Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Wong, Carol A

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.

Summary for Lay Audience

Nursing leadership is important as it nurtures nurses’ positive work attitudes and behaviours, and promotes the delivery of high quality patient care. Despite the widely recognized significance of nursing leadership, more research was needed to explore how unit managers’ leadership affects nurses and patients. A model of authentic leadership was useful in helping to understand the direct and indirect effects of leadership as it positioned social identification as an important psychological process through which unit managers influenced nurses’ work attitudes and behaviors, the incidence of harmful patient events, and patient care quality.

The purpose of the present study was to test and refine a model of authentic leadership. Using quantitative research methods and information from 264 registered nurses in Ontario, unit managers’ authentic leadership was found to directly affect staff nurses’ job satisfaction, willingness to speak up, and perceptions of interpersonal safety at work. Furthermore, authentic leadership was found to indirectly affect nurses’ speaking up behaviours through perceptions of interpersonal safety. In addition, nurses’ ability to provide complete nursing care was found to increase job satisfaction, decrease the occurrence of hospital acquired infections, patient falls and medication errors, and increase the quality of patient care. Unfortunately, support was not found for the arguments that unit managers’ authentic leadership would promote staff nurses’ identification with the profession, identification would increase nurses’ likelihood of speaking up, and speaking up would facilitate nurses’ ability to provide complete patient care. Additionally, the strength of the relationship between nurses’ professional identification and speaking up did not increase as nurses’ perceptions of interpersonal safety increased.

Results highlighted the importance of developing unit manager authentic leadership abilities. Unit managers who have high levels of authentic leadership may help nurses feel satisfied with their jobs and can be leveraged to create a space for nurses to speak up and voice their opinions related to improved organizational functioning and patient care. Furthermore, results demonstrated the importance of directing resources toward increasing nurses’ ability to provide complete patient care, thereby improving their job satisfaction, decreasing the incidence harmful patient events, and increasing the quality of patient care.

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