21

NURSING LEADERSHIP STYLES AND THEIR IMPACT ON LEADERSHIP
OUTCOMES
By
M. Joan Libsekal
A Research Study Presented in Partial Fulfillment

Of the Requirements for the Degree
Doctor of Philosophy
Capella University
June 2006
UMI Number: 3232065
Copyright 2006 by
Libsekal, M. Joan
All rights reserved.
UMI Microform 3232065

Copyright 2006 by ProQuest Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
ProQuest Information and Learning Company

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P.O. Box 1346
Ann Arbor, MI 48106-1346
M. Joan Libsekal, 2006
Abstract
Nursing leadership styles impact leadership outcomes. Using the transformational
leadership model as the conceptual framework, the study sought to determine what
nursing leadership styles positively correlated with leadership outcomes of extra effort,
effectiveness, and satisfaction as perceived by staff nurses. Quantitatively data was
collected using a Multifactor Leadership Questionnaire 5X Short Rater form from a
sample population of 144 staff nurses in Western Canada. Findings revealed significant
positive relationships existed between extra effort and transformational leadership style, r
(111) = .94, p < .01 and transactional leadership styles, r (111) = .64, p < .01. Significant
positive relationships were found between effectiveness and transformational leadership
style, r (111) = .90, p < .01 and transactional leadership styles r (111) = .68, p < .01.
Significant
positive
relationships
were
also
found
between
satisfaction
and
transformational leadership style, r (111) = .96, p < .01 and transactional leadership
styles, r (111) = .47, p < .01. These findings support previous research on
transformational leadership styles and outcomes. Future recommendations include further
research in other geographical locations, comparative studies of raters and self rater
ratings of leadership styles, focused study on one leadership style, broaden the study to
include other health professionals and implementation of transformational leadership
training for front line nurse managers.
Dedication
This dissertation is dedicated to the three most important and special people whom I have
been blessed with in my life, Kebreab, Efrem and Saba.
Kebreab, my loving husband has provided me with the unconditional love, courage and
support necessary for my dissertation and degree to become a reality.
Efrem and Saba, my two beautiful children, have demonstrated maturity and
understanding well beyond their years in allowing me to achieve my PhD.
Acknowledgments
This dissertation would not have been possible without the many individuals who
contributed in a variety of ways. Thank you for your contributions. To each of you, I will
be forever grateful. I wish to formally acknowledge the following people.
The registered nurses who participated in my research studythank you for your
participation and time in completing the surveys. I value your input. Without you, there
would not be a research study.
Dr. Suzanne Holmes, my dissertation committee chair, valued mentor and exceptional
role modelthank you for your sound guidance, knowledge, expertise and common sense
approach that assisted me in strengthening my abilities and knowledge to bring them to a
new level. I can only hope to begin to measure up to your standards.
Jim Sanderson, my Vice President and executive supporter of my dissertationthank you
for making the time to listen, for your words of encouragement and most importantly for
your support in allowing me to complete my research study and PhD. For this, I am
grateful.
Arlene MacLellan, my dear friend and colleague who knows only too well that timing is
everything-your magnificent sense of humor, honesty and trustworthiness are greatly
appreciated. Thank you for being the wonderful person that you are. I am honored and
privileged to have your friendship. I will not forget you.
Finally, to my family who deserve nothing but the best and need to know the vital role
they played in helping me achieve my goal. Each of you in your own special way has
been instrumental in making sure I reached the finish line. My success is because of you.
Saba, my beautiful daughterI thank you for your honesty and feedback when Moms
study time was taking precedence over more important things. Now we can do normal
things.
Efrem, my wonderful sonI thank you for your humor and understanding during these
past two years when doing other things would have been more fun. Now we can do
normal things.
Kebreab, my beloved husband and best friendI thank you for your strength, your
commitment to us and your support of me in achieving this goal. More importantly, I
thank you for your love and understanding that has sustained me throughout this
marathon. Now it is our time.
vi
Table of Contents
Page
Acknowledgements
vi
List of Tables
List of Figures
xii
CHAPTER 1. INTRODUCTION
Introduction to the Problem
Conceptual Theoretical Framework
Background of the Study
12
Statement of the Problem
15
Purpose Statement
16
Research Questions and Hypotheses
18
Nature of the Study
20
Significance of the Study
21
Definition of Terms
22
Assumptions and Limitations
24
Organization of the Remainder of the Study
25
CHAPTER 2. LITERATURE REVIEW
27
Transformational Leadership Theory
27
Empirical Research Review
40
Nursing Research Review
47
Summary
56
vii
CHAPTER 3. METHODOLOGY
58
Research Philosophy
60
Theoretical Framework
61
Research Design
68
Sampling Design
70
Measures
72
Data Collection Procedures
76
Data Analysis Procedures
77
Limitations of Methodology
78
Ethical Issues
80
Timelines for Research Activities
82
Summary
82
CHAPTER 4. PRESENTATION AND ANALYSIS OF DATA
84
Preliminary Analyses
84
Nursing Leadership Styles and Outcomes Findings
86
Hypotheses Testing
95
Summary
107
CHAPTER 5. SUMMARY, RECOMMENDATIONS AND CONCLUSIONS
111
Summary of Findings
114
Discussion
120
Recommendations for Future Research
126
viii
Conclusions
127
REFERENCES
130
APPENDIX A. LETTER OF PERMISSION
140
ix
List of Tables
Page
Table 1. Variable Linked to Multifactor Leadership Questionnaire 5X Short Rater
74
Form
Table 2. Leadership Factor and Outcome Measure Ratings MLQ 5X Short Rater Form 75
Table 3. Research Study Timeline
82
Table 4. Mean and Standard Deviations of Transformational Leadership Style and
90
Behaviors
Table 5. Mean and Standard Deviations of Transactional Leadership Style and
92
Behaviors
Table 6. Mean and Standard Deviations of Laissez-Faire Leadership Style and
93
Behavior
Table 7. Mean and Standard Deviations of Leadership Outcomes
95
Table 8. Pearson r Correlations between Extra Effort and MLQ Leadership Behaviors 97
Table 9. Multiple Regression on Extra Effort and Three MLQ Leadership Styles of
99
Transformational, Transactional and Laissez-Faire

Table 10. Pearson r Correlations between Effectiveness and MLQ Leadership
101
Behaviors
Table 11. Multiple Regression on Effectiveness and Three MLQ Leadership Styles
103
of Transformational, Transactional and Laissez-Faire

Table 12. Pearson r Correlations between Satisfaction and MLQ Leadership
Behaviors
104
Table 13. Multiple Regression on Satisfaction and Three MLQ Leadership Styles
of Transformational, Transactional and Laissez-Faire
xi
106
List of Figures
Page
Figure 1. Full Range of Individual Leadership
xii
CHAPTER 1. INTRODUCTION
Introduction to the Problem

What is leadership? What is an effective leadership style? What is a leader? What
is an effective leader? The quest for answers to such questions continues, despite more
than 100 years of study (Fairholm, 1998). Leadership is a relation-based activity in which
a common vision and shared values are endorsed by a leader and their followers
(Fairholm & Fairholm, 2000). Leadership is future oriented (Sarros & Santora, 2001). To
be successful, leaders need to fully understand their roles, their own visions and values as
well as those of their followers regardless of the type of business or organizations they
are leading (Fairholm, 1998). This applies to health care organizations such as hospitals
and their nursing leaders. The purpose of this research is to determine what nursing
leadership styles positively correlate with leadership outcomes. The leadership styles
include transformational, transactional and laissez-faire while leadership outcomes
consist of satisfaction, extra effort and effectiveness. This chapter introduces the research
problem and provides background on the study, identifies the problem and purpose
statements, research questions and hypotheses, nature and significance of the study,
defines terms used in the study, identifies assumptions and limitations followed by an
overview of the remainder of the study.
Todays nursing leaders function in environments where change is the only
constant (Clancy, 2003). They face critical leadership challenges in a world of fast paced
turbulent change from both the organization and the environment (Kerfoot, 2000). Such
Nursing Leadership Styles and Outcomes
challenges include health care delivery systems, multiple demands for quality services,
and shortages within the nursing profession (Newman, 2002; Peterson, 2001).
Organizational change and how health care delivery systems are managed have led to
role changes of nurse leaders (Ribelin, 2003). Additionally, how effective leaders are
impacts their employees along with organizational success (Manion, 2000; Sarros &
Santora, 2001; Scoble & Russell, 2003; Shader, Broome, Broome, West & Nash, 2001;
Song, Daly, Rudy, Douglas & Dyer, 1997; Steinbrook, 2002). Review of the literature
reveals that leadership outcomes such as extra effort; effectiveness and satisfaction are
impacted by leadership styles (Avolio & Bass, 2004; Kelloway & Barling, 2000). Based
on these findings, there is a need for effective leadership.
Effective leaders at all organizational levels including middle and front line
managers are needed (Manion, 2004). Health care impacts individuals across the entire
spectrum (Friedrich, 2001). Health care users expect and demand quality services
(George, 2002). Given the magnitude of the health care industry and its impact on people
of all ages everywhere, the need for effective leaders is evident (Kerfoot, 2000). Health
care professionals in general and nurses specifically, are in high demand and short supply
(Cowin, 2002; Ribelin, 2003). These vital, but precious resources need to be valued and
protected if health care services are to continue being provided (Sherman, 2002). Health
care executives are demanding their leaders to deliver high quality services in cost
effective ways (Cullen, 1999). Continuous attempts at doing more with less require
strong leaders (Kerfoot, 2000). Given the demands of the public, employees and
executive leaders, coupled with the turbulent ever-changing health care environment, it is
not easy to be a leader in health care in these demanding circumstances (Ribelin, 2003).
This information offers support for the important role nursing leaders play in this
complex setting. It further demonstrates the need to study the relationship between
nursing leadership styles and leadership outcomes so as to better understand effective
leadership and develop effective leaders.
Although there have been decades spent on leadership research, a void still exists
between leadership research findings and their application in practice (Fairholm, 1998;
Sarros & Santora, 2001; Tjosvold & Wong, 2000). In turn, this creates a further void
between leaders and followers (Sarros & Santora, 2001). This gap needs to be addressed
so effective nurse leaders are able to achieve goals on a consistent basis through the trust
and commitment gained from their followers (Manion, 2004). In this type of environment
the leader and followers are able to entrust the intent, actions and purposes of others and
thus commit to organizational goals (Fairholm & Fairholm, 2000). Benefits to
implementing such leadership are directed towards organizations, leaders, followers and
the clients being served (Landrum, Howell, & Paris, 2000). This leads one to question
what leadership model is to be followed.
Conceptual Theoretical Framework

An abundance of literature has been published on leadership over the past several
decades (Fairholm, 1998; Sarros & Santora, 2001; Tjosvold & Wong, 2000). Leadership
models that worked in the past may no longer be viable in the constantly changing
environment of today. Early leadership theories and models emphasized the need for
order and control, while the past 30 years have experienced a new group of leadership
theories known as transformational leadership theory (Bryman, 1992). This leadership
theory began with Burns and was further expanded by Bass (Fairholm, 1998). It is the
guiding framework for this research study.
Transformational leadership is referred to as a process in which followers are
motivated by appealing to their moral values and higher ideals (Burns, 1978). Bass
(1990) defines transformational leadership as an exemplary leadership style in which
followers interests are elevated and broadened. These leaders are aware of and accept the
mission and goals of the larger group and they willingly look past self-interests to those
of the group (Bass, 1990; 1998). The leaders and their followers form a relationship that
accounts for exceptional performances and accomplishments (Bass, 1998). The
transformational leadership theory is a means of explaining this leader follower
relationship.
Leadership, as posited by Bass (1985) consists of three second order domains that
include transformational, transactional and laissez-faire. This is referred to as the full
range of individual leadership (Bass, 1990). Bass views transformational and
transactional leadership as separate conceptually (Tejeda, 2001). Both styles are however
seen as positive with effective leaders displaying both behavioral types (Avolio & Bass,
2000). Bass and Avolio (1994) theorized that transformational leadership consists of four
dimensions including idealized influence, individualized consideration, inspirational
motivation and intellectual stimulation. It is these dimensions or behaviors that foster the
leader follower relationship amongst transformational leaders and their followers (Bass &
Avolio, 1997). The following pages outline the conceptual and operational definitions of
transformational leadership.
Conceptual Definition of Transformational Leadership
Transformational leadership. Transformational leadership is a visionary
leadership style characterized by behaviors intended to empower, inspire and motivate
followers to exceed expectations as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2000). The behaviors include
idealized influenceattributed, idealized influencebehavioral, inspirational motivation,
intellectual stimulation and individualized consideration (Bass, 1999).
Operational Definitions of Transformational Leadership
Idealized influenceattributed. Idealized influenceattributed is a transformational
leadership behavior that refers to the transformational leaders charismatic quality which
results in followers having confidence, respect and trust in their leader as measured by
the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the Multifactor Leadership Questionnaire items that measure this
factor.
Idealized influencebehavioral. Idealized influencebehavioral is a
transformational leadership behavior that alludes to the charismatic quality of the
transformational leader which results in followers identifying with their leader, the vision
and the sense of purpose as measured by the Multifactor Leadership Questionnaire 5X
Short Rater form (Avolio & Bass, 2000). Table 1 identifies the Multifactor Leadership
Questionnaire items that measure this factor.
Inspirational motivation. Inspirational motivation is a transformational leadership

behavior that deals with the role model capabilities of the leader that results in building
confidence and inspiring followers to believe as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2000). Table 1 identifies the
Multifactor Leadership Questionnaire items that measure this factor.
Individualized consideration. Individualized consideration is a transformational
leadership behavior that focuses on the leaders ability to support, coach and provide
learning opportunities for followers so they may achieve to their greatest potential as
measured by the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio &
Bass, 2000). Table 1 identifies the Multifactor Leadership Questionnaire items that
measure this factor.
Intellectual stimulation. Intellectual stimulation is a transformational leadership
behavior that refers to the leaders ability to understand and solve problems using
innovative approaches, which in turn encourages followers to use creativity and intellect
to solve their own problems as measured by the Multifactor Leadership Questionnaire 5X
Transactional leadership, on the other hand is an exchange process in which
followers receive rewards when performance requirements are completed (Bass, 1990).
Transactional leadership behaviors include contingent rewards, management by
exception-active and management by exception-passive. Bass and Avolio (1997) view
the two former behaviors as positive, while the latter one is not. The conceptual and
operational definitions of transactional leadership are explained below.
Conceptual Definition of Transactional Leadership
Transactional leadership. Transactional leadership is a leadership style
characterized by behaviors of risk avoidance, operating within existing systems; close
attention paid to efficiency and time constraints and maintains control through processes
(Bass, 1997). Behaviors included in this style of leadership are contingent reward,
management by exceptionactive and management by exceptionpassive.
Operational Definitions of Transactional Leadership
Contingent reward. Contingent reward is a transactional leadership behavior that
places emphasis on clarifying goals and recognizing when they are achieved as measured
by the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
factor.
Management by exceptionactive. Management by exceptionactive is a
transactional leadership behavior that encompasses the leader stating the standards to be
complied with as well as those that are ineffective performance as measured by the
Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000). Table
1 identifies the Multifactor Leadership Questionnaire items that measure this factor.
Management by exceptionpassive. Management by exceptionpassive is a
transactional leadership behavior that includes a more passive and reactive approach to
concerns as the leader fails to act until one is made aware of the mistakes as measured by
factor.
Laissez-faire leadership is the third leadership style and is referred to as a
leadership condition in which there is no leadership or intervention when needed is
avoided (Bass & Avolio, 1997). This leadership style is viewed as ineffective (Fairholm
& Fairholm, 2000; Sarros & Santora, 2001). Below are the conceptual and operational
definitions of this leadership style.
Conceptual Definition of Laissez-Faire Leadership
Laissez-faire leadership. Laissez-faire leadership is a leadership style that is
viewed as leaders failing to accept responsibilities, refrain from expressing views on
important issues and failing to follow up on requests for assistance (Avolio & Bass,
1999).
Operational Definition of Laissez-Faire Leadership
Laissez-faire leadership. Laissez-faire leadership is leadership behavior that is
viewed as passive and ineffective as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2004). Table 1 identifies the
Multifactor Leadership Questionnaire items that measure this factor.
This full range of individual leadership as conceptualized by Bass (1990) from the
laissez-faire to the transactional and the transformational is depicted in Figure 1.
EFFECTIVE
Individualized
Consideration
Intellectual
Stimulation
Inspirational
Motivation
Idealized
Influence
Four Is
Contingent
Reward
PASSIVE
ACTIVE
Management
by ExceptionActive
Management
by
ExceptionPassive
LaissezFaire
INEFFECTIVE
Figure 1. Full Range of Individual Leadership
Adapted from Bass and Avolio, (1997), Improving Organizational Effectiveness
Through Transformational Leadership, p. 5.
Beginning in the bottom left hand corner, the laissez-faire leadership style is
shown as the most passive and ineffective followed by the transactional behavior of
management by exceptionpassive (Bass & Avolio, 1990). Management by exception-
10
active is viewed as more effective and less passive than the former two, but not as
effective as the transactional behavior of contingent rewards (Bass & Avolio, 1997). On
the right hand side, the four transformational behaviors are identified including
individualized consideration, intellectual stimulation, inspirational motivation and
idealized influence which are viewed by Bass and Avolio, (1997) as the most active and
effective.
Transactional and transformational leadership styles are effective in different
circumstances (Avolio & Bass, 2000; Fairholm & Fairholm, 2000; Sarros & Santora,
2001), while laissez-faire leadership is viewed as ineffective (Bass & Avolio, 1997).
Transactional leaders place emphasis on clarifying expectations and creating confidence
in their followers to successfully achieve desired outcomes (Avolio & Bass, 2000).
Transformational leaders move beyond the transactional approach to transforming
individuals and organizations to achieve higher-level goals (Bass, 1998). Depending on
the situation, to be effective the appropriate leadership style may vary (Fairholm &
Fairholm, 2000).
Differences exist amongst the three leadership styles. The primary difference
between the three leadership styles lies in the relationship that is present between the
leader and followers (Bass & Avolio, 1997). Transformational leaders successfully
establish and maintain an effective leader-follower relationship that results in followers
consistently exceeding expectations (Avolio & Bass, 2000). The other two leadership
styles do not result in establishing this unique relationship (Bass & Avolio, 1997). The
11
latter styles are more reactive to situations as opposed to the transformational leaders
proactive approach (Avolio & Bass, 2000).
Regardless of the leadership styles being practiced, they result in leadership
outcomes, which impact followers. Three leadership outcomes cited by Bass (1990) are
satisfaction, extra effort and effectiveness. Satisfaction refers to how satisfied followers
are with their leaders and their jobs (Avolio, 1999). According to Bass (1997), extra
effort refers to the leaders ability to increase followers desires to succeed and
willingness to try harder. Effectiveness is the third leadership outcome identified that
alludes to the leaders abilities to lead an effective group and meet the followers job
related needs (Bass, 1998).
Bass and Avolio (1997) contend that enhanced performance and effectiveness in
various cultures and organizations is correlated with effective leadership. Research
studies show that the performance of followers is positively affected to a greater extent
and in different ways by transformational leadership than any other style of leadership
(Avolio, 1999; Bass, 1998; Fairholm, 1998; House & Aditya, 1997). Bratt, Broomer,
Kelber and Lostocco, (2000) found a positive correlation between job satisfaction and
nursing leadership. Loke (2001) explored nursing leadership and their effects on
employee outcomes and reported a strong correlation between job satisfaction and
leadership behaviors. These findings are based on perceptions of the leader which
according to Avolio and Bass (2000) is a useful way to measure leadership behaviors.
Understanding the leader-follower relationship is vital to the transformational
leadership theory. The aforementioned studies support the need for and value in effective
12
leaders however the leaders in these studies are in middle or senior management level
positions as opposed to front line managers with staff nurses reporting directly to them.
Numerof, Abrams, and Ott (2004) surveyed superior hospitals in the United States and
found that the main variable defining and affecting the attractiveness of the work
environment was the role of the front line nurse manager. While Avolio and Bass (2000)
contend that leadership is based on perceptions of those evaluating the leader, it leads one
to question what staff nurses perceptions are of their front line leaders. If leaders impact
their followers to the extent described in the literature (Avolio, 1999; Avolio & Bass,
2000; Bass, 1998; Bratt et al., 2000; Fairholm, 1998; House & Aditya, 1997; Loke, 2001;
Numerof et al., 2004), it is necessary to study this leader-follower relationship at the
direct report level within the nursing domain.
Various tools are available to measure leadership styles and leadership outcomes.
The challenge with these tools is ensuring the definitions are compatible with the
theories. In keeping with the transformational leadership theory, Bass and Avolio (2004)
developed a Multifactor Leadership Questionnaire that measures the leadership styles and
outcomes.
Background of the Study

Leadership has been the topic of research studies for the past century. Despite the
time directed towards investigating this concept, gaps continue to exist between
leadership practices and leadership theories (Thyer, 2003). Early models and theories on
leadership placed emphasis on the importance of and need for control and order while
13
more recent theories have focused on the value of transformational leaders (Bryman,
1992). These leaders are visionary, charismatic individuals who inspire followers to excel
and exceed expectations (Bass & Avolio, 2004). In contrast to past leadership theories,
transformational leaders encourage innovation and shared decision making (Thyer,
2003).
Research has shown that followers are impacted by the style of the leader (Altieri,
1995; Branham, 2001; Hill, 2003; Ma, Samuels & Alexander, 2003; McNeese-Smith,
1995; Neuhauser, 2002; Solovy, 2002; Wieck, Prydun & Walsh, 2002). The challenges
presented within this vast wealth of information are the variations in leadership outcomes
as well as the theories upon which the studies are based. Follower satisfaction, turnover,
commitment, extra effort, effectiveness, and client satisfaction are identified by various
researchers as leadership outcomes (Avolio & Bass, 2000; DeGroot, Kiker & Cross,
2000; Doran, McCutcheon, Evans, MacMillan, Hall, Pringle, et al., 2004; Kelloway &
Barling, 2000). Definitions for each of these outcomes by various researchers are not
standardized, thereby creating challenges when contrasting and comparing research
findings. For example, satisfaction may be defined and measured in numerous ways;
hence studies are not measuring the same phenomena (Ma et al., 2003). With regards to
leadership theories, there are a multitude of theories to draw from which results in studies
again looking at leadership in different ways.
Various researchers have examined leadership styles and outcomes in numerous
ways using different tools (Blegen, 1993; Cullen, 1999; Deluga, 1988; Friedrich, 2001;
House & Aditya, 1997; McNeese-Smith, 1995; Vandenberghe, 2002). Variations lie in
14
the definitions used for these outcomes as well as the instruments to score them with.
This creates challenges when comparing studies.
The idea that transformational leadership positively affects organizational
outcomes has been demonstrated in research studies of general leadership (Avolio, 1999;
Banerji & Krishnan, 2000; Bass, 1990, 1995; 1998; Hater & Bass, 1998; Judge &
Piccolo, 2004; Krishan, 2001). Followers job satisfaction and performance have been
associated with ratings of their leaders as demonstrating transactional and
transformational styles of leadership (Bass, 1998; Bryman, 1992; Hater & Bass, 1998;
Yammarino & Bass, 1990). Gray-Toft and Anderson (1985) supported the premise that
staff nurse job satisfaction was positively influenced by effective leadership. Lower
levels of staff satisfaction were reported with laissez-faire and management by
exceptionpassive leadership behaviors (Bass, 1990; Bass & Avolio, 1990; Lowe,
Kroeck & Sivasubramaniam, 1996). Although these research results add support for the
transformational leadership theory, studies evaluating front line nurse managers
leadership styles and outcomes are lacking. Additionally, deficiencies exist in the
literature regarding standardized approaches to measuring variables of leadership styles
and outcomes.
Amongst the published nursing leadership studies, the focus is primarily on
middle and senior leaders (Bratt et al., 2000; Clancy, 2003; Dunham-Taylor & Klafen,
1990; Gray-Toft & Anderson, 1985; McDaniel & Wolf, 1992). This information adds to
the leadership research base, but there is limited information on leadership styles and
outcomes of front line nurse managers. Given the impact the nurse manager has on
15
outcomes such as staff satisfaction (Bratt et al., 2000; Loke, 2001; Numerof et al., 2001),
as well as the positive results found in studies involving the transformational leadership
theory (Branham, 2001; Hill, 2003; Ma et al., 2003), it is necessary to further investigate
this area of front line nursing leadership from the perspective of the staff nurses.
The lack of a standardized approach to measure leadership styles and leadership
outcomes was noted by Bass (1985) who was instrumental in developing a tool to address
the need. The Multifactor Leadership Questionnaire developed by Bass and Avolio
(1997) is a tool used to identify the leadership styles and leadership outcomes. It provides
a standardized consistent approach to measuring these variables. This tool has been
analyzed, reviewed and critiqued by researchers (Avolio, 1999; Bass, 1985; Bass &
Avolio, 1994; 2004; Bycio, Hackett & Allen, 1995; Hartog, VanMuijen & Koopman,
1997; Vandenberghe, 2002) and has alpha coefficients ranging from .74 to .96 (Avolio &
Bass, 2000). In addition to its validity, this 45-item questionnaire takes 15 minutes to
complete. The questionnaire may be used to rate ones own leadership style or by raters
above, below or on the same level as the leader. The Multifactor Leadership
Questionnaire has been tested in multiple settings including health care (Avolio & Bass,
2000).
Statement of the Problem

Effective leadership styles result in leadership outcomes of extra effort,
effectiveness and satisfaction (Bass & Avolio, 1997). This is important for hospitals,
nursing leaders and staff nurses for a variety of reasons. Hospitals are continually
16
challenged to provide quality health care services in the most cost efficient means
(Cullen, 1999). Effective leaders are needed to achieve this (Kerfoot, 2000). Nursing
leaders have to implement such changes in a complex, fast paced, constantly changing
environment (Ribelin, 2003). Effective leadership styles are necessary if front line
managers are to be successful (Cullen, 1999; Kerfoot, 2000). Staff nurses, who are
already in high demand and short supply, are faced with providing quality care to their
patients under the direction of their nursing leaders (Cullen, 1999). These nurses have
options available to them such that they are able to dictate what type of work they choose
to do and where they choose to do it (Ribelin, 2000). If nurses do not view their leader as
effective nor express levels of satisfaction, they may opt to leave the organization
(Cullen, 1999; Ribelin, 2000). This in turn impacts the remaining nursing staff,
management and the patients (Cullen, 1999; Kerfoot, 2000; Ribelin, 2000). In order to
stop this vicious cycle, answers to nursing leadership questions need to be sought from
the individuals most directly impacted; the staff nurses. It is not known if staff nurses
perceptions of their direct leaders styles of leadership positively correlate with their
perceptions of leadership outcomes of extra effort, effectiveness and satisfaction in acute
care hospitals.
Purpose Statement
The purpose of this research was to determine what nurse managers leadership
styles positively correlate with leadership outcomes as perceived by staff nurses. This
was done using the Multifactor Leadership Questionnaire 5X Short Rater form to
17
determine the degree to which front line nurse managers practiced transformational
leadership behaviors and to identify which leadership behaviors best predicted leadership
outcomes of satisfaction, extra effort and effectiveness as perceived by acute care staff
nurses employed in Western Canada. The predictor variable of leadership style was
generally defined as the way in which a leader expresses certain leadership behaviors
(House & Aditya, 1997). The three leadership styles included transformational,
transactional and laissez-faire. The former two were further divided into leadership
behaviors. The behaviors falling under transformational leadership were idealized
influence-attributed, idealized influence-behavioral, inspirational motivation,
individualized consideration and intellectual stimulation (Avolio & Bass, 1999).
Transactional leadership behaviors included contingent reward, management by
exceptionactive and management by exceptionpassive (Avolio & Bass, 1999).
The three outcome variables of extra effort, effectiveness and satisfaction were
generally defined. Extra effort referred to exertion demonstrated by followers as a result
of their leader (Bass, 1998). Effectiveness was the measure of followers perceptions of
how well their leader was at meeting job related needs of their followers (Avolio & Bass,
1999). Satisfaction was a measure indicating how satisfied followers were with their jobs
and leaders as well as with their leaders leadership methods (Avolio & Bass 1999). This
was measured by the Multifactor Leadership Questionnaire 5X Short Rater form
developed by Avolio and Bass (1999).
18
Research Questions and Hypotheses

Nurses perceptions of their leaders styles of leadership is important information
for nursing leaders as they play a role in leadership outcomes such as extra effort,
effectiveness and satisfaction (Newman, 2002; Thyer, 2003). The three leadership styles
studied in this research were transformational, transactional and laissez-faire.
Transformational leadership was further broken down into leadership behaviors including
individualized consideration and intellectual stimulation (Bass & Avolio, 1997).
Transactional leadership was also divided into leadership behaviors which included
contingent reward, management by exceptionactive, and management by exception
passive (Bass & Avolio, 1997). Laissez-faire was the third leadership style included in
this study. By performing this research study, the knowledge base of published research
relating to transformational leadership theory in nursing will be expanded upon.
Three research questions; three hypotheses and three null hypotheses were
identified for this research. The three research questions are listed below.
Question 1: What is the relationship between the nurse managers leadership
styles and staff nurses perception of extra effort?
styles and staff nurses perception of effectiveness?
styles and staff nurses perception of satisfaction?
19
The three hypotheses and three null hypotheses for this research are listed as
follows.
Hypothesis 1: Staff nurse perceptions of their nurse managers leadership styles as
determined by the Multifactor Leadership Questionnaire of transformational leadership
including idealized influence-attributed, idealized influence-behavioral, inspirational
motivation, individualized consideration and intellectual stimulation are positively related
to extra effort.
Null Hypothesis 1: There is no positive relation of the nurse managers leadership
styles as determined by the Multifactor Leadership Questionnaire of transformational
leadership including idealized influence-attributed, idealized influence-behavioral,
inspirational motivation, individualized consideration and intellectual stimulation to extra
effort as perceived by staff nurses.
to effectiveness.
inspirational motivation, individualized consideration and intellectual stimulation to
effectiveness as perceived by staff nurses.
20

to satisfaction.
satisfaction as perceived by staff nurses.
Nature of the Study

This study was carried out using the Multifactor Leadership Questionnaire 5X
Short Rater form. Bass and Avolio (1997) developed this instrument specifically for use
by leaders and raters to measure transformational, transactional and laissez-faire
leadership styles as well as leadership outcomes including extra effort, effectiveness and
satisfaction. This tool is a 45-item questionnaire that has undergone revisions to address
identified deficiencies over the past ten years (Bass & Avolio, 1997). A number of
researchers have carried out factor analyses in order to evaluate and replicate validity of
the Multifactor Leadership Questionnaire (Bycio et al., 1995; Hartog et al., 2001;
Vandenbergh, 2002). Alpha coefficients listed for the factors being assessed range from
.74 to .96 (Avolio & Bass, 2000), which support the Multifactor Leadership
21
Questionnaire as a reliable test for measuring behaviors and outcomes of leadership.

Additionally, the Multifactor Leadership Questionnaire has been used in profit and notfor-profit organizations including hospitals in over 30 countries (Bass & Avolio, 2004).
Significance of the Study

This study is significant in several ways for nursing leaders as well as
management in general, Human Resource professionals, nursing associations and nurses.
This study builds on past research studies and adds to the growing body of knowledge on
the transformational leadership theory and leadership outcomes. Previous studies
demonstrated the correlation between various leadership styles and satisfaction in nursing
(Bratt et al., 2000; Clancy, 2003; Dunham-Taylor & Klafen, 1990; Gray-Toft &
Anderson, 1985; McDaniel & Wolf, 1992), but limited information was available on the
correlation between staff nurses perceptions of their direct leaders leadership styles and
leadership outcomes based on the transformational leadership theory.
Based on the validity and reliability of the Multifactor Leadership Questionnaire,
this study adds to the body of nursing leadership knowledge. Nurse leaders will be able to
develop effective interventions and behaviors to enhance relationships between nursing
managers and staff nurses. This study will be of value for management personnel in
healthcare organizations including front line, middle and senior management personnel in
determining, implementing and evaluating effective leadership styles.
Results of this study will aid Human Resource professionals in determining
effective strategies to enhance leadership outcomes of satisfaction, effectiveness and
22
extra effort in organizations. It will also assist in identifying appropriate leadership styles
to develop amongst leaders in order to achieve positive leadership outcomes.
At the professional level, nursing associations will also benefit from the research.
It will provide additional information on issues related to nurse satisfaction, which is an
area of interest for nursing associations. Nurses in general will benefit from this research
as they may seek to find organizations where the nursing leaders practice what nurses
perceive as effective styles of leadership resulting in job satisfaction and retention. This is
also an opportunity for nurses to provide input on what they perceive as effective
leadership behaviors of their Nurse Managers.
Definition of Terms
Contingent reward is a behavior of transactional leaders who clarify what is
expected of followers as well as what the followers will receive when expected
performance levels are met (Avolio & Bass, 2000).
Effectiveness measures followers perceptions of how well their leader is at
meeting job related needs of their followers (Avolio & Bass, 1999).
Extra effort refers to exertion demonstrated by followers as a result of their leader
(Bass, 1998).
Laissez-faire leadership refers to leadership style involving little or no action.
This style is classified as ineffective and inactive (Bass, 1998).
23
Leadership refers to the process of influencing, motivating and inspiring

followers to achieve positive outcomes for individuals and organizations (Bass & Avolia,
1994).
Leadership style is the way in which a leader expresses certain leadership
behaviors (House & Aditya, 1997).
Management by exception-active is a behavior of transactional leaders whereby
the leader actively seeks positive and negative deviations of performance of followers
and rewards or punishes them respectively (Hater & Bass, 1988).
Management by exception-passive is a behavior of transactional leaders whereby
the leader punishes or rewards followers when deviations of performance occur naturally
(Hater & Bass, 1988). In contrast to management by exception-active, these leaders do
not actively look for performance deviations that are outside the predetermined level of
acceptability (Bass, 1998).
Multifactor Leadership Questionnaire 5X Short Rater form is an instrument
containing 45 statements that assesses leadership styles and outcomes using a five point
Likert scale (Avolio & Bass, 1999; Pittenger, 2001; Tejeda, 2001).
Nurse Manager is an individual whose main responsibility includes supervision,
motivation, and managing performance including discipline of staff nurses.
Registered nurse is a person who has been issued a certificate of registration as a
registered nurse pursuant to the Nursing Profession Act and who holds an annual
certificate (Collective Agreement, 2001, p. 4).
24
Satisfaction is a measure indicating how satisfied followers are with their jobs and
leaders as well as with their leaders leadership methods (Avolio, 1999).
Staff nurse is a registered or graduate nurse whose primary responsibilities
include the coordination and provision of patient care in an acute care hospital setting.
Transformational leadership is the ability to engage interests and motivation of
individuals to develop and increase their effectiveness, efforts, confidence and results to
evolve from individual concerns to interest in group or organizational achievements
(Almo-Metcalfe & Alban-Metcalfe, 2001).
Transactional leadership is the process of rewarding or punishing followers for
performance deviation that is positive or negative respectively (Bass & Avolio, 1997).
Assumptions and Limitations

This research was based on the assumption that the key dimensions of
transformational leadership including inspirational motivation; intellectual stimulation,
individualized consideration and idealized influence were related positively to one
another (Bass, 1985; Bass & Avolio, 1994; Hater & Bass, 1998; Yammarino & Bass,
1990). It was assumed that nurses answered the questions independently and honestly.
They participated fully and freely. References made to registered nurse, staff nurses, or
nursing staff was assumed to be meaning the same thing.
This research also had limitations. One of the limitations of this study related to
the leadership styles identified in the Multifactor Leadership Questionnaire 5X Short
Rater form. The leadership classifications postulated by other scholars were beyond the
25
scope of this research. The Multifactor Leadership Questionnaire 5X Short Rater form
was selected because of the frequency in which it was analyzed in the scholarly literature.
While researching additional leadership classifications with respect to nurse satisfaction
was of interest, it was beyond the scope of this dissertation.
This study focused on a nursing population in Western, Canada. The potential
number of participants for this study was 480, which seemed like a representative sample,
but it is relatively small compared to the 263,350 registered nurses in Canada (Canadian
Institute for Health Information, 2004). The study was further limited to staff nurses
working in acute care hospitals. It did not include nurses in other roles in acute care or
staff nurses in long-term care or community-based facilities.
Another limitation of this study related to the geographic location of the nurses
involved in the study. Reasons that are not work-related may exist as to why nurses work
in this particular location and therefore the same study needs to be completed in other
locations provincially, nationally and internationally.
The hospitals in which participants were employed were unionized nonprofit
acute care hospitals. While these factors were common in a number of Canadian
hospitals, they were not universal to all hospitals. These factors were therefore viewed as
a limitation with this study.
Organization of the Remainder of the Study

The remainder of this study is organized into four chapters including the literature
review, methodology, data collection and analysis and results, conclusions and
26
recommendations. This study involved a review of the literature available on the

transformational leadership theory and its key dimensions. There was a review of the
empirical research available as it related to satisfaction, extra effort and leader
effectiveness in general followed by a more detailed review as it focused on nursing.
The research methodology presented includes the research philosophy, theoretical
framework, research design, sampling design and measures. This is followed by data
collection, data analysis procedures, limitations of methodology, expected findings and
ethical issues and timelines. Chapter four focuses on the presentation and analysis of the
data, while chapter five provides a summary, conclusion and recommendations.
CHAPTER 2. LITERATURE REVIEW

Leadership is a process of motivating, influencing and inspiring followers to
achieve positive outcomes for organizations and individuals (Bass & Avolia, 1994).
Transformational leadership promotes innovation, participation and open debate (Bass,
1998). The purpose of this chapter is to critically evaluate research and theory from the
transformational leadership perspective focusing on the relationship of the leaderfollower in general and specifically within the nursing domain as it relates to satisfaction,
extra effort and effectiveness.
Transformational Leadership Theory

Transformational leadership theories began with political scientist, Burns and were
expanded upon by Bass (Fairholm, 1998). Bass (1985) posited that leadership consists of
three-second order domains including transformational, transactional and laissez-faire
leadership. Transformational and transactional leadership styles are further divided into
key dimensions. Idealized influence, individualized consideration, inspirational
motivation and intellectual stimulation fall under transformational leadership while
transactional leadership includes contingent reward, management by exception-active,
and management by exception-passive (Avolio & Bass, 2000). These dimensions are
elaborated on further into this chapter.
The essence of transformational leadership is to emphasize new values and a
vision, which transcends the status quo in order to produce organizational change (Bass
& Avolio, 1993). Transformational leadership, according to Bass (1985) goes beyond
28
transactional behaviors in which followers are rewarded for certain accomplishments to

developing followers who are intellectually stimulated and inspired to put their own
interests secondary to those of the team or organization. The followers successfully
achieve and exceed their goals (Bass & Avolio, 1997).
Understanding transformational leadership is imperative to account for the
exceptional efforts frequently demonstrated by followers (Fairholm, 1991). The
transformational leadership theory is used to explain the relationship connection between
followers and leaders. It is the development of this relationship that accounts for
accomplishments and performances that surpass expectations (Bass, 1998). In essence,
transformational leaders are able to reach their followers in such a way that they willingly
and consistently exceed expectations for the betterment of the organization.
Transformational leaders are able to engage and motivate individuals. Through genuine
interest in their followers transformational leaders encourage individuals to develop and
increase their confidence, effectiveness, efforts and results to evolve from individual
concerns to interest in group and organizational achievements (Almo-Metcalfe & AlbanMetcalfe, 2001; Krishnan, 2001). Gellis (2001) however notes that followers behavior
may be due to factors other than leadership such as their own sense of purpose, their level
of development or intrinsic work environment. Regardless of the viewpoint, the followers
of transformational leaders exceed expectations on a consistent basis.
Moving beyond satisfying follower needs through simple exchanges with
contingent rewards (Graen & Scandura, 1987), transformational leaders seek to develop
followers so they are able to assume leadership roles (Bass, 1985; Bass & Avolio, 1994).
29
As people advance forward and transform their beliefs, values and ideas, Fairholm (1998)
claims their practices and actions change. These followers begin to develop into leaders
(Fairholm, 1998).
It is Bass's view that followers are transformed into leaders and leaders
subsequently become change agents as they endure a process of transformation to
identify personally with the leader (Bass & Avolio, 1994). When learning to lead,
followers begin to transform as they develop commitment and loyalty to the
organization's goals, mission and vision. The leader's ability to compellingly articulate his
or her vision and the susceptibility of the followers to the message are the interacting
forces from which the power of this vision emerges (Yammarino & Bass, 1990). This
view emphasizes the importance role modeling has on the development of one's
followers. The attitudes and behaviors of followers are therefore influenced by their
perceptions of their leaders' attitudes and behaviors (Gellis, 2001).
Transformational Leadership
Transformational leaders, in transforming followers to higher levels of
professional and personal development, display a specific set of behaviors. When these
behaviors are consistent with their own beliefs, the result is achievement of positive
outcomes for the organization and individuals (Almo-Metcalfe & Alban-Metcalfe, 2001).
These behaviors are the key dimensions of transformational leadership and include
idealized influence, inspirational motivation, individual consideration and intellectual
stimulation (Hartog, et al., 1997).
30
Idealized influence. Idealized influence is the first dimension and refers to leaders
being able to create respect and trust of their followers, resulting in a strong
internalization by the followers of the leaders goals and values (Bass & Avolio, 1994).
Followers are then inspired and committed to model their leaders behavior (AlmoMetcalfe & Alban-Metcalfe, 2001). Serving as role models, these leaders engender
confidence and trust in others and emphasize doing the right thing while emitting a strong
sense of commitment to them (Hartog et al., 1997). These leaders consistently convey far
sightedness, determination and high standards of conduct as they project their selfconfidence onto others (Bass & Avolio, 1994). By demonstrating such confidence,
followers willingly make self-sacrifices and attempt to achieve exceptional goals (Hartog
et al., 1997). This powerful motivating force is behind the idealized influence dimension
of the transformational leadership style. It offers support for Gelliss (2001) findings
earlier alluded to regarding the positive influence leaders behaviors and attitudes have on
their followers.
Leaders verbally demonstrate confidence in their followers resulting in followers
making exceptional achievements (Avolio & Bass, 2000). According to Saros and
Santora (2001), this Pygmalion Effect causes increases in self-efficacy and self-esteem of
the followers. Reinhardt (2004) however contends that transformational leaders
manipulate the culture and use their authority and power to reshape the environment.
Aaltio-Marjosola and Takala (2000) attribute transformational leaders successes to their
theatrical abilities to draw attention through drama. While this may be viewed as a less
desirable component of transformational leaders, one may argue that these individuals
31
still have the ability to attract followers and direct them to achieve exceptionally well.
These leaders show an ability to control those they interact with and have a strong sense
of emotional stability (Gellis, 2001; Reinhardt, 2004). Through encouragement strategies,
communication and role modeling, transformational leaders believe their followers will
transform such that organizational goals and mission will take precedence over individual
ones (Gellis, 2001). The nursing leader in this instance needs to ensure his or her vision is
clearly articulated to the staff nurses who in turn must also endorse it if success is to be
attained. The organizational climate must therefore be conducive to the vision (Hartog et
al., 1997) meaning that it supports and builds upon the organizational values. How does
this fit in with the hospital setting?
Hospitals are typically seen as bureaucratic organizations where transactional
leadership style is more commonly practiced (Thyer, 2003). Given the findings of
researchers such as Newman (2002) who found a primary source of job dissatisfaction
amongst nurses was poor management, which included lack of visibility and accessibility
of nurse leaders, hospitals need to look at the leadership practices. Leaders in hospitals
must evaluate their leadership styles and determine their effectiveness. As Clegg (2000)
notes, the unraveling of bureaucracy by transformational leaders is necessary so
opportunities and achievements may be pursued.
Bass (1985) posited that managers leading in a manner consistent with
transformational leadership tend to supervise subordinates with higher levels of job
satisfaction. Dunham-Taylor and Klafen (1990) examined the relationship between nurse
executive leadership and staff nurses according to the transformational leadership
32
dimensions. They found staff nurses reported higher levels of perceived leadership
effectiveness and job satisfaction when they perceived their leaders were demonstrating
transformational leadership behaviors. Because of this enhanced job satisfaction,
followers were frequently inspired to do more than was expected of them (Bass, 1985).
One does, however, question if these employees already possessed certain behaviors that
complimented their leaders or did their leaders inspire the followers to model their
behavior? Which happened first?
The idealized influence dimension has been described as charisma as it aids
followers to experience feelings of meaningfulness in their work (Parkman, 2001).
Hartog et al. (1997) view the charismatic leader as providing vision, instilling pride;
increasing optimism and gaining respect and trust. This charismatic ability demonstrated
in transformational leaders to inspiring subordinates to focus beyond self-interests and
look at the organizational mission and vision is the key dimension that sets these leaders
apart from the rest (Epitropaki, 2001). These leaders have the unique ability to cause
followers to not only follow but to exceed expectations as well (Gellis, 2001; Parkman,
2001).
Transformational leaders implement actions that demonstrate their beliefs, values
and vision (Gellis, 2001); thereby implying leaders perform as they expect their followers
to. While this is a valuable attribute, one assumes the behaviors and actions are based on
good intentions and positive outcomes even though it is not explicitly stated. Although
research findings relative to nursing alluded to in this section offer support for this
dimension in terms of believing in the charismatic leader, there is a lack of empirical
33
evidence to demonstrate the exceptional achievements the followers have made as a

result.
Aaltio-Majosola and Takala (2000) challenge this charismatic quality of
transformational leaders and contend that these leaders have different characteristics
during times of crisis. Aware of their surroundings, transformational leaders use media
influence and impression management to gain support for their goals and advance
towards their planned actions (Aaltio-Majosola & Takala, 2000). Waldman, Ramirez,
House, and Puranam, (2001) assert that periods of instability in organizations are times
when charismatic behaviors are developed because organizations during this phase will
be open to such leaders. While these findings may be accurate, they do not negate other
research studies that identify charisma as an important and positive characteristic of
effective leaders.
Inspirational motivation. The second dimension to the transformational theory is
inspirational motivation, which is closely linked to idealized influence. Inspirational
motivation emphasizes building of confidence and inspiring belief into followers (Gellis,
2001). This dimension focuses on the capacity the leader has to act as a role model for
followers (Hartog et al., 1997) and aligns subordinates toward action, inspiring belief in a
cause as well as building confidence (Gellis, 2001). Thyer (2003) maintains that
transformational leaders are optimistic about the future and are able to motivate
individuals intrinsically. The value of transformational leaders in an organization is their
ability to initiate discontentment in status quo, focus on the future and produce new ideas
34
(Gellis, 2001). In nursing, these are valuable traits given the changes that are constantly
occurring in health care.
Individualized consideration. Besides idealized influence and inspirational
motivation, a third dimension identified is individualized consideration. Individualized
consideration is thought to contribute to followers being able to achieve their fullest
potential (Hartog et al., 1997). This alludes to the leader's ability to treat all followers
with concern and care. Transformational leaders are interested in the development and
well being of their followers treating them as unique individuals, coaching them and
ensuring followers carry out tasks that provide learning opportunities (Vandenberghe,
2002). While the need for and value in individualized consideration is evident, the
challenge lies in being able to carry through with it. It is not easy to be able to offer such
a variety of tasks while still allowing followers enough time to complete their jobs. In
nursing for example, there are certain less desirable tasks that must be done despite their
necessity and importance. Difficulties may arise for the nurse leader and the followers in
achieving successful outcomes. In addition to these challenges, Trofino (2000) raises an
interesting point also.
Trofino (2000) claims that transformational leadership is best suited to the
development of teams and team building. Although there is no rationale provided to
support this claim, teams are common and familiar to nurses in the hospital setting.
Hence, transformational leadership is appropriate within the nursing department. One
does however question why transformational leadership is affiliated with team
35
development when one of the key dimensions of transformational leadership theory is

individualized consideration whereby emphasis is placed on the individual.
Research studies indicate nurses want work life balance, a sense of belonging and
sincere caring (Cumby & Alexander, 1998; Lewis & Matthews, 1998; Peterson, 2001;
Solovy, 2002). According to Kerfoot (1998), if people feel an attachment to their
colleagues and unit, they will work regardless of the amount of adversity they may face.
These findings, while not specifically studied in relation to transformational leadership,
add support for the key dimension of individual consideration.
Providing continuous feedback to staff on their performance and linking their
current needs to the mission of the organization fall under this dimension (Vandenberghe,
2002). This is important and valuable information for nurse leaders to strive for. One sees
a challenge in implementing this related to the time factor. If nurse leaders are expected
to provide such individual attention, one questions how feasible it actually is. In today's
climate of health care, where resources are already limited and organizations are expected
to do more with less, it creates a challenge for the nurse leader. Nursing leaders
frequently voice concerns regarding heavy workloads with unrealistic deadlines to
complete various tasks (Sherman, 2002). This raises questions as to how individual
attention to staff nurses will be accommodated into an already heavy workload. It would
be more feasible for leaders to offer additional autonomy and responsibility to the nurses
to pursue their professional interests on their own, which is linked to the next dimension.
Intellectual stimulation. Intellectual stimulation is the last dimension of
transformational leadership. Transformational leaders are able to comprehend and solve
36
problems in innovative ways (Gellis, 2001). They in turn encourage staff to solve
problems by answering their own questions using their intellect, creativity and
innovativeness (Gellis, 2001). These leaders emphasize the importance of logical
reasoning as well as evidence to make decisions and solve problems as opposed to using
unsupported opinions (Vandenberghe, 2002). This is seen as a positive factor in nursing,
as research studies have shown that staff nurses enjoy autonomy, having input into
decisions and being allowed to make decisions regarding patient care (Dunham-Taylor &
Klafen, 1990; Reinhardt, 2004; Ribelin, 2003). Based on these findings, transformational
nurse leaders will be instrumental in enhancing job satisfaction of nurses.
Transformational leaders encourage innovation and solution proposals by
followers to organizational challenges thereby allowing them to experience responsibility
for problem-solving and opportunities to use problem-solving skills (Vandenberghe,
2002). Creativity and innovation are behaviors that are not only exhibited by
transformational leaders but also amongst followers (Bass & Avolio, 2004). These factors
contribute to the improved motivation (Gellis, 2001). Given this information, one
assumption made is that followers are interested in taking on problem-solving
responsibilities.
These four key dimensions of transformational leadership theory offer support for
nurse leaders to consider implementing transformational leadership behaviors in the
hospital setting. By focusing on idealized influence, inspirational motivation,
individualized consideration and intellectual stimulation, nursing leaders have
37
opportunities to establish effective relationships with their staff nurses so as to exceed

organizational expectations. There is however one component missing from this theory.
There is a lack of discussion throughout the transformational leadership theory on
what excites these leaders. How do these leaders define success? Is it organizational or
personal achievements? What motivates them? Do they have the same motivational
factors as their followers? Bass (1985) contends that transformational leadership
behaviors can be learned and that people are not born with them. This is supported in the
discussions of transformational leaders motivating the followers so they in turn assume
similar leadership behavior and responsibility (Cook, 2001; Gould, Kelly, Gladstone, &
Maidwell, 2000; Kosinka & Nierbroj, 2003). It is however not clearly indicated what
makes transformational leaders behave as they do. This area requires further discussion
and development relative to the transformational leadership theory.
Transactional Leadership
Transactional leadership is the second leadership style discussed. Leader-follower
relationships in this leadership style are based on a series of implicit bargains or
exchanges between followers and their leaders (Hartog et al., 2001). In comparing the
two leadership styles, transformational leaders serve change while transactional leaders
emphasize stability (Reinhardt, 2004). Transactional leadership is primarily found in
bureaucratic organizations (Burns, 1978). Health care is viewed as a hierarchical
bureaucratic structure and thus attracts transactional leadership frameworks (Thyer,
2003). Transactional leadership emphasizes task completion and focuses on rewards,
decision making at the senior management level as well as endorsement of management
38
by exception philosophy (Bass & Avolio, 1998). Burns (1978) asserts that transactional
leadership approaches will result in short term change practice while transformational
approaches will have a much longer-term impact. Bass and Avolio (2004) argue that
transactional and transformational leadership styles are both positive forms of leadership
with effective managers demonstrating both types of behaviors.
Three behaviors found in the transactional leadership style are contingent reward,
management by exception-active, and management by exception-passive. The contingent
reward leadership behavior focuses on clarifying goals and recognizes goals when they
are achieved (Avolio & Bass, 2000). Through goal clarification and recognition of
achievement, people will achieve expected levels of performance according to Avolio
and Bass (2000). As earlier alluded to, this reinforces the leadership style of the
transactional leader who emphasizes status quo as opposed to change.
The management by exception-active behavior of transactional leadership is the
second behavior found in transactional leadership. Management by exception-active
leadership behavior involves leaders specifying the standards that are to be complied
with, in addition to establishing what constitutes ineffective performance (Bass & Avolio,
2004). These leaders are focused on close monitoring for mistakes, deviances or errors so
corrective action will be implemented as quickly as possible (Avolio & Bass, 2000).
The third behavioral style of transactional leadership is management by exceptionpassive, which is not viewed as positive as the others already addressed. These leaders
are more passive and reactive to issues, taking action when problems are of a serious
nature (Avolio & Bass, 2000). The management by exception-passive leaders fail to act
39
until they are made aware of mistakes (Avolio & Bass, 2000). This passive, reactive
approach to leading may be appropriate in certain circumstances, but is seen as
ineffective by Avolio and Bass (2000).
Laissez-Faire Leadership
In addition to transformational and transactional leadership styles, laissez-faire is
the third style to be reviewed. Transformational and transactional leaders are more active
and try to prevent problems, while laissez-faire leaders are inactive (Hartog et al., 2001).
These leaders avoid supervisory responsibility and decision making (Bass, 1998). Bass
(1985) further reports a negative relationship between satisfaction, extra effort and
effectiveness with laissez-faire leadership behavior. This implies laissez-faire leadership
is an inappropriate and ineffective way to lead. These leaders frequently are absent when
they are really needed and they delay or avoid responding to urgent questions (Bass &
Avolio, 2004).
Having identified the key dimensions of transformational leadership theory
including transformational, transactional, and laissez-faire leadership styles, one develops
an understanding of the behaviors demonstrated by the various types of leaders within
this framework. Transformational leadership, the first dimension is broken down into
four main behaviors of idealized influence, inspirational motivation, intellectual
stimulation and individualized consideration (Bass & Avolio, 2004). Transactional
leadership is the second dimension discussed. The three behaviors of transactional
leadership are contingent reward, management by exceptionactive, and management by
exceptionpassive. The third dimension focuses on laissez-faire leadership, which is
40
viewed as a passive and ineffective leadership style and behavior (Bass & Avolio, 2004).
Keeping this theory in perspective, the next step is to review the available empirical
research.
Empirical Research Review

James Burns (1978), the political scientist who first identified the transformational
construct of this leadership model built upon theories such as Maslows hierarchy of
needs and Webers charismatic leadership work (Hartog et al., 1997). Bass (1985) in turn
further developed the transformational leadership theory by defining transformational
leaders as individuals with opportunity seeking and risk taking behaviors trying to create
rather than react to environmental circumstances. Because the followers positively
received their leaders, the followers exceeded job expectations (Bass & Avolio, 2004;
Gellis, 2001; Parkman, 2001).
Transformational leaders successfully establish strong relationships with their
followers (Avolio & Bass, 2000). It is this leader-follower relationship that separates
transformational leaders from other leaders and attributes to their successes (Bass &
Avolio, 2004). These claims as well as the transformational leadership theory have been
subject to empirical examination over time. A baseline study was carried out by Bass and
Avolio (2004) that involved 2,154 participants from various business and occupational
fields including the United States army, a government research agency, undergraduate
students, a Scottish firm, United States business firms and nursing students. The
Multifactor Leadership Questionnaire 5X Short Rater form was used in this study to
41
determine raters perceptions of their leaders leadership styles and leadership outcomes
based on the transformational leadership theory. One purpose of this study was to identify
and compare results from this questionnaire with earlier versions of the Multifactor
Leadership Questionnaire (Bass & Avolio, 2004). Findings of this study revealed a
transformational leadership style mean score of 2.26, a transactional leadership style
mean score of 1.98 and a laissez faire leadership style mean score of 1.00 (Bass &
Avolio, 2004). These results supported the transformational leadership theory and found
the transformational leadership style to be viewed most frequently by raters (Bass &
Avolio, 2004).
This baseline study by Bass and Avolio (2004) focused on leadership outcomes of
satisfaction, extra effort and leader effectiveness. These three common leadership
outcomes were also prevalent amongst other studies looked at throughout the empirical
research review. Each of the leadership outcomes is outlined below.
Satisfaction
Satisfaction as a leadership outcome relates to individuals feelings regarding their
jobs (Trossman, 2002). Additionally, satisfaction encompasses followers feelings of
satisfaction with their leaders and their leaders styles of leadership (Avolio, 1999).
Satisfied individuals are equated with motivated, inspired and successful individuals
(Gellis, 2001; Parkman, 2001). Transformational leaders inspire and motivate their
followers to consistently exceed expectations because of the strong leader-follower
relationship that has developed (Bass & Avolia, 1998). These findings have been
42
demonstrated empirically and are discussed in greater detail (Deluga, 1988; Hater &
Bass, 1988; Howell & Avolio, 1993; Howell & Frost, 1989; Kirkpatrick & Locke, 1996).
A study carried out in an air delivery firm by Hater and Bass (1988) involving 28
top performing managers and 26 average performing managers, had 362 of their
followers complete Multifactor Leadership Questionnaires to assess managers leadership
styles and leadership outcomes. Their findings indicated that the transformational
leadership style was a predictor of high levels of satisfaction and effectiveness of the
leader from followers ratings (Hater & Bass, 1988).
Deluga (1988) studied employee satisfaction and leader effectiveness with a
convenience sample of 117 managers and laborers including 76 females and 41 males. It
is of interest to note that this sample contained more females than males, as this is a
common trait found in the nursing profession. Transformational leadership was closely
linked to employee satisfaction and leaders effectiveness regardless of gender or
management level (Deluga, 1988). These two early research studies were important in
showing support for the relationship that exists between employee satisfaction and
In an experimental design, Howell and Frost (1989) observed that participants
working for transformational leaders showed higher rated task performance levels
regardless of the established productivity norms. A laboratory simulation study
conducted by Kirkpatrick and Locke (1996) with research participants revealed that
performance leaders with a clear vision and an open communication style, which are
43
characteristics of transformational leaders, positively impacted outcomes such as

satisfaction and productivity.
Howell and Avolio (1993) studied 78 managers of a financial institution to assess
whether unit performance was predicted by transformational leadership behavior. Their
findings revealed that leaders demonstrating transformational leadership behaviors such
as intellectual stimulation and individualized consideration positively contributed to the
successful achievement of organizational goals (Howell & Avolio, 1993). Although these
findings imply unit performance was improved, it does not specifically state it.
Extra Effort
Another important outcome of transformational leadership is extra effort, which
refers to the amount of work followers are willing to exert as a result of their leader (Bass
& Avolia, 1997). Within the transformational leadership theoretical construct, extra effort
and commitment are the result of transformational leaders acting as role models for their
followers, who in turn become more committed and exert more effort toward the
organization (Bass & Avolia, 1997). Two research studies that examined this association
found in the literature were by Barling, Weber and Kelloway, (1996) and Bycio et al.,
(1995).
Using an experimental design, Barling et al. (1996) assessed causal influences of
transformational leadership behaviors on followers perceptions of their managers
transformational leadership behaviors, financial performance and organizational
commitment of followers by randomly assigning the managers to a training or control
group. Followers using three subscales of the Multifactor Leadership Questionnaire
44
including individualized consideration, idealized influence and intellectual stimulation

rated managers leadership behaviors. The organizational commitment questionnaire
developed by Mowday, Porter and Dubin (1982) was also completed by followers.
Completion of the questionnaires was done two weeks before the training on
transformational leadership and five months following the group based training.
Results of the pre-test post-test control group design revealed that managers who
received the transformational leadership training were perceived by their followers as
having higher individualized consideration, intellectual stimulation and idealized
influence than the followers of the managers that did not receive the training (Mowday et
al., 1992). In addition to these findings, the followers of the managers in the training
group identified more organizational commitment than the followers of the control group
managers (Mowday et al., 1992). These findings support the value of transformational
leadership training and the positive outcome results of organizational commitment and
extra effort of followers.
Bycio et al. (1995) used a confirmatory factor analysis to assess the content
validity of the Multifactor Leadership Questionnaire and examine its structure.
Organizational commitment, intent to leave, performance and satisfaction relative to
transformational leadership were also studied by surveying 1376 nurses using the
Multifactor Leadership Questionnaire (Bycio et al., 1995). Results showed commitment
score differences were statistically significant (p < .01) amongst those who reported to
transformational leaders (Bycio et al., 1995). These findings offer support for
45
Leader Effectiveness
In addition to satisfaction and extra effort, leader effectiveness is the third theme
commonly found in the literature on transformational leadership. In order for leaders to
lead, they must have followers. As earlier alluded to, the exceptional trait found in
transformational leaders is the ability to motivate followers to exceed expectations on a
consistent basis. Followers will follow when they believe in their leaders (Yamarino &
Bass, 1990). How effective leaders are depends on the perceptions of their followers
(Avolio & Bass, 2000). This section focuses on followers perceptions of the
effectiveness of their leaders.
In a study examining self-rater ratings, Bass and Yamarino (1991) hypothesized
that leaders rated themselves higher than their followers in terms of frequency of
transformational leadership behaviors. Naval officers and their followers were involved
in this study. Research findings showed over self-ratings by the officers as compared to
their followers (Bass & Yamarino, 1991). These results indicate the need for leaders to
ensure they elicit feedback from their followers on performance and effectiveness as
opposed to limiting oneself to self-perceptions and evaluations.
A second research study involved two management levels of a government agency
in New Zealand who were examined to determine whether the transformational
leadership behaviors practiced by the first level of supervisors were displayed by the next
level of supervisors reporting to them (Bass, Waldman, Avolio & Bebb, 1997). Their
findings showed similar ratings of the two levels of management. Bass et al. (1997)
referred to this as the cascading effect in which the degree of transformational
46
leadership behavior perceived at one level tends to be present at the next level as well.
Bass et al. (1997) offered three explanations for this. Second level managers may have
been selected based on their perceived leadership styles that were similar to their
supervisors is one possible explanation. Certain leadership behaviors may be accepted
and reinforced by the organizational cultural norms is a second possible explanation. The
third explanation is that second level managers attempt to model their leaders behavior,
which is a belief in the transformational leadership theory as earlier alluded to (Bass et
al., 1997). Regardless of the explanation, these findings support the need to continue
examining the relationship of the leader-follower and its ongoing development.
Gellis (2001) empirically evaluated the transformational leadership model using
the Multifactor Leadership Questionnaire with a sample of 187 hospital employed
clinical social workers. Findings revealed that transformational leadership positively
impacted the perceived leader effectiveness and satisfaction with the leader as rated by
the social workers (Gellis, 2001). From these findings, further support is added to the
positive leadership outcomes of leaders practicing transformational leadership behaviors.
The relationship between leadership behaviors and leadership outcomes was
empirically studied by Spinelli (2006) using Basss model of transformational leadership.
There were 101 Multifactor Leadership Questionnaires completed by subordinates rating
their health administrators leadership behaviors and outcomes (Spinelli, 2006). Findings
revealed that the more subordinates perceived their leaders to practice behaviors of
transformational leadership, the greater the extra effort, effectiveness and satisfaction
results (Spinelli, 2006). The relationship between transformational leadership style and
47
leadership outcomes was positive and stronger than transactional or laissez faire
leadership styles (Spinelli, 2006). The transactional leadership style did however show a
stronger positive relationship with leadership outcomes than the laissez-faire leadership
style, which was negatively correlated to leadership outcomes (Spinelli, 2006). These
findings support those of Bass (1985) and Bass and Avolio (1997). Spinellis (2006)
research supports the full range of leadership model earlier alluded to as it demonstrates
that subordinates who perceived their leaders as practicing transformational and
transactional leadership behaviors were positively correlated to leadership outcomes of
extra effort, effectiveness and satisfaction.
Nursing Research Review

The empirical research previously alluded to provide support for transformational
leadership behavior in a wide variety of settings. Narrowing this focus to the nursing
literature resulted in the identification of nurse researchers who examined satisfaction,
extra effort or effectiveness and leadership behaviors using the transformational
leadership model (Dunham-Taylor, 2000; Manion, 2004; McDaniel & Wolf, 1992;
Strodeur, Vandenberghe, & Dhoore, 2000). Nurses reported empowerment,
effectiveness, extra effort, lower levels of nurse turnover and high levels of job
satisfaction in these studies (Dunham-Taylor, 2000; McDaniel & Wolf, 1992; Strodeur et
al., 2000). Similar to the empirical research findings, this review is presented under the
three headings of satisfaction, extra effort, and leader effectiveness.
48
Satisfaction
Satisfaction in the clinical group is related to the work environment and whether or
not it encourages autonomy as well as professional nursing practice (Boyle, Bott, &
Hanson, 1999; Coile, Jr., 2002; Cowin, 2002; Fletcher, 2001; Upenieks, 2003). Although
numerous factors have been affiliated with nurse turnover, a frequently cited factor is low
job satisfaction (Aiken, Clarke, & Sloane, 2000; Blegen, 1993; Brownson & Harriman,
2000; Cavanaugh & Coffin, 1992; Ingersoll, Olson, Drew-Cates, DeVinney & Davies,
2002; Irvine & Evans, 1995; Kuhar, Millter, Spear, Ulreich, & Mion, 2004; Price &
Mueller, 1981). These findings offer support for the important role job satisfaction takes
relative to nurse retention.
In terms of professions, nursing may be one of the most dissatisfied ones in the
United States. Reports noted that 70% of registered nurses were moderately satisfied with
their work in comparison to other professional workers at 90% (United States Department
of Health & Human Services, 2000). Job satisfaction levels were minimally impacted by
personal factors including experience, education and age. High levels of job
dissatisfaction were consistent across all pay levels and age groups. From the findings,
one may imply it is not the individual, but rather the job that is the main problem with
nurse dissatisfaction.
Greater work satisfaction amongst staff nurses is associated with effective nursing
leadership (Kleinman, 2004) and is identified as a key factor in retention of staff nurses
(Cook, 2001; Ribelin, 2003). Nurses cite autonomy and empowerment as important
factors in job satisfaction (Vandenberghe, 2002). Nursing leaders must allow for this to
49
occur. Dunham-Taylor and Klafen (1990) found in a study of nurse executives identified
as transformational leaders that hospital retention rates were 85%. McDaniel and Wolf
(1992) tested the transformational leadership theory and claimed its factors were
comparable to the leadership qualities described in magnet hospitals. Clancy (2003)
found that nursing supervisors with transformational leadership traits were more effective
leaders. In a cross-sectional study involving 519 respiratory therapists, transformational
leadership styles were positively correlated with subordinate levels of satisfaction
(Parkman, 2001). These findings offer support for transformational leadership styles in
hospitals in general and nursing specifically. It is however not known if other factors
such as age, education and experience of these leaders had any impact on the styles of the
leaders or the perceptions of the subordinates in these studies.
Cline, Reilly and Moore (2003) sought to identify any disparity between what
nurses gave employers as their reasons for leaving and what they would reveal to a third
party. Seven nurses willingly participated in a focus group process in which researchers
followed a set of scripted questions developed to elicit discussion amongst the
participants. They found that management and staffing concerns were the two main
reasons nurses gave for leaving (Cline et al., 2003). One limitation observed in this study
relates to the nurses volunteering for the study. It is not known if these nurses were a
representative sample of the majority of nurses that left the organization.
Newmann, Maylor and Chansarker (2002) interviewed 130 nurses and reported
shortage of staff and poor management as the key factors impacting nurse dissatisfaction.
Concerns regarding poor management were directed at the lack of job flexibility,
50
demanding, uncaring, and remote managers, lack of recognition and support, and poor
communications (Newmann et al., 2002). These identified behaviors are in direct
opposition to those found amongst transformational leaders (Bass & Avolio, 2000).
According to Georges (2002) findings, nursing leadership is the most significant
factor impacting the nursing workforce and whether or not nurses remain in their place of
work. Leadership styles of their managers directly relates to the retention of the
professional nurses. Bleich, Hewlett, Santos, Rice, Cox and Richmeier, (2003) also found
job satisfaction as the key to retaining nurses and components that affect satisfaction
levels in their jobs were directly related to nurse leaders and their behaviors.
Doran et al. (2004) conducted a research study, using a descriptive correlation
design involving 41 nurse managers and 717 nursing staff at seven Canadian teaching
and community-based hospitals. Using the Multifactor Leadership Questionnaire as their
survey instrument, Doran et al. (2004) had a 96% response rate from the staff nurses and
found a positive correlation between transformational leadership style and nurses job
satisfaction. Their findings revealed that the higher the nurses rated their managers as
transformational leaders, the higher the nurses rated their levels of satisfaction in their
jobs (Doran et al., 2004). In regards to nurse turnover, findings showed transformational
nurse leaders had lower turnover rates on their units than nurse leaders practicing other
styles of leadership (Doran et al., 2004). These findings support research findings
previously alluded to regarding the important role nurse leaders play in nurse retention
and satisfaction. The retention rate was calculated over a one-year period for each unit. It
is unclear whether or not the nurse managers were in place in the respective nursing units
51
during the time period used to calculate the retention rates. If they were not in these roles
for the specified timeframe, the rates will not necessarily be reflective of the nurse
managers leadership behaviors.
Nurses in magnet hospitals were found to verbalize high levels of satisfaction
with their jobs compared to nurses employed in nonmagnet hospitals (Upenieks, 2002).
They were satisfied with the participative management and two-way communication
supported by their well-qualified, highly visible leaders (Upenieks, 2002). The behaviors
cited by these nurses are similar to those of transformational leaders.
Extra Effort
Extra effort within the nursing domain refers to the level of exertion toward the
patients, the nursing unit or department as well as to the organization. Kleinman (2004)
found in her study of 79 staff nurses and ten nurse managers in an acute care hospital that
staff nurses who had not thought about leaving their jobs reported much higher
frequencies of following leaders who demonstrated intellectual stimulation, inspirational
motivation, individual consideration and idealized influence. These are behaviors found
in transformational leaders. An additional finding of interest was that nurses working
evening and night shifts were less likely than those on the day shift, to report such
behaviors of their leaders. Because the day shift nurses work along side their leaders, one
questions whether or not staff nurse perceptions of their leaders is based on what they
actually see them doing as opposed to hearing about it. These findings underline the
importance of the leader needing to be visible.
52
Coile, Jr., (2002) found the work environment to be the key to retaining nurses in
the organization and not the salaries nurses were offered. McNeese-Smith (1995)
supported these findings and concluded in her research nursing job satisfaction levels and
organizational commitments were influenced by the characteristics of their leaders.
Enabling others to act and inspiring the shared vision were predictors of significant
impact relative to job satisfaction (McNeese-Smith, 1995). These behaviors are those
found amongst transformational leaders.
Providing encouragement is a means of enhancing commitment. Kerfoot (2000)
supports this by stating that nurses will go the extra mile when they feel their leaders care
about them and are willing to support them. Transformational leaders ensure praise is
given honestly and when it is appropriate (Epitropaki, 2001). Kleinman (2004) notes that
leaders in health care do not view providing encouragement to followers as a high
priority. Appreciation is however, increasing that encouragement as a transformational
leadership technique is related to quality work and job productivity (Kleinman, 2004).
Nurses stayed longer in jobs where participative management models were
endorsed by their managers and staff input was encouraged in decision making processes
according to Strachota, Nomandin, OBrien, Clary and Krukow, (2003). Although this
study did not specifically identify transformational leaders, the behaviors listed are
similar to those found in transformational leaders.
Leonard (1999) found in his research, 95% of respondents surveyed identified the
main factor related to staying or leaving a job depended upon development of trust with
their manager. Solovy (2002) found from 300 nurses interviewed, the direct relationship
53
with the supervisor was the main cause for 25% of them leaving their jobs. These
findings support the value of transformational leaders in keeping nurses who are
committed to the organization.
A true transformational leader gains cooperation and commitment of all team
members, departments or hospitals and inspires them to not only succeed, but exceed in
achieving expectations (Gellis, 2001). Empathy, which is a common characteristic
amongst nurses, is a catalyst for motivating others with vision, identifying needs,
building trust and developing common goals (Kerfoot, 2000; Kosinska & Nierbroj,
2003). This implies the need for nurse leaders to understand things from the perspectives
of their followers.
Leader Effectiveness
A key component to nurse satisfaction is its leadership. Research findings have
clearly identified one of the main reasons individuals resign is because of their supervisor
(Branham, 2001; Hill, 2003; Neuhauser, 2002; Sherman, 2002). Cline et al. (2003)
carried out a focus group qualitative study with seven registered nurses who resigned
from their positions in 1999 to determine why nurses voluntarily left the hospitals. The
primary reason cited was management that included lack of support, not responding or
listening to concerns and ineffective management training (Cline et al., 2003).
Upenieks (2002) compared 16 nurse leaders from magnet and nonmagnet
hospitals to determine what leadership traits were considered valuable in todays health
care environment. She found the magnet nurse leaders most consistently identified
similar traits where nurse retention was the focus of their strategies (Upenieks, 2002).
54
The traits included highly visible innovative leaders who encouraged staff participation in
decision-making (Upenieks, 2002). These traits are similar to those found in
transformational leaders.
As nurse leaders, being able to put their words into actions is critical to their
success. Research studies found that nurse leaders perceived themselves as demonstrating
transformational behavior more frequently than their staff nurses (Dunham-Taylor &
Klafen, 1990; Kleinman, 2004; McDaniel & Wolf, 1992). This raises concerns when a
leaders self-evaluation does not match with followers evaluation of their leader.
Because leadership is dependent upon followers, nurse leaders need to elicit feedback
from their staff to evaluate their leadership style and effectiveness.
Wieck et al. (2002) studied leadership traits practicing nurses valued in their
leaders. Honesty was noted as the most valuable trait in their leaders and was the primary
reason nurses continued working in that environment (Wieck et al., 2002). Qualitatively,
nursing leadership was explored by Wood-Allen (1998) who found nurse leaders directly
impacted the work environment and staff retention. Strategies these nurse leaders
employed were honest, open staff communication and their involvement in decision
making (Wood-Allen, 1998). These findings support the characteristics and behaviors of
transformational leaders.
Effective transformational nurse leaders need to clearly articulate their vision so
the nursing staff believes in and endorse it (Trofino, 2000). Communication is a large
component of how the nurse leader can articulate the vision. A participative
communication system implies an open, honest two-way system whereby people are
55
listening and understanding what is being said (Thyer, 2003). A critical segment of
communication therefore is to actively listen to followers, not just share ones vision with
them. Trofino (2000) found transformational leaders practiced uncensored
communication with nursing staff at all times including downsizing and budget
adjustments. For this level of information exchange to occur, mutual trust and respect
between the leader and followers is needed (Avolio & Bass, 2000).
Clegg (2000) reported in her study that nurses dissatisfied with nursing
management made reference to their leaders being invisible and not understanding their
concerns. The need for and value in being visible as a leader is supported by these
findings. By offering true accounts to nurses, their leaders are able to reach them and
identify with them (Clegg, 2000). This is necessary if leaders are to be successful in
motivating followers to achieve organizational goals.
In another study, Ribelin (2003) found through a questionnaire to over 2000
registered nurses in a large mid-western health care system that nurses were more intent
on staying when the leadership style of the nurse leader was positively perceived.
Nursing leaders that provided nurses with resources, opportunities, information and
support were preferred by the nurses responding to the questionnaire (Ribelin, 2003).
These findings were supported by Friedrich (2001) who discovered that organizational
policies and procedures were of less impact to employees than the opinions they had of
their supervisors. While these research studies do not identify transformational leadership
specifically as the preferred leadership style, they allude to components and behaviors
56
found in transformational leaders such as individual consideration and inspirational

motivation.
Summary
In summary, transformational leadership involves developing followers who are
intellectually stimulated and inspired to willingly put individual interests secondary for
the betterment of the overall organization (Thyer, 2003). Four key dimensions of the
transformational leadership theory are idealized influence, inspirational motivation,
individual consideration and intellectual stimulation (Avolio & Bass, 2000). Within these
dimensions, transformational leaders are often described as charismatic leaders who are
able to create trust and respect of their followers who in turn idealize their leaders as role
models (Clancy, 2003; Parkman, 2001). These leaders clearly articulate their vision and
inspire belief in their followers. They consider followers as individuals who are treated
with care and concern (Cline et al., 2003; Kleinman, 2004; Wieck et al., 2002).
Transformational leaders are creative and innovative and encourage their followers to be
the same when attempting to solve problems and arrive at decisions (Doran et al., 2004;
Solovy, 2002; Trofino, 2000). Research findings reveal that transformational leaders
positively impact satisfaction (Clancy, 2003; Deluga, 1988; Doran et al., 2004; DunhamTaylor & Klafen, 1990; Hater & Bass, 1998; Howell & Avolio, 1993; Howell & Frost,
1989; Kirkpatrick & Locke, 1996; McDaniel & Wolf, 1992; Parkman, 2001), extra effort
(Barling et al., 1996; Bycio et al., 1995; Kleinman, 2004; Leonard, 1999; Solovy, 2002;
Strachota et al., 2003) and leader effectiveness (Bass et al., 1997; Cline et al., 2003;
57
Gellis, 2001; Kleinman, 2004; Ribelin, 2003; Spinelli, 2006; Trofino, 2000; Wieck et al.,
2002; Wood-Allen, 1998). Much of the empirical research reviewed is directed at senior
or middle level leaders as opposed to front line managers who have been cited as a main
factor affecting the work environment (Numerof et al., 2004). By carrying out this
research study, a better understanding of the relationship between front line nurse
leaders leadership styles and leadership outcomes of satisfaction, extra effort and
effectiveness as perceived by staff nurses will be achieved.
CHAPTER 3. METHODOLOGY
The purpose of this chapter is to outline the methods used to carry out this
research. Discussions focus on the research philosophy, theoretical framework, research
design, sampling design, measures, data collection procedures, data analysis procedures,
limitations of methodology, ethical issues and timelines for research activities. There are
three research questions and three hypotheses and three null hypotheses identified for this
proposal, which is listed below.
styles and staff nurses perception of extra effort?
styles and staff nurses perception of effectiveness?
styles and staff nurses perception of satisfaction?
The three hypotheses and three null hypotheses for this research are listed below.
to extra effort.
59

to effectiveness.
to satisfaction.
60
Research Philosophy
According to Bass and Avolio (1997), effective leadership styles result in
leadership outcomes of effectiveness, extra effort, and satisfaction. These outcomes in
turn positively impact health care services and the delivery of them in an effective
manner (Ribelin, 2000). While the value of effective nursing leadership is found in the
literature (Bycio et al., 1995; Clancy, 2003; Doran et al., 2004; Kleinman, 2004;
Strachota et al., 2003; Trofino, 2003), previous research findings suggest such
correlations between leadership styles and outcomes exist for middle and senior nurse
executives (Dunham-Taylor, 2000; Manion, 2004; Strodeur et al., 2000). Little is known
about staff nurses perceptions of leadership styles of front line nurse managers and their
correlation with leadership outcomes. This area requires further research.
This research asked three questions that focused on the relationship between nurse
managers leadership styles and staff nurses perceptions of leadership outcomes.
Answers to these questions were sought quantitatively through the Multifactor
Leadership Questionnaire 5X Short Rater form developed by Bass and Avolio (2004).
This research builds on the body of knowledge that currently exists.
It is recognized that one reality exists and it may be tested (Mertens, 2005).
Discovery of this reality relies upon theory, although one cannot prove the theory
(Mertens, 2005). This research used the transformational leadership theory as its
theoretical framework. One of the basic premises of this theory is the leader motivates
and transforms followers to exceed at meeting organizational or team goals through the
61
establishment and maintenance of a unique, effective leader-follower relationship (Bass

& Avolio, 2004). The leader communicates the importance of task outcomes to their
followers, having followers commit to organizational or team goals ahead of personal
ones and reaching their needs of a higher order (Bass, 1987).
One recognizes the importance of objectivity as the standard of which one strives
for. Results of this research study were analyzed based on the identified variables of
leadership behaviors and leadership outcomes. One remained neutral to prevent biases or
values from influencing the work while carrying out the study by following the
prescribed data collection procedures rigorously. Participants completed the survey
questionnaires anonymously. The data was acquired through the use of a survey tool,
which had a fixed format allowing participants to reply to questions individually. Data
collection and analysis procedures were strictly followed throughout the study as outlined
in the following pages to ensure privacy and confidentiality of the research participants as
well as to prevent values and biases from influencing results.
Theoretical Framework
This research was undertaken based on the transformational leadership theory. It
is used to explain the relationship connection between leaders and their followers, which
Bass (1998) identifies as the rational to account for exceptional accomplishments and
performances by followers. This full range of individual leadership model identifies three
key leadership styles, which are further divided into leadership behaviors. The three
leadership styles are transformational, transactional and laissez-faire.
62
Transformational leadership is referred to as an outstanding leadership style

whereby followers interests are broadened and elevated (Burns, 1990). This type of
visionary leadership demonstrates certain behaviors geared towards motivating, inspiring
and empowering followers to implement change and achieve organizational goals
(Avolio & Bass, 2000). The leadership behaviors of transformational leadership cited by
Bass (1998) are idealized influence-attributed, idealized influence-behavioral,
inspirational motivation, intellectual stimulation and individualized consideration. Each
of these behaviors, while separate are viewed as integrated with each other to
demonstrate the characteristics and behaviors of the transformational leader (Hartog et
al., 1997). The conceptual and operational definitions of transformational leadership are
listed on the following page.
Conceptual Definition of Transformational Leadership
Transformational leadership. Transformational leadership is a visionary
leadership style characterized by behaviors intended to empower, inspire and motivate
followers to exceed expectations as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2000). The behaviors include
intellectual stimulation and individualized consideration (Bass, 1999).
Operational Definitions of Transformational Leadership
Idealized influenceattributed. Idealized influenceattributed is a transformational
leadership behavior that refers to the transformational leaders charismatic quality which
results in followers having confidence, respect and trust in their leader as measured by the
63
Idealized influencebehavioral. Idealized influencebehavioral is a
transformational leadership behavior that alludes to the charismatic quality of the
transformational leader, which results in followers identifying with their leader, the vision
and the sense of purpose as measured by the Multifactor Leadership Questionnaire 5X
Inspirational motivation. Inspirational motivation is a transformational leadership
behavior that deals with the role model capabilities of the leader, which results in
building confidence, and inspiring followers to believe as measured by the Multifactor
Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000). Table 1 identifies
the Multifactor Leadership Questionnaire items that measure this factor.
Individualized consideration. Individualized consideration is a transformational
leadership behavior that focuses on the leaders ability to support, coach and provide
learning opportunities for followers so that they may achieve to their greatest potential as
measured by the Multifactor Leadership Questionnaire 5 x short rater forms (Avolio &
Bass, 2000). Table 1 identifies the Multifactor Leadership Questionnaire items that
measure this factor.
Intellectual stimulation. Intellectual stimulation is a transformational leadership
behavior that refers to the leaders ability to understand and solve problems using
innovative approaches, which in turn encourages followers to use creativity and intellect
64
to solve their own problems as measured by the Multifactor Leadership Questionnaire 5X

Leaders practicing these behaviors are effective with their followers and use an
active approach to leading (Almo-Metcalfe & Alban-Metcalfe, 2001; Altieri, 1995; Bass,
1998; Bass & Avolio, 2004). Bass (1995) posits that transformational leaders are able to
influence and inspire followers so personal goals are secondary to team or organizational
goals and followers succeed at surpassing expectations. This relates back to the unique
and effective leader-follower relationship established amongst transformational leaders
and their followers.
Besides the transformational leadership style, the second leadership style alluded
to by Bass (1997) is transactional leadership. Behaviors emphasized within this
leadership style relate to corrective and constructive transactions (Avolio & Bass, 2000).
These leaders focus on defining expectations and encouraging performance of followers
to meet the expectations (Bass, 1997). Greater importance is placed on maintaining status
quo as opposed to change and risk taking behaviors demonstrated by transformational
leaders (Hartog et al., 1997). Behaviors associated with transactional leadership include
contingent reward, management by exception-active, and management by exceptionpassive. Below are the conceptual and operational definitions of this leadership style.
Conceptual Definition of Transactional Leadership
Transactional leadership. Transactional leadership is a leadership style that is
characterized by behaviors of risk avoidance, operating within existing systems; close
65
attention paid to efficiency and time constraints and maintains control through processes
(Bass, 1997). Behaviors included in this style of leadership are contingent reward,
management by exceptionactive and management by exceptionpassive.
Operational Definitions of Transactional Leadership
Contingent reward. Contingent reward is a transactional leadership behavior that
places emphasis on clarifying goals and recognizing when they are achieved as measured
by the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
factor.
Management by exceptionactive. Management by exceptionactive is a
transactional leadership behavior that encompasses the leader stating the standards to be
complied with as well as those that are ineffective performance as measured by the
Management by exceptionpassive. Management by exceptionpassive is a
transactional leadership behavior that includes a more passive and reactive approach to
concerns as the leader fails to act until one is made aware of the mistakes as measured by
factor.
The former two leadership behaviors, while viewed as active and effective for
leaders, Bass and Avolio, (2004) contend they are not equivalent to transformational
66
leadership behaviors. The transactional approach is necessary at certain times such as

when lower performance levels are required (Avolio & Bass, 2000). Management by
exception-passive is seen as a more passive leadership approach and less effective than
the former behaviors listed (Bass & Avolio, 2004).
In addition to transformational and transactional leadership styles, the third style
is laissez-faire. Laissez-faire leadership is a passive approach to leading where little or no
direction is given to followers (Bass, 1995). This approach is viewed as passive as well as
ineffective (Avolio & Bass, 2000). The conceptual and operational definitions are
described below.
Conceptual Definition of Laissez-Faire Leadership
Laissez-faire leadership. Laissez-faire leadership is a leadership style that is
viewed as leaders failing to accept responsibilities, refraining from expressing views on
important issues and failing to follow up on requests for assistance (Avolio & Bass,
1999).
Operational definition of Laissez-Faire Leadership
Laissez-faire leadership. Laissez-faire leadership is a behavior that is viewed as
passive and ineffective as measured by the Multifactor Leadership Questionnaire 5X
Having identified the three key leadership styles of transformational, transactional
and laissez-faire conceptually as well as the affiliated behaviors of each approach, the
next step is to review leadership outcomes. Leadership styles impact leadership outcomes
67
of satisfaction, extra effort and leader effectiveness (Barling et al., 1996; Bass et al.,
1997; Bycio et al., 1995; Clancy, 2003; Cline et al., 2003; Deluga 1988; Doran et al.,
2004; Dunham-Taylor & Klafen, 1990; Gellis, 2001; Hater & Bass, 1998; Howell &
Avolio, 1993; Howell & Frost, 1989; Kirkpatrick & Locke, 1996; Kleinman, 2004;
Leonard, 1999; McDaniel & Wolf, 1992; Parkman, 2001; Ribelin, 2003; Solovy, 2002;
Strachota et al., 2003; Trofino, 2000; Wieck et al., 2002; Wood-Allen, 1998). These
definitions are outlined below.
Conceptual Definition of Leadership Outcomes
Leadership outcomes. Leadership outcomes are related to the success of
transformational and transactional leadership behaviors on the followers as measured by
The outcomes include extra effort, effectiveness and satisfaction.
Operational Definitions of Leadership Outcomes
Extra effort. Extra effort is a leadership outcome that refers to a leaders ability to
heighten followers desires to succeed, exceed expectations and encourages them to try
harder as measured by the Multifactor Leadership Questionnaire 5X Short Rater forms
(Avolio & Bass, 2000). Table 1 identifies the Multifactor Leadership Questionnaire items
that measure this factor.
Effectiveness. Effectiveness is a leadership outcome that alludes to the leaders
ability to lead a group effectively, meet organizational requirements, meet others job
related needs and their ability to represent their group to higher authority as measured by
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factor.
Satisfaction. Satisfaction is a leadership outcome that encompasses followers
feelings of satisfaction with their leaders and leadership styles as well as their jobs as
measured by the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio,
1999). Table 1 identifies the Multifactor Leadership Questionnaire items that measure
this factor.
Research Design
Bass and Avolios (1997) full range of individual leadership model was used as
the theoretical framework for this research to answer questions regarding relationships
between leadership styles and leadership outcomes as perceived by staff nurses. This
research was carried out from a quantitative, descriptive approach using a correlational
design. Review of the selected research design and rationale for this choice are outlined
below.
A descriptive research approach is the process of taking information that is
already known and adding to it (Glicken, 2003). Applying this to the research study, it is
known that leadership styles impact leadership outcomes for middle and senior nurse
executives (Bycio et al., 1995; Doran et al., 2004; Kleinman, 2004; Strachota et al., 2003;
Trofino, 2003). This research took this knowledge and applied it to the front line nurse
managers to determine how staff nurses perceive their managers leadership styles and
outcomes. This research did not focus on breaking new ground, which Glicken (2003)
69
refers to as exploratory research, but rather adding to the knowledge that is already
known.
Having identified this research as quantitative and descriptive, the next step is to
elaborate on the design choice. The correlational design was used to carry out this
research. While correlational research may be predictive or relationship studies (Mertens,
2005), this research focused on the latter. Relationship studies explore relationships to
gain further understanding of factors that contribute to a more complex characteristic
(Mertens, 2005, p. 150) by measuring variables received from the same individuals. This
research obtained such information through the use of the Multifactor Leadership
Questionnaire 5X Short Rater form from acute care staff nurses. The predictor variables
measured were the leadership styles including transformational, transactional and laissezfaire. The outcome variables were the leadership outcomes of satisfaction, extra effort
and effectiveness.
This design was chosen because it provided an opportunity to look at relationships
between different variables obtained from the same individuals at approximately the same
time (Neuman, 2003). Additionally, correlational research allows several variables to be
included in one study (Glicken, 2003). This research studied nine predictor variables and
three outcome variables as previously alluded to. The variables selected relate to the
theoretical framework of the full range of individual leadership. Glicken (2003) identifies
the need to ensure variables are selected prior to data collection. When choosing such
variables, past research and theory believed to be related to the variables should be the
basis for the choices (Glicken, 2003). When analyzing results, an understanding of
70
correlational coefficients is necessary. Correlational coefficient is close to the plus or

minus one (Glicken, 2003). Two variables that increase or decrease together have a
positive correlation while no relationship exists if a correlation coefficient is close to
zero.
A strong relationship may be found between predictor and outcome variables, but
other explanations may exist for these correlations (Mertens, 2005). One means of
addressing this potential issue is through the selection of a homogenous group (Glicken,
2003). The research participants for this study were acute care staff nurses.
It is recognized positive correlations between two variables does not prove
causation, but rather identifies a strong positive relationship. To measure the predictor
and outcome variables, the Multifactor Leadership Questionnaire 5X Short Rater form
was used. This instrument was selected because of its acceptance in the scholarly
literature (Avolio et al., 1999; Bass, 1985, 1990; Bass & Avolio, 1990; Bycio et al., 1995;
Hartog et al., 1997; Yamarino & Bass, 1990) as well as its simplicity to use (Avolio &
Bass, 2000; Gellis, 2001).
Sampling Design
The target population was acute care staff nurses working in Western Canada,
which included 480 staff nurses. Eligibility to participate in the study included registered
nurses currently employed as acute care staff nurses in a Western Canada health region.
The total sampling frame of 480 registered nurses was targeted but the proposed
sample size was 144 nurses. This sample size was chosen in an attempt to elicit an
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adequate number of participants. Sample size is dependent upon the degree of accuracy
required, degree of variability or diversity in the population and the number of variables
being examined simultaneously (Neuman, 2003). Avolio and Bass (2000) note there is no
optimal, minimum or maximum size of the rater group suggested for evaluation of a
single leader when completing the Multifactor Leadership Questionnaire 5X Short Rater
forms. According to Neuman (2003), an appropriate sample size of a population of less
than 1000 is 30%. Based on this information, a sample size of 144 participants was
needed for this study.
The population ages ranged from 21 to 66 years of age with 470 or 98% of the
population being female. This was congruent with the nursing profession nationally and
internationally whereby 94% of nurses were female. The predictor variables examined
were leadership styles of transformational, transactional, and laissez-faire. The outcome
variables were leadership outcomes of extra effort, effectiveness and satisfaction.
The entire population of acute care staff nurses in a Western Canada health region
constituted the research population and all had equal opportunity to participate in the
research study. The list of staff nurses was obtained from the Human Resources
information system, which the researcher had permission to access. The findings were
generalizable to the target population of acute care staff nurses in a Western Canada
health region.
A list of the population was attained from the Human Resources information
system and their e-mail addresses were identified. An individual e-mail was sent to each
of the 480 potential participants outlining the research study as well as an electronic copy
72
of the informed consent. Potential participants were instructed to print off a hard copy of
the consent form, read and sign it, and then return the completed form in a private and
confidential sealed envelope with the researchers name on the envelope through the
inter-office mail with a two-week deadline. An e-mail was sent out one week and two
days prior to the deadline reminding potential participants of the pending deadline. There
were 144 signed consent forms returned. From the signed consent forms a list of
participants agreeing to participate in the study was made that included their first and last
names and their e-mailing address.
Measures
Multifactor Leadership Questionnaire (MLQ)
The Multifactor Leadership Questionnaire 5X Short Rater form was used in this
study. Permission was obtained to use this instrument (Appendix A). First introduced in
1985 by Doctors Bass and Avolio (2000), the purpose of this instrument was to establish
a means of quantifying leadership. Bass and Avolio (1997) developed this instrument
specifically for use by leaders and raters to measure transformational, transactional and
laissez-faire leadership styles as well as leadership outcomes including extra effort,
effectiveness and satisfaction. This tool is a 45-item questionnaire that has undergone
revisions to address identified deficiencies over the past ten years (Bass & Avolio, 1997).
It was revised several times because of criticisms associated with the accuracy of the
instrument (Pittenger, 2001). The Multifactor Leadership Questionnaire has 45 statements
used to assess leadership styles and outcomes by respondents using a five point Likert
73
scale (Avolio & Bass, 1999; Tejeda, 2001). Named after its developer, the Likert rating
scale contains five choices that are arranged on a continuum from zero to four (Cohan &
Swedlik, 2002). Zero means not at all, one is once in awhile, two is sometimes, three is
fairly often and four is frequently, if not always (Avolio & Bass, 2000).
The Multifactor Leadership Questionnaire 5X Short Rater form is comprised of 12
main factorsnine of which focus on transformational, transactional and laissez-faire
leadership styles and three factors which look at leadership outcomes including extra
effort, effectiveness and satisfaction. Five of these factors are defined as transformational
leadership behaviors including idealized influence-attributed, idealized influencebehavioral, inspirational motivation, individual consideration and intellectual stimulation
(Avolio & Bass, 1999; Bass, 1985). Three factors of the Multifactor Leadership
Questionnaire 5X Short Rater form relate to transactional leadership behaviors including
contingent rewards, management by exception-active and management by exceptionpassive. One factor focuses on laissez-faire behavioral leadership style. There are a total
of 36 questions affiliated with the three leadership styles. The questions are evenly
distributed with four questions asked relative to each of the nine leadership behaviors.
The Multifactor Leadership Questionnaire 5X Short Rater form contains three
factors dealing with leadership outcomes of extra effort, effectiveness and satisfaction.
The nine remaining questions are distributed amongst the three leadership outcomes, with
three questions linked to extra effort, four are related to effectiveness and two questions
focus on satisfaction. The link between variables and questionnaire items on the
Multifactor Leadership Questionnaire 5X Short Rater form are identified in Table 1
74
below. From this table, it is evident that the questions are not asked in chronological
order to coincide with the respective leadership styles and outcomes. They are, instead
asked in a random format.
Table 1. Variable Linked to Multifactor Leadership Questionnaire 5X Short Rater Form

Variable
Transformational Leadership Style (Predictor Variable)
Idealized Influence-Attributed
Idealized Influence-Behavioral
Individual Consideration
Inspirational Motivation
Intellectual Stimulation
Transactional Leadership Style (Predictor Variable)
Contingent Reward
Management by Exception-Active
Management by Exception-Passive
Laissez-Faire Leadership Style (Predictor Variable)
Laissez-Faire
Extra Effort (Outcome Variable)
Effectiveness (Outcome Variable)
Satisfaction (Outcome Variable)
MLQ Questions Linked to Variable

10, 18, 21, 25
6, 14, 23, 34
15, 19, 29, 31
9, 13, 26, 36
2, 8, 30, 32
1, 11, 16, 35
4, 22, 24, 27
3, 12, 17, 20
5, 7, 28, 33
39, 42, 44
37, 40, 43, 45
38, 41
Instrument Reliability and Validity

Researchers have analyzed, reviewed and critiqued the Multifactor Leadership
Questionnaire 5X Short Rater form since its inception in 1985 (Avolio, 1999; Bass, 1985;
Bass & Avolio, 1994; 2000; Bycio et al., 1995; Hartog et al., 1997; Vandenberghe, 2002;
Yamarino & Bass, 1990). Bass and Avolio (2004) consider this form to have high
construct validity. Construct validity refers to the rationales and evidence that support the
trustworthiness of the meaning of the score (Mertens, 2005). Factor analyses have been
performed by a number of researchers (Bycio et al., 1995; Hartog et al., 1997;
75
Vandenberghe, 2002) in attempts to evaluate and replicate validity of the Multifactor

Leadership Questionnaire factor structure. Bass and Avolio (2004) surveyed 2080
individuals including health care, government and military organizations and obtained
alpha coefficients for the Multifactor Leadership Questionnaire 5X Short Rater form
ranging from .74 to .96 as outlined in Table 2. These subscales have good internal
consistency with Cronbachs alpha meeting the criterion of .70 (Nunnally, 1978).
Table 2. Leadership Factor and Outcome Measure Ratings Multifactor Leadership
Questionnaire 5X Short Rater Form
Construct
Idealized InfluenceAttributed
Idealized InfluenceBehavioral
Individualized Consideration
Contingent Reward
Management by Exception-Active
Management by Exception-Passive
Laissez-Faire
Extra Effort
Effectiveness
Satisfaction
Alpha Coefficient
.90
.91
.94
.93
.93
.91
.81
.87
.74
.94
.94
.96
In addition to validity, reliability also needs to be addressed. Reliability refers to

the need for data collection instruments to be consistent (Mertens, 2005). Alpha
coefficients of the factors and outcomes are greater than .70 making it a reliable tool.
These high coefficient alpha values demonstrate the Multifactor Leadership
Questionnaire 5X Short Rater form as a reliable test to measure leadership behaviors and
outcomes.
76
The Multifactor Leadership Questionnaire 5X Short Rater form may be completed

anonymously in 15 minutes and is inexpensive to administer. It is easy to analyze and
may be administered to a large number of individuals. There is no minimum or maximum
number of participants required for evaluation of a single leader (Bass & Avolio, 2004).
The tool has been used in more than 30 countries in profit and not-for-profit
organizations including education, military, correctional, government, volunteers and
hospitals. Males and females have completed the Multifactor Leadership Questionnaire
5X Short Rater form on both male and female leaders. This is relevant because of the
high number of females compared to males in the nursing profession. The questionnaire
already exists and the researcher was able to gain access to data to test hypotheses with.
Data Collection Procedures

Data was collected using the Multifactor Leadership Questionnaire 5X Short Rater
form. The researcher sent out an electronic message via e-mail to the 144 research
participants outlining the research study, instructions on completing the Multifactor
Leadership Questionnaire 5X Short Rater form, along with the Multifactor Leadership
Questionnaire 5X Short Rater form as an attachment. The participants were instructed to
print off the Multifactor Leadership Questionnaire 5X Short Rater form, complete it and
return it via inter-office mail in a private and confidential sealed envelope addressed to
the researcher. A two-week deadline was given to return the completed questionnaire to
the researcher. The inter-office mail method was selected because it was a neutral mail
drop in which participants anonymity was maintained. After one week, a reminder e-
77
mail was sent to all participants individually reminding them of the deadline and a final
reminder was sent out two days prior to the deadline. This was done to encourage the
potential number of completed questionnaires. An acceptable response rate was set at
70% of the sample, which is deemed as appropriate for survey questionnaires (Mertens,
2005). Based on 144 participants who agreed to participate, an acceptable response rate
was 101 completed questionnaires. There were 111 questionnaires returned which was a
response rate of 77%.
Completed consent forms, Multifactor Leadership Questionnaire 5X Short Rater
forms and participant mailing lists were securely stored in a folder locked in the
researchers personal filing cabinet located at the researchers residence. Access to this
data was limited to the researcher only. The data will be stored for the required seven
year period in a fireproof safe at the researchers residence upon which time, the data will
be destroyed through paper shredding and burning by the researcher.
Data Analysis Procedures

All Multifactor Leadership Questionnaire 5X Short Rater forms were reviewed for
completeness and legibility by the researcher and assigned a number starting with one up
to 111. This number was used to track the completed questionnaires when the data was
being inputted into an excel spreadsheet. Forms received after the deadline was excluded
from the data analysis.
Objectivity refers to the degree individuals administering, scoring or interpreting
the instrument may influence it by their beliefs and biases (Mertens, 2005). The scoring
78
of the results was in accordance with the instructions in the manual by Avolio and Bass,
(2000). This involved summing the items and dividing by the number of items that make
up that scale. For example, there are four items that make up the scale of idealized
influenceattributed. The scores of the four questions affiliated with this leadership
behavior were totaled and divided by four to derive at a score for idealized influenceattributed. Where items on the questionnaire were left blank, the total score was
calculated by dividing the total for that scale by the number of items answered which was
in accordance with the scoring instructions (Avolio & Bass, 2000). The researcher
collected, entered, and analyzed all data using the Excel program. The researcher verified
the accuracy of all data by double-checking the data after it was entered into the computer
to ensure the highest reliability of results.
Correlational statistics were used to describe relationship strengths and direction
between predictor and outcome variables. Pearson r correlations were reported between
predictor and outcome variables. The level of significance was set at 0.05. Regression
analysis, using Statistical Package for Social Sciences (SPSS) version 13.0 for Windows
was performed with the predictor and outcome variables to show the amount of variance
that predictor variables explained.
Limitations of Methodology
Limitations of methodology existed with the correlational design. It was
recognized that correlation is not causation. Correlation may show a direct relationship
between two factors, but cannot prove causation. Another limitation to this method
79
included the potential for participant bias because of the wording of the questionnaire.
The Multifactor Leadership Questionnaire 5X Short Rater form has previously been
tested by a number of participants from within nursing and outside (Bass & Avolio,
1997). Raters that have completed this form in the past vary in age across the working life
span as well as educational backgrounds ranging from less than high school to doctoral
degree (Bass & Avolio, 1997).
Surveys are thought to be impersonal and the researcher may not receive the entire
account or careful feedback (Neuman, 2002). This research study focused on the specific
factors that raters were asked to rate their leaders on as identified on the Multifactor
Leadership Questionnaire 5X Short Rater form. The survey was short and took
approximately 15 minutes to complete. This avoided participants from getting bored and
careless with their responses. While the survey does not allow for the acquisition of an all
inclusive understanding of responses, this research was intentionally limited to focus on
staff nurses perceptions of their leaders style of leadership as well as leadership
outcomes in an objective format which this survey offered.
Although comparable results have been obtained for peers, direct reports and
supervisors, Seltzer and Bass (1990) reported inflated ratings by raters when their leader
instead of an independent authority contacted them. In this study, the researcher
communicated directly with the raters, thereby eliminating the need for the nurse
managers to be involved in the study as well as reducing the risk of potentially inflated
ratings.
80
Ethical Issues
Individuals were able to freely consent to participate in the research study and
withdraw without fear of repercussion. An informed consent form was required to be
completed by all research participants. To ensure protection and privacy of participants
who agreed to participate in the study, access to completed consent forms and lists of
participants was limited to the researcher.
A potential risk for participants involved in this study was fear of repercussions
from their nurse managers in rating them. Reduction of this potential risk was
accomplished by required anonymity of the participants when completing the
questionnaire as well as anonymity of the managers being rated. The researcher contacted
participants through email regarding the completion of the survey to further reduce this
risk. The nurse managers were not involved in the administration or monitoring of the
study nor did they have knowledge of who the research participants were in the study.
Maintaining anonymity of participants and those that were rated protected both
groups, as one is unable to identify whom the participants were or the individuals the
participants were rating. Potential benefits to participants involved in this study included
them having opportunity to identify their managers leadership styles and their level of
satisfaction and effectiveness with it. This information is in turn useful identifying
programs to develop future nurse leaders to practice effective leadership styles.
All acute care staff nurses in a Western Canada health region had equal
opportunity to voluntarily participate in the research study. The researcher invited all
acute care staff nurses to participate in the study and conducted individual contact with
81
all potential participants via e-mail. Individual as opposed to group contact aided in
preventing potential participants from knowing who else received the information and
agreed to participate in the study.
The researcher ensured all research data and results were securely locked with
access limited to the researcher to protect the privacy and confidentiality of the
participants. The data will be maintained for the required seven years by the researcher.
The researcher will destroy the information through shredding of the data as well as
burning it in an incinerator. No personal identifiable information was on the
questionnaires so anonymity of participants as well as their leaders was maintained. The
researcher received approval from the Institutional Review Board of Capella University
prior to proceeding with the proposed study as well as the Western Canada health region
to ensure compliance with applicable standards and policies were met.
The researcher was employed in the Human Resources department of a health
region in Western Canada. A potential risk for participants was fear of job security and
repercussions from management staff in completing the survey questionnaire. This was
addressed as outlined below. The researcher had no reporting relationships with the
participants or the nursing managers they rated. By requesting anonymity of the
participants as well as the nurse leaders being evaluated, the researcher was unable to
identify who completed the surveys. Choice of the inter-office mail delivery system was
another added means of ensuring anonymity, as there were no identifiers on the survey
forms, the sealed envelopes or the inter-office mail system. The researcher was not able
to track who completed the survey forms or identify what nurse leaders were being rated.
82
The data was presented in aggregate form to further protect anonymity of research
participants and the leaders being rated.
Timelines for Research Activities

This research study was carried out over a six-month period. Upon approval of the
Institutional Review Board from Capella University, the recruitment of research
participants began. The time frame followed for data collection is outlined in Table 3.
Table 3. Research Study Timeline

Activity
Timeline
Population list obtained from Human Resources System

Individual e-mails to 480 potential participants with 2 week deadline
1 week e-mail reminder sent to potential participants
2 day e-mail reminder sent to potential participants
Consent forms used to identify participant list
E-mail to participants along with MLQ with 2 week deadline
1 week e-mail reminder sent to potential participants
2 day e-mail reminder sent to potential participants
Collate data
Analyze data
March 2006
March 2006
March 2006
March 2006
March 2006
March 2006
March 2006
March 2006
March 2006
April 2006
Summary
Effective leadership styles result in leadership outcomes of satisfaction, extra
effort and effectiveness (Bass & Avolio, 1997; Dunham-Taylor, 2000; Manion, 2004;
Strodeur et al., 2000). The purpose of this research was to determine the relationship
between front line nurse leaders leadership styles and leadership outcomes as perceived
by acute care staff nurses using the Multifactor Leadership Questionnaire 5X Short Rater
83
form. Based on the transformational leadership theory, leaders are able to motivate their
followers to perform organizational and team goals in favor of personal ones and to
exceed expectations of achieving these goals through the established leader follower
relationship (Bass & Avolio, 2004).
This research was carried out from a quantitative, descriptive approach using a
correlational design. This method was selected as it allows relationships between
variables obtained from the same individuals at about the same time to be studied
(Neuman, 2003). The Multifactor Leadership Questionnaire 5X Short Rater form, which
is a 45-item questionnaire was the instrument selected to acquire the data. Instrument
reliability and validity was established (Avolio, 1999; Bass & Avolio, 2004; Hartog et al.,
1997; Vandenberghe, 2002). The sample population was acute care staff nurses working
in a Western Canada health region, which included 480 nurses with all of them having
equal opportunity to participate. An informed signed consent was required of all
participants prior to them being allowed to participate. Data collection and analysis
procedures were outlined to ensure objectivity, validity and reliability of the research was
maintained. Limitations of the proposed method were discussed as well as ethical issues
regarding the research study. A timeline was provided to identify data collection and
analysis procedure time frame. Upon approval of the Institutional Review Board of
Capella University, the research study was carried out.
CHAPTER 4. PRESENTATION AND ANALYSIS OF DATA

This research study focused on the relationship between front line nurse
managers leadership styles and leadership outcomes as perceived by staff nurses who
reported to them. The purpose of this chapter is to present and analyze the collected data.
It is subdivided into three sections including preliminary analyses, nursing leadership
styles and outcomes findings and hypotheses testing.
Preliminary Analyses
Data was gathered from staff nurses in a Western Canada health region over a
four-week period. Completed questionnaires were returned to the researcher by research
participants in private and confidential sealed envelopes through the inter-office mail. All
completed questionnaires received up to the preset deadline were included in the study.
There were two completed questionnaires returned after the deadline and were therefore
excluded from the study.
The researcher collected the data from the completed Multifactor Leadership
Questionnaire 5X Short Rater forms, reviewed it and then entered the data into an excel
spreadsheet and the Statistical Package for Social Sciences version 13.0. All
questionnaires were reviewed by the researcher to identify errors such as more than one
response per question or for questions left blank. There were no questionnaires with more
than one response per question. There were a total of 12 unanswered questions on the
completed questionnaires. Unanswered questions, according to Bass and Avolio (2000)
are common in these types of questionnaires, but do not preclude the use of the data.
85
Instructions for calculating results were carried out according to the Multifactor
Leadership Questionnaire manual (Bass & Avolio, 2000). When returned questionnaires
showed evidence of incompletion, the data was entered in the excel spreadsheet and the
unanswered questions were left blank. Means were then calculated on the total number of
completed responses to accurately reflect the data collected. The excel spreadsheet was
used to calculate means and standard deviations, while the Statistical Package for Social
Sciences version 13.0 was used for testing the hypotheses. The level of significance was
set at 0.05. The researcher double-checked all the data entered into the excel spreadsheet
and the Statistical Package for Social Sciences version 13.0 as well as the results to
ensure the highest reliability of results.
Response Rates
The target population was acute care staff nurses employed in a Western Canada
health region. The total sampling frame of 480 nurses was targeted, but the sample size
was 144 nurses. Each of the 144 participants were sent a Multifactor Leadership
Questionnaire 5X Short Rater form along with instructions on its completion and how to
return the completed questionnaire to the researcher. There were 111 useable Multifactor
Leadership Questionnaires 5X Short Rater forms returned. Of the 144 participants
included in the sample size, 111 responded by returning the completed questionnaires
resulting in a 77% response rate of the sample population.
General Description of Participants
Research participants were registered nurses employed as staff nurses working in
acute care hospitals within a Western Canada health region. The listing of potential
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participants, male to female ratio and age range was obtained through a Human
Resources information system. In order to ensure respondent anonymity there was no
demographic information collected through the survey questionnaire.
Nursing Leadership Styles and Outcomes Findings

The Multifactor Leadership Questionnaire 5X Short Rater form categorizes raters
responses into one of 12 sections. These 12 sections were attributed to one of three
leadership styles and one of three leadership outcomes (Avolio & Bass, 2000). The three
leadership styles included transformational, transactional and laissez-faire (Avolio &
Bass, 2000). The three leadership outcomes identified were extra effort, effectiveness and
satisfaction (Bass & Avolio, 2004). The aggregate mean scores are indicative of how
frequently staff nurses perceived their nurse leaders to demonstrate certain behaviors or
characteristics of transformational, transactional and laissez-faire leadership styles. Every
item on the Multifactor Leadership Questionnaire 5X Short Rater form was scored on a
Likert scale from zero to four, with zero being not at all, one meaning once in awhile, two
was sometimes, three was fairly often and four was frequently, if not always to identify
mean scores of each of the behaviors of the leadership styles and leadership outcomes.
The purpose of this section is to present mean scores and standard deviations of the
leadership behaviors that are categorized within the three leadership styles as well as the
mean scores and standard deviations of the three leadership outcomes.
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Transformational Leadership Style

Transformational leadership involves engaging, motivation and interests of people
to develop and increase their confidence, effectiveness and efforts to evolve from
personal concerns to broader interests of the organization (Almo-Metcalfe & AlbanMetcalfe, 2001). Of the 111 staff nurses who rated their nurse leaders using the
Multifactor Leadership Questionnaire 5X Short Rater form, 32 or 29% of them identified
their leaders as transformational leaders. Ratings by the staff nurses who perceived their
nurse managers to display transformational leadership styles had higher mean scores in
the five associated leadership behaviors of idealized influenceattributed, idealized
influencebehavioral, inspirational motivation, intellectual stimulation and individualized
consideration than the leadership behaviors of transactional or laissez-faire styles of
leadership. The mean transformational leadership style score for all respondents was 2.15
with a standard deviation of 0.18 (Table 4). This mean indicates that staff nurses
perceived their nurse leaders to demonstrate transformational leadership behaviors
sometimes. The standard deviation is an indication of how tightly a set of values is
clustered around the mean, which in this instance is low at 0.18. Further breakdown of
the five transformational leadership behaviors are outlined below.
Idealized influenceattributed. Idealized influenceattributed is one of the five
leadership behaviors affiliated with the transformational leadership style. This leadership
behavior is in reference to the leaders charisma that causes followers to respect, trust and
hold confidence in their leader (Avolio & Bass, 2000). The mean score as rated by staff
nurses was 2.27 for idealized influenceattributed with a standard deviation of 0.95
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(Table 4). This score indicates that staff nurses perceived their nurse leaders to
demonstrate idealized influenceattributed leadership behaviors sometimes. Of the five
transformational leadership behaviors, the idealized influenceattributed mean score was
the second highest score.
Idealized influencebehavioral. Idealized influencebehavioral is the second
leadership behavior that falls under the transformational leadership style. This leadership
behavior is similar to idealized influenceattributed in that it alludes to the charismatic
quality of leaders however the idealized influencebehavioral emphasizes the followers
ability to identify with their leader, their vision and purpose (Avolio & Bass, 2000). The
mean score as rated by staff nurses was 2.33 for idealized influencebehavioral with a
standard deviation of 0.98 (Table 4). This score indicates that staff nurses perceived their
nurse leaders to demonstrate idealized influencebehavioral leadership behaviors
sometimes. Of the five transformational leadership behaviors, the idealized influence
behavioral mean score was the highest score.
Inspirational motivation. Inspirational motivation falls under the transformational
leadership style and is identified as the third leadership behavior. This leadership
behavior focuses on the leaders role model abilities that create increased confidence of
followers as well as inspiring them to believe (Avolio & Bass, 2000). The mean score as
rated by staff nurses was 2.23 for inspirational motivation with a standard deviation of
1.00 (Table 4). This score indicates that staff nurses perceived their nurse leaders to
demonstrate inspirational motivation leadership behaviors sometimes. Of the five
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transformational leadership behaviors, the inspirational motivation mean score was the
third highest score.
Intellectual stimulation. The fourth leadership behavior that is associated with the
transformational leadership style is intellectual stimulation. This leadership behavior
looks at the leaders ability to understand and solve problems using innovative techniques
(Avolio & Bass, 2000). In turn, this encourages creativity and use of intellect by
followers to identify solutions to their own problems (Avolio & Bass, 2000). The mean
score as rated by staff nurses were 1.95 for intellectual stimulation with a standard
deviation of 0.89 (Table 4). This score indicates that staff nurses perceived their nurse
leaders to demonstrate intellectual stimulation leadership behaviors once in awhile. Of
the five transformational leadership behaviors, the intellectual stimulation mean score
was the lowest score and below the transformational leadership style mean score of 2.15.
Individualized consideration. Individualized consideration is the fifth leadership
behavior that falls under the transformational leadership style. This leadership behavior
encompasses the leaders ability to coach, support and offer learning opportunities to
followers so they may successfully achieve to their greatest potential (Avolio & Bass,
2000). The mean score as rated by staff nurses was 1.97 for individualized consideration
with a standard deviation of 0.85 (Table 4). This score indicates that staff nurses
perceived their nurse leaders to demonstrate individualized consideration leadership
behaviors once in awhile. Of the five transformational leadership behaviors, the
individualized consideration mean score was the second lowest score and below the
transformational leadership style mean score of 2.15.
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Table 4. Mean and Standard Deviations of Transformational Leadership Style and

Behaviors
MLQ Scales (Number of items)
Transformational Leadership Style (20)
Idealized InfluenceAttributed (4)
Idealized InfluenceBehavioral (4)
Inspirational Motivation (4)
Intellectual Stimulation (4)
Individualized Consideration (4)
Mean
2.15
2.27
2.33
2.23
1.95
1.97
SD
0.18
0.95
0.98
1.00
0.89
0.85
Note. n = 111.
Transactional Leadership Style
Transactional leadership is the leadership style that is primarily characterized by
behaviors of risk avoidance, close attention to time constraints and efficiency,
maintenance of control through processes and operating within existing systems (Bass,
1997). Of the 111 staff nurses who rated their nurse leaders using the Multifactor
Leadership Questionnaire 5X Short Rater form, 79 or 71% of them identified their
leaders as transactional leaders. The majority of the respondents perceived their nurse
leaders to be practicing transactional leadership style more so than transformational or
laissez faire styles of leadership. There are three leadership behaviors according to Bass
and Avolio (2004) associated with the transactional leadership style including contingent
reward, management by exceptionactive, and management by exceptionpassive. The
mean transactional leadership style score for all respondents was 2.09 with a standard
deviation of 0.23 (Table 5). This score indicates that staff nurses perceived their nurse
leaders to demonstrate transactional leadership style sometimes. The standard deviation is
an indication of how tightly a set of values is clustered around the mean, which in this
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instance is low at 0.23. A more detailed discussion of the three transactional leadership
behaviors is outlined below.
Contingent reward. Contingent reward is the first of three leadership behaviors
that is part of the transactional leadership style. This leadership behavior emphasizes the
clarification of goals as well as recognizing when they are achieved (Avolio & Bass,
2000). The mean score as rated by staff nurses was 2.15 for contingent reward with a
standard deviation of 0.87 (Table 5). This score indicates that staff nurses perceived their
nurse leaders to demonstrate contingent reward leadership behaviors sometimes. Of the
three transactional leadership behaviors, the contingent reward mean score was the
second highest mean score.
Management by exceptionactive. The second leadership behavior affiliated with
transactional leadership style is management by exceptionactive. This leadership
behavior involves leaders identifying what standards are to be complied with and what
constitutes ineffective performance (Avolio & Bass, 2000). The mean score as rated by
staff nurses for management by exception-active was 2.29 with a standard deviation of
0.52 (Table 5). This score indicates that staff nurses perceived their nurse leaders to
demonstrate management by exception-active leadership behaviors sometimes. Of the
three transactional leadership behaviors, the management by exception-active mean score
was the highest mean score.
Management by exceptionpassive. Management by exceptionpassive is the final
leadership behavior associated with transactional leadership style and is not viewed as
effective as the former two leadership behaviors under this category (Bass & Avolio,
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2004). The management by exceptionpassive leadership behavior is a more reactive and

passive approach to issues than the management by exceptionactive. This approach is
seen when leaders neglect to take action until they are made aware of mistakes (Avolio &
Bass, 2000). The mean score as rated by staff nurses for management by exception
passive was 1.84, which is lower than the other two mean scores previously alluded to.
The standard deviation is 0.90 (Table 5). This score indicates that staff nurses perceived
their nurse leaders to demonstrate management by exceptionpassive leadership
behaviors once in awhile. Of the three transactional leadership behaviors, the
management by exceptionpassive mean score was the lowest mean score.
Table 5. Mean and Standard Deviations of Transactional Leadership Style and Behaviors
Mean
SD
Transactional Leadership Style (12)
2.09
0.23
Contingent Reward (4)
2.15
0.87
Management by ExceptionActive (4)
2.29
0.52
Management by ExceptionPassive (4)
1.84
0.90
Note. n = 111.
Laissez-Faire Leadership Style
Laissez-faire leadership is viewed by Avolio and Bass (1999) as leaders failing to
follow up on requests for assistance, refraining from expressing views on issues of
importance and neglecting to accept responsibilities. Of the 111 staff nurses who rated
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their nurse leaders using the Multifactor Leadership Questionnaire 5X Short Rater form,
none of them identified their leaders as primarily laissez-faire leaders. It has one
leadership behavior associated with it known as laissez-faire, which is viewed as passive,
and ineffective (Avolio & Bass, 2000). The mean score as rated by staff nurses for
laissez-faire was 1.16, which was the lowest mean score of all the leadership behaviors
and the standard deviation was 0.75 (Table 6). This score indicates that staff nurses
perceived their nurse leaders to demonstrate laissez-faire leadership style once in awhile.
The standard deviation is an indication of how tightly a set of values is clustered around
the mean, which in this instance is high at 0.75. Because this leadership style is seen by
Bass and Avolio (2004) as ineffective, a low mean score is desirable, which was found in
this research study.
Table 6. Mean and Standard Deviations of Laissez-Faire Leadership Style and Behavior
Mean
SD
Laissez-Faire Leadership Style (4)
1.16
0.75
Laissez-Faire (4)
1.16
0.75
Note. n = 111.
Leadership Outcomes
Within the Multifactor Leadership Questionnaire 5X Short Rater form, a section
exists relating to leadership outcomes. The three leadership outcomes are extra effort,
effectiveness and satisfaction, which are results of leadership styles (Bass & Avolio,
2004). Researchers contend that leadership styles have a positive or negative affect on
94
leadership outcomes (Avolio & Bass, 2000; Clancy, 2003; Doran et al., 2004; Gellis,
2001; Hater & Bass, 1998; Howell & Frost, 1989; Ribelin, 2003). The results of the mean
leadership outcome scores as attained through the Multifactor Leadership Questionnaire
5X Short Rater forms are presented in the pages following and the data is summarized in
Table 7.
Extra effort. The first leadership outcome is extra effort, which deals with the
leaders ability to increase followers desires to exceed expectations, succeed and
encourage them to put forth additional effort (Avolio & Bass, 2000). The mean score as
rated by all staff nurses was 1.84 for extra effort with a standard deviation of 1.04 (Table
7). The mean score indicates that staff nurses perceived extra effort leadership outcomes
occurred once in awhile. The standard deviation score shows how closely clustered the
values were around the mean. These findings revealed that the extra effort was the least
closely linked of the three leadership outcomes.
Effectiveness. The second leadership outcome is effectiveness. This leadership
outcome refers to the leaders ability to lead a group effectively, meet others job related
needs, and meet organizational requirements and how well leaders represented their
followers to authorities of a higher level (Avolio & Bass, 2000). The mean score as rated
by all staff nurses was 2.37 for effectiveness with a standard deviation of 0.73 (Table 7).
This mean score indicates that staff nurses perceived effectiveness leadership outcomes
occurred sometimes. The standard deviation shows that the values were not as tightly
clustered around the mean as compared to the transformational and transactional
leadership styles, but were the most closely linked of the three leadership outcomes.
95
Satisfaction. Satisfaction is the third leadership outcome and includes feelings of

satisfaction followers have with their leaders and their leaders leadership styles (Avolio
& Bass, 2000). The mean score as rated by all staff nurses was 2.27 for satisfaction with a
standard deviation of 0.91 (Table 7). The mean score indicates that staff nurses perceived
satisfaction leadership outcomes occurred sometimes. The standard deviation score
indicates how closely clustered the values are around the mean. In this study, the values
were not as tightly clustered around the mean in satisfaction as compared to
effectiveness, but more so than extra effort.
Table 7. Mean and Standard Deviations of Leadership Outcomes

Mean
SD
Extra Effort (3)
1.84
1.04
Effectiveness (4)
2.37
0.73
Satisfaction (2)
2.27
0.91
Note. n = 111.
Hypotheses Testing
There were three hypotheses and three null hypotheses tested in this research
study. Each hypothesis was analyzed using Statistical Package for Social Sciences
version 13.0 with results presented in related tables. The data was collected from the
completed Multifactor Leadership Questionnaire 5X Short Rater forms. From the data
alluded to earlier, 79 staff nurses or 71% of the study population perceived their leaders
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to practice the transactional leadership style. The remaining 32 staff nurses or 29% of the
study population perceived their leaders to practice the transformational leadership style.
There were no nurse leaders that practiced Laissez-faire leadership style as perceived by
staff nurses. The purpose of this section is to determine if there is a positive correlation
between the nurse leaders leadership style and the leadership outcomes as perceived by
staff nurses. The hypotheses were tested at a level of .05 for significance.
Hypothesis 1
The first hypothesis and null hypothesis are listed below.
to extra effort.
Analysis of Hypothesis 1. The null hypothesis 1 can be rejected if there is a
positive correlation between extra effort and leadership behavioral scores of nurse
managers as perceived by staff nurses. To test hypothesis 1, nine Pearson r correlations
were conducted on extra effort with the nine Multifactor Leadership Questionnaire 5X
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Short Rater form leadership behavioral scores of idealized influence-attributed, idealized

influence-behavioral, inspirational motivation, individualized consideration, intellectual
stimulation, contingent reward, management by exception-active, management by
exception-passive, and laissez-faire. A significant relationship exists between extra effort
and all the Multifactor Leadership Questionnaire 5X Short Rater form leadership
behaviors (Table 8).
Table 8. Pearson r Correlations between Extra Effort and MLQ Leadership Behaviors
MLQ Leadership Behaviors
Contingent Reward
Management by ExceptionActive
Management by ExceptionPassive
Laissez-Faire
Extra Effort
.89**
.89**
.94**
.88**
.90**
.96**
.54**
.80**
.67**
Note. ** p < 0.01, n = 111.

As extra effort scores increase, idealized influence-attributed, idealized influencebehavioral, inspirational motivation, individualized consideration, intellectual
stimulation, contingent reward, and management by exceptionactive scores increase,
management by exception-passive, and laissez-faire scores decrease. Three Pearson r
correlations were conducted on extra effort with the three Multifactor Leadership
Questionnaire 5X Short Rater form leadership styles of transformational, transactional,
and laissez-faire. A significant positive relationship exists between extra effort and
transformational leadership style, r (111) = .94, p < .01, and transactional leadership
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style, r (111) = .64, p < .01. The relationship between transformational leadership style
and extra effort is stronger at r (111) = .94, p < .01, than transactional leadership style
and extra effort at r (111) = .64, p < .01. As extra effort scores increase, transformational
and transactional leadership style scores also increase. A significant negative relationship
exists among extra effort and laissez-faire leadership style, r (111) = .67, p < .01. As
extra effort scores increase, Laissez-faire leadership style scores decrease. These findings
support Bass (1985), Bass and Avolio (1997) and Spinellis (2006) research whereby
positive correlations were reported between transformational leadership style behaviors
of idealized influence-attributed, idealized influence-behavioral, inspirational motivation,
individualized consideration, and intellectual stimulation, as well as transactional
leadership style behaviors of contingent reward, management by exception-active, while
negative correlations were found between management by exception-passive and laissezfaire leadership behaviors and extra effort.
A multiple regression was conducted on extra effort as the criterion with the three
Multifactor Leadership Questionnaire 5X Short Rater form leadership styles of
transformational, transactional, and laissez-faire as the predictors. Assumptions of
regression including linearity, homoscedasticity, and absence of multicollinearity were
met. The model was significant, F (3, 107) = 398.62, p < .001; and transformational,
transactional, and laissez-faire leadership style scores predicted 91.8% of the variance in
extra effort scores. Regression coefficients are presented in Table 9, where for every oneunit increase in transformational leadership style scores, extra effort scores increase by
1.03. For every one-unit increase in transactional leadership style scores, extra effort
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scores increase by 1.23, and for every one-unit increase in laissez-faire leadership style
scores, extra effort scores increase by 0.15.
Table 9. Multiple Regression on Extra Effort and Three MLQ Leadership Styles of
Predictors
SE
Significance
Transformational
1.03
.05
.90
20.59
.001
Transactional
1.23
.17
.24
7.43
.001
Laissez-Faire
0.15
.06
.11
2.61
.001
Based on these findings, hypothesis 1 which stated that staff nurse perceptions of
their nurse managers leadership styles as determined by the Multifactor Leadership
Questionnaire of transformational leadership including idealized influence-attributed,
idealized influence-behavioral, inspirational motivation, individualized consideration, and
intellectual stimulation are positively related to extra effort was supported. Null
hypothesis 1 that stated there was no positive relation between nurse managers
leadership styles as determined by the Multifactor Leadership Questionnaire of
transformational leadership including idealized influence-attributed, idealized influencebehavioral, inspirational motivation, individualized consideration and intellectual
stimulation and extra effort as perceived by staff nurses was rejected.
Hypothesis 2
The second hypothesis and null hypothesis are identified as follows.
100

to effectiveness.
Analysis of Hypothesis 2. The null hypothesis 2 can be rejected if there is a
positive correlation between effectiveness and leadership behavioral scores of nurse
managers as perceived by staff nurses. To test hypothesis 2, nine Pearson r correlations
were conducted on effectiveness with the nine Multifactor Leadership Questionnaire 5X
Short Rater form leadership behavior scores of idealized influence-attributed, idealized
stimulation, contingent reward, management by exception-active, management by
exception-passive, and laissez-faire. Findings revealed that a significant relationship
existed between effectiveness and all the Multifactor Leadership Questionnaire 5X Short
Rater form leadership behaviors (Table 10).
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Table 10. Pearson r Correlations between Effectiveness and MLQ Leadership Behaviors
Contingent Reward
Laissez-Faire
Effectiveness
.82**
.91**
.86**
.90**
.85**
.94**
.72**
.86**
.79**
Note. ** p < 0.01, n = 111.

As effectiveness scores increase, idealized influence-attributed, idealized
stimulation, contingent reward, and management by exception-active scores also
increase; but as effectiveness scores increase management by exception-passive and
laissez-faire scores decrease. Three Pearson r correlations were conducted on
effectiveness with the three Multifactor Leadership Questionnaire 5X Short Rater form
leadership styles of transformational, transactional, and laissez-faire. A significant
positive relationship exists between effectiveness and transformational leadership style, r
(111) = .90, p < .01, and transactional leadership style, r (111) = .68, p < .01. The
relationship between transformational leadership style and effectiveness is stronger at r
(111) = .90, p < .01, than transactional leadership style and effectiveness at r (111) = .68,
p < .01. As effectiveness scores increase transformational and transactional leadership
style scores also increase. A significant negative relationship exists among effectiveness
and laissez-faire leadership style, r (111) = .79, p < .01. As effectiveness scores increase,
102
laissez-faire leadership style scores decrease. These findings support Bass (1985), Bass
and Avolio (1997) and Spinellis (2006) research whereby positive correlations were
reported between transformational leadership style behaviors of idealized influenceattributed, idealized influence-behavioral, inspirational motivation, individualized
consideration and intellectual stimulation as well as transactional leadership style
behaviors of contingent reward, and management by exception-active, while negative
correlations were found between management by exceptionpassive and laissez-faire
leadership behaviors and effectiveness.
A multiple regression was conducted on effectiveness as the criterion with the
three Multifactor Leadership Questionnaire leadership styles of transformational,
transactional, and laissez-faire as the predictors. Assumptions of regression including
linearity, homoscedasticity, and absence of multicollinearity were met. The model was
significant, F (3, 107) = 337.68, p < .001; and transformational, transactional, and laissezfaire scores predicted 90.2% of the variance in effectiveness scores. Regression
coefficients are presented in Table 11, where for every one-unit increase in
transformational leadership style scores, effectiveness scores increase by 0.50. For every
one-unit increase in transactional leadership style scores, effectiveness scores increase by
1.02, and for every one-unit increase in laissez-faire leadership style scores, effectiveness
scores decrease by 0.19.
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Table 11. Multiple Regression on Effectiveness and Three MLQ Leadership Styles of
Predictors
Transformational
Transactional
Laissez-Faire
SE
Significance
0.50
1.02
0.19
.04
.13
.04
.61
.28
.20
13.07
8.08
4.38
.001
.001
.001
Based on these findings, hypothesis two which stated that staff nurse perceptions
of their nurse managers leadership styles as determined by the Multifactor Leadership
idealized influence-behavioral, inspirational motivation, individualized consideration and
intellectual stimulation are positively related to effectiveness was supported. Null
stimulation and effectiveness as perceived by staff nurses was rejected.
Hypothesis 3
The third hypothesis and null hypothesis are listed below.
to satisfaction.
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Analysis of Hypothesis 3. Null hypothesis 3 can be rejected if there is a positive
correlation between satisfaction and leadership behavioral scores of nurse managers as
perceived by staff nurses. To test hypothesis 3, nine Pearson r correlations were
conducted on satisfaction with the nine Multifactor Leadership Questionnaire leadership
behavior scores idealized influence-attributed, idealized influence-behavioral,
inspirational motivation, individualized consideration, intellectual stimulation, contingent
reward, management by exception-active, management by exception-passive, and laissezfaire. Findings revealed a significant relationship existed between satisfaction and all the
Multifactor Leadership Questionnaire leadership behaviors (Table 12).
Table 12. Pearson r Correlations between Satisfaction and MLQ Leadership Behaviors
Contingent Reward
Laissez-Faire
Note. ** p < 0.01, n = 111.
Satisfaction
.84**
.97**
.92**
.96**
.93**
.92**
.72**
.80**
.71**
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As satisfaction scores increase, idealized influence-attributed, idealized influencebehavioral, inspirational motivation, individualized consideration, intellectual
stimulation, contingent reward and management by exceptionactive scores also increase;
as satisfaction scores increase management by exception-passive and laissez-faire scores
decrease. Three Pearson r correlations were conducted on satisfaction with the three
Multifactor Leadership Questionnaire leadership styles of transformational, transactional,
and laissez-faire. A significant positive relationship exists between satisfaction and
style, r (111) = .47, p < .01. The relationship between transformational leadership style
and satisfaction is stronger at r (111) = .96, p < .01, than transactional leadership style
and satisfaction at r (111) = .47, p < .01. As satisfaction scores increase, transformational
and transactional leadership style scores also increase. A significant negative relationship
exists among satisfaction and laissez faire leadership style, r (111) = .71, p < .01. As
satisfaction scores increase, laissez-faire leadership style scores decrease. These findings
support Bass (1985), Bass and Avolio (1997) and Spinellis (2006) research whereby
positive correlations were reported between transformational leadership style behaviors
of idealized influence-attributed, idealized influence-behavioral, inspirational motivation,
individualized consideration and intellectual stimulation as well as transactional
leadership style behaviors of contingent reward and management by exception-active,
while negative correlations were found between management by exception-passive and
laissez-faire leadership behaviors and satisfaction.
106
A multiple regression was conducted on satisfaction as the criterion with the three
Multifactor Leadership Questionnaire leadership styles of transformational, transactional,
and laissez-faire as the predictors. Assumptions of regression including linearity,
homoscedasticity, and absence of multicollinearity were met. The model was significant,
F (3, 107) = 477.33, p < .001; and transformational, transactional, and laissez-faire
leadership style scores predicted 93.0% of the variance in satisfaction scores. Regression
coefficients are presented in Table 13, where for every one-unit increase in
transformational leadership style scores, satisfaction scores increase by 1.02.
Table 13. Multiple Regression on Satisfaction and Three MLQ Leadership
Styles of Transformational, Transactional and Laissez-Faire
Predictors
Transformational
Transactional
Laissez-Faire
SE
Sig.
1.02
0.09
0.04
.04
.14
.05
.99
.02
.03
24.97
0.68
0.86
.001
.501
.394
Based on these findings, hypothesis 3 which stated that staff nurse perceptions of
their nurse managers leadership styles as determined by the Multifactor Leadership
intellectual stimulation are positively related to satisfaction was supported. Null
transformational leadership including idealized influence-attributed, idealized influence-
107
behavioral, inspirational motivation, individualized consideration and intellectual

stimulation and satisfaction as perceived by staff nurses was rejected.
Summary
Focusing on leadership styles and leadership outcomes, this study sought to
determine if positive relationships existed between front line nurse managers styles of
leadership and leadership outcomes as perceived by staff nurses. The Multifactor
Leadership Questionnaire 5X Short Rater form was the instrument used to collect data
from 144 staff nurses employed in acute care hospitals in a Western Canada health
region. There were 111 useable Multifactor Leadership Questionnaire 5X Short Rater
forms returned. Data from these questionnaires were reviewed, entered into an excel
spreadsheet and verified by the researcher for accuracy by double-checking all the data.
The Statistical Package for Social Sciences version 13.0 was used to test the hypotheses.
Aggregate mean scores and standard deviations were determined that identified staff
nurses perceptions of their front line leaders leadership styles of transformational,
transactional and laissez-faire.
Findings revealed 32 or 29% of staff nurses perceived their leaders as displaying
transformational leadership style, while the remaining 79 or 71% of staff nurses
perceived their leaders as showing transactional leadership styles. No staff nurses
perceived their leaders as displaying the laissez-faire style of leadership. Aggregate mean
scores were calculated for the five transformational leadership behaviors of idealized
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individualized consideration and intellectual stimulation, the three leadership behaviors

of transactional leadership style including contingent reward, management by exceptionactive and management by exception-passive and the one laissez-faire leadership
behavior of laissez-faire.
Leadership outcomes of extra effort, effectiveness and satisfaction were then
reviewed. Aggregate mean scores of 1.84, 2.37 and 2.27 respectively and standard
deviations for each of these leadership outcomes were presented. The leadership outcome
of effectiveness has the highest mean score, followed by satisfaction and extra effort.
Hypothesis testing was then presented of the three hypotheses and three null
hypotheses. The purpose was to determine if a positive relationship existed between nurse
leaders leadership styles and leadership outcomes as perceived by staff nurses.
Hypothesis 1, which focused on staff nurse perceptions of their nurse managers
transformational leadership style behaviors including idealized influence-attributed,
intellectual stimulation being positively related to extra effort was tested. Three Pearson r
correlations were conducted on extra effort with the three Multifactor Leadership
and laissez-faire. A significant positive relationship exists between extra effort and
style, r (111) = .64, p < .01. As extra effort scores increase, transformational and
transactional leadership style scores also increase. A significant negative relationship
exists among extra effort and laissez-faire leadership style, r (111) = .67, p < .01.
109

leadership style behaviors including idealized influence-attributed, idealized influencebehavioral, inspirational motivation, individualized consideration and intellectual
stimulation being positively related to effectiveness was tested. Three Pearson r
correlations were conducted on effectiveness with the three Multifactor Leadership
and laissez-faire. A significant positive relationship exists between effectiveness and
style, r (111) = .68, p < .01. As effectiveness scores increase, transformational and
exists among effectiveness and laissez-faire leadership style, r (111) = .79, p < .01.
leadership style behaviors including idealized influence-attributed, idealized influencebehavioral, inspirational motivation, individualized consideration and intellectual
stimulation being positively related to satisfaction was tested. Three Pearson r
correlations were conducted on satisfaction with the three Multifactor Leadership
and laissez-faire. A significant positive relationship exists between satisfaction and
style, r (111) = .47, p < .01. As satisfaction scores increase, transformational and
exists among satisfaction and laissez-faire leadership style, r (111) = .71, p < .01.
110
In summary, the research findings revealed significant positive relationships

existed between extra effort and transformational leadership style, r (111) = .94, p < .01
and transactional leadership styles, r (111) = .64, p < .01. Significant positive
relationships were found between effectiveness and transformational leadership style, r
(111) = .90, p < .01 and transactional leadership styles r (111) = .68, p < .01. Significant
positive relationships were also found between satisfaction and transformational
leadership style, r (111) = .96, p < .01 and transactional leadership styles, r (111) = .47, p
< .01. These findings supported the three hypotheses tested as well as confirmation of
Bass and Avolios (2004) belief that transformational leadership style is positively related
to leadership outcomes of extra effort, effectiveness and satisfaction, while laissez-faire
leadership styles are not. Based on these findings, the three null hypotheses were rejected.
CHAPTER 5. SUMMARY, RECOMMENDATIONS AND CONCLUSIONS

Leadership has been the topic of study for decades, but many unanswered
questions remain. Multiple leadership theories have evolved over time, each with their
own strengths and weaknesses. One such theory is the transformational leadership theory
that is deemed as an effective approach to leading followers (Avolio, 1990; Bass, 1998;
Fairholm, 1998; House & Aditya, 1997). The transformational leadership theory was the
framework used in this research study. The purpose of this chapter is to present a
summary of the findings of the research study. Future recommendations for study are
outlined and conclusions are discussed.
The transformational leadership theory began its development under Dr. Burns
and was expanded upon by Bass and Avolio (1994, 1997, 2004). The basic premise
underlying this theory is the unique leader-follower relationship that exists between the
two parties results in followers not only putting individual interests aside for the
betterment of the organization, but also exceeding expectations on a consistent basis
(Bass & Avolio, 2004). Four key dimensions are found within the transformational
leadership theory. They include idealized influence, inspirational motivation, intellectual
stimulation and individualized consideration (Bass & Avolio, 2004). The idealized
influence dimension is further divided into idealized influenceattributed and idealized
influencebehavioral. Each of these dimensions places emphasis on particular behaviors
and characteristics of transformational leaders that attract followers to them.
The transformational leadership theory is applicable to leaders in various settings
including nurse leaders in hospitals. Nurse leaders practicing transformational leadership
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style behaviors are described as charismatic, proactive change agents who motivate their
followers to not only achieve organizational goals, but to exceed expectations (Clancy,
2003; Cline et al., 2003; Doran et al., 2004; Kleinman, 2004; Solovy, 2002; Trofino,
2000; Wieck et al., 2002). Positive leadership outcomes cited by followers of
transformational leaders include extra effort (Barling et al., 1996; Bycio et al., 1995;
Kleinman, 2004; Leonard, 1999; Solovy, 2002; Strachota et al., 2003), effectiveness
(Bass et al., 1997; Cline et al., 2003; Gellis, 2001; Kleinman, 2004; Ribelin, 2003;
Spinelli, 2006; Trofino, 2000; Wieck et al., 2002; Wood-Allen, 1998) and satisfaction
(Clancy, 2003; Deluga, 1988; Doran et al., 2004; Dunham-Taylor & Klafen, 1990; Hater
& Bass, 1998; Howell & Avolio, 1993; Howell & Frost, 1989; Kirkpatrick & Locke,
1996; McDaniel & Wolf, 1992; Parkman, 2001). The majority of these research findings
relate to senior and middle management nurse leaders. While this information is valuable,
a void exists in the literature regarding the relationship between front line nurse managers
and their staff nurses. This area of nursing leadership requires further investigation.
The purpose of this research study was to determine what nursing leadership
styles of front line nurse managers positively correlated with leadership outcomes as
perceived by acute care staff nurses. The transformational leadership theory was the
selected framework for this research study. The target population was acute care
registered nurses in a Western Canada health region. In keeping with the purpose of this
research study to determine if a positive correlation existed between the transformational
leadership style and leadership outcomes, a correlational research design was selected to
carry out the study using a quantitative approach.
113
The Multifactor Leadership Questionnaire 5X Short Rater form was the

instrument selected for data collection. This instrument consists of 45 questions that
raters rate their perceptions of their leaders leadership styles and leadership outcomes.
There were a number of reasons as to why this instrument was chosen for this study.
Developed by Bass and Avolio (2004), the Multifactor Leadership Questionnaire
5X Short Rater form compliments the transformational leadership theory as it focuses on
transformational, transactional and laissez-faire leadership styles and leadership outcomes
of extra effort, effectiveness and satisfaction. The Multifactor Leadership Questionnaire
5X Short Rater form has been used in more than 30 countries, in profit and not-for-profit
organizations including hospitals, by men and women 16 years of age and greater, for
rating leaders in different levels of management as well as for male and female leaders
(Bass & Avolio, 2004). Registered nurses have also used it. Additionally, this instrument
exceeds Cronbachs alpha coefficient of more than 0.70, with ranges of 0.74 to 0.90
thereby adding to its reliability and validity (Bass & Avolio, 2004). The Multifactor
Leadership Questionnaire 5X Short Rater form is short and takes approximately 15
minutes to complete thereby reducing the chance of participants becoming bored with
completing it. Responses are based on a Likert scale ranging between zero and four, thus
allowing participants to select the appropriate rating. Permission was granted by the
owners of the Multifactor Leadership Questionnaire 5X Short Rater form for its use in
this research study (Appendix A). The research participants anonymously completed the
Multifactor Leadership Questionnaire 5X Short Rater forms. The option to maintain
anonymity of the leaders being rated also exists and was exercised for this study. This
114
offered additional protection of anonymity of both research participants and their nurse
manager leaders.
The total sampling frame of 480 acute care staff nurses was targeted for this
study, but the sample size was 144 acute care staff nurses who agreed to participate. Data
collection procedures were strictly followed. Participants were sent, via e-mail, a copy of
the Multifactor Leadership Questionnaire 5X Short Rater form along with information on
the research study, instructions to print off a copy of the questionnaire, and to return the
completed questionnaire by a specific date via inter-office mail to the researcher in a
sealed private and confidential envelope marked with the researchers name. The interoffice mail method was selected as a neutral mail drop and to protect the anonymity of
participants. There were 111 useable completed questionnaires returned that were
included to calculate data results. To ensure anonymity of the raters and the leaders being
rated, there was no demographic data collected through the Multifactor Leadership
Questionnaire 5X Short Rater forms. The collected data was securely stored in a folder in
a locked filing cabinet with access limited to the researcher.
Summary of Findings
This research study tested three hypotheses and three null hypotheses with
collected data from acute care staff nurses employed in a Western Canada health region.
The Multifactor Leadership Questionnaire 5X Short Rater form was the instrument used
for data collection. Based on collected information from various sources, it was
hypothesized that staff nurses perceptions of their nurse managers leadership styles as
115
determined by the Multifactor Leadership Questionnaire 5X Short Rater form of

stimulation were positively related to leadership outcomes of extra effort, effectiveness
and satisfaction. A sample of 144 participants or 30% of the target population of 480 staff
nurses agreed to voluntarily participate in the study by completing a Multifactor
Leadership Questionnaire 5X Short Rater form. There were 111 or 77% of the 144
participants who returned completed questionnaires for the study.
The collected data was reviewed by the researcher for completeness and then
entered into an excel spreadsheet by the researcher. Aggregate mean scores and standard
deviations of the Multifactor Leadership Questionnaire 5X Short Rater completed forms
were calculated using the excel program. Findings revealed that 79 or 71% of the 111
staff nurse participants who returned completed questionnaires perceived their leaders as
demonstrating a transactional leadership style while the remaining 32 or 29% of the
participants rated their leaders as practicing a transformational style of leadership. These
findings support Thyers (2003) view that transactional leadership is commonly found in
hospitals and other bureaucratic organizations.
The transformational leadership style mean score for all respondents was 2.15
with a standard deviation of 0.18. Overall staff nurses perceived their nurse managers as
demonstrating the transformational leadership style sometimes. The low standard
deviation indicated the values were closely clustered around the mean. Amongst the five
leadership behaviors within the transformational leadership style, idealized influence-
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attributed, idealized influence-behavioral and inspirational motivation were perceived to

be practiced by nurse mangers sometimes, while individualized consideration and
intellectual stimulation mean scores indicated nurse managers practiced the latter two
behaviors once in awhile. The standard deviations ranged between 0.85 and 1.00 for the
transformational leadership style behaviors, which was indicative of the values being
widely spread around their respective means.
The transactional leadership style mean score was 2.09 with a standard deviation
of 0.23. This indicated staff nurses perceived their nurse managers as practicing
transactional leadership style sometimes and the values were closely clustered around the
mean. The three leadership behaviors within the transactional leadership style were
perceived to be practiced by nurse managers sometimes for contingent reward and
management by exception-active while the management by exception-passive leadership
behavior was seen once in awhile. The standard deviations ranged between 0.52 and 0.90
for the transactional leadership style behaviors, which indicated a broader dispersion of
the values around their respective means than transformational and transactional
leadership styles. These findings support Bass and Avolios (2004) research that the
former five transformational and two transactional leadership behaviors were perceived
to be practiced sometimes, while the third transactional leadership behavior of
management by exception-passive was perceived as being practiced once in awhile.
The mean score of the laissez-faire leadership behavior was the lowest of all the
leadership behaviors at 1.16 with a standard deviation of 0.75. These findings indicated
staff nurses perceived their leaders to practice this leadership behavior once in awhile.
117
The standard deviation indicated values were not as clustered to the laissez-faire
leadership behavior mean as compared to the transformational or transactional leadership
means and standard deviations. The low mean score of the laissez-faire leadership
behavior was also found in previous research studies of Bass (1985), Bass and Avolio
(1997) and Spinelli (2006).
Aggregate mean scores were calculated for the three leadership outcomes of extra
effort, effectiveness and satisfaction with results of 1.84, 2.37 and 2.27 respectively. The
standard deviations were reported as extra effort at 1.04, effectiveness at 0.73 and
satisfaction was 0.91. Although staff nurses perceived extra effort to occur once in
awhile, effectiveness and satisfaction were perceived to happen sometimes. The standard
deviations indicated a wide dispersal of the values around the respective means. Based on
this data related to leadership outcomes, effectiveness was perceived to occur most often,
followed by satisfaction and finally extra effort. Comparing this to Bass and Avolios
(2004) findings revealed the latter reported higher mean scores amongst leadership
outcomes. The extra effort mean score was 2.78; effectiveness was 3.09 as was
satisfaction, with standard deviations of 0.94, 0.78 and 0.91 respectively (Bass & Avolio,
2004). Gellis (2001), in comparison carried out a similar study involving 187 social
workers rating their front line managers in a hospital setting and reported aggregate
means of leadership outcomes that were lower. Extra effort was reported as 2.11,
effectiveness as 1.67 and satisfaction as 1.49 by Gellis (2001).
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Discussion of Hypotheses
Of the three hypotheses and three null hypotheses tested, research findings
indicated support for all three hypotheses, while the three null hypotheses were rejected.
Research findings revealed stastically significant positive correlations between
transformational leadership style behaviors of idealized influence-attributed, idealized
influence-behavioral, inspirational motivation, individualized consideration, and
intellectual stimulation and the leadership outcomes of extra effort, effectiveness and
satisfaction.
Hypothesis 1. Empirical findings indicated a significant positive relationship
existed between extra effort and the transformational leadership style behaviors of
idealized influence-attributed, idealized influence-behavioral, inspirational motivation,
individualized consideration, and intellectual stimulation, two of the transactional
leadership style behaviors of contingent reward and management by exception-active,
while a significantly negative relationship was found to exist between management by
exception-passive and laissez-faire leadership behaviors and extra effort. The
transformational leadership style and extra effort relationship was stronger at r (111) =
.94, p < .01 than the transactional leadership style and extra effort relationship which was
r (111) = .64, p < .01.
These findings supported hypothesis 1, which focused on staff nurse perceptions
of their nurse managers transformational leadership style of leadership behaviors of
individualized consideration, and intellectual stimulation were positively related to extra
119
effort. Null hypothesis 1, which stated there was no relationship between the
intellectual stimulation and extra effort was rejected.
existed between effectiveness and the transformational leadership style behaviors of
leadership style behaviors of contingent reward and management by exception-active
exception-passive and laissez-faire leadership behaviors and effectiveness. The
transformational leadership style and effectiveness relationship was stronger at r (111) =
.90, p < .01 than the transactional leadership style and effectiveness relationship, which
was r (111) = .68, p < .01.
These findings supported hypothesis 2, which focused on staff nurses perceptions
individualized consideration, and intellectual stimulation were positively related to
effectiveness. Null hypothesis 2, which stated there was no relationship between the
intellectual stimulation and effectiveness was rejected.
120

existed between satisfaction and the transformational leadership style behaviors of
leadership style behaviors of contingent reward and management by exception-active
exception-passive and laissez-faire leadership behaviors and satisfaction. The
transformational leadership style and satisfaction relationship was stronger at r (111) =
.96, p < .01 than the transactional leadership style and satisfaction relationship, which
was r (111) = .47, p < .01.
These findings supported hypothesis 3, which focused on staff nurses perceptions
individualized consideration, and intellectual stimulation were positively related to
satisfaction. Null hypothesis 3, which stated there was no relationship between the
intellectual stimulation and satisfaction was rejected.
Discussion
The findings of this research study add support to research studies previously
alluded to that found job performance of followers was positively correlated to
121
transformational leadership more so than other leadership styles (Avolio, 1999; Bass,
1998; Bass & Avolio, 2004; Fairholm, 1998; House & Aditya, 1997; Spinelli, 2006).
Additionally, the negative correlation between the laissez-faire leadership style and
leadership outcomes of extra effort, effectiveness and satisfaction reported in this study
support research findings of others (Bass, 1990; Bass & Avolio, 1990; 2004; Lowe et al.,
1996; Spinelli, 2006).
The results of this study are similar to those found in the Bass and Avolio (2004)
baseline study, which is of interest for a number of reasons. Bass and Avolio (2004)
further developed the transformational leadership theory and established the Multifactor
Leadership Questionnaire 5X Short Rater form. Their research involved a total of 2,154
participants including 416 undergraduate students, 66 participants from a government
research agency, 99 participants in a Scottish firm, 1,296 individuals from United States
business firms, 202 participants from the United States army and 75 nursing students
(Bass & Avolio, 2004). While the number of participants as well as their occupations
differ from this research study, both studies involved followers rating their leaders, using
the Multifactor Leadership Questionnaire 5X Short Rater form to identify raters
perceptions of their leaders leadership styles and leadership outcomes based on the
transformational leadership theory.
Bass and Avolio (2004) reported a mean score of 2.60 and a standard deviation of
0.87 for the transformational leadership style as rated by followers. Based on the Likert
scale used in the Multifactor Leadership Questionnaire 5X Short Rater form, these results
were interpreted as followers perceiving their leaders to display transformational
122
leadership styles sometimes. In comparison, mean scores found in this research study for
the transformational leadership styles were 2.15 with a standard deviation of 0.18 and
were also interpreted as followers perceiving their leaders as demonstrating the
transformational leadership style sometimes. The low standard deviation in this study
indicated the values were closely clustered around the mean value. Although the mean
score of the Bass and Avolio (2004) study was higher than the reported mean in this
study, the standard deviation was also higher in the former study indicating the data was
more broadly dispersed.
Under the transactional leadership style, Bass and Avolio (2004) identified a
mean score of 1.98 with a standard deviation of 0.83. Research findings in this study
reported a higher mean score of 2.09, but a lower standard deviation of 0.23 for the
transactional leadership style. The acute care nurses perceived their leaders to practice the
transactional leadership style sometimes and the lower standard deviation indicated a
closer cluster of the values than what Bass and Avolio (2004) reported.
The mean score reported by Bass and Avolio (2004) for the laissez-faire
leadership style was 1.00 with a standard deviation of 0.78. In comparison, this study
revealed a mean score for the laissez-faire leadership style of 1.16 and a standard
deviation of 0.75. The mean score was slightly higher, but the standard deviation revealed
a difference of 0.03 from Bass and Avolios (2004) reported results. Given the
comparable results of this study to the Bass and Avolio (2004) baseline study, further
credence is given to the validity and reliability of these research results.
123
The statistically significant strong positive correlations reported in this study

between transformational leadership style behaviors of idealized influenceattributed,
idealized influencebehavioral, inspirational motivation, individualized consideration and
intellectual stimulation with leadership outcomes of extra effort, effectiveness and
satisfaction were similar to the findings of Spinelli (2006). Spinellis (2006) study
involved 101 subordinates rating their health administrators using the Multifactor
Leadership Questionnaire 5X Short Rater form based on the transformational leadership
theory. In both Spinellis (2006) and this study, findings revealed stronger relationships
between transformational leadership style behaviors and leadership outcomes than with
the transactional leadership style behaviors and leadership outcomes. Implications for
these findings include support for the transformational leadership style to be practiced
amongst leaders in health care if positive outcomes such as extra effort, effectiveness and
satisfaction are desired.
The findings of this research study support previously published studies. DunhamTaylor and Klafen (1990) examined the relationship between staff nurses and nurse
executive leadership using the Multifactor Leadership Questionnaire 5X Short Rater form
and found staff nurses identified higher levels of satisfaction and effectiveness when they
perceived their leaders as demonstrating transformational leadership style behaviors.
Findings of Gellis (2001) are also supported by this research study as both
reported statistically significant positive correlations between perceived transformational
leadership style behaviors and leadership outcomes of extra effort, effectiveness and
satisfaction. Additionally, the transactional leadership style behaviors of management by
124
exceptionpassive and the laissez-faire leadership style were reported as a statistically

significant negative correlation with extra effort, effectiveness and satisfaction (Gellis,
2001). The transactional leadership style behavior of contingent reward was found to be a
statistically significant positive correlation to the three leadership outcomes of extra
effort, effectiveness and satisfaction in both studies, but differences in the management
by exceptionactive leadership behavior of transactional leadership style were found.
Gellis (2001) reported statistically significant negative correlations between management
by exceptionactive and leadership outcomes while this study found them to be positively
correlated. The primary difference between the two studies relates to the raters with the
former group of participants being social workers, while the latter study involved staff
nurses. Both groups of participants were in hospital settings rating their front line
supervisors leadership styles and leadership outcomes using the Multifactor Leadership
Questionnaire 5X Short Rater form.
Although this study builds on previous research findings, there are limitations
within it. Such limitations include the design choice, data collection method, hospital
setting and sampling population. The results of this research are limited by its
correlational research design. Recognition is given to the fact that a strong positive
relationship between the variables being tested does not prove causation. It does however
indicate the existence of a strong positive relationship.
Data collection methods for this study were limited to a single method of the
Multifactor Leadership Questionnaire 5X Short Rater form. DeGroot et al. (2000) note
the use of questionnaire data as independent and dependent variables and having it
125
gathered from a single source may cause common method variance. A means of avoiding
this is to use multiple methods and instruments to gather the data while still measuring
the same constructs. The inclusion of qualitative responses could have been included to
provide clarification of some of the responses.
A third limitation to this study relates to the context in which the study was
undertakenthe acute care hospital. Acute care hospitals may be environments whereby
specific leadership styles such as transactional are more conducive than in other settings.
Broadening the context in which the study was carried out may include long-term care
facilities or community based health centers.
Linked to the acute care hospital setting, the sample population is the fourth
limitation to this study. The sample population was limited to acute care staff nurses
working in a health region in Western Canada. To overcome this limitation, a broader
sample size of staff nurses could be used that includes other provinces or countries.
Another option to consider would be to include different health care professionals in a
similar study. This would broaden the generalizability of the results of this study.
Recommendations for Future Research

Retrospectively, there are various enhancements to the study that would address
some of its limitations. The purpose of this section is to discuss these enhancements and
identify areas for future research. The subsections discussed include geographical
location, rater and self-rater study, focus on one leadership style, and broaden study to
126
include different health care professionals and transformational leadership program

implementation.
This study was carried out in Western Canada. It is not known what, if any impact
geographical location has on staff nurses perceptions of leadership styles and leadership
outcomes. It is recommended that the same study be carried out in a similar setting in
different geographical locations within North America to determine similarities and
differences in results and broaden its generalizability.
A second recommendation for future research is directed at a study involving
leadership style rating by the leader and followers. This would include staff nurses rating
their nurse managers as well as the nurse managers rating themselves using the
Multifactor Leadership Questionnaire 5X Short Rater forms. The value in such a study
would allow a comparative analysis of the leaders own perceptions of their leadership
styles with that of their followers perceptions of the leadership styles.
This study involved data collection on three leadership styles of transformational,
transactional and laissez-faire. It is recommended that a future study be carried out
focusing on one particular leadership style such as transformational leadership to allow a
more detailed look at the leadership style and its impact on leadership outcomes.
A fourth recommendation relates to the sample population and the leaders being
evaluated. It is recommended that a similar study be carried out amongst other health care
professionals in the acute care setting such as physiotherapists, occupational therapists
and social workers thereby broadening the generalizability of the results.
127
The final recommendation relates to the implementation of a transformational

leadership program for nurse managers. As evidenced by the research findings, staff
nurses indicated higher rates of extra effort, effectiveness and satisfaction when they
perceived their nurse managers to be displaying transformational leadership style
behaviors. In order to build on the positive leadership outcomes, training of nurse
managers on transformational leadership is encouraged. Prior to implementing such a
program, a baseline of information attained through a pre survey using the Multifactor
Leadership Questionnaire 5X Short Rater form should be undertaken for the leaders and
their followers to evaluate their perceptions of the leaders leadership styles and
leadership outcomes. Once the program training has been provided for the nurse
managers, a post survey should be undertaken to evaluate leadership styles and leadership
outcomes in the same way as the pre survey. By comparing pre and post survey results,
program effectiveness may be evaluated as well as what, if any changes in styles of
leadership occurred.
Conclusions
Front line nurse managers play key roles in hospital leadership and are charged
with responsibilities of providing positive safe work environments for their nursing staff
(Doran et al., 2004). Additionally, their leadership styles impact leadership outcomes of
extra effort, effectiveness and satisfaction (Cline et al., 2003; Doran et al., 2004;
Kleinman, 2004; Ribelin, 2003; Trofino, 2000). In essence, how satisfied staff nurses are
in their jobs, how much extra effort they are willing to put in and how effective they
128
perceive their leaders to be are impacted by their leaders leadership style. The results of
this research support the value of transformational leadership style in being positively
related to leadership outcomes of extra effort, effectiveness and satisfaction. While
adding insight in to the unique leader-follower relationship of transformational leadership
styles and its positive correlation with leadership outcomes, additional research questions
emerge.
Through the examination of the relationship between leadership styles and
leadership outcomes within nursing, this study contributes to the body of leadership
literature in general. It also adds to the literature relevant to transformational leadership
within health care organizations in general as well as within nursing specifically. The
findings of this study offer support for the hypothesized positive relationship between
transformational leadership style behaviors and leadership outcomes of extra effort,
effectiveness and satisfaction. This study found statistically significant positive
correlations between the transformational leadership style behaviors of idealized
individualized consideration, and intellectual stimulation and leadership outcomes of
extra effort, effectiveness and satisfaction.
The results of this research study are of interest to a number of individuals
including staff nurses, nurse leaders, health care executives and Human Resources
professionals. This study provided staff nurses with opportunities to anonymously rate
their leaders on their styles of leadership and leadership outcomes. As a result of their
input, additional opportunities exist for management and Human Resources professionals
129
within health care organizations. Encouragement is given to health care executives and
Human Resources professionals to endorse the transformational leadership theory and
develop training programs for current and new managers teaching them effective
leadership styles and behaviors within the hospital setting. Nurse Managers need to
reflect on these findings. By applying this information to their individual leadership
styles, Nurse Managers will determine what leadership skills are effective and what skills
need to be improved upon. Strong effective leadership skills will lead to positive
leadership outcomes of extra effort, effectiveness and satisfaction. The potential for
positive impact goes beyond the individual, affecting organizational and professional
levels also in terms of leadership outcomes.
What is leadership? What is an effective leadership style? What is a leader? What
is an effective leader? Having posed these four questions at the beginning of this study,
answers are yet to be found. This research has however found leadership outcomes of
extra effort, effectiveness and satisfaction are positively correlated to transformational
leadership style behaviors of idealized influenceattributed, idealized influence
behavioral, inspirational motivation, individualized consideration, and intellectual
stimulation of nurse managers as perceived by acute care staff nurses. Based on these
findings, one questions whether or not the transformational leadership style is the answer
to an effective leadership style for front line nurse managers in hospital settings to
pursue?
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APPENDIX A
LETTER OF PERMISSION
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NURSING LEADERSHIP STYLES AND THEIR IMPACT ON LEADERSHIP

A Research Study Presented in Partial Fulfillment

UMI Number: 3232065

UMI Microform 3232065

ProQuest Information and Learning Company

M. Joan Libsekal, 2006

Introduction to the Problem

Conceptual Theoretical Framework

Background of the Study

Statement of the Problem

Research Questions and Hypotheses

Nature of the Study

Significance of the Study

Assumptions and Limitations

Organization of the Remainder of the Study

CHAPTER 2. LITERATURE REVIEW

Transformational Leadership Theory

Empirical Research Review

Nursing Research Review

Data Collection Procedures

Data Analysis Procedures

Timelines for Research Activities

CHAPTER 4. PRESENTATION AND ANALYSIS OF DATA

Nursing Leadership Styles and Outcomes Findings

CHAPTER 5. SUMMARY, RECOMMENDATIONS AND CONCLUSIONS

Recommendations for Future Research

APPENDIX A. LETTER OF PERMISSION

Table 4. Mean and Standard Deviations of Transformational Leadership Style and

Transformational, Transactional and Laissez-Faire

of Transformational, Transactional and Laissez-Faire

Introduction to the Problem

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Conceptual Theoretical Framework

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Inspirational motivation. Inspirational motivation is a transformational leadership

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Background of the Study

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Statement of the Problem

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Research Questions and Hypotheses

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Hypothesis 3: Staff nurse perceptions of their nurse managers leadership styles as

Nature of the Study

Nursing Leadership Styles and Outcomes

Questionnaire as a reliable test for measuring behaviors and outcomes of leadership.

Significance of the Study

Nursing Leadership Styles and Outcomes

Nursing Leadership Styles and Outcomes

Leadership refers to the process of influencing, motivating and inspiring

Nursing Leadership Styles and Outcomes