Show Greta G. Cummings, ... Gargi E. Chatterjee, in International Journal of Nursing Studies, 2018 3 Results3.1 Search resultsThe electronic database search yielded a total of 50,941 titles and abstracts, with 16,277 titles and abstracts resulting from the search update. Following removal of duplicates in the updated search, 5898 titles and abstracts were screened using the inclusion criteria and 351 manuscripts were retrieved for full-text screening. After final selection using the inclusion criteria for this review, 76 studies (reported in 84 papers) were added to the 53 studies included in the original review (1985–2009). In cases where multiple manuscripts were published from a single study, we counted them as one study in our analysis. Therefore, 129 studies (53 original and 76 updated) were included. All studies were quantitative in design. See Table 1 for search results. Table 1. Search strategy.
Note: For the updated search (2007–2017) the term nurs* was added as a search heading for each database in order to return only nursing relevant studies. Of the 129 included studies, published between 1985 and 2017, 74 were conducted in North America (43 in the United States, 29 in Canada, 1 in Canada and the United States, and 1 in Canada and Australia), 24 in Europe, 11 in Asia, 8 in the Middle East, 4 in Australasia, 2 in Africa, and 6 had no stated country. See Table 2 for all characteristics of included studies. Table 2. Characteristics of included studies.
PV = Previously Validated. NR = Not Reported. 3.2 Summary of quality reviewWeaknesses in the 129 quantitative study designs related to sampling, design, and analysis (see Table 3). All 129 studies used correlational, non-experimental, or cross-sectional designs and were rated as moderate (scores = 5–9) or high quality (scores ≥ 10). However, these correlational designs limit interpretations of causality. Only 33 of the 129 included studies used probability sampling, partially due to the difficulty in using random sampling methods to study leadership in specific individuals or units. Many studies used correlational and regression analyses and 100 studies did not report the management of outliers. Only 65 studies addressed appropriateness of sample size and 95 of 129 addressed anonymity of respondents. Ninety-six of 129 studies used samples from more than one site. Effects or outcomes of leadership were most often self-reported (n = 110), rather than observed. Table 3. Summary of Quality Assessment – 129 included quantitative studies.
A strength of included studies was the pervasive use of theory to guide research (113 of 129 studies), with some authors integrating several established theories to guide their research. These leadership theories and frameworks most often applied included Bass (and Avolio)’s Transformational and Transactional Leadership (33 studies), and Full Range Leadership Model (4 studies), Avolio and Gardner’s Authentic Leadership (11 studies), Kanter’s Organizational Empowerment Theory (10 studies), Kouzes and Posner’s Leadership Practices (6 studies), Hersey and Blanchard’s Situational Leadership Model (2 studies), Path Goal Theory (2 studies), Magnet Hospital Model (2 studies), and Consideration and Initiation (2 studies). Promoting Action on Research Implementation in Health Services (PARIHS) was used to frame the research design in 2 studies. All remaining leadership theories were used in single studies. Twenty studies in this review employed higher level multivariate statistical procedures, such as hierarchical regression, and 22 studies specifically applied structural equation modeling. Of those using structural equation modeling, 18 studies were published within the last 10 years. 3.3 The outcomes of leadershipA total of 121 identified outcomes were grouped into six categories, 1) staff satisfaction with job factors, 2) staff relationships with work, 3)staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. See Table 4 for all outcomes sorted by category, relational leadership style (shaded), task-focused leadership (non-shaded), frequency, and significance of outcomes or effects. In studies examining multiple relational and/or task-focused leadership styles, outcomes are accounted for in each category in which they were reported in Table 4. For the following results section, we present categories, most frequently cited outcomes, and difference in outcomes. In text citation numbers for each outcome refers to study numbers in Table 2. Table 4. Outcome differences between relationally focused (shaded) and task focused (non-shaded) leadership styles. Total: 121 outcomes in 129 studies. Note: Numbers in each column = reference numbers of included studies from Table 2. Shaded results = Relational leadership styles. Non-shaded results = Task focused leadership styles. Some studies examined multiple relational and/or task-focused styles with mixed results, and are accounted for in each category they were reported for. Staff Satisfaction with work, job and their Leaders. Sixty-five studies reported 18 outcomes influenced by leadership style related to staff satisfaction with work, job and their leaders, which also included satisfaction with roles, policies and rewards. The most frequently examined outcome of leadership in this review was nursing job satisfaction (n = 57). Fifty-two of 57 studies reported highest job satisfaction associated with a variety of relational focused leadership styles, such as socio-emotional, consideration, authentic, inspirational, resonant and transformational leadership (4, 5, 7–10, 14, 19, 21, 22, 24, 25, 28, 31, 32, 34, 35, 36, 38–40, 46, 47, 50, 54, 55, 58, 62, 63, 66, 68, 69, 73, 77, 80, 83–85, 90, 92, 98, 105, 107, 109, 111, 112, 115, 117, 118, 122, 124, 126). In 4 studies, the task-focused style transactional leadership was associated with increased job satisfaction (54, 98, 105, 111). Sixteen studies reported that job satisfaction was significantly lower with task-focused forms of leadership, such as management by exception, instrumental, and laissez faire leadership (5, 7, 8, 10, 21, 25, 28, 32, 40, 47, 50, 54, 58, 105, 108, 117). Relational leadership styles were not significantly associated with job satisfaction in two studies (37, 42). Significantly higher satisfaction with their leader was reported in 9 studies when leadership styles were authentic, charismatic, resonant, or transformational (6, 10, 11, 19, 43, 49, 78, 117, 126). Two studies examining consideration and initiating structures found equivocal results (19, 43). Management by exception (6), transactional and laissez faire (11, 58, 59, 117), and dissonant (10) leadership styles were associated with significantly lower satisfaction with their leader in 6 studies. The next most frequently examined outcomes included satisfaction with organizational work, work itself, and power, which were reported significantly higher with authentic, resonant, empowering, initiating structure and consideration styles of leadership (10). Results for remaining outcomes were equivocal or reported in a small number of studies. 3.3.1 Staff relationships with workIn this category about how staff engaged with or felt about their work and job, 72 studies reported 41 outcomes. Outcomes most frequently examined were staff reports of organizational commitment, empowerment, intent to stay or leave, and retention. Outcomes most frequently examined in this category include staff reports of organizational commitment, empowerment, intent to stay or leave, and retention. Seventeen studies reported significantly increased organizational commitment with transformational leadership (2, 9, 35–37, 45, 80, 89, 90), supportive leadership (21, 76), consideration (28), charismatic leadership (6, 33), empowerment based leadership (64, 85) and resonant leadership (122). Six studies reported significantly lower organizational commitment with transactional, management by exception and instrumental leadership styles (6, 21, 28, 33, 35 60). One study reported significantly lower organizational commitment with the leadership practice of inspiring a shared vision (35). Significantly higher staff empowerment at work was reported for relational leadership styles in 16 studies; transformational leadership (2, 25, 40, 62, 86), authentic leadership (81, 84, 110, 126), resonant leadership (83), supportive leadership (76), and motivational or empowering leadership (29, 64, 85). Passive management and transactional styles were related to nurses’ reports significantly lower empowerment (40, 60). Nurses’ intent to stay was significantly higher with supportive and consideration leadership styles, and lower with decision decentralization (5, 71, 76, 112, 117). Nurses’ intent to leave was significantly higher with management by exception leadership, abusive leadership, authoritarian leadership, or when nurses reported their leaders were not engaging in relational leadership (6, 87, 108, 117), and lower with transformational and charismatic leadership (6, 61, 66, 86, 87, 92, 117). Actual retention was significantly higher with consideration and supportive styles (50, 103, 112, 117), and better subordinate relations (51), while a decrease in turnover was found with leader-member exchange (12), and transformational leadership practices (20). Retention was significantly lower following decision decentralization (51). Relational leadership styles also were associated with increased engagement (73, 75, 88, 96, 97), job autonomy (43, 46, 68, 73, 110) and decreased reports of personalization (27, 67, 79, 115) and turnover (12, 20, 55). Results for remaining outcomes were equivocal or reported in a small number of studies. 3.3.2 Relations among staffTwenty-three studies reported 23 outcomes associated with leadership style related to relations among staff, or how individuals or groups of staff interacted with each other. The most frequently examined outcomes included teamwork between physicians and nurses, team innovation/creativity, work-team climate, conflict management and nursing work group collaboration. Teamwork between physicians and nurses was reported to be better in association with authentic leadership (110) resonant leadership (10), greater nurse manager ability, supportive leaderships (27, 28, 112), and leader empowering behaviours (39). Team innovation/creativity increased significantly with authentic (94), servant (107) and transformational (100) leadership styles. Work-team climate was enhanced when leaders enacted authentic (110), consideration (43) and transformational (100) styles, or with leadership characterized by responsiveness and clear communication (32). Conflict management and nursing workgroup collaboration improved with relational leadership styles (63), such as authentic leadership (128), transformational (100) and servant leadership (107) styles, respectively, and was lower in association with transactional leadership (17) and dissonant leadership (10), respectively. Results for remaining outcomes were equivocal or reported in a small number of studies. 3.3.3 Staff health & wellbeingThirty studies reported 13 outcomes related to staff health and well-being. Emotional exhaustion and job stress were reported lower with transformational leadership (48, 67, 79), empowering leadership (26), resonant leadership (10, 83), authentic leadership (82,84), transactional leadership (67), and nurse assessed nurse manager ability, leadership and support of nurses (27). Dissonant leadership (10) and management by exception (48) were associated with poorer emotional health and greater emotional exhaustion. Job tension or stress decreased when nurses had a positive perception of nursing leadership or when leaders embodied an authentic leadership style (26, 32, 39). Transformational leadership was also associated with decreased burnout (61, 88, 114). Results for remaining outcomes were equivocal or reported in a small number of studies. 3.3.4 Organizational environment factorsTwenty-eight studies reported 13 outcomes influenced by leadership style pertaining to organizational environment factors, specific to the organizational environment, culture, community and structures. Outcomes most commonly examined were organizational climate or culture, organizational support and staffing. Eight studies reported that culture and climate were better in association with authentic leadership, supportive leadership, transformational leadership, structural leadership, initiative structure, and change oriented leadership (15, 16, 18, 32, 41, 43, 70, 100, 106, 125). Perceived support was highest with relational leadership styles (56), specifically transformational leadership (43, 86, 90, 100), authentic (84), empowering (64), and support (76) styles. Staffing was perceived to be better or increased when leaders employed supportive (27, 76, 112, 117) or authentic (81) leadership styles. Results for remaining outcomes were reported in a small number of studies. 3.3.5 Productivity & effectivenessThirty-two studies reported 13 outcomes related to productivity and effectiveness outcomes influenced by leadership style in. Factors frequently examined were extra effort by staff, productivity and effectiveness. Extra effort by staff was significantly higher in association with transformational leadership styles in eight studies (1, 6, 7, 42, 58, 78, 80, 118). Outcomes reflecting individual, team and organizational productivity and effectiveness were significantly higher in 18 studies with charismatic, authentic, supportive, transformational, and change oriented leadership (1, 6, 7, 9, 11, 15, 18, 20, 26, 35, 36, 37, 49, 58, 87, 60, 118, 78). Leadership styles such as management by exception, transactional, laissez faire, and peer leadership were associated with reported significant decreases in effectiveness and productivity (6, 11, 18, 26, 36). Results for remaining outcomes were equivocal or reported in a small number of studies What is the leader behaviors in path goal include?The original path-goal theory identifies achievement-oriented, directive, participative, and supportive leader behaviors: The directive path-goal clarifying leader behavior refers to situations where the leader lets followers know what is expected of them and tells them how to perform their tasks.
What leadership type is best for tasks that are structured and unsatisfying?Supportive style works best with tasks that are structured, unsatisfying or frustrating. Participative leadership is best when a task is ambiguous; it gives greater clarity of how certain paths lead to certain goals.
What are the three key follower characteristics in the pathThere are three components of task characteristics in path-goal theory; “the design of the follower's task, the formal authority system of the organization, and the primary work group of followers” (Northouse, 2016, p. 119).
How can a leader find out what is rewarding to followers about their work?This undergirds the path-goal theory because a leader can use the expectancy theory to find out what is rewarding to the followers about their work and then make those rewards available to them when they accomplish the requirements of their work.
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