Teresa Anderson, EdD, MSN, RNC-OB, NE-BCChief Nursing Officer, Voalte, Inc.

ANCC Magnet Program® Consultant

This quantitative, descriptive, correlation study examined the relationships of the perceived levels of transformational and authentic leadership among Chief Nurse Executives (CNEs) of acute care U.S. hospitals with personal attributes and organizational context variables.

Transformational leadership◦ Idealized attributes◦ Idealized behaviors◦ Inspirational motivation◦ Intellectual stimulation◦ Individual consideration

Authentic leadership◦ Transparency◦ Moral/Ethical◦ Balanced Processing◦ Self-awareness

Organizational Context Variables◦ Licensed bed size◦ Profit status◦ Religious affiliation◦ Magnet® status◦ Healthy Work Environment®◦ Nursing professional practice

culture

Personal Attributes◦ Age◦ Leadership tenure◦ Level of Education◦ Type of Education

No consistent definition of “success” for nursing leadership was evident within the literature reviewed.

Successful nurse executives must possess strong communication, management, and business skills.

(Corning, 2002; Dunham & Fisher, 1990; Kirk, 2008; Poulin, 1984; Upenieks, 2002, 2003)

Preliminary work confirms that transformational and transactional leadership form a meaningful framework in which to assess self and staff perceptions of leadership style.

(Avolio & Bass, 2004; Bass & Riggio, 2006; Burns, 1978; Dunham-Taylor & Klafehn, 1995; Judge & Piccolo, 2004; Walumbwa et al., 2007)

ANCC describes transformational leadership as a component of success in Magnet Recognized® facilities.

(Aiken et al., 2008; ANCC, 2008; McClure & Hinshaw, 2002)

Authentic leadership has captured the interest of social and behavioral scientists as a basis for other forms of leadership.

(Avolio & Gardner, 2005, Gardner et al., 2005; George, 2003)

Authentic leadership is based upon positive psychology, is evident in genuine, ethical, and optimistic individuals, and develops through self-reflection of trigger events and meaning within the leadership role.

(Michie & Gooty, 2005; Shamir & Eilam, 2005; Sparrowe, 2005) AACN identifies authentic leadership as a key component

of a Healthy Work Environment®. (AACN, 2005; Shirey, 2006)

Positive PsychologyPositive Psychology

Personal Attributes

Organizational Context

Transformational Leadership Transformational Leadership

Successful Nursing

Leadership

Authentic Leadership

Authentic Leadership

IdealizedInfluence

(attributes/ behaviors)

EthicalMoral

Individualized Consideration

Inspirational Motivation

Intellectual Stimulation

SelfAwareness

Transparency

BalancedProcessing

AACN HealthyWork Environment®

ANCC Magnet Recognition®

Figure 1. Anderson Predicted Nursing Executive Leadership Conceptual Model

Full Range of Leadership ModelFull Range of Leadership Model

Effective

Contingent Reward

IneffectiveLaissez-Faire

Passive Active

Management By Exception

Passive

Management By Exception

Active

Transformational

Figure 2. Full-Range of Leadership Model. Bass, B.M., & Avolio, B.J. (1990). Manual for the Multifactor Leadership Questionnaire. Menlo Park, CA: Mind Garden, Inc. Copyright 1990 by Bruce Avolio. Used with permission.

Population◦ Active CNE members of the American Organization of Nurse

Executives (AONE) Hosted CSM webpage linking to ◦Online survey at Mind Garden, Inc. website

Multifactorial Leadership Questionnaire (MLQ) Authentic Leadership Questionnaire (ALQ) Demographic Data Survey

Data spreadsheet◦ .csv file uploaded to PASW and compatible with Excel

Multifactorial Leadership Questionnaire◦ 45 items◦ Nine subscales total, 5 subscales for Transformational

Leadership (idealized attributes, idealized behaviors, inspirational motivation, intellectual stimulation, and individualized consideration)

Authentic Leadership Questionnaire◦ 16 items◦ Four subscales (transparency, moral/ethical, balanced

processing, self-awareness) Demographic Data Survey◦ 12 items

184 completed surveys◦ 1 subject eliminated for substantial missing data◦ 39 subjects eliminated for failure to meet study inclusion

criteria 144 subjects included in study data analysis◦ Sample size differed by variable based upon the number of

responses to individual questions

◦ Represent 38 states◦Mean age of participants was 53.8 years (range 33 – 69 years)◦Mean years within their role was 9.8 years (range 0 – 38 years)◦ 80.6% were educated at a masters degree level (35% of these

had nursing administration focus) and 8.3% were educated at a doctoral level

◦ 88.5% work in organizations aspiring to or having achieved Magnet Recognition® status

◦ 64.6% were implementing the AACN Healthy Work Environment ®standards

◦ 71.5% were not for profit or identified their organization as not religiously affiliated

◦Mean bed size was 302.91 beds (range 14 – 2,200 beds)

The age distribution of the participants represented a non-normal distribution, skewed to the older end of the range

Figure 4. Chief Nurse Executive Age Distribution by Decade

Transformational Leadership

Authentic Leadership

PERSONAL ATTRIBUTES

Age

Tenure in Executive Role

Level of Education

Type of Education

ORGANIZATIONAL CONTEXT

Bed Size

Profit Status

Religious Affiliation

Nursing Professional Practice Culture

Magnet® Status

Healthy Work Environment®

What are the relationships between the perceived levels of transformational leadership (TL) and authentic leadership (AL) of chief nurse executives (CNEs) in U.S. acute care hospitals?

The research question was fully supported

◦ There were statistically significant positive relationships between TL and AL on all subscales as analyzed by Spearman Rho Correlations (between the five TL subscales and the four AL subscales)

Variable TransparencyMoral/Ethical

Balanced Processing

Self Awareness

Idealized Attributes(A) 0.36** 0.28** 0.35** 0.41**

Idealized Influence (B) 0.32** 0.41** 0.39** 0.33**

Inspirational Motivation 0.41** 0.35** 0.38** 0.42**

Intellectual Stimulation 0.28** 0.28** 0.47** 0.51**

Individual Consideration 0.34** 0.36** 0.52** 0.48**

Note. *p < .05, **p < .01 Associations were all significant at p < .01 with effect size ranging from small to large. Cohen (1988) defines significance: .10 - .29 = small; .30 - .49 = medium; > .50 = large .

Research variableStudy

MNormative

M

MLQ

Idealized Influence (Attributes)3.47 2.95

Idealized Influence (Behaviors)3.60 2.99

Inspirational Motivation3.64 3.04

Intellectual Stimulation3.45 2.96

Individual Consideration 3.64 3.16

Normative Mean Database maintained by Mind Garden, Inc.

What are the relationships between the perceived levels of transformational and authentic leadership of CNEs in U.S. acute care hospitals and the organizational context variables of the setting in which the chief nurse executive is employed?

Demonstrated mixed findings and the research question was only partially supported

◦ Bed size, profit status, religious affiliation, and Healthy Work Environment showed no association

◦ Magnet Status and NPPC demonstrated positive associations with only two leadership subscales (Idealized Behaviors and Ethical/Moral)

There was only one significant relationship between transformational leadership (TL) and the organizational context variables:◦ The Idealized Behaviors subscale was positively associated

with having an active Magnet Recognition® application. (Mann Whitney U-test: U = 364.50, p < .009)

There was only one significant relationship between authentic leadership (AL) and the organizational context variables:◦ The Ethical/Moral subscale demonstrated a small positive

association with the presence of a Nursing Professional Practice Culture

(Spearman Rho Correlation: 0.20, p <.05)

What are the relationships between the perceived levels of transformational and authentic leadership of CNEs in U.S. acute care hospitals and the personal attribute variables of the chief nurse executives?

Demonstrated mixed findings and the research question was partially supported

Specific Findings:

Transformational Leadership subscale positive correlations included:

◦ Intellectual Stimulation and Individual Consideration with age

◦ Intellectual Stimulation, Inspirational Motivation, and Idealized Behaviors with level of education

Idealized Attributes showed no associations

Variable Age TenureLevel of

Education

Idealized Attributes 0.10 0.07 0.15

Idealized Behaviors 0.13 0.10 0.19*

Inspirational Motivation 0.08 0.15 0.17*

Intellectual Stimulation 0.23** 0.10 0.22**

Individual Consideration 0.22** 0.04 0.13

Note. *p < .05, **p < .01

Cohen (1988) defines significance: .10 - .29 = small; .30 - .49 = medium; > .50 = large .

Specific Findings:

Authentic Leadership subscale positive correlations include:

◦Moral/Ethical, Balanced Processing, and Self-Awareness with age

◦Moral/Ethical with tenure and level of education

Transparency showed no associations.

Type of education could not be analyzed fully due to excessive stratification of the findings; however, ancillary analyses were conducted relative to master’s education in nursing administration, with no significant findings.

Note. *p < .05, **p < .01

Variable Age TenureLevel of

Education

Transparency 0.02 -0.03 -0.01

Moral/Ethical 0.20* 0.22** 0.15

Balanced Processing 0.21* 0.01 0.10

Self-Awareness 0.20* 0.14 0.10

Cohen (1988) defines significance: .10 - .29 = small; .30 - .49 = medium; > .50 = large .

Are there statistically significant differences in MLQ and ALQ sub-scores by level of education (Diploma, ASN, BSN degrees vs. Master’s degree vs. Doctoral degree) of chief nurse executives (CNEs) in US acute care hospitals?

◦ The TL subscale Intellectual Stimulation revealed significant

differences by education level (master’s and doctoral higher)

◦ The AL subscale Moral/Ethical revealed significant differences by education level (master’s higher)

U Test U pMean Rank

Sum ofRanks

Intellectual Stimulation Diploma/ASN/BSN 509.05 .003 40.34 645.50 Master’s degree 70.11 8132.50 Diploma/ASN/BSN 43.50 .013 11.22 179.50 Doctoral degree 18.88 226.50Moral/Ethical Diploma/ASN/BSN 458.00 .000 37.13 594.00 Master’s degree 70.02 8052.00 Diploma/ASN/BSN 53.00 .047 11.81 189.00 Doctoral degree 18.08 217.00

The significance value of p was determined to be at .025 (.050/2) for the pair-wise comparison.

All statistical associations were in a positive direction; as one variable increased so did the other

Transformational and authentic leadership were significantly associated with each other

Transformational and authentic leadership were only minimally associated with organizational context variables

Transformational and authentic leadership were positively associated with personal attributes more often than with organizational context variables

Positive PsychologyPositive Psychology

EthicalMoral

Individualized Consideration

Inspirational Motivation

Intellectual Stimulation

SelfAwareness

Transparency

BalancedProcessing

ANCC Magnet Recognition® No IntentNo ApplicationActive ApplicationMagnet Status

AACN Healthy Work Environment®

IdealizedAttributes

Tran

sform

ation

al

Lead

ersh

ipAuthentic

Leadership

IdealizedBehaviors

AgeLevel of EducationType of Education

Tenure

Profit StatusReligious AffiliationLicensed Bed SizeNPPC

Organizational Context

Personal Attributes

Figure 5. Anderson Nursing Executive Leadership Conceptual Model. Arrows represent statistically significant associations between variables.

NOTE: All associations were positive

Research Question 1 CNEs who perceive themselves as transformational

leaders, also perceive themselves as authentic leaders◦ authentic leadership as a basis for other forms of

leadership (Avolio & Gardner, 2005)

Although associated, transformational and authentic leadership are two distinctly different leadership styles (Walumbwa et al., 2008)

Transformational and authentic leadership are strongly related, which might have implications for ◦ screening and selection of future leaders◦ education and development of future leaders

Research Question 2

The relationships between transformational and authentic leadership and organizational context were not consistent with the results of previous studies (AACN, 2005; ANCC, 2008; Bass & Riggio, 2006; Dirks & Ferrin, 2002; Drenkard, 2009; Dunham-Taylor, 2000; McClure & Hinshaw, 2002; Shirey, 2006; Upenieks, 2003)

suggesting◦ the need for further study in this area

The moral/ethical component of authentic leadership did not associate with religious affiliation as suggested by positive psychology findings (Dirks & Ferrin, 2002; Dunham & Fisher, 1990; Gardner, Avolio, Luthans, May, & Walumbwa, 2005; Michie & Gooty, 2005; Upenieks, 2002, 2003)

Research Question 2 The relationship between transformational leadership and

the ANCC Magnet Recognition Program® was minimal, which ◦ does not validate or negate this leadership style as critical to

building an excellent nursing practice environment (ANCC, 2008)

The relationship between authentic leadership and the implementation of the AACN Healthy Work Environment was not significant, which ◦ suggests the need for further research to validate this leadership

style as a key component of a healthy work environment (AACN, 2005)

Research Question 3 The mean age of CNEs in the study was 53.8 years (median

55 years), and 80.5% were over the age of 50 years, which may impact◦ turnover and vacancy of CNEs nationally within the next 10 – 15

years◦ conscious attention to CNE succession planning is needed now

The relationship between age and authentic leadership suggests◦ support for findings related to conscious self-reflection and

trigger events over time (Avolio & Gardner, 2005; Ilies et al., 2005)

Research Question 3 The relationship of education level and

transformational leadership◦ supports the findings of others (Dunham & Klafehn, 1990)◦ could be impacted by Magnet Program® eligibility requirements

The mean tenure of Chief Nurse Executives is 9.8 years suggesting that◦ CNEs seek advancement within different facilities, or experience

dissatisfaction or burn-out in the role (Jones, Havens, Thompson, & Knodel, 2008)

◦ mobility of chief nurse executives may mediate the impact of setting or organizational context

◦ CNE tenure may implicate experience as a factor in leadership success (Henderson, 1995; Linton & Farrell, 2009)

Education Availability of nursing administration master’s programs◦ Declined between 2004 and 2008 (Institute of Medicine, 2011)

Impact of DNP programs on educational preparation of CNEs (Institute of Medicine, 2011)

Competition between academia and practice for highly qualified nurses to fill openings ◦ 54.5% vacancies, and 20.1% additional faculty needed (Tracy & Fang,

2010)

◦ Flexibility of curricula ◦ Creative solutions – dual roles or subsidized faculty positions

Practice Transformational leadership may develop as a result of

authenticity (self-awareness, balanced processing, moral/ethical, and transparency) or concurrently with it

Authenticity develops as a result of reflection upon the events of one’s life over time, which suggests◦ a possible connection to age, experience and level of education

Further analysis of relationships between authentic leadership and the other forms of leadership within the Full Range of Leadership Model is needed (Bass & Avolio, 1990)

Laissez-Faire

Management by Exception - Passive

Management by Exception - Active

Contingent Reward

Transformational Leadership

Authentic Leadership

?

+

Findings suggest a positive relationship between transformational and authentic leadership as perceived by CNEs

The relationship between age, level of education, tenure, and leadership style suggests that personal attributes are important determinants of leadership style and may possibly mediate success

The impact of personal attributes, leadership style, and the development of leaders will be critical as the majority of nurse executive incumbents retire over the next 10 – 15 years

Transformational leadership and authenticity may provide leaders with the means to channel their “passion” for the nursing executive role into strategic vision and operational success.

Next steps…Analysis of remaining data

Chief Nurse Executive Life Stories

402-556-4274 – home402-679-1551 – cellular

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Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.

American Association of Critical-Care Nurses [AACN]. (2005). AACN standards for establishing and sustaining healthy work environments a journey to excellence. Retrieved from http://www.aacn.org/WD/HWE/Docs/ HWEStandards.pdf

American Nurses Credentialing Center. (2008). Application manual magnet recognition program. Silver Spring, MD: Author.

Avolio, B. J., & Bass, B. M. (2004). Multifactor leadership questionnaire: Manual and sampler set (3rd ed.). [Adobe Acrobat 7.0 Document]. Retrieved from http://www.mindgarden.com/login/55442/50380

Avolio, B. J., & Gardner, W. L. (2005). Authentic leadership development: Getting to the root of positive forms of leadership. The Leadership Quarterly, 16, 315-338.

Bass, B. M., Avolio, B. J., Jung, D. I., & Berson, Y. (2003). Predicting unit performance by assessing transformational and transactional leadership. Journal of Applied Psychology, 88(2), 207-218.

Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

Burns, J. M. (1978). Leadership. New York, NY: Harper & Row.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). St. Paul, MN: West Publishing.

Corning, S. P. (2002). Profiling and developing nursing leaders. Journal of Nursing Administration, 32(7/8), 373-375.

Dirks, K. T., & Ferrin, D. L. (2002). Trust in leadership: Meta-analytic findings and implications for research and practice. Journal of Applied Psychology, 87(4), 611-628.

Drenkard, K. (2009). The Magnet imperative. Journal of Nursing Administration, 39(7/8), S1-S2.

Dunham, J., & Fisher, E. (1990). Nurse executive profile of excellent nursing leadership. Nursing Administration Quarterly, 15(1), 1-8.

Dunham-Taylor, J. (2000). Nurse executive transformational leadership found in participative organizations. Journal of Nursing Administration, 30(5), 241-250.

Dunham-Taylor, J., & Klafehn, K. (1995). Identifying the best in nursing executive leadership: Part 1 questionnaire results. Journal of Nursing Administration, 25(6), 68-70.

Gardner, W. L., Avolio, B. J., Luthans, F., May, D. R., & Walumbwa, F. (2005). “Can you see the real me?” A self-based model of authentic leadership and follower development. The Leadership Quarterly, 16, 343-372.

George, B. (2003). Authentic leadership: Rediscovering the secrets to creating lasting value. San Francisco, CA: Jossey-Bass.

George, V., Farrell, M., & Brukwitzki, G. (2002). Performance competencies of the chief nurse executive in an organized delivery system. Nursing Administration Quarterly, 26(3), 34-43.

Henderson, M. C. (1995). Nurse executives: Leadership motivation and leadership effectiveness. Journal of Nursing Administration, 25(4), 45-51.

Ilies, R., Morgeson, F. P., & Nahrgang, J. D. (2005). Authentic leadership and eudaemonic well-being: Understanding leader-follower outcomes. The Leadership Quarterly, 16, 373-394.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

Jones, C. B., Havens, D. S., Thompson, P. A., & Knodel, L. J. (2008). Chief nursing officer retention and turnover: A crisis brewing? Results of a national survey. Journal of Healthcare Management, 53(2), 85-102.

Judge, T. A., & Piccolo, R. F. (2004). Transformational and transactional leadership: A meta-analytic test of their relative validity. Journal of Applied Psychology, 89(5), 755-768.

Kirk, H. (2008). Nurse executive director effectiveness: A systematic review of the literature. Journal of Nursing Management, 16, 374-381.

Linton, J., & Farrell, M. J. (2009). Nurses’ perceptions of leadership in an adult intensive care unit: A phenomenologic study. Intensive and Critical Care Nursing, 25, 64-71.

McClure, M. L., & Hinshaw, A. S. (Eds.). (2002). Magnet hospitals revisited: Attraction and retention of professional nurses. Washington, DC: American Nurses Publishing.

Michie, S., & Gooty, J. (2005). Values, emotions, and authenticity: Will the real leader please stand up? The Leadership Quarterly, 16, 441-457.

Poulin, M. (1984). The nurse executive role: A structural and functional analysis. Journal of Nursing Administration, 14, 9-14.

Shamir, B., & Eilam, G. (2005). “What’s your story?” A life-stories approach to authentic leadership development. The Leadership Quarterly, 16, 395-417.

Shirey, M. (2006). Authentic leaders creating healthy work environments for nursing practice. American Journal of Critical Care, 15(3), 256-268.

Sparrowe, R. T. (2005). Authentic leadership and the narrative self. The Leadership Quarterly, 16, 419-439.

Tracy, C., & Fang, D. (2010). Special survey on vacant faculty positions for academic year 2010-2011. Retrieved from http://www.aacn.nche.edu/IDS/pdf/vacancy10.pdf

Upenieks, V. V. (2002). What constitutes successful nurse leadership? A qualitative approach utilizing Kanter’s theory of organizational behavior. Journal of Nursing Administration, 32(12), 622-632.

Upenieks, V. V. (2003). Nurse leaders’ perceptions of what compromises successful leadership in today’s acute inpatient environment. Nursing Administration Quarterly, 27(2), 140-152.

Walumbwa, F. O., Lawler, J. J., & Avolio, B. J. (2007). Leadership, individual differences, and work-related attitudes: A cross-cultural investigation. Applied Psychology: An International Review, 56(2), 212-230.

Walumbwa, F. O., Avolio, B. J., Gardner, W. L., Wernsing, T. S., & Peterson, S. J. (2008). Authentic leadership: Development and validation of a theory-based measure. Journal of Management, 34(1), 89-126. doi: 10.1177/0149206307308913