Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
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
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
& 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
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
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.
Table 3
Summary of the hierarchical regression analysis for variables predicting job satisfaction (n = 308)
Table 4
Summary of the hierarchical regression analysis for variables predicting intention to stay at work (n = 308)
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).
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).
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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