Exploring the leadership styles of nurse managers in Hail, Saudi Arabia: A cross-sectional analysis

Leadership’s profound influence in the healthcare sector is indisputable, especially due to its ripple effect on all tiers of hospital staff, with nurses at the forefront. Nursing, which is central to patient safety and ensuring quality care, is a profession deeply rooted in human interaction, making leadership an essential competency for nurses across all levels of the hierarchy.^[1] Leadership encompasses the capacity to influence followers by offering direction, inspiration, and supervision, thereby contributing to productive organizational achievement.^[2] The leadership approaches embraced by nurse managers were shown to play a crucial role in fostering an empowered and satisfied nursing workforce which also contributes significantly to bolstering nurse retention .^[3] When encouraged and given authority by effective nursing leaders to pursue individual or team objectives, nurses have been shown to be highly driven, knowledgeable, more inclined to adopt evidence-based practices, and more committed to the institution’s objectives .^[1] These factors are in turn intrinsically linked to the quality of patient care, underscoring the pivotal role of effective leadership in ensuring positive healthcare outcomes .^[4]

Comprehensive studies within numerous healthcare institutions have delved into the nursing leadership styles, drawing insights from the perspectives of both nursing leaders and their staff. Notably, some of this research has specifically investigated scenarios within healthcare settings in Saudi Arabia,^{[5,6,7,8,9,10]} while further insights have been contributed by a variety of global studies.^{[11,12,13,14,15,16,17]} Among the various leadership styles, transformational leadership stands out as one of the most highly valued leadership patterns in the realm of nursing management ^[4] due to its capacity to foster and amplify nurses’ inherent professional traits. The term transformational leadership, initially introduced by James MacGregor Burns, encapsulates a leadership approach where leaders and their followers synergistically elevate each other to advanced levels of drive and ethical standards. Burns’s seminal work in 1978 ^[18] revolutionized the understanding of leadership dynamics, highlighting the benefits of symbiotic leader-follower relationships in organizational settings.

Transformational leadership is often identified as the dominant style in various studies. Yet, a deviation from this is noted in other research narratives, where a preference for transactional methods surfaces among Italian nursing leaders, which adversely affected the job satisfaction levels of staff nurses.^[12] This spectrum of leadership styles extends to include a mix of transformational and transactional strategies in other studies .^{[7, 8]} In a notable contrast within the USA, staff nurses perceive their nurse managers to exhibit lower levels of both transformational and transactional leadership traits than what is typically observed at national levels in a magnet hospital .^[11]

The contrasting findings of leadership styles in Hail’s healthcare sector, as reported by Albagawi in 2019 and Al-Shammari in 2014, suggest a potential evolution in management approaches over five years. Albagawi^[9] discovered that nurses perceived their leaders’ style as transformational, a view that was consistent with the leaders’ self-perceptions, suggesting alignment in leadership practices and awareness. In contrast, the earlier study by Al-Shammari ^[10] pointed to a predominance of laissez-faire leadership, despite this, transformational leadership stood out as being effective. These differences raise the question of whether the shift towards transformational leadership witnessed in the latter study reflects a deliberate change in leadership strategies over time, potentially influenced by shifting perceptions and expectations among nursing staff.

Several studies from Saudi Arabia, Pakistan, Ethiopia, USA, Indonesia, and Greece have indicated a strong inclination among nursing personnel towards leaders who primarily demonstrate transformational leadership qualities.^{[5, 8, 13, 15]} This leadership paradigm not only significantly bolsters nurse job satisfaction but also instils a robust propensity among staff to go beyond their conventional duties. Predominantly, these studies have revealed a positive relationship between transformational leadership and nurses’ enhanced job satisfaction, organizational commitment and quality of work life.^{[5,6,7,8, 10, 14,15,16, 19, 20]} However, it is worth noting that transactional leadership has also received recognition for its positive resonance with job satisfaction in various countries, albeit to a lesser extent .^{[8, 12, 21]}

Despite the contrasting findings across various research endeavors, it remains evident that distinct leadership styles wield unique influences on various aspects of nursing management and practice. This observation underscores the rationale behind some researchers’ call for the adoption of diverse leadership styles to achieve specific healthcare outcomes.^[22] Furthermore, recognizing the dynamic interplay between leadership styles and the contextual factors inherent to different healthcare settings is imperative. As such, adapting and tailoring leadership styles to align with the specific contextual nuances of healthcare organizations is strongly recommended, as this can substantially enhance the effectiveness of leadership within these diverse healthcare environments.

The purpose of this study is to explore the dominant nursing leadership style of nurse managers in Hail city as perceived by their nursing staff. Additionally, the study examines the impact of leadership behaviors on organizational outcomes, such as leader effectiveness, employee satisfaction and staff willingness to put in extra effort.

Conceptual framework

2.1Design

2.2Setting

2.3Sampling

2.4Data collection

2.5Ethical considerations

2.6Data analysis

In a survey of 372 nurses from Hail City’s main public hospitals, the majority (70.4%) were under 35 and female (88.2%), and nearly half (45.7%) had 1-2 years of clinical experience, as detailed in Table 1.

A comparison of leadership styles reveals an overall higher average score for transformational leadership (2.56±0.75) versus transactional leadership (2.27±0.68), suggesting a preference for or greater alignment with transformational qualities among the participants leaders (p < .001). Notably, the perception of transformational leadership was more pronounced among males, Saudi nationals, and those with less than one year of experience. Meanwhile, transactional leadership scores were markedly higher among the male and Saudi participants (p < .01) compared to their female and non-Saudi counterparts.

Dissecting the transformational leadership components, we see that the perception among males outperformed females in categories like idealized attributes and behaviors, inspirational motivation, intellectual stimulation, and individualized consideration, as evidenced by the higher mean scores (p < .05). Similarly, Saudi participants scored higher in these components compared to their non-Saudi counterparts (p < .05), as shown in Table 1.

Table 2 presents a robust correlation between transformational leadership and positive leadership outcomes (effectiveness, extra effort, satisfaction), with R2 values of 0.828, 0.786, and 0.760, respectively, overshadowing those of the transactional and laissez-faire styles. Within the transformational framework, inspirational motivation emerges as the most potent component, correlating strongly with positive outcomes. Conversely, transactional leadership, though less influential than transformational methods, still maintains a stronger relationship with positive outcomes than laissez-faire approaches (p < .001).

Table 3 synthesizes the impact of leadership styles on various outcomes through linear regression analysis. Transformational leadership explains a significant proportion of positive outcomes, accounting for 69% of effectiveness, 61.7% of extra effort, and 58% of participant satisfaction. In comparison, the influence of transactional leadership is discernible but less pronounced, contributing to 36% of effectiveness, 32% of extra effort, and 31% of participant satisfaction.

The study’s findings shed light on the prevailing leadership styles among nurse managers. It emerged that a predominant transformational leadership style was prevalent, with transactional leadership following as the next most common approach. This discovery aligns with similar studies in Saudi Arabia and Ethiopia,^{[9, 17, 28]} in which the consensus among staff nurses is that they are primarily led by transformational and transactional leaders.

In terms of leadership outcomes, this study yielded noteworthy results. Nurses reported high levels of job satisfaction, perceived their leaders as effective, and felt motivated to exert extra effort when they were exposed to a transformational leadership style. These findings are consistent with multiple studies from Saudi Arabia, Pakistan, and the USA.^{[5,6,7,8, 10, 14,15,16, 28]} For instance, Choi’s ^[29] research indicated that job satisfaction among nurses increases with transformational leadership, mainly due to its empowering effects. Suratno et al.^[20] also underscored how transformational leadership improves nurses’ quality of work life, resulting in enhanced work quality, employee well-being, and work relationships. Furthermore, transformational leadership was found to be inversely related to the intention of employees to leave the organization .^[30] Moreover, nurse managers’ adoption of transformational leadership styles empowers staff nurses to act as catalysts of positive change within their healthcare settings. Underscoring the significance of transformational leadership in the healthcare context, particularly in the provision of high-quality nursing care .^[3]

The study emphasizes the integral role of transformational leadership components, such as idealized behaviors, attributes, and inspirational motivation, in shaping effective nursing leadership, with Bass and Avolio ^[27] highlighting the influential power of a leader’s charisma in guiding team actions. In fact, inspiring leadership has been found to be correlated with nurses’ reports of fewer work issues and improved team satisfaction.^[31] Furthermore, the cruciality of robust nursing performance in sustaining effective nursing leadership ^[32] necessitates that nurse leaders adopt practices that enhance intrinsic motivation and overall performance in their teams. As shown by Cummings et al.,^[3] these leadership approaches are essential in steering individual and organizational goals, thereby contributing to enhanced healthcare quality. By fostering a culture of inspiration and high performance, nurse leaders can significantly influence broader institutional success, driving superior patient care through their leadership styles.

Limitations

This study highlights transformational leadership’s critical importance in healthcare. Therefore, nurse leaders are urged to adopt this approach by concentrating on motivational strategies. Such strategies, which have been proven to amplify commitment and satisfaction among staff, are vital in the demanding healthcare sector. This further asserts the need for healthcare facilities to implement specific programs aimed at nurturing transformational traits within their leadership cadre, acknowledging the substantial impact that these qualities have on staff enthusiasm and institutional excellence. By establishing a culture of inspiration and high performance, this approach can become instrumental in enhancing healthcare outcomes, confirming that the heart of superior care lies in empowering leadership.

All authors contributed equally to the research.

This study was self-funded by the authors.

The authors declare they have no conflicts of interest.

Obtained.

The Publication Ethics Committee of the Sciedu Press. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

Not commissioned; externally double-blind peer reviewed.

The data that support the findings of this study are not publicly available due to privacy or ethical restrictions.

No additional data are available.