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Journal of Nursing Management, 2012, 20, 668–678

The impact of leadership styles on nursesÕ satisfaction and


intention to stay among Saudi nurses

1 2
RAEDA F. ABUALRUB RN, PhD and MOHAMMED G. ALGHAMDI RN, MSN
1
Associate Professor, College of Nursing, Jordan University of Science and Technology, Irbid, Jordan and 2Director
of Nursing Research and Practice Development, Ministry of Health, Riyadh, Kingdom of Saudi Arabia

Correspondence A B U A L R U B R . F . & A L G H A M D I M . G . (2012) Journal of Nursing Management 20, 668–678


Raeda F. AbuAlRub The impact of leadership styles on nursesÕ satisfaction and intention to stay
PO Box 1894 among Saudi nurses
Irbid
Jordan Aim To examine the impact of leadership styles of nurse managers on Saudi nursesÕ
E-mail: raeda71@yahoo.com job satisfaction and their intent to stay at work.
Background Increasing nursesÕ satisfaction is one of the key elements in meeting
challenges of quality outcomes, patient satisfaction and retention of staff nurses in
hospitals.
Methods This study used a descriptive correlational design. The Multifactor
Leadership Questionnaire (MLQ-5X), Job Satisfaction Survey (JSS), the McCainÕs
Intent to Stay Scale and a demographic form were used to collect the data from a
convenience sample of 308 Saudi nurses.
Results Saudi nurses were moderately satisfied in their jobs. In addition, nurses were
more satisfied with leaders who demonstrated transformational leadership styles,
and those who were more satisfied with their jobs intended to say at work. The
background variables, the transformational leadership style and the transactional
style explained 32% of the variation in job satisfaction.
Conclusions The results of the study emphasized the importance of transforma-
tional leadership, which indicates the need for further attention to training and
development of effective leadership behaviours.
Implications for nursing management Nurse administrators in Saudi Arabia should
capitalize on the importance of transformational leadership style in enhancing the
level of job satisfaction.
Keywords: hospital nurses, intention to stay, job satisfaction, leadership styles, Saudi
Arabia

Accepted for publication: 5 September 2011

desired goals; therefore, success cannot be achieved


Introduction
without their efforts and commitment (Huber 2006).
Health-care organizations are social systems where Leadership is concerned with how leaders influence
human resources are generally the most important change and induce followers to produce changes (Ellis
factor for the delivery of health care. Such organizations & Hartley 2009). Nurse managers should create
need effective managers and employees to achieve hospital environments that support and motivate staff

DOI: 10.1111/j.1365-2834.2011.01320.x
668 ª 2011 Blackwell Publishing Ltd
Leadership styles, satisfaction, and intention to stay

nurses. Nursing managers are responsible for the procedures to achieve specific organizational goals (Ellis
retention of their staff nurses once they are recruited; & Hartley 2009). There are many leadership styles that
thus, leadership styles exhibited by leaders are a major nurse managers and leaders demonstrate to lead staff
contributing factor to a nurseÕs decision to stay in a nurses in hospitals such as classical leadership (auto-
current position, transfer or seek employment elsewhere cratic, democratic, laissez-faire, bureaucratic and situ-
or outside of the nursing profession. ational) and contemporary leadership (charismatic,
McCloskey and McCain (1987) defined intention to transactional, transformational, connective and shared
stay as the likelihood of nurses to stay in their present leadership) (Huber 2006). In hospital settings, it is be-
job. Although, the behavioural intention to leave or to lieved that the leadership style of head nurses could
stay at work received significant attention in early influence job satisfaction (AL-Hussami 2008). Bass and
1980s as being one of the most accurate predictors of Avolio (1990) found that transformational (TF) lead-
nursing turnover, it has not been given any attention ership styles were preferred over transactional (TA)
from researchers in recent years within nursing litera- leadership styles, and managers who exhibited trans-
ture (McCarthy et al. 2007). The concept of nursesÕ job formational characteristics reported more satisfied staff
satisfaction is also important for nursing administra- nurses.
tors. Adams and Bond (2000) defined job satisfaction as Before the introduction of transformational leader-
Ôthe degree of positive affect towards a job or its com- ship theory, the transactional leadership style was per-
ponentsÕ. Satisfied nurses are more likely to stay not ceived by most leaders as the most effective style in
only in the profession of nursing but also in the orga- organizations (Bass et al. 2003). Bass (1985) defined
nization in which they are satisfied. transactional leadership as the process in which leaders
In the current worldwide nursing shortage, there is expect followers to perform services in exchange for
great interest in retention of nurses. Nurse administra- payment and fulfilling their demands. Transactional
tors and managers should examine the factors that leaders could utilize: (1) a contingent reward approach
might enhance the satisfaction and retention of their in which they clarify their expectations and goals and
staff. As nursesÕ satisfaction increases, the quality of care only provide recognition upon achievement of goals, (2)
provided to patients and organizational commitment active management by exception in which they specify
might also be enhanced (Al-Aameri 2000, Mrayyan the standards of performance and punish followers for
2006, AL-Hussami 2008). As intention to stay at work any non-compliance with those standards, and (3)
increases, the high cost associated with nurses leaving passive avoidant or laissez-faire in which they are pas-
their work is reduced (Zaghloul et al. 2008). The sig- sive and only take actions after problems occur (Bass
nificance of the study is manifested in the fact that et al. 2003).
nurses are the first-line health-care providers who spend In contrast, the transformational leadership style in-
more time and effort with patients than other health- cludes the characteristics of idealized influence, inspi-
care professionals. Factors that may enhance their sat- rational motivation, intellectual stimulation, and
isfaction are paramount as their satisfaction will be individualized consideration (Avolio et al. 1999, Bass
noticed in terms of increasing patientÕs quality of care, & Avolio 2004). According to Avolio et al. (1999),
increasing patient satisfaction, providing a positive view leaders who use a style of idealized influence are re-
of the hospital from the community perspectives, and spected and admired to the extent that followers want
increasing nursesÕ productivity, efficiency and retention to imitate them. In this style of leadership, followerÕs
(Adams & Bond 2000, Lu et al. 2005, AbuAlRub et al. needs come first. Leaders who inspirationally motivate
2009). Therefore, the present study examines the impact their followers try to provide meaning and challenge to
of leadership styles of nurse managers on Saudi nursesÕ their work. Leaders who used intellectual stimulation
job satisfaction and their intent to stay at work. stimulate their followers to be creative and innovative,
and involve them in the process of solving the problems.
For individualized consideration, leaders consider the
Literature review individual differences of their followers and mentor
them to achieve professional growth (Avolio et al.
Leadership styles
1999, Bass & Avolio 2004).
While leadership refers to the ability to influence others The style that leaders use is based on a combination
through guiding, motivating and directing to achieve of their beliefs, values and preferences, as well as the
organizational effectiveness, management refers to organizational culture and norms, which encourage
coordinating resources through a series of functions and some leadership styles and discourage others (Marquis

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Journal of Nursing Management, 2012, 20, 668–678 669
R. F. AbuAlRub and M. G. Alghamdi

& Huston 2009). Charismatic leadership, situational patients with quality care were among the determinants
leadership, transactional leadership, and transforma- of job satisfaction. Similar findings were also reported
tional leadership are some of the forms of leadership by Mcleannan (2005) who conducted a study among 60
styles (Huber 2006). The present study intends to Canadian nurses to examine work-enabling factors.
investigate the transformational and transactional Relationships with colleagues and providing quality
leadership styles of Saudi hospital nurses. patient care were among the sources for job satisfaction
among participants.
In Japan (n = 480), Yasushi et al. (2006) found that
Job satisfaction
intention to stay was significantly correlated with all job
The concept of nursesÕ job satisfaction is extremely satisfaction factors except employment status; further-
important for nursing administrators. If nurse leaders more, intention to stay was greater among nurses who
understand what makes their nurses satisfied, they can were older and more satisfied with their work. In Jordan
make changes to facilitate nursesÕ satisfaction and (n = 483), AbuAlRub et al. (2009) also found that as job
therefore improve patient satisfaction and nursesÕ satisfaction increased among hospital nurses, intention
retention. Campbell et al. (2004) reported that staff to stay at work also increased. In the USA, AL-Hussami
nurses working in US health-care organizations were (2008) investigated the effect of organizational com-
more satisfied in work environments that encouraged mitment, perceived organizational support, transfor-
participative management and shared decision making. mational leadership, transactional leadership style and
Furthermore, Dunn et al. (2005) surveyed 278 Austra- level of education on nursesÕ job satisfaction among 60
lian nurses to examine perceptions of working as a American nurses who worked in nursing homes The
nurse in acute care settings. They found that leadership, results indicated Ôorganizational supportÕ to be the
providing quality care, relationships with colleagues strongest predictor of the four variables, and Ôtransac-
and autonomy were among the factors that enhanced tional leadershipÕ was the weakest predictor of job
job satisfaction. The results from research studies indi- satisfaction. The results also revealed a positive
cate the need for further attention in staff training to correlation between nursesÕ job satisfaction and the other
develop effective leadership behaviours (Chen et al. four independent variables: organizational commitment,
2005, Acree 2006). organizational support, level of education and transfor-
In Saudi Arabia, Omer (2005) found that both nurse mational leadership.
managers and staff nurses gave a higher rating to
transformational factors than transactional factors. Al-
Intention to stay at work
Ahmadi (2002) examined job satisfaction among 360
Saudi nurses. The overall job satisfaction was found to Researchers have found a difference between the effec-
be moderate. The most important determinants of job tiveness of a transformational leadership style and that
satisfaction were recognition, technical aspects of of a transactional leadership style in retaining nurses in
supervision, work conditions, utilization of skills, pay hospitals (Acree 2006). Studies related to retention and
and job advancement. Zaghloul et al. (2008) also indi- recruitment of nurses have shown that low wages and
cated that Saudi nurses (n = 499) were: (1) least satisfied poor job satisfaction were the primary reasons why
regarding working environment, salary, promotions and nurses left their work; their dissatisfaction was often
hospitalÕs policies; and (2) dissatisfied with fairness of attributed to heavy workloads, leadership styles, moti-
the performance appraisal system, bonuses, paid time vation, inadequate training and lack of respect (Lu et al.
off and statement of recognitions of achievements. Sev- 2005). Nurses who reported a high level of job satis-
enteen per cent of the participants in the study of faction were more likely to show greater intention to
Zaghloul et al. (2008) intended to leave, while more stay in their current work (Tourangeau & Carnley
than half of the participants could not tell exactly 2006, McCarthy et al. 2007, Zaghloul et al. 2008,
whether they intended to quit or not. However, El-Gi- AbuAlRub et al. 2009). Few studies nationally and
lany and Al-Wehady (2001) reported that more than 87 internationally have attempted to investigate the rela-
and 92% of Saudi female nurses (n = 233) were satisfied tionship between leadership styles and retention.
with their work place and the role assigned respectively. Pointing out the effect of leadership styles on the level of
In Norway, Bégat et al. (2005)examined job satis- intent to stay is of paramount significance for nurse
faction of 71 nurses with their work environment. Their administrators in such a critical state of nursing short-
findings indicated that good communication, good age, wherein all health-care organizations are desperate
relationship with peers, job motivation and providing to retain their nurses. Doran et al. (2004) found that

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670 Journal of Nursing Management, 2012, 20, 668–678
Leadership styles, satisfaction, and intention to stay

transformational leadership styles were better than was to recruit a sample of 600 registered nurses from
others. The higher the nurses rated their manager as the selected hospitals (100 nurses form each hospital) to
having a transformational leadership style, the higher compensate for an incomplete response rate and to
was the nursesÕ job satisfaction and the lower was the enhance the generalizability of the results as the sample
unit turnover rate. is a convenience one. According to Nieswiadomy
In summary, the reviewed research studies supported (2008) larger sample sizes are required when non-
the notion that the leadership styles of nurse managers probability sampling techniques are used to enhance the
influenced job satisfaction of staff nurses and their representation of the population.
intention to stay at work. Most studies indicated that The inclusion criteria for the participants were: (1)
the transformational leadership style was positively holding a registered nursing license and practicing as a
associated with job satisfaction, and job satisfaction was registered nurse, (2) having at least 6 months of expe-
positively associated with intention to stay at work. rience in their current job, and (3) working under the
However, there was a scarcity in the literature regarding direct supervision of a nurse manager in a hospital
the effect of leadership styles on retention. Therefore, setting. Among the 600 questionnaires that were dis-
the present study was designed to examine the impact of tributed, a total of 308 participants (n = 308) replied,
leadership styles on the levels of intent to stay at work which is an acceptable response rate of 51.3%.
and job satisfaction among Saudi hospital nurses. The
following hypotheses were tested: (1) a transformational
Instruments
leadership style of nurse managers increases nursesÕ job
satisfaction, (2) a transactional leadership style of nurse A structured questionnaire was used for collecting the
managers decreases nursesÕ job satisfaction, (3) a data for the purpose of this study. The questionnaire
transformational leadership style of nurse management consists of the Multifactor Leadership Questionnaire
enhances nursesÕ level of intention to stay at work, (4) a (MLQ-5X) (Bass & Avolio 2004), Job Satisfaction
transactional leadership style of nurse management de- Survey (Spector 1985), the McCainÕs Intent to Stay
creases nursesÕ level of intention to stay at work, and (5) Scale (McCloskey & McCain 1987) and the demo-
as the level of nursesÕ job satisfaction increases, the level graphic form.
of their intention to stay at work also increases. Both the Job Satisfaction Survey and the McCainÕs
Intent to Stay Scale were translated from English to
Arabic by an individual who was proficient in both
Methods
languages, and then back-translated from Arabic to
This study used a descriptive correlational design. This English by another individual who was also proficient in
design was used for the present study because there both languages. The translated versions were reviewed
were limited studies on the variables of interest among and examined by a committee, who were interested in
Saudi nurses. the research topic and competent in both Arabic and
English languages. The committee considered the
equivalence of terms, clarity and cultural adaptation.
Study setting and sample
Modifications were made according to the committee
The setting of this study was six public hospitals in the recommendations. Moreover, all instruments were pilot
Western Region of Saudi Arabia that were affiliated tested among 18 nurses to point out any technical,
with the Ministry of Health. These hospitals were clarity and reliability problems.
chosen from the three biggest cities in the western re-
gion of Saudi Arabia (Jeddah, Makah and Taif). The Leadership styles
two largest general (not specialized) and public hospi- Leadership styles were measured using the Multifactor
tals in each of the cities selected were chosen to be in- Leadership Questionnaire (MLQ-5X). The MLQ-5X
cluded in the study. The accessible population was all measures how nurse managers lead and manage nurses
Saudi registered nurses in the selected hospitals in the in hospital settings. The MLQ-5X consists of 45 ques-
western region of Saudi Arabia. A convenience sam- tions using a Likert rating scale from 0 to 4 (0 = not at
pling method was employed. According to Cohen tables all, 1 = once in a while, 2 = sometimes, 3 = fairly often
(multiple regression with 12 independent variables) or and 4 = frequently, if not always) (Bass & Avolio
Pearson correlation coefficient, the necessary sample 2004). The rating of this scale was converted to be from
size for a medium effect size and an a level of 0.05 at a 1 to 5, comparing to the ratings of the other instruments
power of 0.80 is <150 nurses (Cohen 1992). The aim used in the study which started form 1, wherein 1 = not

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Journal of Nursing Management, 2012, 20, 668–678 671
R. F. AbuAlRub and M. G. Alghamdi

at all, 2 = once in a while, 3 = sometimes, 4 = fairly before conducting the study. The purpose and signifi-
often and 5 = frequently, if not always). cance of the study were explained to participants. All
Previous reliability was established; CronbachÕs a heads department in the targeted hospitals were in-
coefficients ranged from 0.74 to 0.94 (Bass & Avolio formed about the studyÕs purpose and significance.
2004). The Arabic version was developed by the origi- All nurses working in the various shifts in the targeted
nal authors of the English version (Bass & Avolio hospitals were invited to participate in the study
2004). The permission to use the Arabic version of through their managers. All participants were in-
MLQ-5X, which consisted of 35 items, was granted formed that participation was completely voluntary
before conducting the study. In the present study, the and were assured that their responses would remain
CronbachÕs a coefficient of the total scale of the MLQ- confidential. Participants were asked to seal the com-
5X was 0.87. pleted questionnaire in the enclosed envelope and drop
it in a box in the managerÕs office. The questionnaires
Job satisfaction were collected personally by the researcher. The ano-
Job satisfaction was measured by the Job Satisfaction nymity of participants and confidentiality of their re-
Survey (JSS) (Spector 1985). This scale consists of 36 sponses were ensured by (1) no reporting of the
items including nine facets. Each facet is assessed with participantsÕ identities, (2) reporting the findings in
four items and a total score is computed from all items. aggregate, and (3) the assurance that the raw data
A summated rating scale format is used, with six choi- would be destroyed after the analysis process is com-
ces per item ranging from 1 = strongly disagree to pleted. Data were collected between June and August
6 = strongly agree. Items are written in both positive 2009.
and negative formats. The nine facets are pay, promo-
tion, supervision, fringe benefits, contingent rewards
Data analysis procedure
(performance based rewards), operating procedures
(required rules and procedures), coworkers, nature of The statistical package of social sciences (SPSS) version
work and communication. The internal reliability of the 17 (SPSS Inc., Chicago, IL, USA) was used for data
scale was established with a CronbachÕs a of 0.91 for analysis. The reverse scored items of Job Satisfaction
the entire scale (Spector 1985). In the present study, the Survey were recoded. Descriptive statistics (frequencies
CronbachÕs a for the total scale of JSS was 0.73 indi- and percentages) were used to describe the participants
cating a good internal reliability. as well as other variables of the study. PearsonÕs cor-
relation (r) was used to test the correlations between
Intention to stay at work the study variables. Hierarchical regression analysis
Intention to stay at work was measured by the was also used to examine how much of the variation
McCainÕs Intent to Stay Scale (McCloskey & McCain in job satisfaction, as a dependent variable, could be
1987). This instrument is a five-item subscale from the explained by leadership styles while controlling for
McCainÕs Behavioural Commitment Scale. The instru- demographic variables. It was also used to examine
ment consists of five items on a rating scale from 1 to 5 how much of the variation in the level of intent to
(1 = strongly disagree; 5 = strongly agree). The overall stay, as a dependent variable, could be explained by
a was reported as 0.88 (McCloskey & McCain 1987). job satisfaction and leadership styles while controlling
In the present study, the CronbachÕs a of the scale was for demographic variables.
0.80. According to Montgomery et al. (2001), hierarchi-
cal regression is used to evaluate the relationship
The demographic form between a set of independent variables and the
The demographic form includes information about age, dependent variable, controlling for or taking into
gender, marital status, educational degree, years of account the impact of a different set of independent
experience, current hospital experience, working variables on the dependent variable. This type of
schedule, average number of patients and working regression usually has two blocks of variables that are
department. control variables, usually the demographics, entered
in the first block and a set of predictor variables
entered in the second block. The researchers believed
Data collection procedures and ethical issues
that it was reasonable to accept a probability of 5%
The formal approval of the Institutional Review Board to indicate a difference or a relationship when there
(IRB) of the Saudi Ministry of Health was obtained was none.

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672 Journal of Nursing Management, 2012, 20, 668–678
Leadership styles, satisfaction, and intention to stay

means that nurses who were satisfied intended to stay


Results
longer in their jobs.
Participants characteristics In contrast, the results did not support hypotheses 3
and 4, and indicated that the relationship between the
Ages of participants ranged from 21 to 59 years, with
transformational leadership style and the level of intent
the highest percentage (71%) falling between the ages
to stay was statistically insignificant (r = 0.08, P =
of 20 and 29 years. Over half the participants (56%)
0.14). This means that transformational leadership style
were females. Almost half of the participants (53%)
did not have an effect on the level of intent to stay at
were single. The majority of the participants (52%) had
work. The results also indicated that the relationship
a diploma. The total years of nursing experience ranged
between the transactional leadership style and the level
from 1 year to 30 years. Regarding hospital experience,
of intent to stay was statistically insignificant (r = 0.01,
49% of the subjects had 1–3 years experience in their
P = 0.81). This means that the transactional leadership
current hospital. Over half (59%) of the subjects pro-
style did not have an effect on the level of intent to stay
vided care for more than six patients per shift. Half of
at work.
the participants (50%) worked morning shift. They also
Further analysis was done to examine means (M) and
worked in a variety of units such as medical/surgical
standard deviations (SD) of the study variables. The
departments (31%), emergency department (21%),
mean score of nursesÕ job satisfaction for the partici-
intensive care units and coronary care units (16%),
pants of the study was moderate (M = 3.69, SD = 0.49)
dialysis unit (7%), obstetrics or gynaecology depart-
representing ÔambivalenceÕ, which had been defined as
ments (4%), paediatric, operating room and recovery
Ôthe extent to which a personÕs reactions associated
room (4%), and other areas (10%).
with an attitude object are evaluatively mixed, or
composed of both satisfaction and dissatisfaction statusÕ
Analysis of hypotheses (Thompson et al. 1995). The subscale of Ônature of
workÕ had the highest mean (M = 4.81, SD = 1.02),
Table 1 presents data about correlations between study
while the subscale of Ôfringe benefitsÕ had the lowest
variables. The results supported hypotheses 1, 2 and 5
mean (M = 2.95, SD = 0.92). Table 2 presents data
and indicated that there was a significant moderate
about means, standard deviations, and ranges for the
correlation in the positive direction between transfor-
variables of the study.
mational leadership style and nursesÕ job satisfaction
The results indicated that the mean of transforma-
(r = 0.45, P < 0.001); which means, nurses who had
tional leadership style (M = 3.43, SD = 0.82) was
leaders using transformational leadership style had
higher than the mean of transactional leadership style
greater satisfaction. The results also indicated that there
(M = 2.98, SD = 0.57). This means that participants
was a significant weak relationship in the negative
perceived their managers as transformational leaders
direction between transactional leadership style and job
rather than transactional leaders. In the subscales of
satisfaction (r = )0.14, P < 0.01), which means that
leadership styles, the subscale of Ôinspirational motiva-
nurses who had leaders using a transactional leadership
tionÕ had the highest mean among the transformational
style were less satisfied. The results also indicated that
leadership subscales (M = 3.57, SD = 1.02) and the
there was a significant weak correlation in the positive
lowest mean was the Ôindividualized considerationÕ
direction between nursesÕ job satisfaction and nursesÕ
subscale (M = 3.27, SD = 1.04). For the transactional
intention to stay at work (r = 0.15, P < 0.01), which
subscales, Ôcontingent rewardÕ had the highest mean
(M = 3.45, SD = 1.00), whereas the subscale of Ôlaissez
Table 1 faireÕ had the lowest mean (M = 2.54, SD = 1.00). The
Pearson correlations among job satisfaction, intention to stay, mean of nursesÕ intention to stay was moderate
transformational leadership, and transactional leadership (n = 308) (M = 3.24, SD=1.04): that is, the nurses were unsure
JS ITS TF TA whether they would stay or leave their jobs.
Hierarchical multiple regression was used to examine
JS 1
ITS 0.15** 1
how much variation of nursesÕ job satisfaction and their
TF 0.45** 0.08 1 intention to stay at work could be explained by nurse
TA )0.14* 0.01 0.23** 1 managersÕ leadership styles while controlling for
demographic data. For one analysis, job satisfaction
JS, job satisfaction; ITS, intention to stay; TF, transformational
leadership; TA, transactional leadership. was treated as a dependent variable, while leadership
*P < 0.05, **P < 0.01. styles and demographic variables were treated as

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Journal of Nursing Management, 2012, 20, 668–678 673
R. F. AbuAlRub and M. G. Alghamdi

Table 2 of the variation in job satisfaction. The second step, in


Means, standard deviations and ranges for the variables and the
which the transformational leadership style variable
subscales of transformational leadership style, transactional leader-
ship style, job satisfaction and intention to stay was added to the regression equation, indicated that
19% was the net change that was added to the accu-
Variables Mean SD Range
mulative R2 (23%).
Transformational leadership style 3.43 0.82 1.06–5.00 The third step indicated that the net change that was
(on a scale from 1 to 5) added to the cumulative R2 when the transactional
Idealized influence (attitude) 3.54 0.92 1.00–5.00
Idealized influence (behaviour) 3.44 0.80 1.00–5.00 leadership was added to the regression equation was
Inspirational motivation 3.57 1.02 1.00–5.00 9%. The Ôcontingent rewardÕ subscale (a transactional
Intellectual stimulation 3.42 0.99 1.00–5.00 leadership characteristic) was removed because of the
Individualized consideration 3.27 1.04 1.00–5.00
Transactional leadership style 2.98 0.57 1.07–4.93
effect of multicolinearity; it has a correlation with
(on a scale from 1 to 5) Ôintellectual stimulationÕ (a subscale of transformational
Contingent reward 3.45 1.00 1.00–5.00 style) that exceeded 0.70 (r = 0.77, P < 0.01). Overall,
Management-by-exception (active) 3.35 0.79 1.00–5.00
the final model of the hierarchical regression analysis
Management-by-exception (passive) 2.71 0.90 1.00–5.00
Laissez faire 2.54 1.00 1.00–5.00 indicated that 32% of the variation in job satisfaction
Job satisfaction (on a scale from 1 to 6) 3.69 0.49 2.28–5.19 was explained by the background variables, transfor-
Pay 3.76 1.01 1.00–6.00 mational leadership style and the transactional style.
Promotion 3.46 0.96 1.00–6.00
Supervision 4.19 1.14 1.00–6.00 A summary of the hierarchical regression analysis is
Fringe benefits 2.95 0.92 1.00–5.75 presented in Table 3.
Contingent rewards 3.34 0.82 1.25–5.75 The first step of the hierarchical regression analysis
Operating conditions 3.24 0.83 1.00–5.50
Co-workers 4.05 0.89 1.50–6.00
treating Ôthe level of intention to stay at workÕ as a
Nature of work 4.81 1.02 2.00–6.00 dependent variable indicated that the demographic
Communication 3.39 0.99 1.00–6.00 variables explained 2% of the variation in the level of
Intention to stay (on a scale from 1 to 5) 3.24 1.04 1.00–5.00
intention to stay at work. In the second step, in which
the transformational leadership style variable was ad-
independent variables. In another analysis, the level of ded to the regression equation, the model explained
intention to stay was treated as a dependent variable, 3%; that is, transformational leadership style explained
while leadership styles, job satisfaction and demo- 1% of the variation in intention to stay.
graphic variables were treated as independent variables. The third step, in which the variable of transactional
Both concepts of job satisfaction and the level of leadership style was added to the regression formula,
intention to stay are considered as organizational out- indicated that there was not any increment in Table 3.
comes and can be treated as dependent variables. The fourth step, in which job satisfaction variable was
The first step of the hierarchical regression analysis add to the regression formula, indicated that job satis-
indicated that the demographic variables explained 4% faction explained 2% of the variation in intention to

Table 3
Summary of the hierarchical regression analysis for variables predicting job satisfaction (n = 308)

Std b Std b Std b


Variables set Step 1 Step 2 Step 3 R2 Acc R2 Inc

Background variables 0.04 0.04


Age (twenties) )0.11 )0.09 )0.09
Gender )0.01 0.00 )0.02
Marital status (married) 0.09 0.08 0.08
Education level (diploma) )0.02 0.00 )0.05
Nursing experience (<5 years) 0.21* 0.14 0.13
Hospital experience (1–3 years) )0.04 )0.02 )0.03
Duty type (shifting) 0.01 0.04 0.04
Patient average (>6) 0.06 0.04 0.04
Unit (medical/surgical) 0.01 )0.02 )0.1
Transformational leadership style 0.44* 0.43** 0.23 0.19
Transactional leadership style )0.30** 0.32 0.09

Std b, the standardized coefficient; R2 Acc, R2 accumulative; R2 Inc, R2 increment.


*P < 0.05, **P < 0.01.

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674 Journal of Nursing Management, 2012, 20, 668–678
Leadership styles, satisfaction, and intention to stay

Table 4
Summary of the hierarchical regression analysis for variables predicting intention to stay at work (n = 308)

Std b Std b Std b Std b


Variables set Step 1 Step 2 Step 3 Step 4 R2 Acc R2 Inc

Background variables 0.02 0.02


Age (twenties) 0.00 0.00 0.00 0.02
Gender )0.08 )0.08 )0.08 )0.08
Marital status (married) )0.02 )0.02 )0.02 )0.03
Education level (diploma) 0.00 0.01 0.01 0.02
Nursing experience (<5 years) )0.04 )0.06 )0.06 )0.08
Hospital experience (1–3 years) 0.02 0.02 0.02 0.03
Duty type (shifting) 0.07 0.07 0.07 0.07
Patient average (>6) 0.05 0.05 0.05 0.04
Unit (medical/surgical) )0.06 )0.07 )0.07 )0.07
Transformational leadership style 0.10 0.10 0.02 0.03 0.01
Transactional leadership style 0.00 0.04 0.03 0.00
Job satisfaction 0.17* 0.05 0.02

Std b, the standardized coefficient; R2 Acc, R2 accumulative; R2 Inc, R2 increment.


*P < 0.05, **P < 0.01.

stay. Overall, the final model of hierarchical regression 2008). Nurse managers should therefore be appropri-
analysis indicated that 5% of the variation in the level ately equipped with the best leadership skills using the
of intent to stay was explained by the background transformational model.
variables, transformational leadership style, transac- The study findings did not support the research
tional leadership style and job satisfaction. A summary hypotheses concerning the relationship between lead-
of the hierarchical regression analysis for Ôthe intent to ership styles and intention to stay at work, but a
stay at workÕ as a dependent variable is presented in transformational leadership style was found to lower
Table 4. turnover rates (Doran et al. 2004). An explanation for
the findings of the present study might be that the
study was conducted in six hospitals affiliated with the
Discussion
Ministry of Health in Saudi Arabia. Such governmen-
The purpose of the study was to examine the impact of tal health institutions usually have a centralized
leadership styles of nurse managers on Saudi nursesÕ job structure that has several layers of management that
satisfaction and their intention to stay at work. control the work flow by maintaining a high level of
This study indicated that a transformational leader- authority and, therefore, nurses are not afraid of any
ship style enhanced level of nursesÕ job satisfaction. disciplinary actions that might be enacted by their
Such results are congruent with the results of AL- direct managers. Therefore, in public hospitals, nurse
Hussami (2008) and Bass and Avolio (1990). These managers do not have enough authority to affect job
studies support the notion that nurses who worked with security, salaries, or nursesÕ intention to stay. On the
leaders exhibiting transformational leadership styles contrary, they may share similar levels of intention to
were more satisfied. These characteristically involved stay and job satisfaction as their nurses do. The indi-
spending time teaching and coaching nurses, focusing viduals upon whom the organization relies to address
on developing nurses strengths, providing advice for critical retention issues might be ill-equipped to meet
professional development, treating followers as indi- that challenge.
viduals, listening to concerns and promoting self- A significant but weak positive relationship was
development (Bass & Avolio 2004). found between job satisfaction and nursesÕ intention to
The results also revealed that a perceived transac- stay in the current job. The findings of the current study
tional leadership style negatively influence nursesÕ job contribute additional evidence to the literature indicat-
satisfaction. Therefore, the findings support the prefer- ing that job satisfaction is one of the factors that might
ence of a transformational leadership style over the a enhance the level of nursesÕ intention to stay at work.
transactional leadership style. Such results support These findings are supported by previous studies in
several previous studies that indicated a transactional Saudi Arabia as well as other countries (Al-Aameri
leadership style was the weakest predictor of job satis- 2000, Lu et al. 2005, Mrayyan 2006, AL-Hussami
faction (Bass & Avolio 1990, Omer 2005, AL-Hussami 2008, Zaghloul et al. 2008, AbuAlRub et al. 2009).

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Journal of Nursing Management, 2012, 20, 668–678 675
R. F. AbuAlRub and M. G. Alghamdi

Furthermore, the results of the hierarchical regression and Omer (2005). Saudi nurses were unsure whether
analysis indicated that 32% of the variation in job they would stay or leave their jobs. Understanding staff
satisfaction was explained by the background variables, intention to stay or leave might facilitate the role of
transformational leadership style and transactional nurse managers in introducing appropriate retention
leadership style. In contrast, the regression analysis strategies (McCarthy et al. 2007).
indicated that 5% of the variation in Ôthe level of
intention to stay at workÕ was explained by the back-
Limitations of the study
ground variables, transformational leadership style,
transactional leadership style and job satisfaction. Such The study findings should be interpreted taking into
weak (5%) and below moderate percentages (32%) consideration the following limitations: the study (1)
confirmed the notion that satisfaction and intention to used a convenience sample from only six public hospi-
stay at work are complex variables that are affected by tals, and (2) the collected data relied on the recall of
many personal and organizational factors that are not participants which might create a reporting bias.
accounted for by the present study. While the transac-
tional style did not explain any of the variance of the
Conclusion
level of intention to stay, the transformational style and
job satisfaction only explained 1 and 2% of its variance, The results of the study emphasized the importance of
respectively; such results indicate that leadership styles transformational leadership style in enhancing job sat-
and job satisfaction have very small impact on the level isfaction. Effective nurse managers have been described
of intention to stay. Thus nurse administrators should as more frequently demonstrating transformational
explore further the factors that most affect the level of leadership characteristics. Although such relationships
intention to stay at work. have been indicated in the literature, it remains unclear
Further analysis of the data of the study revealed that how to develop effective leadership characteristics
the participants were moderately satisfied. Like other among nurse executives and managers. Further research
studies reviewed in literature, Saudi nurses reported a is needed to explore effective strategies needed for fur-
moderate level of job satisfaction (El-Gilany & Al- ther development of positive leadership characteristics
Wehady 2001, Al-Ahmadi 2002, Zaghloul et al. 2008). among nurse managers.
Such results indicate that further exploration of nursesÕ
job satisfaction in Saudi Arabia is required. The par-
Implications for nursing management
ticipants were most satisfied with the Ônature of workÕ
(subscale of job satisfaction). Such a result is supported Several implications arise from the results of the present
by the notion that the most notable situational influence study. Nurse managers and head nurses can use the data
on job satisfaction is the nature of the work itself, often from this study to develop effective leadership styles
called Ôintrinsic job characteristicsÕ (McCarthy et al. that can enhance nursesÕ job satisfaction and their
2007). This means that the nature of work and envi- intention to stay at work. It is important to provide
ronment in Saudi public hospitals were good enough for nurses with opportunities to present their thoughts and
nurses. However, the participants were least satisfied opinions. These thoughts and opinions can then be
with Ôfringe benefitsÕ (a subscale of job satisfaction). In considered and incorporated into management deci-
the public hospitals, where the study took place, the sions. Nurses are more willing to accept change when
Ministry of Health in Saudi Arabia provides several they have input into the change process. Nurse admin-
facets of fringe benefits for nurses such as health and istrators in Saudi Arabia should capitalize on the
dental insurance, child-care services, flexible work importance of transformational leadership style in
schedule, maternity leave and education programmes. enhancing the level of job satisfaction. They could use
However, the results of this study indicate that such innovative ways to enhance their staff satisfaction and
benefits might not be enough to raise the level of sat- retention, such as spending time helping good per-
isfaction of the participants. Thus, nurse administrators formers move to new positions and minimizing poor
in these hospitals should re-evaluate the package of performance, creating open communication channels to
fringe benefits. encourage employees to speak frankly with their man-
The findings of the current study indicate that nursing agers without fear of repercussion, and offering a
managers tend to use transformational leadership more competitive benefits package (especially considering
often than transactional leadership styles, reinforcing that Ôfringe benefitsÕ had the lowest mean of the
the findings of AL-Hussami (2008), Doran et al. (2004) subscales of satisfaction in the present study).

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676 Journal of Nursing Management, 2012, 20, 668–678
Leadership styles, satisfaction, and intention to stay

Future consideration should be given to addressing Bass B. & Avolio B. (1990) The implications of transactional and
retention planning by first addressing the work envi- transformational leadership for individual, team, and organi-
zational development. Research in Organizational Change &
ronment of the nurse managers. Saudi nurse managers
Development 4, 231–272.
need to be empowered by nursing leaders and admin- Bass B. & Avolio B. (2004) Manual for Multifactor Leadership
istrators in order to be able to empower their staff Questionnaire: Sampler Set, 3rd edn, Mind Garden Inc.,
nurses and be able to perform actions that might en- Redwood City, CA.
hance their retention. The results of the present study Bass B., Avolio B., Jung D. & Berson Y. (2003) Predicting unit
also indicate the importance of further exploration of performance by assessing transformational and transactional
leadership. Journal of Applied Psychology 88, 207–218.
the factors that affect job satisfaction and the decision
Bégat I., Ellefsen B. & Severinsson E. (2005) NursesÕ satisfaction
of nurses to stay or leave work and then, accordingly, with their work environment and the outcomes of clinical nurs-
designing and implementing retention strategies. ing supervision on nursesÕ experience of well-being – a Norwe-
gian study. Journal of Nursing Management 13, 221–230.
Campbell S., Fowles E. & Weber B. (2004) Organizational
Acknowledgement structure and job satisfaction in public health nursing. Public
Health Nursing 21, 564–571.
The authors would like to thank the Saudi Ministry of Chen H., Beck S. & Amos L. (2005) Leadership styles and nursing
Health for funding the study, and all nurses who par- faculty job satisfaction in Taiwan. Journal of Nursing Schol-
ticipated in the study. arship 37, 374–380.
Cohen J. (1992) A power primer. Psychological Bulletin 112,
155–159.
Source of funding Doran D., McCutcheon A., Evans M., MacMillan K., Hall M. &
Pringle D. et al. (2004). Impact of the ManagerÕs Span of
This study was funded by the Saudi Ministry of Health. Control on Leadership and Performance. Canadian Health
Services Research Foundation. Available at: http://www.
nursingleadership.org.uk/publications/doran2_final.pdf, accessed
Ethical approval 12 March 2009.
Dunn S., Wilson B. & Esterman A. (2005) Perceptions of working
The formal approval of the Institutional Review Board as a nurses in acute care setting. Journal of Nursing Manage-
(IRB) of the Saudi Ministry of Health was obtained ment 13, 22–31.
before conducting the study. El-Gilany A. & Al-Wehady A. (2001) Job satisfaction of female
Saudi nurses. Eastern Mediterranean Health Journal 7, 31–37.
Ellis J. & Hartley C. (2009) Managing and Coordinating Nursing
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