THE RELATIONSHIP BETWEEN TRANSFORMATIONAL LEADERSHIP AND

THE RELATIONSHIP BETWEEN TRANSFORMATIONAL LEADERSHIP AND

ORGANIZATIONAL COMMITMENT IN NONPROFIT LONG TERM CARE

ORGANIZATIONS: THE DIRECT CARE WORKER PERSPECTIVE

___________________________________

By

JEANETTE A. PORTER

___________________________________

A DISSERTATION

Submitted to the faculty of the Graduate School of Creighton University in Partial

Fulfillment of the Requirements for the degree of Doctor of Education in

Interdisciplinary Leadership

_________________________________

Omaha, NE

(October 7, 2014)

Copyright 2014, Jeanette A. Porter

This document is copyrighted material. Under copyright law, no part of this document may be reproduced without the expressed permission of the author.

iii

Abstract

The United States population is rapidly aging, impacting the demand and supply of direct

care workers who provide long term care services. Retaining direct care workers will be

a workforce concern for industry and policy leaders for decades to come. Issues such as

turnover, recognition, and supervisory practices have all been studied relative to direct

care worker retention, but leader behaviors are of special interest because of documented

influence on organizational commitment. Research on leader behaviors has been focused

on managerial and executive levels, with scant consideration in long term care at the

lower hierarchical levels. The quantitative correlational study explored the relationship

between transformational leadership and organizational commitment among 322 direct

care workers employed by nonprofit, multi-level long term care organizations located in

the Midwest. Results revealed a statistically significant relationship between

transformational leadership and affective and normative commitment dimensions, with

no significant relationship found between transformational leadership and continuance

commitment. In considering differences between long term settings, findings indicated

significance with organizational commitment, but not for transformational leadership,

suggesting that other factors, such as autonomy, may contribute more to organizational

commitment than does transformational leadership. The study results are beneficial to

industry leaders, researchers, and policymakers for addressing operational policies,

leadership training, human resource practices, and workforce policy development.

Keywords: transformational leadership, organizational commitment, affective

commitment, continuance commitment, normative commitment, Midwest, long term care

organizations, nonprofit

iv

Dedication

I first thank my parents, John and Patricia Gebhart, who instilled in me a love of lifelong

learning and who have always demonstrated God’s love to those around them. To my

husband, Chad, and our children, Jenae and Quinton, who demonstrated an incredible

level of patience for my limited availability in the evenings and on weekends; thank you

for your understanding and encouragement to meet my goals and for your love and

support during my moments of frustration. To the Creighton University faculty and staff

in the Ed.D. Leadership Program, thank you for helping me grow in my Catholic faith

and for living out the Jesuit values.

v

Acknowledgements

I wish to thank my committee members, Dr. Jenna Woster, Dr. Peggy Hawkins,

and Dr. Kathleen Zajic, who provided encouragement and direction throughout the

dissertation process. Thank you to Dr. Peggy Hawkins, who also served as my advisor

and provided me with support and encouragement along my journey. A special thank

you is extended to Dr. Isabelle Cherney for her words of wisdom, her personal interest in

every student, and her passion for leadership as the director of the Ed.D. Leadership

Program. A special thank you goes to Dr. Rob Koonz who inspired my dissertation topic

during the organizational behavior course. In addition to those already mentioned, I am

grateful to every faculty who taught me in the program and uniquely inspired me in my

learning. I sincerely appreciate Cohort 10 for all their encouragement and support

throughout my doctoral journey, especially Diana McGuire and Daniel Hoffman-Zinnel.

I would also like to acknowledge the University of South Dakota Beacom Opportunity

Fund for providing me a $2500 research stipend to complete the data collection phase of

my research.

vi

Table of Contents

Page

Abstract . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . iii

Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Table of Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

List of Tables . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

CHAPTER ONE: INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Statement of the Problem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Purpose of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Research Questions and Hypotheses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Method Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Definition of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Delimitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Significance of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

CHAPTER TWO: LITERATURE REVIEW . . . . . . . . . . . . . . . . . . . . . . . 18

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Literature Search Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Transformational Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

vii

Historical Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Full Range Leadership Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Transformational leadership constructs . . . . . . . . . . . . . . . . . . . . . 22

Idealized influence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Inspirational motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Intellectual stimulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Individualized consideration . . . . . . . . . . . . . . . . . . . . . . . . . 23

Transactional leadership constructs . . . . . . . . . . . . . . . . . . . . . . . 23

Contingent reward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Management by exception . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Nontransactional laissez-faire construct. . . . . . . . . . . . . . . . . . . . . 24

Leadership Challenge Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Leadership practice constructs . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Model the way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Inspire a shared vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Challenge the process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Enable others to act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Encourage the heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Other Theories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Criticism of Transformational Leadership . . . . . . . . . . . . . . . . . . . . . . 27

Organizational Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Affective Commitment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Continuance Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

viii

Normative Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Empirical Evidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Transformational Leadership and Organizational Commitment . . . . . . . . . . . . . . 39

The Nonprofit Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Leadership in Nonprofit Organizations . . . . . . . . . . . . . . . . . . . . . . . 46

Similarities to Transformational Leadership Theories. . . . . . . . . . . . . . . . 48

Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

CHAPTER THREE: METHODOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . 52

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Research Questions and Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Description of Sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Survey Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Leadership Practices Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Three-Component Model of Employee Commitment . . . . . . . . . . . . . . . 58

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Pilot Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Data Collection Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Data Analysis Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Assumptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

ix

CHAPTER FOUR: FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Review of the Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

Data Analysis Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Participant Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Survey Instrument Descriptive Statistics and Reliability Levels. . . . . . . . . . . 75

Research Question One and Related Hypotheses . . . . . . . . . . . . . . . . . . 77

Research Question Two and Related Hypothesis. . . . . . . . . . . . . . . . . . 80

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS . . . . . . . . . . . 84

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Summary of the Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Summary of the Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Implications for Action/Recommendations for Further Research . . . . . . . . . . . . . . 90

Scholarship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Recommendation one: Further research is warranted. . . . . . . . . . . . . . . 91

Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Recommendation two: Review operational policies. . . . . . . . . . . . . . . 93

Recommendation three: Incorporate leadership development training. . . . . . 94

Recommendation four: Revisit human resources practices. . . . . . . . . . . 94

Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Recommendation five: Evaluate the content of workforce resources . . . . . . 96

x

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

.

xi

List of Tables Page

Table 1. Parallels of Transformational Leadership Theories. . . . . . . . . . . . . . . 21

Table 2. Pilot Study Reliability Levels for LPI and TCM Survey Instruments, by

Subscales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Table 3. LPI and TCM Means and Standard Deviations . . . . . . . . . . . . . . . . 75

Table 4. Current Study Reliability Levels for LPI and TCM Survey Instruments, by

Subscales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 5. Spearman’s rho Correlations between Transformational Leadership and

Organizational Commitment, Overall and by Subscales. . . . . . . . . . . . . 80

Running head: LEADERSHIP AND ORGANIZATIONAL COMMITMENT 1

CHAPTER ONE: INTRODUCTION

Background of the Problem

The failure to attract and retain direct care workers (DCWs) in long term care has

been described as the worst challenge facing the long term care industry (Stone, 2011).

For the last three decades, recruitment and retention of direct care workers has remained

a major issue for providers and policymakers at all government levels (Stone, 2004;

2011). At the same time, the Bureau of Labor Statistics (BLS) projects a large increase in

the demand for DCWs, spanning the long term care continuum (PHI, 2013a; 2013b;

Smith & Baughman, 2007). Salient factors affecting recruitment and retention include

challenging work environments, noncompetitive wages, and supervisor qualities (Culp,

Ramey, & Karlman, 2008; Decker, Harris-Kojetin, & Bercovitz, 2009; Lee, Coustasse, &

Sikula, Sr., 2011; Stearns & D’Arcy, 2008; Stone, 2004). Stone (2011) asserted that

interdependent factors such as regulations, wage levels, targeted government workforce

resources, organizational management, and society’s value of caregiving all influence

recruitment and retention. Of the organizational management elements, studies have

found that compensation, work environments and interpersonal relationships directly

affect DCWs (Culp, et al., 2008; Stearns & D’Arcy, 2008; Stone, 2004; 2011).

In 2012, the BLS reported a figure of 4 million DCWs, representing three

occupations: nursing assistants, home health aides, and personal care aides. This is an

under-reported statistic because there are an additional 800,000 DCWs working as

independent providers for consumers and state or county agencies (PHI, 2013b). The

nearly 5 million DCWs in the 2012 labor market represents an increase of over 30% from

2008 BLS numbers (PHI, 2011). BLS reports home health aides, nursing assistants, and

LEADERSHIP AND ORGANIZATIONAL COMMITMENT 2

personal care aides within its top ten occupations projected to produce new jobs within

the U.S. economy (PHI, 2011; 2013b), primarily due to the growing aging population.

Projected demand indicates an additional 1.6 million DCW positions added to the labor

market by 2020 (PHI, 2013b). Despite the positive growth projections, median hourly

wages for DCWs ($10.63) are below the national median wage for all U.S. workers

($16.71), with inflation-adjusted hourly wages having declined over the last ten years

(PHI, 2013b). Many DCWs work part-time and lack health coverage; many also earn

below 200 percent of the federal poverty income level and rely on some level of public

assistance, such as food stamps (PHI, 2013b; Stone, 2004).

The Census Bureau projects the 65 and older age demographic to grow by 45

percent by 2025 (Census Bureau, n.d.) and the fastest growing segment of the population

are those 85 and older (Robnett & Chop, 2010). The growth and aging of the older adult

population will be accompanied by greater chronic disease burden (Dall et al., 2013;

Robnett & Chop, 2010; Stone, 2004). The growth in direct care employment will

depend on workforce supply and demand, particularly in rural areas. Workforce demand

outpaces supply (PHI, 2013a; Smith & Baughman, 2007), and health policy has a

substantial impact on leaders’ ability to determine wages, health insurance, and other

compensation (Smith & Baughman, 2007; Stone, 2004). As a result, other factors such as

leadership behaviors and practices become more prominent management considerations

in determining organizational commitment for DCWs.

The traditional hierarchy in long term care has assured that the locus of control

remains with those furthest from patient care (Caspar & O’Rourke, 2008). DCWs

provide over 80% of all patient care, have the least amount of education, receive the


lowest pay, and exercise the least amount of decision-making authority and autonomy

(Caspar & O’Rourke, 2008; Liu, Liu, & Wang, 2011; PHI, 2013a; 2013b; Stone, 2011).

DCWs have stated that what they desire most is respect, recognition and rewards, as well

as inclusion in decision-making and empowerment (Bowers, Esmond, & Jacobson, 2003;

Casper & O’Rourke, 2008; Leutz, Bishop & Dodson, 2009; Secrest, Iorio & Martz, 2005;

Stone, 2004; 2011). Such factors have influenced organizational commitment (Liou,

2008). As a result, it is important to consider the DCW perspective in understanding

commitment levels to long term care organizations.

Statement of the Problem

Similar to other industries and organizations, long term care leaders must consider

how leadership practices influence organizational commitment. To date, scant literature

exists that addresses the DCW perspective of leadership qualities and the effect on

organizational commitment. Furthermore, the existent literature primarily explores the

leadership qualities of higher hierarchical levels, despite evidence that transformational

leadership behaviors have been shown to cascade downward to other managerial, leader

positions, benefitting organizational performance as a whole (Bass, Waldman, & Avolio,

1987; Eaton, 2001; Godwin & Neck, 1998). The correlation between transformational

leadership and organizational commitment among DCWs in long term care organizations

has not been empirically tested. Job characteristics and work experiences have been

identified as influences, or antecedents, on organizational commitment; these

characteristics and experiences include job challenge, work relationships, feedback

quality, group attitudes, empowerment, role stress, job satisfaction and trust (Liou, 2008).

Transformational leadership has not been studied as an antecedent in the context of long


term care. To respond to this deficiency, additional research is warranted to study

leadership behaviors that are of immediate influence for DCWs, from the immediate

supervisor.

Furthermore, while leadership has been studied both empirically and conceptually

across many disciplines and industries, McMurray, Pirola-Merlo, Sarros, and Islam

(2010) argued that context is lacking in the literature relative to differences in for-profit

and nonprofit organizations. In their study of faith-based organizations specifically, they

contended unique challenges exist because organization and employee issues are

addressed with spirituality in mind (McMurray, et al., 2010). Thus, nonprofit-based

missions present complexity in understanding the relationship of leadership on

organizational and employee variables (McMurray et al., 2010). Contextually, the study

of nonprofit organizations reflects the importance of social missions in the provision of

welfare, health care, education and other services. The nonprofit long term care industry

has historically stressed a wide range of benefits of nonprofit management and

ownership, despite a lack of empirical evidence. This study intends to advance

knowledge in this area.

Purpose of the Study

The purpose of the quantitative correlational study was to explore the relationship

between transformational leadership and organizational commitment among DCWs in

nonprofit, long term care organizations. The predictor variable was defined as

transformational leadership, generally understood as a process whereby leaders have a

conscious goal to develop followers into leaders, exhibit behaviors that elicit trust, and

display self-sacrificial perspectives to build commitment and influence, and demonstrate


a moral compass towards mission and purpose (Avolio, 2011; Bass, 1985; Kouzes &

Posner,1988; 2012). The criterion, or outcome, variable was defined as organizational

commitment, generally described as a psychological state linking employees to their

organizations and considered along three dimensions: affective, continuance, and

normative (Meyer & Allen, 1997, p. 23).

Research Questions and Hypotheses

Two primary research questions were explored in the research study to better

understand the relationship between transformational leadership and organizational

commitment among direct care workers (DCW) in nonprofit long term care

organizations. The first question inquired about the relationship between

transformational leadership practices as measured by the subscales of the Leadership

Practices Inventory (LPI) (Kouzes & Posner, 2013) and organizational commitment as

measured by the Three-Component Model (TCM) of Employee Commitment Survey

(Meyer & Allen, 2004). The rationale for the question rested on the assumption that

DCWs perceive leadership practices to influence the work environment, thus affecting

DCW organizational commitment, or intent to stay. The second question inquired about

potential differences in the types of long term settings, such as nursing facilities, assisted

living, and senior housing. The question was important in understanding how differences

in long term settings might influence the variables of interest and where interventions

might be most valued by the industry (Kim, Wehbi, DelliFraine, & Brannon, 2013). The

research questions and specific hypotheses tested in this study included:


RQ1: What is the relationship between transformational leadership and organizational

commitment (affective, continuance, and normative) among direct care workers in

nonprofit long term care organizations?

H1: There is a significant positive relationship between transformational

leadership and DCW affective commitment.

H2: There is a significant inverse relationship between transformational

leadership and DCW continuance commitment.


leadership and DCW normative commitment.

RQ2: Is there a difference, if any, between types of long term care settings on

transformational leadership and organizational commitment?

H4: There is no difference between types of long term care settings for

transformational leadership and organizational commitment.

Method Overview

The theories of transformational leadership and organizational commitment

formed the theoretical framework of the study. For purposes of this theoretical

framework, the study addressed the transformational leadership theory of Kouzes and

Posner (1988; 2012), coined The Leadership Challenge. The theory reflects Burns

(1978) notion that the ultimate effects of leadership are only understood by way of

evaluating leader and follower interactions, or in research design, what is referred to as

causal mechanisms (Gerring, 2012). Kouzes and Posner (2012) have accumulated an

extensive database of survey responses spanning organizational sectors using the

Leadership Practices Inventory (LPI). The long term care industry, specifically nonprofit


organizations, prefers research applications that support its capacity to communicate in

terminology easily understood by all levels of an organization, suggesting the industry

will respond more favorably to a study utilizing the Kouzes and Posner (2012) theory.

Organizational commitment is considered one of many job attitudes studied

within the body of organizational behavior research (Robbins & Judge, 2012).

Substantial evidence exists to illustrate a predictive relationship of organizational

commitment (Meyer & Allen, 1997). The evolution of the concept of organizational

commitment has resulted in acknowledgment of and an empirical understanding of three

primary dimensions: affective, continuance, and normative (Liou, 2008; Meyer & Allen,

1997). Affective commitment represents the emotional component of organizational

commitment, or the degree to which employees are emotionally attached to the

organization and its beliefs and values (Liou, 2008; Meyer & Allen, 1997; Robbins &

Judge, 2012). Continuance commitment considers employees’ perceptions of value in

staying with the organization, including socioeconomic factors such as wages and

benefits (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012). Normative

commitment occurs as a result of employees’ sense of obligation to remain with the

organization; a level of conformity exists between beliefs and values and organizational

norms (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012). Because of the

depth and breadth of organizational commitment as a concept, it is important to

empirically study it along these commitment dimensions in order to further evaluate its

effect in the workplace. This study utilized the (TCM) of Employee Commitment Survey

developed by Meyer and Allen (2004), modified from their original Three-Component

Model of Commitment Survey (1997).


The study sample consisted of DCWs currently working at nonprofit long term

care organizations in the Midwest and utilized a quantitative correlational design.

Quantitative methods are more appropriate than qualitative methods to determine the

strength of relationships between the variables of interest (Gerring, 2012). Unlike a

qualitative study, use of a quantitative correlational design helps determine the strength

of the relationships existing between variables (Creswell, 2012). Because the purpose of

the study was to explore the relationship between transformational leadership and

organizational commitment among DCWs in nonprofit long term care organizations, a

quantitative approach was appropriate.

Participating organizations were required to provide permission for onsite surveys

with DCWs. Organization administrators completed a demographic information sheet in

order to obtain general information on the organization, such as types of long term care

services provided. All DCWs were invited to participate in the survey during designated

times throughout the day. Snacks were provided as an incentive to participate, as

approved by the IRB. As part of the survey completion, each participant was provided

with informed consent/assent documentation to further explain and solicit voluntary

participation in the study. Participants completed a demographic form and the LPI

survey (Kouzes & Posner, 2013) and the TCM Employee Commitment Survey (Meyer &

Allen, 2004), all of which were combined into one document for ease in instruction and

completion. Survey collection areas were chosen for accessibility to DCWs while also

providing for a private area to complete the surveys. Supervisors or other organization

agents were discouraged from access to the survey area during survey completion. To

ensure confidentiality and anonymity, no identifying information was collected from the


DCWs. Surveys were turned in directly to the study investigator and put in a confidential

box for transfer from the study site. No reports of DCW participation were provided to

the organization. Organizations were de-identified in the data software application. The

survey document was field tested in a pilot study with 13 DCWs prior to administering

the surveys for the study, to test for usefulness, ability to complete the surveys, and

reliability. The participants assisting in the field test were excluded from the study.

Internal reliability testing was conducted using Cronbach’s alpha to determine if

the survey scales were reliable (Creswell, 2012). Correlational, nonparametric statistical

analysis was used to evaluate the first research question, test the respective hypotheses,

and consider the strength of the variables based upon the specific survey subscales within

the transformational leadership and organizational commitment constructs. To evaluate

the data for the second research question regarding differences between types of long

term care settings, the independent t-test was used to compare groups (Creswell, 2012).

Definition of Terms

The following definitions of terms were used in this research study:

Activities of Daily Living (ADLs): Major everyday activities such as eating, bathing,

walking, and toileting.

Affective Commitment: “An employee’s emotional attachment to, identification with, and

involvement in the organization; employees remain with the organization because they

want to” (Meyer & Allen, 1997, p. 11).

Continuance Commitment: “An employee’s awareness of the costs associated with

leaving the organization; employees remain with the organization because they have to”

(Meyer & Allen, 1997, p. 11).


Direct Care Worker (DCW): A direct care worker is an individual who provides a high

level of direct care and service to others requiring long term care services in a broad set

of long term care settings. In addition to providing assistance with ADLs, a DCW also

provides assistance with instrumental activities of daily living (IADLs). A direct care

worker requires limited training beyond a high school education. For purposes of this

study, a DCW consisted of positions such as nursing assistants, medication assistants,

home health aides, personal care assistants, housekeeping/laundry assistants, universal

workers, cooks, dietary aides, and related positions.

Frontline Worker: A term used synonymously with direct care worker in this study.

Home Health Aides (HHAs): A direct care worker who provides the same care and

services as a nursing assistant but within the home or community setting (PHI, 2013b).

Instrumental Activities of Daily Living (IADLs): Normal everyday activities such as

housekeeping, food preparation, shopping, transportation, finances, and laundry.

Long Term Care Organization: Organizations that provide a broad set of medical,

nursing, rehabilitation, palliative care, and home assistance services to patients in assisted

living, home health, nursing facilities, hospice, and other community-based settings.

Long term care organizations may also be referred to as long term care providers. For the

purpose of this study, long term care organizations provide multiple levels of long term

care services.

Normative Commitment: “An employee’s feeling of obligation to continue employment;

employees remain with the organization because they feel they ought to” (Meyer &

Allen, 1997, p. 11).


Nursing Assistants (NAs): A direct care worker who assists residents with activities of

daily living (ADLs) and instrumental activities of daily living (IADLs). They may also

perform limited clinical tasks, such as blood pressure readings and range of motion

exercises. Nursing assistants work in nursing homes, assisted living facilities, hospitals,

and other community-based settings (PHI, 2013b).

Organizational Commitment: “A psychological state linking employees to their

organizations” (Meyer & Allen, 1997, p. 23). Organizational commitment is considered

along three dimensions: affective, continuance, and normative.

Personal Care Aides (PCAs): A direct care worker who provides assistance with ADLs

and IADLs. They work in many different long term care settings and may also be

employed and supervised directly by consumers, known as independent providers. They

may have many titles, including personal care attendant, home care worker, or personal

assistant (PHI, 2013b).

Transformational Leadership: A process whereby leaders have a conscious goal to

develop followers into leaders, exhibit behaviors that elicit trust, and display self-

sacrificial perspectives to build commitment and influence, and demonstrate a moral

compass towards mission and purpose (Avolio, 2011; Bass, 1985; Kouzes &

Posner,1988; 2012).

Assumptions

There were multiple assumptions for the study. First, it was assumed that

participants would answer the surveys honestly and completely and would complete the

surveys with their immediate supervisor in mind. It was also assumed that cultures

within the long term care organizational sites provide safe and confidential environments


for DCWs to participate in the study. Hence, local leadership was assumed to be

supportive of the study. Additionally, it was presumed that the sample size would be

high due to effective use of time and location for survey completion. The researcher also

presumed that participants would trust the researcher to maintain confidentiality and

anonymity, thus also affecting response rates. Finally, the researcher assumed that the

relationship between transformational leadership and organizational commitment can be

demonstrated using proper research rigor and methodology (Gerring, 2012).

Delimitations

The study was restricted to surveying DCWs in nonprofit long term care

organizations in the Midwest. Only those nonprofit long term care organizations with

multiple levels of long term care services were invited to participate in the study. The

study did not include supervisors or other employees not meeting the definition of a

DCW, thus limiting the perspective to the intent of the study. Survey instruments used

were limited to the demographic questions, the Kouzes and Posner LPI (Kouzes &

Posner, 2013), and the Meyer and Allen TCM of Employee Commitment Survey (Meyer

& Allen, 2004). The data collection and analysis occurred from May 2014 to July 2014.

The sample size included 322 DCWs from the participating organizations. A sample size

of 287 was targeted in order to achieve a 4-6% error rate with a 95% confidence interval

(Creswell, 2012). A target of 5-6 long term organizations was needed to achieve this

sample size, and nine organizations participated. Increasing the sample size would have

added time and costs.


Limitations

The study was conducted on site at each participating location. Participants of the

study provided individual perspectives of leadership practices within their respective

location. Responses may contain bias or be affected by psychological and emotional

states at the time of the survey. Participants represented an unknown proportion of long

term care settings provided by their respective locations. Response rates varied

depending on the time and location of the surveys and the support of leadership.

Significance of the Study

The research study was stimulated by practical considerations. DCWs form the

core of the long term care industry, providing services essential to the quality of life and

quality of care for consumers. Demographic trends do not bode well for the future

availability of direct care workers because of the rapidly aging United States population.

The population of older adults is growing dramatically and will continue to do so over the

next 50 years; the baby boomer generation will reach 65 years of age between 2011 and

2029, those age 85 and older are the fastest growing group of older adults, and by 2050,

one in five Americans will be over the age of 65 (Center for Health Workforce Studies,

2006; Dall et al., 2013). Leaders must utilize practices that develop and sustain the

workforce at both policy and practice levels. Understanding the relationship of

leadership and organizational commitment may help provide a better understanding of

leadership factors affecting the commitment process and allow industry practitioners and

researchers to consider carefully the effect of leadership behavior and practices on

DCWs. Findings of the study can benefit scholarship, practice, and policy within the

long term care industry.


Within scholarship, meta-analysis of transformational leadership has revealed an

influence on organizational commitment in industries other than long term care (Avolio,

2011). Researchers have supported additional study on transformational leadership

within hierarchical levels (Avolio, 2011; Heldenbrand & Simms, 2012). This study

responded to this deficiency, focusing research on leadership practices and behaviors that

have immediate influence for DCWs, their immediate supervisors. This study also

provided additional evidence-based insight into the relationship between transformational

leadership and organizational commitment among workers closest to patient care.

Furthermore, the study’s focus on nonprofit organizations will contribute to the

expanding literature in the nonprofit leadership arena. Such research will enhance the

literature as well as provide evidence-based support for leadership development in the

long term care industry.

For industry practice application, long term care leaders must consider how

leadership practices and behaviors affect organizational commitment. Liou (2008)

argued that organizational commitment must be given more priority in health care

organizations. In prioritizing an emphasis on organizational commitment, long term care

leaders can focus their efforts on antecedents that foster increased organizational

commitment and, as a result, increase retention and performance. Organizational

commitment is an outcome of a complex set of factors. Simply providing more

education, higher pay, or better supervisors will not likely improve organizational

commitment to any appreciable degree. However, understanding how such factors

influence organizational commitment lends value to the interventions that should be

considered and reinforced to produce necessary improvement.


Specifically, leadership styles have been shown to influence turnover (Donoghue

& Castle, 2009), and nursing home administrators specifically have been found to lack

leadership skills necessary to improve organizational performance (Scott, Vojir, Jones, &

Moore, 2005). Low organizational commitment contributes to turnover, which is costly

to long term care employers (Smith & Baughman, 2007), most recently estimated at over

$3300 for each turnover (Stone, 2004). High quality leadership and management,

including the offering of recognition, feedback, and a culture of value and respect for

DCWs has been associated with low turnover (Eaton, 2001). To develop and sustain a

quality workforce, leaders must have a broader understanding of what leadership factors

affect organizational commitment.

Furthermore, the evolution of person-centered care into the long term care

industry has demanded more of providers in the implementation of practices that

operationalize person-centered care concepts. Successfully implemented, person-

centered care models have been shown to positively influence the work environment by

inviting DCWs to actively participate in decision-making, encourage teamwork and

expand their job tasks beyond the traditional job role (Leutz, Bishop & Dodson, 2009;

Stone, 2011). As a result, transformational leadership is a consideration in the

supervisor-DCW relationship within the person-centered care approach. Understanding

the relationship between transformational leadership and organizational commitment will

lend value to the long term care industry in modifying operational practices, identifying

training and development needs, and revisiting human resource practices.

From a policy view, the healthcare environment is in the midst of drastic change

due to changes in existing regulations, broad health reform, and effects of the Patient


Protection and Affordable Care Act. Government reimbursements, regulations, and

workforce resources all influence recruitment and retention in the long term care

industry. Compensation in particular has been shown to directly affect DCWs (Stone,

2004; 2011) and is linked to continuance commitment, one of the three dimensions of

organizational commitment (Meyer & Allen, 2004). Such statistics reinforce the

challenges in retaining DCWs as a primary employee source in long term care.

Understanding the degree to which transformational leadership influences organizational

commitment, or the intent to stay on the job, is integral to the formation of long term care

policy that maintains the current DCW supply. As previously discussed, the aging

population is creating a demographic trend that will influence the demand for long term

care services. A quality long term care workforce is required to support the consumers of

long term care services and their informal caregiving networks. Recruiting and retaining

quality DCWs is a major issue for policymakers at state and federal levels. This study

can advance policymaker understanding of leadership factors affecting DCW

organizational commitment. Furthermore, it will assist in clarifying for policymakers the

degree to which the dimensions of organizational commitment are influencing DCWs

intent to stay. Knowledge of this relationship may assist policymakers in formulating

policies and targeting resources in ways that lead to successful development of the

frontline workforce.

Summary

A growing aging population and workforce shortage provide great challenges for

the long term care industry. Leaders within the industry must face these challenges not

only by addressing a wide range of external factors but also by looking inward to


leadership practices directly affecting the workforce they hope to retain. The purpose of

the study was to explore the relationship between transformational leadership and

organizational commitment among DCWs in nonprofit long term care organizations. A

quantitative correlational design study was used to assess the strength of the relationships

between the variables. The study included DCWs currently working in nonprofit long

term care organizations located in the Midwest. The research contributes to filling a gap

in the literature by identifying the relationship of leadership practices as a predictor of

organizational commitment for DCWs, an often ignored perspective in long term care.

As the health care landscape continues to change, long term care providers will need to

have the leadership skills necessary to overcome challenges, implement new operational

models, and address workforce retention. The research study provided an opportunity to

establish both external and internal validity based on the sampling quality and results of

the quantitative analysis (Gerring, 2012).


CHAPTER TWO: LITERATURE REVIEW

Introduction

Chapter one included an overview of the study and its purpose to explore the

relationship between transformational leadership and organizational commitment among

DCWs in nonprofit long term care organizations. Information was provided regarding

the problem statement and the significance of the study. The research questions

described the basis of the study. Chapter two presents a literature review of

transformational leadership, organizational commitment, and nonprofit considerations in

context to the intended study.

Chapter two contains five main sections: literature search process,

transformational leadership, organizational commitment, nonprofit considerations, and

conclusions. Each section contains discussion of the study variables addressing broadly

the perspectives of history, theory, and relationship to leadership and outcomes.

Literature Search Process

The review of the literature occurred manually and electronically via libraries,

library databases, and the Internet. The literature search primarily included the two

variables, transformational leadership and organizational commitment, in the initial broad

search and subsequently narrowed to the health care industry, the long term care industry,

and finally, the nonprofit sector. A search of the terms transformational leadership and

direct care workers, transformational leadership and long term care, transformational

leadership and nursing facilities, organizational commitment and direct care workers, in

addition to similar combinations attempting to isolate the variables to direct care workers

and long term care produced minimal results. Thus, more defined search terms were


required to isolate specific health care related studies on leadership and organizational

commitment. Specific search terms included nursing assistants, home health, personal

care assistants, employee commitment, worker commitment, nurses, nurse managers,

nurse supervisors, and frontline workers. Nonprofit search terms included nonprofit

sector, not-for-profit, nonprofit organizations and non-profit. Combining these search

terms with the study variables provided additional literature results. The databases used

to search for peer-reviewed research were EBSCOHost, ProQuest, ProQuest Digital

Dissertations, Thomson Gale, InfoTrac, ERIC, AgeLine, MEDLINE, EBSCO

MegaFILE, SocINDEX, PsychINFO, Business Source Premier, CINAHL, and Academic

Search Premier.

Transformational Leadership

Historical Overview

The term transformational leadership originated by Downton in his early writings

on charismatic leadership and leader follower relations in mass social movements

(Downton, 1973; Northouse, 2007). However, the term went unnoticed until it evolved

from Burns’ (1978) theoretical perspective of transforming leadership, whereby leaders

seek to identify the higher need motives of followers and convert followers into leaders

and ideally, moral agents, thus creating social change (emphasis added). Burns (1978)

discussed transforming and transactional leadership within a political context, evaluating

the behaviors and actions of leaders that led to political actions and social change. In his

seminal efforts in leadership research, Burns (1978) expressed a sincere curiosity about

leadership as a component of causation. He contended that leadership could be further

refined by definition and variety in order to deconstruct its multiple variables as causal


factors to a plethora of implications (Burns, 1978; Gerring, 2012). The application of

transforming leadership within the corporate context was suggested (Burns, 1978) and as

a result, transformational leadership was identified by Bass (1985) (emphasis added).

Bass (1985) distinguished leadership behavior via transformational (idealized

influence, inspirational motivation, intellectual stimulation, individualized consideration)

and transactional (contingent reward, management by exception) characteristics. Bass

incorporated concepts of Burns’ (1978) theory with elements of the path-goal theory

which House and colleagues expanded with regard to leadership and the pursuit of

employee performance and motivation (Northouse, 2007). Over time and in concerted

effort with colleagues Riggio and Avolio, the Full Range Leadership Theory (FRLT) was

developed, utilizing the aforementioned leadership behaviors to distinguish between

transformational, transactional, and laissez-faire leadership (Bass and Riggio, 2010).

During the same time Bass and colleagues were developing the FRLT, Kouzes

and Posner (1988; 2012) were exploring transformational leadership from a different

perspective. Kouzes and Posner (1988; 2012) suggested that leadership impact was best

understood by everyday leadership practices, or causal mechanisms (Gerring, 2012), that

occurred within a dynamic process. Through extensive qualitative research, five primary

leadership practices were identified as characteristic of effective leaders: model the way,

inspire a shared vision, challenge the process, enable others to act, and encourage the

heart, identified as the Leadership Challenge Theory (LCT) (Kouzes & Posner, 1988;

2012). As illustrated in Table 1, the Kouzes and Posner (1988; 2012) leadership practices

parallel the transformational leadership qualities identified in the FRLT such that

inspiration, vision, influence, motivation, development, and individual attention are


cornerstones to achieving higher-level purposes. The comparative descriptions of these

two prominent transformational leadership models illustrate commonalities of the

authors’ intentions. This research study utilized the LCT as its primary framework.

However, it is necessary to present a full explanation of both the FRLT and LCT in order

to present clarity between the two theories, because the bulk of the transformational

leadership literature involves the FRLT, or components thereof.

Table 1

Parallels of Transformational Leadership Theories

Full Range Leadership Theory (Bass & Riggio, 2010)

Leadership Challenge Theory (Kouzes & Posner, 1988; 2012)

Idealized Influence Inspire a Vision Model the Way

Inspirational Motivation Encourage the Heart

Model the Way

Intellectual Stimulation Enable Others to Act Challenge the Process

Individualized Consideration Encourage the Heart

Full Range Leadership Theory

Bass (1985) began his journey into transformational leadership theory by first

reinforcing Burns’ (1978) assertion that transformational leaders are moral agents striving

for higher-level missions. Transformational leaders are individuals with 1) conscious

goals to develop followers into leaders, 2) behaviors that elicit trust, and 3) self-sacrificial

perspectives to build commitment and influence (Bass, 1985). By building trust, loyalty

and respect, transformational leaders can propel followers to greater performance (Bass,

1985). However, Bass (1985) distinguished himself from Burns (1978) by arguing that a


progression existed in a leader’s evolution from a transactional to transformational leader.

As a result, the Full Range Leadership Theory (FRLT) was developed by Bass and

colleagues as a purported description of three typologies of leadership behavior:

transformational, transactional and nontransactional laissez-faire leadership, claiming a

need for balance between transformational and transactional leadership behaviors for

optimal effectiveness (Antonakis, Avolio, & Sivasubramaniam, 2003; Avolio, 2011). In

support of the FRLT, the Multi-factor Leadership Questionnaire (MLQ) was developed

for use in empirical research. Over time, the MLQ has been refined to its current nine

factor constructs representing distinction between transformational, transactional, and

laissez-faire characteristics.

Transformational leadership constructs. The transformational leadership

constructs were formulated by articulating the defining characteristics that motivate

followers to exceed their own expectations; they include idealized influence, inspirational

motivation, intellectual stimulation, and individualized consideration (Avolio, 2011;

Bass, 1985; Bass & Riggio, 2006).

Idealized influence. Followers seek to emulate leaders due to the leaders’ self-

sacrifice and higher-level mission and goals. Power is used to accomplish goals rather

than for personal gain. The idealized leader is seen as the central force for achieving the

vision. Followers rely on the leader to do the right thing despite how challenging it might

be to do so (Antonakis, Aviolio, & Sivasubramaniam, 2003; Avolio, 2011; Bass & Riggo,

2006; Bass & Riggio, 2010). In the nine factor MLQ, idealized influence is

differentiated by attribution (perception) and behavior (actions) (Antonakis, et al., 2003).


Inspirational motivation. Leaders are optimistic and enthusiastic and these

sentiments are positively perceived by followers. Such motivation is viewed as

meaningful to followers and inspires further spirit around the vision, mission, and goals

of the organization (Antonakis, et al., 2003; Avolio, 2011; Bass & Riggo, 2006; Bass &

Riggio, 2010).

Intellectual stimulation. Leaders challenge followers to improve, ask questions,

reframe problems, consider different perspectives, be innovative, and encourage new

approaches rather than the status quo (Antonakis, et al., 2003; Avolio, 2011; Bass &

Riggo, 2006; Bass & Riggio, 2010).

Individualized consideration. Leaders act as mentors and coaches to elicit

individual follower development. Differences are not only recognized in a supportive

manner, but also used to enhance creativity and innovation. Communication and

interaction is encouraged and personalized. Delegation is utilized as a development

mechanism rather than as an aspect of performance response (Antonakis, et al., 2003;

Avolio, 2011; Bass & Riggo, 2006; Bass & Riggio, 2010).

Transactional leadership constructs. Transactional leadership by itself mimics

the ideas of leader-member exchange and path-goal theories, whereby leaders reward or

discipline followers (members) based on the followers’ behaviors or performance

(Avolio, 2011; Northouse, 2007; Yukl, 2006). Leadership exchanges are driven by three

primary constructs, contingent reward, active management by exception, or passive

management by exception (Antonakis, et al., 2003; Avolio, 2011; Bass & Riggo, 2006;

Bass & Riggio, 2010).


Contingent reward. When followers satisfactorily meet expectations, leaders will

respond accordingly with rewards (Antonakis, et al., 2003; Avolio, 2011; Bass & Riggo,

2006; Bass & Riggio, 2010).

Management by exception. Management by exception involves the use of

corrective transactional behavior to monitor followers’ behaviors and performance.

Disincentives are utilized as warning for inadequate performance, and punitive action

may occur to correct unwanted behavior and performance. Whether management by

exception is defined as active or passive is distinguished by the level of ongoing

monitoring that occurs. Active management reflects an ongoing vigilance for mistakes,

whereas passive management waits for the mistakes to occur prior to taking action

(Antonakis, et al., 2003; Avolio, 2011; Bass & Riggo, 2006; Bass & Riggio, 2010).

Nontransactional laissez-faire construct. A nontransactional laissez-faire

leadership approach represents an absence of leadership. In essence, the leader avoids or

abdicates decision-making and does not use authority. When important situations arise,

actions are delayed and responsibility is ignored (Antonakis et al., 2003; Avolio, 2011;

Bass & Riggio, 2010).

Leadership Challenge Theory

Kouzes and Posner (2012) have studied leader behavior for over two decades and

identified transformational leadership as exemplified by five leadership practices that can

be learned: model the way, inspire a shared vision, challenge the process, enable others to

act, and encourage the heart. The Kouzes and Posner (2012) theory is coined The

Leadership Challenge and reflects Burns’ (1978) notion that the ultimate effects of

leadership are only understood by way of evaluating leader and follower interactions, or


in research design, what is referred to as causal mechanisms (Gerring, 2012). To support

research rigor, Kouzes and Posner (1988; 2012; 2013) developed a quantitative

measurement tool called the Leadership Practices Inventory (LPI). The LPI can be used

by leaders and followers to measure transformational leadership in a variety of

organizational settings (Kouzes & Posner, 2013). To date, over one million individuals

have completed the LPI to better understand the level of transformational leadership

within organizations, according to the researchers’ website.

Leadership practice constructs. The leadership practice constructs were

identified through early qualitative research with organizational executives striving to

understand and learn what key attributes existed when leaders were performing at their

personal best (Kouzes & Posner, 1988). Themes revealed qualities such as involvement,

persistence, vision, and encouragement (Kouzes & Posner, 1988). Using a qualitative

research approach, Kouzes and Posner (1988; 2012) established what they now call the

Five Practices of Exemplary Leadership: model the way, inspire a shared vision,

challenge the process, enable others to act, and encourage the heart.

Model the way. Modeling the way involves three distinct characteristics. First,

the leader must be self-aware of his or her personal beliefs and values. Once established,

the leader then needs to affirm the shared values of the group. Finally, the leader must

set the example, or model for others, what actions are aligned with the shared values

(Kouzes & Posner, 2012).

Inspire a shared vision. An exemplary leader has a dream, or vision, of what the

future can be. In inspiring the vision, the leader imagines and communicates the

possibilities and enlists others for the vision by appealing to common aspirations. The


leader frequently refers to the vision and creates a unity of purpose for followers (Kouzes

& Posner, 2012).

Challenge the process. In challenging the process, Kouzes and Posner (1988;

2012) believed that common experiences with change and the effects of change help both

leaders and followers in finding common ground. All individuals face change of one

sort or another, and exemplary leaders capitalize on this commonality of overcoming

uncertainty or fear. Leaders challenging the process seek opportunities for improvement,

seize initiatives, generate small wins to celebrate, and learn from experience (Kouzes &

Posner, 2012).

Enable others to act. Team effort is a consideration of leadership, and leaders

must foster collaboration among group members by building trust and facilitating

relationships (Kouzes & Posner, 2012). Enabling others also infers that development of

individuals is an important aspect to strengthening self-determination and competence.

Individuals that feel trusted and are empowered to make decisions will focus energies

toward the organization (Kouzes & Posner, 2012).

Encourage the heart. Encouraging the heart requires leaders to focus on

recognition, support, and appreciation for individuals (Kouzes & Posner, 2012).

Recognition is used to keep individuals motivated and to overcome the challenges of hard

work. Individuals that feel appreciated will direct additional energy to the organization.

Leaders must also create a sense of community by celebrating the values and successes of

the organization (Kouzes & Posner, 2012).


Other Theories

Bennis (1997) articulately described the differences between a manager and

leader, noting that managing is more about conducting and controlling whereas leading is

about influencing and guiding. Adaptations of transformational leadership theories have

occurred over time as transformational leadership studies have accumulated. For

instance, in the mid-80s, Bennis and Nanus (1985) identified four common strategies of

transformational leaders: presenting a clear vision, acting as social architects, creating

trust, and using creative deployment of leader strengths. Additionally, Podsakoff,

MacKenzie, Moorman, and Fetter (1990) conceptualized transformational leadership

based on six behavior-oriented dimensions: articulating a vision, providing an appropriate

model, fostering the acceptance of group goals, setting high performance expectations,

providing individualized support, and offering intellectual stimulation. Yukl (as cited in

Bass & Bass, 2008) also organized a taxonomy of leadership and management practices

based on extensive literature review, resulting in the origination of a managerial practices

survey instrument, which he later reported validation findings with colleagues. Despite

these adaptations, by far, the vast majority of empirical research exists with the FRLT

utilizing the MLQ (Avolio, 2011; Yukl, 2006). However Kouzes and Posner (2012) have

accumulated an extensive database of LPI survey responses spanning organizational

sectors.

Criticisms of Transformational Leadership

Primary criticisms of the FRLT revolve around clarity and overlap of constructs

(Northouse, 2007; Yukl, 2006), of which Bass and Avolio have considered and addressed

with further refinement of the MLQ (Antonakis et al., 2003; Avolio, Bass & Jung, 1999).


Bass and Riggio (2006) argued that both subjective and objective studies have

statistically supported the significance of transformational leadership on effects such as

job satisfaction, organizational commitment, and organizational performance. The

extensive collection of empirical research on the FRLT, using the MLQ (Avolio, 2011),

has supported the rigor needed to further investigate the ambiguities of leadership as a

concept (Gerring, 2012).

Kouzes and Posner (2012) posited that leader actions contribute to such factors as

commitment, engagement, loyalty, and productivity more than any other single variable.

Critics have claimed that the LPI has limited generalization to research due to its primary

use for educational purposes in leadership development (Tourangeau & McGilton, 2004).

Furthermore, Tourangeau and McGilton (2004) asserted the need for a shortened LPI to

relieve respondent burden and research costs, particularly for study in the health care

sector. They proposed a 21-item version of the LPI, which requires further testing for

validation (Tourangeau & McGilton, 2004). Additionally, there is limited research

illustrating a quantitative relationship between transformational leadership using the LPI

and organizational outcomes, such as organizational commitment. As previously noted,

Kouzes and Posner expressed support for additional research using the LPI.

Further criticism exists with respect to transformational leadership itself. Some

critics have asserted that the growth in transformational leadership studies and books

have advanced a blind view of the potential negative consequences of transformational

leadership (Tourish, 2013; Yukl, 1999). For instance, Tourish (2013) claimed that a

multitude of negative qualities exist with transformational leadership behaviors, including

but not limited to the creation of a monoculture, where organizational members conform


to similar norms, values, and beliefs to the detriment of dissenting feedback that may be

warranted to highlight problematic behaviors (Alatrista & Arrowsmith, 2004). Tourish

(2014) reinforced Yukl’s (1999) previous writings that transformational leadership

creates a false premise of heroic behavior by single leaders rather than advancing Burns’

(1978) initial perspective that transformational leadership should lead to shared

leadership. Such criticism should be carefully considered in order to continue to advance

research in the area of leadership theory. While transformational leadership theory has

dominated the literature in recent decades, it should not be viewed as diminishing the

opportunities that exist to further develop an understanding of leaders and organizational

behavior.

Organizational Commitment

Organizational commitment is a job attitude defined as the degree to which an

employee identifies with an organization and its goals and desires to remain with the

organization (Robbins & Judge, 2012). Liou (2008) argued that organizational

commitment must be given more priority in health care organizations, particularly as it

relates to addressing workforce shortages in the United States. In prioritizing an

emphasis on organizational commitment, health care leaders can focus their efforts on

antecedents that foster increased organizational commitment and, as a result, increase

retention and performance. As a construct, commitment addresses empowerment and its

effect on behavior; empowerment reflects the psychological and social attachments to

people, places or things, such as career professions or organizations (Liou, 2008; Meyer

& Allen, 1997), which in turn can be influenced by leadership behaviors (Avolio, 2011).


From an organizational perspective, having committed employees can be viewed

as a competitive advantage, particularly as it relates to outcomes such as productivity and

profitability. Committed employees may be described as those that work above and

beyond the call of duty, graciously accept overtime at the sacrifice of personal needs,

stick with the organization through the good and bad, look out for the interests of the

organization, publicly share the organization’s mission, and embrace changes to adapt to

the external environment. Employers may view a committed workforce as a measure of

leadership success in retaining employees, communicating vision and mission, and

implementing a successful strategic plan. However, there are potential repercussions for

committed employees, manifested by an imbalance of work and personal time or lack of

motivation or incentive to further develop professional skills that are marketable to other

organizations (Meyer & Allen, 1997).

In some organizations, turnover is used as a measurable outcome of

organizational commitment. While Meyer and Allen (1997) cautioned against this as a

sole focus, turnover is one of many key quality indicators within the long term care

industry, specifically within nursing facilities where regulators seek to understand the

influence of turnover on the quality of care for residents. Turnover is costly to long term

care employers (Smith & Baughman, 2007), most recently estimated at over $3300 in

direct cost for each turnover (Stone, 2004). In a study of Pennsylvania long term care

providers, the estimated cost of training due to turnover was over $35 million (Stone,

2004). In Iowa, direct cost of turnover in the direct care workforce was estimated at $189

million in 2011, an individual cost of $3839, representing the time and expenses in

addressing separation issues and replacing workers (Iowa Direct Care Worker Advisory


Council, 2012). A recent study by Mukamel and colleagues (2009) revealed a net

savings of $167,063 for every 10% increase in turnover for California nursing facilities,

as calculated using reported revenues and expenses on submitted cost reports; they

suggested this savings offered an explanation for persistent turnover in the industry.

However, not included in reported numbers for these studies are the indirect costs

associated with turnover, such as lost productivity, reduced service quality, lost patient

revenue, and declines in organizational reputation (Seavey, 2004), all of which contribute

to a complete understanding of turnover in long term care.

High quality leadership and management, including the offering of recognition,

feedback, and a culture of value and respect for DCWs has been associated with low

turnover (Eaton, 2001). However, simply focusing on turnover is short-sighted because

organizational commitment is a multidimensional construct with varied consequences

(Meyer & Allen, 1997). Low turnover is generally positively perceived, but if employees

have low levels of organizational commitment, then other factors such as quality,

customer satisfaction, and resident well-being can suffer (Bowers, Esmond, & Jacobson,

2003; Stone, 2004; Teal, 2002) . High turnover can have the same effects. To develop

and sustain a quality workforce, leaders must have a broader understanding of what other

factors affect organizational commitment. It behooves leaders to consider other factors,

not just retention and turnover rates (Meyer & Allen, 1997). A stable workforce is a

necessary condition for quality, but it should not be exercised as a strategy at the expense

of poor performers with low organizational commitment (Meyer & Allen, 1997).

Organizational goals should include a highly committed workforce and low levels of

turnover among its measures of organizational performance.


As a job attitude, Liou (2008) discussed the variance in theoretical definitions of

organizational commitment. Despite its complexity, Morrow and McElroy (1993)

asserted that “organizational commitment is the most maturely developed of the work

commitment family of constructs” (p. 1). The evolution of the concept of organizational

commitment has resulted in commonalities among the many theoretical definitions:

psychological bond to the organization, a belief in the organization, an acceptance of the

organization’s goals and values, sacrifice for the good of the organization, and a

willingness to remain with the organization (Allen & Meyer, 2000; Liou, 2008; Meyer &

Allen, 1997). Early in its research history, organizational commitment was studied as

unidimensional relative to attitudinal commitment, calculative commitment, and

behavioral commitment, where distinctions were derived from observing the different

processes in which employees became attached to organizations and their ensuing

outcomes, such as absenteeism and turnover (Allen & Meyer, 2000; Becker, 1960;

Mowday, Porter, & Steers, 1982). These distinctions were important to the further

development of research about organizational commitment as a construct. Over time, an

empirical understanding of organizational commitment resulted in three broad themes

around commitment: 1) commitment toward an organization involves the affective

domain; 2) employees recognize that there are costs associated with leaving an

organization; and 3) commitment towards an organization reflects a level of obligation

from employees (Allen & Meyer, 2000; Meyer & Allen, 1997). Following their meta-

analysis of the literature, Meyer and Allen (1997) chose to address these three broad

themes within three primary dimensions: affective, continuance, and normative (Liou,

2008; Meyer & Allen, 1997). In clarifying the distinctions previously observed in the


literature, Meyer and Allen (1997) likened attitudinal commitment (Mowday, et al.,

1982) to affective commitment, compared calculative commitment (Becker, 1960) to

continuance commitment, and paralleled behavioral commitment (Mowday, et al., 1982)

with both continuance and normative commitment. Meyer and Allen’s (1991) work

resulted in the introduction of the multi-dimensional model of organizational

commitment called the Three-Component Model.

Affective commitment represents the emotional component of organizational



Judge, 2012). Continuance commitment considers the employees’ perceptions of value

in staying with the organization, including socioeconomic factors such as wages and

benefits (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012). Normative

commitment occurs as a result of the employees’ sense of obligation to remain with the

organization; a level of conformity exists between the employees’ beliefs and values and

organizational norms (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012).

Because of the depth and breadth of organizational commitment as a concept, it is

important to empirically study it along these commitment dimensions in order to further

evaluate its influence in the workplace. Accordingly, Meyer and Allen (1997) have

cautioned that organizational commitment should not be analyzed without considering

these dimensions independently because of the existential variation in employees’

relationships with their organizations. Employees will experience the affective,

continuance, and normative commitment dimensions in varying degrees, with each

contributing to overall organizational commitment; thus, each can be hypothesized


independently of each other when considered in relationship to antecedents and

intervening processes (Allen & Meyer, 2000; Meyer, Stanley, Herscovitch, &

Topolnytsky, 2002).

Affective Commitment




Judge, 2012). Affective commitment is analogous to the Mowday et al. (1982)

description of attitudinal commitment where the focus is on employee mindsets in which

values and beliefs are determined to be congruent with organizations. In this sense, the

commonality is found within the affective domain characteristic. Employees with strong

affective commitment stay with organizations because they “want” to (Meyer & Allen,

1991, p. 67). Of all of the dimensions, affective commitment has been studied the most,

primarily due to the benefits of building positive employee emotions toward

organizations (Allen & Meyer, 2000; Meyer & Allen, 1997). In meta-analyses research,

it has consistently shown to have positive correlations with desirable work behaviors,

such as attendance and organizational citizenship behavior (Allen & Meyer, 2000;

Mathieu & Zajac, 1990; Meyer et al., 2002).

Continuance Commitment

Continuance commitment considers employees’ perceptions of value in staying

with organizations, including socioeconomic factors such as wages and benefits (Liou,

2008; Meyer & Allen, 1997; Robbins & Judge, 2012). Early in the research, continuance

commitment was addressed along Becker’s (1960) side bets theory, which referred to the


idea that employees link extraneous interests, such as seniority, to calculative decisions

about staying or leaving organizations. But in its limited context, the application of the

side bets theory restricted the continuance commitment construct, and over time,

continuance commitment evolved analogous to the Mowday et al.’s (1982) description of

behavioral commitment, where focus is on the processes organizations use to retain

employees, such as competitive wages and benefits (Meyer & Allen, 1991). Employees

with strong continuance commitment stay with organizations because they “have” to

(Meyer & Allen, 1991, p. 67). Thus, continuance commitment can be thought of in an

economic sense. Continuance commitment for employees will vary depending on the

range of alternatives available (Meyer & Allen, 1997). Likewise, individual employee

situations will dictate whether continuance commitment is weak or strong. For example,

an employee may want to leave to find a position with better pay, but if a spouse has lost

a job, the employee is less likely to leave for a different position. In meta-analyses

research, continuance commitment has been shown to have primarily negative

correlations with desirable work behaviors, such as attendance and organizational

citizenship behavior (Allen & Meyer, 2000; Mathieu & Zajac, 1990; Meyer et al., 2002).

Normative Commitment

Normative commitment occurs as a result of employees’ sense of obligation to

remain with organizations; a level of conformity exists between an employees’ beliefs

and values and organizational norms (Liou, 2008; Meyer & Allen, 1997; Robbins &

Judge, 2012). Normative commitment is also analogous to the Mowday et al. (1982)

description of behavioral commitment where focus is on processes organizations use to

retain employees; however, organizational culture and practices that connect to employee


values and beliefs formulate a basis for normative commitment, rather than pay and

benefits. Employees with strong normative commitment stay with organizations because

they feel they “ought” to (Meyer & Allen, 1991, p. 67). Normative commitment is

believed to develop early in life based on parental role modeling and over time with

advancement of loyalty and social identity to organizations (Allen & Meyer, 2000; Meyer

& Allen, 1997), although Meyer and Allen’s survey instruments have been revised to

address the perceived decreased effect that early life plays in normative commitment

(Meyer et al., 2002). Loyalty and social identity, or internalization behaviors, have

become more prominent in focus (Meyer, et al., 2002). Loyalty involves a level of

faithfulness to organizations. Social identity suggests that employees seek to find their

sense of self through group membership and will pursue meaning within and among in-

groups and out-groups within organizations (Haslam, Reicher, & Platow, 2011). The

degree to which organizations can develop and implement practices that enhance loyalty

and social identity will inform the level of normative commitment. In meta-analyses

research, normative commitment has consistently shown to have positive correlations

with desirable work behaviors, such as organizational citizenship behavior and

performance (Allen & Meyer, 2000; Mathieu & Zajac, 1990; Meyer et al., 2002).

Empirical Evidence

Liou (2008) asserted that organizational commitment is directly related to

employee retention, based on broad business industry research on the subject. However,

there is little known about this relationship for DCWs. Turnover and retention are widely

studied for DCWs in nursing facilities. However, their study is largely targeted toward

understanding the relationship to quality of care and job satisfaction (Stone, 2011).


Specifically distinguishing between job satisfaction and organizational commitment is a

salient point because they do present differences. While both represent affective

responses, job satisfaction addresses responses to specific elements of the job itself, such

as level of responsibility, whereas organizational commitment addresses the affective

response to the whole organization (Williams & Hazer, 1986; Emery & Barker, 2007).

Furthermore, organizational commitment is not intended to be analogous to job or

occupational commitment, which refers to employees’ attachments to particular jobs or

occupations (Williams & Hazer, 1986; Meyer & Allen, 1997). For example, a DCW may

not be committed to an organization, but will remain committed to working in DCW

positions.

A multitude of variables have been studied relative to understanding the

antecedents, correlates, and consequences of affective, continuance, and normative

commitment. Three categories (organizational characteristics, personal characteristics,

and work experiences) encompass the variables considered in the broad range of research

on organizational commitment (Meyer & Allen, 1997). Organizational characteristics

consider such factors as structure (levels of hierarchy and decision-making), policies and

fairness (including pay), communication, and leadership behaviors. Personal

characteristics include factors such as gender, age, length of employment, and

personalities. And work experiences include factors such as job roles, job scope,

autonomy, empowerment, and supportive behaviors. Generally, researchers have

contended that affective commitment is mostly developed based on work experiences,

supportive leadership practices, and fairness; continuance commitment develops based on

economic conditions; and normative commitment develops based on early life role


modeling and over time through organizational work experiences (Allen & Meyer, 2000;

Meyer & Allen, 1997; Meyer et al., 2002). The variation in antecedent, correlate, and

consequential variables represent the complexity with which organizational commitment

can be studied.

Multiple variables have been studied as either antecedents or correlates of

organizational commitment relative to various outcomes, such as quality of care, job

satisfaction, and performance (Liou, 2008; Meyer et al., 2002). As affective and

normative commitments increase, turnover rates drop and organizational citizenship

behavior improves (Liou, 2008; Meyer et al., 2002). Furthermore, leader behaviors

exhibited in how DCWs were treated accounted for turnover more than low wages,

(Rosen, Stiehl, Mittal, & Leana, 2011; Secrest, Iorio & Martz, 2005) (emphasis added).

Leaders demonstrating behaviors that promote supportive work environments are more

effective in developing higher commitment levels, particularly with the affective and

normative dimensions, evidenced by positive correlations with transformational

leadership (Meyer et al., 2002).

Connections between demographic characteristics and organizational commitment

have been inconsistent (Emery & Barker, 2007; Meyer & Allen, 1997; Williams &

Hazer, 1996). Recent studies analyzing demographic characteristics and organizational

commitment have revealed significant correlations within a global context (Al-Hussami,

Darawad, Saleh, & Hayajneh, 2014; Qiao, Khilji, & Wang, 2009), supporting the small

scale evaluation of demographic variables done by Meyer et al. (2002) on studies

conducted outside of North America. These results suggest that cultural differences may

exist within this relationship. However, Mathieu and Zajac (1990) demonstrated that


demographic variables, such as age, should be viewed as inferior to other variables in

developing organizational commitment.

Work stressors such as role ambiguity and role conflict have consistently shown

to have negative correlations to normative commitment whereas autonomy,

empowerment, and fairness have revealed positive correlations with affective

commitment (Lambert, Kelley, & Hogan, 2013) and overall organizational commitment

(Al-Hussami, 2008; Meyer & Allen, 1997). While the aim of some of the research has

been to establish causal mechanisms, research methods around organizational

commitment have primarily involved cross-sectional and correlational designs, thus

limiting the ability to establish causality (Gerring, 2012; Meyer & Allen, 1997).

Summarily, according to Liou (2008), there are five stages of organizational

commitment (exploration, testing, passion, quiet boredom, and integration) that occur

within the workplace. These stages reflect the dynamic nature of organizational

commitment along temporal aspects, demonstrating a slow and consistent development

process (Liou, 2008), and represent the importance of leadership behaviors over time and

for all employees, regardless of length of employment or rank in the organization (Allen

& Meyer, 2000). This temporal aspect of organizational commitment illuminates the

need for its ongoing consideration within organizations, because levels of commitment

will vary within and among individual employees, units, and as a whole (Heldenbrand &

Simms, 2012).

Transformational Leadership and Organizational Commitment

Transformational leadership has been shown to influence individual, team, and

organizational performance due to the effect that transformational leadership has on


levels of commitment and trust of followers (Avolio, 2011; Avolio & Bass, 1995; Bycio,

Hackett, & Allen, 1995; DeChurch, Hiller, Murase, Doty, & Salas, 2010; Meyer et al.,

2002). The breadth and depth of empirical research has revealed that leaders cannot

directly control follower commitment; however, leaders can influence commitment

through effectively communicating the vision, sharing and modeling beliefs and values,

supporting followers, and managing leader self-awareness (Bass & Bass, 2008; Emery &

Barker, 2007; Goleman, 2013). These positive leadership practices increase the affective

connection between leaders and followers and result in an increased identification with

the vision, mission, and values of organizations, thus influencing commitment and

consequently, performance (Avolio, 2011). Furthermore, research has shown that

transformational leadership can be learned (Avolio, 2011; Duygulu & Kublay, 2011;

Kouzes & Posner, 2012). While the literature is minimal in addressing transformational

leadership in long term care, there are a variety of studies addressing transformational

leadership in a broader context.

In long term care, empowerment is a key determinant of workforce issues.

Empowerment prescribes the involvement of employees in organizational decision-

making processes and more specifically, in the patient dyadic relationship where patient-

centered customer orientation is of primary importance. Leaders that insist on

micromanaging DCWs risk decreased employee engagement and subpar continuous

improvement efforts, negatively affecting employee commitment over time, whereas

implementation of employee participation in decision-making has been shown to

positively influence employee behaviors at work (Heldenbrand & Simms, 2012). Among

nurses in Singapore, empowerment was found to be a mediating factor for


transformational leadership and organizational commitment (Avolio, Zhu, Koh, & Puja,

2004). Transformational leadership behaviors have been shown to cascade downward to

other managerial, leader positions, benefitting organizational performance as a whole

(Bass, Waldman, & Avolio, 1987; Eaton, 2001; Godwin & Neck, 1998). The leader

behaviors of immediate supervisors, as perceived by employees, have been shown to

influence employee attitudes (Culp, Ramey, & Karlman, 2008; Emery & Barker, 2007).

Thus, when residents report having negative views of care, they also report having

negative experiences with DCWs or report stories reminiscent of employees complaining

while providing care (Eaton, 2001).

Research outcomes emphasize the effects of transformational leadership in

motivating and influencing employees toward a collective goal (Bass & Riggio, 2010).

Substantial evidence exists to illustrate a predictive relationship of organizational

commitment (Bono & Judge, 2003; Meyer & Allen, 1997). Within the three dimensions

of organizational commitment, significant relationships have been shown to exist

between transformational leadership and affective and normative commitment, with

limited or no relationship with continuance commitment (Dunn, Dastoor, & Simms,

2012; Liou, 2008; Meyer & Allen, 1997; Meyer et al., 2002). McMurray et al. (2010)

found that transformational leadership is a limited predictor of overall commitment and

noted that articulating vision and fostering goal acceptance were observed to specifically

have a significant relationship. However, in a recent study of nonprofit employees,

transformational leadership was found to be positively correlated with normative

commitment and negatively correlated with both affective and continuance commitment,

contradicting earlier studies (Freeborough, 2013).


In long term care, high commitment levels have been demonstrated to enhance

dyadic patient-caregiver relationships and quality of life, as primarily influenced by

effective supervision and illustrated by supervisory support, autonomy, and respect

(Bishop et al., 2008; McGillis-Hall et al., 2005). Additional research has provided

support for decentralized structures combined with communication in reducing DCW

intent to leave (Kim, et al., 2013). Bureaucratic, or hierarchical cultures have been

shown to be negatively correlated to organizational commitment (Pennington, Townsend,

& Cummins, 2003). Furthermore, organizational structures that support openness for

suggestions, innovative mindsets, and a willingness to try new things may be more

conducive to transformational leadership styles (Emery & Barker, 2007). Podsakoff,

MacKenzie, and Bommer (1996) studied the effects of situational variables as potential

substitute behaviors for leaders; routine tasks, indifference to organizational rewards, and

rewards out of leaders’ control all resulted in decreased organizational commitment,

suggesting that participatory and inclusive cultures may advance a more committed

workforce.

Further study of nursing home administrators and directors of nursing found that

transformational leadership qualities have no statistically significant relationship on

quality of resident care (Marotta, 2010). This suggests that transactional leadership

qualities are necessary in highly regulated environments, such as nursing facilities.

Nursing facility providers have long touted the extreme level of regulations in the

industry, of which is supported by the literature (Forbes-Thompson & Gessert, 2006).

Because the long term care industry is highly regulated, transactional leadership

behaviors may be necessary to assure compliance. However, disputes exist about


whether regulations are adequate within such long term care settings as assisted living.

Crawford (2005) found that nursing home administrators rate high in both

transformational and transactional leadership behaviors, reinforcing the assertion by

Avolio, Bass and Jung (1999) that transformational leadership augments transactional

leadership. Administrators with consensus-based leadership styles, evidenced by

transformational leadership qualities (Bass, 1985), have been shown to influence turnover

at its lowest levels (Donoghue and Castle, 2009). Long term care leaders must balance

the need for transactional leadership qualities that benefit quality of care and regulatory

compliance and transformational leadership qualities that enhance innovation, change

orientation, and consumer/employee focus (Berndt, 2012; Dana & Olson, 2007).

Furthermore, the evolution of person-centered care into the long term care

industry has demanded more of providers in the implementation of practices that

operationalize person-centered care concepts. Successfully implemented, person-

centered care models have been shown to positively influence the work environment by

inviting DCWs to actively participate in decision-making, encourage teamwork and

expand their job tasks beyond the traditional job role (Leutz, Bishop & Dodson, 2009;

Stone, 2011). Implementation of person-centered care practices dictates the necessity for

transformational leadership practices because it directly affects job redesign and elements

of the job characteristics model, such as autonomy (Leutz, Bishop & Dodson, 2009;

Robbins & Judge, 2012). Transformational leaders can influence how employees

perceive their work, and when employees perceive it to be important and meaningful,

they are more committed (Bono & Judge, 2003). Person-centered care has also been

shown to influence low turnover (Stone, 2011). As a result, transformational leadership


is a consideration in the supervisor-DCW relationship within the person-centered care

approach. Understanding the relationship between transformational leadership and

organizational commitment will lend value to the long term care industry in formulating

public policy, modifying operational practices, identifying training and development

needs, and revisiting human resource practices.

The Nonprofit Perspective

Supportive nursing practice environments in nonprofit long term care settings

have been shown to positively influence nursing home patient outcomes, evidenced by

higher quality ratings (Lutfiyya, Gessert, & Lipsky, 2013). Since the 1970s, high

turnover has been associated with for-profit long term care organizations (Stone, 2004,

2011; Stryker-Gordon, 1979); however, no significant relationship was shown to exist in

the Donoghue & Castle (2009) study. Research is also mixed about whether nonprofits

are more efficient, have less code violations, experience higher customer satisfaction, or

offer lower wages than their counterparts (DiMaggio & Anheier, 2001). However, the

importance of the nonprofit sector cannot go unrecognized. Based on an analysis of data

from the Bureau of Labor Statistics (BLS), when compared with for-profit entities,

nonprofit organizations historically pay higher wages, are more resilient when faced with

change, employ more individuals (particularly in service sectors), are driven by moral

constructs and values, and are major job creators (Salamon, Sokolowski, & Geller, 2012).

Studying leadership in nonprofit long term care organizations will enhance the literature

focused on the nonprofit sector.

Many long term care organizations have their origins in voluntary associations or

religious or community-based affiliations (Pratt, 2010). Over time, they became


corporatized and adopted business principles to sustain operations; they can, and do,

make money. In many cases, nonprofit long term care organizations look nothing

different than their for-profit counterparts, other than their legal tax exempt status by the

Internal Revenue Service (Ott, 2001). Nonprofits do not have accountability to

shareholders; however, they do have accountability to their governing boards, and in

many cases, to the public because revenues most often come from taxpayers via

government programs. For instance, nonprofit long term care organizations have deep

roots in utilizing government programs like Medicaid and Medicare as revenue sources

and are subject to regulatory scrutiny in the use of such government funds (Pratt, 2010).

Beyond the tax legality that nonprofits observe, their missions are primarily

formed to encourage benevolence and minimize social injustices (Block, 2001; Felkins &

Croteau-Chonka, 2014; Ott, 2001). Nonprofit missions vary, but often similarities exist

in advancing quality of life and seeking the common good. Felkins and Croteau-Chonka

(2014) have characterized the commitment to the common good as the “Nonprofit Factor,

motivating people to donate time and resources to help others and to work together for

positive change at local and global levels” (p. 3). Nonprofit long term care organizations

pursue the common good by providing services to older adults and others with chronic

long term health care needs that otherwise have no other sufficient help to obtain

services. On this premise, they are able to appeal to the emotions of the public in their

cause. Nonprofit missions are also used to solicit the help of employees with similar

helping values. The idea of shared commitments for social good and the challenges that

encompass such goals are reasons that attract leaders to nonprofit organizations (Bear &

Fitzgibbon, 2005).


Leadership in Nonprofit Organizations

Nonprofit leadership has espoused the characteristics of transformational

leadership in order to effectively address the challenges of multiple stakeholders,

operational issues, and sufficient resources (Bear & Fitzgibbon, 2005). And yet, research

on transformational leadership in the nonprofit sector is lacking (Riggio & Orr, 2004).

Nonprofit leaders need to articulate a compelling vision and inspire followers

participation to move the vision forward (Bear & Fitzgibbon, 2005), focusing on shared

values and mutual benefits (Felkins & Croteau-Chonka, 2014). In nonprofit

organizations, the combination of these aspects has been described as a “social contract,”

or a commitment acknowledging that mutual obligations and responsibilities are

necessary to form and develop sustaining relationships among stakeholders and cooperate

accordingly to achieve the vision and mission (Felkins & Croteau-Chonka, 2014, p. 12;

Smith, 2001), representing a shared leadership model. While social contracts are not

necessarily formal in nature, they form the basis of a philosophy for cultural norms

within a nonprofit organization (Felkins & Croteau-Chonka, 2014). For instance, a

cultural norm within many nonprofit organizations is that profits are needed to survive

and expenses should be kept sufficiently low to meet objectives; a consequence often

involves low wages for employees (Pallotta, 2008). Palotta (2008) asserted the

elimination of this idea and reinforced that nonprofits should pay competitive wages

similar to their counterparts and rally around the benefits they provide to the public, thus

improving overall turnover among nonprofit leaders and their corresponding followers

who hold worthy values and beliefs but leave the sector due to the inability to balance the

stresses that come with nonprofit work and inadequate pay. Nonprofit leaders also often


lack leadership training. In a 2003 survey of nonprofit leaders, staff, and volunteers,

emotional leadership was isolated as a specific leadership training need, in addition to

fundraising and project management (Bear & Fitzgibbon, 2005). In addition to needing

business skills similar to those required in the private sector, Bear and Fitzgibbon (2005)

mimic Kouzes and Posner ‘s (2012) LCT by stating that nonprofit leaders also need

compassionate behaviors, those that guide the organization, empower others, and

encourage with the heart.

Andrew Carnegie and John D. Rockefeller were instrumental agents of change in

donating their large fortunes to a plethora of nonprofit organizations (Scott, 2001).

Carnegie was quoted as saying “no man will make a great leader who wants to do it all

himself, or to get all the credit for doing it” (Bear & Fitzgibbon, 2005, p. 101), and he

clearly understood the need for shared responsibility, as Burns (1978) encouraged in his

seminal writings on transforming leadership for social change. Among the many

challenges that exist in nonprofit organizations, leaders must be actively involved in

pursuing a healthy culture and workforce and can benefit from learning about best

practices from other sectors and applying them to nonprofit principles. Some interesting

studies exist that provide unique insight into the nonprofit sector. Galaskiewicz and

Bielefeld (2001) studied nonprofits from a variety of organizational theory perspectives

to better understand how organizational change has affected the nonprofit sector. Using

randomized sampling, data were collected from Midwest charitable organizations

between 1980 and 1992. Regarding the growth and/or decline of performance, data

revealed that niche, nonprofit organizations were more likely to increase income,

donations, employees and volunteers. Likewise, nonprofits that employed more


managerial and political tactics during change were more likely to increase income and

employees over time, whereas those that chose retrenchment strategies experienced the

opposite effects. Furthermore, nonprofit organizations that are more dependent on

commercial income with high resource dependence (employees) are more likely to

increase managerial and political tactics over time while also considering centralized

decision-making. This is important to the study of long term care organizations because

these types of organizations are highly resource dependent, both on staff and financial

reimbursements from government and other insurance programs. Long term care

organizations are also considered niche services because they isolate services to those

with chronic and long term care needs.

Similarities to Transformational Leadership Theories

Little empirical study has been conducted in the nonprofit sector relative to

transformational leadership and/or organizational commitment. However, nonprofit

leadership holds many similarities to transformational leadership theories and

organizational commitment frameworks. First, the vision and mission are front and

center for nonprofit organizations (Felkins & Croteau-Chonka, 2014). Nonprofit

founders are integral to the formulation and articulation of a vision and mission (Ott,

2001), but the commitment to the vision and mission must be sustained by others in the

organization (Felkins & Croteau-Chonka, 2014). Leaders must share the vision and

mission and inspire others to achieve it (Avolio, 2011; Bass, 1985; Kouzes & Posner,

2013). Furthermore, to the extent that these visions and missions seek to solve societal

injustices, they are analogous to the kinds of transforming social change Burns (1978)

stressed were the impetus for leader-follower exchange in developing a moral compass


and influencing change. Second, relationships are a key component to effective

leadership and built upon shared values (Felkins & Croteau-Chonka, 2014).

Transformational leadership theories promote shared values, transparency of information

for mutual goals, empowerment, and participatory decision-making. Transformational

leaders seek to understand what is meaningful to followers and then influence and guide

them to achieve the vision and mission (Avolio, 2011; Bass, 1985; Kouzes & Posner,

2013). Godwin and Neck (1998) found that those leaders within religious organizations

at closest proximity to followers ranked highest in importance for transformational

leadership, suggesting that followers are able to more visibly observe transformational

leader behaviors when they occur at lower levels in the organization. However, they also

found that vision and goal-setting are recognized by followers as more important at

higher leadership levels (Godwin & Neck, 1998). Successful application of positive

leadership practices are intended to positively influence organizations in such ways as

productivity, efficiency, profits, retention and turnover, and employee commitment.

Third, nonprofits use emotional elements to brand their missions (Felkins &

Croteau-Chonka, 2014). Transformational leadership behaviors utilize charismatic

qualities such as inspirational storytelling to share an organization’s purpose both

internally and externally. Such storytelling and other emotional methods are meant to

broaden a nonprofit’s reach within people’s affective domain, creating an emotional bond

with the organization. Emotional attachment garners additional support for the

organization from donors, volunteers, and the public (Felkins & Croteau-Chonka, 2014),

and has the potential to increase organizational commitment by employees (McMurray, et

al., 2010; Meyer & Allen, 1997). Finally, nonprofit leadership seeks to advance the


many advocacy efforts of nonprofits in addressing the social injustices and inequities that

exist in society (Felkins & Croteau-Chonka, 2014; Frumkin, 2002). Transformational

leadership theories promote behaviors that challenge the process (Kouzes & Posner,

2013) and encourage entrepreneurship and innovation (Avolio, 2011). There are

different perspectives regarding change management processes, but common to them all

is the importance of influence, power, and relationships (Burke, 2011), all of which are

addressed within the context of transformational leadership.

Summary

Transformational leadership theories have advanced the notion that certain

behavioral characteristics (such as visioning, caring, and empowering) will transcend

organizational activities and employees toward higher goals, efficiencies, and

productivity. For decades, theorists have studied leadership in an attempt to identify,

understand, and develop optimal leader behavioral characteristics. Two transformational

leadership theories, the Full Range Leadership Theory (Avolio, 2011) and the Leadership

Challenge Theory (Kouzes & Posner, 2013) remain popular for researchers and

practitioners. Despite the positive advancement of these and other leadership theories,

criticism does remain, which stimulates further study. Additionally, organizational

commitment has been advanced over time as a multi-dimensional construct for

understanding the reasons employees stay or leave organizations. Three specific

dimensions, affective, continuance, and normative commitment, have become prominent

in the research literature. Transformational leadership has been studied in a limited

fashion as an antecedent to organizational commitment, and results have generally

provided consistent results, although recent studies in the nonprofit sector have been


contradictory (Freeborough, 2013). The need for additional research on transformational

leadership and organizational commitment within the nonprofit sector is warranted to

better understand the dynamics of nonprofit leadership as it pertains to organizational

practices and behavior. This study aims to address this gap within the context of the

nonprofit long term care industry, with a focus on DCWs and their perceptions of leader

behaviors of their immediate supervisors. The research methodology for this study will

be examined in Chapter three.


CHAPTER THREE: METHODOLOGY

Introduction

Chapter three discusses the research design, research questions and hypotheses,

methodology rationale, the sample, survey instrumentation and its reliability and validity,

variables, data collection and analysis, and ethical considerations of this study. The

purpose of this quantitative study was to determine what relationship exists between

transformational leadership and organizational commitment for DCWs in nonprofit long

term care organizations. The research study was stimulated by practical considerations.

DCWs form the core of the long term care industry, providing services essential to the

quality of life and quality of care of consumers. Demographic trends do not bode well

for the future availability of direct care workers. The United States has a rapidly aging

society, with the population of older adults growing dramatically over the next 50 years;

the baby boom generation will reach 65 between 2011 and 2029, those 85 and older will

grow at the fastest rate, and by 2050, one in five Americans will be over the age of 65

(Center for Health Workforce Studies, 2006; Dall et al., 2013). These consumers will

demand choice and options for long term care services, which require a sufficient supply

of DCWs. Leaders must utilize practices that develop and sustain the workforce at both

policy and practice levels. Understanding the relationship of leadership and

organizational commitment will help provide a better understanding of factors affecting

the commitment process and allow industry practitioners and researchers to consider

carefully the effect of leadership behavior and practices on direct care workers. The

study sought to fill a gap in the literature representing the relationship of transformational

leadership and organizational commitment within the long term care industry, as well as


to add to the body of knowledge about leadership in nonprofit organizations. Findings of

the study may benefit scholarship, practice, and policy within the long term care industry.

Research Questions and Hypotheses

The correlation between transformational leadership and organizational

commitment among DCWs in nonprofit long term care organizations has not been

empirically tested. Demographics, job characteristics and work experiences have been

identified as influences, or antecedents, on organizational commitment, including but not

limited to job challenges, work relationships, feedback quality, group attitudes,

empowerment, role stress, job satisfaction and trust (Liou, 2008; Meyer et al., 2002). In

an extensive review of the literature, no study was found that evaluated transformational

leadership as an antecedent to organizational commitment in the context of long term

care and DCWs. The traditional hierarchy in long-term care has assured that the locus of

control remains with those furthest from patient care (Caspar & O’Rourke, 2008), such

that DCWs provide over 80% of all patient care, have the least amount of education,

receive the lowest pay and exercise the least amount of decision-making authority and

autonomy (Caspar & O’Rourke, 2008; Stone, 2011). DCWs have stated that what they

desire most is respect, recognition and rewards, as well as inclusion in decision-making

and empowerment (Casper & O’Rourke, 2008; Leutz, Bishop & Dodson, 2009; Secrest,

Iorio & Martz, 2005; Stone, 2011), all components of transformational leadership

behaviors.

A primary research question guided this quantitative study:


RQ1: What is the relationship between transformational leadership and organizational

commitment (affective, continuance, and normative) among direct care workers in

nonprofit long term care organizations?

Three specific hypotheses were investigated in this study:







A secondary research question inquired about potential differences in the types of long

term settings, such as nursing facilities, assisted living, and senior housing. This question

was important in understanding how differences in long term settings might influence the

variables of interest and where interventions might be most valued by the industry (Kim,

Wehbi, DelliFraine, & Brannon, 2013), particularly where DCWs are employed by

organizations providing multiple types of long term care settings on their campuses.

RQ2: Is there a difference, if any, between types of long term care settings for




Method

This study used a quantitative, correlational research design and nonprobability

sampling. For the study, transformational leadership was the predictor variable, and


organizational commitment was the criterion, or outcome, variable. The study design

utilized nonprobability sampling to obtain study participants, representing a purposeful

sampling approach (Creswell, 2012). This study was correlational in nature because the

research question was evaluating the relationship between two variables (Creswell,

2012), whereby manipulation of the predictor variable, transformational leadership was

not the purpose of the research. Specifically, the objective of the correlational study was

to examine the extent to which the variables co-vary (Creswell, 2012). Thus, a

correlational study design was appropriate for this study. However, the design was not

used to establish causality (Gerring, 2011), rather it assisted in predicting the relationship

of transformational leadership and organizational commitment.

Two instruments were used for this study: a) Leadership Practice Inventory (LPI)

Observer which measures transformational leadership (Kouzes & Posner, 2013), and b)

Three-Component Model Commitment Survey (TCM) which measures organizational

commitment (Meyer & Allen, 2004). Correlational, nonparametric statistical analysis

was used to test the hypotheses and consider the strength of the variables based upon the

specific survey subscales within the transformational leadership and organizational

commitment constructs.

Description of Sample

The population of the study consisted of DCWs employed by nonprofit

Midwestern long term care organizations. A purposeful sample approach was used for

the study, which is considered a nonprobability sampling method (Creswell, 2012).

Purposeful sampling was used to identify nonprofit long term care organizations that met

specific criteria. The criteria for selection included: a) long term care organizations that


were nonprofit; b) long term care organizations that provide multiple service lines, or

types of long term care settings on their campuses, including nursing facilities, assisted

living, and senior housing; and c) long term care organizations willing to participate in

the study. The rationale for selecting the first criterion was directly related to the need to

add to the body of knowledge about nonprofit organizations. The second criterion was

related to the secondary research question addressing differences between types of long

term care settings. The third criterion was related to the difficulty in obtaining

permission from long term care organizations to survey employees. Thus, executives of

nonprofit long term care organizations fitting the criteria were approached for their

willingness to participate. Based on the willingness of several nonprofit, long term care

organizations, approximately 1,100 DCWs were invited to participate in the study.

Survey Instrumentation

Two survey instruments, the LPI Observer (Kouzes & Posner, 2013) and the

TCM (Meyer & Allen, 2004), were utilized in this study. Permission to use each

instrument was obtained from the respective authors. Demographic information such as

gender, age, ethnicity, education, and length of employment was also obtained by

participants during survey completion in order to provide descriptive statistics of the

participants. Survey instrumentation is included in Appendix A.

Leadership Practices Inventory

Transformational leadership was measured using Kouzes’ and Posner’s (2013)

Leadership Practices Inventory (LPI) Observer. The long term care industry, specifically

those organizations of nonprofit status, prefers research applications that support its

capacity to communicate in terminology easily understood by all levels of the


organization, suggesting the industry will respond more favorably to a study utilizing the

LPI instrument (Kouzes & Posner, 2013). Such perception largely addresses the LPI

based on face validity and may be considered industry bias.

Participants responded to thirty items in the LPI using a 10-point scale with

responses ranging from 1 = almost never to 10 = almost always. A higher value

represents behaviors used more frequently (Kouzes & Posner, 2002).This scale was

treated as a continuous measure (Creswell, 2012). The LPI measured the five practices of

exemplary leaders as described in Kouzes’ and Posner’s (1988, 2012) theoretical

leadership challenge framework of core leadership competencies. The LPI utilizes thirty

descriptive, behavioral statements in which the respondent is asked to assess leader

behaviors. For this study, survey participants assessed leader behaviors based on the

supervisor to whom they directly report, as they perceive the supervisor’s leader

behaviors.

The thirty statements in the LPI are further broken down into five subscales (six

statements each): a) model the way, b) inspire a shared vision, c) challenge the process,

d) enable others to act, and e) encourage the heart (Kouzes & Posner, 2013). Permission

to use the LPI was conditioned upon results being shared with Kouzes and Posner as the

developers. This condition allows them to further advance their understanding of validity

and reliability of the instrument. To address construct validity, numerous researchers

have conducted factor analysis studies on the LPI and results have provided continued

empirical support for the categorization of leader behaviors within these five primary

leader practices across a variety of organizational settings (Kouzes & Posner, 2000;

Kouzes & Posner, 2002). Validity can be addressed at both internal (sample) and


external (population) levels (Creswell, 2012). For purposes of this study, internal validity

was of primary interest. The use of the LPI Observer instrument was particularly

important because it minimizes self-report bias that is often a concern with the use of the

LPI Self instrument. Participants in the current study were asked to assess their direct

supervisor, not themselves. Because the current study was based on a nonprobability

sampling approach, external validity was difficult to assert with regard to generalizations

of the broader population (Gerring, 2012).

Internal reliability refers to the level of precision and consistency of the survey

relative to measurement errors that can result in differing scores for reasons unrelated to

the participants (Gerring, 2012). For instruments with items scored as continuous

variables, the coefficient alpha is generally used to test for internal consistency (Creswell,

2012). For the LPI, internal reliability has been consistent in revealing reliability

coefficients above the .75 level as measured by Cronbach’s alpha (Kouzes & Posner,

2000). Reliability coefficients for the five subscales met acceptable levels: model the

way (.88), inspire a shared vision (.92), challenge the process (.89), enable others to act

(.88), and encourage the heart (.92) (Kouzes & Posner, 2002). Similarly, test-retest

reliability has been consistently strong (Kouzes & Posner, 2002). Test-retest reliability

procedures are used to examine the extent that the instrument is stable over time, with .6

as an acceptable level (Creswell, 2012).

Three-Component Model of Employee Commitment

Organizational commitment was measured using the academic version of the

Three-Component Model (TCM) of Employee Commitment Survey developed and

modified by Meyer and Allen (2004). The TCM consisted of eighteen statements among


three subscales (affective, continuance, normative) that represent employees’ mindsets

toward their organization. Study participants were asked to indicate the degree of

agreement with each statement based on their feelings about their respective

organizations. The statements required respondents to rate the degree of agreement on a

7-point Likert-type scale, ranging from 1 = strongly disagree to 7 = strongly agree. This

scale was treated as a continuous measure (Creswell, 2012; Meyer et al., 2002).

Numerous studies have assessed construct validity and have concluded consistency exists

for macro generalization of the model (Jaros, 2007; Meyer et al., 2002), although specific

wording among the normative and continuance commitment subscales still garners

interest by researchers in order to further address micro generalization considerations

such as employment status (Jaros, 2007; Meyer, Becker, & Van Dick, 2006).

Confirmatory factor analysis has provided empirical evidence that the subscales are

highly correlated (Hackett et al., 1994; Meyer et al., 2002) and internal reliability was

within acceptable rates (above .70) (Allen & Meyer, 2000; Meyer & Allen, 1997; Meyer

et al., 2002). The TCM dominates the research literature, and rather than creating new

survey instruments, researchers are adding to the TCM use for further refinement of the

model for micro generalization (Jaros, 2007) and cross-cultural application (Allen &

Meyer, 2000; Meyer et al., 2002).

Demographics

The demographic questions were developed to describe the characteristics of the

study participants as well as information about the organizations in general. Participants

were asked about gender, age, ethnicity, length of employment, service in the military,

wages, yearly income, benefits, relationship status, living arrangements, education,


government assistance, availability of transportation, type of long term care setting they

work in, and whether they are considering an employment change. These questions were

chosen based on the potential influence they have to the organizational commitment

subscales addressing affective, normative, and continuance commitment. Organizational

demographics were obtained by the administrators on site at the time of data collection.

Organization information included total employees, number of DCWs, year-to-date

turnover, wage ranges, availability of benefits, types of services provided, premium costs

of health insurance, and consideration of increasing wages. Similarly, these questions

were asked to address the potential implication of organization commitment as well as to

provide general descriptive information of the organizations for comparison purposes.

Pilot Study

The survey instruments were field tested with thirteen DCWs in a pilot study

conducted in a Midwestern long term care organization located in close proximity of the

researcher. The long term care organization was selected based on the willingness of the

administrator to participate in the pilot study. The pilot study utilized a focus group

method and was conducted mid-afternoon on a Monday. Data were analyzed using

SPSS® 22. Participants gathered as a group, grabbed snacks, and obtained instructions

for survey completion. After individually completing the survey, the researcher asked the

participants for feedback about the survey and process in general. The focus group lasted

one hour in duration. Of the pilot participants, 92.3% were female, the mean age was

49.58 years, and 84.6 percent classified themselves as white with regard to race. The

mean length of employment with the organization was coded as 2.75 and the mean length

of time working in long term care was coded as 4.53, indicating that many of the pilot


participants have worked in other long term care organizations. The average time of

survey completion was 13.54 minutes, with a range of 9 to 22 minutes. Cronbach’s alpha

analysis was utilized to measure reliability of the LPI and TCM survey instruments.

Overall reliability for the LPI was .982 and .793 for the TCM. Both exceed acceptability

levels for reliability (Creswell, 2012). Individual reliability measures for the subscales

are provided in Table 2. Of all of the subscales, the continuance commitment subscale

was the only subscale to not meet an acceptable reliability level. This may support Jaros

(2007) view that the TCM survey questions on continuance commitment are too closely

related to normative commitment constructs, thus insufficiently addressing the costs

associated with leaving an organization and requiring rewording. However, the field

testing involved a very small sample, and further reliability analysis was required after all

data were collected.

Table 2

Pilot Study Reliability Levels for LPI and TCM Survey Instruments, by Subscales LPI TCM Model the Way .912 Affective Commitment .719

Inspire a Shared Vision .960 Continuance Commitment .382

Challenge the Process .925 Normative Commitment .850

Enable Others to Act .898

Encourage the Heart .966

Pilot participants did not have concerns with any of the LPI or TCM survey

questions. No participant expressed a lack of understanding of any of the questions.

Participants did ask why age and hourly wage were included in the demographic portion


of the survey and stated they were uncomfortable in providing the information without

knowing how the information would be used. After an explanation, they expressed

agreement that the data should be gathered but suggested including a short note by the

specific questions to minimize skipped answers. In response to asking what methods

were best for reaching DCWs, flyers and change of shift reminders were agreed to be the

best methods. Invitation letters, whether mailed or distributed in advance onsite, were

not viewed as optimal because participants felt the invitation letters would be discarded

and forgotten. Participants suggested that flyers be posted around the organization and

particularly by the time clock. They added that a shift change reminder would enhance

participation. They suggested multiple opportunities (at least three) to participate. With

regard to snacks, they supported the use of snacks similar to what was provided to them

(pretzels, granola bars, and bottled water) and reinforced the need to tailor the snack to

the time of day, e.g. muffins for breakfast. Lunch was determined to be unnecessary due

to the perceived time and cost constraints and inequitable availability to all participants.

The pilot study concluded by informing the participants that their completed surveys

would be excluded from the overall study results and sharing appreciation for their

assistance. As a result of the pilot study, several changes were made to the survey

process. Flyers and shift change reminders were used to invite DCWs to participate in

the study. The survey document was revised to incorporate participant feedback. All

changes were submitted to and approved by the Creighton IRB for approval for use in the

primary study.


Variables

Transformational leadership and organizational commitment were the variables of

interest for this study. The predicting variable was transformational leadership and was

defined as a process whereby leaders have a conscious goal to develop followers into

leaders, exhibit behaviors that elicit trust, and display self-sacrificial perspectives to build

commitment and influence, and demonstrate a moral compass towards mission and

purpose (Avolio, 2011; Bass, 1985; Kouzes & Posner,1988, 2012). The criterion, or

outcome, variable was organizational commitment. For purposes of this study,

organizational commitment was defined as a psychological state linking employees to

their organizations (Meyer & Allen, 1997, p.23). The study further considered

organizational commitment along three dimensions: affective, continuance, and

normative.

Data Collection Procedures

The target population for this study was DCWs employed by nonprofit long term

care organizations in the Midwest. Prior to data collection, approval for the research was

obtained by the Creighton University Institutional Review Board. Using a purposeful

sampling approach, nine nonprofit, long term care organizations in the Midwest agreed to

participate, contributing 1,127 DCWs for participation in the study. Utilizing both

conference calls and electronic mail communication, on site visits were scheduled and

data collection occurred between May and July 2014. In advance of onsite visits,

participants were provided with an invitation to participate in the study utilizing flyers

and change of shift reminders. Once onsite, DCWs were provided multiple opportunities

to participate in the study and complete a paper survey. Multiple opportunities were


intended to accommodate the varied work schedules of DCWs and provide ample

occasions to participate in the study. Survey completion time was estimated to be fifteen

minutes. Prior to completing the survey, participants were provided the informed

consent/assent information, followed by the two survey instruments and the demographic

information. Because no identifying information was collected by the participants,

informed consent/assent was implied through completion of the survey, as approved by

the IRB. Following survey completion, the surveys were transferred to a secure container

to ensure confidentiality. To thank participants, snacks were provided.

Data Analysis Plan

SPSS® 22 was used to calculate statistics and test the hypotheses. Following

onsite visits, survey data were coded and entered into the SPSS® 22 application. A code

key was utilized to ensure responses were coded correctly and consistently. Coding

involved assigning numerical values to all responses (Creswell, 2012). Data analysis

included the calculation of response rates, use of descriptive statistics (mean, standard

deviation, percentages) to identify general trends and results, and evaluation of

correlations using inferential statistical analysis. Data was checked to ensure the data met

the assumptions for the statistical tests used for the study. Nonparametric statistical tests

were used due to the nonprobability sampling approach for the study; however, normality

was tested using the Shapiro-Wilk test for confirmation (Creswell, 2012). The LPI and

TCM instruments used in the study utilized Likert-type measurement scales that were

treated as interval scales. Correlational analysis was used to measure the relationship

between the interval variables and to assist in making predictions about the variable

associations (Creswell, 2012). When investigating linear-related variables, the


Spearman’s rank order correlation (Spearman’s rho) can be used for nonparametric

testing and is recommended especially when normality is questioned (Kowalski, 1972;

Onwuegbuzie & Daniel, 2002). Internal reliability testing was conducted using

Cronbach’s alpha to determine if the survey scales were reliable (Creswell, 2012). To

evaluate the data for the research question regarding differences between types of long

term care settings, the independent t- test was used to allow a comparison of independent

groups (Creswell, 2012). The independent t-test has been found to be a valid statistical

test for both normally and non-normally distributed samples and in samples as small as

100 in size (Lumley, Diehr, Emerson, & Chen, 2002). A significant relationship was

defined using a 95% confidence interval for statistical testing of the hypotheses.

Assumptions

Numerous studies have assessed validity and reliability of the LPI and TCM

survey instruments and have concluded internal consistency and validity exist (Kouzes &

Posner, 2000, 2002; Jaros, 2007; Meyer et al., 2002). Demonstrated reliability indicated

that field testing was not necessary. However, given the lack of empirical research in the

long term care industry, the survey instruments were field tested to analyze reliability as

well as obtain feedback on the clarity of instructions and identification of best options for

survey invitation. Due to the nonprobability sampling approach for the study,

nonparametric statistical testing was utilized and normality tests were conducted.

Ethical Considerations

Ethical considerations were present for this study and addressed responsibility,

respect, and integrity for the participating organizations and their employees. This

research study was approved by the Creighton University Institutional Review Board


(IRB). Privacy, confidentiality, and anonymity were all applicable issues for this study.

Privacy was addressed with respect to providing DCWs a perceived safe location to

complete the onsite survey. Site administration and supervisors were discouraged access

to the room in which participants completed the surveys. Confidentiality was preserved

to the level that DCWs chose to avoid discussion with each other or other employees

about their participation in the study. Anonymity and confidentiality were preserved by

not obtaining identifying information from participants on the survey document or in any

other form. All completed surveys were put in a secure box for confidential transfer from

the study site. Additionally, all data were analyzed in the aggregate, thus strengthening

the commitment to anonymity for participants.

Each organization was required to formally address permissive rights for the

researcher to engage in research activities as a part of the study. Participation in the

study was voluntary, and there were no consequences for not participating. It was

possible that DCWs under the age of majority would participate in the study due to data

collection occurring in the summer. For this reason, the researcher reviewed the

inclusion of children as important to the study. This segment of the DCW population

completes the same DCW tasks as their colleagues, regardless of age. Likewise, those

under the age of majority have completed the same training to perform DCW tasks. No

more than minimal risk was expected for DCWs under the age of majority because they

were not being treated any differently than any of their corresponding colleagues. It

would have been difficult to obtain parental permission for these DCWs to participate in

the study because by doing so, identifying information would be collected, thus creating

an imbalance to the commitment of anonymity and confidentiality. As a result, a waiver


of assent was required and approved by the Creighton University IRB. Participants

received an informed consent/assent form prior to participation. To ensure anonymity

and confidentiality of participation, no signatures were obtained to indicate consent or

non-consent to participate. Completion of the survey constituted consent/assent to

participate.

There were no direct benefits to participating in the study. Participation in the

study provided insight into the relationship between transformational leadership and

organizational commitment. Participants had the option to not complete the survey. In

these instances, there were no other alternatives to participating in the study. Snacks

were provided to participants as an incentive to participate in the study. Not completing a

survey did not preclude DCWs from receiving the incentive, assisting the researcher in

alleviating any appearance of coercion.

The researcher intends to publish the results of the study, but no identifying

information will be disclosed. Participating organizations will receive a copy of the

research as a benefit to participating. However, to preserve anonymity and

confidentiality of participating DCWs, data were evaluated in the aggregate. Direct

benefits to the researcher involve completion of academic requirements of Creighton

University as well as future publication of research findings.

Summary

Chapter three discussed the research methodology employed to investigate the

research questions and corresponding hypotheses. The research methodology included a

review of methodology rationale, the sample, survey instrumentation and its reliability

and validity, variables, data collection and analysis, and ethical considerations of this


study. This quantitative correlational study described the relationship between

transformational leadership and organization commitment among direct care workers in

nonprofit, long term care organizations. A correlational design was the most appropriate

research design due to the need to understand how the variables co-vary (Creswell,

2012). The study also addressed any differences between long term care settings.

Nonparametric statistical testing methods were utilized given the nonprobability

sampling approach.

The survey document included the LPI (Kouzes & Posner, 2013) and TCM

(Meyer & Allen, 2004) survey instruments as well as demographic questions needed for

descriptive statistics. Both instruments have been established as valid and reliable

(Kouzes & Posner, 2000, 2002; Jaros, 2007; Meyer et al., 2002). The survey document

was field tested for additional internal consistency and to obtain feedback for potential

adjustments to the document and process in general. Ethical considerations were

addressed, reviewed, and approved by the Creighton University IRB.

Chapter four contains the results of the study. Data were interpreted through

statistical analysis and displayed in appropriate format.


CHAPTER FOUR: FINDINGS

Introduction

The purpose of this quantitative study was to determine what relationship exists

between transformational leadership and organizational commitment for direct care

workers in nonprofit long term care organizations. Presented in Chapter four are the

results of the analyses addressing the research questions and hypotheses posed in the

study. The research questions and hypotheses tested were:

RQ1: What is the relationship between transformational leadership and

organizational commitment (affective, continuance, and normative) among direct care

workers in nonprofit long term care organizations?

Three specific hypotheses will be investigated in this study:







RQ2: Is there a difference, if any, between types of long term care settings for





Review of the Methodology

This study used a quantitative, correlational research design and nonprobability

sampling. For the study, transformational leadership was the predictor variable, and

organizational commitment was the criterion, or outcome, variable. The study design

utilized nonprobability sampling to obtain study participants, representing a purposeful

sampling approach (Creswell, 2012). Two instruments were used for this study: a)

Leadership Practice Inventory (LPI) Observer which measured transformational

leadership (Kouzes & Posner, 2013), and b) Three-Component Model Commitment

Survey (TCM) which measured organizational commitment (Meyer & Allen, 2004).

Correlational, nonparametric statistical analysis was used to test the hypotheses. The

population of the study consisted of DCWs employed by Midwestern nonprofit long term

care organizations meeting specific criteria: a) nonprofit status, b) provision of multiple

lines of service, or types of long term care settings, and c) willingness to participate.

Following approval by the Creighton University IRB, the survey instruments were

field tested with thirteen DCWs in a pilot study conducted in a Midwestern long term

care organization located in close proximity of the researcher. Data were analyzed using

SPSS® 22. Cronbach’s alpha analysis was utilized to measure reliability of the LPI and

TCM survey instruments from the pilot study. Feedback from the pilot study also

informed the researcher of changes needed in the overall survey format as well as

provided input on perceived best methods for participant invitation in the study. Changes

to the survey document were submitted for review and approval by the Creighton

University IRB prior to data collection.


Using a purposeful sampling approach, nonprofit, long term care organizations in

the Midwest were contacted to participate and conference calls, electronic mail, and

phone calls were utilized to schedule the dates and times for data collection. Based on

the number of DCWs employed at the organizations at the time of data collection, 1,127

DCWs were invited to participate through the use of flyer invitations posted at visibly

accessible locations on site, including the time clock areas. Data collection occurred

within an eight-week time frame during May, June, and July, 2014. Once onsite, DCWs

were provided multiple opportunities to participate in the study and complete a paper

survey in order to accommodate the varied work schedules of DCWs. Participants were

provided informed consent/assent information prior to completing the survey, and survey

completion time was approximately fifteen minutes. No identifying information was

collected by the participants, with informed consent/assent implied through completion of

the survey, as approved by the IRB. Following survey completion, the surveys were

transferred to a secured container to ensure confidentiality. To thank participants, snacks

were provided. The data collection process resulted in a sample of 322 surveys,

constituting a 28.6% response rate.

Data Analysis Procedures

SPSS® 22 was used to calculate statistics and test the hypotheses. Because the

data collection involved paper surveys and manual data entry, a ten percent random

sample of the data was used to identify any input errors in SPSS® 22. Participants were

allowed to skip survey questions, thus creating opportunity for missing data. Missing

data were coded uniquely and excluded as appropriate within the data analysis. The most

frequently excluded data were age, hourly wage, and income level. Nonparametric


statistical tests were used due to the nonprobability sampling approach for the study, and

normality was tested using the Shapiro-Wilk test, confirming the expected non-normal

distribution with significance levels ranging from .000 to .036 (Creswell, 2012). Q-Q

plots were also used to graphically review for normality and also confirmed non-normally

distributed data. The LPI and TCM instruments used in the study utilized Likert-type

measurement scales and were treated as interval scales. Correlational analysis was used

to measure the relationship between the interval variables and to assist in making

predictions about the variable associations (Creswell, 2012). When investigating linear-

related variables when normality is questioned, the Spearman’s rank order correlation

coefficient (Spearman’s rho) can be used and is recommended as more robust than the

Pearson correlation (Kowalski, 1972; Onwuegbuzie & Daniel, 2002).

Internal reliability testing was conducted using Cronbach’s alpha to determine if

the survey scales are reliable (Creswell, 2012). To evaluate the data for the research

question regarding differences between types of long term care settings, the independent

t-test was used to allow a comparison of two independent groups (Creswell, 2012), which

has been found to be a valid statistical test regardless of data distribution (Lumley, Diehr,

Emerson, & Chen, 2002). Normality testing was conducted using the Shapiro Wilk test

and homogeneity of variance was tested using Levene’s Test of Equality of Variances

(Creswell, 2012). A significant relationship was defined using a 95% confidence interval

for statistical testing of the hypotheses.


Results

Participant Characteristics

Participants represented DCWs employed at nonprofit long term care

organizations offering multiple service settings (nursing facilities, assisted living, home

health, hospice, senior housing, and adult day services). Participant characteristics were

identified based on service setting and several demographic considerations, including

age, gender, ethnicity, hourly wage, annual income, education level, and years of

employment at the respective organization and in long term care in general. Of

participants responding (n=314), 79.3% work in nursing facilities, 15.2% in assisted

living facilities, 11.8% in independent living senior housing, 4.5% in home health, 2.9%

in hospice, 1.3% in affordable senior housing, and .6% in adult day services.

Female participants dominated the study sample at 82.7% (n=317). Participants

ranged in age from 17 to 77 years old, with a mean of 39.05 years (n=303). Regarding

ethnicity, white participants constituted a majority at 76.7%, with African/black

participants following at 11.8%. The remaining participants were Hispanic (5.6%), Asian

(2.2%), American Indian (1.2%), and other (.6%). Of the participants responding, 9.3%

indicated that English was their second language. The median hourly range of

participants was $12.00 (n=295, SD = 2.69), with a range of $7.35 to $30 per hour, with

88.5% of participants reporting an annual income less than $30,000 (n=304). Of those

responding (n=313), 20.4% stated they have more than one job, and 50.5% (n=317)

indicated a dissatisfaction with their pay. Of 314 responding participants, 11.5% reported

receiving government assistance, such as Medicaid, food assistance, and utilities

assistance. Participants reported a range of formal education (n=314); 52.5% reported


having a high school diploma or GED, while 38.2% have an undergraduate college

degree, 8% have a graduate college degree and 1.3% have less than a high school

education.

Length of employment was also evaluated, both from an organizational standpoint

as well as from an industry context. Organizationally, 21.2% of participants reported

being newly hired less than one year in their employment (n=316). Other tenure was

reported as follows: 1 to 3 years (32.3%), 4 to 6 years (15.8%), 7 to 9 years (10.4%), and

more than 10 years (20.3%). Based on survey coding, the average length of employment

was 2.76, representing employment between one and six years. Industry employment

tenure exceeds organizational tenure, with 32.3% of participants working in the industry

for over ten years (n=315). Just under ten percent (9.8%) of participants reported less

than one year of employment in the industry, with 40% indicating industry tenure

between one and five years and 17.8% indicating tenure between six and ten years.

Average employment tenure in the industry was 3.11, representing employment between

six and ten years. When asked whether participants were considering a job change,

26.3% indicated affirmatively and 25.7% stated “not sure, maybe” (n=315).

Site administrators at participating organizations reported employing 1,127

DCWs, accounting for 54.6% of total employees. A mean turnover rate of 33.4% was

reported, with turnover ranging between 16% and 51.5%. The wage range for DCWs

was $7.50 to $20.63 depending on position and experience. National median hourly

wage ranges between $9.57 and $11.74, depending on the type of DCW position (PHI,

2013b). All organizations reported providing health insurance benefits in addition to

benefits such as paid vacation, paid sick time, paid holiday time, and retirement plans.


However, study participants reported differently; a range of participants reported that

either their employer did not offer or they did not know if their employer offered the

aforementioned benefits (health insurance, 11.1%; paid vacation, 13.2%; paid sick time,

32.6%; paid holiday time, 9.8%; and retirement plans, 27.9%). Site administrators were

asked about the cost of monthly family health insurance premiums, which were reported

to cost over $500 per month for 71.4% of the organizations. Only 1.9% of study

participants reported paying over $500 in monthly health insurance premiums (n=309);

12.3% reported having no health insurance and 29.4% reported having health insurance

coverage through other avenues. When asked if DCWs are paid a sufficient wage, 41.9%

of site administrators indicated affirmatively.

Survey Instrument Descriptive Statistics and Reliability Levels

The LPI and TCM survey instruments both included statements requiring

respondents to rate the degree of agreement on a Likert-type scale. The mean and

standard deviations, by total score and by subscales, were calculated for the survey

instruments and are illustrated in Table 3.

Table 3

LPI and TCM Means and Standard Deviations Mean Standard Deviation LPI Total Score 188.07 63.92

LPI Model the Way 39.24 12.67

LPI Inspire a Shared Vision 35.26 13.69

LPI Challenge the Process 35.12 13.53

LPI Enable Others to Act 41.22 13.46


LPI and TCM Means and Standard Deviations LPI Encourage the Heart 37.22 14.77

TCM Total Score 79.68 18.96

TCM Affective Commitment 27.31 8.73

TCM Continuance Commitment 25.93 8.73

TCM Normative Commitment 26.44 8.65

Note: After exclusion of missing data, n=289

Internal reliability refers to the level of precision and consistency of the survey

relative to measurement errors that can result in differing scores for reasons unrelated to

the participants (Gerring, 2012). For instruments with items scored as continuous

variables, the coefficient alpha is generally used to test for internal consistency (Creswell,

2012). For the LPI, internal reliability has been consistent in revealing reliability

coefficients above the .75 level as measured by Cronbach’s alpha (Kouzes & Posner,

2000). Reliability coefficients for the five subscales meet acceptable levels as illustrated

in Table 4. Test-retest reliability procedures are used to examine the extent that the

instrument is stable over time, with .6 as an acceptable level (Creswell, 2012). Kouzes

and Posner (2002) have reported similar test-retest reliability for the LPI. Internal

reliability is also within acceptable rates (above .70) for the TCM (Allen & Meyer, 2000;

Meyer & Allen, 1997; Meyer et al., 2002). In the pilot study, the continuance

commitment subscale at .382 was below the acceptable level, possibly attributed to the

small sample size. In the research study, the continuance commitment reliability level

was .739, reaching an acceptable reliability level.


Table 4 Current Study Reliability Levels for LPI and TCM Survey Instruments, by Subscales

LPI TCM Model the Way .883 Affective Commitment .817

Inspire a Shared Vision .916 Continuance Commitment .739

Challenge the Process .897 Normative Commitment .835

Enable Others to Act .911 TCM Overall Scale .856

Encourage the Heart .935

LPI Overall Scale .978

Research Question One and Related Hypotheses

The first research question posed for the study was: What is the relationship

between transformational leadership and organizational commitment (affective,

continuance, and normative) among direct care workers in nonprofit long term care

organizations?

Three specific hypotheses were tested:







As previously noted, an examination of the Shapiro Wilks test and Q-Q plots suggested

non-normal distribution, thus warranting the use of the Spearman’s rank order correlation


coefficient (Spearman’s rho) as a nonparametric statistical test to address the research

question and hypotheses. The correlation coefficient is used to identify the degree of

association between transformational leadership and organizational commitment, ranging

from -1.00 (nonlinear association) to +1.00 (linear association); a 0.00 correlation

coefficient indicates no correlation (Creswell, 2012).

Spearman’s rho revealed a statistically significant relationship between

transformational leadership and overall organizational commitment among DCWs in

nonprofit long term care organizations (rs [289]=.378, p < .000). The correlation

coefficient falls within the .35-.65 range, indicating limited prediction (Cohen, 1988),

although meta-analysis has shown this similar range to be beneficial for prediction in the

relationship of two variables (Hemphill, 2003). Squaring the correlation coefficients

indicated that 14.3% of the variance in overall organizational commitment was explained

by the presence of transformational leadership. The aforementioned hypotheses address

the organizational subscales of affective, continuance, and normative commitment with

respect to the antecedent transformational leadership.

The first hypothesis stated that there would be a significant positive relationship

between transformational leadership and organizational commitment. The Spearman’s

rho revealed a statistically significant relationship between transformational leadership

and affective commitment (rs [289]=.398, p < .000). The correlation coefficient falls

within a .35-.65 range, indicating limited prediction as described by Cohen (1988),

although meta-analysis has shown this similar range to be beneficial for prediction in the

relationship of two variables (Hemphill, 2003). Squaring the correlation coefficients

indicated that 15.8% of the variance in affective commitment was explained by the


presence of transformational leadership. Because the p value is less than the alpha level

(.05), the hypothesis is supported that there is a significant positive relationship between

transformational leadership and affective commitment.

The second hypothesis stated that there would be a significant inverse relationship

between transformational leadership and continuance commitment. This means that as

transformational leadership increases, continuance commitment decreases. The

Spearman’s rho revealed no significant relationship between transformational leadership

and continuance commitment (rs [289]=.021, p < .722). The correlation coefficient falls

below .20, indicating there is little usefulness or value in predicting the relationship

between transformational leadership and continuance commitment (Cohen, 1988;

Hemphill, 2003). Also, the p value (.722) is greater than the alpha level (.05). Thus, the

second hypothesis is rejected that there is a significant negative relationship between

transformational leadership and continuance commitment.

The third hypothesis stated that there would be a significant positive relationship

between transformational leadership and normative commitment. The Spearman’s rho

revealed a statistically significant relationship between transformational leadership and

normative commitment (rs [289]=.395, p < .000). The correlation coefficient falls within

the .35-.65 range, indicating limited prediction (Cohen, 1988), but meta-analysis has

described this level as beneficial for prediction in the relationship of two variables

(Hemphill, 2003). Squaring the correlation coefficients indicated that 15.6% of the

variance in normative commitment was explained by the presence of transformational

leadership. Because the p value is less than the alpha level (.05), the hypothesis is


supported that there is a significant positive relationship between transformational

leadership and normative commitment.

Additional strengths of association between the transformational leadership

subscales and organizational commitment and its corresponding subscales are noted in

Table 5 for illustrative purposes. While not specifically addressed within the hypotheses

of this study, the correlations demonstrated a consistently positive relationship between

all five transformational leader behaviors and both affective and normative commitment.

Of the five leader behaviors, “Model the Way” (rs [289]=.407, p < .000) had the most

association with normative commitment. Model the Way as a leader practice involves

setting a personal example for others, clarifying values, following through on

commitments, and holding people accountable (Kouzes & Posner, 2012). The

relationship between “Inspire a Shared Vision” and continuance commitment indicated a

negative association with no significance (rs [289]=.808, p < -.014); the remaining

transformational leader practices indicated positive, yet insignificant, relationships with

continuance commitment.

Table 5 Spearman’s rho Correlations between Transformational Leadership and Organizational Commitment, Overall and by Subscales Affective

Commitment Continuance Commitment

Normative Commitment

Organizational Commitment

(Overall) Model the Way .396** .012 .407** .376**

Inspire a Shared Vision .334** -.014 .354** .334**

Challenge the Process .366** .054 .364** .361**

Enable Others to Act .377** .023 .354** .356**


Spearman’s rho Correlations between Transformational Leadership and Organizational Commitment, Overall and by Subscales Encourage the Heart .366** .041 .386** .366**

Transformational Leadership (Overall)

.398** .021 .395** .378**

Note: Missing data excluded, n=289 ** Correlation is significant at the .01 level (2-tailed) Research Question Two and Related Hypothesis

The second research question for the study was: Is there a difference, if any,

between types of long term care settings on transformational leadership and

organizational commitment? The hypothesis is there is no difference between types of

long term care settings on transformational leadership and organizational commitment.

Participants of the study were employed by nonprofit long term care organizations with

multiple lines of long term care services, such as nursing facilities, assisted living

facilities, home health agencies, and senior housing. Participants were asked to identify

the setting in which they worked. Due to small sample sizes for many of the settings, the

setting categories were collapsed to two categories, nursing facilities and other. The

“other” category included senior housing settings such as assisted living and independent

housing as well as home- and community-based services such as home health. Inspection

of Shapiro Wilk test indicated that both transformational leadership (p =.000 for nursing

facilities and p =.009 for “other”) and organizational commitment (p =.000 for nursing

facilities and p =.003 for “other”) were non-normally distributed for both groups with p

values below .05 alpha level. There was homogeneity of variance as assessed by

Levene's Test for Equality of Variances, indicating that the group variances can be treated

as equal (Gastwirth, Gel, & Miao, 2009). The nursing facility group contained 235

participants and the other group contained 79 participants. When considering


transformational leadership in comparing the groups, the data showed the nursing facility

group reported lower transformational leader behaviors (M =184.37, SD = 64.83) than the

“other” group (M =196.72, SD = 57.43). For organizational commitment, the nursing

facility group (M =77.56, SD = 19.41) also reported lower organizational commitment

scores than the “other” group (M =85.85, SD = 18.72). Comparing the means for the

groups revealed the following results for each variable: a) transformational

leadership t(312) = -1.506, p = .133, and b) organizational commitment t(312) = -

3.311, p = .001. The conclusion is to fail to reject the hypothesis that there is no

difference between types of long term care settings (between nursing facilities and

“other”) with regard to transformational leadership. However, the data shows that the

hypothesis can be rejected that there is no difference between types of long term care

settings (between nursing facilities and “other”) with regard to organizational

commitment.

Summary

The first three hypotheses of the study were related to either significant positive

or inverse relationships between transformational leadership and organizational

commitment and the subscales of affective, continuance, and normative commitment

among DCWs in nonprofit long term care organizations. The Spearman’s rank order

correlation coefficient statistical test was used to analyze whether the variables co-vary.

The first hypothesis was supported, indicating there is a significant positive relationship

between transformational leadership and affective commitment. The second hypothesis

was rejected, indicating there is not a significant inverse relationship between

transformational leadership and continuance commitment. The third hypothesis was


supported, indicating there is a significant positive relationship between transformational

leadership and normative commitment. In evaluating the relationship of transformational

leadership with overall organizational commitment, a significant positive relationship

was revealed in the data analysis.

The fourth null hypothesis addressed no difference between types of long term

care settings for transformational leadership and organizational commitment. An

independent t-test was used to compare the means of two groups, those DCWs working

in nursing facilities and those DCWs working in other long term care settings. For

transformational leadership, the null hypothesis failed to be rejected, indicating there is

no difference between types of long term care settings. For organizational commitment,

the null hypothesis was rejected, indicating there is a significant difference between types

of long term care settings, specifically nursing facilities and “other” in this study.

Presented in Chapter five are the conclusions, implications, and recommendations of the

data analysis results.


CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS

Introduction

The aim of this study was to gain further understanding about how leader

behaviors influence organizational commitment among DCWs in the nonprofit long term

care industry by providing DCWs an opportunity to voice their perspective and

advocating on their behalf. The purpose of the quantitative correlational study was to

explore the relationship between transformational leadership and organizational

commitment among DCWs in nonprofit, long term care organizations. Transformational

leadership, as the predictor variable is generally understood as a process whereby leaders

have a conscious goal to develop followers into leaders, exhibit behaviors that elicit trust,

and display self-sacrificial perspectives to build commitment and influence, and

demonstrate a moral compass towards mission and purpose (Avolio, 2011; Bass, 1985;

Kouzes & Posner,1988; 2012). Organizational commitment, as the outcome variable, is

generally described as a “psychological state linking employees to their organizations”

and considered along three dimensions: affective, continuance, and normative (Meyer &

Allen, 1997, p. 23).

Similar to other industries and organizations, long term care leaders must consider

how leadership practices influence organizational commitment and yet, little literature

exists that addresses the DCW perspective of leadership qualities and the importance to

organizational commitment. Because transformational leadership has not been studied as

an antecedent in the context of long term care, this study was intended to respond to this

deficiency as well as contribute to the nonprofit literature in reflecting the importance of

transformational leadership in this context. Findings of the study can benefit scholarship,


practice, and policy within the long term care industry. Within the scholarship arena, this

study responded to a research deficiency by focusing on DCWs and their immediate

supervisors; however, further research is warranted. For industry practitioners and policy

makers, the findings are useful in considering modifications of operational policies,

identifying training and development needs, revisiting human resources practices, and

evaluating workforce resources. Conclusions, implications, and recommendations are

addressed in Chapter five.

Summary of the Study

A growing aging population and workforce shortage provide great challenges for

the long term care industry. Leaders within the industry must tackle these challenges by

addressing a wide range of external factors and looking to leadership practices directly

affecting the workforce they hope to retain. The purpose of the study was to explore the

relationship between transformational leadership and organizational commitment among

DCWs in nonprofit long term care organizations. Two research questions were

addressed: a) What is the relationship between transformational leadership and

organizational commitment (affective, continuance, and normative) among direct care

workers in nonprofit long term care organizations? and b) Is there a difference, if any,

between types of long term care settings for transformational leadership and

organizational commitment? A quantitative correlational design study was used to assess

the strength of the relationships between the variables. The study included 322 DCWs

employed by nine nonprofit long term care organizations located in the Midwest. The

study participants completed a survey document including the LPI (Kouzes & Posner,

2013) and the TCM (Meyer & Allen, 2004) survey instruments and demographic


questions. For participants, the completion of the survey was confidential and

anonymous. SPSS® 22 was used to analyze the data, and statistical tests included

normality testing, Spearman’s rank order correlation coefficient, and independent t-tests.

Findings revealed a significant positive relationship between transformational leadership

and overall organizational commitment, a significant positive relationship between

transformational leadership and both affective and normative commitments and no

significant relationship between transformational leadership and continuance

commitment. Significant differences between types of settings (nursing facilities and

“other”) were only observed for organizational commitment and not transformational

leadership.

Summary of the Findings

Transformational leadership was found to significantly correlate with

organizational commitment among DCWs in nonprofit long term care organizations.

This finding supports the existing literature that organizational characteristics such as

leader practices contribute to organizational commitment (Kouzes & Posner, 2012;

Meyer & Allen, 1997). However, one critical aspect of the study hypotheses addressed

organizational commitment within its three dimensions of affective, continuance, and

normative commitment. This is an imperative component of the analysis because

organizational commitment as a job attitude is complex (Liou, 2008; Meyer & Allen,

1997; Morrow & McElroy, 1993). If organizational commitment is analyzed only in its

totality, it ignores the variation of employee relationships with their leaders and

organizations (Meyer & Allen, 1997). Thus, a dimensional view takes this complexity


into consideration when considering the impact of transformational leadership on

organizational commitment.


commitment (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012) whereas

normative commitment represents an employee’s sense of obligation to remain with the

organization (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012). In the study,

transformational leader behaviors were significantly positively related to both affective

commitment and normative commitment. In previous meta-analyses of correlations

between transformational leadership and affective and normative commitment, affective

commitment was shown to have a stronger relationship (Meyer et al., 2002). In this

study, affective and normative commitments were similar in their correlation strengths

(.398 and .395 respectively), although the variances attributable to transformational

leader behaviors was not high (15.8% and 15.6% respectively). This may be related to

the strength of DCW conformity between personal and organizational beliefs and the

emotional attachment this lends to nonprofit missions. It is possible that DCWs who

already have a desire to help others and work in a nonprofit setting feel compelled to

remain in nonprofit settings, and while transformational leader behaviors assist in

increasing affective and normative commitments, they may not be as compelling as the

nonprofit mission itself.

Supervisory support, autonomy, and respect were found to influence high

commitment levels in long term care (Bishop et al., 2008) and DCWs have expressed that

they most desire recognition, respect, rewards, empowerment, and inclusion in decision-

making (Bowers, Esmond, & Jacobson, 2003; Casper & O’Rourke, 2008; Leutz, Bishop


& Dodson, 2009; Secrest, Iorio & Martz, 2005; Stone, 2004; 2011). All such leader

behaviors are reflected in the five transformational leadership subscales in some fashion,

and the study results illustrated the statistically significant relationship between the

transformational leadership subscales and overall organizational commitment, affective

commitment, and normative commitment. For example, “model the way” exhibits

qualities that show respect for others, “inspire a shared vision” appeals to empowerment

by building goals to achieve a shared vision, “challenge the process” assures that support

exists for DCWs wanting to test new approaches to care, “enable others to act” ensures

that collaborative cultures are created for shared decision-making, and “encourage the

heart” recognizes and rewards DCWs for accomplishments and makes people feel valued.

In total, transformational leadership practices, described by Kouzes & Posner (2012) as

the five practices of exemplary leadership, are based on “mobilizing others to want to

struggle for shared aspirations” (p. 30). The leader/follower relationship is integral to

organizational commitment along the affective and normative commitment dimensions.

Continuance commitment considers the DCWs’ perceptions of costs in leaving

the organization (Liou, 2008; Meyer & Allen, 1997; Robbins & Judge, 2012). Contrary

to initial expectations for this study, there was no significant relationship between

transformational leader behaviors and organizational commitment. Results showed that

the relationship was in fact a slight positive relationship (.021) despite the hypothesized

inverse relationship. However, when looking at the transformational leadership

subscales, a negative relationship existed between “inspire a shared vision” and

continuance commitment. This is contrary to previous research (Dunn, Dastoor, & Sims,

2012). This reveals a potential linkage as to what hierarchy levels DCWs expect to


communicate the vision. Because immediate supervisors were the target for leader

behavior perception, DCWs may not hold them responsible for sharing the vision, thus

not providing them “credit” for doing so in the survey.

Continuance commitment also takes into account both the sacrifices involved in

leaving an organization as well as the awareness of available job alternatives (Hackett et

al., 1994; Meyer & Allen, 1997). Rather than leader behaviors affecting continuance

commitment, other personal (age, length of employment) or organizational factors

(autonomy, pay) may be more attributable to an understanding of continuance

commitment (Hackett et al., 1994; Meyer & Allen, 1997). While the study revealed that

the median hourly wage of DCWs ($12.00) was higher than the most recent national

report ($10.63), median hourly wage remains lower than the median wage for all U.S.

workers ($16.71) (PHI, 2013b). It is also worth considering that DCWs may feel their

skills in long term care are less transferrable to another organization or industry or they

perceive limited employment alternatives, thus increasing continuance commitment

levels (Meyer et al., 2002). Furthermore, the nonprofit mission may contribute to a

lessening of economic considerations with DCWs, thus reducing their desire to leave for

higher pay. For example, if a nonprofit organization provides desired support for work-

family balance, thus reducing stress for the DCW, higher pay may become less valuable

to the DCW. Each of these considerations are worthy of further exploration and research.

With regard to types of long term care settings, there was support for differences

between service settings for organizational commitment but not transformational

leadership. This may be explained by the reduced level of regulations in senior housing

and home- and community-based services (the “other” category) as compared to nursing


facilities. DCWs in these settings may have more autonomy and empowerment in their

roles, thus lending to an increase in organizational commitment levels. Furthermore,

because normative commitment includes social identity considerations, the smaller

employee numbers that senior housing and home- and community-based settings employ

may contribute to perceived ease of in-group membership, thus increasing commitment

levels. Because the study participants were employed at multi-level long term care

organizations, transformational leader behaviors may be consistent across types of

settings, thus limiting its influence, whereas employees consistently working in one type

of setting over another more closely identify with those issues and situations occurring in

their own work setting.

The study provided evidence for correlational understanding between leader

behaviors and organizational commitment but should not be construed as inferring

causality (Gerring, 2012; Onwuegbuzie & Daniel, 2002). Limitations of the study

included the purposeful sampling approach with data collection occurring at limited

points in time for each participating site. Furthermore, participants were limited to those

working at the time of data collection. Findings provide validity for the population

studied and may be valuable in understanding multi-level, nonprofit long term care

organizations in the Midwest; however, application to other geographic locations and

organizational capacities should be applied cautiously.

Implications for Action/Recommendations for Further Research





advocating on their behalf. The research study was inspired by practical considerations

because DCWs form the core of the long term care industry and the rapidly aging

demographic trends challenge the future availability of DCWs in the provision of long

term care services. Leaders are responsible for creating work environments that develop

and sustain the workforce. Findings of the study can benefit scholarship, practice, and

policy within the long term care industry.

Scholarship

Within scholarship, meta-analysis of transformational leadership has revealed an

influence on organizational commitment in industries other than long term care (Avolio,

2011), and researchers have advocated for further study on transformational leadership in

hierarchical levels other than middle to senior levels ((Avolio, 2011; Heldenbrand &

Simms, 2012). This study responded to this deficiency by focusing on DCWs and their

immediate supervisors. The study provided additional empirical evidence into the

relationship between transformational leadership and organizational commitment as well

as the nonprofit leadership arena.

Recommendation one: Further research is warranted. The current study was

conducted with the purpose of examining the relationship between transformational

leadership and organizational commitment among DCWs in nonprofit long term care

organizations. Study findings were valuable; however, further research is warranted to

evolve the long term care industry’s understanding of the relationship between

transformational leadership and organizational commitment. A larger sample of DCWs

would be helpful to increase the sample sizes of other types of long term care settings

besides nursing facilities. Furthermore, the lack of finding an inverse relationship


between leadership and continuance commitment does not lessen the need for further

research on the issue of pay in long term care.

Future researchers could take quantitative, qualitative, or mixed-method

approaches to collecting leadership and organizational commitment data. Examining

leader behaviors and organizational commitment through interviews, surveys, and

observation could provide additional insight into successful and exceptional leadership in

long term care. Additionally, following participants for an extended period of time rather

than collecting data at one point time could provide useful for data analysis.

Longitudinal studies may be useful in tracking data over time with long term care

organizations willing to commit to such an endeavor. For example, during the this study,

one organizational leader confidentially shared their organization’s story of initiating

leadership training utilizing the Kouzes & Posner’s (2012) Leadership Challenge Theory.

Conducting research that analyzes leadership training pre- and post- training would be

valuable for the industry.

With respect to the LPI survey instrument (Kouzes & Posner, 2013), Tourangeau

and McGilton (2004) encouraged revision of the LPI to shorten its length for use in

health care to relieve participant burden as well as decrease research costs. Subjectively,

participants in this study commented on the length of the survey, and some participants

did not complete the survey because they did not feel they had the time or could leave

their work, despite encouragement from others. Future researchers may wish to consider

tackling this issue. Other areas of further research on transformational leadership and

organizational commitment could include an analysis of other factors, such as


demographics, stress, health and well-being, and conflict as they relate to the variables

and a comparison of for-profit and nonprofit long term care organizations.

Industry Practice

Liou (2008) asserted that health care organizations must give more attention to

organizational commitment. Prioritizing an emphasis on commitment can assist leaders

in focusing on antecedents that foster increased organizational commitment, resulting in

increased retention and performance. This study aimed to understand how

transformational leadership may relate to organizational commitment in order to provide

value to leadership as a critical skill in long term care. Changes in long term care, partly

due to health care reform, are demanding more of long term care providers in the

implementation of effective care practices. Such demands can be taxing on both leaders

and DCWs who are instrumental to successful implementation. This study found that

leader behaviors are related to organizational commitment among DCWs. The findings

are useful in considering modifications of operational policies, identifying training and

development needs, and revisiting human resources practices.

Recommendation two: Review operational policies. Leaders would benefit

from collaborating with internal stakeholders to review operational policies. Policies

should reflect the values of the organization. The organization’s vision and mission

should be included in the policies and procedures and be visible to employees

implementing them on a daily basis. Policies can be used to establish standards of

excellence as goals for others to follow. However, operational policies follow a strategic

planning process that takes into consideration the organization’s vision and mission and a

complex set of stakeholders (Bryson, 2011). If a vision and/or mission statement is in


need of revision, leaders must first address the overall strategic direction. Creating,

communicating, and sharing a compelling (and collective) vision and mission is critical

to engaging employees in their work and appealing to shared aspirations.

Recommendation three: Incorporate leadership development training.

Leadership development training should be considered for continuing education

requirements for supervisors at all levels. Research has shown that leadership skills can

be developed (Avolio, 2011), and a recent qualitative study on coaching as a leader

practice in long term care revealed benefits in communication skills, staff empowerment,

and feedback processes (Cummings et al., 2014). Current education and training

requirements for administrators and managers are not sufficient in addressing leadership

skills development (Dana & Olson, 2007). Supplemental and focused leadership

education and training is needed. There are many external leadership programs, but

many are prohibitive due to financial constraints. Large nonprofit organizations may

benefit from corporate office support for internal leadership development training.

However, smaller independent nonprofit organizations may be more resource

constrained. Thus, leadership skills training must be accessible to supervisors in a

broader context. State and national long term care provider associations are one vehicle

for providing leadership training during highly attended association meetings where

continuing education is offered. For example, this study can be submitted as an

education session at state and national provider associations to advance the research

findings and further encourage leadership development.

Recommendation four: Revisit human resource practices. Oftentimes, human

resource practices are associated with operational policies and exhibit a transactional


approach to organizational issues. However, many human resource practices are also part

of the organization’s cultural norms. For example, many nonprofit long term care

organizations are faith-based and incorporate prayer into daily practice. Leaders in long

term care can revisit human resource practices to evaluate alignment with the

organization’s vision, mission, and values. Are the values and principles concerning the

way people should be treated consistent with and carried out through human resources

practices and leader behaviors? Leaders can collaborate with others to assess alignment

issues and modify expectations and practices accordingly. Research findings can assist

leaders in understanding which leader behaviors influence outcomes and concentrate

leadership training on a timelier basis. Other organizational tools, such as employee

satisfaction surveys, can be utilized to identify specific areas of concern and direct

training resources appropriately.

Additionally, human resource practitioners and administrators should consider the

communication methods used to share benefits information with employees. In this

study, up to 33% of DCWs indicated that their organization did not offer or they were

unsure if their organization offered benefits such as health insurance, paid vacation, paid

sick time, paid holiday time, and retirement plans. Because continuance commitment

involves benefits as an economic consideration to leaving an organization, it makes sense

that organizations should strive for a goal that 100% of their employees fully understand

the pay and benefit package offered. Furthermore, communication on benefit offerings

should be done on an ongoing basis, rather than just upon hire or at insurance enrollment

timeframes. Utilizing assessment through employee satisfaction surveys is one method

of obtaining employee input on this subject. Other methods might include organization


websites, paycheck reminders, informational postings in staff areas, reminders at staff

meetings, and direct mailings to employees. As society increasingly moves to electronic

communication methods, it is important to remember that not all DCWs have ready

access to computers and other electronic devices.

Policy

Government reimbursements, regulations, and workforce resources all influence

recruitment and retention in the long term care industry, and compensation in particular

has been shown to directly affect DCWs (Stone, 2004; 2011). Compensation is linked to

continuance commitment and is often the subject of long term care policy aimed at

maintaining current DCW supply. As previously discussed, the aging population is

introducing a demographic trend that will influence the demand for long term care

service, and a quality workforce is required to support the consumers of long term care

services and their informal caregiving networks. This study revealed that leader

behaviors are related to organizational commitment. The findings support the need to

evaluate the content of workforce resources incorporated into policy development.

Recommendation five: Evaluate the content of workforce resources. The

content of workforce resources incorporated into policy development should be

evaluated. Generally, compensation for DCWs is the focus of policy discussion;

however, pay as a component of continuance commitment is only one avenue for

influencing overall organizational commitment, as evidenced by the study findings.

Policymakers must consider other options for tackling the DCW supply challenge.

Policymakers may want to consider including leadership skills as a continuing education

requirement for administrators and other licensed professionals working in long term care


in positions of supervisory authority. Leadership skills training may also be a

consideration within reimbursement incentives, such as inclusion as a pay for

performance criterion on workforce practices. Even non-monetary incentives, such as

state-level government awards, can be designed to recognize long term care organizations

that include leadership skills development for improving workforce practices and

engaging DCWs as much as possible in planning and executing activities to improve

performance. Study findings can be shared with policymakers, state agencies, and

provider association policy advocates as vehicles for communicating the benefits of

transformational leader behaviors on organizational commitment of DCWs in long term

care organizations.

Summary




advocating on their behalf. Two research questions were addressed: a) What is the

relationship between transformational leadership and organizational commitment

(affective, continuance, and normative) among direct care workers in nonprofit long term

care organizations? and b) Is there a difference, if any, between types of long term care

settings for transformational leadership and organizational commitment? A quantitative

correlational design study was used to assess the strength of the relationships between the

variables. The study included 322 DCWs employed by nine nonprofit, multi-level long

term care organizations located in the Midwest. The study participants completed a

survey document including the LPI (Kouzes & Posner, 2013) and the TCM (Meyer &


Allen, 2004) survey instruments and demographic questions. For participants, the

completion of the survey was confidential and anonymous. Findings revealed a

significant positive relationship between transformational leadership and overall

organizational commitment, a significant positive relationship between transformational

leadership and both affective and normative commitment and no significant relationship

between transformational leadership and continuance commitment. Significant

differences between types of settings (nursing facilities and “other”) were only observed

for organizational commitment and not transformational leadership.

The study provided evidence for correlational understanding between leader

behaviors and organizational commitment but should not be construed as inferring

causality (Gerring, 2012; Onwuegbuzie & Daniel, 2002). Limitations of the study

included the purposeful sampling approach with data collection occurring at limited

points in time for each participating site. Furthermore, participants were limited to those

working at the time of data collection conducted onsite at the participating organizations.

Findings provided validity for the population studied and may be valuable in

understanding multi-level, nonprofit long term care organizations in the Midwest;

however, application to other geographic locations and organizational capacities should

be applied cautiously.

The research study was inspired by practical considerations because DCWs form

the core of the long term care industry and demographic trends will challenge the future

availability of DCWs in providing long term care services to aging consumers. Leaders

are responsible for creating work environments that develop and sustain the workforce.

Findings of the study can benefit scholarship, practice, and policy within the long term


care industry. Within the scholarship arena, this study responded to a research deficiency

by focusing on DCWs and their immediate supervisors. The study provided additional

empirical evidence into the relationship between transformational leadership and

organizational commitment as well as for the nonprofit leadership arena. For the long

term care industry, this study found that leader behaviors are related to organizational

commitment among DCWs. The findings are useful in considering modifications of

operational policies, identifying training and development needs, and revisiting human

resources practices. For policymakers, the findings support the need to evaluate the

content of workforce resources incorporated into policy development. The aging

population is introducing a demographic trend that will influence the demand for long

term care services, and a quality workforce is required to support the consumers of long

term care services and their informal caregiving networks.


References

Alatrista, J., & Arrowsmith, J. (2004). Managing employee commitment in the not-for-

profit sector. Personnel Review, 33(5), 536-

548. http://dx.doi.org/10.1108/00483480410550143

Al-Hussami, M. (2008). A study of nurses’ job satisfaction: The relationship to

organizational commitment, perceived organizational support, transactional

leadership, transformational leadership, and level of education. European Journal

of Scientific Research, 22(2), 286-295.

Al-Hussami, M., Darawad, M., Saleh, A., & Hayajneh, F. A. (2014). Predicting nurses’

turnover intentions by demographic characteristics, perception of health, quality

of work attitudes. International Journal of Nursing Practice, 20(1), 79-88. Doi:

101111/ijn.12124

Allen, N. J., & Meyer, J. P. (2000). Construct validation in organizational behavior

research: The case of organizational commitment. In R. D. Goffin & E. Helmes

(Eds.). Problems and solutions in human assessment: Honoring Douglas N.

Jackson at seventy (pp. 285-314). Norwell, MA: Kluwer Academic Publishers.

Antonakis, J., Avolio, B. J., & Sivasubramaniam, N. (2003). Context and leadership:

An examination of the nine-factor full-range leadership theory using the

multifactor leadership questionnaire. The Leadership Quarterly, 14, 261-

295. http://dx.doi.org/10.1016/S1048-9843(03)00030-4

Avolio, B. J. (2011). Full range leadership development (2nd ed.). Thousand Oaks,

CA: Sage Publications.

Avolio, B. J. & Bass, B. M. (1995). Individual consideration viewed at multiple levels

http://dx.doi.org/10.1108/00483480410550143

http://dx.doi.org/10.1016/S1048-9843%2803%2900030-4


of analysis: A multi-level framework for examining the diffusion of

transformational leadership. Leadership Quarterly, 6(2), 199-

218. http://dx.doi.org/10.1016/1048-9843(95)90035-7

Avolio, B. J., Bass, B. M., & Jung, D. I. (1999). Re-examining the components of

transformational and transactional leadership using the multi-factor leadership

questionnaire. Journal of Occupational and Organizational Psychology, 72, 441-

462. http://dx.doi.org/10.1348/096317999166789

Avolio, B. J., Zhu, W., Koh, W., & Puja, B. (2004). Transformational leadership and

organizational commitment: Mediating role of psychological empowerment and

moderating role of structural distance. Journal of Organizational Behavior, 25,

951-968. http://dx.doi.org/10.1002/job.283

Bass, B. M. (1985). Leadership and performance beyond expectations. New York,

NY: Free Press.

Bass, B. M., & Bass, R. (2008). The Bass handbook of leadership: Theory, research &

managerial applications (4th ed.). New York, NY: Free Press.

Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Mahweh,

NJ: Lawrence Erlbaum Associates.

Bass, B. M., & Riggio, R. E. (2010). The transformational model of leadership. In G.

R. Hickman (Ed.), Leading organizations: Perspectives for a new era (2nd ed.)

(pp. 76-86). Thousand Oaks, CA: Sage.

Bass, B. M., Waldman, D. A., & Avolio, B. J. (1987). Transformational leadership

and the falling dominoes effect. Group & Organization Studies, 12(1), 73-

87. http://dx.doi.org/10.1177/105960118701200106

http://dx.doi.org/10.1016/1048-9843%2895%2990035-7

http://dx.doi.org/10.1348/096317999166789

http://dx.doi.org/10.1002/job.283

http://dx.doi.org/10.1177/105960118701200106


Bear, A. B., & Fitzgibbon, M. A. (2005). Leadership in a not-for-profit world: A mixed

Toolbox. In R. R. Sims & S. A. Quatro (Eds.). Leadership: Succeeding in the

private, public, and not-for-profit sectors (pp. 87-104). Armonk, NY: M.E.

Sharpe.

Becker, H. S. (1960). Notes on the concept of commitment. American Journal of

Sociology, 66, 32-42. http://dx.doi.org/10.1086/222820

Bennis, W. G. (1997). Learning to lead: A workbook on becoming a leader. New York,

NY: Perseus.

Bennis, W. G., & Nanus, B. (1985). Leaders: Strategies for taking charge. New York,

NY: Harper & Row.

Berndt, J. (2012). Ever forward: Identifying effective change leadership in social ministry

organizations. (Doctoral thesis). Bethel University.

Bishop, C. E., Weinberg, D. B., Leutz, W., Dossa, A., Pfefferle, S. G., & Zincavage, R.

M. (2008). Nursing assistants’ job commitment: Effect of nursing home

organizational factors and impact on resident well-being. Gerontologist, 48(1),

36-45. PMID:18694985

Block, S. R. (2001). The history of the discipline. In J. S. Ott (Ed.), The nature

of the nonprofit sector (pp.97-111). Boulder, CO: Westview Press.

Bono, J. E., & Judge, T. A. (2003). Self-concordance at work: Toward understanding the

motivational effects of transformational leaders. Academy of Management

Journal, 46(5), 554-571. http://dx.doi.org/10.2307/30040649

Bowers, B. J., Esmond, S., & Jacobson, N. (2003). Turnover reinterpreted: Cnas talk

http://dx.doi.org/10.1086/222820

http://dx.doi.org/10.2307/30040649


about why they leave. Journal of Gerontological Nursing, 29(3), 36-

43. http://dx.doi.org/10.3928/0098-9134-20030301-09

Bryson, J. M. (2011). Strategic planning for public and nonprofit organizations: A guide

to strengthening and sustaining organizational achievement (4th ed.). San

Francisco, CA: John Wiley & Sons.

Burke, W. W. (2011). Organization change: Theory and practice (3rd ed.). Thousand

Oaks, CA: Sage Publications.

Burns, J. M. (1978). Leadership. New York, NY: Harper & Row.

Bycio, P., Hackett, R. D., & Allen, J. S. (1995). Further assessments of Bass’s (1985)

conceptualization of transactional and transformational leadership. Journal of

Applied Psychology, 80, 468-478. http://dx.doi.org/10.1037/0021-9010.80.4.468

Caspar, S., & O’Rourke, N. (2008). The influence of care provider access to structural

empowerment on individualized care in long-term care facilities. Journal of

Gerontology: Social Sciences, 63B(4), S255-

S265. http://dx.doi.org/10.1093/geronb/63.4.S255

Census Bureau. (n.d.). 2012 national population projections. Retrieved from

http://www.census.gov/population/projections/data/national/2012.html

Center for Health Workforce Studies. (2006). The impact of the aging population on the

health workforce in the United States: Summary of key findings. Washington, DC:

Health Resources and Services Administration. Retrieved from

http://www.albany.edu/news/pdf_files/impact_of_aging_excerpt.pdf

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.).

Hillsdale, NJ: Erlbaum.

http://dx.doi.org/10.3928/0098-9134-20030301-09

http://dx.doi.org/10.1037/0021-9010.80.4.468

http://dx.doi.org/10.1093/geronb/63.4.S255


Crawford, D. B. (2005). The bases for executive action: A multiple case study of

leadership in the highly regulated long-term health care industry. (Doctoral

dissertation). Regent University School of Business and Leadership.

Creswell, J. W. (2012). Educational research: Planning, conducting, and evaluating

quantitative and qualitative research (4th ed.). Boston, MA: Pearson Education.

Culp, K., Ramey, S., & Karlman, S. (2008). Iowa certified nursing assistants study: Self-

reported ratings of the nursing home work environment. Research in

Gerontological Nursing, 1(2), 87-96. http://dx.doi.org/10.3928/19404921-

20080401-01

Cummings, G., Mallidou, A. A., Masaoud, E., Kumbamu, A., Schalm, C., Laschinger,

H., & Estabrooks, C. A. (2014). On becoming a coach: A pilot intervention study

with managers in long-term care. Health Care Management Review, 39(3), 198-

209. doi:10.1097/HMR.obo13e318294e586

Dall, T. M., Gallo, P. D., Chakrabarti, R., West, T., Semilla, A. P., & Storm, M. V.

(2013). An aging population and growing disease burden will require a large and

specialized health care workforce by 2025. Health Affairs, 32(11), 2013-

2020. http://dx.doi.org/10.1377/hlthaff.2013.0714

Dana, B., & Olson, D. (2007). Effective leadership in long term care: The need and the

opportunity. (American College of Health Care Administrators Position Paper).

Retrieved from

http://www.achca.org/content/pdf/ACHCA_Leadership_Need_and_Opportunity_

Paper_Dana-Olson.pdf

DeChurch, L. A., Hiller, N. J., Murase, T., Doty, D., & Salas, E. (2010). Leadership

http://dx.doi.org/10.3928/19404921-20080401-01

http://dx.doi.org/10.3928/19404921-20080401-01

http://dx.doi.org/10.1377/hlthaff.2013.0714


across levels: Levels of leaders and their levels of impact. The Leadership

Quarterly, 21, 1069-1085. http://dx.doi.org/10.1016/j.leaqua.2010.10.009

Decker, F. H., Harris-Kojetin, L. D., & Bercovitz, A. (2009). Intrinsic job satisfaction,

overall satisfaction, and intention to leave the job among nursing assistants in

nursing homes. The Gerontologist, 49(5), 596-610, doi: 10.1093/geront/gnp051

DiMaggio, P. J. & Anheier, H. K. (2001). The sociology of nonprofit organizations and

sectors. In J. S. Ott (Ed.), The nature of the nonprofit sector (pp.274-287).

Boulder, CO: Westview Press.

Donoghue, C., & Castle, N. G. (2009). Leadership styles of nursing home administrators

and their association with staff turnover. The Gerontologist, 49(2), 166-174.

doi:10.1093/geront/gnp021

Downton, J. V. (1973). Rebel leadership: Commitment and charisma in revolutionary

process. New York, NY: Free Press.

Dunn, M. W., Dastoor, B., & Sims, R. L. (2012). Transformational leadership and

organizational commitment: A cross-cultural perspective. Journal of

Multidisciplinary Research, 4(1), 45-59.

Duygulu, S., & Kublay, G. (2011). Transformational leadership training programme for

charge nurses. Journal of Advanced Nursing, 67(3), 633-

642. http://dx.doi.org/10.1111/j.1365-2648.2010.05507.x

Eaton, S. C. (2001). What a difference management makes: Nursing staff turnover

variation within a single labor market. In Abt Associates (Eds.). Appropriateness

of minimum nurse staffing ratios in nursing homes (pp. 5-1 – 5-64). Phase II Final

Report to Congress. Washington, DC: Department of Health and Human Services.

http://dx.doi.org/10.1016/j.leaqua.2010.10.009

http://dx.doi.org/10.1111/j.1365-2648.2010.05507.x


Emery, C. R., & Barker, K. J. (2007). The effect of transactional and transformational

leadership styles on the organizational commitment and job satisfaction of

customer contact personnel. Journal of Organizational Culture, Communication

and Conflict, 11(1), 77-90.

Felkins, P. K., & Croteau-Chonka, C. C. (2014). The nonprofit factor: Gathering at the

table for the common good. New York, NY: Hampton Press.

Forbes-Thompson, S., & Gessert, C. E. (2006). Nursing homes and suffering: Part of the

problem or part of the solution? The Journal of Applied Gerontology, 25(3), 234-

251. doi:10.1177/0733464806288561

Freeborough, R. E. (2013). Exploring the affect of transformational leadership on

nonprofit leader engagement and commitment. (Doctoral dissertation). Capella

University.

Frumkin, P. (2002). On being nonprofit: A conceptual and policy primer. Cambridge,

MA: Harvard University Press.

Galaskiewicz, J., & Bielefeld, W. (2001). Nonprofit organizations in an age of

uncertainty. In J. S. Ott (Ed.), The nature of the nonprofit sector (pp.297-310).

Boulder, CO: Westview Press.

Gastwirth, J. L., Gel, Y. R., & Miao, W. (2009). The impact of Levene’s test of equality

of variances in statistical theory and practice. Statistical Science, 24(3), 343-360,

doi:10.1214/09-STS301

Gerring, J. (2012). Social science methodology: A unified framework (2nd ed.). New

York, NY: Cambridge University Press.

Godwin, J. L., & Neck, C. P. (1998). Desired transformational leadership behaviors in a


religious organization: Analysis by hierarchical organizational level. International

Journal of Organization Theory & Behavior, 1(2), 163-179.

Goleman, D. (2013). The focused leader: How effective executives direct their own – and

their organizations’ – attention. Harvard Business Review, 91(12), 50-60.

Hackett, R. D., Bycio, P., & Hausdorf, P. A. (1994). Further assessments of Meyer and

Allen’s (1991) three-component model of organizational commitment. Journal of

Applied Psychology, 79(1), 15-23. http://dx.doi.org/10.1037/0021-9010.79.1.15

Haslam, S. A., Reicher, S. D., & Platow, M. J. (2011). The new psychology of leadership:

Identity, influence and power. New York, NY: Psychology Press.

Heldenbrand, L., & Simms, M. S. (2012). Missing link: integrated individual leadership

development, employee engagement, and customer value-added improvement.

Performance Improvement, 51(2), 28-35. http://dx.doi.org/10.1002/pfi.21247

Hemphill, J. F. (2003). Interpreting the magnitudes of correlation coefficients. American

Psychologist, 58(1), 78-80, doi:10.1037/0003-066X.58.1.78

Iowa Direct Care Worker Advisory Council. (2012). Costs of turnover in the direct care

workforce. Des Moines, IA: Iowa Department of Public Health. Retrieved from

http://www.idph.state.ia.us/directcare/Council.aspx

Jaros, S. (2007). Meyer and Allen model of organizational commitment: Measurement

issues. Icfai Journal of Organizational Behavior, 4(4), 7-25.

Kim, J., Wehbi, N., DelliFraine, J. L., & Brannon, D. (2013). The joint relationship

between organizational design factors and HR practice factors on direct care

workers’ job satisfaction and turnover intent. Health Care Management Review,

1-11, doi: 10.1097/HMR.0b013e31828c8b8f

http://dx.doi.org/10.1037/0021-9010.79.1.15

http://dx.doi.org/10.1002/pfi.21247


Kouzes, J. M., & Posner, B. Z. (1988). The leadership challenge: How to get

extraordinary things done in organizations. San Francisco, CA: Jossey-Bass

Publishers.

Kouzes, J. M., & Posner, B. Z. (2000). Leadership practices inventory: Psychometric

properties. Retrieved from

http://www.leadershipchallenge.com/UserFiles/lc_jb_psychometric_properti.pdf

Kouzes, J. M., & Posner, B. Z. (2002). The leadership practices inventory: Theory and

evidence behind the five practices of exemplary leaders. Retrieved from

http://www.leadershipchallenge.com/UserFiles/lc_jb_appendix.pdf

Kouzes, J. M., & Posner, B. Z. (2012). The leadership challenge: How to make

extraordinary things happen in organization (5th ed.). San Francisco, CA: Jossey-

Bass Publishers.

Kouzes, J. M., & Posner, B. Z. (2013). Leadership practices inventory: Observer (4th

ed.). San Francisco, CA: Wiley.

Kowalski, C. J. (1972). On the effects of non-normality on the distribution of the sample

product-moment correlation coefficient. Journal of the Royal Statistical Society:

Series C (Applied Statistics), 21(1), 1-12.

Lambert, E., Kelley, T., & Hogan, N. (2013). The association of occupational stressors

with different forms of organizational commitment among correctional staff.

American Journal of Criminal Justice. 38(3), 480-501. doi:10.1007/s12103-012-

9183-1

Lee, D., Coustasse, A., & Sikula Sr., A. (2011). Transformational leadership and


workplace injury and absenteeism: Analysis of a national nursing assistant survey.

Health Care Management Review, 36(4), 380-387.

doi:10.1097/HMR.0b013e3182100bf7

Leutz, W., Bishop, C. E., & Dodson, L. (2009). Role for a labor-management partnership

in nursing home person-centered care. The Gerontologist, 50(3), 340-351. doi:

10.1093/geront/gnp123

Liou, S. (2008). An analysis of the concept of organizational commitment. Nursing

Forum, 43(3), 116-125. http://dx.doi.org/10.1111/j.1744-6198.2008.00103.x

Liu, L., Liu, W., & Wang, J. (2011). Work autonomy of certified nursing assistants in

long-term care facilities: Discrepant perceptions between nursing supervisors and

certified nursing assistants. Journal of the American Medical Directors

Association, 12(7), 524-534. http://dx.doi.org/10.1016/j.jamda.2010.05.006

Lumley, T., Diehr, P., Emerson, S., & Chen, L. (2002). The importance of the normality

assumption in large public health data sets. Annual Review Public Health, 23,

151-169. doi:10.1146/annurev.publheath.23.100901.140546

Lutfiyya, M. N., Gessert, C. E ., & Lipsky, M. S. (2013). Nursing home quality: A

comparative analysis using CMS nursing home compare data to examine

differences between rural and nonrural facilities. Journal of the American Medical

Directors Association, 14(8), 593-

8. http://dx.doi.org/10.1016/j.jamda.2013.02.017

Marotta, J. (2010). Leadership, emotional intelligence, and quality care in long-term care

facilities. Doctoral dissertation). Retrieved from ProQuest Dissertation Database.

(UMI Number: 3441253).

http://dx.doi.org/10.1111/j.1744-6198.2008.00103.x

http://dx.doi.org/10.1016/j.jamda.2010.05.006

http://dx.doi.org/10.1016/j.jamda.2013.02.017


Mathieu, J. E., & Zajac, D. (1990). A review and meta-analyses of the antecedents,

correlates, and consequences of organizational commitment. Psychological

Bulletin, 108, 171-194. http://dx.doi.org/10.1037/0033-2909.108.2.171

McGillis-Hall, L., McGilton, K. S., Krejci, J., Pringle, D., Johnston, E., Fairley, L., &

Brown, M. (2005). Enhancing the quality of supportive supervisory behavior in

long-term care facilities. Journal of Nursing Administration, 35(4), 181-187.

McMurray, A. J., Pirola-Merlo, A., Sarros, J. C., & Islam, M. M. (2010). Leadership,

climate, psychological capital, commitment, and wellbeing in a non-profit

organization. Leadership and Organization Development Journal, 31(5), 436-

457. http://dx.doi.org/10.1108/01437731011056452

Meyer, J. P., & Allen, N. J. (1991). A three-component conceptualization of

organizational commitment. Human Resource Management Review, 1, 61-

89. http://dx.doi.org/10.1016/1053-4822(91)90011-Z

Meyer, J. P., & Allen, N. J. (1997). Commitment in the workplace: Theory, research and

application. Thousand Oaks, CA: Sage Publications.

Meyer, J. P., & Allen, N. J. (2004). TCM employee commitment survey academic users

guide 2004. Ontario: University of Western Ontario.

Meyer, J., Becker, T., & Van Dick, R. (2006). Social identities and commitments at

work: Toward an integrative model. Journal of Organizational Behavior, 27, 665-

683. http://dx.doi.org/10.1002/job.383

Meyer, J. P., Stanley, D. J., Herscovitch, L., & Topolnytsky, L. (2002). Affective,

http://dx.doi.org/10.1037/0033-2909.108.2.171

http://dx.doi.org/10.1108/01437731011056452

http://dx.doi.org/10.1016/1053-4822%2891%2990011-Z

http://dx.doi.org/10.1002/job.383


continuance, and normative commitment to the organization: A meta-analysis of

antecedents, correlates, and consequences. Journal of Vocational Behavior, 61,

20-52. http://dx.doi.org/10.1006/jvbe.2001.1842

Morrow, P. C., & McElroy, J. C. (1993). Introduction: Understanding and managing

loyalty in a multi-commitment world. Journal of Business Research, 26(1), 1-

3. http://dx.doi.org/10.1016/0148-2963(93)90038-Q

Mowday, R. T., Porter, L. W., & Steers, R. (1982). Organizational linkages: The

psychology of commitment, absenteeism, and turnover. San Diego, CA:

Academic Press.

Mukamel, D. B., Spector, W. D., Limcangco, R., Wang, Y., Feng, Z, & Mor, V. (2009).

The costs of turnover in nursing facilities. Medical Care, 47(10), 1039-1045.

doi:10.1097/MLR.0b013e3181a3cc62

Northouse, P. G. (2007). Leadership theory and practice (4th ed.). Thousand Oaks, CA:

Sage Publications.

Onwuegbuzie, A. J., & Daniel, L. G. (2002). Uses and misuses of the correlation

coefficient. Research in the Schools, 9(1), 73-90.

Ott, J. S. (Ed.). (2001). The nature of the nonprofit sector. Boulder, CO: Westview Press.

Palotta, D. (2008). Uncharitable: How restraints on nonprofits undermine their potential.

Medford, MA: Tufts University Press.

Paraprofessional Health Institute (PHI). (2011, February). Who are direct-care workers?

(Facts Brief 3). New York, NY: PHI. Retrieved from PHI website:

http://www.phinational.org/sites/phinational.org/files/clearinghouse/PHI%20Facts

%203.pdf

http://dx.doi.org/10.1006/jvbe.2001.1842

http://dx.doi.org/10.1016/0148-2963%2893%2990038-Q


Paraprofessional Health Institute (PHI). (2013a, February). Occupational projections for

direct-care workers 2010-2020. (Facts Brief 1). New York, NY: PHI. Retrieved

from PHI website:

http://phinational.org/sites/phinational.org/files/phi_factsheet1update_singles_2.p

df

Paraprofessional Health Institute (PHI). (2013b, November). America’s direct-care

workforce. (Facts Brief 3). New York, NY: PHI. Retrieved from PHI website:

http://phinational.org/sites/phinational.org/files/phi-facts-3.pdf

Pennington, P., Townsend, C., & Cummins, R. (2003). The relationship of leadership

practices to culture. Journal of Leadership Education, 2(1), 27-

44. http://dx.doi.org/10.12806/V2/I1/RF2

Podsakoff, P. M., MacKenzie, S. B., & Bommer, W. H. (1996). Transformational leader

behaviors and substitutes for leadership as determinants of employee satisfaction,

commitment, trust, and organizational citizenship behaviors. Journal of

Management, 22(2), 259-298. http://dx.doi.org/10.1016/S0149-2063(96)90049-5

Podsakoff, P. M., MacKenzie, S. B., Moorman, R. H., & Fetter, R. (1990).

Transformational leader behaviors and their effects on followers’ trust in leader,

satisfaction, and organizational citizenship behaviors. Leadership Quarterly, 1,

107–142. http://dx.doi.org/10.1016/1048-9843(90)90009-7

Pratt, J. R. (2010). Long-term care: Managing across the continuum, (3rd ed.). Sudbury,

MA: Jones and Bartlett.

Qiao, K., Khilji, S., & Wang, X. (2009). High-performance work systems, organizational

http://dx.doi.org/10.12806/V2/I1/RF2

http://dx.doi.org/10.1016/S0149-2063%2896%2990049-5

http://dx.doi.org/10.1016/1048-9843%2890%2990009-7


commitment, and the role of demographic features in the People's Republic of

China. International Journal of Human Resource Management, 20(11), 2311-

2330. doi:10.1080/09585190903239682

Riggio, R. E., & Orr, S. S. (Eds.). (2004). Improving leadership in nonprofit

organizations. San Francisco, CA: Jossey-Bass.

Robbins, S. P., & Judge, T. A. (2012). Essentials of organizational behavior (11th ed.).

Upper Saddle River, NJ: Prentice Hall.

Robnett, R. H., & Chop, W. C. (2010). Gerontology for the health care professional (2nd

ed.). Sudbury, MA: Jones and Bartlett.

Rosen, J., Stiehl, E. M., Mittal, V., & Leana, C. R. (2011). Stayers, leavers, and switchers

among CNAs in nursing homes: A longitudinal investigation of turnover intent,

staff retention, and turnover. The Gerontologist, 51(5), 597-

609. http://dx.doi.org/10.1093/geront/gnr025

Salamon, L. M., Sokolowski, S. W., & Geller, S. L. (2012). Holding the fort: Nonprofit

employment during a decade of turmoil. (Nonprofit Employment Bulletin No.

39). Johns Hopkins University Center for Civil Society Studies. Retrieved

from http://ccss.jhu.edu/wp-

content/uploads/downloads/2012/01/NED_National_2012.pdf

Scott, J. T. (2001). Voluntary sector. In J. S. Ott (Ed.), The nature of the nonprofit sector

(pp. 40-45). Boulder, CO: Westview Press.

Scott, J., Vojir, C., Jones, K., & Moore, L. (2005). Assessing nursing homes’ capacity to

create and sustain improvement. Journal of Nursing Care Quality, 20(1), 36-

42. http://dx.doi.org/10.1097/00001786-200501000-00007

http://dx.doi.org/10.1093/geront/gnr025

http://ccss.jhu.edu/wp-content/uploads/downloads/2012/01/NED_National_2012.pdf

http://ccss.jhu.edu/wp-content/uploads/downloads/2012/01/NED_National_2012.pdf

http://dx.doi.org/10.1097/00001786-200501000-00007


Seavey, D. (2004). The cost of turnover in long-term care. Washington, DC: Better Jobs

Better Care. Retrieved from

http://www.leadingage.org/uploadedFiles/Content/About/Center_for_Applied_Re

search/Center_for_Applied_Research_Initiatives/Cost_Frontline_Turnover.pdf

Secrest, J., Iorio, D. H., & Martz, W. (2005). The meaning of work for nursing assistants

who stay in long-term care. Journal of Clinical Nursing, 14, 90-

97, doi:10.1111/j.1365-2702.2005.01282.x

Smith, D. H. (2001). The impact of the voluntary sector on society. In J. S. Ott (Ed.), The

nature of the nonprofit sector (pp.79-87). Boulder, CO: Westview Press.

Smith, K., & Baughman, R. (2007, September). Caring for America’s aging population:

A profile of the direct-care workforce. Monthly Labor Review, 20-26.

Stearns, S. C., & D’Arcy, L. P. (2008). Staying the course: Facility and profession

retention among nursing assistants in nursing homes. Journal of Gerontology:

SOCIAL SCIENCES, 63B(3), S113-

S121. http://dx.doi.org/10.1093/geronb/63.3.S113

Stone, R. (2004). The direct care worker: The third rail of home care policy. Annual

Review of Public Health, 25, 521-

537. http://dx.doi.org/10.1146/annurev.publhealth.25.102802.124343

Stone, R. (2011). Long-term care for the elderly. Washington, DC: The Urban Institute.

Stryker-Gordon, R. (1979). Minnesota study suggests means of reducing turnover rates in

nursing homes. Journal of Nursing Administration, 9(4), 17-

20. http://dx.doi.org/10.1097/00005110-197904010-00003

Teal, C. (2002). Direct care workers – number one quality indicator in long-term care: A

http://dx.doi.org/10.1093/geronb/63.3.S113

http://dx.doi.org/10.1146/annurev.publhealth.25.102802.124343

http://dx.doi.org/10.1097/00005110-197904010-00003


consumer’s perspective [Commentary]. North Carolina Medical Journal, 63(2),

102-105.

Tourangeau, A. E., & McGilton, K. (2004). Measuring leadership practices of nurses

using the leadership practices inventory. Nursing Research, 53(3), 182-

189. http://dx.doi.org/10.1097/00006199-200405000-00005

Tourish, D. (2013). The dark side of transformational leadership: A critical perspective.

New York, NY: Routledge.

Williams, L. J., & Hazer, J. T. (1986). Antecedents and consequences of satisfaction and

commitment in turnover models: A reanalysis using latent variable structural

equation methods. Journal of Applied Psychology, 71(2), 219-231.

http://dx.doi.org/10.1037/0021-9010.71.2.219

Yukl, G. (1999). An evaluation of conceptual weaknesses in transformational and

charismatic leadership theories. Leadership Quarterly, 10(2), 285-

305. http://dx.doi.org/10.1016/S1048-9843(99)00013-2

Yukl, G. (2006). Leadership in organizations (6th ed.). Upper Saddle River, NJ: Prentice

Hall.

http://dx.doi.org/10.1097/00006199-200405000-00005

http://dx.doi.org/10.1016/S1048-9843%2899%2900013-2


Appendix A

IRB#: 14-17015 Questionnaire Number: _________ Study Site Number: ____________

Leadership and Organizational Commitment: The Direct Care Worker Perspective


NOTE: Do NOT write your name or any identifying information on this form. This is to maintain anonymity and confidentiality to the survey process. Thank you!

Leadership Instructions: You are being asked to assess leadership behaviors for your direct/immediate supervisor. When selecting your response to each statement:

• Be realistic about the extent to which this person actually engages in the behavior.

• Be as honest and accurate as you can be.

• DO NOT answer in terms of how you would like to see this person behave or in terms of how you think he or she should behave.

• DO answer in terms of how this person typically behaves on most days, on most projects, and with most people.

• Be thoughtful about your responses. For example, giving this person 10s on all

items is most likely not an accurate description of his or her behavior. Similarly, giving someone all 1s or 5s is most likely not an accurate description either. Most people will do some things more or less often than they do other things.

• If you feel that a statement does not apply, it’s probably because you don’t see or

experience the behavior. That means this person does not frequently engage in the behavior, at least around you. In that case, assign a rating of 3 or lower.

For each statement, decide on a response and then record the corresponding number in the box to the right of the statement. After you have responded to all thirty statements, go back through one more time to make sure you have responded to each statement. Every statement must have a rating. The Rating Scale runs from 1 to 10. Choose the number that best applies to each statement. Rating Scale 1- Almost Never 3-Seldom 5-Occasionally 7-Fairly Often 9-Very Frequently 2-Rarely 4-Once in a While 6-Sometimes 8-Usually 10-Almost Always


Name of Leader I am assessing: My Direct/Immediate Supervisor. To what extent does this leader engage in the following behaviors? Choose the response number that best applies to each statement and record it in the box to the right of that statement. Rating Scale 1- Almost Never 3-Seldom 5-Occasionally 7-Fairly Often 9-Very Frequently 2-Rarely 4-Once in a While 6-Sometimes 8-Usually 10-Almost Always He or She:

1. Sets a personal example of what he/she expects of others. 2. Talks about future trends that will influence how our work gets done. 3. Seeks out challenging opportunities that test his/her own skills and abilities. 4. Develops cooperative relationships among the people he/she works with. 5. Praises people for a job well done. 6. Spends time and energy making certain that the people he/she works with adhere

to the principles and standards that we have agreed on.

7. Describes a compelling image of what our future could be like. 8. Challenges people to try out new and innovative ways to do their work. 9. Actively listens to diverse points of view. 10. Makes it a point to let people know about his/her confidence in their abilities. 11. Follows through on the promises and commitments he/she makes. 12. Appeals to others to share an exciting dream of the future. 13. Searches outside the formal boundaries of his/her organization for innovative

ways to improve what we do.

14. Treats others with dignity and respect. 15. Makes sure that people are creatively rewarded for their contributions to the

success of projects.

16. Asks for feedback on how his/her actions affect other people’s performance. 17. Shows others how their long-term interests can be realized by enlisting in a

common vision.

18. Asks “What can we learn?” when things don’t go as expected. 19. Supports the decisions that people make on their own. 20. Publicly recognizes people who exemplify commitment to shared values. 21. Builds consensus around a common set of values for running our organization. 22. Paints the “big picture” of what we aspire to accomplish. 23. Makes certain that we set achievable goals, make concrete plans, and establish

measurable milestones for the projects and programs that we work on.

24. Gives people a great deal of freedom and choice in deciding how to do their work.

25. Finds ways to celebrate accomplishments. 26. Is clear about his/her philosophy of leadership. 27. Speaks with genuine conviction about the higher meaning and purpose of our

work.

28. Experiments and takes risks, even when there is a chance of failure. 29. Ensures that people grow in their jobs by learning new skills and developing

themselves.


30. Gives the members of the team lots of appreciation and support for their contribution.

Copyright © 2013 James M. Kouzes and Barry Z. Posner. All rights reserved. Used with permission.

Organizational Commitment Instructions: Listed below is a series of statements that represent feelings that individuals might have about the company or organization for which they work. With respect to your own feelings about the particular organization for which you are now working, please indicate the degree of your agreement or disagreement with each statement by marking a number from 1 to 7 using the scale below.

1 = strongly disagree 2 = disagree 3 = slightly disagree 4= undecided 5 = slightly agree 6 = agree 7 = strongly agree

1. I would be very happy to spend the rest of my career with this organization. 2. I really feel as if this organization's problems are my own. 3. I do not feel a strong sense of "belonging" to my organization. 4. I do not feel "emotionally attached" to this organization. 5. I do not feel like "part of the family" at my organization. 6. This organization has a great deal of personal meaning for me. 7. Right now, staying with my organization is a matter of necessity as much as

desire.

8. It would be very hard for me to leave my organization right now, even if I wanted to.

9. Too much of my life would be disrupted if I decided I wanted to leave my organization now.

10. I feel that I have too few options to consider leaving this organization. 11. If I had not already put so much of myself into this organization, I might

consider working elsewhere.

12. One of the few negative consequences of leaving this organization would be the scarcity of available alternatives.

13. I do not feel any obligation to remain with my current employer. 14. Even if it were to my advantage, I do not feel it would be right to leave my

organization now.

15. I would feel guilty if I left my organization now. 16. This organization deserves my loyalty. 17. I would not leave my organization right now because I have a sense of obligation

to the people in it.

18. I owe a great deal to my organization. Used with permission © Meyer and Allen 2003


Demographic Information

Instructions: Please answer the following questions based on the options provided by placing a checkmark or X for your answer. All answers will remain confidential and will not be used to identify you, thus providing you anonymity in your responses. If you have any questions about any of the items, please ask the researcher.

What is your gender? ☐Female ☐Male What is your age? ____________ (This information will be used to understand the average age of direct care workers in the study. It will NOT be used to identify you or others in the study.) What is your ethnicity? ☐White ☐African/Black ☐Hispanic ☐American Indian ☐Asian ☐Other (specify) ____________________________ Have you ever served in the U.S. military? ☐Yes ☐No What is your highest level of formal education (if you have education in another country, please rate according to the option that best represents education levels in your country)? ☐Elementary School ☐Middle School ☐High School/GED ☐College/University with undergraduate degree ☐College/University with a graduate degree


What of the following best describes your relationship status? ☐Married ☐Single, never married ☐Single, but living with a significant other ☐Separated ☐Divorced ☐Widowed ☐In a domestic partnership or civil union Is English your first language? ☐Yes ☐No What is your length of employment at this organization? ☐Less than one year ☐1 to 3 years ☐4 to 6 years ☐7 to 9 years ☐More than 10 years What is your total time of experience working in long term care, with ANY employer? ☐Less than one year ☐1 to 5 years ☐6 to 10 years ☐11 to 15 years ☐16 to 20 years ☐21 to 25 years ☐More than 25 years What is your hourly wage? ___________________ (This information will be used to understand the average wage of direct care workers in the study. It will NOT be used to identify you or others in the study.) Are you satisfied with your pay at its current level? ☐Extremely satisfied ☐Somewhat satisfied ☐Somewhat dissatisfied ☐Extremely dissatisfied Do you belong to a union at your workplace? ☐Yes ☐No


How would you describe your yearly income? ☐Under $5000 ☐$5001-$10,000 ☐$10,001-$15,000 ☐$15,001-$20,000 ☐$20,001-25,000 ☐$25,001-30,000 ☐Over $30,000 Do you receive any income from Social Security? ☐Yes ☐No Do you receive any government assistance, such as Medicaid, food assistance, or utility (gas/fuel) assistance? ☐Yes ☐No Do you rent or own the place where you live? ☐Rent ☐Own ☐Neither, I am living with someone but do not pay rent Do you have more than one job? ☐Yes ☐No Does your employer provide health insurance benefits? ☐Yes ☐No ☐ I do not know How much do you pay in health insurance premiums? ☐Less than $100 per month ☐$101-$200 per month ☐$201-$300 per month ☐$301-$400 per month ☐$401-$500 per month ☐Over $500 per month ☐ I do not have health insurance ☐ I have health insurance, but not through this organization


Does your employer provide a retirement or pension plan for its employees? ☐Yes ☐No ☐Don’t know Does your employer provide paid sick time? ☐Yes ☐No ☐Don’t know Does your employer provide paid holiday time? ☐Yes ☐No ☐Don’t know Does your employer provide paid vacation time? ☐Yes ☐No ☐Don’t know In what location do you work at this organization (check all that apply)? ☐Nursing Home ☐Assisted Living ☐Home Health ☐Senior Housing/Independent Living Apartments ☐HUD/Low Income/Affordable Housing Apartments ☐Hospice ☐Adult Day Services What is your major source of transportation to and from work? ☐Drive myself ☐Ride from family, friends, or co-workers ☐Public transportation (bus, taxi) ☐Walk or Bike ☐Other (specify) ____________________________ Are you thinking about finding a different job? ☐Yes ☐No ☐Not sure, maybe Thank you for participating in the study! Please return this survey to Jen Porter for placement in a confidential envelope/box.


IRB#: 14-17015 Study Site Number: ____________

Study Site Administrator Site Information


How many total employees work at this location (include full-time, part-time, and PRN)? __________

How many direct care workers work at this location (please note by position category that closely resembles your job titles)?

Nursing assistants

Medication assistants

Dietary assistants

Cooks

Universal Workers

Home Health Aides

Housekeeping

Laundry Assistants Activity/Recreation Assistants

Other What is your current year-to-date (YTD) turnover for the direct care workers? What is the wage range for direct care workers? As an employer, which of the following benefits do you provide to direct care workers?

☐Health Insurance ☐Retirement or Pension Plan ☐Paid Vacation Time ☐Paid Sick Time ☐Paid Holiday Time

Within what settings does your organization directly provide services (not by a third party) at this organization (check all that apply)?

☐Nursing Home ☐Assisted Living ☐Home Health ☐Senior Housing/Independent Living Apartments


☐HUD/Low Income/Affordable Housing Apartments ☐Hospice ☐Adult Day Services

How much are health insurance premiums under your employer health insurance plan for family coverage? ☐Less than $100 per month ☐$101-$200 per month ☐$201-$300 per month ☐$301-$400 per month ☐$401-$500 per month ☐Over $500 per month ☐ I do not know

Generally speaking, would you say that direct care workers earn a sufficient wage? ☐Yes ☐No ☐Not sure Generally speaking, would you like to see the federal minimum wage increased? ☐Yes ☐No ☐Not sure Generally speaking, do you think an increase in the federal minimum wage would adversely affect your operations? ☐Yes ☐No ☐Not sure

Documents

THE RELATIONSHIP BETWEEN TRANSFORMATIONAL LEADERSHIP AND