Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Heather Laschinger


The Canadian Adverse Events Study (Baker, et al., 2004) revealed that the rate of adverse events in Canadian hospitals is 7.5% and almost 37% of these are preventable. Given these statistics, it is essential that healthcare organizations develop strategies and engage in leadership practices, which will address the complexity of healthcare processes and ensure that care is provided in a consistent, reliable manner in order to achieve the desired outcomes (Frankel, Gandhi & Bates, 2003). It is equally vital that leaders create supportive practice environments that promote a non-punitive culture of learning, continuous improvement, inter professional collaboration, and professional autonomy, thus engaging nurses in safe practice aimed at improving patient outcomes (Aiken, 2008; Pronovost et al., 2003). In order to understand how nursing leadership affects outcomes, it is important to assess what leadership behaviours are most effective in promoting a patient safety culture.

This study tested a hypothetical model which predicted the influence of nurse manager Transformational Leadership behaviour on staff nurse perceptions of supportive practice environments, organizational citizenship behaviours, patient safety culture, job satisfaction and objective measures of selected nurse sensitive outcomes. Findings supported the hypothesized model χ2(df = 22) = 40.72, p = .008 ; CFI = .958; TLI = .916; RMSEA = .079; SRMR = .045 linking transformational leadership to nurse and patient outcomes through supportive practice environments, organizational citizenship behaviours, safety culture and job satisfaction. Transformational Leadership had a significant indirect effect on patient falls (β = -.08, p

These results provide a unique contribution to the body of literature and understanding about the role Transformational Leadership might play in optimizing nursing practice environments and patient outcomes. Therefore it has important implications for the professional development of nurse managers and leadership curriculum design. Findings will also potentially influence strategic planning within the organization and broader policy development at a LHIN or provincial level.