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Head nurse leadership : perceptions of leaders Fraser, Katherine Theresa Mulligan 1992

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HEAD NURSE LEADERSHIP: PERCEPTIONS OF LEADERS  by  KATHERINE THERESA MULLIGAN FRASER B.Sc.N., The University of Ottawa, 1975  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING  in  THE FACULTY OF GRADUATE STUDIES School of Nursing  We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA August 1992 © Katherine Theresa Mulligan Fraser, 1992  In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.  (Signature)  Department of ^Nursing The University of British Columbia Vancouver, Canada Date^August 7, 1992  DE-6 (2/88)  Abstract This descriptive study was designed to explore the perceptions of leadership among acute care hospital head nurses by using an established leadership framework called the Transformational Leadership Model (Bass, 1985b) to identify and measure leadership styles and outcome factors. Specifically, the study investigated head nurses' perceptions of their leadership from transformational and transactional perspectives, the relationships among leadership styles and between leadership styles and outcome factors, and the relationship between selected demographic and professional characteristics of the head nurse and level of transformational leadership. The study was conducted at four acute care hospitals in the Lower Mainland of British Columbia. A purposive sample of 51 head nurses completed a Demographic Information Form and a Multifactor Leadership Questionnaire. Data were analyzed and compared to normative data using descriptive statistics. Pearson's correlation coefficient and the chi-square test of association were also used to analyze the sample data. Generally, head nurses perceived their leadership as highly transformational and to a lesser degree, transactional. Significant relationships were identified among the leadership styles and between the leadership styles and outcome factors. Compared to other managers, first-line nurse managers were more transformational and employed more Contingent Reward in transactional leadership, and perceived that Satisfaction and Effectiveness levels were higher owing to their leadership. The evidence did not support ii  an association between head nurse charcteristics and transformational leadership. Implications for nursing administration, nursing education, and nursing research are presented.  iii  Table of Contents  Page Abstract ^ Table of Contents ^ List of Tables ^ Acknowledgements ^  ii iv vi vii  Chapter One: Introduction Background to the Problem ^ Conceptual Framework ^ Problem Statement ^ Research Questions ^ Definition of Terms ^ Assumptions and Limitations ^ Significance of the Study ^ Organization of the Thesis ^  1 5 8 8 9 10 10 11  Chapter Two: Review of the Literature 12 Nature of the Head Nurse Role ^ Leadership in Nursing Administration ^ 14 Leadership in Business and Education ^ 19 20 Psychological Model ^ 20 Trait Perspective ^ 20 Behavioural Perspective ^ 21 Situational Perspective ^ 22 Multiple-Influence Model ^ 23 Political Model ^ Transformational Leadership Studies ^ 25 31 Summary ^ Chapter Three: Methodology 35 Overview ^ 35 Sample ^ Data Collection Procedures ^ 36 Instruments ^ 37 Multifactor Leadership Questionnaire ^ 38 Demographic Information Form ^ 42 Data Analysis ^ 43 Human Rights Protection ^ 45  iv  Chapter Four: Findings and Discussion 46 Sample Characteristics ^ 48 Educational Preparation ^ 52 Age ^ 54 Gender ^ 55 Marital Status ^ Nursing, Management, Position, and 55 Organizational Tenure ^ 56 Clinical Focus of Unit ^ Operating Budget Responsibility ^ 57 57 Salary ^ Research Questions Head Nurse Leadership Styles and Normative Data ^ 58 62 Transformational Factors ^ 67 Transactional Factors ^ 71 Nonleadership ^ 72 Outcome Factors ^ 74 ^ Leadership Styles and Outcome Factors Selected Professional and Demographic Characteristics and TF Leadership ^ 79 82 Summary ^  Chapter Five: Summary, Conclusions, and Implications 85 Summary ^ 90 Conclusions ^ 91 Implications ^ Implications for Nursing Administration ^ 91 Implications for Nursing Education ^ 94 Implications for Nursing Research ^ 94  References ^  97  Appendices: Appendix A - Letter of Introduction ^ 102 Appendix B - Information Letters ^ 104 Appendix C - Questionnaire Introduction ^ 107 Appendix D - Multifactor Leadership Questionnaire ^  108  Appendix E - Demographic Information Form ^ 112  V  List of Tables Page  Table ^  1. Numbers of Head Nurses in Agency, Head Nurses Nominated, and Subjects by Hospital ^ 47 2. Basic Preparation of Head Nurses by Hospital ^  49  3. Graduate Preparation of Head Nurses by Hospital ^  49  4. Head Nurses Employed in Hospitals by Level of Education ^  50  5. Age Distribution of Sample ^  53  6. Head Nurses Employed in Nursing by Age ^ 54 7. Comparison of Leadership Styles and Outcome Factors between Study Sample and Normative Group ^  60  8. Intercorrelations between Leadership Styles and Outcome Factors ^  76  9. Chi-square Results of Selected Professional and Demographic Head Nurse Characteristics and Level of TF Leadership  vi  80  Acknowledgements  There are many people who contributed to the completion of this thesis. I would like to thank my thesis committee members, Dr. Marilyn Willman and Dr. Sonia Acorn for their patience, skill and effort in guiding this work. My appreciation to the nurse administrators who facilitated this investigation in their hospitals.^I thank the nurse managers who through their interest and participation made this research possible. To my family, my husband, Dan and our daughter, Vanessa for their invaluable and enduring love and support. Finally, to my parents, Jack and Edna Mulligan who have always believed in their children and in the value of educating them.  I Chapter One Introduction  Background to the Problem Most large bureaucratic Organizations, including hospitals and nursing organizations, are dominated by an inherent conservatism. Out of this conservatism has evolved the development of managers. It has been suggested, however, that leaders hold in their hands an organization's ability to survive and function effectively (Bennis & Nanus, 1985). Therefore, the future of nursing service organizations will largely be determined by nurse managers who are also leaders and who occupy pivotal positions in the organization's chain of communication and control. The trend toward decentralization in nursing suggests that nursing is practiced in complex environments in which centralized decision making and limited participation in organizational issues are no longer effective means of leadership (Storch Ringerman, 1990). As decentralization advances, expectations of the head nurse role change to include goal-setting, budgeting, staffing, policy-making, and labor relations decisions that affect the nursing service on each unit (Beaman, 1986; Clifford, 1981; Harrison, 1981; Hodges, Knapp & Cooper, 1987; Rotkovitch, 1983). Concurrent with these changes, systems of nursing care delivery are moving from functional and team nursing models to primary care, in which the professional staff nurse has the  2 authority and accountability for individual patient care decisions (Clifford, 1981; Harrison, 1981; Rotkovitch, 1981; Sullivan & Decker, 1988). As the responsibility and authority for individual patient care decisions shifts from the head nurse to the staff nurse, key functions of the head nurse role change. Increasingly, the head nurse serves to integrate the individual staff nurse's needs and the organizational goals, and thus, the evolving role demands the development of leadership skills. The head nurse must lead staff with a vision of what the unit (within the organization) can accomplish, and inspire and empower staff in pursuit of that vision (Dunham & Klafehn, 1990). As decentralization of nursing services enters a second decade as the dominant organizational context for nursing service, it is opportune to examine concomitant changes in head nurse leadership. Empirical inquiry into the role and activities of the head nurse is limited. Studies of head nurse leadership have focussed mainly on leadership style and selected dimensions of leader behaviour. Further, leadership is most often described from the perspective of the staff nurse, as researchers attempt to link head nurse leadership style to staff nurse job satisfaction, burnout, and retention (Duxbury, Henley & Armstrong, 1982; Duxbury, Armstrong, Drew & Henley, 1984; Maguire, 1986; Pryer & Distefano, 1971). Other investigators have studied differences in role perceptions of head nurses working in various types of hospital settings (Miller & Heine, 1988), the tasks common to  3 nurse managers (Beaman, 1986), and the competencies expected of first-line nurse managers (Duffield, 1989). Outside the field of nursing, progress in business and education leadership research has been impeded by a disparity of approaches, a proliferation of terms, a tendency of researchers to concentrate on narrow aspects of leadership, and an absence of an integrating conceptual framework (Immegart, 1988; Murphy, Hallinger & Mitman, 1983; Yukl, 1981). Further, investigators have often failed to distinguish between the organizational concepts of leadership and management. Leadership is defined as "the identification of tomorrow's problems and the setting in place today of the problem-solving mechanisms that will be needed tomorrow" (Sheldon & Barrett, 1977, p.79). Sergiovanni (1984) views leadership as a hierarchy of forces in which management techniques take meaning and direction from higher-order cultural and symbolic forces. Mintzberg (1980) sees leadership as an interpersonal role in which the manager's function is to integrate individual needs and organizational goals. In Burns's (1978) view, leadership is an interactive political process in which leaders induce followers to act for specific goals that represent the values of the organization and the motivations of both leader and follower. ^Further, leadership requires an individual who holds a vision of what the unit can accomplish and who can mobilize the staff. These characteristics describe transformational leadership which must  4 be coupled with transactional skills; those that concern the day-to-day managerial functions (Bass, 1985a; Bass, 1985b; Bass & Avolio, 1990; Burns, 1978). In contrast, management is described as a set of skills that includes problem-solving, communication, motivating, decisionmaking, and conflict resolution (Whetton & Cameron, 1984), or according to three domains of skills, technical, interpersonal, and conceptual (Katz, 1974). Hersey and Blanchard (1988) view management as working with and through individuals and groups to accomplish organizational goals. In essence, leadership includes a vision for the future, is required to a greater degree in times of uncertainty, and is a broader concept than management. However, the two concepts may be seen as separate but related continua, "highly interconnected and mutually reinforcing activities" (Murphy, Hallinger & Mitman, 1983, p.300). Missing from these views, however, is a perspective that encompasses an expanded set of leadership variables and recognizes that leaders' perceptions of their own behaviour may differ from those of superordinates and subordinates (Immegart, 1988; Smeltzer & Vicario, 1988). This study will attempt to address these shortcomings and describe leadership behaviours in the head nurse role from the perspective of head nurse leaders.  S Conceptual Framework  Transformational and transactional leadership theory, developed by Burns (1978) and extended by Bass (1985b), will provide the framework for this study. Burns defines leadership as "the utilization of resources for the purpose of achieving valued goals and ends" (p.3). In his view, leaders induce "followers to act for certain goals that represent the values and the motivations (the wants and needs, the aspirations and expectations) of both leaders and followers" (p.19). Burns's approach encompasses more variables than models of leadership used in many earlier studies and broadens the concept of leadership by emphasizing its political aspects. Because head nurse leadership involves many variables and political aspects, this is an appropriate basis for a study of head nurse leadership. Burns (1978) identified two types of leadership: transactional and transformational. The transactional leader recognizes what actions subordinates must take to achieve goals. Such a leader engages in an exchange with followers to meet stated goals. Transactional leaders clarify role and task requirements for their subordinates so that employees are clear about the efforts required for the task. Further, the transactional leader identifies subordinates' needs and wishes and clarifies how these will be satisfied in exchange for the needed efforts. This leader does not identify values common to both leader and follower and has no vision of what the future  6 could be. In contrast, the transformational leader is committed to the organization, holds a vision of what could be accomplished, and empowers others in pursuit of that vision. The leader identifies values common to both leader and followers and bonds with followers on those values that are revered by both. The transformational leader motivates followers to do more than they expected to do. This leader accomplishes "transformations" by raising followers' levels of consciousness about the importance and value of specified outcomes as well as ways of reaching these. In addition, the leader convinces followers to transcend their own self-interest for the sake of the group or organization (Burns, 1978). Bass (1985b) has since expanded on Burns's definitions of transformational and transactional leadership. According to Bass, true leadership demands that both types of leadership be practiced in varying degrees by the same individual. He has refined his framework by testing the model in studies of military and industrial leaders. The framework identifies three general categories that include seven specific leadership factors and three outcome factors (Bass & Avolio, 1990), defined as follows:  Transformational Factors charismatic - enables leader to attract a following by building staff's confidence and trust so that followers react by identifying with and emulating the leader.  7 . inspirational - enables leader to commit staff to a vision by  communicating the vision in a meaningful way and describing how their work contributes to fulfillment of the vision. .  individualized consideration - the leader gives as much  responsibility to all levels of management as is needed to utilize their potential. intellectual stimulation - combines values common to staff  and leader and the vision so that change in both problem awareness and problem solving is noted. Transactional Factors contingent reward - occurs when both leader and staff "agree  to what (staff) needs to do to be rewarded or to avoid punishment" (Bass, 1985b, p.210). • management-by-exception - occurs when the leader's only  contact with staff occurs when something goes wrong. Nonleadership Factor .  laissez-faire - indicates the absence of leadership,  intervention avoidance or both. Outcome Factors ▪ extra effort - the extent to which followers exert effort  beyond the ordinary as a consequence of the leadership. • effectiveness - the extent to which the leader perceives that  s/he is effective in meeting both followers' needs and organizational goals. • satisfaction - indicates from the leader's perception, how  satisfied both leader and followers are with the leader's  8 style and methods. Bass's extension of Burns's 1978 model provides a structure whereby the leadership attitudes and behaviour of head nurses can be examined and will be used as the framework for this study.  Problem Statement In the nursing literature, the head nurse role is often described from the perspective of the staff nurse and, less often, from the perspective of the hospital chief executive nurse. Overall, what is known about the head nurse role has been reported by nurses other than head nurses. Further, studies of head nurse leadership have often employed a narrow perspective to study a complex phenomenon. Generally, the focus of these studies has been head nurse leadership style and behaviour which is one variable of many now being considered in leadership research. There is a deficit of knowledge, therefore, of head nurse leadership generally and, specifically, head nurses' own perceptions of their leadership.  Research Questions This study is designed to address the following questions: 1.  How do head nurse leaders describe their leadership from transformational and transactional perspectives and the outcomes of that leadership and how do the descriptions compare with those of a normative sample?  2.  What are the relationships among transformational, transactional, and nonleadership styles and between  9 leadership styles and outcome factors for head nurse leaders as measured by scores on the Multifactor Leadership Questionnaire? 3. What is the relationship between selected demographic and professional characteristics and level of transformational leadership for head nurse leaders as measured by scores on the Multifactor Leadership Questionnaire?  Definition of Terms For purposes of this study, the following definitions will be used.  Leadership - An interactive, political process in which leaders induce followers to act for certain goals that represent organizational values and the motivations of both. The concept encompasses two types of leadership. .  transactional leadership involves an exchange process in which followers' needs are met if their performance is carried out as contracted with the leader.  .  transformational leadership means followers commit to a vision and are empowered to work for self-actualizing needs and organizational rather than individual goals (Burns, 1978).  Head Nurse - The first-level nursing manager in a hospital nursing organizational structure. Other names commonly used include nurse manager, unit manager, and patient care  10  coordinator. Head Nurse Leader  -  A head nurse who is nominated as a  leader by supervisors and/or colleagues using the above definition of leadership.  Assumptions and Limitations The following assumptions were directly pertinent to this investigation: 1) Head nurse leadership is similar across situations in the environments in which head nurses work. 2) Head nurse leadership can be compared to the leadership of leaders in first line management positions in other industries. Limitations were as follows: 1) Due to the purposive sampling, the findings are not generalizable beyond the study group. 2) The self-report method used in this survey design may have required knowledge (to interpret particular items) that the head nurse did not possess. Guessing may have resulted which could interfere with obtaining true measures.  Significance of the Study  A head nurse position is critical to the success of any nursing organization, yet perceptions of leadership held by those deemed "leaders" have not been described. Therefore, this study generated new information, potentially important to all  11 nurse administrators. Through the perception of the head nurse, insights into leadership in first-line management positions within nursing administration were gained using a pluralistic leadership model. This study may initiate other research in this area, thereby contributing to nursing leadership theory building. From such a theory base, those charged with educating future nurse managers may more adequately prepare nurses to provide leadership in first-line nursing management positions.  Organization of the Thesis  The thesis is organized into five chapters. Chapter One has reviewed the background to the problem, explained the conceptual framework, and outlined the purpose of the study. Chapter Two details the relevant literature on leadership theory development, nature of the head nurse role and transformational leadership. Chapter Three outlines the research methodology. Chapter Four presents the findings and their interpretation. The summary, conclusions, and implications are presented in Chapter Five.  12 Chapter Two Review of the Literature  Although much has been written about leadership in nursing, there is a dearth of research describing the leadership of nurse managers in particular. The many opinion articles about head nurse leadership and training speak to the importance and  centrality of the concept in the evolving role. However, findings from empirical studies examining variables pertinent to leadership in nursing management are few. Outside of nursing, while progress in the field is evident, scholars lament that "Much remains to be done in mapping the leadership domain, in identifying dimensions and variables critical to the phenomenon and in developing viable conceptualizations and constructs to guide research" (Immegart, 1988, p. 273). In this chapter, the literature addressing leadership will be reviewed. The discussion is organized into two main sections. In the first section current literature and research on the head nurse position and leadership within nursing is presented. In the second section, leadership literature is examined which encompasses both theoretical development and empirical research outside the context of nursing.  Nature of the Head Nurse Role Many authors view the head nurse as the manager with 24-hour responsibility for nursing care, patient teaching, staff  13 development, and unit management on a single patient unit. The head nurse carries out these resposibilities through the management functions of planning, directing, controlling and organizing (Beaman, 1986; Hodges, Knapp & Cooper, 1987; Miller & Heine, 1988; Sullivan & Decker, 1988). Currently, nurse authors emphasize the increasing complexity of the decentralized work environment in which the head nurse works. Miller (1989) claims that, because of this complexity, nursing services are managed differently today and, thus, success in nursing management requires forging new leadership roles. Harrison (1987) suggests that the emphasis placed on management functions in nursing was appropriate when authority and responsibility were clear, but questions the relevancy of this position given the complex issues now facing nurse managers. Similarly, Kirsch (1988) asserts that the classical view of management does not accurately reflect the work of nurse managers, who spend more than 80% of their time in interpersonal interactions. Kirsch (1988) employs Mintzberg's (1973) framework in which all managerial work is delineated into ten roles, to describe the head nurse role. Both writers identify the interpersonal role of "leader" as the most important. In addition to management skills, Kirsch (1988) suggests that head nurses need leadership skills. Miller (1989) and Kirsch (1988) recommend Burns's model to guide leadership skill development pertinent to the head nurse role.  14 The message is clear that the pressure for change in nursing organizations will intensify, not diminish. Head nurses must perform their roles with higher level managerial and leadership skills (Dunne, Ehrlich & Mitchell, 1988; Kirsch 1988; Patz, Biordi & Holm, 1991). Therefore, an appropriate frame of reference is needed to guide development in the evolving role. Currently, both inside nursing and in fields outside of nursing, investigators are using leadership frameworks to describe skills and behaviours that managers require in today's complex organizational environments.  Leadership in Nursing Administration  Recent studies about head nurses examine a variety of aspects, such as, the nature of the role, their specific function, their skills, and educational requirements for the role. However, very few have sought to empirically examine head nurse leadership. These researchers typically report the staff nurse's perspective and relate leadership style to staff nurse satisfaction, burnout, and retention. An integration of these findings is difficult, as dissimilar terms and varying instruments are used for similar constructs. However, two behavioural dimensions, consideration and initiating structure, dominate these works as the fundamental measures of consequence to leadership. Currently, however, nurse researchers are beginning to employ broader frameworks in the study of leadership. A review  15 of four leadership studies follows. Three of these employed different instruments to measure leadership behaviour according to the dimensions of either initiating structure and consideration or similarly task and relationship. Duxbury, Armstrong, Drew, and Henley (1984) studied staff nurses'perceptions of head nurse leadership style and the effect of that style on staff nurse burnout and Job satisfaction in a neonatal intensive care unit (N.I.C.U.). The sample, 283 staff nurses from 14 N.I.C.U.s, responded to two instruments that measured Job satisfaction and to the Leadership Opinion Questionnaire (L.O.Q.) which measured the staff nurses' perceptions of head nurse leadership. The L.O.Q. measures two leadership dimensions that include consideration and structure (Fleishman & Harris, 1962). Consideration indicates a relationship with subordinates characterized by mutual trust, respect for ideas and feelings, and two-way communication. Structure reflects the degree to which the leader actively directs the unit activities toward goal achievement (Fleishman & Harris, 1962). Findings indicated that staff nurses' perceptions of head nurse leadership were primarily influenced by the amount of consideration shown by the head nurse towards the staff nurse (Duxbury et al., 1984). Staff nurses' satisfaction was directly and positively related to considerate head nurse leadership style while staff nurse burnout was directly and inversely related to considerate head nurse leadership (Duxbury et al., 1984).  16 Head nurse leadership structure had a clear effect on staff nurse satisfaction and burnout only when combined with leader consideration. The amount of structure that the head nurse exercised was important to burnout or satisfaction only if that head nurse was ranked high on consideration. For both staff satisfaction and burnout, the leadership style of low consideration combined with high structure was most deviant. Head nurses who exhibited this style supervised staff nurses who were significantly more burned-out and dissatisfied with the job. Duxbury et al. (1984) conclude that head nurse leadership style contributes significantly to staff nurses' ability to deal effectively with the complex work requirements of the N.I.C.U.. Thus, the standard of nursing care delivered can be positively influenced by head nurse leadership style when the leader also manifests higher scores on consideration. These findings are congruent with those of an earlier study by Duxbury et al. (1982) and with those of Pryer and Distefano (1971). In a related study, Maguire (1986) investigated staff nurses' perceptions of leadership styles of head nurses on primary units and those of head nurses on nonprimary units. Demographic information about the respondents was elicited from 198 staff nurses from one acute care hospital on the first part of the questionnaire. The second part of the questionnaire was a Leader Effectiveness and Adaptability Description (L.E.A.D.) developed by Hersey and Blanchard (1977). The L.E.A.D. instrument is comprised of 12 situations that commonly occur when  17 a group leader makes a decision that affects either a leader's interaction with group members (relationship) or goal attainment (tasks) or both (Maguire, 1986). Findings demonstrated a significant difference between the primary and nonprimary groups on only two variables: hours worked per week and months worked with current head nurse. A greater percentage of head nurses on primary units showed a higher relationship behaviour in their leadership style than did head nurses of nonprimary units. The researcher concludes that head nurse leadership style relates to leader effectiveness and that the adept head nurse can learn to predict the leadership style that promotes effective staff responses and outcomes. According to Maguire (1986), the manner in which the head nurse communicates with and relates to staff members has a direct impact on unit productivity. Head nurses who improve relationships with staff nurses can enhance co-operation at the unit level and improve operational productivity (Maguire, 1986). Pryer and Distefano (1971) studied individuals at three different levels to determine how they perceived the leadership behaviour of their immediate supervisors and to examine the relationship between these perceptions and lob satisfaction and generalized expectancies about reward. The study samples included 39 attendants and 40 psychiatric aides who were randomly selected, and all of the 20 day shift staff nurses. On the Leadership Behavior Description Questionnaire (L.B.D.Q.) attendants described their psychiatric supervisor;  18  psychiatric aides described their R.N. supervisor; and staff R.N.s described their head nurse. In addition, subjects responded to the Job Descriptive Index (J.D.I.) which measures Job satisfaction and to the Internal-External Scale that measures individual perceptions about the control of rewards. Comparison of all three levels on consideration and initiating structure revealed no significant differences in leader climates as defined by either of these measures. Findings demonstrated that, for the first two levels, consideration was correlated positively with overall satisfaction. At the R.N. level, total Job satisfaction scores were not related to either measure; however, consideration was significantly and positively related to satisfaction with head nurse supervison. Findings suggest that the leadership dimension of consideration was positively related to job satisfaction at all levels and initiating structure was related to satisfaction with supervision only when a group of nonprofessionals rated professional supervisors. Further, aides who perceived rewards as more externally controlled tended to view leaders as less considerate and were also less satisfied with their jobs. Dunham and Klafehn (1990) reflect the movement in leadership research to examine variables beyond initiating structure and consideration. These researchers employed an exploratory research design and Bass's extension of Burns's leadership framework to study the leadership qualities of nurse executives. A convenience sample of 80 nurse executives was  19 selected for the study. The selection process began with a group of nurse executives perceived as "excellent" by their peers (75%); by associated faculty X15%); and by other nursing administration personnel (10%). Executives thus identified were then asked to nominate other "excellent" executives. The same executives' names appeared again and again and these people became a priority for inclusion in the study. Those names occurring less frequently were selected on a convenience basis. The research question asked by Dunham and Klafehn (1990) was: " Are excellent nurse executives transformational leaders from their own perception and from immediate staff members' perceptions?" (p. 30). All 80 executives and a total of 213 staff members who reported directly to the executives completed Bass's Multifactor Leadership Questionnaire (MLO) (Bass, 1985b). In completing the questionnaire, the executives and the staff were requested to rate on a five- point Likert scale how often the individual nurse executive displayed each of the leadership behaviours or attitudes. The investigators reported that both the nurse executives and their staff found the executives to be predominantly transformational leaders, but all possessed transactional leadership qualities as well (Dunham & Klafehn, 1990).  Leadership in Business and Education The business and education leadership literature includes two major investigative approaches: the psychological model, encompassing four major perspectives on leadership, and the  20 political model which includes cultural perspectives. Literature relating to both approaches is presented chronologically, moving from the earlier trait studies through current investigative emphases. The section concludes with a review of transformational studies. Psychological model. This model includes four perspectives all addressing a  concentration on the individual and the social group (Jago, 1982). This domain includes the trait, the behaviour, the situational perspective, and the multiple influence models of leadership. Trait perspective. Early attempts to study leadership dealt with leader traits  such as intelligence, confidence, and ability to communicate (Foster, 1986; Stodgill, 1959). Because the trait approach was not generalizable, it offered little to explain or predict the nature of leadership and the theory was largely abandoned. Behavioural perspective.  Foremost among these works were the Ohio State Studies and the University of Michigan Studies. Ohio researchers, Hemphill and Coons (1957), developed the Leadership Behaviour Description Questionnaire (L.B.D.Q.) to measure two behavioural dimensions: consideration (recognition of individual needs) and initiating structure (goal or task orientation). The identification of these behaviours as the two major behavioural dimensions of leadership was a significant development in leadership research.  21 Although different terms have been used, these two classes of behaviours have repeatedly reappeared in other theoretical approaches to leadership (Immegart, 1988; Foster,1986; Yukl, 1981). Concurrently, University of Michigan researchers were investigating factors that contribute both to group productivity and to the satisfaction of group members. They derived two dimensions of leadership: the production orientation dimension (task orientation) and the employee orientation dimension (people orientation (Likert, 1967). The similarities between the conceptualizations of the Ohio State and Michigan researchers are apparent and remarkable. The major contribution of these works to leadership research was in defining and describing the behaviours displayed by leaders. However, because effects such as productivity, efficiency, and satisfaction were not identified as outcomes of the leadership behaviours identified in this perspective, theorists embraced a third perspective. Situational perspective.  Fiedler's (1967) "contingency" model of leadership assumes that the leader's effectiveness in a given situation will depend on the "match" between leader style (measured by the Least Preferred Co-worker Scale) and the amount of the manager's control over the work situation. A leader is most effective when leadership style and the situation match and Fiedler recommends that leaders attempt to seek situations in which their  a2 predominant style is most appropriate (Fiedler, 1967; Foster, 1986). Other contingency theories include House's (1971) path-goal theory, and Vroom and Yetton's (1973) model of decision- making. In the path-goal theory, House (1971) suggests that the function of the leader lies in the clarification of the particular organizational paths that lead to goals valued by subordinates, and that the leader must adjust his/her style to the needs of the situation. Vroom and Yetton (1973) propose a model for determining the amount of participation in decision-making to be used in different situations. Similarly, Hershey and Blanchard (1976) claim that leadership style must vary according to the situation. Variables in their model include the task and relationship behaviours of the leader and the maturity level of the followers. Maturity is defined as "the capacity to set high but attainable goals, willingness and ability to take responsibility, and education/or experience of an individual or a group" (Hershey & Blanchard, 1976). This perspective was unique because it considered both the leader-follower relationship and the situation as important in determining leadership behaviour. Multiple-influence model.  The multiple-influence model of leadership assumes that an organization's environment, its context for action (size and technology) and its structure (all macrovariables), and conditions within the work units in the organization  23 (microvariables) influence the role of a manager (Hunt, 1984; Sheridan, Vredenburgh & Abelson, 1984). This model reflects a trend to employ broader perspectives that include leader traits, behaviours, influence processes, and intervening variables, such as, situations and end-results, in the study of leadership. Political model. Foster (1986), Pfeffer (1981), and Yukl (1981) use the term "political model" to include those approaches in which "followers exert as powerful an influence on leaders, as leaders exert upon followers." In the political model, the most dynamic aspect of leadership, politics, is added. Leadership is the playing out of the political process in ways satisfactory to both leaders and followers (Foster, 1986; Pfeffer, 1981). One political theorist, Selznick (1957) differentiated between the manager and the leader by claiming that the leader is concerned with "critical" (not routine) decisions in the institution. Another political theorist, Burns (1978), studied world political and business leaders using historical and biographical data in order to define leadership. He concluded that leadership is the utilization of resources for the purpose of achieving valued goals and ends. In exercising leadership, leaders induce followers to act for certain goals that represent the values and motivations of both leaders and followers. In Burns's view, leadership is purposive, oriented toward a goal or vision. Further, Burns identified two types of leadership. Transactional leadership involves an exchange  24 process in which followers' needs can be met if their performance is as contracted with their leader. In contrast, transformational leadership involves motivating followers to work for higher-order, self-actualizing needs and for organizational goals rather than individual needs (Burns, 1978). Bass (1985a, 1985b; Bass & Avolio 1990) applied Burns's framework to organizational management in studies of military and industrial leaders. From these studies, Bass derived seven factors to further describe Burns's leadership categories. Three general categories of leadership are detailed by seven specific factors. Four factors reflect transformational leadership: 1) inspiration 2) charisma 3) individualized consideration and 4) intellectual stimulation; two factors describe transactional leadership: 1) contingent reward and 2) management-by-exception; and one factor, laissez-faire, represents nonleadership (Bass, 1985a; Bass, 1985b; Bass & Avolio, 1990). Further analysis demonstrated that, when a leader displayed both transactional and transformational abilities, extra effort was made by subordinates beyond what could be attributed to transactional factors alone. In addition, transformational factors were more highly correlated than the transactional factors with subordinates' satisfaction and leaders' perceived effectiveness (Bass, 1985a, 1985b; Bass & Avolio, 1990). Additional studies using the transformational approach will be presented in the next section of this chapter. While Burns focuses on the leadership behaviours of a  25 leader, Selznick views leadership in the context of organizational culture. Their conceptions, however, have a number of common elements. Leadership is seen as an interactive (not manipulative) process between the leader and his followers. The process is primarily political in nature as it involves the exchange of valued resources. The symbolic elements of leadership in the political models are expanded in the cultural views where the leader is seen as a symbol of what is true and good in the organization. As people attempt to socially reconstruct their reality, the leader provides a vision of both the necessary and the sacred. In this perspective, the exercise of leadership is facilitated by the culture within which the group exists (Peters & Waterman, 1982; Pondy, 1978; Sergiovanni, 1984). Thus, the political perspectives represent major conceptual advances over the simplistic notion of leadership as a mere management process of motivating subordinates to accomplish tasks. Transformational Leadership Studies  Singer (1985) studied managers' perceptions of their superiors' leadership in an attempt to replicate Bass's (1985b) finding that transformational (TF) factors were more highly correlated than transactional (TA) factors with subordinates' satisfaction and with leaders' perceived effectiveness. Subjects were 38 randomly selected, male, business managers. They completed the MO twice, once to describe a "real"  26 superior's behaviour and the other to describe an "ideal" superior to determine the TF nature of these images, and whether the discrepancy scores correlated negatively with subordinates' satisfaction and perceived leader effectiveness. Findings indicated that, except for perceived work-unit effectiveness, the TF factors were more highly correlated than the TA factors with perceived leaders' effectiveness and subordinates' job satisfaction. These findings were congruent with Bass's (1985b) findings. Further, managers in this study would prefer to work with leaders who are more TF than TA and believed they could carry out their duties more effectively with transformational leaders. The greater the discrepancy between ideal and real images of a leader for subordinates, the lower was the perceived leader's effectiveness and subordinate's job satisfaction (Singer, 1985). Singer and Singer (1986) explored the relationship between subordinates' personality traits and their preference for either TF or TA leadership style. Subjects, 87 male, undergraduate commerce students, completed the MLQ according to their image of an "ideal" leader, and the Edwards' Achievement, Affiliation, and Succordance Subscales and a 7-point conformity rating scale. Findings demonstrated that affiliation correlated significantly with charisma, individualized consideration, and the over-all TF score, and conformity related positively to intellectual stimulation and negatively to succorance. The researchers concluded that "affiliators" favor leadership  27 qualities such as charisma and individualized consideration and both "nonconformers" and "achievers" prefer leaders who provide intellectual stimulation. Further, subjects preferred working with leaders were more transformational than transactional. This finding is consistent with those of Bass (1985b) and Singer (1985). Bass, Waldman, Avolio and Bebb (1987) examined the relationship between the leadership performance of first-line government managers and their superiors. Fifty-six male firstlevel managers responded to the MLQ twice. They first described their superior's actual leadership and second, their perceptions of leadership required of the superior. Five subordinates of each first-level manager also completed the MLQ to describe that manager's actual leadership. Results confirmed signifcant correlations for the TF leadership factors between behaviours observed in the firstlevel managers and those observed in their superiors. However, between levels correlations results were mixed for the TA factors. Further, the more charismatic first-line managers required less charisma from their superiors. More TF leadership was observed in the second-level managers than in first-level managers. Similar to Bass's (1985b) findings, much more TF leadership was required of the second-level managers than they displayed. For the TA factors, more contingent reward (CR) was both required and observed of second-level managers compared with first-level. Less management-by-exception (MBE) was observed in  28 second than in first-level managers, but even less was required. The researchers concluded that, as expected, a cascading effect of TF leadership emerged in the study. The degree of TF leadership observed at one level of management tended also to be seen at the next lower level. The leadership patterns between subordinate-superior tended to match each other which may relate to modeling behaviours and selection practices (Bass et al., 1987). Waldman, Bass and Yammarino (1990) examined subordinates' and superiors' perceptions of contingent reward (CR) and charismatic behaviours of 186 navy officers to determine the relationship of these dimensions to leader effectiveness. The subjects, 793 subordinates of the all but one male officers, responded to the MLQ. Additional measures of leader effectiveness included participants' ratings of the effectiveness of both their work unit and their superior in meeting organizational goals and superiors' ratings of officers from performance appraisal data. Results indicated that contingent rewards (CR) were positively correlated with charisma. Two consistent patterns of correlation emerged between the leadership scales and effectiveness measures. First, CR and charisma were most highly correlated with subordinate-rated effectiveness. Second, although both leadership scales were significantly correlated with each effectiveness measure, the lower relationships were with CR.  29 For each measure of effectiveness, CR accounted for significant variance (22-64%) and, as predicted, charisma added unique variance (8-34%) beyond that of CR behaviour in the effectiveness measures. In sum, charisma augmented the understanding of effectiveness beyond contingent rewards, but, no effect was found for CR augmenting charisma. These findings are congruent with other research conducted in industrial settings (Hater & Bass, 1988; Waldman, Bass & Einstein, 1987). Further, despite evidence that more charisma tends to be shown at higher management levels (Bass, 1985b; Bass et al., 1987), the present findings suggest that charismatic leadership may be important at lower management levels as well (Waldman et al., 1990). Seltzer and Bass (1990) explored the relationship between initiation and consideration dimensions of leadership and TF leadership to test whether adding the TF variables explained a greater proportion of the variance in leadership outcomes (leader's effectiveness and subordinates' satisfaction and extra effort). A total 138 subordinates responded to the MLQ to describe the leadership of 55 manager superiors and to the Leader Behavior Description Questionnaire (Stogdill, 1963) to describe initiation and consideration leadership behaviours of their superiors. Hierarchical regression analyses demonstrated that initiation and consideration explained a significant amount (2250%) of the variance of outcome measures. The TF scales added an additional 8-28% to the explanation, and while TF scales  30 augmented initiation and consideration, the reverse was not found. Initiation, consideration, and charisma were positively related to all three outcome measures and intellectual stimulation was positively related to extra effort. Therefore, the TF scales indeed added to the variance of outcome measures explained by initiation and consideration. The researchers concluded, as previous studies have shown, that TF leadership augments TA leadership, but they further demonstrated that TF leadership also augments initiation and consideration. Therefore, the findings support the importance of adding TF variables in such studies (Seltzer & Bass, 1990). Hater and Bass (1988) examined subordinates' perceptions of TF leadership to determine if these add to the prediction of subordinates' satisfaction and effectiveness ratings beyond that of perceptions of TA leadership. A total of 362 subordinates responded to the MLQ to describe the leadership of 28 top performing and 47 ordinary first-(33%), second-(50%) and third(17%) level business managers. Of the combined group, 81% were male. In addition, subordinates rated the effectiveness of their work unit and their manager in meeting job requirements, as well as their satisfaction with the manager's leadership methods. Manager performance was measured by supervisor's rating of individual performance and of work group performance, and by data from performance review records. Results indicated that in both samples, the correlations between the TF factors and subordinates' ratings were high,  31 whereas, the correlations between the TA factors and subordinates' ratings were low to moderate. Higher correlations were found between TF variables and predicted effectiveness and satisfaction than between these outcomes and TA variables. Further, hierarchical regression analysis demonstrated that TF leadership factors add to the prediction of subordinates' ratings of effectiveness and satisfaction beyond that of TA factors. Top performers were significantly higher than ordinary managers on charisma and individualized consideration and no differences were identified between samples on TA factors. Findings demonstrated that, within the top-performer sample, the TF factors showed moderate prediction of individual performance, which was significant for charisma. In contrast, the TA factors showed low or negative correlations with both individual and work group performance. Only the ordinary manager sample demonstrated very strong relationships between TF and TA factors and ratings of specific manager performance (Hater & Bass, 1988).  Summary In summary, literature pertinent to leadership in the nurse manager role and to leadership in management in the fields of business and education was reviewed. The generalizability of the research findings reviewed is limited by the use of varying conceptualizations and by a variety of methodological problems. The nursing literature describes major changes in the head nurse's role and environment. Often these studies are reported  32 solely from the perspective of the staff nurse. Findings from these studies generally succeed in underscoring the importance of staff nurses' perceptions that head nurse leadership is primarily influenced by the amount of consideration shown by the head nurse toward the staff nurse. However, a comparison of the findings from these studies is confounded by the use of different terms and various instruments to measure similar constructs. Further, most studies examine leadership from unitary perspectives that investigate only leadership style or consideration and initiating structure dimensions of leader behaviour. Because of this, the utility of these findings is limited. Similarly, in the fields of business and education, the dimensions of initiating structure and consideration have dominated leadership research. Recently, however, the literature provides evidence of a paradigm shift as researchers have begun to use broader approaches to examine an expanded set of factors that include traits, behaviours, political processes, and intervening variables in order to more fully decribe what leaders do. Findings from the transformational studies which also link leader behaviour to productivity outcomes, indicate that TF factors are more highly correlated than TA factors with subordinates' satisfaction and with the leader's perceived effectiveness. Moreover, transformational augments transactional leadership, and also augments initiation and consideration leadership.  33 Based on the literature reviewed, this study will advance the knowledge about leadership in the head nurse role by addressing the limitations noted in the literature. First, the transformational model developed by Bass (1985b) provides a framework to describe leadership as an interactive political process. The conceptualizations and constructs of the model are well established and can enhance the understanding of head nurse leadership according to dimensions now considered pertinent to the concept. Second, some of the methodologocal problems in the reviewed studies related to instrument development, study design, and sample selection are addressed in this study. Specifically, the MLQ was designed by Bass (1985b) to measure leadership behaviours according to transformational, transactional and nonleadership scales, and outcomes of leadership. This instrument has been tested in studies with numerous samples from a variety of settings from which normative data have been established. Thus, the scores for this sample of nurse managers can be compared to those of other managers. Further, the study was designed to investigate three sets of variables (i.e., leader characteristics, behaviour and outcomes) and thus overcomes the weakness found in the reviewed studies of examining a single variable set. Last, subjects selected for the current study were actual leaders, purposively and systematically sampled. This addresses the problem of subjects who do not offer the potential for illuminating the concept. The  34  subjects for this transformational study are predominantly female, first-line nurse managers working in hospitals whereas samples from the reviewed studies were predominantly male managers working in business, industrial, and military settings.  35  Chapter Three Methodology  Overview The methodology for the study is described in this chapter. Specifically, the sample, the data collection procedure, the instruments used, the analysis, and procedures for protection of human rights are detailed. Sample The purposive sample consisted of 54 head nurses drawn from the population of head nurses who were permanently employed in current first-line management positions for one year or more in tertiary-level acute care hospitals in the Lower Mainland of British Columbia. Each subject was nominated by supervisors and/or colleagues for his/her exercise of leadership according to the investigator's definition of leadership outlined in the letter of introduction (Appendix A). The chief nurse executives of each of four agencies (on five sites) were asked to request the nursing directors to collaborate with head nurses and staff nurses to identify the organization's head nurse leaders. Between August 1991 and January 1992, a total of 16 nursing directors from four hospitals provided the names of 69 head nurses to the investigator. The researcher then sent each of the nominated head nurse leaders the information letter (Appendix B) which explained the  36 purpose of the study and requested the nominated leader's voluntary participation.  Data Collection Procedures  Based on the selection criteria for the study sample, the investigator identified four, tertiary- level, acute care hospitals in the Lower Mainland of British Columbia suitable for inclusion in the study. The Vice-President (VP) Nursing at each of the four hospitals was contacted by the researcher via a letter of introduction (Appendix A) regarding the proposed study. Each VP Nursing granted permission to conduct the study in that agency. No other hospitals were identified or approached. In a meeting room at each hospital, the researcher met the subjects, distributed the questionnaires with the Questionnaire Introduction letter (Appendix C) which includes the purpose of the study, ethical considerations and questionnaire instructions. A verbal explanation by the investigator of the purpose of the study, the procedures for data collection, and the intended analysis of the data was given to all volunteers. The investigator responded to questions and collected the questionnaires once completed. In addition, individual appointments were made with head nurse volunteers who found the suggested times inconvenient. The schedule of possible appointments covered times during which the head nurses were on paid time. Some head nurses, however, made appointments to complete the questionnaires outside their working hours.  37 Data collection began February 24, 1992 and ended March 25, 1992. With the exception of hospital 4, the investigator spent two days at each hospital site collecting data. In the case of hospital 1, data collection occurred at one site on two different occasions that spanned one week, and at another site on two occasions that spanned two weeks. Subjects from hospital 2 completed the questionnaires on two different dates over a oneweek period. Head nurses from hospital 3 completed the questionnaires on two different dates over one week. Because of the wide geographical dispersion of nursing units at hospital 4, questionnaires were mailed within that hospital to the nominated head nurses with a request that they be returned via mail to the investigator within two weeks. During each two-day collection period, hospital 1, site A offered four possible appointment times and site B five different times, hospital 2 provided four times, and hospital 3 four times. At any one time, the number of head nurses completing the instruments ranged from one to four. A total of 63 instrument sets was distributed. Fifty-one responses were usable (nine instruments were not returned and three were returned incomplete). Instruments The instruments used included the the Multifactor Leadership Questionnaire- Self-Rating Form (5R) (Bass & Avolio, 1990) (Appendix D) to describe leadership according to transactional, transformational and non-leadership categories and  38 the Demographic Information Form (Appendix E) to describe the sample.  Multifactor Leadership Questionnaire The researcher purchased this instrument and obtained written permission to use it from Consulting Psychologists Press, Inc., Palo Alto, California. This instrument was chosen because it is brief and one of few empirically tested tools available to measure leadership behaviours. Moreover, the MLQ reflects the excercise of leadership or leadership as a process, and specifically, an interactive political process, rather than a management process. Further, the constructs defining the instrument form a new paradigm for understanding leadership that goes beyond the unitary perspectives to which leadership researchers have limited their study for half a century. This paradigm provides a means to systematically measure and describe factors that contribute to leadership. Previously, the MLQ has been used with predominantly male, first-line managers, and mostly in military, industrial and business settings. Recently, it has been used to study the leadership of predominantly female, nurse executives (Dunham & Klafehn, 1990). The MLQ (Appendix D) was designed by Bass for the purpose of describing leadership according to transactional, transformational, and non-leadership categories. He empirically derived these three leadership categories which are further detailed by seven scales that reflect seven factors: four  39 transformational factors, two transactional factors and one nonleadership factor. The transformational category is described by the four factors, Inspiration, Charisma, Individualized Consideration, and Intellectual Stimulation. The transactional category is detailed by the two factors Contingent Reward and Management-By-Exception, and the nonleadership category is represented by the Laissez-faire factor (Bass, 1985b; Bass & Avolio, 1990). Six of the leadership scales of the MLQ contain 10 items with the Inspiration scale containing seven. Respondents are requested to indicate, using a 5-point Likert scale, how often they display each of the 67 leadership behaviours or attitudes using the following scale: A, frequently, if not always (4 points); B, fairly often (3 points); C, sometimes (2 points); D, once in a while (1 point); and E, not at all (0 points). Thus, an average score of 3 or more represents behaviour that is present fairly often for the area being evaluated (Bass & Avolio, 1990). In addition, scores are obtained on three scales for outcome measures: Extra Effort, Effectiveness, and Satisfaction (Bass & Avolio, 1990). Extra Effort reflects the extent to which followers exert extra effort beyond the ordinary as a consequence of the leadership. This subscale is scored on the same 5-point Likert scale described for the leadership items. Satisfaction reflects, from the leader's perception, how satisfied both leader and followers are with the leader's style  40  and methods. Respondents indicate on a 5-point scale whether they are: very satisfied (4 points); fairly satisfied (3 points); neither satisfied nor dissatisfied (2 points); somewhat satisfied (1 point) or very dissatisfied (0 points). Effectiveness reflects the extent to which the leader perceives that he/she is effective in meeting both followers' needs and the goals of the organization. Respondents indicate on a 5-point scale whether they are: extremely effective (4 points); very effective (3 points); effective (2 points); only slightly effective (1 point) or not effective (0 points) (Bass & Avolio,1990). Scores for the 67 items are divided into the seven factor groupings. Individual scores for each respondent on each factor are obtained by summing the results for the items, each with a possible score of 0 to 4, then dividing the sum by the number of items, to yield an average response to the items of each scale. A mean score is obtained for each factor for every subject, and composite means and standard deviations are determined for each of the general leadership categories for each head nurse. Scores obtained from each item in the instrument are summed to obtain a single score for each subject. Although a good leader is expected to possess elements of both leadership characteristics, the characteristic with the highest mean score will be considered the predominant leadership pattern excercised by the respondent. A cut-off score arbitrarily set at 3 divides high and low scores. For example, a score of 3 or more for the factor  41 Intellectual Stimulation indicates that the subject frequently provides ideas which result in rethinking of issues that have never been questioned before and which enable subordinates to think about old problems in new ways. The mean frequency of a leader's perceptions of displaying each of the leadership factors is calculated similarly. A profile emerges that provides a description of the respondent's preference for specific leadership factors, as well as the general pattern of leadership (Bass & Avolio, 1990). Bass (1985b) reported testing reliability of the MLQ using internal consistency analyses (tests of instrument homogeneity) to set up two scales, one each for either transactional or transformational responses. Split-half reliabilities were .86 and .80 respectively. Dunham and Klafehn (1990) reported that reliability was not established for the nurse executive group because of the exploratory nature of their study. A variety of studies involving military, industrial and business leaders, have yielded the following ranges for reliabilities of the individual scales (assessed by coefficient alphas): Charisma, .82-.94; Inspiration, .45-.83; Individualized Consideration, .71-.90; Intellectual Stimulation, .78-.89; Contingent Reward, .74-.86; Management-By-Exception, .60-.75; and Laissez-faire, .60-.69 (Bass 1985b; Bass & Avolio, 1990; Bass, Avolio & Goodheim, 1987; Hater & Bass, 1988; Waldman, Bass & Yammarino, 1990). Empirical testing of the MLQ involved 1,006 subordinates  42 and 251 business leaders. Based on these MLQ scores, normative data were generated. Alpha reliability coefficients for the self-ratings ranged from a high of .83 for Charisma to a low of .60 for Inspiration for the seven leadership subscales, and .73, .67, and .92, respectively for the outcome subscales of Extra Effort, Effectiveness, and Satisfaction (Bass & Avolio, 1990). According to Burns and Grove (1987), construct validity is now considered the most important type of validity to examine. Those authors define construct validity as "the degree to which a measurement strategy measures the construct it was designed to measure" (p.237). Initial steps involved in developing construct validity for the MLQ include concept analysis and factorial validity. Bass (1985b) details the development of five initial leadership factors through factor analysis and various methods used to test construct validity in his studies using 104 and 176 cases. According to Bass and Avolio (1990), data collected on the refined MLQ indicate substantial support for the construct validity of the current seven factors. Dunham and Klafehn (1990) report the test of halves was not significant, thereby establishing the internal validity of the instrument for that study. Demographic Information Form  The impact of demographic and professional characteristics upon the process of leadership and the leader's effectiveness are still viewed as critical considerations in recent approaches to the study of leadership. Therefore, these data were collected on  43  a form developed by the investigator. Demographic data included age, gender, marital status and education. Professional nursing data included nursing employment tenure, hospital tenure, head nurse tenure, current position tenure, clinical focus of the unit and number of full time equivalents (FTEs) for which the respondent is accountable. Data Analysis  All data were analyzed using the computer program Statistical Package for the Social Sciences (SPSS-X). Initially, one-way analysis of variance was conducted on each hospital subgroup to test for significant differences among these with respect to data from the MLQ and data from the Demographic Information Form. Descriptive statistics of frequency and percentages were used to analyze the demographic variables, for example gender, marital status, education, clinical focus of unit, and operating budget responsibility (FTEs). Means, ranges, and standard deviations (SD), measures of central tendency and dispersion, were used to analyze the continuous demographic variables of age, tenure of nursing employment, agency tenure, head nurse tenure, and current position tenure. For each head nurse, scores were calculated for each of the seven measures of leadership preference. Scores on Charisma, Inspiration, Intellectual Stimulation, and Individualized Consideration leadership provide an over-all transformational measure (i.e., the sum of the factor scores on the four  44  transformational factors); scores on Contingent Reward and Management-By-Exception provide an over-all transactional measure (i.e., the sum of the two transactional factor scores), and the score on the Laissez-faire factor provides the non-leadership measure. Descriptive statistics applied to the MLQ from the study sample focussed on means and standard deviations. The Z test was used to analyze differences between the means of the study sample data and the normative data. Pearson's correlation coefficient was used in two ways. First, the method was used to determine whether a relationship exists between the level of TF score and the level of TA score, and between leadership scores and outcome variables. Second, those coefficients that were statistically significant were examined to determine their strength. According to Burns and Grove (1987), r- values that are between .10 and .30 are considered weak; between .30 and .50 moderate; and above .50 strong. These authors suggest that weak correlations tend to be disregarded in nursing research which may result in ignoring a relationship that may have significance within nursing when examined within the context of other variables. Therefore, if the relationship is intuitively important, despite a small Pearson's coefficient, Burns and Grove (1987) recommend recording the information, "as one may have to plan better designed studies and reexamine the relationship" (p.510). Lastly, a series of chi-square tests was conducted in an  45 effort to determine if the level of the transformational score was related to selected demographic variables. Human Rights Protection  Procedures employed in this study to protect human rights were reviewed and approved by the U.B.C. Behavioural Sciences Screening Committee for Research and Other Studies Involving Human Subjects. Approval for the study was granted by the ethics committee of each participating hospital through the  respective directors of nursing research or the VP Nursing. The researcher specifically addressed informant anonymity, and confidentiality of information in the letter of introduction (Appendix A). Additionally, in the information letter to potential subjects (Appendix B), informed consent and the subject's right to withdraw or refuse to participate at any time without being penalized were addressed. The information letter also explained that any information personally identifying a respondent would remain strictly confidential. Subjects were informed of the voluntary nature of participation in both the information letter and the questionnaire introduction letter, and were verbally reminded of this immediately prior to completion of the study instruments. Fair treatment of subjects during the course of the study was ensured by having a specific agreement, (See Appendices A and B) about what comprised the sujects' participation. The researcher respected that agreement by maintaining the schedule of appointments set and by being punctual.  46 Chapter Four  Findings and Discussion The findings of this study are presented in three sections. The first section describes the total sample and the five subgroups from the four hospitals. The second section provides the results of the descriptive analysis of the MLQ and the results of the correlational analysis of the leadership variables and the outcome variables, findings relative to the first two research questions. The third section details the results of the analysis of selected demographic and professional characteristics of the head nurse sample and the level of TF leadership as measured by the MLQ. Sample Characteristics  Although 69 head nurses were nominated, six declined to participate. A total of 63 instrument sets was distributed to head nurses in four tertiary-level acute care hospitals in the Lower Mainland of British Columbia who were nominated for their leadership and were permanently employed in the position for one year or more. Bed capacities of the hospitals ranged from 5601500. Nine instrument sets were not returned and three were returned incomplete. A total of 51 completed instrument sets was used for data analysis. The five subgroups were composed of nine head nurses in Hospital 1A, eight in Hospital 1B, 12 in Hospital 2, 11 in Hospital 3, and 11 in Hospital 4, as shown in  47 Table 1. Based on the total number of head nurses who were nominated and, thus, could have completed the instrument sets, the response rate of usable instruments was 69%, 80%, 75%, 85% and 65%, respectively. Initially, one-way analysis of variance (ANOVA) was conducted to determine if there were significant differences between the subgroups. Results indicated that for gender, age, educational preparation, marital status, tenure in nursing, in management, in current position and organizational tenure, clinical focus and operating budget, all of the demographic and professional characteristics, the subgroups were not significantly different (p<.05). Therefore, the results from the subgroups were combined for reporting purposes.  Table 1  Numbers of Head Nurses in Agency, Head Nurses Nominated, and Subjects by Hospital Hospital  No. HNs  No. HNs Nominated  No. Subjects  1^A  19  13  9  B  16  10  8  2  35  16  12  3  26  13  11  4  67  17  11  163  69  51  Total  48  Educational preparation. The educational preparation of the head nurses is presented according to sample subgroups in Table 2. The predominant educational qualification of subjects from Hospitals 1A, 1B, and 4 was that of a baccalaureate degree in nursing, while, for Hospital 3, most of the participants either had completed some courses towards or held that degree. In Hospital 2, exactly one half of the respondents either held the degree or had completed some courses towards that degree and the other half held a diploma. A diploma only as the highest level of education was reported by one of the respondents from Hospitals 1A, 1B, and 4, six from Hospital 2, and five from Hospital 3. As shown in Table 3, ten respondents (19.6%) in total reported a master's degree as the highest level of education. Of the master's degrees, one half were in nursing. No respondents reported an educational level beyond the master's degree. Table 4 illustrates the educational profile of head nurses in Canada and in British Columbia according to Statistics Canada (1991) and the educational profile of the entire sample of head nurses in this investigation. To facilitate comparison, the educational categories are grouped and reported as three levels of: (a) nursing diploma plus post-basic diploma/certificate; (b) baccalaureate degree or diploma plus degree courses; and (c) a master's/ higher degree. Only 27.5% (n=14) of the head nurse respondents reported a diploma as the highest level of education.  49 Table 2 Basic Preparation of Head Nurses by Hospital Hospitals 3  4  n (%)  n^(%)  n^(%)  1 (12.5)  6 (50.0)  5 (45.4)  1 (9.1)  2 (22.2)  0 (0.0)  2 (16.7)  2 (18.2)  1 (9.1)  5 (55.6)  6 (75.0)  4 (33.4)  4 (36.4)  7 (63.6)  Non-nursing 1 (11.1) baccalaureate degree  1 (12.5)  0 (0.0)  0 (0.0)  1 (9.1)  lA  1B  Basic Education  n (%)  n (%)  Nursing diploma  1 (11.1)  Some university courses Nursing degree  Total (N=50)  n=9 (100%)  2  n=12 (100%)  n=8 (100%)  n=10 (91.9%)  n=11 (100%)  Table 3 Graduate Preparation of Head Nurses  by  Hospital 4  Graduate Education  1A  1B  2  3  n (%)  n^(%)  n^(%)  n  Master's nursing  2 (22.2)  2 (25.0)  1^(8.3)  0 (0.0)  0 (0.0)  0 (0.0)  0^(0.0)  1 (9.1)  3 (27.3)  1 (9.1)  3 (27.3)  Master's 1 (11.1) non-nursing Total  3 (33.3)  2 (25.0)  1^(8.3)  (%)  n (%)  50 Table 4 Head Nurses Employed in Hospitals by Level of Education  Levels of  Canada *  Education  n=5,646^(%)  Nursing diploma & nursing plus post-basic diploma Baccalaureate degree^(nursing)  4,453^(78%)  B.C.* n=1,192^(%)  931^(78%)  Study Sample n=51^(%)  14^(27.5%)  1,132^(20%)  246^(21%)  26^(51.0%)  (other)  not reported  not reported  3^(5.9%)  Diploma plus degree courses  not reported  not reported  7^(13.7%)  Master's/Higher degree (nursing) (other)  61^(1%)  15^(1%)  10^(19.6%)**  61^(1%)  15^(1%)  5^(10.3%)**  not reported  not reported  5^(10.3%)**  Missing^24^(.004%)^3^(.003%)^1 (2%)  *^Source: Statistics Canada (1991) ** Percentage of total sample  51 A diploma plus some courses towards the baccalaureate degree was reported by 13.7% (n=7) of participants. Fifty-one percent (n=26) held a baccalaureate degree in nursing and 5.9% (n=3) held baccalaureate degrees in a non-nursing area. The educational profile of this sample of head nurses is strikingly different from that of the population of head nurses employed in hospitals in Canada (Statistics Canada, 1991). Statistics Canada (1991) reported that, of hospital nurses employed in the position of head nurse, 51% held a nursing diploma, 27% held a post-basic diploma/certificate, 20% held a baccalaureate degree and 1% held a master's degree or higher. Some educational differences are evident in the province of British Columbia, as reported by Statistics Canada (1991) for hospital nurses employed in the position of head nurse. Specifically, those who held a diploma as their highest level of education accounted for only 32% of the population, while 47% of head nurses held a post-basic diploma/certificate. Similar to the statisics for Canada, 21% of provincial hospital head nurses held a baccalaureate degree and 1% possessed master's/higher degrees (Statistics Canada, 1991). These statistics suggest that head nurses in B.C. have higher levels of education than do head nurses generally in Canada, particularly with regard to courses towards a baccalaureate degree and baccalaureate and master's preparation. There are four likely explanations for the variance in educational profile between the study sample and the population  52 of head nurses in Canada as reported by Statistics Canada. First, all hospitals included in the study are in the Lower Mainland of British Columbia and, thus, are in close proximity to two universities both of which offer opportunities for part-time and distance study. Second, the tertiary level hospitals from which samples were drawn now require a baccalaureate degree in nursing as the minimum qualification for a head nurse position, and prefer candidates with a master's degree. Third, Statistics Canada (1991) identifies four categories of hospital head nurses by highest level of education: nursing diploma, post-basic diploma/certificate, baccalaureate degree, and masters or higher degree. Thus, only completion of a baccalaureate degree enables the head nurse to meet the criteria for that category. Those currently undertaking study toward a baccalaureate in nursing are not identified. Further, no category specifying area of study exists within each degree category which precludes delineating nursing and non-nursing degrees. In contrast, this investigation identified in a separate category those subjects who had completed courses towards a baccalaureate degree and also identified whether each degree held was in nursing or a nonnursing area. Last, some systematic differences are likely in this sample owing to the sampling method wherein subjects were nominated as potential subjects and not randomly selected. Age.  Almost half of the respondents (47.8%; n=22) were 39 years of age or younger as shown in Table 5. Respondents ranged from  53 25 to 60 years with a mean age of 42.2 years. The majority (54.4%) of the head nurses were between the ages of 35 and 47, while 23.9% of respondents were 50 years of age or over. Only 17.4% of head nurses were 34 years of age or younger.  Table 5 Age Distribution of Sample  Age Range  under 25 25 -29 30-34 35-39 40-44 45-49 50-54 55 -60 not reported Total  n  %  Cumulative %  0 2 6 14 10 3 5 6 5  0.0 4.0 11.8 27.4 19.6 6.0 9.9 11.9 9.8  0.0 4.3 17.4 47.8 69.6 76.1 87.0 100.0  51  100.  100.0  These figures are almost identical to those reported for both Canada and British Columbia. As can be seen in Table 6, Statistics Canada (1991) reported that 54% of head nurses employed in Canada and 54% of those employed in British Columbia were between the ages of 35 and 49 and, in both groups, 35% of the head nurses were 50 years of age or over. From both national and provincial figures, almost 11% of the head nurses were 34 years of age or less, whereas that age range circumscribes 17.4% of respondents, and a smaller percentage of respondents were 50  54 Table 6 Head Nurses Employed in Nursing by Age ^ Canada*^B.C.*^Study Sample Age Range  under 25 25-29 30-34 35-39 40-44 45-49 50-54 55 and over not reported  n=8,161  n=1,420  n=51  n^(%)  n^(%)  n^(%)  13 236 (3) 684 (8) 1,365 (17) 1,538 (19) 1,498 (18) 1,295 (16) 1,525 (19) 7 (0.0)  30 (2) 122 (9) 216 (15) 271 (19) 285 (20) 244 (17) 252 (18) 0 (0.0)  2 (4.3) 6 (11.8) 14 (27.4) 10 (19.6) 3 (6.0) (9.9) 5 6 (11.9) 5 (9.8)  * Source: Statistics Canada (1991).  years of age or more, which indicates that a larger percentage of the head nurse subjects were younger. Gender. The respondents were 96.1% female and 3.9% male, the proportion of which is similar to that reported for head nurses employed in Canada (97% female, 3% male) and those employed in British Columbia (96% female, 4% male) (Statisics Canada, 1991). Dunham and Klafehn (1990) reported that of 80 nurse executives studied, 92% were female and 8% were male, while all 43 head nurse subjects in another study were female (Miller & Heine, 1988). Marital status. The marital status of the head nurses in this sample  55 indicated 51.0 % were married, 29.4% never married, 2.0% were separated, 13.7% were divorced, and 2.0% were widowed. For head nurses in general in Canada, Statistics Canada (1991) reported that marital status was not reported for 57% of the population, while for those responding, 30% were married, 7% were single and 6% were in the category "other." For the province of British Columbia, Statistics Canada (1991) reported the marital status of employed head nurses as 67% married, 18% single, 15% other, and not stated for 1% of the group. Nursing, management, position, and organizational tenure.  In terms of experience, the head nurses in the sample had been employed in nursing for a mean of 19.3 years and had worked in a head nurse position for a mean of 8.7 years. From the sample, 52.9% of respondents have 7 or less years of experience as a head nurse, and only 37.3% of the nurses have 10 or more years of management experience. Respondents indicated that they had held their current position for an average of 6.3 years and almost half of the participants (n=24; 47.1%) had held their current position for 3 years or less. The head nurses in the sample had been employed at their current hospital for an average of 11.3 years. While no national data exist regarding head nurse tenure in nursing, management, position, or the organization, the patterns of these variables for this sample are consistent with those reported in the literature. Storch Ringerman (1990) reported that the 292 nurse manager respondents in that study had  56 been nurses for an average 18.25 years and had worked in their current positions for a mean number of 6.35 years. Weaver, Byrnes, Dibella and Hughes (1991) reported that, of 113 acute care nurse manager subjects, the mean number of years in nursing was 17.4, while Duffield (1992) reported that the mean number of years in nursing for 318 nurse manager respondents was 14.7. The mean number of years both in a head nurse position and in their current head nurse position for Duffield's (1992) sample was 4.7. Miller and Heine (1988) indicated that over half of the 43 head nurse participants in their study had been employed at their current hospital for six years or more, whereas the 155 middle nurse managers in Patz, Biordi and Holm's (1991) study had worked at their current institution for an average of 8 to 11 years.  Clinical focus of unit. Of the head nurse participants in this study, 21.6% indicated that they managed medical units, 31.4% surgical units, 9.8% critical care units, 3.9% operating rooms, 3.9% psychiatry, 13.7% geriatrics, 2.0% obstetrical units, and 13.7% reported "other" (e.g., outpatient units). Regrouped for purposes of comparison: 72.6% managed medical-surgical units, 13.0% critical care units and 13.75% other kinds of units. The distribution of clinical focus for this sample differs from Storch Ringerman's (1990) sample, wherein 80% of 113 head nurse subjects managed inpatient units and of those, 36% of the respondents in that study managed medical-surgical units and 23% managed critical  57 care units (Storch Ringerman (1990). Operating budget responsibility. The head nurse respondents in this study indicated that they were responsibile for a mean number of 30.8 full-time equivalents (FTEs) which is similar to the 25.4 FTEs reported by head nurse respondents in Miller and Heine's (1988) study. Using the B.C. nurses collective agreement, the annual budget for this number of FTEs is approximately $1,090,320 (Cdn.). Patz, Biordi, and Holm (1991) reported that middle nurse manager subjects with responsibility for three or more units managed average budgets of $8.9 million (U.S.). Dunham and Klafehn (1990) reported that, for the nurse executive sample, the range of the total number of FTEs for which these executives were responsible was 118 to 2050. Salary. Most of the demographic information in the MLQ overlapped with that identified in the form drafted by the investigator. However, one useful MLQ demographical parameter that provided information about the study sample related to salary. The salary range reported by all of the head nurse subjects was $40,000 to $59,999 (Cdn.) per annum. This range for the subjects is fixed, as all hospitals included in the study pay head nurse salaries according to the nurses' collective agreement. The annual salary of respondents contrasts with Hodges, Knapp and Cooper's (1987) finding that 50.2% of head nurse subjects earned an average annual salary of $25,000 to  58 $29,000 (U.S.). It should be noted, however, that four years have elapsed since that finding was reported and further, the salary range is reported in U.S.A. figures. The current finding is similar to that reported by Patz et al. (1991) that middle nurse manager subjects (n=155) earned an average annual salary of $50,000 to $59,000 (U.S.). In summary, the characteristics of this sample of head nurses, with the exception of educational preparation, are similar to those described in other reports and studies. ^In relation to national and provincial data, the head nurses in this sample were of similar ages, marital status, and gender distribution. However, the educational level of this sample was reported to be higher than those in either provincial or national data. Research Questions Head Nurse leadership styles and normative data. The descriptive analysis of the MLQ data from the study sample is presented and compared to normative data to answer the first research question: How do head nurse leaders describe their leadership from transformational and transactional perspectives and the outcomes of that leadership? Normative data for all measures of the MLQ are the result of 1,006 employees describing the leadership of their immediate supervisors and 251 supervisors, representing first- to upper-level management, completing the self-rating form of the ML() to evaluate how frequently they engage in a specific leadership behaviour. Data  59 were obtained from subjects in numerous settings in both the public and private sectors (Bass & Avolio, 1990). For all five hospital subgroups of head nurse participants, a one-way analysis of variance was conducted to determine if the subgroups were significantly different from one another with regard to the leadership factors and the outcome factors. The results indicated that the subsamples were not significantly different with respect to any of the leadership or outcome factors. Table 7 presents the means and standard deviations for the ten scales of the MLQ for the study sample and for the normative data together with the differences expressed in Z scores. A number of initial impressions arise from reviewing the  sample means and standard deviations. For example, the mean tranformational composite score (i.e., grand mean for the four TF factors) is 3.23. Since a score of 3.0 means that this style occurs fairly often and a score of 4.0 means that this style is occurring frequently, if not always, the results indicate that this sample perceived themselves as possessing a predominantly TF leadership style. That observation gains further support by noting the composite score for the two factors associated with the transactional leadership style, which for the head nurse respondents was 2.17. Based on the scale provided this means that the head nurses see themselves as "sometimes"  60 Table 7 Comparison of the Leadership Styles and Outcome Factors between Study Sample and Normative Group  Study Sample^Norm group Difference n=51^n=251  Mean  Mean  SD  Z-Score  SD  Leadership Factors Transformational^(TF) Charisma Inspiration Intell.^Stimulation Indiv. Consideration Composite TF Score  2.90 2.36 2.93 3.10 2.82  .52 .50 .44 .45 -  4.71* 10.57* 3.57* 6.20* 8.20*  3.23 3.10 3.18 3.41 3.23  .47 .50 .49 .35 .38  2.61 1.73 2.17  .54 .56 .47  2.16 1.91 2.04  .60 .41  5.63* -2.25 1.86  1.10  .50  .90  .44  2.86*  2.92 3.08 3.50  .76 .43 .51  2.82 2.97 3.12  .73 .49 .64  .91 1.83* 5.43*  Transactional^(TA) Contingent Reward M.B.E. Composite TA Score Nonleadership Laissez-faire Outcome Factors Extra Effort Effectiveness Satisfaction  Note: MLQ rating scale ranges from 0 to 4 * Q. <.05  61 possessing the transactional characteristics. Therefore, this sample of head nurse leaders indicated from their perception that their leadership is predominantly transformational, but is also, to a lesser degree, transactional. For the Nonleadership category, the head nurse respondents indicated an overall score of 1.10 (S.D.=.50) which means "once in a while" subjects engaged in laissez-faire behaviours that reflect the absence of leadership, the avoidance of intervention, or both. In observing the mean scores for each leadership subscale, every TF score exceeded each of the TA scores. This sample of leading head nurses possesses a TF leadership style, while to a lesser extent pays attention to operational detail, which is the combination of scores that researchers have found provides the most effective leadership (Bass, 1985b; Bass, Avolio, & Goodheim, 1987; Dunham & Klafehn, 1990). The TF factors of Individualized Consideration and Charisma were rated highly by the head nurse respondents with mean scores of 3.41 and 3.23, respectively. This finding is consistent with Hater & Bass's (1988) finding that, when 312 subordinates rated the leadership of 54 managers, those identified as top performers (n=28), were not only rated higher on TF leadership, but were also rated significantly higher on charismatic leadership (7=3.21 versus 7=2.95, p<.05), and on individualized consideration (Y=3.08 versus 7=2.79, a <.01), than the randomly chosen sample of ordinary managers (n=26). Moreover, for the study sample all of the scores were  62 tightly clustered around the mean. This suggests that there is a high degree of agreement among the head nurses' perceptions that they treat staff differently, but equitably, on an individual basis, and not only recognize the staff nurse's needs, but raise these to higher levels. Strong agreement between respondents was also found on the dimension Charisma. This indicated agreement that these head nurses perceived themselves as leaders with whom staff nurses identify and who they emulate, and who staff trust and see as having both an attainable mission and a vision. Of the transactional factors, contingent reward was the highest scored factor, with a mean of 2.61. This variable also exhibited a somewhat wider variation (S.D.=.54) about the mean and, thus, a lower degree of agreement among the head nurses that they perceived themselves placing emphasis on exchanging rewards for performance in interchanges with nurses. Even more variation of opinion was found on the Management-By-Exception factor, with a mean of 1.73 and a S.D. of .56 indicating lower agreement for this sample of head nurses that they intervened only after mistakes occurred. Generally, in MBE, the modes of reinforcement are criticism, correction, negative feedback, and negative reinforcement.  Transformational factors. Bass (1985b) described the transformational leader as one who motivates followers to do more than they originally  63 expected. Such a transformation can be achieved by raising followers' awareness of the importance and value of designated outcomes, motivating followers to transcend their own selfinterests for the interest of the work group or organization, and altering or expanding followers' needs on Maslow's hierarchy of needs (Bass, 1985b). Transformational leadership is postulated to be responsible for subordinates performing beyond expectations, as well as for exceptional achievements. Its motivational potential surpasses that of leadership characterized by leader-follower exchanges or transactions. Transformational and transactional leadership differ both with regard to the process by which the leader motivates subordinates, and the types of goals set. For all of the four dimensions of TF leadership, sample means for the head nurse participants were significantly higher than those in the normative group. Those dimensions were Charisma, Individualized Consideration, Inspiration, and Intellectual Stimulation. Charisma refers to the degree to which followers identify with and emulate the leader, who is trusted and seen as having an attainable mission and vision (Bass & Avolio, 1990). The mean score for the study sample (3.23) indicated that these head nurses from their perception employ a high degree of charismatic influence through which staff nurses gain confidence and trust in their manager and view the head nurse as having referent power. Head nurses in this study had a mean score (I= 3.23) that was  64 significantly higher than that of the normative group (f=2.90, Z=4.71) indicating that these head nurses see themselves as respected managers, who hold high standards, and set challenging goals for staff. This finding is important as charismatic leadership is central to the transformational process. Moreover, findings from a study conducted by Bass, Avolio, and Goodheim (1987) indicated that charisma accounts for the largest percentage of common variance (28%) in transformational leadership ratings while Waldman et al. (1990) found that charisma added unique variance (8 to 34%) beyond that of contingent reward in each effectiveness measure. Staff want to emulate their charismatic leaders; nurses place a great deal of trust and confidence in the vision and values espoused by the head nurse leader, and typically develop intense emotional feelings about these head nurses. The construct, Inspiration, may or may not overlap with charismatic leadership, depending on how much followers seek to identify with the leader (Bass & Avolio, 1990). This factor refers to leadership that provides symbols and images to increase followers' awareness and understanding of mutually desired goals. The high mean score (3.10) obtained by the study respondents indicated that they see themselves as fairly often engaging in symbolic behaviours to raise staff nurse's expectations and beliefs concerning the mission and the vision for the hospital and the nursing unit. Head nurses in this study obtained a significantly higher mean score (3.10) than that of the normative  65 group (2.36). This implies a perception on the part of these nurse managers that they use symbols and images to focus the efforts of staff nurses toward achievement of shared goals. Intellectual Stimulation refers to the degree to which leaders encourage subordinates to question their routine approaches to work and their own values, beliefs and expectations as well as those of the leader and of the organization (Bass & Avolio, 1990). The high mean score (3.18) achieved by the study sample for this subscale implies that the head nurse respondents support staff nurses to think independently, address challenges, and consider different ways to develop their abilities. The mean score obtained by these nurses (Y=3.18) was significantly higher than that of the normative group (7=2.93). The head nurses indicated that they fairly often encourage staff nurses to think about old problems in new ways, whereas the majority of normative leaders engage in such behaviours, only "sometimes." As a consequence of being intellectually stimulated, nurses develop their own capabilities to solve problems which is key as nursing moves to primary nursing models and shared governance. Individualized Consideration describes behaviours wherein staff are treated differently but equitably on a one-to-one basis. Further, it describes the extent to which the leader recognizes the needs of staff and the means by which staff can more effectively meet goals and challenges. For this factor, the sample mean (Y=3.41) and the normative mean (Y=3.10) were  66 statistically different. Further, this was the highest mean score for head nurses on any variable in the MLQ. Head nurses reported strongly and uniformly that they determine the individual nurse's needs and attempt to raise these to higher levels. The high score (3.41) for the study sample on the Individualized Consideration subscale indicates these nurse managers perceive that they focus strongly on the development needs of their staff, for example, they delegate patient assignments according to the learning opportunities that they provide the particular nurse. The composite score (i.e., grand mean) for the TF scores for the sample group was 3.23 (S.D.=.38), whereas that for the normative group was significantly lower at 2.82 (Z=8.20). This finding is consistent with that of Dunham & Klafehn (1990) who reported that the transformational scores of the 80 nurse executives in that study were higher than those of world leaders, administrators and managers in studies conducted by Bass (1985b). Similarly, Hater & Bass (1988) reported that top performing managers (n=28) scored significantly higher than ordinary managers (n=26) on the Charismatic and Individualized Consideration dimensions of transformational leadership, and higher though not significantly so on the Intellectual Stimulation dimension. Further, these researchers reported a significant correlation between the transformational factors and the top performing manager category. This result for the study sample was predictable from Bass & Avolio (1990) report from  67 normative group findings that female leaders tend to score higher in transformational and lower in transactional leadership than their male counterparts.  '  The present results replicate the findings of earlier studies (Bass, 1985; Bass, Avolio & Goodheim, 1987; Waldman, Bass & Einstein, 1987; Waldman, Bass & Yammarino, 1990) that support the basic propositions of the transformational model. The model postulates that tranformational leadership is not uncommon in different organizational settings including hospitals, nor is it limited to upper level managers and worldclass leaders. Some degree of TF leadership is practiced at the most senior levels down to first-level management in all settings as was the case in this study. Transactional factors. Transactional leadership is characterized by the two factors of Contingent Reward and Management-By-Exception. The active transactional leader, through an exchange with subordinates, emphasizes the giving of rewards if subordinates meet agreed upon standards (Contingent Reward). This form of leadership emphasizes the clarification of goals, work standards, and assignments. The less active transactional leader practices avoidance of corrective action (Management-By-Exception) as long as standards are being met (Bass, 1985b). Comparing mean scores obtained by head nurses in the sample and leaders in the normative group, a significant difference was found for the Contingent Reward factor but not for the Management-By-Exception  68 factor. Contingent Reward refers to leadership that recognizes the roles and tasks required for followers to reach desired outcomes. Interactions between leader and followers emphasize an exchange wherein the leader provides appropriate rewards when staff meet mutually agreed-upon objectives. Further, subordinates' needs are identified, then linked both to what the leader expects to accomplish and to rewards if objectives are met. The Contingent Reward mean score for the study sample (2.61) indicated that head nurses perceive that they engage at least sometimes in interactions with staff nurses to emphasize an exchange that involves rewards for the staff nurse when s/he meets agreed-upon goals. Further, this sample of nurse managers identified staff's needs and linked these to both the manager's expectations and to rewards for goal achievement. This finding contrasts with Hater & Bass's (1988) finding of no significant differences between the top-performing manager and the ordinary manager subsamples for the Contingent Reward factor, and with Bass and Avolio's report from the normative findings that female leaders generally scored lower on the TA factors than their male counterparts. Although the current sample was not selected according to the performance criteria for Hater & Bass's (1988) sample of top-performers, the nurse subjects were nominated for their leadership by nurses at all management levels, which suggests they are more similar to top performers than ordinary managers.  69 Burns (1978) defines a transactional leader as one who is more concerned with the traditional management functions and the day-to-day operations. Bass, Avolio and Goodheim (1987) posit that transformational leadership is not effective if it stands alone. The most effective transformational leader must also be adept at managing the daily operation, generally considered the purview of the transactional leader. This sample of nurse  managers indicated that they engaged in Contingent Reward transactions to a greater degree than managers in the normative group. One may postulate that, given the unique advanced educational preparation of this sample, subjects likely have a management qualification, at least at the baccalaureate level, which would have addressed the theory of contingent reward. Management-By-Exception (MBE) refers to the extent to which a leader allows the status quo to exist without being addressed. Only when things go wrong will this leader intervene to make some correction. Generally, the modes of reinforcement applied involve correction, criticism, negative feedback, and negative contingent reinforcement, rather than the positive reinforcement used with Contingent Reward leadership. Punishment is also used in conjunction with MBE (Bass & Avolio, 1990). The mean for the sample of head nurses (I=1.73) was lower than the mean for the normative group (f=1.91) but this finding was not statistically significant. Although not signifcant, this negative finding suggests that these head nurses intervene and take corrective measures before substandard nursing  70 care is delivered by staff working on the unit. Moreover, this finding implies that head nurses use measures other than criticism, correction, and negative reinforcement to address problems with staff. This sample of nurse managers indicated a propensity to intervene and not "avoid trying to change what they (staff) do as long as things go smoothly." This finding may well be describing a fundamental responsibility of the head nurse role. While standards of nursing care generally refer to the desired level of achievement for quality patient care, the baseline criterion for acceptable performance is patient safety. Therefore, when a head nurse evaluates nursing interventions against the standard and deems these potentially problematic, the head nurse must intervene to prevent negative consequences to patient care. This explanation is congruent with Bass & Avolio's (1990) proposition that MBE may be more situationally determined than any other of the MLQ factors, so that the situation or context may moderate the use of MBE. This finding is also related to that of Bass, Waldman, Avolio & Bebb (1987) in a study of employees' (n=280) perceptions of leadership, both actual and required, of first and second-line managers (n=56). Employees in both groups indicated less MBE was required (7=1.63) than was observed (F=1-95). Also related is Hater & Bass's (1988) finding that, within the topperformer sample, the transactional factors correlated poorly or negatively with individual performance and negatively with work  71 group performance. In addition, these researchers reported that, within the ordinary manager sample, both transactional factors correlated negatively with the individual performance criteria. Nonleadership. Laissez-faire, the only nonleadership factor, indicates the absence of leadership, the avoidance of intervention, or both. In "avoiding" leadership, there are generally neither transactions nor agreements with followers. Decisions are often delayed; feedback, rewards and leader involvement are absent; and there is no attempt to motivate followers or to recognize and satisfy staff's needs (Avolio & Bass, 1990). For this factor, these head nurses obtained a sample mean (Y=1.10) which was significantly higher than that of the normative group (Y=.90), but this also represents the lowest mean score on any variable in the MLQ. This finding means that the head nurses perceived that they rarely avoid leadership. The explanation for this result is not obvious. No leadership study was found that reported findings related to this variable. One can only speculate that, given the shift to, and emphasis on, more autonomous practice for staff nurses, these managers, albeit infrequently, engaged in behaviours that reflect items such as: "avoid telling them (staff) how to perform their jobs;" "avoid getting involved in their (staff's) work;" and perceive that the head nurse's presence "has little effect on their (staff's) performance."  72  Outcome factors. Bass's model (1985b) postulates that transformational leadership contributes to the prediction of follower outcomes beyond that of transactional leadership. Empirical evidence has supported this proposition in that transformational leadership has been positively correlated with how much effort subordinates say they will expend for the leader, how effective the leader is as perceived by subordinates, how satisfied the subordinates are with the leader, and how well subordinates perform as rated by the leader (Bass, 1985b; Bass, Avolio & Goodheim, 1987; Hater & Bass, 1988; Singer, 1985). In the same studies, transactional leadership (Contingent Reward and MBE) was also positively correlated with these outcomes, but, in general, the relationships were considerably lower than those found for transformational leadership. Extra Effort describes the extent to which the leader perceives that followers exert effort beyond the ordinary as a consequence of the leadership. This factor is scored on the same 5-point Likert scale described earlier for the leadership factors in the MI .1 (Bass & Avollo, 1990). The mean score for the -  nurse respondents (2.92) indicated their view that staff nurses fairly often exert extra effort because of the leadership provided by the head nurse. Comparing the mean score obtained by head nurses in the sample (i=2.92) with that of the normative group (7=2.82), the head nurses scored more highly on this factor, although the difference is not statistically  73 significant. Both the head nurses and the normative group perceived that their staffs expend effort (beyond what is expected) owing to the leadership provided. Effectiveness reflects a leader's perception of effectiveness in four areas: meeting the job-related needs of followers; representing followers' needs to higher-level managers; contributing to organizational effectiveness; and performance by the leader's work group (Bass & Avolio, 1990). A five-point rating scale rating the frequency of leader behaviours is used for effectiveness (0=not effective; 1=only slightly effective; 2=effective; 3=very effective; 4=extremely effective). This sample of nurse managers obtained a mean score (g=3.08) that was significantly higher than that obtained by managers in the normative sample (g=2.97). The nurse respondents indicated that their leadership is perceived as very effective in meeting staff's needs and presenting these to superiors. In addition, the head nurses indicated a perception that, because of their leadership, their unit is very effective in meeting organizational goals. Satisfaction reflects how satisfied the leader is, and perceives subordinates are, with the leader's style and methods, as well as how satisfied staff are in general with the leader. This factor is scored on a 5-point rating scale (0=very satisfied; 1=somewhat dissatisfied; 2=neither dissatisfied or satisfied; 3=fairly satisfied; 4=very satisfied) (Bass & Avolio, 1990). Nurse managers in this study obtained a significantly  74 higher mean score (3.50) than did normative managers (3.12). Of all mean scores on the MLQ, this was the highest, indicating these head nurses believed staff nurses are fairly satisfied with the manager's leadership behaviours and their leader in general, and the managers themselves are satisfied with these. In summary, these head nurses described their own leadership as predominantly transformational, while to a lesser extent, transactional. In influencing staff nurses, they highly and uniformly reflect individualized consideration and charisma. To a lesser degree, they engage in leadership activities to intellectually stimulate and inspire staff nurses to transcend their self-interests for the sake of patient care, the nursing unit or the hospital. This sample of nurse managers approaches staff nurses with an eye to exchanging rewards for performance in meeting shared goals and intervening early to prevent problems. They also indicate satisfaction with their methods of leadership and perceive these as effective measures that promote staff to perform beyond expectations.  Leadership Styles and Outcome Factors  The results of the correlational analysis address the second research question: What are the relationships among transformational, transactional, and nonleadership styles and between leadership styles and outcome factors for head nurse leaders as measured by scores on the MLQ? Pearson's correlation coefficient was used to test the relationships among  75 transformational, transactional, and nonleadership styles, and between those styles and the outcome factors, respectively (Table 8). Transformational leadership was significantly correlated with all three outome factors: Extra Effort (r=.7300), Effectiveness (r=.4568), and Satisfaction (r=.5540). The strength of the correlations was moderate for Effectiveness, and strong for both Satisfaction and Extra Effort. This is consistent with Seltzer & Bass's (1990) finding of moderate correlations between transformational scores and all three outcome measures. Surprisingly, in the current study, a weak (r=.1461) and statistically nonsignificant correlation was demonstrated for transformational leadership with transactional leadership. By contrast, Dunham and Klafehn (1990) found that those nurse executive subjects (n=80) who rated themselves highly on TF also rated themselves highly on TA leadership. Those researchers posit that this finding may be a measure of the executive's self-esteem or experience. Similarly, the inexperience of the head nurse subjects may explain the nonsignificant correlation found between TF and TA leadership for this sample. Almost half of the respondents (47.1%) had held their current head nurse position for 3 years or less. Moreover, Bass et al. (1987) confirmed significant correlations both for the TF factors and Contingent Reward between behaviours observed in the first-level manager subjects (n=56) and those observed in their superiors. The researchers concluded that the leadership patterns between  TABLE 8 INTERCORRELATIONS BETWEEN LEADERSHIP STYLES AND OUTCOME FACTORS T.F.  T.A.  T.F.  1.0000  .1461  T.A.  .1461  1.0000  NONLEADERSHIP  -^.1034  .2712*  NON LEADERSHIP -^.1034  EFFORT  EFFECTIVENESS  SATISFACTION  .7300 **  .4568**  .1053  .1346  -^.0372  1.0000  -^.1457  -^.0673  -^.0505  1.0000  .2712*  EFFORT  .7300 **  .1053  -^.1457  EFFECTIVENESS  .4568^**  .1346  -^.0673  .2960 *  SATISFACTION  .5540 **  -^.0372  -^.0505  .3619^**  .2960 * 1.0000 .4976 **  .5540 **  .3619^** .4976 ** 1.0000  p <.05*, r=.235 p <.01**, r=.328  41  77 subordinate-superior tended to match each other which may relate to modeling behaviours and selection practices. Thus, it may be that the second-level nurse manager selects for hire the firstline manager whose leadership behaviours do not reflect a consistent TA to TF pattern, and then the superior continues to model an inconsistent pattern for the inexperienced head nurse. Transactional leadership was weakly, but significantly correlated with nonleadership (Laissez-faire) (r=,2712). This implies that the more the head nurse offers staff rewards for performance and does not intervene in problems, the more s/he also "avoids" leadership. No significant correlations were obtained for transactional leadership with any of the outcome factors (i.e., Extra Effort, r=.1053; Effectiveness, r=.1346; and Satisfaction, r=-.0372). Although not statistically significant, the negative correlation between TA leadership and Satisfaction suggests that the more the head nurse engages in Contingent Reward and MBE behaviours, the less satisfied the head nurse is and perceives staff to be with her leadership. Nonleadership was significantly correlated only with transactional leadership (r=.2712) as reported. The outcome factor, Extra Effort, was significantly correlated with Effectiveness (r=.2960), Satisfaction (r=.3619), and transformational leadership (r=.7300). The strength of the correlation with Effectiveness was weak, while moderate with Satisfaction. In addition, the outcome factor, Effectiveness was significantly correlated with Satisfaction (r=.4976). The  78 correlations between Effectiveness and Extra Effort, and Effectiveness and Satisfaction, respectively, were weak and moderate. With respect to Satisfaction, the three correlations previously described (i.e., Extra Effort, Effectiveness, and TF) were all highly significant. The results indicate that, for this sample of head nurses, the leadership style that they perceived particularly linked with the outcomes of staff's Extra Effort, Satisfaction and Effectiveness, predictably, was transformational. However, contrary to prediction was the lack of significant relationship between TF and TA leadership. These results support the proposition of Bass's (1985b) model that TF leadership is linked to outcome measures beyond that of TA leadership. The findings support the proposition of Bass's (1985b) model that there are significant relationships between leadership style and outcome factors. All outcome factors were significantly correlated with TF leadership. No significant relationship was found between any outcome factor and TA leadership. Extra Effort and Effectiveness outcomes correlated positively with TA leadership, but a negative correlation was found between TA leadership and Satisfaction. The outcome factors Extra Effort, and Satisfaction were strongly related to TF leadership, while Effectiveness was moderately related. With one exception, these findings lend support to Bass's (1985b) model which postulates that TA leadership is positively correlated with these outcomes, but, in general, the  79 relationships are considerably lower than those found for TF leadership. The exception was that Satisfaction correlated negatively with TA leadership. No significant correlations were found for TF leadership and TA leadership, or between TF and nonleadership. However, TA leadership correlated significantly with nonleadership. The nonleadership factor, Laissez-faire, was weakly associated with TA leadership.  Selected Professional and Demographic Characteristics and TF Leadership  The results of the chi-square analysis address the third research question: What is the relationship between selected demographic and professional characteristics and level of transformational leadership for head nurse leaders as measured by scores on the MLQ? Using seven selected professional and demographic characteristics of the head nurse and three measures of TF leadership, a 7 cell chi-square was developed (Table 9). Only two head nurse characteristics approached significant associations with level of TF score. These characteristics were age and years of experience in nursing. Age was positively associated with TF score at the .15 level (X 4 =6.67). Of those scoring in the top one third (TF>3.4) on the TF scale, almost half (42.9%) were less than 36 years of age. Of those scoring in the middle one third (TF=3.0-3.4), the majority (56.3%) were between 36 and 48 years of age. Of those  TABLE 9 CHI-SQUARE RESULTS OF SELECTED PROFESSIONAL AND DEMOGRAPHIC HEAD NURSE CHARACTERISTICS AND LEVEL OF TF LEADERSHIP HEAD NURSE CHARACTERISTICS  TF LEADERSHIP  AGE  6.67057 .1544 4  EDUCATIONAL PREPARATION  6.65516 .3539 6  YEARS EXPERIENCE  6.33594 .1754 4  YEARS AS HEAD NURSE  1.21771 .9760 6  TENURE CURRENT POSITION  2.37812 .6666 4  CLINICAL FOCUS  3.35217 .5007 4  F.T.E.'S  2.84477 .5842 2  Xz significance level d.f.  < .05*  81 scoring less than 3 on the TF scale, most (70.0%) were between 36 and 48 years old. Years of experience in nursing was positively associated with TF score at the .17 level of significance (e=6.34). Of the top one third TF scores (TF>3.4), the majority (42.1%) had less than 15 years of experience. Of those who scored between 3.0 and 3.4 on the TF composite score, most (55.0%) had between 15 and 28 years in nursing. Of the bottom one third TF scores, almost half (45.5%) had between 15 and 28 years of experience. In sum, the majority of respondents obtaining the top third of TF scores were less than 36 years of age and had less than 15 years experience working as a nurse. These nonsignificant findings were unpredicted as they differ from those reported in the literature. For example, Dunham & Klafehn (1990) reported that, for nurse executive subjects, the level of TF score was affected by demographic variables. Specifically, those with advanced degrees rated themselves in the top 50% of TF scores (TF>3.20). Further, the researchers found that those with master's preparation in nursing were more transformational than those with master's preparation in other areas. All other tests examining demographic variables in that study (i.e., age, FTEs, position tenure, marital status) were not significant. Hater and Bass (1988) reported that the top-performer sample of managers (n=28) who were rated higher than the ordinary manager sample on TF, were significantly older than the  82 ordinary managers, and had significantly longer tenure as managers. Further, no significant differences were found by these researchers on tenure in the company (Hater & Bass, 1988). However, the findings of the current study suggest that there is no significant association between professional and demographic characteristics of head nurse leaders, that is age, years of nursing experience, education (basic and advanced), tenure of nurse manager, tenure of current head nurse position, organizational tenure, clinical focus of unit, and FTEs, and level of TF score. Therefore, the focus on head nurse characteristics appears of little value to understanding TF leadership.  Summary The findings of this study have been presented in three sections. The first section presented the findings with regard to the sample which consisted of 51 head nurses nominated for their leadership from four hospitals in Lower Mainland British Columbia. The head nurses in this sample were found to have characteristics similar to those reported in the literature. However, the level of education among the head nurses in this sample was higher and the age of respondents was lower than those recorded in other studies and reports. The second section described and discussed the study findings relative to two research questions concerning the levels of TF, TA, and nonleadership, outcome measures, and the relationship among these factors. Both descriptive and  83 correlational analyses were employed. In relation to the first research question, the study sample was compared to normative data and samples from related'studies. The results indicated that the mean scores for the study sample on each of the four TF leadership subscales on the MLQ were consistently higher than the normative group means and the means in other studies. Further, the mean scores for this sample of head nurses for the TA subscale, Contingent Reward and for the nonleadership subscale were consistently higher than the normative means. The study sample was generally characterized by TF leadership with a preference for individualized consideration and charisma, and to a lesser extent by TA leadership. In addition, mean scores for this sample of head nurses on each of the outcome measures were consistently higher than those of the normative group. The study findings relative to the second research question revealed no significant relationship between the level of TF score and the level of TA score for the study sample which was contrary to prediction from empirical evidence. However, significant correlations were found between all three outcome measures ( Extra Effort, Satisfaction, and Effectiveness) and TF leadership. The study was unable to confirm a correlation between these outcomes and TA leadership. Correlational results generally supported the theoretical model by Bass (1985b). The findings support the proposition of the model that there are significant relationships between leadership style and outcome factors, and that TF leadership is linked to outcome factors  89  beyond that of TA leadership. Finally, in the third section, a chi-square test of association was used to test research question three. The results failed to demonstrate a significant relationship between professional and demographic characteristics of the head nurses and levels of TF leadership.  85 Chapter Five Summary, Conclusions, and Implications  Summary The impetus for this study grew from the investigator's interest in leadership research in nursing. In the few studies found, researchers primarily investigated a single variable set, the initiation and consideration dimensions of leadership, and reported these findings most frequently from the perspective of the staff nurse. This study was designed to enhance knowledge about head nurse leadership from the perspective of head nurses themselves by using an established transformational leadership framework (Bass, 1985b) and a standardized tool called the Multifactor Leadership Questionnaire (MLQ) (Bass & Avolio, 1990). Data regarding demographic and professional characteristics of the respondents were collected via the Demographic Information Form which was developed by the investigator. Specific questions guiding the study were: (1) How do head nurse leaders describe their leadership from transformational (TF) and transactional (TA) perspectives and the outcomes of that leadership and how do the descriptions compare with those of a normative sample?; (2) What are the relationships among transformational, transactional, and nonleadership styles and between leadership styles and outcome factors for head nurse leaders as measured by scores on the MLQ?; and (3) What is the relationship between selected demographic and professional characteristics and level of TF leadership for head nurse leaders  86  as measured by scores on the MLQ? The study was carried out at four acute care hospitals in the Lower Mainland of British Columbia. Data were collected from 51 head nurses who were identified as leaders by superiors and/or colleagues. Each participant completed the Demographic Information Form and responded to the Multifactor Leadership Questionnaire. Data were analyzed using the computer program Statistical Package for the Social Sciences (SPSS-X). Descriptive statistics, Pearson's product-moment correlations, and chi-square, were used in the analysis. The findings related to the demographic and professional characteristics of this sample revealed that the majority of the head nurses were between the ages of 35 and 47. Most of the respondents were female and married. The average length of nursing experience was 19.3 years with a mean of 8.7 years for experience as a head nurse. The average length of current position experience was 6.3 years and almost half of the respondents (47.1%) had held their current position for 3 years or less. Respondents in this sample indicated that they had been with the current employer for a mean of 11.3 years. The majority of the head nurses (72.6%) indicated that the clinical focus of their unit was medical-surgical nursing while 13.0% managed critical care units and 13.7% other kinds of units. The number of FTEs on average for which these respondents were responsible was 30.8 and annual salaries were $40,000 to $59,999 (Cdn.). Of the entire sample, with respect to  87  educational level, 51% held the baccalaureate degree in nursing and 27.5% indicated a nursing diploma only as their highest level of education. From the total sample, ten respondents (19.6%) reported holding master's degrees, half of which were in nursing. The profile of this group of head nurses, generated from information about educational preparation, age, gender, marital status, tenure in nursing, management, position, and the organization, clinical focus, operating budget responsibility and salary was similar to that reported through national and provincial data and other studies with one exception. The educational level was found to be generally higher among this sample of head nurses than among those from other reports. The first research question asked how head nurse leaders describe their leadership from tranformational and transactional perspectives and the outcomes of that leadership and how the descriptions compare with those of a normative sample. The findings indicated that head nurse leaders perceive their leadership as predominantly transformational and, to a lesser degree, transactional. To a minimal degree, they describe engaging in nonleadership behaviours. In transformational leadership, the head nurses' self-perceptions demonstrated very high levels of Individualized Consideration and Charisma, and high levels of Intellectual Stimulation and Inspiration behaviours. For all four of these TF factors, the head nurses rated themselves at significantly higher levels than did managers  88  from professional, business, and industrial settings, the normative group. In transactional leadership, the head nurses described themselves as employing very high levels of Contingent Reward behaviours and once in a while engaging in Management-ByException (MBE). Further, compared to other managers' selfratings, head nurse leaders employed a significantly greater degree of Contingent Reward behaviour. With respect to the transactional factor, MBE, head nurses identified that they used this form of TA behaviour to a lesser degree, but not significantly so, than other managers. Thus, this sample of head nurses indicated a propensity to intervene before a problem arises and take corrective measures to prevent negative consequences to patient care. With respect to Nonleadership, results indicated that the head nurse respondents engaged to a lesser extent in Laissez-faire leadership, but did so at a significantly higher level than did normative group managers. Bass's model (1985b) postulates that transformational leadership contributes to the prediction of follower outcomes to a greater degree than transactional leadership. For two of the three outcome factors, Effectiveness and Satisfaction, the head nurses described significantly higher levels than did normative group managers. Thus, from self-ratings, their leadership was perceived as very effective in meeting staff nurses' needs and presenting these to superiors, and their unit as very effective in meeting organizational goals as a consequence of their leadership. With respect to Satisfaction, results indicated that  89 head nurses perceived staff nurses as fairly satisfied with their manager's leadership behaviours and their leader in general, and the head nurses themselves are satisfied with these. For the third outcome factor, Extra Effort, the study sample described a higher level than did the normative group, although the difference was not statistically significant. These results support the basic propositions of Bass's (1985b) model that transformational leadership is found in different organizational settings and is practiced not only by upper level, but also by first-level managers. The second research question inquired into the relationship among the leadership styles and between leadership styles and outcome factors for head nurse leaders as measured by scores on the MLQ. The findings, based on correlational analysis, provided general support for the relationships between leadership style and outcome factors postulated by Bass's (1985b) Transformational Leadership Model. Significant correlations were found between all outcome factors and TF leadership. The outcome factors, Extra Effort and Satisfaction, displayed strong correlations with TF leadership, while Effectiveness was moderately related. No significant correlations were demonstrated for any outcome factor with TA leadership. No evidence was found to support a significant relationship between TF and TA leadership and no significant correlations were found between nonleadership and TF. However, TA leadership was weakly, yet, significantly correlated with nonleadership.  90  The third research question addressed the relationship between selected demographic and professional characterictics and level of transformational leadership for head nurse leaders as measured by scores on the MLQ. Those characteristics were age, educational preparation, years of nursing experience, years as a head nurse, tenure in current position, clinical focus, and F.T.E.s. The findings, based on chi-square analysis, failed to demonstrate significant relationships between demographic and professional characteristics and level of transformational leadership. Conclusions  Analysis of the data for this sample of head nurse leaders supports the following major conclusions: 1.  The leadership of first-level nurse managers is characterized by an effective balance of very high levels of transformational and high levels of transactional leadership.  2.  Transformational leadership is common to all organizational settings including nursing organizations in acute care hospitals and is found at all levels of management including first-level.  3.^Compared to managers in general as reported in normative data, first-line nurse managers who are also leaders are more transformational.  91 4.  The findings support Bass's (1985b) Transformational Leadership Model which postulates that there are significant relationships between leadership style and outcome factors.  5.  No relationship exists between transformational and transactional leadership styles but there is a relationship between Laissez-faire and TA leadership.  6.  Demographic and professional characteristics of the nurse leader are not related to level of TF leadership.  7.  The Multifactor Leadership Questionnaire is a useful instrument for measuring leadership behaviours of head nurses. Implications  The implications of this study are relevant for the domains of nursing administration, education, and research which serve to support nursing practice. Nursing administration sets the management and leadership philosophy that directs the nursing organization. Nursing education prepares students to practice leadership in management roles. Nursing research can guide leadership theory development in nursing administration. Implications for Nursing Administration  One of the major findings of this study was that head nurses leaders describe their leadership as predominantly transformational and, to a lesser degree, transactional. Therefore, it could be valuable for the nurse administrator to consider the suitability of this model to direct leadership in  92 management roles throughout the nursing organization. Further, the literature supports the view that transformational leadership is required to a greater degree in times of uncertainty. In this time of chronic, rapid change, uncertainty characterizes the internal and external contexts of nursing organizations. Once the model is chosen by the nurse administrator, leadership training is required that involves all levels of management in the nursing organization. This strategy would involve providing transformational leadership training initially to top-level managers. These managers would, in turn, serve as role models for the other levels of managers. The role-modeling aspect of this plan is critical as success in developing leadership abilities at one level of management will hinge in part on the leadership shown at the next higher level. This plan could form the basis of an organizational development program emphasizing the improvement of leadership practices. In addition, the nurse administrator could increase the level of transformational leadership in the nursing organization through hiring practices such as interviews that aim to seek out the TF and TA skills and abilities of managerial applicants. Other study findings identified that the outcome factors, Satisfaction, Extra Effort, and Effectiveness, were significantly correlated with transformational leadership alone. The knowledge that significant relationships are found between leadership style and outcome factors is important to the nurse  93 administator as it provides direction to address particular related divisional or unit problems. For example, completion of MLQ profiles by both the head nurse and the staff nurses from one unit would provide the nurse executive with an assessment of the leadership of that unit and measure the Effectiveness, Satisfaction and Extra Effort consequent to that leadership. Once the predominant leadership style is identified, the nurse executive could plan appropriate action to increase the head nurse's level of transformational leadership. This may involve, first, increasing the head nurse's awareness of the way in which she leads staff using her responses on the MLQ. The nurse executive and the head nurse could then set goals that include: 1) challenging staff nurses' work routines; 2) providing images of how to improve nursing practice for better quality patient care; 3) facilitating staff's understanding of the unit's goals within the mission of the hospital and 4) providing staff nurses with patient assignments that provide suitable learning opportunities. Once the head nurse demonstrates a higher level of transformational skill, staff satisfaction may improve and thus staff nurse retention may be enhanced. The link between transformational leadership and the outcomes of Extra Effort, Satisfaction and Effectiveness provides the nurse executive with productivity measures for the nursing department, which are largely undefined in nursing and generally assume greater significance in times of economic constraint. Because the nurse executive cannot afford to support nonproductive employees, it is  94 important that all employees develop their potential and be motivated to perform at higher levels. Implications for Nursing Education  The findings reinforce the importance of teaching transformational and transactional leadership theory to students in both undergraduate and graduate level management courses. Nurse educators in the classroom setting can impart an understanding of behaviours that reflect TF and TA leadership and of the postulated relationships between these factors and the outcome factors. The leadership behaviours could be demonstrated through such activities as role playing. Nurse educators can extend this teaching to the clinical setting by role modeling the leadership behaviours and encouraging students to utilize the appropriate leadership skills. Implications for Nursing Research A number of implications for nursing research arise from the  findings of this study. There is a need for further study of transformational and transactional leadership behaviours among head nurses. What are the antecedent conditions associated with each of these leadership styles? Is the transformational style less sensitive than transactional leadership to situational variations? Is there a relationship between the amount of TF and TA leadership demonstrated by nurse managers and the amount demonstrated by their superiors? The answers to these questions would provide additional information regarding the development of leadership skills and the context for leadership, and the impact  95 of a leader's behaviours and attitudes on those of staff within nursing administration. Further study of the use'of Individualized Consideration, Charisma, Inspiration, Intellectual Stimulation, and Contingent Reward leadership behaviours by head nurses would be valuable. Research could explore staff nurses' perceptions of these behaviours concomitantly with superiors' perceptions of these. Further, with respect to the high levels described by the head nurses for the outcome factors, it would be useful to compare these with staff nurses' perceptions of Extra Effort, Effectiveness, and Satisfaction relative to the leadership provided. The findings from such an investigation could be useful in redesigning the role expectations of the nurse manager and the nurse so that the head nurse role provides leadership appropriate to staff nurses who also have higher levels of education and seek increased autonomy over their practice. Further research could help to explicate those factors that influence the emergence of transformational leadership among nursing administrators. The values, beliefs, and norms of an organization, and the environmental and technical demands of that organization may generate job requirements and therefore dictate the leadership observed and required at all levels throughout the organization. It may be useful to examine the relationship between leadership and organizational culture and environmental demands in order to identify factors that facilitate and those that inhibit the development of transformational leadership.  96 Finally, replications of this study are necessary to further the theoretical and empirical knowledge about leadership in management positions. The propositions of the Transformational Leadership Model (1985b) have generally been supported in this investigation. This model provides an organizing framework for future examinations of leadership within nuring administration at a time when the pressure for change in the health care system and in nuring organizations continues to intensify. 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V3S 5N7 October 21, 1991 Dear Nurse Executive: As a student in the Master of Science in Nursing program at the University of British Columbia, I am interested in studying nursing leadership, as described by head nurses in the nursing department of a hospital. I am writing to request your participation in the research study. Your participation is requested in two ways: 1) To request that nursing directors select, in collaboration with head nurses and staff nurses, those head nurses who have been permanently employed in their positions for one year or more and are identified for leadership (see definition attached) in their head nurse role and to submit these names to the researcher. The researcher will then contact the nominated head nurses by letter and ask them to participate in the study. 2) To authorize the researcher to contact the appropriate department in your hospital to reserve a room for two or three occasions, so that the head nurses (who have agreed to participate) may respond to a questionnaire. The researcher will be present to distribute and collect the questionnaires, which require about 30 minutes to complete. Confidentiality will be maintained by having the head nurses anonymously complete the questionnaires. Each participant will be made aware (in the attached information letter) of her/his right to refuse to answer any question or to withdraw from the study at any time. If you have any questions regarding the study, please contact me or the chair of my thesis committee Dr. Marilyn Willman (822-7748). Thank you for your assistance. Sincerely, Kathy Mulligan-Fraser (Ph. 597-1157)  103  For the purpose of this study, head nurse leadership is defined as: An interactive political process in which leaders induce followers to act for certain goals that represent organizational values and the motivations of both.  104  Appendix B Information Letter Dear Colleague: I am writing to you to request your voluntary participation in the study of head nurse leadership style. The study entitled " Head Nurse Leadership: Perceptions of Leaders" is my master's thesis. To date research investigating head nurses' perceptions of their leadership has been limited. In order for nursing departments to adapt to changing professional and organizational environments, head nurses must excercise leadership. Descriptions of head nurse leadership will provide information important to nurse managers and administrators trying to meet these challenges. The purpose of this study is to describe head nurse leadership from the perspective of identified leaders in the position. This information may be helpful in examining role expectations of nurse managers. If you agree to participate, it will involve setting a convenient appointment time to complete a questionnaire. The questionnaire takes about 30 minutes to complete and will be done in a meeting room at your hospital. The completion of the questionnaire will be taken as your consent to participate in the study. You will have the right to refuse to answer any question or to withdraw from the study at any time, and this decision will in no way influence your hospital position. Confidentiality will be maintained by anonymously completing the questionnaires. Your name and any other identifying information will not be used in the study or in any future publications of the findings. If you have any questions regarding the study, please contact me or the chair of my thesis committee Dr. Marilyn Willman (8227748).  105 If you are willing to participate, please meet me at one of the following times: ^ ^ Date:^Room:^ Time: Date:^Room:^ Time: Time: Room: Date: If none of these are convenient to you, please contact me.  Yours truly,  Kathy Mulligan-Fraser, R.N., B.Sc.N. Graduate Student University of British Columbia Telephone: 597-1157  106 Appendix B Information Letter Dear Colleague: I am writing to you to request your voluntary participation in the study of head nurse leadership style. The study entitled " Head Nurse Leadership: Perceptions of Leaders" is my master's thesis. To date research investigating head nurses' perceptions of their leadership has been limited. In order for nursing departments to adapt to changing professional and organizational environments, head nurses must excercise leadership. Descriptions of head nurse leadership will provide information important to nurse managers and administrators trying to meet these challenges. The purpose of this study is to describe head nurse leadership from the perspective of identified leaders in the position. This information may be helpful in examining role expectations of nurse managers. If you agree to participate, it involves completing the attached questionnaire which takes about 30 minutes. The completion of the questionnaire will be taken as your consent to participate in the study. You will have the right to refuse to answer any question or to withdraw from the study at any time, and this decision will in no way influence your hospital position. Confidentiality will be maintained by anonymously completing the questionnaires. Your name and any other identifying information will not be used in the study or in any future publications of the findings. Please complete the questionnaire and return it to me in the enclosed, self-addressed envelope via the hospital mail by MARCH 25, 1992. "They" in the questionnaire refers to the people who report directly to you or your immediate subordinates. If you have any questions regarding the study, please contact me or the chair of my thesis committee Dr. Marilyn Willman (8227748). Yours truly,  Kathy Mulligan-Fraser, R.N., B.Sc.N. Graduate Student University of British Columbia Telephone: 597-1157  107 Appendix C Questionnaire Introduction Thank you for volunteering to participate in the study of head nurse leadership style. The study entitled " Head Nurse Leadership: Perceptions of Leaders" is my master's thesis. To date research investigating head nurses' perceptions of their leadership has been limited. In order for nursing departments to adapt to changing professional and organizational environments, head nurses must excercise leadership. Descriptions of head nurse leadership will provide information important to nurse managers and administrators trying to meet these challenges. The purpose of this study is to describe head nurse leadership from the perspective of identified leaders in the position. This information may be helpful in examining role expectations of nurse managers. The completion of the questionnaire will be taken as your consent to participate in the study. The questionnaire takes about 30 minutes to complete. You have the right to refuse to answer any question or to withdraw from the study at any time, and this decision will in no way influence your hospital position. Confidentiality will be maintained as the questionnaire is completed anonymously. Your name and any other identifying information will not be used or in any future publications of the findings. Please use a pencil to mark the questionnaire. Complete the questionnaire first and the "Demographic Information" last. "They" in the questionnaire refers to the people who report directly to you or your immediate subordinates. I would be pleased to answer any questions you may have about the study. The chair of my thesis committee is Dr. M. Willman, telephone 822-7748.  Katherine Mulligan-Fraser R.N., B.Sc.N. Graduate Student University of British Columbia Telephone 597-1157  108  APPENDIX D  M LQ  •PIRePfeer •FIC-P434;14  Bernard M. Bass and Bruce J.Arcflio  RO  MLQ COORDINATOR: FILL OUT YOUR  'MARKING INSTRUCTIONS  INSTITUTIONAL ADDRESS BELOW  • Use a soft (No. 2) black lead pencil. • Make dark, heavy marks that fill the oval. MarkONLY the oval areas.,,.. .tiMaker MI-stray • Erasecompletelyanyitnswer you wish to change. • Do not fold or staple answer sheet. Proper Mark^' Improper Marks EXAMPLES:  • cdoiceueD  Multifactor Leadership Questionnaire—Self-Rating Form  NAME INSTITUTION ADDRESS  06000 (Zoo°  CITY  RATER: Please read the marking instructions above and turn to the second page to begin.  STATE  ZIP CODE  (PLEASE DO NOT USE ADDRESS STICKER) Multi/ actor Leadership Questionnaire-5R Copyright t 1989 by Consulting Psychologists Press. Inc. All rights reserved Printed in the USA  CODE  Gi) GNID GD CID GID GI) OD GI) GD CO CD CD 0 CD CD 0 0 0 0 0 0 CDGDGDCIlip? 4919W-,110GDGO COCIDCDdhltd#61346/DCDCDO) )(4)00 (1)CDONIVI)01 OD OD OD II is 'A Idb SIBS CI) 0 (14.10A c: 12 g CI) 0 GO a) (f) al 6010E5 Ilra ■Ir4 *I *II CZ) cii GDGDCIDOGDODOGDODOCID CAD Oi) CIIG) CD (I) GD 0 (1) CV  e  CONSULTING PSYCHOLOGISTS PRESS, INC.  TO BE FILLED OUT BY MLQ COORDINATOR ORGANIZATION NAME: Print the name of the organization, one letter per box, in the boxes below. Skip a box between words. Fill in the appropriate ovals below each box, including blank ovals for skipped boxes. (The organization is the name of the largest organization or institution appearing on the organization's letterhead. If the person being rated works for the government, - organization" refers to the agency or de artment. •  MARK ONE LEADER SEX 0 MALE o FEMALE  ORGANIZATION 1.0.11  0000000000000000000  cDaDoma)coso®mcfp®cDe!)®scs)a) aDaDapocveDocvaxmo®cvaDapcnom ap zaD (ID ©a) az ap ap © © ap an am cm cm ©ma) (r) (ID (2) co cm ari) aD ap op am cr) ma) cr) ap ap or) cip ap ,  CDODOMCDCOCE)000000000000 GDCDGD¢DGOGNIDGIDaDGDGDGDODGDCMGDOIDOZICID (E> OD CliD COMM CM ®® ®®®®®® ® (3) ® OCDOCDOCDCDCD00000000000 00000MO000000000000 GD (ID CED (JD (1) CEO CD CIO CE) CD (I) OD CD GO CID CD CID CD CIO 0000000000000000000 GDISIIDOGIX/DISMODIESSOCSOCSOCSCR CEE/E/COMEIMICEEE/IMMQDCME)Mei)(3)(3) 13:0 ©CD GO CD CD GIIXID GNIIXIMD (1) GD (1I) GT) all) 0000000000000000002) GI) Zi II1) CD CD CID 4:19 GID Gli) Gli)(1) QM) GD CD GO G) a:014D CID CID CD OD OD CID CD CE/ 0) OD GD CDOCI:XIDCDCIDCDCDMICDGE) GDODOD (1) GD(.13 CDCDCDCDCDCDCDCDCDCDCDCDCDCDOCDOCDCD (Z) GD0:0 Cfil IED 4:0 CO CO ID CID GED CD CD CZ) GE/ OD GD GD (17) GD (7) CID CD CE) CD 4:7) CD CD 04061)€/aDOSSIIMOIEIVOGY/G30(EBISe (K) CD CD 01)(10 OD CID CO aXID 03) CID a/ CD CD CE/ ®® CD II/^GD^G)^OCIDOO CD CD CD CID CD CID CD CD GD (3) CEXID CD GD GD GD OD CD CD OD a)  (OPTIONAL)  I ^ 1 ^1 ^ 1 ^ 1 ^ 1 ^ 1 ^1  GID 0OlD CD GI) OD 13/) Cli) 000000OCID0 CD GO (2) CII) CD CD OD GD  ® ®®®®m®®® ma) ma) a) ocoaxmocpcoma)  coaDaDepoDeDaDaDaD (DaDczooma)a)a)  CD CD CD Cr/ CP CD CP C2) CD  CIXIADOCICOGMCD CD CD OD CD OD OD Cf) OD CD  LEADER I.D.# (OPTIONAL)  1^1^1^1^1^1^1^1  GlEg3:0 (1) GII) CD000000CDO CD CD CD CD OD OD OD CD CD CD CD CD CI) CD CM 0) CD CND CD C21) CD CD GD GO 0 GO (1) GO CD GD CD OD al) (1) O CIDGDGDGDOOMCD CDCDCDCDCDCDCD(Da/ 0GD0000000 CD CV a) CD GD CV GD CD (1)  LEADER NAME: Print his/her name, one letter per box, in the boxes below. Print the last name first, skip one box, and print as much of the first name as possible. Fill in the appropriate oval below each box, including the blank' ovals for skipped boxes. Create a unique code name if the leader chooses to remain anonymous.)  11111 111 11111111  00000000000000000 CE) CD (E) ® I:D(E) CID CE) CE) (E1) 000CEI0OCEX0COGDOUDCD(I)C00(1) ID GD ©ID GD GE) Clf/ CD CD CO ©ID © 0XEMEI0M0000GD0X000D0MCD CD GIND G) CD ID CID OD CD GD GD OD CD (I) (D 000000000000O000O GOMGDGDGDGDOIDGDOMIXIDaDGDGDGIDIIIDGO OD OD (E) OD CE) EE) CB, OM® CID GC 000000000CD00000ODO 00000000000000000 OXIMODOCEIOCDODCD(E)GDIMGDGIDO 000(1)0000000000000 IBS CE> GO SIBS® Se?) ffl) MIZIODCEICE/CEEEIMMITOSCE)0(1000 GI) GD GD GD GlD GD CM GDGD GlEXID GD CID 00ODE/CE/00e.) ,M(1)TiaDOCIDMCDC!) SIB S®CD®O®®®O®CDC ® 0O MODGDCEIGDM(IDMCDOCIDODGEIGDMGDO GDIDCiDGDGDODCOODWGDCDGDOOCDXCE) CDCDOCD000CDOCDOCDCDCDCDCDCT) GD GD IV) CD CD ID CD CD GD CIXID GI) GI) GE1 CD CD CD O CSO CD Gf) MG) GD (DO ®W GOO Se Gi) OW CO WOG:1Z MGDMODOMODODOCK/CDODOCIDOODO CD CD^(1) GC CD CID GO GDCDCD CDCID GD CID OD CD OD OM 0  DO NOT MARK IN THIS AREA  O MLQ-SR-1254  0.00•1110M0000111110000000  DO NOT MARK IN THIS AREA  100196  ^3151 PR.54321  109  This is a questionnaire to provide a descr.iption of you. Answer all questions on the answer sheet with a No. 2 pencil. When the item is irrelevant or does not apply, or where you are uncertain or don't know, leave the answer blank. Make no more than one mark for each question. Directions: Listed below are descriptive statements. For each statement, we would like you to judge how frequently it fits you. Example: "They can discuss their problems with me." They means those below you in the organization who report directly to you -your immediate subordinates or supervisees -or those at the same level in your organization -your co-workers or colleagues. If this is true of you most of the time or "frequently, if not always," then mark the number 4; "fairly often," mark number 3; "sometimes," mark number 2; "once in awhile," mark number 1; "not at all," mark 0. Mark the statement below which applies best: 0 0 0 0 0  The people I'm referring to report directly to me. The people I'm referring to are my peers or co-workers. The people I'm referring to report directly to me and are my peers or co-workers. The people I'm referring to are clients, customers or constituents of mine. A combination of the above. Use this key for the five possible responses to items 1-70. ^ 0^ 1^ 2^ 3 Not at all^Once in awhile^Sometimes^Fairly often  ^  4 Frequently, if not always  CIDCDCDCDO 1. They feel good when they're around me. CIDCDCIDGIDO 2. I set high standards. 0)0MM® 3. My ideas have forced them to rethink some of their own ideas that they had never questioned before. CDCDCDCDO 4. I give personal attention to those who seem neglected. 1:190:)a)00 5. They can negotiate with me about what they receive for their accomplishments whenever they feel it necessary. GDCDCDCD4:D 6. I am content to let them do their jobs the same way as they've always done it, even if changes seem necessary. izitjaDimc)^7. I avoid telling them how to perform their jobs. CDCDCDCDED 8. They are proud to be associated with me. MO a) o 9. I present a vision to spur them on. apilDcpxocco 10. I enable them to think about old problems in new ways. GDOGOCDO 11. I get them to look at problems as learning opportunities. (Doppia) 12. I show them that I recognize their accomplishments. 0)000)0 13. I avoid trying to change what they do as long as things are going smoothly. cipa) cp a) so 14. I steer away from showing concern about results. MOGDCDO 15. They have complete faith in me. CDOCI)00 16. I express our important purposes in simple ways. or_DGDQD0) 17. I provide them with new ways of looking at problems which initially seemed puzzling to them. 0:CiCIDCDCDOD 18. I let them know how they are doing. oppop 19. I make sure that there is close agreement between what they are expected to do and what they can get from me for their effort. 00000 20. I am satisfied with their performance as long as the established ways work. 00000 00 21. I avoid making decisions. 00000 22. I have a special gift for seeing what is really worthwhile for them to consider. 00 000 23. I develop ways to encourage them. 0000(1) 24. I provide them with reasons to change the way they think about problems. 00000 25. I treat each of them as an individual. CD 0 CD CD 0 26. I give them what they want in exchange for their showing support for me. 00000 27. I show that I am a firm believer in "if it ain't broken, don't fix it." 00000 28. I avoid getting involved in their work. 00000 29. I view myself as a symbol of success and accomplishment. 00000 30. I use symbols and images to focus their efforts.  Oa  •  110  1  1 Use this key for the five possible responses to items 1-70. 3^ 0^ 1^ 2^  4 s. Not at all^Once in awhile^Sometimes^Fairly often^Frequently, if not always ^  00CDC00 31. I emphasize the use of intelligence to overcome obstacles. CDCIDCD00 32. I find out what they want and help them to get it. 000CDO 33. When they do good work, I commend them. CDCDGDOO 34. I avoid intervening except when there is a failure to meet objectives. them. 00000 35. If they don't contact me, I don't contact CDOCDCDCD 36. I have their respect. MOCDCDO 37. I give encouraging talks to them. MO CD MO 38. I require them to back up their opinions with good reasoning. 0 0 0 CD 0 39. I express my appreciation when they do a good job. 0O0CD0 40. I see that they get what they want in exchange for their cooperation. 00 ©©O 41. I focus attention on irregularities, mistakes, exceptions, and deviations from what is expected of them.  CDOCDCDO 42. My presence has little effect on their performance. M0MCD0 43. I show enthusiasm for what they need to do. CDOCDCDO 44. I communicate expectations of high performance to them. 0)0.000 45. I get them to identify key aspects of complex problems. GDOCDa.)0 46. I coach individuals who need it.^ CDOOMO 47. I let them know that they can get what they want if they work as agreed with me. 000®O CD^48. I do not try to make improvements, as long as things are going smoothly. ^ poppy 49. I am likely to be absent when needed. CDOCDOG) 50. I have a sense of mission which I communicate to them. 00000 51. I get them to do more than they expected they could do. CDCDCDCDO 52. I place strong emphasis on careful problem solving before taking action. 00000 53. I provide advice to them when they need it. CDCDCDMO 54. They have a clear understanding with me about what we will do for each other. 000m0 55. A mistake has to occur before I take action. ODCDCBCD0 56. I am hard to find when a problem arises. CD 0 MO 0 57. I increase their optimism for the future. CD0000 58. I motivate them to do more than they thought they could do.^ 00000 59. I make sure they think through what is involved before taking action. 00000 60. I am ready to instruct or coach them whenever they need it. 00000 61. I point out what they will receive if they do what needs to be done. 00000 62. I concentrate my attention on failures to meet expectations or standards. 00000 63. I make them feel that whatever they do is okay with me. CDOCDCDO 64. They trust my ability to overcome any obstacle. CD 0 CD OD 0 65. I heighten their motivation to succeed. 00000 66. I get them to use reasoning and evidence to solve problems. ®0000 67. I give newcomers a lot of help. 00000 68. I praise them when they do a good job. MOCDCDO 69. I arrange to know when things go wrong. aDommo 70. I don't tell them where I stand on issues.  Ni= win  mis  Use this key for the five possible responses to items 71-74. 0^ 1^ 2^ 3^ 4 Not effective^Only slightly effective^Effective^Very effective^Extremely effective  ow.  00000 71. The overall effectiveness of the group made up of yourself, your supervisees, and/or your co-workers can be classified as  1.1  ^  MCDCOCDO 72. How effective are you in representing your group to higher authority? 00CDC00 73. How effective are you in meeting the job-related needs of supervisees and/or co-workers? CDCDCDCD0 74. How effective are you in meeting the requirements of the organization? CONTINUE ON BACK  ape  111  75.  In all, how satisfied do you think your supervisees and/or co-workers are with you as a leader?  78.  Of the alternatives below, which is the highest level possible in your organization? 0 First-level (lowest level of supervision or equivalent)  CD Very dissatisfied (^0 Somewhat dissatisfied  OD Second-level  ODi Neither satisfied nor dissatisfied  (supervises first-level)  CD Third-level  CD Fairly satisfied  Q Fourth-level  CD Fifth-level or higher  ENDCD Very satisfied  CD Not applicable 76. In all, how satisfied are you with the methods of min^leadership you use to get your group's job done?  79.  o no^CD Very dissatisfied  0 Science-engineering-technical  0 Somewhat dissatisfied  OD Social science or humanities  Im•^CD Neither satisfied nor dissatisfied ▪  My primary educational background is (mark as many as apply) ^  CD Business  (2) Fairly satisfied  (I) Professional (law, health field, social service)  0 Very satisfied  CD Other educational background  O Did not attend college  .m 77. My position is ^  CD First-level (lowest level of supervision or equivalent)  80. To what extent does this questionnaire accurately represent your leadership performance? 0 Not at all  OD Second-level (supervises first-level) ia) Third-level  0 To some degree  CD Fourth-level  0 Fairly well  CD Fifth-level or higher  O Extremely well  CD Not applicable  cp Exactly  Please fill out the following information for research on the MLQ (OPTIONAL): TODAY'S DATE Jan 0 Day  Year  YOUR AGE  Feb 0 Mar  0  Apr 0 May  0  Jun  0  CD CD  Jul 0 Aug 0  tD  YOUR RACE  MARK ONE YOUR SEX  0 Black  TYPE OF ORGANIZATION  YOUR EDUCATION (Mark Highest Level)  Manufacturing Military  0 MALE  0 Asian  O Elementary  O  0 FEMALE  0 Hispanic  O  Some High School  0 Educational  O Naive American  0  Hip School Grad  0 White  O  Some College  O 0  0  College Grad  0 Correctiondi law enforcement security  CDC CDCD CDCD 00 CD®  O  Other  0 0  0 Some Grad Work  O  Graduate Degree  Set:, 0 Oct 0  0  Religious  Research anti development  Volunteer association Health service  0 Social service  O  Nov 0  O CD®  Dec 0 YOUR 01:1F YEARS WORK EXPERIENCE  OCID  Other ^  (1) GE) YOUR N OF YEARS IN MANAGEMENT OR SUPERVISORY POSMON  YOUR II OF YEARS WITH PRESENT ORGANIZATION  N OF PEOPLE WHO REPORT DIRECTLY TO YOU  0 OF LEVELS OF MANAGEMENT BELOW YOU  OF WEEKS YOU SPENT IN LEADERSHIP TRAINING IN THE PASTE YEARS  YOUR CURRENT SALARY 0 Less than $20.000 O 520-39.999  00  —  Nell  GDM 00 COGD CDCID CD® 00 CD® CDCD  00 CDO CDGD CDCD 0(D CD0 CDCD  oaD  CD0 00 GDGD (DO 00  0® GDM CD0 0® CD®  oup  CD® CD 0 (DO CD CD  MCD  (Do  GDCD  00 CDO GDM CD® 00 CID® COGD CDCD CD CD  a)  0 560-79.999 0 580-99.999 C) 5100-119.999  05120 - 139.999 GD  0 5140-159.999 0 5160 179.999  a)  0 5180-199.999  O  DO NOT MARK IN THIS AREA  EC/11001111110•••0000.11110000000  ^0111---111^411  0 540-59.999  0 0200.000 or mote  ‘or morel  ^  DO NOT MARK IN THIS AREA  100196  Appendix E^  12  Demographic Information The following questions relate to specific information about yourself. 1.  Age: ^  2.  Gender: Female^Male  3.  Marital Status: Married^Never Married ^ Separated^Divorced^Widowed ^  4.  Educational Background: Basic: ^ Hospital or college diploma ^ B.S.N. ^ Some courses towards B.S.N. Other baccalaureate degree (specify) ^ Graduate: ^ Master's degree ^ Nursing Other (specify) ^ Doctoral degree ^ Nursing ^ Other (specify) ^  5.  For how many years have you been employed in nursing? ^  6.  For how many years have you worked at this hospital?  7.  For how many years have you worked as a head nurse?  8.  For how many years have you been in your current head nurse position? ^  9.  The clinical focus of your unit is: Medicine ^ Surgery Critical Care^O.R.^Psychiatry^Geriatrics Obstetrics^Other (specify)  10.  For what number of full time equivalents (F.T.E.^) are you responsible in your head nurse job?  

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