For example, those marked with an * use TFL questionnaires.
| ARTICLE TITLE | Manfredi, C. M., (1996). Descriptive
study of nurse managers.
West. J. Nur. Res |
McDaniel, C., Wolf, G. (1992).
Transformational leadership.
J. Nur. Administration |
Young, S. (1992). Educational experiences
of transformational nurse leaders.
Nur Admin Qtrly. |
Dunham, J., Klafehn, K. (1990).
Transformational leadership & nurse executive.
J. Nur. Administration |
| PROBLEM STATEMENT | Purpose was to describe the leadership activities of nurse managers. Although not clearly stated, the problem statement indicated a conflict between managing and leading and a need to develop a better instrument to assess leadership in nurse managers. | Purpose was to test both transformational leadership (TFL) and TFL theory in a nursing department. The problem is that many leadership theories don’t readily apply to labor intensive, professional settings such as healthcare. Does application of this theory to nursing contribute to staff satisfaction and nurse retention? | Purpose was to describe educational activities that contribute to the development of TFL in nurse leaders. The problem statement was that while many leaders have both a vision and the ability to communicate it, they are unable to develop action plans to implement the necessary changes. | Purpose was to identify TFL characteristics of nurse executives. The problem statement indicated that in times of change, transactional leadership is employed, where cosmetic and superficial changes are made, but no long lasting fundamental changes occur. It is applicable to nursing because of the tremendous changes in healthcare throughout the country. |
| CONCEPTUAL FRAMEWORK, MODEL OR THEORY USED IN THE STUDY & LITERATURE REVIEW | TFL concepts used in
literature review Based on 7 concepts culled from the definition of leadership: goals, change, influence, power, growth, mentoring and vision. Lit review focused on definitions of above 7 concepts and definitions of leadership, management and nurse manager. Concepts were well-defined, mapped out in a model and are also the study variables. No apparent hypothesis or research questions. TFL questionnaires |
TFL theory is the framework for study. Lit review focused on description of the theory and previous studies – most on male, industrial type settings. Four clear hypothesis questions: * leader self-assessment score (SAS) will be higher than respective administrative follower; leader SAS will be higher than follower’s assessment of leader; staff nurse work satisfaction will be above average or higher (for areas using TFL based on scores); and staff nurse turnover will be low. | Although not explicitly stated, study
uses TFL theory as the framework. Lit review describes the theory
characteristics, with a focus on vision and the visionary leader. It
also reviewed nurse leader behavior and employee satisfaction. There was
a good review of studies that looked at both formal & informal
educational activities and the most frequently used teaching strategies.
It also provided support for the idea that TFL can be learned. These
were all factors measured in the study. No formal hypothesis or research
questions were presented. TFL concepts guide descriptive methods used |
This study also used TFL theory as the framework. The literature review is extensive covering the TFL theory in depth. It also compares transactional theory to TFL. There is very little discussion of other studies on this aspect of TFL. It does address that most previous studies focused on male executives, and the use of nurse executives (primarily female) offers a good contrast. The research question presented was whether or not excellent nurse executives transformational leaders from their own perception and from immediate staff perceptions. |
| RESEARCH DESIGN | A descriptive study that used a purposive sample of 42 nurse managers identified by graduate students. Nurse managers were "reputed" to be leaders by their colleagues and peer. They were all invited to participate. Possible biases in that the sample not randomized. Questionnaire was developed based on the framework and focused on leadership rather than management skills. | An explanatory (comparative) study with cross-sectional survey methods. Analyzed 1 nurse executive, 11 mid-level administrators and 77 RNs. Measurement tools used: Multi-factor Leadership Questionnaire, & Work Satisfaction scale (5 subscales, not explained), both with prior validity established. The MLQ tested self-scores for transformational and transactional leadership characteristics for the 3-admin levels. | * An ex post facto (retrospective) design. Investigated the degree of TFL already present in nurse leaders and whether educational activities contributed to the development of TFL. Sample included 66 nurse leaders from 11 different hospitals. Instruments included Leadership Behavior Questionnaire (LBQ), Leadership Development Inventory (LDI), both well described and previously validated and reliable. | * An exploratory research design (primarily descriptive) was developed for this study. 80 nurse executives were selected based on referrals of "excellent" from peers, faculty and other nurse administrators from all over the country. Some were referred by more than one source. The Multifactor Leadership Questionnaire was the only tool used, in addition to demographic data. Internal validity was established but reliability wasn’t listed. |
| DATA COLLECTION & STATISTICS | Graduate students conducted face to face interviews that were also tape-recorded, using an investigator-constructed interview guide. Mock interviews investigator helped prepare the data collectors. Study participants received questionnaire in advance to prepare answers. Data analyzed through content analysis using 3 concurrent processes of data reduction, data display & conclusion verification. Inter-rater reliability 85% agreement in 7 categories & 80% agreement on activities related to themes. Informed consent was obtained prior to data collection. | Study subjects received packets in mail and returned them by mail, without identifying data which allowed for anonymity but not follow-up. Analysis done with paired t-tests that revealed statistically significant scores on all 4 hypotheses. The results supported the hypotheses. Informed consent was obtained prior to data collection. | Phase I of the study included administering the 2 questionnaires (distribution methods not noted) and dividing sample into 3 groups based on LBQ scores-high, moderate & low TFL. Phase II included ethnographic interviews from sub-sample, randomly selected from each group. No information was provided on who conducted the interviews or how they were prepared. Factorial design was used to analyze the data. Interview data was analyzed before the questionnaires with qualitative procedures to eliminate researcher- coding bias. Informed consent was obtained prior to data collection. | The MLQ was self-administered to the nurse executives and to 3 staff member who reported directly to those nurse executives. Staff was conveniently selected by the nurse executive or researcher (213 returned MLQ) (questionable reporting bias). Means and standard deviations were computed for TFL and transactional leadership according to their individual factors. The questionnaires were analyzed by the Chi-square test looking at several different aspects of the MLQ. Informed consent was obtained prior to data collection. |
| INTERPRETATION, DISCUSSION & CLINICAL
APPLICATION
TFL is used in interpretation of data and generating new hypotheses |
Nurse managers identified 5 categories of goals: administrative, patient-care, unit, staff, & personal/professional. Also identified 5 source of change: top down ideas, unit problems/errors, patient-care needs, professional programs, & need for stimulation. Influence included 4 areas: credibility, visibility, education/information, & role modeling. 3 types of power: legitimate, expert & referent. They identified 5 approaches to growth: staff interviews, observation, analyze feedback, attend change of shift report/meetings, and review records & reports. There were four areas related to mentoring: availability, networking, educational counseling, career opportunities/counseling. Nurse managers identified professional reading, conferences, and academic courses as sources of vision. Study concluded congruence between literature and nurse manager responses toward the 7 leadership concepts. There was no discussion of study weakness, application of findings, new instrument development or areas for further research. | Study discussed each hypothesis
individually and related them to each other. The scores showed a
cascading result from the nurse executive level down, and were
comparable to other studies with non-nurse administrators and nurse
executives. The difference in scores at each level of leadership
suggests that TFL is more prevalent at higher position levels. This
study measured three leadership levels (all from same facility),
however; there was only one subject in the top level, which limits the
generalizability of the study. The authors also noted these limitations.
The authors also identified additional areas of research to include transformational qualities within nursing service with interventions and controlled designs. The implications of the study are that nursing staffs, and ultimately patients, benefit from TFL because it reinforces the value of individual contributions and considerations. The authors identified that TFL characteristics can be and should be taught, especially in the era of change. |
Study presented results based on the three groupings. The factors were each applied to the groupings. The discussion of the results was somewhat confusing because initials instead of using full labels identified the groups and factors. Several tables were included to present the data. The conclusions were clear, but limited to this study because of sample size and regional representation. Nurses who scored high on TFL showed common characteristics. They included: BSN or higher degree, >5 years of leadership experience, promoted staff empowerment, believed they made a difference, perceived previous informal education as very important and viewed mentoring as the most important informal educational experience. The implications of the study are that mentoring is one way of teaching TFL, another is to develop a formal leadership orientation program within hospitals as well as graduate nursing programs. Further recommendations for research included measuring the degree of TFL in both nurse executives and nurse managers and evaluate existing educational activities for leaders to ensure it equates educational activities for managers. | Study reported a wide variety of demographic data. This was a well-dispersed sample, which make the findings more generalizable to other nurse executives. TFL emerged as the predominant leadership style, although most nurse executives possessed characteristics for both styles. This finding was consistent between self-reports and staff members surveyed. Another area of significance was that those with higher educational levels rated themselves higher for TFL and that those with a master’s degree in nursing showed more TFL than those with master’s in other disciplines. The results of this study were then compared to a study done with non-nursing world leaders and executives and the nurse executives had consistently higher transformational scores. The results answered the research question is a very positive manner. Other studies recommended include a cross-sectional study to see if the TFL style is predominant with every in a nurse executive role. The implications are that nurse executives can determine their own style and work on the weaker TFL characteristics. These characteristics can also be developed in nurse managers who use more transactional leadership in their day to day decisions, so they can rise in the leadership ranks. |
