Unit Managers’ Authentic Leadership, Staff Nurses’ Work Attitudes and Behaviours, and Outcomes of Care: A Structural Equation Model
Abstract
Nursing leadership is fundamental in the development of positive work attitudes and behaviours among staff nurses, and the provision of high quality patient care. Although direct empirical links were well established, there was a lack of research testing the indirect effects of leadership on nurses and patients. As such, it was proposed that the concept of authentic leadership could help explain the complex psychological processes that mediated relationships between nurse managers’ leadership, staff nurses’ work attitudes and behaviours, and outcomes of care.
The purpose of the present study was to test a model of authentic leadership in a sample of registered nurses, working in acute care hospitals, in Ontario (n=264). The hypothesized model was analyzed using multiple regression and latent variable path analysis. Results did not support the moderating effect of psychological safety; therefore, it was removed from subsequent analysis. Although the structural model achieved good fit in the first iteration [c2 MLR(182)= 295.041, p= <0.001, RMSEA=.049, 90% CI= .038 and .058, SRMR=.083, CFI= .957], the direct effects of authentic leadership on professional identification, professional identification on voice behaviour, and voice behaviour on missed nursing care were non-significant (p>.05). Model modifications were made in a step-wise manner and all non-significant paths were deleted. The final structural model achieved good fit [c2 MLR(131)= 203.829, p= <0.001, RMSEA=.046, 90% CI= .033 and .058, SRMR=.073, CFI= .969] and supported the direct effects of authentic leadership on voice behaviour and job satisfaction, while missed nursing care had significant direct effects on job satisfaction, nurse-assessed quality, and adverse events (p< .001). An alternative model was also tested which achieved good fit [c2 MLR(184)= 272.249, p= <0.001, RMSEA=.043, 90% CI= .031 and .053, SRMR=.078, CFI= .966] and supported the direct effect of authentic leadership on psychological safety and indirect effect of authentic leadership on voice behaviour through psychological safety (β= .188, p< .001).
Findings highlighted the importance of developing unit manager’s authentic leadership, thereby nurturing staff nurses’ psychological safety, voice behaviour, and job satisfaction. In addition, attention to the antecedents of missed nursing care may increase nurses’ job satisfaction, decrease adverse events, and improve the quality of patient care.