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Nursing Economics ----------------- January 01, 2008 Casida, Jesus "Jessie"; Pinto-Zipp, Genevieve COPYRIGHT 1999 Jannetti Publications, Inc. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright
OVER THE PAST SEVERAL DECADES, the phenomena of leadership and organizational culture (OC) continue to predominate in mainstream business and health care literature. Scholars in various disciplines have defined these phenomena as the driving forces in the success or failure of an organization (Schein, 2004). Although, leadership and OC constructs have been studied well, its relationship, however, is not definitively established in nursing literature. Previous studies in the nursing literature have been concerned mainly with the leadership role of the chief nurse executive, with little attention to first-line nursing leadership, such as nurse managers (NMs). Effective organizations have first-line leaders that demonstrate transformational leadership behaviors (Al-Mailam, 2005; Block, 2003). A leader, such as a NM who practices transformational leadership creates and implements a vision of what can be accomplished at work and empowers the staff with that vision, while keeping abreast of health care changes and interacting with others inside and outside of the organization (Robbins & Davidhizar, 2007). Today, NMs must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex and turbulent health care delivery system. Such a climate is characterized by a cost and time-constrained work environment, nursing shortage, increased patient acuity, use of sophisticated technology in patient care, and the challenge of achieving desired patient outcomes (Contino, 2004; Mathena, 2002). Additionally, NMs must possess a strategy related to accomplishing more with decreasing resources, molding staff members into clinical or unit-based leaders, motivating staff members to go beyond their own self-interests for the good of the organization, and elevating staff performance (Ohman, 2000; Robbins & Davidhizar, 2007). Despite these difficulties, this strategy must result in high-quality, cost-effective patient care, accompanied by high levels of patient satisfaction. Improvement of client services (in health care, the patient; in business, the customer) is the ultimate goal of leadership in an institution (Al-Mailam, 2005; Vance & Larson, 2002). Utilizing the transformational leadership style is a strategy that can assist NMs in achieving these goals as well as address the challenges of the current health care climate (Tourangeau & McGilton, 2004).
Organizational culture is a significant variable influencing organizational performance, such as organizational effectiveness (Denison, Haaland, & Goelzer, 2003). Research that addresses the link between OC and effectiveness in nursing context, however, is limited. The majority of the nursing literature that addresses OC includes assessment, diagnosis, or evaluation of nursing unit cultures is outdated. Moreover, those studies were carried out before and after implementation of organizational change (Forsythe, 2005), performance improvement (Baker, King, MacDonald, & Horbar, 2003), patient care delivery models (Jones, DeBaca, & Yarbrough, 1997), and innovations in nursing units (Coeling & Simms, 1993). Today, NMs play a pivotal role in driving the success or failure of hospitals' nursing units, which in turn, affects the global performance of acute care hospitals. In the current health care environment, patient safety, quality, and cost-effective patient care and patient satisfaction occupy the top priorities of health care organizations' strategic plan. Alignment of the nursing units' OC with the hospital's strategic plan is essential in achieving the hospital's goals and objectives. Leadership and OC are two important explanatory constructs influencing organizational performance (Burke & Litwin, 1992). For nearly 2 decades, nurses have been investigating these constructs and their implications to nursing practice (Garret, 1991; McDaniel & Stumpf, 1993). They found that leadership and OC are two important variables affecting organizational outcomes. For example, NMs who have used transformational leadership styles have shown a positive impact on organizational outcomes (Robbins & Davidhizar, 2007) such as on work environment (Whiley, 2001) and staff nurse retention (Kleinman, 2004a). Moreover, a nursing service or unit that typifies a constructive OC showed high levels of patient satisfaction (Wooten & Crane, 2003); while a hierarchical or bureaucratic type of OC negatively impacts nurses' retention and quality of work life (Gifford, 2002). Clearly, leadership and OC impact organizational performance. However, despite the many references in mainstream business and health care literature about such an impact, no research has been done to examine the relationship of NMs' leadership styles and nursing unit OC.
Thus, the purpose of this study was to explore the relationship between NMs' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. In this context, the full-range leadership theory (FRLT) and the Denison's Organizational Culture Model (DOCM) were used as a conceptual framework. The FRLT (see Table 1) describes three broad categories of leadership behaviors that are highly transformational at one end to highly avoidant at the other end: transformational (TF), transactional (TS), and non-transactional laissez-faire (LF) leadership (Antonakis, Avolio, & Sivasubramaniam, 2003; Avolio & Bass, 2004). The DOCM (Table 2) describes four OC traits that are characteristics of organizational effectiveness including adaptability, involvement, consistency, and mission (Denison, 2005; Denison et al., 2003). The lack of empirical finding and the need to clearly understand the leadership-culture relationship phenomena in nursing was addressed by a research question: Does a relationship exist between the NMs' leadership styles and nursing unit's OC as perceived by staff nurses? Based on this, a main hypothesis (H) was framed, which postulated that there is an existing relationship between NMs' leadership styles and nursing unit OC as perceived by staff nurses (SNs). This H was expanded into sub-hypotheses to further examine the nature of the leadership-culture relationship phenomena in nursing by determining which NM leadership style is associated with the nursing unit OC's internal and external environment attributes. These included: (Ha) SNs' perceptions of their nursing units' OC in terms of mission and adaptability are positively associated with the level of their NM's TF leadership; and (Hb) SNs' perceptions of their nursing units' OC in terms of involvement and consistency are positively associated with the level of their NM's TS leadership.
Methods Descriptive and exploratory correlational designs were used to describe the types of NMs' leadership styles and OC of …
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