Running head: TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
Transformational Nursing Leadership and Effects on Job Satisfaction: An Integrated Literature
Review
Karen Fugate
University of Central Florida
1
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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Abstract
Aim. To critique the evidence that examines the impact of transformational leadership compared
to other leadership styles on nurse job satisfaction in the hospital setting.
Background. Nursing shortages and escalating clinical demands on staff can lead to job
dissatisfaction and subsequent nurse turnover. The leadership styles of nurse managers can
influence staff nurse job satisfaction. Therefore it is of utmost importance to identify the
leadership style associated with the highest level of staff nurse job satisfaction.
Design. An integrated literature review.
Method. Searches of CINAHL, PubMed, and the Cochrane Library between 1999 - February
2014. Included articles were appraised and synthesized into a narrative summary.
Conclusions. Results indicate there is a positive correlation between transformational leadership
and increased nurse job satisfaction in the hospital setting. Conversely, task focused and passive
leadership styles are negatively correlated with nurse job satisfaction.
Relevance to clinical practice. Transformational leadership is the preferred leadership style to
increase nurse job satisfaction. Transformational leadership must be supported and nurse leaders
should be encouraged to develop knowledge and skills related to transformational leadership.
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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Transformational Nursing Leadership and Effects on Job Satisfaction: An Integrated Literature
Review
Significance
Healthcare organizations are systems where human resources are the most important
factor for the delivery of quality healthcare; nursing is the largest workforce within the
healthcare organization. Nurses are the front line healthcare providers who spend more time with
patients than any other healthcare professional. Therefore achieving optimal healthcare delivery
is difficult, if not impossible without the efforts and commitment of staff nurses. Nursing
leadership has a significant impact on creating practice environments that support and motivate
staff nurses to provide the highest level of care to healthcare consumers.
The concept of job satisfaction is of paramount importance to nursing leadership. Nurse
satisfaction has been linked to positive patient outcomes (Aiken, Clark, Sloane, Sochalski, &
Silber, 2002). Nursing job satisfaction is also critical for nurse retention; dissatisfied nurses are
more likely to quit resulting in high turnover rates within the healthcare organization (Larrabee et
al., 2003, Weberg, 2010). The economic implications of high nurse turnover to the healthcare
organization cannot be understated. The loss of an experienced nurse can lead to short staffing,
increased recruitment and orientation costs, increased adverse patient outcomes and
consequently higher staff dissatisfaction (Hayes, Bonner, & Pryor, 2010). It is estimated that the
cost to replace a nurse is between $22,000 and $64,000 with the loss of experienced nurses being
especially costly as it takes years to develop nursing expertise (Robert Wood Johnson
Foundation [RWJF], 2009). On a more national scale, job dissatisfaction may result in nurses
leaving the profession altogether which further exacerbates the current nursing shortage
(American Association of Colleges of Nursing [AACN], 2014). McHugh et al. (2011) found
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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patient satisfaction levels to be lower in hospitals with higher nurse dissatisfaction rates.
Additionally, job satisfaction has been linked to higher overall life satisfaction which indicates
how satisfied the nurse is with life in general and how well their physical and psychological
needs are being met (Hayes, Bonner, & Pryor, 2010). Many factors influence nursing job
satisfaction; a factor receiving much attention lately is nursing leadership (Cummings et al.,
2010).
According to Cummings et al. (2010), leadership includes four elements: 1) leadership is
a process, 2) involves influence, 3) occurs within a group context, and 4) involves achieving
common goals. Within healthcare there are several leadership styles that can be grouped into
relationally focused or those that focus on people and relationships and task focused (nonrelationally focused) or those that focus on tasks to be completed (Cummings et al., 2010). The
relationally focused group includes transformational leadership, individualized consideration,
and resonant leadership; the task focused group includes management by exception, laissez-faire,
transactional, dissonant, and instrumental leadership styles (Cummings et al., 2010).
The transformational leader has the relational skills to motivate followers to do more than
they originally intended and more than they thought they were capable of (Cummings et al.,
2010). The transformational leader embodies several traits including expanding and elevating the
interests of their followers, building awareness and commitment to the organizational mission,
and facilitating followers to transcend their own self-interests for the betterment of the team
(Weberg, 2010). The transformational leader inspires and engages followers.
Nursing job satisfaction is related to patient clinical (Aiken et al., 2002) and satisfaction
outcomes (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011), nurse retention (RWJF,
2009, AACN, 2014), and overall life satisfaction (Hayes et al., 2010). Nursing leadership style
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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influences nurse job satisfaction (Cummings et al., 2010). It is imperative that nurse leaders
understand which leadership style has the most impact on nurse job satisfaction. This leadership
style should be encouraged and developed to enhance nurse job satisfaction. Transformational
leadership has been given much attention recently; however does it positively impact nurse job
satisfaction? To gain insight into transformational leadership compared to other leadership styles
and their effect on nurse job satisfaction, the following PICO question was formulated to guide
the literature review: How does transformational leadership (I) compared to other leadership
styles (C) influence job satisfaction (O) for the hospital staff nurse (P)?
Methods
A literature search was conducted to answer the PICOT question, how does
transformational leadership (I) compared to other leadership styles (C) influence job satisfaction
(O) for the hospital staff nurse (P). The search was conducted in the following databases:
Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Cochrane
Database of Systematic Reviews. Key search terms included singly or in various combinations:
nurse, “staff nurse”, leadership, “leadership styles”, “transformational leadership”, “nurs*
leadership”, “nurs* leadership styles”, “job satisfaction”, satisfaction, “nurs* job satisfaction”,
and “nurs* work environment”. A manual search was also conducted using the ancestry
approach by reviewing the reference lists of each selected article to identify additional journal
articles. The search was limited to quantitative research articles that examined the influence of
transformational leadership compared to other leadership styles on acute care nurse job
satisfaction. Additionally, the search was limited to articles published in the last fifteen years.
Exclusion criteria were also considered while extracting relevant articles. Articles measuring job
satisfaction in nurse managers or nurse administration were excluded. Articles measuring quality
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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of work environment or work life that did not specifically measure job satisfaction were
excluded as were articles measuring satisfaction with leadership. Articles that did not include
transformational leadership or compare transformational leadership to at least one other
leadership style were not included. Additionally, articles that addressed nurse satisfaction in a
setting other than acute care were excluded (i.e. outpatient, elder care, long term acute care or
skilled nursing facility setting). Lastly, level of evidence and quality of the articles was taken
into consideration. The Rating System for the Hierarchy of Evidence of Intervention/Treatment
Questions (Melnyk & Fineout-Overholt, 2011) was utilized to rate the quality of the articles. The
articles were selected for their validity, reliability, and applicability with reference to the PICOT
question.
Results
Search results
Despite a comprehensive search, there were few research studies related to
transformational leadership’s effect on nurse job satisfaction compared to other leadership styles.
A total of fifty-three articles were identified from database searches: twenty-eight from
CINAHL, twenty-five from PubMed, and zero from the Cochrane Database of Systematic
Reviews. Additionally, three articles were identified via the ancestry method from a manual
review of article reference lists.
Of the CINAHL articles, five were included and twenty-three were eliminated. Four
were eliminated because they were in a non-hospital setting – two elder care, one long-term care
facility, and one ambulatory care. Five did not address nurse job satisfaction specifically and four
measured job satisfaction in managers, leaders, and faculty. Four did not include
transformational leadership style as one of the measures and one evaluated transformational
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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leadership only. Five articles were commentaries and or exemplars and were eliminated for their
lack of quantitative evidence. The PubMed search identified twenty-five articles. Twenty-one of
the articles were duplicates of the CINAHL search. Of the four remaining articles, one was a
commentary, one did not evaluate nurse job satisfaction, and two did not correlate job
satisfaction with leadership style.
After review, eight articles were found to be suitable for appraisal and pulled as full text
– five from the CINAHL search and three identified through review of article reference lists.
Upon evaluation, all eight articles were found to be relevant to the PICOT question. There were
no randomized controlled trials or controlled trials without randomization. The level of evidence
for this literature review consisted of two Level V articles (systematic reviews of descriptive and
qualitative studies) and six Level VI articles (single descriptive or qualitative studies) (Melnyk &
Fineout-Overholt, 2011).
A summary of the design, level of evidence, sample characteristics and results for each of
the eight articles included in the integrated literature review are included as tables. The articles
are organized alphabetically by first author and are classified into the following three themes
based on the influence of nurse leadership style on job satisfaction (Table 1), nurse work
environment (Table 2), and nurse manager outcomes (Table 3).
Job satisfaction
Two studies (Abualrub & Alghamdi, 2012; Failla & Stichler, 2008) and one evidence
review (Weberg, 2010) address the impact of leadership style on job satisfaction (see Table 1).
When transformational leadership was compared to other leadership styles, transformational
leadership was related to increased job satisfaction whereas other leadership styles were
associated with decreased job satisfaction. Abualrub and Alghamdi (2012) and Failla and
Stichler (2008) report a significant and moderate positive relationship between transformational
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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leadership and job satisfaction (r = 0.45 and 0.38 respectively). Failla and Stichler (2008) also
report positive correlations between transformational subscales and job satisfaction; the strongest
correlation (r = 0.425) was between the transformational subscale “attributed idealized
influence” and job satisfaction indicating the leader that is seen as charismatic, powerful and
confident is more likely to have staff that are satisfied with their job. Conversely, negative
correlations are reported between transactional, passive avoidance and laissez-faire leadership
styles and job satisfaction; laissez-faire had the strongest negative correlation (Abualrub &
Alghamdi, 2012; Failla & Stichler, 2008). In addition to the findings in the two studies, Weberg
(2010) evaluates seven articles in his evidence review and concludes that transformational
leadership increases job satisfaction and transactional and laissez-faire leadership lead to poor
job satisfaction.
One of the two studies was conducted in Saudi Arabia strengthening the argument and
indicating the findings are not limited to the United States (Abualrub & Alghamdi, 2012). Both
studies use validated psychometric tools to measure leadership style and job satisfaction. The
Multi-factor Leadership Questionnaire (MLQ) is utilized in both studies to measure leadership
style which provides for consistent measurement of leadership traits.
Table 1: Studies related to job satisfaction
Primary
Study,
Country
Abualrub
et al.
(2012)
Saudi
Arabia
Design, Level of
Evidence, Sample
Descriptive
correlational
design
Level VI
A convenience
sample of staff
RNs working in 6
public hospitals
n = 308
Characteristics of
Intervention
No direct intervention.
The study was designed to
examine the impact of
leadership styles
(transformational and
transactional) on levels of
intent to stay at work and job
satisfaction among hospital
nurses. A structured
Results
There was a significant
correlation in the positive
direction between job
satisfaction scores and
transformational leadership
style (r = 0.45, P <0.001).
Conversely, there was a
significant correlation in the
negative direction between
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
Primary
Study,
Country
Design, Level of
Evidence, Sample
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Characteristics of
Intervention
Results
questionnaire combining the
Multifactor Leadership
Questionnaire (MLQ-5X),
Job Satisfaction Survey
(JSS), and McCain’s Intent to
Stay Scale was used to
collect data and measure the
study variables.
job satisfaction scores and
transactional leadership style
(r = - 0.14, P < 0.01).
Results of hierarchical
regression analysis indicated
that 32% of variation in job
satisfaction was explained by
the background variables,
transformational and
transactional leadership style.
Significant and positive
correlations were
demonstrated between
aggregate scores of work
satisfaction and
transformational leadership
style overall and in 4
subscales of the MLQ:
Transformational leadership
overall – r = 0.348a
Attributed idealized influence
– r = 0.425a
Behavioral idealized
influence – r = 0.265a
Inspirational motivation – r =
0.413a
Intellectual stimulation – r =
0.282a
Transactional leadership
showed a statistically positive
correlation in one subscale
only (contingent reward – r =
0.0328a and passive-avoidant
leadership showed
statistically negative
correlation overall (r = 0.0241a) and laissez-faire (r =
-0.290a)
aSignificant at <.05 level
3 studies evaluated leadership
style and influence on staff
satisfaction (2 were
conducted in large acute care
Failla et
al.(2008)
United
States of
America
Cross-sectional,
descriptive
correlational
design
Level VI
A convenience
sample drawn from
a population of
nurses and nurse
managers in a large
metropolitan
hospital campus
n = 92 (76 staff
nurses)
No direct intervention.
Data were collected from
self-administered
questionnaires. The
Multifactor Leadership
Questionnaire (MLQ) was
used to measure leadership
characteristics and the Index
of Work Satisfaction
Questionnaire – Part B (IWSB) was used to measure work
satisfaction. The intent of the
study was to answer 4
research questions, one of
which was the relationship
between nurse manager’s
leadership style and level of
job satisfaction among
his/her staff.
Weberg
(2010)
United
States of
Evidence review
Level V
7 studies were
included in the
No direct intervention.
The evidence review was
conducted to answer the
PICO question “In healthcare
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
Primary
Study,
Country
America
10
Design, Level of
Evidence, Sample
Characteristics of
Intervention
Results
final evaluation of
evidence. All were
quantitative in
design and used
correlational, nonexperimental, or
cross-sectional
designs.
organizations (P), how does
transformational leadership
(I) influence staff satisfaction
and job burnout (O)?”
hospitals and one in an elder
care center).When
transformational leadership
was compared with other
leadership styles looking at
staff satisfaction as an
outcome, transformational
leadership was related to an
increase in staff satisfaction
in healthcare organizations
whereas other leadership
styles were related to a
decrease in staff satisfaction.
Work environment
Two studies (Larrabee et al., 2003; Malloy & Penprase, 2010) and one systematic review
(Cummings et al., 2010) are included to address the impact of leadership style on the nurse work
environment (see Table 2). As in the “job satisfaction” theme, the MLQ is utilized in both studies
ensuring a consistent method to measure leadership traits. Both studies utilize a conceptual
model suggesting they were guided by a theoretical framework which strengthens the validity of
the study findings. Larrabee et al. (2003) study nurse job satisfaction compared to work
environment variables of context of care, structure of care, and nurse attitudes; work
environment context variables include leadership styles. Larabee et al. (2003) reveal a significant
strong positive correlation between nurse job satisfaction and transformational leadership (r =
0.53) and a significant moderate negative correlation between more passive leadership styles management by exception and laissez faire. Malloy and Penprase (2010) examine the correlation
between leadership style components and psychosocial work environment dimensions one of
which is job satisfaction. Malloy and Penprase (2010) report significant positive correlations
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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between all components of transformational leadership and job satisfaction; the strongest
correlations are between idealized influence attributes, inspirational motivation, and intellectual
stimulation. Cummings et al. (2010) conduct a systematic review of the relationship between
leadership styles and nursing workforce and work environment outcomes; outcomes are grouped
into five categories one of which is staff satisfaction with work. Upon review of fifty-three
articles, Cummings et al. (2010) report a positive association between relationship-focused
leadership styles such as transformational leadership and higher nurse job satisfaction in twentytwo studies, whereas ten studies reveal leadership styles focused on tasks are correlated with
lower nurse job satisfaction.
All three articles report a positive relationship between leadership styles that fit the
transformational form of leadership and job satisfaction. They also reported lower job
satisfaction with more task focused forms of leadership such as management by exception and
laissez-faire leadership. This is consistent with findings in the aforementioned “job satisfaction”
theme.
Table 2: Studies related to work environment
Primary
Design, Level of
Study,
Evidence, Sample
Country
Systematic review
Cummings
et al. (2009) Level V
53 total studies
Canada
were included
which were all
quantitative in
design and used
correlational, nonexperimental, or
cross-sectional
designs
Characteristics of
Intervention
No direct intervention.
The specific aim of the
review was to
systematically review the
literature to examine the
relationships between
various styles of leadership
and outcomes for the
nursing workforce and their
work environments. Studies
were divided into 5 themes
which investigated the
outcomes of leadership on,
Results
Nursing satisfaction was the
most frequently examined
outcome of leadership (24
studies). Twenty-two studies
reported highest job
satisfaction with a variety of
relational focused leadership
styles including
transformational leadership.
Two studies found that
relational leadership styles
were not significantly
associated with job
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
Primary
Study,
Country
Larrabee et
al. (2003)
United
States of
America
Malloy et
al. (2010)
United
States of
America
Design, Level of
Evidence, Sample
Characteristics of
Intervention
1) staff satisfaction, 2) staff
relationships with work, 3)
staff health and well-being,
4) work environment
factors, and 5) productivity
and effectiveness.
Non-experimental, The purpose of the study
descriptive design was to examine the relative
Level VI
influence on nurse attitudes,
Nonrandom
context of care, and
sample of RNs in
structure of care on job
a large university
satisfaction and intent to
hospital (n = 90)
leave. Several instruments
with known psychometric
properties were utilized
including the Multifactor
Leadership Questionnaire to
measure nurse manager
leadership style and the
Work Quality Index (WQI)
to measure RN job
satisfaction.
Correlational
No direct intervention. The
design
aim of this study was to
Level VI
examine the relationship
Convenience
between leadership style
sample of RNs
and the psychosocial work
working for a
environment of registered
government
nurses. The Multifactor
agency - n = 122
Leadership Questionnaire
(35 supervisory
5X was used to evaluate
and 87 nonleadership style and the
supervisory)
Copenhagen Psychosocial
Questionnaire was used to
measure psychosocial work
environment.
12
Results
satisfaction. Ten studies
reported job satisfaction was
significantly lower with more
task focused forms of
leadership.
Multivariate regression
analyses evaluated models
that best predict RN job
satisfaction.
Pearson correlation between
RN job satisfaction and:
Transformational leadership –
r = 0.53, P < 0.0001
Contingent reward – r = 0.52,
P < 0.0001
Management by exception
(passive) – r = -0.041, P
<0.0001
Laissez-faire leadership – r =
-0.42, P < 0.0001
Correlations between
leadership model components
and job satisfaction measured
by Pearson’s r (*P < 0.05,
**P < 0.01). Components of
transformational leadership
have a higher correlational
with job satisfaction than
transactional and passiveavoidance leadership
components (see below).
Transformational Leadership
components: Idealized
Influence-Attributes (0.48**),
Individual Consideration
(0.44**), Idealized InfluenceBehavior (0.39**)
Inspirational Motivation
(0.48**), Intellectual
Stimulation (0.48**)
Transactional Leadership
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
Primary
Study,
Country
Design, Level of
Evidence, Sample
Characteristics of
Intervention
13
Results
components:
Contingent Reward (0.45**),
Management by ExceptionActive (-0.21*)
Passive-Avoidance
Leadership:
Management by exceptionpassive (-0.44**), Laissez
Faire (-0.53**)
Nurse manager outcomes
Two studies (Cassida & Parker, 2011; Dunham-Taylor, 2000) are included to address the
final theme of influence of leadership style on nurse manager outcomes (see Table 3). As in the
previously described themes, both studies utilize the MLQ to measure leadership traits; however
these two studies also use the MLQ to evaluate the nurse manager outcomes of leader’s extra
effort, leadership effectiveness, and leadership satisfaction (LS). Leadership satisfaction
indicates the manager’s ability to meet the needs of the staff nurse through positive
communication, interaction, and increased visibility, thereby keeping staff nurses satisfied with
their work (Cassida & Parker, 2011). Both studies report significant positive correlations
between transformational (r = 0.82 and 0.79) and transactional (r = 0.27 and 0.37) leadership
styles and LS; however there was a stronger relationship between transformational leadership
and LS (Cassida & Parker, 2011; Dunham-Taylor, 2000). Moreover, Casida and Parker (2011)
report the best predictor for the LS variable to be idealized influence attributes; this result is
similar to findings in previously mentioned studies conducted by Failla and Stichler (2008) and
Malloy and Penprase (2010).
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
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Table 3: Studies related to nurse manager outcomes
Primary
Study,
Country
Casida et
al. (2011)
United
States of
America
DunhamTaylor
(2000)
United
States of
America
Design, Level of
Evidence, Sample
Characteristics of
Intervention
Exploratory
correlational
design
Level VI
Sample derived
from 4 hospitals in
Northeast U.S. –
staff nurses (n =
278, nurse
managers (n = 37)
No direct intervention.
Staff nurses were asked to
evaluate the leadership style
and outcomes of nurse
managers using the
Multifactor Leadership
Questionnaire Form 5xShort. Outcomes included
leader’s extra effort (LEE),
satisfaction with leader (LS),
leadership effectiveness
(LE). All 3 outcomes are
associated with nurse job
satisfaction.
Results
Correlations among nurse
manager leadership styles and
outcomes were measured
using Pearson’s r. Asterisk
denotes statistical significance
P <0.0001.
Transformational leadership
demonstrates positive, strong,
significant correlations with
LEE, LS, and LE (0.83*,
0.82*, 0.89*). There was a
significant weakly positive
correlation between
transactional leadership and
LEE, LS, and LE (0.29*,
0.27*, 0.28*).
Descriptive,
No direct intervention.
As staff rated nurse executive
correlational
Study aimed to examine
transformational leadership as
design
transformational leadership
occurring more frequently,
Level VI
and outcomes (see below),
they rated their satisfaction
Random sample of stage of power, and
with leadership to increase.
nurse executives
organizational climate. Nurse This relationship was strongly
from full-service
executives and staff reporting positive and statistically
or children’s
to them rated the nurse
significant (r = 0.79, P <
general hospitals
executive’s leadership style
0.0001). Staff satisfaction
in the U.S. (n =
and outcomes of staff extra
with leadership style
396) and the staff effort, staff satisfaction, and
decreased as staff rated the
reporting to the
work group effectiveness
executive as being more
nurse executive (n using the Multifactor
transactional (r = 0.37, P <
= 1,115)
Leadership Questionnaire.
0.0001).
Executives’ bosses rated
work group effectiveness.
Nurse executives rated their
stage of power using
Hagberg’s Personal Power
Profile and ranked their
organizational climate using
Likert’s Profile of
Organizational
Characteristics.
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Limitations of evidence
Only published studies were included in this review which may contribute to reporting
bias since published work tends to reflect positive findings. An additional limitation of this body
of evidence is that the data in all the studies were obtained from surveys. Survey study
limitations include respondent bias secondary to convenience sampling. Notable also was the
low survey response rate (<60%) in several of the studies (Abualrub & Alghamdi, 2012; Failla &
Stichler, 2008; Larrabee et al., 2003; Malloy & Penprase, 2010); better response rates would
improve reliability of the results. Another limitation is that there were no randomized controlled
trials; although logistically challenging, this type of evidence would have been helpful. This is
due in part to the nature of studying leadership; the specific leadership style populations are most
easily studied by convenience sampling. Additionally, the single site sample of some of the
studies and small sample size limit generalizability (Failla & Stichler, 2008; Larrabee et al.,
2003; Malloy & Penprase, 2010). Conversely, the consistent use of the MLQ increases the
validity and generalizability of the study results. Limitations are also lessened by the consistent
findings across studies correlating transformational leadership with job satisfaction (r = 0.348,
0.45, 0.53, 0.79, 0.82).
Recommendation for Practice
The research for the PICO question, how does transformational leadership (I) compared
to other leadership styles (C) influence job satisfaction (O) for the hospital staff nurse (P)
resulted in indicating that transformational leadership compared to other leadership styles has a
positive impact on nurse job satisfaction. The nurse manager who displays transformational
leadership qualities will have higher staff nurse satisfaction. Therefore, it is recommended that
transformational leadership is the preferred leadership style to increase nurse job satisfaction.
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
16
Nurse leaders practice multiple styles of leadership. Leadership theory depicts a
continuum of leadership styles ranging from highly engaged on one end of the spectrum
(transformational leadership) to highly avoidant on the other end. Currently many healthcare
leaders are primarily task focused (Cummings et al., 2010). According to Cummings et al.
(2010) and Cassida and Parker (2011), transformational leadership skills can be learned. Hence,
transformational leadership training and mentoring should be offered for nurse leaders to
encourage and develop knowledge and skills related to transformational leadership. Furthermore,
there should be a strong focus on idealized influence attributes as this is the transformational
leadership characteristic most predictive of higher nurse job satisfaction (Cassida & Parker,
2011; Failla & Stichler, 2008; Malloy & Penprase, 2010).
If healthcare is going to effectively confront a rapidly changing, complex environment, it
will need to invest energy and resources into developing insightful, visionary, competent,
motivational leaders that will positively affect nurse job satisfaction which will ultimately
improve the quality care for healthcare consumers. Representing the largest workforce in
healthcare, the transformational nurse leader is perfectly positioned to lead this challenge. In
addition, given the looming nursing shortage and the relationship between nurse job
dissatisfaction and intent to leave (Larrabee et al., 2003; Weberg, 2010), healthcare policy should
address evidence-based strategies such as leadership style that are known to increase nurse
satisfaction. This can start with developing undergraduate and graduate nursing curriculums that
address transformational leadership education.
Future research can continue to inform practice on this very important nursing issue.
Transformational leadership skills can be taught; however little is known about what types of
leadership training are best suited to translate knowledge into action. Future research could
TRANSFORMATIONAL NURSING LEADERSHIP AND EFFECTS ON
concern various types of leadership training and the degree to which they develop
transformational leadership traits in managers and influence nurse job satisfaction. Servant
leadership is similar to transformational leadership in that they both focus on building
relationships (American Association of Nurse Assessment Coordination [AANAC], 2013).
Research on servant leadership compared to transformational leadership and job satisfaction
could inform nursing practice as well.
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