Transformational Nursing Leadership and Effects on Job ...
Transformational Nursing Leadership and Effects on Job Satisfaction: An Integrated Literature ReviewKaren FugateUniversity of Central FloridaAbstractAim. To critique the evidence that examines the impact of transformational leadership compared to other leadership styles on nurse job satisfaction in the hospital setting. Background. Nursing shortages and escalating clinical demands on staff can lead to job dissatisfaction and subsequent nurse turnover. The leadership styles of nurse managers can influence staff nurse job satisfaction. Therefore it is of utmost importance to identify the leadership style associated with the highest level of staff nurse job satisfaction. Design. An integrated literature review.Method. Searches of CINAHL, PubMed, and the Cochrane Library between 1999 - February 2014. Included articles were appraised and synthesized into a narrative summary.Conclusions. Results indicate there is a positive correlation between transformational leadership and increased nurse job satisfaction in the hospital setting. Conversely, task focused and passive leadership styles are negatively correlated with nurse job satisfaction. Relevance to clinical practice. Transformational leadership is the preferred leadership style to increase nurse job satisfaction. Transformational leadership must be supported and nurse leaders should be encouraged to develop knowledge and skills related to transformational leadership.Transformational Nursing Leadership and Effects on Job Satisfaction: An Integrated Literature ReviewSignificanceHealthcare organizations are systems where human resources are the most important factor for the delivery of quality healthcare; nursing is the largest workforce within the healthcare organization. Nurses are the front line healthcare providers who spend more time with patients than any other healthcare professional. Therefore achieving optimal healthcare delivery is difficult, if not impossible without the efforts and commitment of staff nurses. Nursing leadership has a significant impact on creating practice environments that support and motivate staff nurses to provide the highest level of care to healthcare consumers. The concept of job satisfaction is of paramount importance to nursing leadership. Nurse satisfaction has been linked to positive patient outcomes (Aiken, Clark, Sloane, Sochalski, & Silber, 2002). Nursing job satisfaction is also critical for nurse retention; dissatisfied nurses are more likely to quit resulting in high turnover rates within the healthcare organization (Larrabee et al., 2003, Weberg, 2010). The economic implications of high nurse turnover to the healthcare organization cannot be understated. The loss of an experienced nurse can lead to short staffing, increased recruitment and orientation costs, increased adverse patient outcomes and consequently higher staff dissatisfaction (Hayes, Bonner, & Pryor, 2010). It is estimated that the cost to replace a nurse is between $22,000 and $64,000 with the loss of experienced nurses being especially costly as it takes years to develop nursing expertise (Robert Wood Johnson Foundation [RWJF], 2009). On a more national scale, job dissatisfaction may result in nurses leaving the profession altogether which further exacerbates the current nursing shortage (American Association of Colleges of Nursing [AACN], 2014). McHugh et al. (2011) found patient satisfaction levels to be lower in hospitals with higher nurse dissatisfaction rates. Additionally, job satisfaction has been linked to higher overall life satisfaction which indicates how satisfied the nurse is with life in general and how well their physical and psychological needs are being met (Hayes, Bonner, & Pryor, 2010). Many factors influence nursing job satisfaction; a factor receiving much attention lately is nursing leadership (Cummings et al., 2010).According to Cummings et al. (2010), leadership includes four elements: 1) leadership is a process, 2) involves influence, 3) occurs within a group context, and 4) involves achieving common goals. Within healthcare there are several leadership styles that can be grouped into relationally focused or those that focus on people and relationships and task focused (non-relationally focused) or those that focus on tasks to be completed (Cummings et al., 2010). The relationally focused group includes transformational leadership, individualized consideration, and resonant leadership; the task focused group includes management by exception, laissez-faire, transactional, dissonant, and instrumental leadership styles (Cummings et al., 2010). The transformational leader has the relational skills to motivate followers to do more than they originally intended and more than they thought they were capable of (Cummings et al., 2010). The transformational leader embodies several traits including expanding and elevating the interests of their followers, building awareness and commitment to the organizational mission, and facilitating followers to transcend their own self-interests for the betterment of the team (Weberg, 2010). The transformational leader inspires and engages followers. Nursing job satisfaction is related to patient clinical (Aiken et al., 2002) and satisfaction outcomes (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011), nurse retention (RWJF, 2009, AACN, 2014), and overall life satisfaction (Hayes et al., 2010). Nursing leadership style influences nurse job satisfaction (Cummings et al., 2010). It is imperative that nurse leaders understand which leadership style has the most impact on nurse job satisfaction. This leadership style should be encouraged and developed to enhance nurse job satisfaction. Transformational leadership has been given much attention recently; however does it positively impact nurse job satisfaction? To gain insight into transformational leadership compared to other leadership styles and their effect on nurse job satisfaction, the following PICO question was formulated to guide the literature review: How does transformational leadership (I) compared to other leadership styles (C) influence job satisfaction (O) for the hospital staff nurse (P)?MethodsA literature search was conducted to answer the PICOT question, how does transformational leadership (I) compared to other leadership styles (C) influence job satisfaction (O) for the hospital staff nurse (P). The search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Cochrane Database of Systematic Reviews. Key search terms included singly or in various combinations: nurse, “staff nurse”, leadership, “leadership styles”, “transformational leadership”, “nurs* leadership”, “nurs* leadership styles”, “job satisfaction”, satisfaction, “nurs* job satisfaction”, and “nurs* work environment”. A manual search was also conducted using the ancestry approach by reviewing the reference lists of each selected article to identify additional journal articles. The search was limited to quantitative research articles that examined the influence of transformational leadership compared to other leadership styles on acute care nurse job satisfaction. Additionally, the search was limited to articles published in the last fifteen years. Exclusion criteria were also considered while extracting relevant articles. Articles measuring job satisfaction in nurse managers or nurse administration were excluded. Articles measuring quality of work environment or work life that did not specifically measure job satisfaction were excluded as were articles measuring satisfaction with leadership. Articles that did not include transformational leadership or compare transformational leadership to at least one other leadership style were not included. Additionally, articles that addressed nurse satisfaction in a setting other than acute care were excluded (i.e. outpatient, elder care, long term acute care or skilled nursing facility setting). Lastly, level of evidence and quality of the articles was taken into consideration. The Rating System for the Hierarchy of Evidence of Intervention/Treatment Questions (Melnyk & Fineout-Overholt, 2011) was utilized to rate the quality of the articles. The articles were selected for their validity, reliability, and applicability with reference to the PICOT question.ResultsSearch resultsDespite a comprehensive search, there were few research studies related to transformational leadership’s effect on nurse job satisfaction compared to other leadership styles. A total of fifty-three articles were identified from database searches: twenty-eight from CINAHL, twenty-five from PubMed, and zero from the Cochrane Database of Systematic Reviews. Additionally, three articles were identified via the ancestry method from a manual review of article reference lists. Of the CINAHL articles, five were included and twenty-three were eliminated. Four were eliminated because they were in a non-hospital setting – two elder care, one long-term care facility, and one ambulatory care. Five did not address nurse job satisfaction specifically and four measured job satisfaction in managers, leaders, and faculty. Four did not include transformational leadership style as one of the measures and one evaluated transformational leadership only. Five articles were commentaries and or exemplars and were eliminated for their lack of quantitative evidence. The PubMed search identified twenty-five articles. Twenty-one of the articles were duplicates of the CINAHL search. Of the four remaining articles, one was a commentary, one did not evaluate nurse job satisfaction, and two did not correlate job satisfaction with leadership style. After review, eight articles were found to be suitable for appraisal and pulled as full text – five from the CINAHL search and three identified through review of article reference lists. Upon evaluation, all eight articles were found to be relevant to the PICOT question. There were no randomized controlled trials or controlled trials without randomization. The level of evidence for this literature review consisted of two Level V articles (systematic reviews of descriptive and qualitative studies) and six Level VI articles (single descriptive or qualitative studies) (Melnyk & Fineout-Overholt, 2011). A summary of the design, level of evidence, sample characteristics and results for each of the eight articles included in the integrated literature review are included as tables. The articles are organized alphabetically by first author and are classified into the following three themes based on the influence of nurse leadership style on job satisfaction (Table 1), nurse work environment (Table 2), and nurse manager outcomes (Table 3).Job satisfactionTwo studies (Abualrub & Alghamdi, 2012; Failla & Stichler, 2008) and one evidence review (Weberg, 2010) address the impact of leadership style on job satisfaction (see Table 1). When transformational leadership was compared to other leadership styles, transformational leadership was related to increased job satisfaction whereas other leadership styles were associated with decreased job satisfaction. Abualrub and Alghamdi (2012) and Failla and Stichler (2008) report a significant and moderate positive relationship between transformational leadership and job satisfaction (r = 0.45 and 0.38 respectively). Failla and Stichler (2008) also report positive correlations between transformational subscales and job satisfaction; the strongest correlation (r = 0.425) was between the transformational subscale “attributed idealized influence” and job satisfaction indicating the leader that is seen as charismatic, powerful and confident is more likely to have staff that are satisfied with their job. Conversely, negative correlations are reported between transactional, passive avoidance and laissez-faire leadership styles and job satisfaction; laissez-faire had the strongest negative correlation (Abualrub & Alghamdi, 2012; Failla & Stichler, 2008). In addition to the findings in the two studies, Weberg (2010) evaluates seven articles in his evidence review and concludes that transformational leadership increases job satisfaction and transactional and laissez-faire leadership lead to poor job satisfaction.One of the two studies was conducted in Saudi Arabia strengthening the argument and indicating the findings are not limited to the United States (Abualrub & Alghamdi, 2012). Both studies use validated psychometric tools to measure leadership style and job satisfaction. The Multi-factor Leadership Questionnaire (MLQ) is utilized in both studies to measure leadership style which provides for consistent measurement of leadership traits. Table SEQ Table \* ARABIC 1: Studies related to job satisfactionPrimary Study, CountryDesign, Level of Evidence, SampleCharacteristics of InterventionResultsAbualrub et al. (2012) Saudi ArabiaDescriptive correlational designLevel VIA convenience sample of staff RNs working in 6 public hospitalsn = 308No direct intervention.The study was designed to examine the impact of leadership styles (transformational and transactional) on levels of intent to stay at work and job satisfaction among hospital nurses. A structured questionnaire combining the Multifactor Leadership Questionnaire (MLQ-5X), Job Satisfaction Survey (JSS), and McCain’s Intent to Stay Scale was used to collect data and measure the study variables. There was a significant correlation in the positive direction between job satisfaction scores and transformational leadership style (r = 0.45, P <0.001).Conversely, there was a significant correlation in the negative direction between job satisfaction scores and transactional leadership style (r = - 0.14, P < 0.01).Results of hierarchical regression analysis indicated that 32% of variation in job satisfaction was explained by the background variables, transformational and transactional leadership style.Failla et al.(2008) United States of AmericaCross-sectional, descriptive correlational designLevel VIA convenience sample drawn from a population of nurses and nurse managers in a large metropolitan hospital campusn = 92 (76 staff nurses)No direct intervention.Data were collected from self-administered questionnaires. The Multifactor Leadership Questionnaire (MLQ) was used to measure leadership characteristics and the Index of Work Satisfaction Questionnaire – Part B (IWS-B) was used to measure work satisfaction. The intent of the study was to answer 4 research questions, one of which was the relationship between nurse manager’s leadership style and level of job satisfaction among his/her staff.Significant and positive correlations were demonstrated between aggregate scores of work satisfaction and transformational leadership style overall and in 4 subscales of the MLQ:Transformational leadership overall – r = 0.348aAttributed idealized influence – r = 0.425aBehavioral idealized influence – r = 0.265aInspirational motivation – r = 0.413aIntellectual stimulation – r = 0.282aTransactional leadership showed a statistically positive correlation in one subscale only (contingent reward – r = 0.0328a and passive-avoidant leadership showed statistically negative correlation overall (r = -0.0241a) and laissez-faire (r = -0.290a)aSignificant at <.05 levelWeberg (2010) United States of AmericaEvidence reviewLevel V7 studies were included in the final evaluation of evidence. All were quantitative in design and used correlational, non-experimental, or cross-sectional designs.No direct intervention.The evidence review was conducted to answer the PICO question “In healthcare organizations (P), how does transformational leadership (I) influence staff satisfaction and job burnout (O)?”3 studies evaluated leadership style and influence on staff satisfaction (2 were conducted in large acute care hospitals and one in an elder care center).When transformational leadership was compared with other leadership styles looking at staff satisfaction as an outcome, transformational leadership was related to an increase in staff satisfaction in healthcare organizations whereas other leadership styles were related to a decrease in staff satisfaction.Work environmentTwo studies (Larrabee et al., 2003; Malloy & Penprase, 2010) and one systematic review (Cummings et al., 2010) are included to address the impact of leadership style on the nurse work environment (see Table 2). As in the “job satisfaction” theme, the MLQ is utilized in both studies ensuring a consistent method to measure leadership traits. Both studies utilize a conceptual model suggesting they were guided by a theoretical framework which strengthens the validity of the study findings. Larrabee et al. (2003) study nurse job satisfaction compared to work environment variables of context of care, structure of care, and nurse attitudes; work environment context variables include leadership styles. Larabee et al. (2003) reveal a significant strong positive correlation between nurse job satisfaction and transformational leadership (r = 0.53) and a significant moderate negative correlation between more passive leadership styles - management by exception and laissez faire. Malloy and Penprase (2010) examine the correlation between leadership style components and psychosocial work environment dimensions one of which is job satisfaction. Malloy and Penprase (2010) report significant positive correlations between all components of transformational leadership and job satisfaction; the strongest correlations are between idealized influence attributes, inspirational motivation, and intellectual stimulation. Cummings et al. (2010) conduct a systematic review of the relationship between leadership styles and nursing workforce and work environment outcomes; outcomes are grouped into five categories one of which is staff satisfaction with work. Upon review of fifty-three articles, Cummings et al. (2010) report a positive association between relationship-focused leadership styles such as transformational leadership and higher nurse job satisfaction in twenty-two studies, whereas ten studies reveal leadership styles focused on tasks are correlated with lower nurse job satisfaction.All three articles report a positive relationship between leadership styles that fit the transformational form of leadership and job satisfaction. They also reported lower job satisfaction with more task focused forms of leadership such as management by exception and laissez-faire leadership. This is consistent with findings in the aforementioned “job satisfaction” theme.Table SEQ Table \* ARABIC 2: Studies related to work environmentPrimary Study, CountryDesign, Level of Evidence, SampleCharacteristics of InterventionResultsCummings et al. (2009) CanadaSystematic reviewLevel V53 total studies were included which were all quantitative in design and used correlational, non-experimental, or cross-sectional designsNo direct intervention.The specific aim of the review was to systematically review the literature to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. Studies were divided into 5 themes which investigated the outcomes of leadership on, 1) staff satisfaction, 2) staff relationships with work, 3) staff health and well-being, 4) work environment factors, and 5) productivity and effectiveness. Nursing satisfaction was the most frequently examined outcome of leadership (24 studies). Twenty-two studies reported highest job satisfaction with a variety of relational focused leadership styles including transformational leadership. Two studies found that relational leadership styles were not significantly associated with job satisfaction. Ten studies reported job satisfaction was significantly lower with more task focused forms of leadership. Larrabee et al. (2003) United States of AmericaNon-experimental, descriptive designLevel VINonrandom sample of RNs in a large university hospital (n = 90)The purpose of the study was to examine the relative influence on nurse attitudes, context of care, and structure of care on job satisfaction and intent to leave. Several instruments with known psychometric properties were utilized including the Multifactor Leadership Questionnaire to measure nurse manager leadership style and the Work Quality Index (WQI) to measure RN job satisfaction. Multivariate regression analyses evaluated models that best predict RN job satisfaction.Pearson correlation between RN job satisfaction and:Transformational leadership – r = 0.53, P < 0.0001Contingent reward – r = 0.52, P < 0.0001Management by exception (passive) – r = -0.041, P <0.0001Laissez-faire leadership – r = -0.42, P < 0.0001Malloy et al. (2010) United States of AmericaCorrelational designLevel VIConvenience sample of RNs working for a government agency - n = 122 (35 supervisory and 87 non-supervisory)No direct intervention. The aim of this study was to examine the relationship between leadership style and the psychosocial work environment of registered nurses. The Multifactor Leadership Questionnaire 5X was used to evaluate leadership style and the Copenhagen Psychosocial Questionnaire was used to measure psychosocial work environment.Correlations between leadership model components and job satisfaction measured by Pearson’s r (*P < 0.05, **P < 0.01). Components of transformational leadership have a higher correlational with job satisfaction than transactional and passive-avoidance leadership components (see below).Transformational Leadership components: Idealized Influence-Attributes (0.48**), Individual Consideration (0.44**), Idealized Influence-Behavior (0.39**)Inspirational Motivation (0.48**), Intellectual Stimulation (0.48**)Transactional Leadership components:Contingent Reward (0.45**), Management by Exception-Active (-0.21*)Passive-Avoidance Leadership:Management by exception-passive (-0.44**), Laissez Faire (-0.53**)Nurse manager outcomesTwo studies (Cassida & Parker, 2011; Dunham-Taylor, 2000) are included to address the final theme of influence of leadership style on nurse manager outcomes (see Table 3). As in the previously described themes, both studies utilize the MLQ to measure leadership traits; however these two studies also use the MLQ to evaluate the nurse manager outcomes of leader’s extra effort, leadership effectiveness, and leadership satisfaction (LS). Leadership satisfaction indicates the manager’s ability to meet the needs of the staff nurse through positive communication, interaction, and increased visibility, thereby keeping staff nurses satisfied with their work (Cassida & Parker, 2011). Both studies report significant positive correlations between transformational (r = 0.82 and 0.79) and transactional (r = 0.27 and 0.37) leadership styles and LS; however there was a stronger relationship between transformational leadership and LS (Cassida & Parker, 2011; Dunham-Taylor, 2000). Moreover, Casida and Parker (2011) report the best predictor for the LS variable to be idealized influence attributes; this result is similar to findings in previously mentioned studies conducted by Failla and Stichler (2008) and Malloy and Penprase (2010). Table SEQ Table \* ARABIC 3: Studies related to nurse manager outcomesPrimary Study, CountryDesign, Level of Evidence, SampleCharacteristics of InterventionResultsCasida et al. (2011) United States of AmericaExploratory correlational designLevel VISample derived from 4 hospitals in Northeast U.S. – staff nurses (n = 278, nurse managers (n = 37)No direct intervention.Staff nurses were asked to evaluate the leadership style and outcomes of nurse managers using the Multifactor Leadership Questionnaire Form 5x-Short. Outcomes included leader’s extra effort (LEE), satisfaction with leader (LS), leadership effectiveness (LE). All 3 outcomes are associated with nurse job satisfaction.Correlations among nurse manager leadership styles and outcomes were measured using Pearson’s r. Asterisk denotes statistical significance P <0.0001.Transformational leadership demonstrates positive, strong, significant correlations with LEE, LS, and LE (0.83*, 0.82*, 0.89*). There was a significant weakly positive correlation between transactional leadership and LEE, LS, and LE (0.29*, 0.27*, 0.28*). Dunham-Taylor (2000) United States of AmericaDescriptive, correlational designLevel VIRandom sample of nurse executives from full-service or children’s general hospitals in the U.S. (n = 396) and the staff reporting to the nurse executive (n = 1,115)No direct intervention.Study aimed to examine transformational leadership and outcomes (see below), stage of power, and organizational climate. Nurse executives and staff reporting to them rated the nurse executive’s leadership style and outcomes of staff extra effort, staff satisfaction, and work group effectiveness using the Multifactor Leadership Questionnaire. Executives’ bosses rated work group effectiveness. Nurse executives rated their stage of power using Hagberg’s Personal Power Profile and ranked their organizational climate using Likert’s Profile of Organizational Characteristics.As staff rated nurse executive transformational leadership as occurring more frequently, they rated their satisfaction with leadership to increase. This relationship was strongly positive and statistically significant (r = 0.79, P < 0.0001). Staff satisfaction with leadership style decreased as staff rated the executive as being more transactional (r = 0.37, P < 0.0001).Limitations of evidenceOnly published studies were included in this review which may contribute to reporting bias since published work tends to reflect positive findings. An additional limitation of this body of evidence is that the data in all the studies were obtained from surveys. Survey study limitations include respondent bias secondary to convenience sampling. Notable also was the low survey response rate (<60%) in several of the studies (Abualrub & Alghamdi, 2012; Failla & Stichler, 2008; Larrabee et al., 2003; Malloy & Penprase, 2010); better response rates would improve reliability of the results. Another limitation is that there were no randomized controlled trials; although logistically challenging, this type of evidence would have been helpful. This is due in part to the nature of studying leadership; the specific leadership style populations are most easily studied by convenience sampling. Additionally, the single site sample of some of the studies and small sample size limit generalizability (Failla & Stichler, 2008; Larrabee et al., 2003; Malloy & Penprase, 2010). Conversely, the consistent use of the MLQ increases the validity and generalizability of the study results. Limitations are also lessened by the consistent findings across studies correlating transformational leadership with job satisfaction (r = 0.348, 0.45, 0.53, 0.79, 0.82).Recommendation for PracticeThe research for the PICO question, how does transformational leadership (I) compared to other leadership styles (C) influence job satisfaction (O) for the hospital staff nurse (P) resulted in indicating that transformational leadership compared to other leadership styles has a positive impact on nurse job satisfaction. The nurse manager who displays transformational leadership qualities will have higher staff nurse satisfaction. Therefore, it is recommended that transformational leadership is the preferred leadership style to increase nurse job satisfaction. Nurse leaders practice multiple styles of leadership. Leadership theory depicts a continuum of leadership styles ranging from highly engaged on one end of the spectrum (transformational leadership) to highly avoidant on the other end. Currently many healthcare leaders are primarily task focused (Cummings et al., 2010). According to Cummings et al. (2010) and Cassida and Parker (2011), transformational leadership skills can be learned. Hence, transformational leadership training and mentoring should be offered for nurse leaders to encourage and develop knowledge and skills related to transformational leadership. Furthermore, there should be a strong focus on idealized influence attributes as this is the transformational leadership characteristic most predictive of higher nurse job satisfaction (Cassida & Parker, 2011; Failla & Stichler, 2008; Malloy & Penprase, 2010).If healthcare is going to effectively confront a rapidly changing, complex environment, it will need to invest energy and resources into developing insightful, visionary, competent, motivational leaders that will positively affect nurse job satisfaction which will ultimately improve the quality care for healthcare consumers. Representing the largest workforce in healthcare, the transformational nurse leader is perfectly positioned to lead this challenge. In addition, given the looming nursing shortage and the relationship between nurse job dissatisfaction and intent to leave (Larrabee et al., 2003; Weberg, 2010), healthcare policy should address evidence-based strategies such as leadership style that are known to increase nurse satisfaction. This can start with developing undergraduate and graduate nursing curriculums that address transformational leadership education.Future research can continue to inform practice on this very important nursing issue. Transformational leadership skills can be taught; however little is known about what types of leadership training are best suited to translate knowledge into action. Future research could concern various types of leadership training and the degree to which they develop transformational leadership traits in managers and influence nurse job satisfaction. Servant leadership is similar to transformational leadership in that they both focus on building relationships (American Association of Nurse Assessment Coordination [AANAC], 2013). Research on servant leadership compared to transformational leadership and job satisfaction could inform nursing practice as well.ReferencesAbualrub, R. F., & Alghamdi, M. G. (2012). The impact of leadership styles on nurses’ satisfaction and intention to stay among Saudi nurses. Journal of Nursing Management, 20(5), 668-678. , L. H., Clark, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993.American Association of Colleges of Nursing. (2014). Nursing shortage. Retrieved February 23, 2014, from Association of Nurse Assessment Coordination. (2013). Nursing leadership, management, & leadership styles. Retrieved from , J., & Parker, J. (2011). Staff nurse perceptions of nurse manager leadership styles and outcomes. Journal of Nursing Management, 19(4), 478-486. doi: 10.111/j.1365-2834.2011.01252.xCummings, G., MacGregor, T., Davey, M., Lee, H., Wong, C., Lo, E., ... Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 47(3), 363-385. , J. (2000). Nurse executive transformational leadership found in participative organizations. Journal of Nursing Administration, 30(5), 241-250.Failla, K., & Stichler, J. (2008). Manager and staff perceptions of the manager’s leadership style. Journal of Nursing Administration, 38(11), 480-487.Hayes, B., Bonner, A., & Pryor, J. (2010). Factors contributing to nurse job satisfaction in the acute hospital setting: A review of recent literature. Journal of Nursing Management, 18(7), 804-814. doi:10.1111/j.1365-2834.2010.01131.xLarrabee, J., Janney, M., Ostrow, C., Withrow, M., Hobbs, G., & Burant, C. (2003). Predicting registered nurse job satisfaction and intent to leave. Journal of Nursing Administration, 33(5), 271-283.Malloy, T., & Penprase, B. (2010). Nursing leadership style and psychosocial work environment. Journal of Nursing Management, 18(6), 715-725. doi: 10.111/j.1365-2834.2010.01094.xMcHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with healthcare benefits signal problems for patient care. Health Affairs, 30(2), 202-210. doi: 10.1377/hlthaff.2010.0100Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based Practice in Nursing and Healthcare (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.Robert Wood Johnson Foundation. (2009). Business case/cost of nurse turnover. Retrieved from , D. (2010). Transformational leadership and staff retention: An evidence review with implications for healthcare systems. Nursing Administration Quarterly, 34(3), 246-258. doi: 10.1097/NAQ.0b013e3181e70298 ................
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