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Download PDF FileABSTRACT
This research project aims to determine the impact of leadership styles on nurse job satisfaction in Qatar’s healthcare industries. A questionnaire was built and distributed to nurses working in hospitals in Qatar to assess their job satisfaction in relation to their line manager leadership style. A total of 104 valid responses were used. The data collection period was from April 9, 2020, to April 23, 2020.
The data collected was extracted as an Excel sheet from the Google Forms platform and moved to SPSS for analysis. The Correlation coefficient assessed the linearity of the variable, and a regression analysis was performed to investigate the impact of the independent variables on the dependent variable and test the moderator variable's moderation effect. Results of the study have shown that there is a significant impact of the transactional and transformational leadership styles when it comes to discussing about the level of satisfaction in the profession of nurses. Therefore, in such a case where the transformational and transactional leadership styles greatly influence the satisfaction level among the nurses, it becomes clear that various elements of these leadership styles are also important to be focused on by the managers. However, no significant moderation effect has been observed by years of experience in transformational or transactional leadership. By the study results, it can be concluded that managers have a great influence over their subordinates and when they encourage them in their performance, it increases their level of motivation.
GLOSSARY
INTRODUCTION
Background
The healthcare sector in Qatar is booming, especially with the Qatar National Vision 2030, and it was ranked among the top five in the world and the first in the middle east (Gulf Times,2019). Healthcare spending in Qatar is the highest in the region. Moreover, Hamad medical corporation (HMC), the premier non-profit healthcare provider representing approximately 80% of the health care industry in Qatar, opened six new hospitals in 2018, which was the largest expansion in the HMC's history.
Therefore, the demand for healthcare professionals, especially nursing, is increasing tremendously, and there are more than 16,000 nurses in Qatar with over 48 nationalities. The nursing profession is one of the utmost healthcare professions that have a great impact on the healthcare system. Nurses constitute the largest number in the healthcare industry and have great potential to transform and change the healthcare system(Institute of Medicine, 2011). In Qatar since expatriates represent approximately 85% of the population. This multicultural environment makes it very challenging to maintain the quality of service provided.
In this context, leadership is vital in enhancing the healthcare system and maintaining efficacy and efficiency. A leader that possesses good leadership skills and qualities can have a direct impact on enhancing the entire organization. The general objective of this study is to examine the Impact of leadership styles on nurse job satisfaction. The leadership styles being focused on in this study are transactional leadership and transformational leadership utilized by nurses in Qatar.
The findings of the research can be employed to provide recommendations on leadership styles and skills that contribute to better satisfaction in the nursing field in Qatar.
Leadership Overview
Many researchers developed different theories on leadership, as each person leads differently than others. This helped us to classify and interpret those styles in order to be able to identify and weigh each style and its contribution to job satisfaction.
In 1939, Kurt Lewin defined 3 styles of leadership (Lewin et al., 1939):
- In authoritarian leadership (Autocratic), these leaders provide a clear direction of what, when and how things should be performed. This focus is on both giving orders and controlling. Usually, authoritarian leaders make a decision independently.
- Participative or democratic leaders: these leaders encourage their followers to be a part of the decision process. Moreover, this style contributed to higher productivity among groups.
- Delegative or free rein (laissez-faire) leaders: these leaders are very lenient and provide complete freedom in the decision process and problem-solving to their followers with little to no guidance from leaders.
In late 1970, Hersey and Blanchard developed slightly divergent versions of the Situational Leadership Theory: The Situational Leadership Model (Hersey) and the Situational Leadership II model (Blanchard et al., 1985).
- Delegating Style: These leaders permit their followers to take the initiative and responsibility in decision-making as he is confident that their followers are competent and highly committed to work.
- Supporting Style: These Leaders support their followers by checking the performed work in order to ensure that it is well performed.
- Coaching: These leaders help their followers develop their skills and progress to a higher level.
- Directing: is the basic level of leadership style especially used with a new employee or no previous experience employee. The leader follows and directs the tasks by providing clear instructions on the process. Moreover, the leaders encourage positive results and recommend corrective actions for non-well-performed actions.
In 1985, Bass developed and published “The Bass Handbook of Leadership”, where he highlighted transactional and transformational leadership.
- Transactional Leadership: these leaders evaluate their followers' performance and encourage them through rewards and punishments.
- Transformational leaders – In contrast, these leaders are long-term oriented. They motivate and inspire their followers.
In this thesis, we will choose both transformational and transactional leadership and test their influence on nurses’ satisfaction since they have been used in numerous studies, especially in healthcare facilities.
Problem Statement
It is necessary that firms should possess excellent leadership traits to achieve their goals and to motivate each employee within the firm at any level. This will lead to the success of the overall organization.
The healthcare sector in Qatar witnessed remarkable growth in the region. Consistency in leadership is very important to keep the desired objectives and continue to be among the top in the world. Job Satisfaction is highly linked to the leadership style exerted by managers. Management with ineffective leadership behaviour will create a toxic, destructive, malicious, and harmful effect not only on the employees but the overall organization. (Singh et al., 2019).
Therefore, having a diverse workforce environment, especially in the nursing field, makes it very challenging to lead. The managers should develop a leadership strategy to manage the staff, improve the performance of the operations, and achieve organizational goals by keeping the staff satisfied and motivated.
Very few researches in Qatar deepened nurse managers’ leadership styles and employees’ job satisfaction. The evaluation of the Impact of leadership styles on nurse job satisfaction in this study is built from the literature review.
Purpose of the Research
The aim of this research is to look into the relationship between leadership style (transactional and transformational) on the job satisfaction of nurses in the healthcare industry in Qatar. Moreover, the research will test if years of experience can also have an impact on nurses’ job satisfaction. This will help us to assess which leadership style contributes to better job satisfaction and the moderator impact of the experience.
Transactional leadership is based on good relationships, positive feedback or praise, and negative or reprimands. Transformational leadership is the transforming leader, eminently a supporter of change, subordinates' aspirations, ideals, motivations, and values .
It is important to analyze how the leadership and the relationship that exists between the leader and his collaborators, reviewing antecedents, characteristics, and theories of leadership, as the objectives of this article will seek to understand the degrees of conformity that people feel based on the influence of the leaders (Quinn &Spreitzer, 2005). Leader behaviours generate mechanisms of motivation that affect the behaviour of individuals in the organization. Job satisfaction, over time, has escalated in the pyramid of priorities of employers, which is an essential factor in the quality of life and development of individuals in their professional life (Peiro& Gonzales-Roma, 2003).
The first phase of this paper seeks to conceptualize the benefits that the analysis of leadership and satisfaction can give, for which we will review various investigations on how employees perceive it within organizations. The research will be developed with the aim of briefly it can be analyzed how the characteristics of a leader, i.e., transactional and transformational in the field of nursing, can reach the goal of job satisfaction of nurses, explaining concepts exposed by different authors, and thus have a deeper understanding on the importance of leadership and the impact of leadership styles on nurse job satisfaction.
Afterwards, a survey method will be used and distributed to nurses working in Qatar hospitals. The analysis of data and the results collected from the study will assess the leadership style exerted by the nurse supervisors/managers in the healthcare facilities in Qatar and explore how to adopt the use of transformational/transactional leadership in the context of staff satisfaction.
Research Questions
- Which leadership style contributes to a higher level of satisfaction among nurses?
- Do years of experience influence the leadership style and its effect on nurses’ job satisfaction as a moderator?
CHAPTER 2: LITERATURE REVIEW
Good leaders are an asset to any organization. Good leaders will motivate and provide direction to their staff, thus achieving the organizational objectives. Health care setting is not different from any other industry. Studies have shown how highly effective leadership is related to healthcare providers and their job satisfaction.
Nurses' job satisfaction is crucial since nursing profession greatly impacts the health care system and it is one of the utmost professions that greatly impact the health care system as they constitute the largest number in the healthcare industry (Institute of Medicine, 2011). This literature review aims to deeply elaborate on the leadership style and its influence on nurses’ satisfaction in healthcare settings. In this study, only two different leadership styles will be assessed; the first is transactional, and the second is transformational. Moreover, this thesis will consider the years of experience as a moderator variable to examine if it influences job satisfaction. A healthcare setting was adopted with a focus on nurses, as they deal with human life regularly. Therefore, we need to keep healthcare professionals motivated and satisfied with their jobs to provide the best quality of service and subsequently improve the patient's health.
It is necessary to analyze the effects of leadership, its influence on perceptions, and how they affect the satisfaction perceived by employees. More explicitly, we try to find out how significant the relationship is between leadership styles (transactional and transformational) and nurse satisfaction.
Leadership Styles
The term leader was recognized as early as the 1300s; however, scientific research began to develop in the middle of the 20th century. Many research lines, the main objective of which was to find out the typical behaviours of the leaders and try to relate these behaviours to the performance of the group and the satisfaction of its members. In all of them, the leader's behaviour could be summarised with different names according to the model or the theory in which they are included. In two dimensions or styles of leadership: orientation to the task, where the leader is mainly concerned with achieving the group objectives and orientation to the relationship, where the leader is basically interested in the welfare and satisfaction of the followers. A relationship has also been found between the leader's reward behaviour and job satisfaction (King, 1990). Bass (1985) rescues certain traits exercised by the leaders that generate awareness of the importance and values that can be achieved after obtaining the results when performing the assigned tasks. Thus, for Bass & Riggio (2006), some features of leadership styles related to values can be highlighted:
Transactional
The Transactional Leadership dimension includes the behaviours associated with supervision and can be assimilated into Situational Leadership or Contingent Leadership models. Bass describes two levels of transactional leadership (Northouse, 2010):
- Active Exception Management alludes to the implementation of periodic performance management procedures aimed at preventing problems and increasing the performance of subordinates by watching them closely.
- Passive Exception Management, on the other hand, implies only the response to breaks in the processes where the standards or objectives are not met.
Transaction leadership focus on achieving organizational objectives and goals and use negotiation with subordinates and rewards.
- They closely monitor the tasks of their team in order to avoid mistakes.
- They tend to be proactive and reactive when errors arise.
Transactional leadership helps leaders achieve organisational goals and increase competitiveness; however, this leadership style tends to have some downsides as it might cause demotivation of the employees or to perform outside their duties or think out of the box. Moreover, with transactional leadership, the leader provides comprehensive instruction on the job role and helps them achieve the company goals. Consequently, rewards or reprimands will be provided based on the results. Moura et al. (2017) reviewed related articles from 2011 to 2016 and the data showed a significant relationship between transactional leadership and job satisfaction. From this, the first hypothesis of this study is (H1):
H1. The transactional leadership style has an impact on nursing job satisfaction.
The study's first hypothesis demonstrates that transactional leadership directly influences the level of satisfaction among nurses. Transaction management is based on good relationships, positive feedback or praise, and negative or frightening. The meta-analysis conducted by Dumdum, Lowe and Avolio (2013) compiles studies on the relationship between transformational and transactional leadership styles with satisfaction finding significant and moderately strong correlations. The correlation between the dimensions of consideration and structure with employee satisfaction is observed, all being significant. A considerable impact of leadership styles on nurse job satisfaction is observed that must meet the needs of the moment and evaluate which style is the most effective for that particular situation. Measures such as leadership styles and job satisfaction, guide administrators towards a better understanding of people's needs. These measures also provide more realistic ways of improving the quality of life at work and solving various employee problems related to job satisfaction and the manager's leadership style.
Transformational
Transformational leadership was developed in the 1980s. Many studies demonstrate that this type of leadership is the most preferred among employees in many industries. Transformational leadership tends to motivate the employees, create and increase awareness of main issues, increase the level of need for self-actualization and surpass their interests to the best of the organization. Moreover, this type of leadership empowers the employees to become transformational leaders (Bass, 1995).
A transformational leader provides a vision for the future and promotes the common mission. It is based on a high ethical and moral standard that promotes problem-solving intelligently and rationally. The main challenge of a transformational leader is to motivate their followers, help them achieve more than expected, and contribute to the organization's growth (J. Arenas 2019).
This type of leadership has four transformational behaviours:
- Idealized influence: the leader is a role model to all his subordinates. Therefore, they are respected, admired and trusted in the company. High ethics and morals are processed by this type of leadership
- Inspirational Motivation: It develops motivation and teamwork among the team. The level of productivity is higher than expected.
- Intellectual stimulation: Leaders encourage their followers to be more creative and innovative. This will help to develop a new approach to problem-solving that is efficient.
- Individualized consideration: The leader, coach, and mentor may need to consider the need of each member of the team since the needs might differ from one individual to other.
Alzahrani et al. (2019) conducted a systematic review of the transformational leadership style on nursing job satisfaction, especially since the nursing shortage is a common problem in Saudi Arabia. Understanding the factors that contribute to better satisfaction is important to make the nursing profession attractive. Therefore, nurse managers should improve their leadership skills in order to provide a better working environment for the staff. Nassem et al. (2018) conducted a cross-case study in public hospitals in Lahore, Pakistan. The results revealed that transformational leadership is very effective in promoting nurses' job satisfaction and increasing job performance.
Alshahrani et al. (2016) studied the effect of transactional and transformational leadership styles on nurses' job satisfaction in Saudi Arabia, resulting in higher nurses’. Therefore, the second hypothesis of this study is (H2):
H2. The Transformational leadership style has an impact on nurses’ job satisfaction.
The study's second hypothesis emphasises the association between job satisfaction and transformational leadership. Transformational leadership is part of the paradigm called new leadership, as provided by Bass and Avolio (1993), which has evolved since the 1980s, with special emphasis on emotional and charismatic aspects. In particular, transformational leadership is a process that changes and transforms individuals based on the leader's emotions, values, morals, quality, and long-term goals. For their part, Seidman and Mc Cauley (2011) consider that one of the fundamental characteristics of this is to promote the development of competencies within the organization, where their contribution contributes to significant progress and effort; They motivate and inspire to change the perspective of their collaborators. When it comes to leadership, transformational leadership demonstrate a higher satisfaction level compared to transactional leadership styles. It points to how the leader has the purpose of generating a positive impact on the performance of the collaborators of a company, being human capital, the engine that promotes the organization towards growth (Dumdum, Lowe and Avolio, 2013).
Arisa and Syah (2018) conducted a study to test transformational leadership style of nurse managers and its influence on the level of satisfaction among the staff nurses. Results revealed that transformational leadership significantly increases job satisfaction and leaders who care and help their staff contribute to increased satisfaction. Depending on the level of satisfaction, this may affect the quality and quantity of work, as well as the increase in staff turnover, absenteeism, or poor quality of work.
Job Satisfaction
In general, organizations want their employees to be motivated, actively participate in the work done, and feel valued for their contributions, especially in nursing, since the nurses contribute to enhancing the patient's health. When a collaborator perceives high standards of dissatisfaction decreases their performance in work entrusted, which has been analyzed in various investigations creating theories relating to the effects of this dissatisfaction. The authors Chiang, Méndez & Sanchez (2010) indicated that it is essential to realize how important it is to value that satisfaction in human beings since this is a feeling, either of pleasure or pain, and that is different from what thought or behaviour intentions. It is essential to consider that these factors affect the proper management of the organizations so that they understand the reactions of their collaborators to work carried out.
Therefore, analysing the needs of subordinates, and using good leadership, should obtain optimal employee satisfaction in organizations. The talents, qualities, and knowledge of a person who has the vision and perspective to motivate the people under their command and to carry out specific activities within the company chosen based on their ability, knowledge, and skills, to result in excellent work, in which three psychological needs: autonomy, competence, and link. This demonstrates how the satisfaction of these needs is directly related to intrinsic motivation and, therefore, to greater satisfaction and labour productivity. Rowe (2001) highlighted a symbiosis generated between the leader and subordinates, that is, the trust, amalgamated by fair remuneration, creates in the assistants an impulse of creativity and fulfilment of the goals and objectives of the company, creating a collective human capital, guided by the leader in the function or goals that are proposed. The commitment weights performance. It is much more important when understanding the elements that facilitate an employee's involvement (Perez et al., 2013). This connection between the leader and subordinates working perfectly with clear goals, motivation, and training, creates an environment of satisfaction at work. Human resources have become a strategic asset of the first order since they depend on the knowledge and creativity necessary to promote innovations and increase productivity.
The authors Adams, Djukic, Gregas and Fryer(2018) carried out a new study approach to examine the Leadership Styles in creating a better work environment for nurses and improving patient outcomes. Perez (2014) carried out a study whose objective was to determine the Impact of leadership styles on nurse job satisfaction. This study was conducted in a sample of 32 nurse managers using the Multifactor Leadership Questionnaire, concluding that all the surveyed professionals have leadership skills. In terms of job satisfaction, transformational leadership was found at a high level of satisfaction. Unfortunately, few studies deepened the topic of transactional or transformational leadership quality. However, there are no recipes for good performance since, even with experience, the leader cannot anticipate the problems that will arise daily.
The authors Gonzalez Alvarez, L., et al. (2013) carried out the study "Relationship of Labor Satisfaction with Leadership Styles in Nurses of Public Hospitals of Santiago," aimed to determine whether the job satisfaction perceived by nursing professionals is related to the leadership styles of the Hersey and Blanchard model. A quantitative, cross-sectional, descriptive, correlational study had 214 nurses using a questionnaire on Labor Satisfaction and Leadership Styles as instruments. The results show that there’s no Leadership style better than the other that affects job satisfaction among nurses. Nurse managers can influence by exercising a leadership style appropriate to the situation, thereby increasing their staff's motivation and job satisfaction.
Nurses Leadership
The American Organization of Nurse Executives (AONE) recognizes leadership as an essential competency in the administration of nurses due to their active participation in public policies, health programs, and allocation of resources, analysis of information and direction of working groups (Waxman, Roussel, Herrin-Griffith and D’Alfonso, 2017). In turn, the Institute of Medicine (US) supports the described, stating that leadership is essential to achieve the objectives related to the quality of care and safety of patients. At the same time, it points to transformational leadership, centred on the quality of care, as a necessary element for nurses to face the deficiencies of the work environment (Page, 2004).
For its part, the World Health Organization Health points out that it is a challenge to maintain competent professionals, stating that nurses who occupy leadership positions must be able to influence the decision-making mechanisms that establish priorities and allocate resources for obtaining health. In hospital institutions, as supervisors, nursing professionals need preparation to assume leadership roles, a necessary condition to generate changes in their daily practice and guarantee the quality of care, to reconcile the institutional objectives with the needs of the nursing team. Together, leadership is considered the most important factor that affects nurse satisfaction and contributes to a higher level of job performance. (Naseem, Afzal, Sehar& Gilani, 2018).
The current trend in leadership indicates that this is considered an essential and inherent factor in all organizational theories. And for nursing, it is basic competence in the organizational structure of health institutions due to the need to have efficient and competitive institutions, with human resources prepared in managerial skills and leadership, which promotes social relations centred on culture, communication, and the community. At the same time, it generates analysis processes and the possibility of change in organizations to achieve a better quality of patient care, impact on the work environment, and staff welfare.
The authors Lorber, Treven and Mumel (2016) discussed in their study that nursing professionals have emerged as leaders of the health team due to their training and professional development with certain personal attributes that articulate knowledge and actions necessary to offer creative and quality assistance. Besides, it must have the capacity to generate, develop, promote and evaluate processes of transformation in health services and professional education towards universal coverage and the renewal of primary health care to the highest quality of care. In turn, we must highlight the moral sense of the leadership of these professionals, which responds and accounts for the social commitment that communities and nations have granted to nurses about the provision of social care of the highest quality and universality in favour of health. According to Konstantinou and Prezerakos (2018), "Leadership plays a fundamental role in the lives of nurses" and "Nursing requires strong, coherent and well-informed leaders." However, despite numerous studies that have analyzed and explained the research subject, there is no available evidence on a definitive, effective theory that guides leaders.
Diversity and experience impact on Job Satisfaction
A multicultural working environment accommodates and incorporates the different employees’ ideas and beliefs. Each employee possibly has a diverse social and cultural background (Rozkwitalska&Basinska, 2015). A competent leader must put all these factors in place when choosing a leadership style to employ so that it can be just and fair to all employees. Nursing brings together individuals from different backgrounds and experience levels. This creates a cultural pool whereby different individuals exchange their experiences. This form of experience and cultural exchange serves to enlighten others and create an understanding for one another hence improving relations that result in job satisfaction among nurses (Rittle, 2015). A wise leader understands and acknowledges those facts and employs a strategy to put everyone under a unified work environment, so they feel appreciated when others genuinely understand them.
Nursing is an extensive career that has nurses coming in from different backgrounds. The diverse backgrounds imply a vast information base from the nurses. Different cultures have different ways of doing things compared to how others get them done. A nurse could have a medical practice that other nurses are unaware of and teach them in the long run. Information is shared much more quickly this way. Whenever employees are allowed to take part in matters that are not work-related, only they feel noticed, appreciated and even considered. A vast information pool gets created when nurses from different countries work together toward similar goals. They work hand in hand with each other and assist whenever possible, and in the long run, the enhanced teamwork results in job satisfaction for all employees (Jacobs, 2015).
According to Koopmans 2018, experience is a positive driver in improving the quality of nursing care and job satisfaction. It will enhance communication and teamwork with optimal staff and skill mix. The work gets evenly distributed according to individual competence and area of expertise. Nurses come from various places and different countries with different practices. The nurses should be given work according to their qualifications to relate to the assigned tasks. There are no special employees, but each employee has unique jobs to undertake. Higher qualified or experienced nurses can educate existing personnel, increase problem-solving, and enhance job satisfaction. Therefore, it was hypothesized the following:
H3:The years of experience have a moderation influence on the model
H3a: The years of experience moderately influence the relationship between transactional leadership and nurses' job satisfaction.
H3b: The years of experience moderately influence the relationship between transformational leadership and nurses' job satisfaction.
In nursing, these professionals are responsible for providing comprehensive and quality care while considering psychological, social, cultural and biological aspects, seeking to modify the conception focused on health care and assume leadership, which must be "comprehensive, generating a favourable, participatory work climate, fostering teamwork, involving its staff in decisions" (Sukumarakurup, Hougton, Neck & Ellison, 2015). For their part, teaching nurses must be clear about the concept of leadership and master the practices that promote their development because experience has shown that this notion has different connotations for the same teachers. This requires flexibility in applying leadership and management skills, which are directly related to teamwork, decision-making, and planning, which use different leadership styles depending on the situation that arises and as necessary (Saleh et al., 2018).
In this way, it will be able to influence the nurses, motivating health team behaviours and behaviours towards humanized and quality management practices. Therefore, nursing professionals have the responsibility to direct the road to change, consider the significant problems, and identify the strategies whose actions are required to exercise all their leadership potential. However, the study's results showed significant differences in leadership style perceptions between the managers and staff, which influenced declining satisfaction. (Andrews et al., 2012). Also, taking leadership for yourself does not guarantee its effectiveness. Not only does it influence the direct care of patients, but it also affects the administration, education, decisions and autonomy of peers while promoting the improvement of health and life conditions of the population; the achievement of care objectives specific to the profession, and the achievement of the goals proposed in the health services. For this reason, it is a process that favours social, professional and organizational development, whose magnitude covers all areas of management in nursing, whether they are performing care functions or being in charge of a group of paramedical technicians., administering a service, or participate in the training of new professionals (Higgins, 2015).
The exercise of leadership, despite being involved, is inherent in the organization of work and affects the articulation of teams. When performing his function, a leader must approach a particular style. Among these standouts, according to the model of Blanchard and Hersey, the director, coach, participatory/supporting and delegating. With this, it must be understood that the model or style adopted defines the leader's effectiveness in terms of their ability to use each style according to the collaborators' situation. No leadership style is always correct to use in all situations. Therefore, the most effective leader will be one who demonstrates greater style flexibility and uses the right style with the right person. The Hersey and Blanchard model has helped professionals and consultants worldwide pay more attention to the concept of "situation" (Gonzalez Alvarez, L. et al., 2013).
Nursing professionals who don’t perceive job satisfaction correlate with the delegating and directing styles, respectively, while the perception of the "quite satisfied" level correlates with participative and coaching styles. It is also possible to affirm that nursing professionals' perceived job satisfaction as satisfied is significantly associated with the coach and participative leadership styles. At the same time, those classified as dissatisfied labourers perceive predominant leadership styles as those referred to as director and delegator. These results are supported by various research conducted by the universities of Ohio and Michigan, which showed that leaders who adopt coach and participative styles tend to achieve better performance and satisfaction of their subordinates because they emphasize personal relationships, are particularly interested in the needs of his followers and accept the individualities of the group (Gonzalez Alvarez, L. et al., 2013). A crucial element of effective leadership is that leaders have the confidence of their workers (Omar, 2011).
Therefore, nurses should be visible and close so that the change process is facilitated and the scope of the service that the clients need. This fact may be linked to the lack of emphasis given to acquiring this knowledge since leadership development must begin at the basic level, together with research activities and clinical / community experience (Robles et al., 2005). It is possible to reinforce it through continuing education and perfect it in the master's and doctorate programs, where many leaders flourish fully in all nursing domains: practice, education, administration, and research (Morsiani, Bagnasco and Sasso, 2017).
CHAPTER 3: RESEARCH METHODOLOGY
Objectives of the research
This research project aims to determine the impact of leadership styles on nurse job satisfaction in healthcare industries in Qatar. The methodology is directed and concentrated on the two research questions. First, to investigate which leadership style contributes to a higher level of satisfaction among nurses in Qatar and second if there is a moderation impact of the “years of experience” on the relationships between the leadership styles and the nurse's job satisfaction.
The proposed research model concluded with the idea that transactional and transformational leadership styles directly influence nurses' job satisfaction (Naseem et al., 2018 &Alshahrani et al., 2016).
As a result, the model consists of two variables as predictors for nurses' job satisfaction. The variables are Transformation Leadership Style, and Transaction Leadership Style. Moreover, the model considers the moderation effect of years of experience on the proposed relationships. The model is presented in Figure 1
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Research Instrument
A questionnaire was built and distributed to nurses working in hospitals in Qatar to assess their job satisfaction in relation to their line manager leadership style.
A self-administrated questionnaire was used to collect data. The questionnaire is presented in Appendix A. The online questionnaire comprises three parts; the first comprises questions related to demographics; the second comprises questions concerning the two independent variables: The transformational leadership style or the transactional leadership style exerted by their line manager and its impact on their job satisfaction. The responses to the questions were on a 5-point Likert scale (1= strongly disagree, 2= disagree, 3= Neutral, 4=agree, and 5=strongly agree), in which respondents were asked to rate the level of their agreement with the various items. The third section of the questionnaire included questions about the dependent variable (Job Satisfaction). Respondents were also asked to rate their agreement level with the various items based on a five-point Likert scale.
The electronic version of the questionnaire was in English and sent to nurses’ email through the hospital administration department. The purpose of the study was mentioned to the participants through the information sheet in the email. The participants were informed that their participation in the study was entirely voluntary and anonymous, and they could withdraw from the questionnaire at any time. They were also informed about the required time to finish the questionnaire, which is around ten to fifteen minutes. Moreover, the participant's identity was not required at any time in the study as it is intended to preserve confidentiality.
The subject will get the opportunity to clear their concerns and queries with the principal investigator through email or telephone number available in the information sheet. There is no risk associated with this study. A reminder was sent to the participants at an interval of 1 week to encourage their participation in the study. The survey was open for 2 weeks, and no further follow-up or contact was required with the participants.
Sample and Data Collection Procedure
This section will describe how the data collection and analysis were performed in this study. A quantitative analysis was selected to examine the relationship between different variables for a large group of samples. Since the research analyses, the leadership style and job satisfaction of the nurses, A survey (Appendix) was designed to take into account all the factors that need to be tested in this research and was used as primary data collection. Before distributing to the targeted hospitals, a Qatar University Institutional Review Board approval QU-IRB 1281-E/20 (Appendix)was obtained.
The survey questionnaire was used as primary data collection. A questionnaire was designed based on the research question formulated in the study and distributed to a hospital in Qatar. A proportionate stratified random sampling method was used to collect the data. The nurses' database working in a Qatar healthcare facility was collected from the workforce department. The sampling frame was prepared based on the nurse’s database. A total of 104 valid responses were used. The data collection period was from April 9, 2020, to April 23, 2020. The data collected was extracted as an Excel sheet from the Google Forms platform and moved to SPSS for analysis.
Validity of the questionnaire
The survey was reviewed and approved by Qatar University Institutional Review Board Committee (QUIRB) and the hospital where the study was conducted. The approval is under the number IRB 1281-E/20 (Appendix), and the approval letter is listed in Appendix B.
The purpose of the review is to ensure the validity and integrity of the questionnaire, complying with ethical practices.
Data Management and analysis
The data will be collected by using online survey software, Google forms. The response of the participants will be recorded in the survey software. The data extracted from the survey software will be transferred to an Excel sheet regarding the research study design and objectives. Final data will be accessible by the Principal Investigator and biostatistician for statistical analysis and final report preparation. The study's primary aim is to identify the effect of transactional and transformational leadership styles on nurses' job satisfaction in Qatar. The participant’s answers will be analysed using a five-point Likert scale.
Numerous statistical techniques were used to analyse the data and test the hypothesis. The internal consistency was assessed by a reliability analysis using Cronbach’s Alpha of the items of each variable. Descriptive statistics were used to summarize the data regarding demographic details, educational details, and clinical experience and to evaluate the mean and standard deviation of the study variables and items. The study's primary outcome is to determine the effect of transformational and transactional leadership styles on a nurse's job satisfaction based on the responses to 29 questions. Furthermore, the linearity of the variable was assessed by the Correlation coefficient, and a regression analysis was performed to investigate the impact of the independent variables on the dependent variable and test the moderator variable's moderation effect.
CHAPTER 4: DATA ANALYSIS
Sample Demographics
The questionnaire was distributed to 4 groups of nurses working in a healthcare facility in Qatar: Staff Nurse, Charge Nurse, Head Nurse and Director of Nursing to assess the leadership styles and the impact on job satisfaction.
The number of participants who participated in the research is 104 (n=104), 51% female and 49%, male. The majority of nurses in Qatar are Arabs 75%, Asians 14%, western 10%, Africans 3% and Qatari 2%. In terms of the level of education, 63.5% hold a Bachelor of Science in Nursing, 19.2% a Master's degree, a diploma 12.5% and 4.8% other qualifications. 50% of the nurse's age range between 36 and 45 years old, 35.6% between 25 and 35 years old, 11.5% between 46 and 55 years old and 2.9% above 56 years old. In terms of years of experience, 35.6% have between 11-15 years, 29.8% between 5 to 10 years, 19.2% 16-20 years and 15.4% have more than 20 years of experience. 62.5% of the participants are staff nurses, 18.3 of the participant’s head nurses, 15.4 charge nurses and 3.8% are the director of nursing.
| Frequency | Percent | |
Gender | Female | 53 | 51 |
Male | 51 | 49 | |
Nationality | African | 3 | 2.9 |
Arab | 75 | 72.1 | |
Asian | 14 | 13.5 | |
Qatari | 2 | 1.9 | |
Western | 10 | 9.6 | |
Level of Education: | Bachelor of Science in Nursing - BSN | 66 | 63.5 |
Diploma | 13 | 12.5 | |
Master’s degree | 20 | 19.2 | |
Other Qualification | 5 | 4.8 | |
Age | 25 - 35 | 37 | 35.6 |
36 - 45 | 52 | 50 | |
46 - 55 | 12 | 11.5 | |
Above 56 Years | 3 | 2.9 | |
Years of experience | 11-15 | 37 | 35.6 |
16 - 20 | 20 | 19.2 | |
5-10 | 31 | 29.8 | |
More than 20 years | 16 | 15.4 | |
Job position: | Charge Nurse | 16 | 15.4 |
Director of Nursing | 4 | 3.8 | |
Head Nurse | 19 | 18.3 | |
Staff Nurse | 65 | 62.5 | |
Descriptive Analysis
The second part of the questionnaire (questions 1 -29) targeted the research question to identify the leadership style contributing to higher staff satisfaction. A descriptive analysis was done to evaluate the items’ means and standard deviations of the Likert Scale to check how respondents perceived them. The results are listed in Table 2. Items codes and statements are listed in the questionnaire in Appendix B. A 5-point Likert scale was used in the questionnaire. The mean is classified into Five levels:
- 51-5.00 means the highest degree of agreement with the statement
- 51-4.50 means a high degree of agreement with the statement
- 51 -3.50 means the medium degree of agreement with the statement
- 51-2.50 means a low degree of agreement with the statement
- 00-1.50 means the lowest degree of agreement with the statement
For the Transformational Leadership Style Variable (TF), 6 items mean are highly perceived (3.51-4.50), which indicates a high degree of agreement with the statement, and 7 items mean they are moderately perceived (2.51-3.5), which indicates a moderate agreement with the statement.
For the Transactional Leadership Style Variable (TS), All 9 items mean moderately perceived (2.51-3.5), indicating moderate agreement with the statement.
For Job Satisfaction Variable (JS), only 1 item means they are highly perceived (3.51-4.50), which indicates a high degree of agreement with the statement, and 6 items mean are moderately perceived (2.51-3.5), which indicates a moderate agreement with the statement.
N | Minimum | Maximum | Mean | Std. Deviation | |
TF1 | 104 | 1 | 5 | 3.66 | 1.094 |
TF2 | 104 | 1 | 5 | 3.52 | 1.097 |
TF3 | 104 | 1 | 5 | 3.56 | 1.131 |
TF4 | 104 | 1 | 5 | 3.42 | 1.146 |
TF5 | 104 | 1 | 5 | 3.63 | 1.089 |
TF6 | 104 | 1 | 5 | 3.48 | 1.043 |
TF7 | 104 | 1 | 5 | 3.47 | 1.165 |
TF8 | 104 | 1 | 5 | 3.73 | 1.063 |
TF9 | 104 | 1 | 5 | 3.35 | 1.213 |
TF10 | 104 | 1 | 5 | 3.47 | 1.106 |
TF11 | 104 | 1 | 5 | 3.57 | 1.121 |
TF12 | 104 | 1 | 5 | 3.45 | 1.06 |
TF13 | 104 | 1 | 5 | 3.37 | 1.223 |
TS1 | 104 | 1 | 5 | 2.71 | 1.163 |
TS2 | 104 | 1 | 5 | 2.61 | 1.169 |
TS3 | 104 | 1 | 5 | 3.5 | 1.088 |
TS4 | 104 | 1 | 5 | 3.3 | 1.238 |
TS5 | 104 | 1 | 5 | 3.18 | 1.095 |
TS6 | 104 | 1 | 5 | 2.86 | 1.11 |
TS7 | 104 | 1 | 5 | 3.49 | 1.149 |
TS8 | 104 | 1 | 5 | 2.67 | 1.273 |
TS9 | 104 | 1 | 5 | 3.05 | 1.152 |
JS1 | 104 | 1 | 5 | 2.56 | 1.197 |
JS2 | 104 | 1 | 5 | 3.28 | 1.21 |
JS3 | 104 | 1 | 5 | 3.13 | 1.183 |
JS4 | 104 | 1 | 5 | 3.18 | 1.252 |
JS5 | 104 | 1 | 5 | 3.5 | 1.088 |
JS6 | 104 | 1 | 5 | 2.92 | 1.188 |
JS7 | 104 | 1 | 5 | 3.56 | 0.993 |
Reliability and Validity
A Reliability Analysis was conducted using Cronbach's alpha, a calculation of the correlations between the variable items to test the internal consistency of the variables in this report. While Cronbach's recommended alpha value is above 0.8, values above 0.6 are considered appropriate (Hair, Anderson, Babin, & Black, 2010).
The Cronbach's alpha values for each variable are shown below:
variables | N | Number of items | Cronbach’s alpha |
Transformational Leadership (TF) | 104 | 13 | .964 |
Transactional Leadership (TF) | 104 | 9 | .820 |
Job Satisfaction (JS) | 104 | 7 | .750 |
Correlation
A correlation test was performed between the study variables to verify the linear relationship between them and for multicollinearity. Table 4 shows the findings of the Pearson Correlation Index. With reference to the findings of Schober (2018), the Pearson Correlation value ranges between 0 to 1. More specifically, it is discussed that when the Pearson Correlation value appears within the range of 0.1 to 0.3, a weak association exists between the variables. Moreover, when this value appears within the range of 0.3 to 0.7, it can be stated that a moderately strong association exists between the variables. However, when this value falls within the range of 0.7 to 0.1, it can be suggested that a strong association exists between the variables. In the table (Table 4), the Pearson Correlation value for transformational leadership in relation to job satisfaction appears as 0.745. Since the computed value has fallen within the strong correlation range, it can be stated that transformational leadership is strongly associated with the nurse’s job satisfaction. In terms of transactional leadership and job satisfaction, the Pearson Correlation value has appeared as 0.716. As the obtained value also falls in the range of strong association, it can be stated that transactional leadership is strongly associated with the nurse’s job satisfaction.
TF | TS | JS | ||
TF | Pearson Correlation | 1 | .396** | .745** |
TS | Pearson Correlation | .396** | 1 | .716** |
JS | Pearson Correlation | .745** | .716** | 1 |
**. Correlation is significant at the 0.01 level (2-tailed). | ||||
Regression Analysis and Hypothesis Testing
Multiple regression was performed twice to test the model and the proposed hypotheses. The first execution is to test the model without the moderator to answer the main research question. The second execution was for the model with the moderator variable, which aimed to answer the second research question.
Regression Analysis for the model without the moderation effect
The results of the first regression execution for the model without the moderator are shown in Table 4 and Table 5. Results show that the prediction of nurse’s satisfaction is significant and resulted in an R² = 0.765 (Adjusted R² = 0.760) with an F = 164.156 and a p<0.001. This implies that the overall model is significant. With reference to the findings of Hahne (2014), the R-square value suggests the extent the independent variable predicts the dependent variable. In table 5, the R² value of 0.765 suggests that 76.5 % of the dependent variable, i.e. nurses’ job satisfaction, is predicted by independent variables transformational leadership and transactional leadership.
Results also indicate that the two variables are significant predictors of nurse satisfaction. The strongest predictor is transformational leadership (TF, beta = 0.547, p < 0.001), followed by the transactional leadership predictor (TS, beta = 0.494, p < 0.001). The overall multiple regression equation:
PI = 0.152+ 0.429 TF + 0.494 TS + e
Variables | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | Collinearity Statistics | ||
B | Std. Error | Beta | Tolerance | VIF | |||
(Constant) | 0.152 | 0.171 | 0.893 | 0.374 | |||
TF | 0.429 | 0.041 | 0.547 | 10.405 | 0.000 | 0.843 | 1.186 |
TS | 0.494 | 0.052 | 0.499 | 9.494 | 0.000 | 0.843 | 1.186 |
a. Dependent Variable: JS | |||||||
Model | R | R Square | Adjusted R Square | Std. Error of the Estimate | Change Statistics | ||||
R Square Change | F Change | df1 | df2 | Sig. F Change | |||||
1 | .874a | 0.765 | 0.760 | 0.36012 | 0.765 | 164.156 | 2 | 101 | 0.000 |
a. Predictors: (Constant), TS, TF | |||||||||
b. Dependent Variable: JS | |||||||||
With reference to table 4, the sig value of the independent variables is important to consider. In light of the findings of McShane (2019), the sig value or p-value has a threshold of 0.05. This suggests that to claim a significant impact of the independent variable on the dependent variable, the sig value must be less than 0.05. In table 4, the sig-value for transformational leadership has been obtained as 0.000. As the obtained value is lesser than 0.05 therefore, it can be suggested that transformational leadership significantly impacts the nurse's job satisfaction. Further, the sig value for the transactional leadership style was 0.000. As this value has also appeared as lesser than the threshold of 0.05, it can be suggested that transactional leadership style also significantly impacts the job satisfaction of nurses.
Therefore, the study’s hypotheses H1 and H2 are supported by those results, as shown in Table 4. In the first study, hypothesis H1 shows that Transformational leadership style positively impacts nurse satisfaction. This result is proved in previous studies as well. The second hypothesis, H2, demonstrates that The Transactional leadership style has a positive relationship with Nurse satisfaction, supported by the previous studies. This indicates that both leadership styles positively impact nurses' job satisfaction.
Regression Analysis for the model with the moderation effect
In order to determine the moderation effect of years of experience in the relationship between transactional leadership style and job satisfaction, transformational leadership style and job satisfaction, the researcher has developed a moderation Analysis via PROCESS Makro (Hayes) multiple regression analysis as shown in table 7. Below table 7 is the model summary that highlights the characteristics of the developed model. In the table below, the two values are essential to consider. These values are considered as R-value and R-square. As already discussed, the fundamental model developed in determining the moderating effect was concerned with determining the direct effect of independent variables on the dependent variable. For this case, the value of R has been obtained as 0.771. This suggests that 77.1 % of this model is appropriate for the regression analysis.
The below model is concerned with determining the moderator effect on the independent variable Transactional leadership style and the dependent variable, Job satisfaction. The overall model is significant P=0.000< 0.001. This suggests that the developed regression model for determining the direct effect of the independent variable on the dependent variable is appropriate and fits. However, the moderator effect is insignificant P = 0.1149>0.001. Thus, the study’s hypothesis H3a is not supported. There is no moderator effect on Transactional leadership and job satisfaction. Therefore we reject the null hypothesis.
Table 7: PROCESS regression - for the moderation effect (YOE, TS and JS) | ||||||
Model Summary | ||||||
R | R-sq | MSE | F | df1 | df2 | p |
0.717 | 0.514 | 0.270 | 35.296 | 3.000 | 100.000 | 0.000 |
Model | ||||||
coeff | se | t | p | LLCI | ULCI | |
constant | 1.004 | 0.341 | 2.944 | 0.004 | 0.327 | 1.680 |
TS | 0.721 | 0.107 | 6.733 | 0.000 | 0.509 | 0.933 |
YOE | 0.021 | 0.197 | 0.109 | 0.914 | -0.370 | 0.412 |
Int_1 | -0.017 | 0.067 | -.2559 | 0.799 | -.1490 | 0.115 |
Another PROCESS Makro regression analysis was developed to determine the direct effect of the moderator, i.e. years of experience on the dependent variable job satisfaction and independent variable Transformational leadership style. The R-value for this model has been computed as 0.771. The obtained R-value suggests that 77.1% of the developed model is fit and adequate for analysis.
Moreover, the moderator effect TF x YOE P = 0.0295>0.001. This implies that there’s no moderation effect, and the study’s hypothesis H3b is also not supported.
Table 8: PROCESS regression - for the moderation effect (YOE, TF and JS) | ||||||
Model Summary | ||||||
R | R-sq | MSE | F | df1 | df2 | p |
0.771 | 0.595 | 0.226 | 48.953 | 3.000 | 100.000 | 0.000 |
Model | ||||||
coeff | se | t | p | LLCI | ULCI | |
constant | 1.0041 | 0.2781 | 3.6109 | 0.0005 | 0.4524 | 1.5558 |
TF | 0.663 | 0.0792 | 8.3765 | 0 | 0.506 | 0.8201 |
YOE | 0.0536 | 0.1478 | 0.3627 | .7176 - | 0.2396 | 0.3468 |
Int_1 | -.0561 | 0.0431 | -1.2999 | .1966 | -.1417 | 0.0295 |
Summary
This research features two main research questions. The first research question investigated leadership style and its impact on nurses’ job satisfaction. From the analysis of this study and the discussed previous studies, it was proven that these factors impact the nurse's job satisfaction significantly in general, and transformational leadership is the strongest predictor.
The second research question aimed to investigate if years of experience moderates the relationships between the suggested factors and nurses' job satisfaction. The analysis concluded that the years of experience do not affect any of the proposed relationships. Thus, there is no moderation effect. Table 10 summarises the test hypothesis.
Table 10: Hypothesis Summary
S.No | Hypothesis | Status |
H1 | The transactional leadership style has an impact on nurse’s job satisfaction. | Accepted |
H2 | The transformational leadership style has an impact on nurse’s job satisfaction. | Accepted |
H3a | The years of experience has a moderation influence on the relation between transactional leadership and nurses job satisfaction | Rejected |
H3b | The years of experience has a moderation influence on the relation between transformational leadership and nurses job satisfaction. | Rejected |
CHAPTER 5: CONCLUSION, LIMITATIONS AND FUTURE WORK
Conclusion
This study has focused on the two different leadership styles, i.e. transformational and transactional. In this study, the impact of these leadership styles has been studied on the satisfaction level of the nursing profession. Quantitative measures have been taken where the researcher has collected the quantitative data from the nurses, who have been asked about their managers and leadership styles. However, the questions being asked in the questionnaire were not directly asking about the leadership styles of the managers, but the questionnaire was developed with the support of various studies(Alzahrani et al., 2019; Arisa&Syah, 2018; Judge& Piccolo, 2004) by analyzing the factors of leadership styles separately.
Results of the study have shown that there is a significant impact of the transactional and transformational leadership styles when it comes to discussing about the level of satisfaction in the profession of nurses. Therefore, in such a case where the transformational and transactional leadership styles greatly influence the satisfaction level among the nurses, it becomes clear that there various elements of these leadership styles are also important to be focused on by the managers. By the results, it can be concluded that managers have a great influence over their subordinates and encouraging them on their performance increases their motivation level. Therefore, in such a case, where the manager would be focused on encouraging their subordinates, there are chances that this will initiate the element of self-development among the workers. Therefore it becomes evident that line managers should focus on their subordinates' self-development.
In addition to that, it has also been observed that when managers are motivating their subordinates, there are chances that their subordinates will start feeling empowered and trusted by their managers, resulting in enhanced performance. This makes it clear that trust is another element which is needed for performance enhancement. In this study, the satisfaction element is focused on the nurses. Therefore all the elements which lead towards satisfaction need to be studied. Furthermore, trust could be achieved through task assignments, and for that particular reason, managers must set goals for their team. They should be allowed to show their creativity leading towards innovative solutions.
Moreover, the study results have also made it clear that managers also play role models for their subordinates. If they pay attention to their subordinates, they feel valued by their managers, resulting in increased motivation. It has also been observed that the element of recognition also plays a vital role in satisfaction among nurses. Therefore, the nurses must be recognized based on their performance which is also considered the reward system. However, it is also important that every nurse should not be considered efficient enough to lead every assigned task independently. In such a case, the nurses new to the profession should be provided with supervision by the managers playing the role of leaders or in case the team structure may also be beneficial for the managers to achieve their objectives efficiently.
In this study, it was also observed that the nurses respect their line managers, and in return, they expect trust from them. In addition to that, they also expect justified compensation from them so that they would be able to manage their living at ease. Results have also shown that the role of line managers in the satisfaction level of nurses is the most important as they consider them their mentors and seek guidance from them. Therefore, it can be concluded that the managers are required to work upon their leadership skills to increase the organisation's overall performance, leading to the satisfaction of nurses.
Another aspect observed in this study is that the managers can influence their nurses as they believe they are their role models and respect them. They can use it as an opportunity and design task-based objectives for their subordinates where their subordinates would have an opportunity to show their skills. In such a case, where all the nurses would have equal opportunity to perform and prove how well they can execute their duties, there are chances that the nurses would be able to learn and grow with mutual support. However, in this regard, the managers must provide their input side by side so that the nurses can ensure that the steps they are taking are according to the expectations of their managers. This model would be helpful for managers to increase the performance of their teams.
However, the nurses' satisfaction level is also dependent on the input provided by the HR department on whether the organization is considering their expectations in a justified manner or not. In such a case, where the employees are not provided with sufficient benefits which should be provided to them against their services, there are chances that they would not be able to get the best performance out of their nurses. In addition, years of experience in the case of managers has also been considered in this study but in the form of moderating variable. Furthermore, the results have shown that there is no moderating effect of the managers’ years of experience on influencing the nurses' satisfaction level in either of the cases: transformational leadership and transactional leadership.
Recommendations and Managerial Implications
This research aimed to assess which leadership style contributes to a better nurse’s job satisfaction and if years of experience will have a moderator influence. The literature showed that leadership style, i.e. transactional or transformational, significantly impacts nurses’ job satisfaction. Therefore, it is crucial for the leaders in healthcare facility system to understand their leadership style and how it will impact the employees positively or negatively.
Thus, some recommendations have been provided to the managers to improve their leadership skills. These recommendations would not only be helpful for the managers to improve their managerial skills and the nurses to enhance their performance, resulting in better performance in the healthcare sector.
- It is recommended that the higher management should always take the leadership subject as one of the main factors that contribute to the healthcare facility's success by implementing training for all managers and how the leadership style exerted can encourage the nursing staff to outperform and ensure a high level of job satisfaction, especially in nursing where the nurses are vulnerable to many outside factors that can affect their job satisfaction.
- Trust among the nurses from the managers should be built to make them feel that the organization values them and they are also important to the managers.
- It is also recommended that nurses should be empowered at their jobs, and for that particular reason, they may be assigned tasks and have the liberty to execute them in their way.
- Their organisation's expectations should also be considered, such as sufficient support from managers and justified compensation.
- Managers should also focus the team building among the nurses, which would help them communicate and develop their communication skills, resulting in improved communication at their job.
Furthermore, as the literature reviews showed, leadership can also be flexible since, as humans, the circumstances and the settings differ daily. The manager will assess the situation to deploy the most appropriate leadership style. Nurse managers should acquire the concept of leadership style to maintain the staff job satisfaction as a primary objective which will contribute to the organization's success.
Limitations and Future work
Some limitations were noted in this study. Overcoming them can give opportunities for future studies.
First, this study was conducted in a private hospital. Future studies on all healthcare facilities in Qatar, including private and government healthcare facilities, can be done to improve the study and generalize to Qatar healthcare facilities. This will allow us to highlight further the patterns noted in terms of the implementation of certain aspects of leadership. Moreover, the information obtained is based on nurses' perceptions of their line manager’s leadership style and job satisfaction. Thus, a one-time conflict between the nurse and her line manager could bias the information obtained during data collection.
Moreover, the quantitative research methodology does not allow the researcher to deepen the results but to describe and summarize the facts. Thus, it has been possible to explore the transactional and transformational leadership support of nurse managers in organizational change by qualitative research methodology that can be considered in line with quantitative. Examining prospective moderators such as demographic-related factors could form another interesting research line to investigate. For example, the gender factor in Qatar's nursing population is known for its multicultural aspects.
