ASSESSMENT OF LEADERSHIP STYLE OUTCOME OF HEAD OF DEPARTMENT RADIOLOGY

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ASSESSMENT OF LEADERSHIP STYLE OUTCOME OF HEAD OF DEPARTMENT RADIOLOGY

CHAPTER ONE

INTRODUCTION

Background to the study

The constantly changing health care environment, high technology and high cost of care provision are few factors affecting nursing practice today(Murray, 2010). Hospitals face the problem of how to strategize to achieve their goals in this competitive and changing healthcare environment. This often means constant organizational change to meet new health care challenges. Pressures to provide quality care while cost reduction measures are frequently implemented, results in high stress levels for nurses in the workplace. In addition, constant changes inevitably place considerable pressure on nurse leaders to both adapt and proactively engage their subordinates to embrace changes in the face of acute staff shortages and in some poor cases,that slowly evolving work environment. These combined factors within the hospital arena maycontribute to the lack of satisfaction nurses experience with their jobs. As remarked by Sherman (2010), this scenario desperately calls for new leaders, leaders who inspire others with the vision of what can be accomplished. In order to move forward and survive in the face of these challenges, nurse managers and their subordinates must establish positive and mutually beneficial relationships that favour increased efficiency, productivity, and job satisfaction. Quality nursing leadership is seen as a predictor of job satisfaction (Giallonardo, Wong &Iwasiw, 2010).

Job satisfaction has been described as the most important predictor for nurses’ intention to remain in their work place and is related to the feeling of employees and can be influenced by factors such as the quality of their relationship with their supervisor or employer, the quality of the physical environment in which they work, or the degree of fulfilment in their work (Edwards, Bexley & Richardson, 2011, Ritter, 2010; Mackusick&Minick, 2010).The nurse manager (NM) is officially charged with leadership of a health unit in a hospital system. No one else influences the whole health unit operation and the degree of responsiveness of both the nurses and patients than nurse managers. The quality of patient care, as well as staff recruitment and retention success are the key roles of a nurse manager (Olanrewaju, 2012). NMs as leaders,plan, coordinate and supervise day to day activities and general welfare of the nurses and patients. Their activities positively or negatively affect patient care delivery. The leadership style, skills and abilities of nurse managers are critical to the smooth operation of nursing units, the success of the hospital and by implication the entire healthcare system.

Leadership style has become an important topic of study in the management field. A good leader guides subordinates to work effectively toward organizational goals. According to Schimmoeller (2010) and Fatokun, Salaam and Ajegbomogun(2010), leadership styles can be viewed as series of managerial attitudes, behaviours, characteristics and skills based on individual and organizational values, leadership interests and reliability of employees in

different situations. Organizational success in obtaining its goals and objectives depends on managers and their leadership style.

There are several styles of leadership such as autocratic, bureaucratic, laissez-faire, charismatic, democratic, participative, situational, transactional, and transformational leadership. Not everyone agrees that a particular style of leadership will result in the most effective form of organizational behaviour. Different styles are needed for different situations and each leader needs to know when to exhibit a particular approach. Transformational and transactional leadership behaviours are known as the new leadership theories and are used by most academics who study organizational leadership(Kozier, 2007).By using appropriate leadership styles, managers can affect employee job satisfaction, commitment and productivity.

The relationship between a manager’s leadership and subordinate/employees job satisfaction is well documented (Hall, 2007; Christmas, 2008 &Ma, Lee, Yang & Chang, 2009). Job satisfaction is related to the feeling of employees and can be influenced by factors such as the quality of their relationship with their supervisor or employer, the quality of the physical environment in which they work, or the degree of fulfilment in their work. Job satisfaction can be considered from a global perspective, such as the feelings and emotions perceived by the individual employee based on work experiences (Cowin, Johnson, Craven & Marsh, 2008). It can also be explored through a facet approach- studying employee attitude towards various aspects (facets) of

their jobs. Hegney, Plank and Parker (2006) described two aspects of values,

intrinsic and extrinsic where intrinsic values refer to satisfaction inherent in the work itself (immaterial aspects of the job) such as job variety and autonomy and extrinsic values refer to material work aspects such as salary and opportunity for promotion. Job satisfaction is therefore the result of an evaluation of whether ones job meets ones needs. If one feels dissatisfied, searching for and accepting another place to work will likely occur. Job satisfaction has been described as the most important predictor for nurses’ intention to remain in their work place (Larrabee, Janney, Ostrow, Withrow, Hobbs &Burant, 2003).

Previous studies on the relationship between nurse managers’ leadership style and nurse job satisfaction byTobak andKoprak(2007) found that transformational leadership style exhibited by nurse managers in Israeli public hospitals was best suited for conflict management in an innovative but understaffed system. Similarly, a significant correlation was found to exist, in a study carried out by Sellgren (2007), between nurse manager’s leadership behaviour and job satisfaction in the Karolinska hospital in Stockholm. If the leadership style necessary to manage the present challenging nurses’ work environment is lacking, there is a potential for continued increase in the nursing shortage and its attendant grave consequences.

Statement of the problem

In the University of Nigeria Teaching Hospital (UNTH) ItukuOzalla, the researcher observed gross shortage of nurses in all the nursing units. The record from the nursing service department shows a total number of 588 nurses in UNTH of which 444 were deployed to 26 wards and special clinics of the hospital as at the time of this study. The researcher also observed that, in a ward of 28 to 30 patients, 2 to 3 nurses were seen caring for patients during the day as against 1:6 ratio recommended by WHO (2011) and 1:4-5 (for general wards) and 1:1-3 ( for intensive care units) recommended by Nursing and Midwifery Council of Nigeria (N&MCN, 2005). Records from the department also revealed that 80 nurses left UNTH within the past 3 years (2009-2012). Although death and retirement were contributory to this situation, voluntary resignations also accounted forstaff loss during the period. Nursing staff shortage in UNTH is therefore, obvious given by these statistics. Hall (2007) explained that some of the reasons for nursing staff shortage are due to work stress, physical demands/workload, lack of advancement opportunities, and low pay. MacKusick and Minick (2010) went further to suggest that some of the reasons for the shortage include job dissatisfaction and the challenging relationships among members of the healthcare team. Since a causal relationship has been shown to exist between relationships amongst the healthcare team and job satisfaction by some authors (Cowin, 2008, Ritter, 2010), the leadership style exhibited by nurse managers can either enhance or

retard job satisfaction. This suggests that the acute nursing staff shortage in

UNTH, which is exacerbated by mass loss of nurses due to retirement, may affect the services and job satisfaction of nurses. It is therefore, necessary to empirically determine the leadership styles employed by the nurse managers in UNTH and also how these styles relate with job satisfaction of nurses in this situation of acute shortage of nurses observed in (UNTH) ItukuOzalla Enugu.

Purpose of the study

The purpose of this study is to examine the relationship between perceived leadership styles of nurse managers and job satisfaction of nurses in University of Nigeria Teaching hospitals, Ituku-Ozalla Enugu

The specific objectives of this study are to:

1. determinethe leadership styles utilized by nurse managers as perceived by nurses at the University of Nigeria Teaching Hospital (UNTH).

2. determinethe level of job satisfaction of nurses in UNTH.

3. identifythe relationship between transformational leadership styles and job satisfaction of nurses in UNTH.

4. identifythe relationship between transactional leadership style of nurse managers and job satisfaction of nurses in UNTH.

5. identifythe relationship between laissez-faire leadership style of nurse managers and nurses’ job satisfaction in UNTH.

Research questions

1. What is the perceived leadership style(s) utilized by nurse managers in UNTH?

2. What is the level of job satisfaction of nurses in UNTH?

3. What is the relationship between leadership style of nurse managers and job satisfaction of nurses in UNTH?

Hypotheses

The following null hypotheses guided the study:

1. There is no significant relationship between transformational leadership style of nurse managers and job satisfaction of nurses in UNTH.

2. There is no significant relationship between transactional leadership style of nurse managers and job satisfaction of nurses in UNTH.

3. There is no significant relationship between laissez-faire leadership style of nurse managers and job satisfaction of nurses in UNTH.

Significance of the study

This study will be of great significance to the nurse managers, nurse administrators, patients and the hospital. The finding from this study willprovide a basis for the determination of appropriate leadership style(s) to be used by nurse managers, capable of enhancing job satisfaction nation-wide. Findings from this study can be utilized to educate nurse managers on effective leadership styles and how these styles affect job satisfaction of nurses. By

implementing preferred leadership styles, job satisfaction of nurses will

increase, lowering turnover rates in hospitals and an overall decrease in the amount of money spent for hiring and orientating new employees. For nurse administrators, the results of this study have numerous implications for management practice. Nurses’ satisfaction will be seen by the patient in the form of increased patient care quality. This will in turn create increased patient satisfaction and will reflect a positive view of the hospital by the community. The hospital will also benefit from the satisfaction of registered nurses as seen by an increase in productivity, efficiency and retention.

Scope of the study

This study focused on the relationship between leadership styles of nurse managers and job satisfaction of nurses. It was confined to examining the relationship between transformational, transactional and laissez faire leadership styles on one hand and job satisfaction of nurses on the other. Twenty-six wards in UNTH, where direct nursing care is applied was examined. The study was delimited to nursing personnel categorized into management and subordinate cadres who have spent a minimum period of two years in the wards.

Operational definition of terms

For the purpose of this study the following terms were defined operationally: Leadership style: This strictly refers to the transformational, transactional and laissez-faireleadership styles.

Transformational leadership: is a synthesis of all leadership styles that are essentially employee oriented and includes participatory, democratic, charismatic and situational leadership styles.

Transactional leadership:refers to all leadership styles that are strictly production centred and includes autocratic and bureaucratic leadership styles. Laissez-faire leadership:refers to all leadership styles that are passive in nature whereby the leader adopts a hands-off approach to leadership.

Job satisfaction:refers to the feeling a nurse has about the job being performed. In other words what the nurse likes or dislikes about the job. General characteristics of the job such as pay, promotion, supervision, working conditions and relationships with co-workers were examined.

Nurse Managers: refers to nurses who are in-charge of wards/units and range from the ACNO, CNO to the Deputy Director Nursing (DDN) cadre.

Nurses: refers to non-managerial cadre of nurses in UNTH. They are any of the Principal Nursing Officers (PNO), Senior Nursing Officers (SNO),Senior Nursing Officers (SNO), Senior Nursing Sisters (SNS), Nursing Officer I and II, Nursing Sisters working in UNTH.

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