Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Kerr, Mickey

Abstract

Rising job turnover intentions among staff nurses in Saudi Arabia has become a significant issue that risks increasing the shortage of qualified nurses working in Saudi hospitals. Effective leadership has been found to promote positive work environments and is a key factor influencing nurses’ job turnover intentions. More specifically, nurses led by authentic leaders are more engaged in their work which leads to increased job satisfaction and in turn, decreased job turnover intentions. Thus, the purpose of this study was to test a model that examined the relationships between authentic leadership, psychological safety, work engagement, and team effectiveness, and the subsequent effects of team effectiveness on job turnover intentions and nurse satisfaction with quality of care among nurses who work on inpatient units and outpatient clinics in public hospitals in three cities (Makkah, Jeddah, and Taif) in Saudi Arabia. Avolio et al.’s (2004) theory of authentic leadership was used to guide the study by supporting the hypothesized connections among study constructs. A non-experimental, predictive, correlational, cross-sectional, self-reported survey design was conducted, and structural equation modelling (SEM) was used to test the study model. A total of 656 registered nurses working in inpatient units and outpatient clinics in the selected hospitals participated in this study, so 456 participants were used to test the study model and 200 different subjects were used to test the psychometric proprieties of nurse satisfaction with quality of care scale. Six scales were used to measure the study variables: the Authentic Leadership Questionnaire (ALQ), the Psychological Safety Scale, the Utrecht Work Engagement Scale (UWES), the Technical Quality Subscale, the Job Turnover Intentions Scale, and the Nurses’ Satisfaction with the Quality of Care Scale. The fit indices of the final model indicated good fit between the data and the hypothesized model χ 2 (37) = 93.04, p < 0.001, SRMR = 0.052, RMSEA = 0.058 [90% CI = 0.043–0.072], CFI = 0.98. The SEM results provided evidence for positive and direct relationships between authentic leadership and team effectiveness, work engagement, and psychological safety and a positive and indirect relationship between authentic leadership and team effectiveness through work engagement. Work engagement also had a significant positive impact on team effectiveness but not on nurse satisfaction with quality of care. Team effectiveness had a negative relationship with job turnover intentions but positive relationship with nurse satisfaction with quality of care. However, there was no relationship was found between psychological safety and team effectiveness as well as between psychological safety and job turnover intention. The results also showed that there were significant relationships between authentic leadership and job turnover intention (negative) and nurse satisfaction with quality of care (positive) through work engagement and team effectiveness. The results of this study have implications for nursing research, practice and leadership for nursing in Saudi Arabia. The results highlight a role for authentic leadership in decreasing nurse turnover, considered to be a major issue facing the nursing profession in Saudi Arabia. Introducing programs to support nurse leadership is essential in order to enhance the work environments of staff nurses in Saudi Arabia as this could help to reduce nurses’ intention to leave their jobs and increase their level of satisfaction with the quality of care delivered to patients. Further studies are needed in Saudi Arabia that examine the role of authentic leadership on other important nurse and patient outcomes.

Summary for Lay Audience

The role of leadership in nursing practice is essential. Nurse leaders have the responsibility of cultivating a healthy work environment where staff nurses feel encouraged, motivated, supported, engaged and involved. Because there are different leadership styles reported, nurse leaders need to be aware of leadership styles that are best suited for their area of practice. One of the leadership styles that has been reported recently in the nursing literature is authentic leadership. It has been shown to have positive effects on various nurse, patient, and organization outcomes such as reducing staff nurse turnover intentions, bullying and burnout. Although authentic leadership has been shown to have positive effects on the work environment in several countries, there have been little, if any, studies examining this leadership style in nursing in Saudi Arabia.

A non-experimental, predictive, correlational, cross-sectional survey design study was conducted to examine the relationships among authentic leadership, psychological safety, work engagement, team effectiveness, job turnover intentions, and satisfaction with the quality of care among nurses who work in inpatient units and outpatient clinics in public hospitals in three cities (Makkah, Jeddah, and Taif) in Saudi Arabia.

The results of this dissertation illustrated that authentic leadership had direct, positive and significant effects on nurses’ work engagement, psychological safety, and team effectiveness and indirect relationships with job turnover intentions (negative) and satisfaction with quality of care (positive) through team effectiveness and work engagement. However, no relationship was found between psychological safety and team effectiveness as well as between psychological safety and job turnover intentions. Work engagement was found to have a significant positive impact on team effectiveness but not on nurse satisfaction with quality of care. Team effectiveness had a negative effect on job turnover intentions and positive impact on nurse satisfaction with quality of care.

Future studies are needed to examine the relationships between authentic leadership and other important outcomes related to staff nurses, patients, and healthcare organizations in Saudi Arabia. Also, researchers should continue to focus on examining authentic leadership in nursing in order to help to reduce the current shortage of nurses in Saudi Arabia.

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