Nurses’ and nurse managers’ perceived transformational leadership behavioural practices: a survey

Abstract

Background: In the last two decades, the continuous and progressive changes sweeping healthcare rendered it more difficult to function properly. Thus, an effective leadership is needed to successfully reach long-term goals. Recently, change has driven the healthcare system to lean towards a more transformational leadership style. The latter has been considered to be effective in promoting change in organisations, where the leader guides the followers towards a common vision. Local research on this topic was seen to be lacking, therefore the present study was inspired to fill this gap in local literature. Rationale for narrowing the research to charge nurses and staff nurses rather than the whole managerial system was to see whether transformational leadership style is being practised in ward or unit settings. Aim of the study: The aim of this research study was to identify and compare the perceived transformational leadership behavioural practices of charge nurses and the staff nurses under their direct supervision. Design: A quantitative, descriptive, comparative survey design was chosen for this study. Participants: All charge nurses and staff nurses (registered and enrolled nurses) both male and female at any age and at any level of education working in wards/units within six different health entities in Malta and Gozo. Methods: Quantitative data were collected using a mixed mode survey design, mainly an online and paper survey methods. The Survey Monkey online platform was used to create links to an online survey. An information letter with a link to the online survey was sent electronically to five hospitals including the oncology centre, large public acute, mental health and rehabilitation hospitals in Malta and the public acute hospital in Gozo. The long-term facility utilized the paper survey method as internet access to this entity was not possible. Data collected included the perceived transformational leadership behavioural practices of staff nurses and their immediate charge nurses, which were then compared between these two groups, different clinical settings and health entities. Data were entered into SPSS version 25 for analysis. A purposive sampling method was utilized. The total target population invited to participate in this study included 151 charge nurses and 1950 staff nurses. Results: This study achieved a response rate of 15% (n=315), including both charge nurses and staff nurses. Results show significant difference between these two variables’ perceptions in all five factors including ‘model the way’, ‘inspire a shared vision’, ‘challenge the process’, ‘enable others to act’ and ‘encourage the heart’. However, charge nurses scored higher than staff nurses. Among the ‘acute care wards’ and ‘long-term care wards’, all factors were significantly high but still differed significantly. Additionally, the ‘long-term care wards’ scored higher than the ‘acute care wards’. ‘Model the way’ was the most perceived factor among ‘long-term care wards’ while ‘enable others to act’ was the most perceived factor among ‘acute care wards’. Findings for the ‘acute care hospitals’ and ‘long-term care hospitals’ were consistent with the results reported for the wards. Conclusion: Transformational leadership style is highly perceived among local charge nurses and staff nurses. According to the data collected, the findings show that the nurses in Malta and Gozo are practicing transformational leadership style. The present study also concludes that transformational leadership style is more readily perceived by the ‘long-term care hospital’ rather than ‘acute care hospitals’. This shows that in hospital environments where there is less turnover rates of patients and less critical situations like the long-term care hospital, charge nurses work closer with their nurses by setting a personal example and standing up for one’s beliefs. Meanwhile, the ‘acute care hospitals’, perceive more behaviour which leans towards commitment and accountability, creating ownership and ensuring security.