Teresa Anderson, EdD, MSN, RNC-OB, NE-BC
Chief Nursing Officer, Voalte, Inc.
ANCC Magnet Program® Consultant

This quantitative, descriptive, correlation study
examined the relationships of the perceived levels of
transformational and authentic leadership among
Chief Nurse Executives (CNEs) of acute care U.S.
hospitals with personal attributes and organizational
context variables.


Transformational leadership
◦
◦
◦
◦
◦

Organizational Context
Variables
◦
◦
◦
◦
◦
◦
Idealized attributes
Idealized behaviors
Inspirational motivation
Intellectual stimulation
Individual consideration
Licensed bed size
Profit status
Religious affiliation
Magnet® status
Healthy Work Environment®
Nursing professional practice
culture
Authentic leadership
◦
◦
◦
◦
Transparency
Moral/Ethical
Balanced Processing
Self-awareness

Personal Attributes
◦
◦
◦
◦
Age
Leadership tenure
Level of Education
Type of Education

No consistent definition of “success” for nursing
leadership was evident within the literature reviewed.

Successful nurse executives must possess strong
communication, management, and business skills.
(Corning,
2002; Dunham & Fisher, 1990; Kirk, 2008;
Poulin, 1984; Upenieks, 2002, 2003)

Preliminary work confirms that transformational and
transactional leadership form a meaningful framework
in which to assess self and staff perceptions of
leadership style.
(Avolio & Bass, 2004; Bass & Riggio, 2006; Burns, 1978; Dunham-Taylor &
Klafehn, 1995; Judge & Piccolo, 2004; Walumbwa et al., 2007)

ANCC describes transformational leadership as a
component of success in Magnet Recognized®
facilities.
(Aiken et al., 2008; ANCC, 2008; McClure & Hinshaw, 2002)

Authentic leadership has captured the interest of social and
behavioral scientists as a basis for other forms of
leadership.
(Avolio & Gardner, 2005, Gardner et al., 2005; George, 2003)

Authentic leadership is based upon positive psychology, is
evident in genuine, ethical, and optimistic individuals, and
develops through self-reflection of trigger events and
meaning within the leadership role.
(Michie & Gooty, 2005; Shamir & Eilam, 2005; Sparrowe, 2005)

AACN identifies authentic leadership as a key component
of a Healthy Work Environment®.
(AACN, 2005; Shirey, 2006)
Successful
Nursing
Leadership
ANCC Magnet
Recognition®
Organizational
Context
Personal
Attributes
Individualized
Consideration
Intellectual Transformational
Stimulation Leadership
Inspirational
Motivation
Idealized
Influence
(attributes/
behaviors)
Self
Awareness
Authentic
Leadership
Ethical
Moral
AACN Healthy
Work Environment®
Balanced
Processing
Transparency
Positive Psychology
Figure 1. Anderson Predicted Nursing Executive
Leadership Conceptual Model
Full Range of Leadership Model
Effective
Transformational
Contingent Reward
Management By
Exception
Active
Passive
Active
Management By
Exception
Passive
Laissez-Faire
Ineffective
Figure 2. Full-Range of Leadership Model. Bass, B.M., &
Avolio, B.J. (1990). Manual for the Multifactor Leadership
Questionnaire. Menlo Park, CA: Mind Garden, Inc. Copyright
1990 by Bruce Avolio. Used with permission.

Population
◦ Active CNE members of the American Organization of Nurse
Executives (AONE)

Hosted CSM webpage linking to
◦ Online survey at Mind Garden, Inc. website
 Multifactorial Leadership Questionnaire (MLQ)
 Authentic Leadership Questionnaire (ALQ)
 Demographic Data Survey

Data spreadsheet
◦ .csv file uploaded to PASW and compatible with Excel

Multifactorial Leadership Questionnaire
◦ 45 items
◦ Nine subscales total, 5 subscales for Transformational
Leadership (idealized attributes, idealized behaviors,
inspirational motivation, intellectual stimulation, and
individualized consideration)

Authentic Leadership Questionnaire
◦ 16 items
◦ Four subscales (transparency, moral/ethical, balanced
processing, self-awareness)

Demographic Data Survey
◦ 12 items

184 completed surveys
◦ 1 subject eliminated for substantial missing data
◦ 39 subjects eliminated for failure to meet study inclusion
criteria

144 subjects included in study data analysis
◦ Sample size differed by variable based upon the number of
responses to individual questions
◦
◦
◦
◦
◦
◦
◦
◦
Represent 38 states
Mean age of participants was 53.8 years (range 33 – 69 years)
Mean years within their role was 9.8 years (range 0 – 38 years)
80.6% were educated at a masters degree level (35% of these
had nursing administration focus) and 8.3% were educated at
a doctoral level
88.5% work in organizations aspiring to or having achieved
Magnet Recognition® status
64.6% were implementing the AACN Healthy Work
Environment ®standards
71.5% were not for profit or identified their organization as
not religiously affiliated
Mean bed size was 302.91 beds (range 14 – 2,200 beds)

The age distribution of the participants represented a
non-normal distribution, skewed to the older end of
the range
Chief Nurse Executive Age Distribution
100
90
80
70
60
50
40
30
20
10
0
Number
Percentage
30s
40s
50s
60s
4
24
90
25
2.7
16.7
62.9
17.4
Figure 4. Chief Nurse Executive Age Distribution
by Decade
Magnet® Status
PERSONAL
ATTRIBUTES
Transformational
Leadership
ORGANIZATIONAL
CONTEXT
Age
Bed Size
Tenure in Executive
Role
Profit Status
Level of Education
Type of Education
Authentic
Leadership
Religious Affiliation
Nursing Professional
Practice Culture
Healthy Work
Environment®
What are the relationships between the perceived levels
of transformational leadership (TL) and authentic
leadership (AL) of chief nurse executives (CNEs) in U.S.
acute care hospitals?
 The research question was fully supported
◦ There were statistically significant positive relationships
between TL and AL on all subscales as analyzed by
Spearman Rho Correlations (between the five TL subscales
and the four AL subscales)
Transparency
Moral/
Ethical
Balanced
Processing
Self
Awareness
Idealized Attributes(A)
0.36**
0.28**
0.35**
0.41**
Idealized Influence (B)
0.32**
0.41**
0.39**
0.33**
Inspirational Motivation
0.41**
0.35**
0.38**
0.42**
Intellectual Stimulation
0.28**
0.28**
0.47**
0.51**
Individual Consideration
0.34**
0.36**
0.52**
0.48**
Variable
Note. *p < .05, **p < .01
Associations were all significant at p < .01 with
effect size ranging from small to large.
Cohen (1988) defines significance: .10 - .29 =
small; .30 - .49 = medium; > .50 = large .
Study
M
Normative
M
Idealized Influence (Attributes)
3.47
2.95
Idealized Influence (Behaviors)
3.60
2.99
Inspirational Motivation
3.64
3.04
Intellectual Stimulation
3.45
2.96
Individual Consideration
3.64
3.16
Research variable
MLQ
Normative Mean Database maintained by Mind Garden, Inc.
What are the relationships between the perceived levels
of transformational and authentic leadership of CNEs
in U.S. acute care hospitals and the organizational
context variables of the setting in which the chief nurse
executive is employed?

Demonstrated mixed findings and the research
question was only partially supported
◦ Bed size, profit status, religious affiliation, and Healthy Work
Environment showed no association
◦ Magnet Status and NPPC demonstrated positive associations
with only two leadership subscales (Idealized Behaviors and
Ethical/Moral)

There was only one significant relationship between
transformational leadership (TL) and the organizational
context variables:
◦ The Idealized Behaviors subscale was positively associated
with having an active Magnet Recognition® application.
(Mann Whitney U-test: U = 364.50, p < .009)

There was only one significant relationship between
authentic leadership (AL) and the organizational context
variables:
◦ The Ethical/Moral subscale demonstrated a small positive
association with the presence of a Nursing Professional
Practice Culture
(Spearman Rho Correlation: 0.20, p <.05)
What are the relationships between the perceived levels
of transformational and authentic leadership of CNEs
in U.S. acute care hospitals and the personal attribute
variables of the chief nurse executives?

Demonstrated mixed findings and the research
question was partially supported

Specific Findings:
Transformational Leadership subscale positive correlations
included:
◦ Intellectual Stimulation and Individual Consideration with
age
◦ Intellectual Stimulation, Inspirational Motivation, and
Idealized Behaviors with level of education
Idealized Attributes showed no associations
Level of
Education
Variable
Age
Tenure
Idealized Attributes
0.10
0.07
0.15
Idealized Behaviors
0.13
0.10
0.19*
Inspirational Motivation
0.08
0.15
0.17*
Intellectual Stimulation
0.23**
0.10
0.22**
Individual Consideration
0.22**
0.04
0.13
Note. *p < .05, **p < .01
Cohen (1988) defines significance: .10 - .29 =
small; .30 - .49 = medium; > .50 = large .

Specific Findings:
Authentic Leadership subscale positive correlations include:
◦ Moral/Ethical, Balanced Processing, and Self-Awareness
with age
◦ Moral/Ethical with tenure and level of education
Transparency showed no associations.
Type of education could not be analyzed fully due to
excessive stratification of the findings; however, ancillary
analyses were conducted relative to master’s education in
nursing administration, with no significant findings.
Variable
Level of
Education
Age
Tenure
Transparency
0.02
-0.03
Moral/Ethical
0.20*
0.22**
0.15
Balanced Processing
0.21*
0.01
0.10
Self-Awareness
0.20*
0.14
0.10
-0.01
Note. *p < .05, **p < .01
Cohen (1988) defines significance: .10 - .29 =
small; .30 - .49 = medium; > .50 = large .

Are there statistically significant differences in MLQ and
ALQ sub-scores by level of education (Diploma, ASN,
BSN degrees vs. Master’s degree vs. Doctoral degree) of
chief nurse executives (CNEs) in US acute care hospitals?
◦ The TL subscale Intellectual Stimulation revealed significant
differences by education level (master’s and doctoral higher)
◦ The AL subscale Moral/Ethical revealed significant
differences by education level (master’s higher)
U Test
U
p
Mean
Rank
Sum of
Ranks
Intellectual Stimulation
Diploma/ASN/BSN
509.05 .003 40.34
645.50
Master’s degree
70.11 8132.50
Diploma/ASN/BSN
43.50 .013 11.22
179.50
Doctoral degree
18.88
226.50
Moral/Ethical
Diploma/ASN/BSN
458.00 .000 37.13
594.00
Master’s degree
70.02 8052.00
Diploma/ASN/BSN
53.00 .047 11.81
189.00
Doctoral degree
18.08
217.00
The significance value of p was determined to be at .025 (.050/2)
for the pair-wise comparison.

All statistical associations were in a positive direction;
as one variable increased so did the other

Transformational and authentic leadership were
significantly associated with each other

Transformational and authentic leadership were only
minimally associated with organizational context
variables

Transformational and authentic leadership were
positively associated with personal attributes more
often than with organizational context variables
Personal
Attributes
Organizational
Context
Idealized
Attributes
Transparency
Idealized
Behaviors
ANCC Magnet
Recognition®
No Intent
No Application
Active Application
Magnet Status
Ethical
Moral
Age
Level of Education
Type of Education
Tenure
Individualized
Consideration
Self
Awareness
Profit Status
Religious Affiliation
Licensed Bed Size
NPPC
Intellectual
Stimulation
Balanced
Processing
NOTE:
All associations were positive
Inspirational
Motivation
AACN Healthy Work
Environment®
Positive Psychology
Figure 5. Anderson Nursing Executive Leadership Conceptual Model.
Arrows represent statistically significant associations between variables.
Research Question 1
 CNEs who perceive themselves as transformational
leaders, also perceive themselves as authentic leaders
◦ authentic leadership as a basis for other forms of leadership
(Avolio & Gardner, 2005)

Although associated, transformational and authentic
leadership are two distinctly different leadership styles
(Walumbwa et al., 2008)

Transformational and authentic leadership are strongly
related, which might have implications for
◦ screening and selection of future leaders
◦ education and development of future leaders
Research Question 2

The relationships between transformational and authentic
leadership and organizational context were not consistent
with the results of previous studies (AACN, 2005; ANCC, 2008; Bass &
Riggio, 2006; Dirks & Ferrin, 2002; Drenkard, 2009; Dunham-Taylor, 2000; McClure &
Hinshaw, 2002; Shirey, 2006; Upenieks, 2003)
suggesting
◦ the need for further study in this area

The moral/ethical component of authentic leadership did
not associate with religious affiliation as suggested by
positive psychology findings (Dirks & Ferrin, 2002; Dunham & Fisher, 1990;
Gardner, Avolio, Luthans, May, & Walumbwa, 2005; Michie & Gooty, 2005; Upenieks,
2002, 2003)
Research Question 2
 The relationship between transformational leadership and
the ANCC Magnet Recognition Program® was minimal,
which
◦ does not validate or negate this leadership style as critical to
building an excellent nursing practice environment (ANCC, 2008)

The relationship between authentic leadership and the
implementation of the AACN Healthy Work Environment
was not significant, which
◦ suggests the need for further research to validate this leadership
style as a key component of a healthy work environment (AACN,
2005)
Research Question 3

The mean age of CNEs in the study was 53.8 years (median
55 years), and 80.5% were over the age of 50 years, which
may impact
◦ turnover and vacancy of CNEs nationally within the next 10 – 15
years
◦ conscious attention to CNE succession planning is needed now

The relationship between age and authentic leadership
suggests
◦ support for findings related to conscious self-reflection and
trigger events over time (Avolio & Gardner, 2005; Ilies et al., 2005)
Research Question 3
 The relationship of education level and
transformational leadership
◦ supports the findings of others (Dunham & Klafehn, 1990)
◦ could be impacted by Magnet Program® eligibility requirements

The mean tenure of Chief Nurse Executives is 9.8 years
suggesting that
◦ CNEs seek advancement within different facilities, or experience
dissatisfaction or burn-out in the role (Jones, Havens, Thompson, &
Knodel, 2008)
◦ mobility of chief nurse executives may mediate the impact of
setting or organizational context
◦ CNE tenure may implicate experience as a factor in leadership
success (Henderson, 1995; Linton & Farrell, 2009)
Education

Availability of nursing administration master’s programs
◦ Declined between 2004 and 2008 (Institute of Medicine, 2011)

Impact of DNP programs on educational preparation of
CNEs (Institute of Medicine, 2011)

Competition between academia and practice for highly
qualified nurses to fill openings
◦ 54.5% vacancies, and 20.1% additional faculty needed (Tracy & Fang,
2010)
◦ Flexibility of curricula
◦ Creative solutions – dual roles or subsidized faculty positions
Practice

Transformational leadership may develop as a result of
authenticity (self-awareness, balanced processing,
moral/ethical, and transparency) or concurrently with it

Authenticity develops as a result of reflection upon the
events of one’s life over time, which suggests
◦ a possible connection to age, experience and level of education

Further analysis of relationships between authentic
leadership and the other forms of leadership within the
Full Range of Leadership Model is needed (Bass & Avolio,
1990)
Transformational
Leadership
+
Authentic Leadership
?
Contingent
Reward
Management by
Exception - Active
Management by
Exception - Passive
Laissez-Faire



Findings suggest a positive relationship between
transformational and authentic leadership as perceived
by CNEs
The relationship between age, level of education,
tenure, and leadership style suggests that personal
attributes are important determinants of leadership
style and may possibly mediate success
The impact of personal attributes, leadership style, and
the development of leaders will be critical as the
majority of nurse executive incumbents retire over the
next 10 – 15 years
Transformational leadership and authenticity may
provide leaders with the means to channel their
“passion” for the nursing executive role into strategic
vision and operational success.
Next steps…
Analysis of remaining data
Chief Nurse Executive Life Stories
402-556-4274 – home
402-679-1551 – cellular
tlanderson@cox.net
tlanderson@voalte.com
www.cnoadventure.com
www.Voalte.com
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