereputation of each of these hospitals was that they weregood places to work and gave high quality of nursingcare. The positive climate aided the institution inattracting and retaining their staff. A study from auniversity health centre showed that when the climate isperceived as stagnated, job satisfaction is low, while themore positive the perception of work climate, the lessemployees tend to stay away from work (Sounan &Gagnon 2005). Hemmingway and Smith (1999) alsofound in their study among 252 nurses in Canada thatorganizational climate predicted turnover.The importance of leadership behaviour for a creative

work climate is obvious in the results of our study, assimilar to a study of a state university college in Sweden(Ekvall & Ryhammar 1998). Their results indicatedthat the behavioural style of the manager affectedorganizational outcomes, such as creativity and pro-ductivity through influencing the creative work climate.The significant correlation between leadership behav-iour and organizational outcomes disappeared when theinfluence of the third variable "climate! was removed. Inour study of health care staff, the findings are somewhatdifferent. There are still significant correlations betweenleadership behaviour and variables of job satisfaction,but it is less strong than that of leadership behaviourmediated through work climate.It is important to be aware of the strong relationship

between leadership behaviour and work climate be-cause of the strong correlation between work climateand job satisfaction. This means that the manager in herleadership role is a key to nurse retention. This confirmsreported findings (McNeese-Smith 1996, Taunton et al.1997). While the individual characteristics of a humanbeing may be difficult to change it is possible to adjustone!s leadership behaviour in a specific situation (Ekvall& Arvonen 1991). To lead does not only mean to gobefore, it also means to go with. The results of our studyindicate that the manager!s role as a climate builder isvery important and has great impact on nursing staffjob satisfaction.

Methodological considerations

The dropout rate was normal for this type of study(45%). Analysis of the base data for the total sample

compared with the respondents showed that therewas a significant under- representation of age 31–40among the respondents. The way this may haveinfluenced results is difficult to say. The main criti-cism of questionnaires is that they do not measurereal behaviour, only the attitudes of the subordinatestowards the object. The CPE questionnaire has beentested for the influence of attitude (Ekvall & Arvonen1994). The change and production dimensionsshowed no correlations with attitude while thedimension relation orientation showed a medium-sized coefficient (.40), which is logical, as being ac-cepted is a psychological drive in relations-orientedbehaviour. A further study with a more qualitativeapproach could however add a more in-depthunderstanding of the phenomenon.

Conclusions

This study provides evidence that leadership behav-iour and work climate are essential for the feeling ofjob satisfaction in nursing. The study shows that acreative work climate has the strongest relationship tojob satisfaction and that the manager is an importantlink in creating such a climate. According to this, inorder to improve job satisfaction the manager has towork and develop her leadership behaviour towardsbeing a ‘‘super’’ leader. This type of leader caresabout people in the organization, considers produc-tivity and knows how to handle changes. Training inthese subjects should be arranged by the hospitalmanagement. When organizational changes occur andthe work environment is unstable, it is the managerthat should remain calm and motivate the staff. Toknow how to develop functional work groups isimportant as well as what individual needs that hasto be met. In order to create an open-minded creativeclimate, the manager has to support new ideas andinitiatives from subordinates. In small units wheremanagers work with their staff and where workteams are stable it is easier to foster a creative workclimate. People must be allowed to feel joy atwork even if you are working in a very serious area.When this type of work climate is present it is morelikely that subordinates will feel job satisfaction andremain in their jobs.

Acknowledgements

The authors thank all the nurse managers and nursing staffthat have participated in this study. We also thank OlaAndersson for assistance with the statistical analyses.

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References

Aarons G.A. & Sawitsky A.C. (2006) Organizational climatepartially mediates the effect of culture on work attitudes andstaff turnover in mental health services. Administration andPolicy in Mental Health and Mental Health Services Research33 (3), 289–301.

Albaugh J. (2003) Keeping nurses in nursing: the profession!schallenge for today. Urologic Nursing 23, 193–199.

Antonovsky A. (1979) Health, Stress and Coping. New Perspec-tives on Mental and Physical Well-being. Jossey-Bass, SanFrancisco, CA.

Arno S. & Tunving K. (2002) Arbetstillfredsstallelse ochsjukfranvaro. Psykologiska institutionen, Stockholms universi-tet (in Swedish).

Arvonen J. & Ekvall G. (1999) Effective leadership style: Bothuniversal and contingent? Creativity and Innovation Manage-ment 8 (4), 242–250.

Ashforth B.E. (1985) Climate formation: Issues and extensions.Academy of Management Review 4, 837–847.

Bass B.M. (1985) Leadership and Performance Beyond Expec-tations. Free Press, New York, NY.

Begat I., Ellefsen B. & Severinsson E. (2005) Nurses! satisfactionwith their work environment and the outcomes of clinicalnursing supervision on nurses! experience of well-being – aNorwegian study. Journal of Nursing Management 13 (3),221–230.

Blanchard K. & Waghorn T. (1997) Mission Possible. McGrawHill, New York, NY.

Bondas T. (2006) Paths to nursing leadership. Journal of NursingManagement 14, 332–339.

Burns J.M. (1978) Leadership. Harper & Row, New York, NY.Chan E. & Morrison P. (2000) Factors influencing the retentionand turnover intentions of Registered Nurses in a Singaporehospital. Nursing and Health Sciences 2, 113–121.

Collins J. (2001) From Good to Great: Why Some CompaniesMake the Leap and Others Don!t. Harper Business, New York,NY.

Cook M.J. (2001) The renaissance of clinical leadership. Inter-national Nursing Review 48 (1), 38–46.

Cowin L. (2002) The effects of nurses! job satisfaction on reten-tion. Journal of Nursing Administration 32 (5), 283–291.

Denison R.D. (1996) What is the difference between organiza-tional culture and organizational climate?. A native!s point ofview on a decade of paradigm wars Academy of Managementreview 21 (3), 619–654.

Ekvall G. (1996) Organizational climate for creativity and inno-vation. European Journal of Work and Organizational Psy-chology 5 (1), 105–123.

Ekvall G. (2001) Formular Arbetstillfredsstallelse. ManualStockholm, Ekvall Organisationspsykologi (in Swedish).

Ekvall G. & Arvonen J. (1991) Change centered leadership. Anextension of the two dimensional model. Scandinavian Journalof Management 7, 17–26.

Ekvall G. & Arvonen J. (1994) Leadership profiles, situation andeffectiveness. Creativity and Innovation Management 3 (3),139–161.

Ekvall G. & Ryhammar L. (1998) Leadership style, social climateand organizational outcomes. A study of a Swedish universitycollege. Creativity and Innovation Management 7 (3), 126–301.

Ekvall G., Arvonen J. & Waldenstrom-Lindblad I. (1983) Crea-tive Organizational Climate. Report 2. The Swedish Councilfor Management and Organizational Behaviour, Stockholm.

Fleishman E.A. & Harris E.F. (1962) Patterns of leadershipbehaviour related to employee grievance and turnover. Per-sonnel Psychology 15, 43–56.

Glisson C. & James L.R. (2002) The cross level effects of cultureand climate in human service teams. Journal of OrganizationalBehaviour 23, 767–794.

Hasselhorn H.M., Tackenberg P. & Muller B.H. (2003) WorkingConditions and Intent to Leave the Profession Among NursingStaff in Europe. Report No. 7. SALTSA – Joint Programme forWorking Life Research in Europe. The National Institute forWorking Life, Stockholm.

Health Resources and Services Administration (HRSA) (2002)Projected Supply, Demand, and Shortages of RegisteredNurses: 2000–2020. Available at: http://www.bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/3.htm, accessedon 11 August 2007.

Hegney D., Plank A. & Parker V. (2006) Extrinsic and intrinsicwork values: their impact on job satisfaction. Journal ofNursing Management 14, 271–281.

Hellriegel D. & Slocum J.W. (2004) Organizational Behaviour:Contingency Views, 10th edn. South Western College Pub-lishing, Cincinnati, OH.

Hemmingway M.A. & Smith C.S. (1999) Organizational climateand occupational stressors as predictors of withdrawal behav-iours and injuries in nurses. Journal of Occupational andOrganizational Psychology 72, 285–299.

Hersey P. & Blanchard K.H. (1977) Management and Organi-zational Behaviour. Prentice-Hall, Englewood Cliffs, NJ.

Herzberg F. (1966) Work and the Nature of Man. World Pub-lishing, New York, NY.

Isaksen S.G. & Ekvall G. (2006) Asessing Your CONTEXT forCHANGE: A Technical Manual for the Situational OutlookQuestionnaire The Creative Problem Solving Group, Inc.Orchard Park, New York, NY.

Kant I. (1784) Beantwortung der Frage: Was ist Aufklarung?BerlinischeMonatsschrift 4, 481–494. Available at: http://www.ub.uni-bielefeld.de [accessed on 10 January 2007] (in German).

Kotter J.P. (1990) What leaders really do? Harvard BusinessReview 68 (3), 103–111.

Kotter J.P. (1995) Leading change. Why transformation effortsfail. Harvard Business Review 73 (2), 59–67.

Kramer M. (1990) The magnet hospitals: Excellence revisited.Journal of Nursing Administration 20 (9), 35–43.

Kramer M. & Schmalenberg C. (2004) Essentials of a magneticwork environment. Nursing 34, 50–54.

Larrabee J.H., Janney M.A. & Ostrow C.L. (2003) PredictingRegistered Nurse job satisfaction and intent to leave. Journal ofNursing Administration 33, 271–283.

Laschinger H.K.S., Wong C., McMahon L. & Kaufmann C.M.(1999) Leader behaviour impact on staff nurse empowerment,job tension and work effectiveness. Journal of NursingAdministration 29 (5), 28–39.

McDaniel C. & Wolf G.A. (1992) Transformational leadership innursing service – a test of a theory. Journal of NursingAdministration 22, 60–65.

McNeese-Smith D. (1996) Increasing employee productivity, jobsatisfaction and organizational commitment. Hospital HealthService Administration 41 (2), 160–175.

S. F. Sellgren et al.

586 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16, 578–587

Newman K., Maylor U. & Chansarkar B. (2002) The nurse sat-isfaction, service quality and nurse retention chain. Journal ofManagement in Medicine 16, 271–291.

Price J.L. (2001) Reflections on the determinants of voluntaryturnover. International Journal of Manpower 22 (7), 600–624.

Schneider B. (1990) Organizational Climate and Culture. Jossey-Bass, San Francisco, CA.

Sellgren S., Ekvall G. & Tomson G. (2006) Leadership styles innursing management: preferred and perceived. Journal ofNursing Management 14, 348–355.

Seo Y., Ko J. & Price J.L. (2004) The determinants of job satis-faction among hospital nurses: a model estimation in Korea.International Journal of Nursing Studies 4, 437–446.

Shader K., Broome M.E., Broome C.D., West E. & Nash M.(2001) Factors influencing satisfaction and anticipated turnoverfor nurses in an academic medical centre. Journal of NursingAdministration 31, 210–216.

Sounan C. & Gagnon S. (2005) Relationship among work cli-mate, absenteeism and salary insurance in teaching hospitals.Healthcare Management Forum 18 (3), 35–38.

Spector P. (1997) Job Satisfaction. Application, Assessment,Causes and Consequences. Sage Publications, London.

Talbot R., Cooper C. & Barrow S. (1992) Creativity and Stress.Creativity and Innovation Management 1 (4), 183–193.

Taris R. & Feij F.A. (2001) Longitudinal examination of therelationship between supplies-values fit and work outcomes.Applied Psychology 50 (1), 52–81.

Taunton R.L., Boyle D.K., Woods C.Q., Hansen H.E. & BottM.J. (1997) Manager leadership and retention of hospitalstaff nurses. Western Journal of Nurses Research 19 (2), 205–226.

Taylor S., White B. & Muncer S. (1999) Nurses! cognitivestructural model of work-based stress. Journal of AdvancedNursing 29, 974–983.

Tourangeau A.E. & Cranley L.A. (2006) Nurse intention to re-main employed: understanding and strengthening determi-nants. Journal of Advanced Nursing, 55 (4), 497–509.

Verbeke W., Volgering M. & Hessels M. (1998) Exploring theconceptual expansion within the field of organizationalbehaviour: organizational climate and organizational culture.Journal of Management Studies 35, 303–329.

Wai Chi Tai T., Bame S.I. & Robinson C.D. (1998) Review ofnursing turnover research, 1977–1996. Social Science andMedicine 47, 1905–1924.

Yukl G. (2002) Leadership in Organizations, 5th edn. Prentice-Hall, Englewood Cliffs, NJ.

Zimmerman B., Lindberg C. & Plsek P. (2001) Edgeware, 2ndedn. VHA, Inc., Irving, TX.

Leadership behaviour of nurse managers

ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16, 578–587 587