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The healthcare sector in Qatar is booming especially with the Qatar National Vision 2030 and it was ranked among the first 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 which represents approximately 80% of the healthcare industry in Qatar, opened six new hospitals in 2018 and 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 of 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 a great potential in transforming and changing the healthcare system (Institute of Medicine, 2011). In Qatar since expatriates represent approximately 85% of the population. This multicultural environment makes it very challenging in maintaining the level of quality of service provided.
In this context, leadership plays a vital role in enhancing the healthcare system and maintaining efficacy as well as 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 and its relationship with job satisfaction. 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 style 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 the other. This helped us to classify and interpret those styles 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 should things be performed. This focus on both giving orders and controlling. Usually, authoritarian leaders make decisions 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 their own 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 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 to ensure that it is well performed.
Coaching: These leaders help their followers to develop their skills and to progress further to a higher level.
Directing: is the basic level of leadership style especially used with a new employee or with no previous experience employee. The leader is following 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 published “The Bass Handbook of Leadership” where he highlighted transactional leadership and transformation leadership.
Transactional Leadership: these leaders evaluate the performance of their followers and encourage them through both rewards and punishments.
Transformational leaders – In contrast, these leaders are long-term oriented. They motivate and inspire their followers.
In this thesis, we are going to choose both transformational and transactional leadership and test their influence on nurse satisfaction since they are been used in numerous studies, especially in health care facilities.
Problem Statement
Firms must possess excellent leadership traits to achieve their goals and 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 as well as to 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 behavior will create a toxic, destructive, malicious, has a harmful effect not only on the employees but on the overall organization. (Singh et al, 2019). Therefore, having a diverse workforce environment and especially in the Nursing field make it very challenging to lead. The managers should develop a leadership strategy to be able to manage the staff and 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 leadership styles in this study is built from the literature review.
Purpose of the Research
This research aims 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 impact of the experience. Transactional leadership is based on good relationships, using positive feedback or praise, and negative or reprimand. Transformational leadership is the transforming leader, eminently a supporter of change, the aspirations, ideals, motivations, and values of subordinates.
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 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 behaviors generate mechanisms of motivation that affect the behavior of individuals in the organization. Job satisfaction, over time, has escalated in the pyramid of priorities of employers, such as it 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 that have been carried out, and how employees perceive it within organizations. The research will be developed with the aim that 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 job satisfaction. Afterward, 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’s supervisors/managers in the healthcare facilities in Qatar and explore how to adopt the use of transformational/transactional leadership in a context of staff satisfaction.
Research Question
Which leadership style contributes to a higher level of satisfaction among nurses?
Does years of experience influence moderator the leadership style and its effect on nurse’s job satisfaction.
Research Model
CHAPTER 2: LITERATURE REVIEW
Good leaders are an asset to any organization. Good leaders will motivate and provide direction to their staff and thus they can achieve the organizational objectives. The health care setting is not different from any other industry. Studies have shown how highly effective leadership is related to health care providers and their job satisfaction.
Nurses' job satisfaction is quite crucial since the nursing profession greatly impacts the healthcare system and it is one of the utmost professions that have a great impact on the healthcare 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 transformational, and the second is transactional. Moreover, this thesis will take into consideration 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 the healthcare professionals motivated and satisfied with their jobs to provide the best quality of service and subsequently improve the patients’ 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 is the relationship 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 behaviors of the leaders are and try to relate these behaviors to the performance of the group and the satisfaction of its members. In all of them, the behavior of the leader could be summarized although 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 interested in the welfare and satisfaction of the followers. A relationship has also been found between the leader's reward behavior 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 behaviors associated with supervision and can be assimilated into the models of Situational Leadership or Contingent Leadership. 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 sets are not met.
Transaction leadership focuses on achieving organizational objectives and goals and uses negotiation with subordinates and rewards.
They closely monitor the tasks of their team to avoid mistakes.
They tend to be proactive and reactive when errors arise.
Transactional leadership helps leaders to achieve organizational goals and increase competitiveness however this leadership style tends to have some downside 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 job role and help them towards achieving the company goals. Consequently, rewards or reprimands will be provided based on the results. Moura et al., (2017) performed a deep review of related articles from the period 2011 to 2016 and the data showed that there’s 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 first hypothesis of the study demonstrates that transactional leadership influences directly the level of satisfaction among nurses. Transaction management is based on good relationships, using positive feedback or praise, as well as 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. It is observed that leadership exerts a significant effect on job satisfaction and 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, not only towards a better understanding of people's needs but also towards more realistic ways of improving the quality of life at work and solving various employees’ problems related to job satisfaction and leadership style of the manager.
Transformational
Transformational leadership has been developed in the 1980s. Many studies demonstrate that this type of leadership is the most preferred among the employees in many industries. Transformational leadership style tends to motivate the employees, create and increase the awareness of main issues, increases 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 common vision for the future as well as 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 and help them to achieve more than what’s expected and contribute to organization growth (J. Arenas 2019).
This type of leadership has four transformational behaviors:
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 depend on the need of each member of the team since the needs might differ from one individual to another.
Alzahrani and Hasan (2019) conducted a systematic review of transformational leadership style on nursing job satisfaction, especially since nursing shortage is a common problem in Saudi Arabia, and understanding the factors that contribute to better satisfaction is important to make the profession of nursing attractive. Therefore, nurse managers should improve their leadership skills to provide a better working environment for the staff. Nassem et al (2018) carried out a cross-case study in public hospitals in Lahore, Pakistan. The results revealed that transformational leadership tends to be very effective in promoting nurses' job satisfaction as well as increasing job performance. The authors Alshahrani et al. (2016) studied the effect of leadership styles, transactional and transformational 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 second hypothesis of the study emphasizes 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 demonstrates a higher satisfaction level when it is compared to transactional styles of leadership 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 the transformational leadership style of nurse managers and its influence on the level of satisfaction among the staff nurses. Results revealed that transformational leadership increases significant tly job satisfaction and leaders who care for and help their staff attributeincreasingease the level of 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 and actively participate in the work done, and feel valued for their contributions, especially in the nursing field since the nurses are contributing to enhancing the health of the patients. 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 that this dissatisfaction produces. 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 behavioral intentions. It is essential to take into consideration that these factors affect the proper management of the organizations so that they understand the reactions of their collaborators to work carried out.
Therefore, arriving at an analysis of the needs of subordinates, 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, 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 labor productivity. Rowe (2001), in the symbiosis generated between the leader and subordinates that is the trust, amalgamated by a fair remuneration, creates in the assistants an impulse of creativity and fulfillment 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 at the time of 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.
It was studied that Leadership Styles in creating a better work environment for nurses and lead to improving patient outcomes (Adams, et al, 2018). Perez (2014) carried out the study whose objective was to determine the relationship between leadership and job satisfaction of nursing professionals. This study was conducted on a sample of 32 nurse managers, using the Multifactor Leadership Questionnaire, reaching the conclusion that all the surveyed professionals have leadership skills, in terms of job satisfaction transformational leadership was found to have a high level of satisfaction. The author Perez (2014) set the objective to know the performance of the nursing leaders, the motivation of the personnel they oversee, and the satisfaction of the users for the service they receive. Unfortunately, few studies deepened the topic of leadership quality of either transactional or transformational. However, there are no recipes for a good performance, since even with experience, the leader cannot anticipate the problems that will arise daily.
The authors Gonzalez Alvarez, et al., (2013) carried out the study "Relationship of Labor Satisfaction with Leadership Styles in Nurses of Public Hospitals of Santiago," which 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 as instruments a questionnaire on Labor Satisfaction and Leadership Styles. 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 and thereby increase the motivation and job satisfaction of their staff.
Therefore, nurses should be visible and close so that the change process is facilitated, as well as the scope of the service that the clients need. This fact may be linked to the lack of emphasis given to the acquisition of this knowledge, since the development of leadership 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).
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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, allocation of resources, analysis of information, and direction of working groups (Waxman, et al., 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, centered 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, by stating that nurses who occupy positions of leadership 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, et al., 2018).
The current trend in leadership indicates that this is considered an essential and inherent factor in all organizational theories. And for nursing, 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 centered 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 to 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 favor 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 subject of research, there is no available evidence on a definitive, effective theory that guides leaders.
Diversity and experience impact 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 and Basinska, 2015). A competent leader needs to put all these factors in place when choosing a leadership style to employ so that it can be just and fair to all the 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 also create an understanding for one another hence improving relations that result in job satisfaction among the nurses (Rittle, 2015). A wise leader understands and acknowledges those facts and employs a strategy that tries to put everyone in a unified work environment, so they feel appreciated when others understand them genuinely. Nursing is an extensive career that has nurses coming in from different backgrounds. The diverse backgrounds imply that there is a vast information base among the nurses. Different cultures have different ways of doing things as compared to how others get it 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 the employees (Jacobs, 2015).
According to Koopmans 2018, experience is a positive driver to improve 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 so that they can relate to the tasks assigned. There are no special employees, but each employee has unique jobs to undertake. Higher qualified nurses or experienced nurses can educate existing personnel and increase problem-solving and enhance job satisfaction. Therefore, it was hypothesized the following:
H3: The years of experience have a moderate influence on the relationship between leadership style and nurse'
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 favorable, 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 the application of leadership and management skills, which are directly related to teamwork, decision-making, and planning, which use different styles of leadership, 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 behaviors, and behaviors 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 results of the study showed that there are significant differences in leadership style perceptions between the managers and staff which influenced declining the satisfaction level. (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 favors 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, and among these standout, 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 effectiveness of the leader in terms of his or her ability to use each of the styles according to the situation of the collaborators. 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 from all over the world to pay more attention to the concept of "situation" (Gonzalez Alvarez, 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 the perception of job satisfaction of nursing professionals categorized as satisfied, is significantly associated with the coach and participative leadership styles, while those classified as dissatisfied labor perceive as predominant leadership styles 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, and are particularly interested in the needs of his followers and accept the individualities of the group (Gonzalez Alvarez, et al., 2013). A crucial element of effective leadership is that leaders have the confidence of their workers (Omar, 2011).
Title
In the field of nursing, prevailing literature shows that transformational and transactional leadership influence the satisfaction level of employees or nurses with their respective jobs. Therefore, the skills of a leader tend to affect the performance of employees for the organization.
For this, adequate planning of its members must be carried out, which must be managed in a synchronic and harmonious way concerning its activities, related to the departments that make up the work. Therefore, it should be considered that the basis of these aspects, identified as important, is a reflection of a conception of staff satisfaction and the human factor; the core components of teams within the organization as a key lever for business development. Leadership impact human talent and business performance, it is a central axis in companies toward the efficient performance; it also points to coherence between the dimensions of the strategy, the structure, and job satisfaction of the collaborators.
The satisfaction of this compromises a high level of performance that implies and involves a productive attitude. Another important aspect that is mentioned by several authors is the close relationship with motivation, an internal factor that requires more attention. On the other hand, Kim (2013) explains that motivation comes from the participation of simple elements such as impulses, attributions, or information units under a complex action in the human being managed by simple processes. For Robbins (1998), he considers that the motivation is the willingness to practice a high level of effort towards business goals, conditioned by the ability to satisfy some individual need ".
For Mendoza Martínez, Escobar Álvarez, and García Rivera (2012), leadership is considered an essential element for the efficiency and development of the company; its permanent presence allows the achievement of the mission and organizational goals. The figure of the leader should be the core point between corporate culture, ethics, and work performance. This challenging organizational engine allows maintaining the balance of direction and the satisfaction that sustains the growth of employees within the structure.
It was hypothesized that a positive association exists between job satisfaction and leadership styles i.e., transactional and transformational styles. This literature review showed that there is a relation between transformation and transactional leadership styles and nurses’ satisfaction. Therefore, leadership style is a significant factor in promoting the better satisfaction of employees. The nature of Nurses' work with dealing with a human being the life and a critical situation is stressful, however, providing a happy work environment contributes to nurse’s satisfaction and better performance leads to the overall satisfaction of the organization.
CHAPTER 3: RESEARCH METHODOLOGY
Objectives of the research
The objective of this research project is to determine the impact of leadership styles on nurses’ 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 secondly 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 is concluded on the idea that transactional and transformational leadership styles directly influence nurses’ job satisfaction.
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 takes into consideration the moderation effect of years of experience on the proposed relationships.
Research Instrument
A questionnaire was built and distributed to nurses working in hospitals in Qatar to assess their job satisfaction with their line manager leadership style.
A self-administrated questionnaire was used to collect data. The questionnaire is presented in Appendix A. The online questionnaire is composed of three parts, the first part comprises questions related to demographics; the second part 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 for the questions were on a 5-point Likert scale (1= strongly disagree, 2= disagree, 3= Neutral, 4=agree, and 5=strongly agree) 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), in which respondents were also asked to rate the level of their agreement 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 is entirely voluntary and anonymous and they can 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 identity of the participant 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 the 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 analyse the leadership style and job satisfaction of the nurses, A survey (Appendix) was designed taking into account all the factors that need to be tested in this research and it 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 the 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 database of the nurses working in a health care facility in Qatar 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 the 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 is 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 and that it complies with the 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 given the research study design and objectives. Final data will be accessible by the Principal Investigator and biostatistician for statistical analysis and preparation of the final report.
The primary aim of the study is to identify the effect of transactional and transformational leadership styles and nurses' job satisfaction in Qatar. The participant’s answers will be analyzed using a five-point Likert scale.
Numerous statistical techniques were used to analyze 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 primary outcome of the study is to find out 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 moderation effect of the moderator variable.
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%, African 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, diploma 12.5%, and 4.8% other qualifications. 50% of the nurse's ages 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% 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 directors of nursing.
Descriptive Analysis
The second part of the questionnaire (questions 1 -29) was targeted toward the research question to identify the leadership style that contributes 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 A. A 5-point Likert scale was used in the questionnaire. The mean is classified into five levels:
4.51-5.00 means the highest degree of agreement with the statement
3.51-4.50 means a high degree of agreement with the statement
2.51 -3.50 means the medium degree of agreement with the statement
1.51-2.50 means a low degree of agreement with the statement
1.00-1.50 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 are moderately perceived (2.51-3.5), which indicated a moderate agreement with the statement.
For the Transactional Leadership Style Variable (TS), All 9 items mean moderately perceived (2.51-3.5), which indicated a moderate agreement with the statement.
For Satisfaction Variable (SA), only 1 item mean is highly perceived (3.51-4.50), which indicates a high degree of agreement with the statement and 6items mean are moderately perceived (2.51-3.5), which indicated a moderate agreement with the statement.
Reliability and Validity
A Reliability Analysis was conducted using Cronbach's alpha which is 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 are for each variable are shown below
Correlation
A correlation test was performed between the study variables to verify the linear relationship between them and to verify multicollinearity. Table 4 shows the findings of the Pearson Correlation Index. Concerning 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, then it can be stated that a weak association exists between the variables. Moreover, when this value appears within the range of 0.3 to 0.7, then 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, then it can be suggested that a strong association exists between the variables. In the table (Table 4), the Pearson Correlation value for transformational leadership about job satisfaction has appeared as 0.745. Since the computed value has fallen within the strong correlation range, therefore, 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, therefore, it can be stated that transactional leadership is also strongly associated with the nurse’s job satisfaction.
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. For the model, without the moderator, the first execution was aimed at answering the first research query. The second execution was for the model with the moderator variable which aims 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 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. Concerning the findings of Hahne (2014), the R-square value suggests the extent the dependent variable is predicted by the independent 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 indicates that the two variables are significant predictors for the nurses’ satisfaction. The strongest predictor is transformational leadership (ATF, beta = 0.547, p < 0.001), followed by transactional leadership predictor (ATS, beta = 0.494, p < 0.001). The overall multiple regression equation:
PI = 0.152+ 0.429 ATF + 0.494 ATS + e
Concerning 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 the threshold of 0.05. This suggests that to claim there is a significant impact of the independent variable on the dependent variable, the sig value must be lesser 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 has a significant impact on the job satisfaction of nurses. Further, the sig value for transactional leadership style has been obtained as 0.000. As this value has also appeared as lesser than the threshold of 0.05 therefore, it can be suggested that transactional leadership style also has a significant impact on the job satisfaction of nurses.
Therefore, the study’s hypotheses H1, and H2 are supported by those results as shown in
Table 4. The first study hypothesis H1 shows that Transformational leadership style has a positive impact on 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 which is supported in the previous studies. This indicates that both leadership style has a positive impact on nurses’ job satisfaction.
Regression Analysis for the model with the moderation effect
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 three regression models were mainly developed. The first model is concerned with determining the direct effect of independent variables on the dependent variable. The second regression model has been developed highlighting the direct effect of the moderator on the dependent variable. While the third regression model is concerned with the combined effect of the moderator and the independent variable.
The aforementioned table 4, is the model summary that highlights the characteristics of the developed model. In the table above, the two values are essential to consider. These values are considered as R-value and R-square. As already discussed, the fundamental model that was developed in the course of 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 0.874. This suggests that 87.4 % of this model is appropriate for the regression analysis. Further, the R-square value for this model has been obtained as 0.765. This obtained value suggests that 76.5% of the dependent variable i.e. job satisfaction is predicted by the independent variables transactional leadership and transformational leadership. This suggests that the developed regression model for determining the direct effect of the independent variable on the dependent variable is appropriate and fit.
In the case of determining the direct effect of the moderator i.e. years of experience on the dependent variable job satisfaction, another regression model was developed. The R-value for this model has been computed as 0.880. The obtained R-value suggests that 88% of the developed model is fit and adequate for analysis. Moreover, the R-square value for this has been obtained as 0.774. This concludes that 77.4 % of job satisfaction is predicted by the moderator i.e. years of experience.
Thirdly, there was also another important regression model that was developed to examine whether the moderator moderates the relationship between the dependent and independent variables. For this specific model, the value of R has been computed as 0.885. This suggests that 88.5% of the developed regression is fit and adequate. In addition, the R-square value for this model has been computed as 0.784. From this aspect, it can be suggested that 78.4 % of the dependent variable i.e. job satisfaction is predicted by the moderating effect of the moderator.
The table above (Table 6) is the ANOVA whose main purpose is to also determine the significance of the developed regression models. Here it becomes important to mention that the same sig value is referred to for determining the significance of the model. In the case of regression model 1, the sig value has been computed as 0.000. This suggests that the developed regression model is fit and appropriate for the analysis. In terms of regression model 2, the sig value has also appeared as 0.000. This also suggests that the model is significant and fit for the regression analysis. In the case of regression model 3, the sig value has also appeared as lesser than 0.000. This suggests that this developed regression model 3 is also fit and appropriate to execute the regression analysis.
The table above (Table 6) is the coefficient table in which the individual (direct) effect of the moderating effect has been highlighted. The sig value with the threshold of 0.05 is used as a measure to determine whether the impact is significant or insignificant. From the aforementioned table, it can be observed that there is transformational leadership has a significant impact on job satisfaction. Moreover, transactional leadership also has a significant impact on job satisfaction. It has been due to the sig value that has appeared lesser than the threshold of 0.05. Moreover, it can also be confirmed from table 5, where it has also been found that transactional and transformational leadership has a significant impact on job satisfaction.
In the case of the regression model 2, where the predictors were the independent variables along with the moderating variable, it can be observed that although the independent variables have a significant impact on job satisfaction, however, the moderating variables that comprise different ages do not have a significant impact on the dependent variable.
Lastly, in the case of the regression model 3 where the moderating effect has been computed, it can be observed that YOE (5-10), YOE (16-20) and YOE (More than 20 years) do not significantly moderate the relationship between transformational leadership and job satisfaction. It has been because of the sig value of 0.191, 0.454, and 0.152 that have been computed for YOE (5-10) *TF, YOE (16-20) *TF, and YOE (More than 20 years) *TF respectively.
Moreover, in the case of transactional leadership, it has also been found that years of experience also do not moderate the relationship between transactional leadership and job satisfaction. It is based on the sig value that has appeared as 0.394, 0.952, and 0.927 for YOE (5-10) *TS, YOE (16-20) *TS, and YOE (More than 20 years) *TS. Hence, it is confirmed that years of experience also do not significantly moderate the relation between transactional leadership and job satisfaction.
Summary
This research features two main research questions. The first research question aimed to investigate the leadership style and the impact on nurses’ job satisfaction. From the analysis of this study and the discussed previous studies, it has been found that transactional leadership and transformational leadership have a significant impact on the job satisfaction of nurses.
The second research question aimed to investigate if years of experience moderates the relationships between the suggested factors and nurses' job satisfaction. From the analysis, it was concluded that the years of experience do not affect any of the proposed relationships. Thus, there is no moderation effect.
CHAPTER 5: CONCLUSION, LIMITATIONS, AND FUTURE WORK
Conclusion
This study has focused on the two different leadership styles i.e. transformational and transactional leadership styles. In this study, the impact of these leadership styles has been studied on the satisfaction level of the nursing profession. In this study, quantitative measures have been taken where the researcher has collected the quantitative data from the nurses and they have been asked about their managers and their 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 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 the level of satisfaction in the profession of nurses. Therefore, in such a case where the transformational and transactional leadership styles have a great influence on 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 of the study, it can be concluded that the managers have a great influence over their subordinates, and when they are encouraging them on their performance, it increases their level of motivation. Therefore, in such a case, where the manager would be focused on the encouragement of their subordinates there are chances that this will initiate the element of self-development among the workers. Therefore, in such a case, it becomes evident that the line managers should remain focused on the self-development of their subordinates.
In addition to that, it has also been observed that when the managers are motivating their subordinates there are chances that their subordinates will start feeling empowered and trusted by their managers resulting in terms of enhanced performance. This makes it clear that trust is another element that is needed for performance enhancement. In this study, the element of satisfaction is being focused on the nurses, therefore it was needed that all the elements which lead towards the satisfaction should be studied. Furthermore, the trust could be achieved through the task assignments, and for that particular reason, it is needed that the managers set goals for their team and they should be allowed to show their creativity leading to the innovative solution.
Moreover, the results of the study have also made it clear that the managers also play role models for their subordinates and if they are paying attention to their subordinates, they feel valued by their managers resulting in terms of increased motivation. In this study, it has also been observed that the element of recognition also plays a vital role in the satisfaction among the nurses. Therefore, it is needed that the nurses should be recognized based on their performance which is also considered a reward system. However, it is also important that every nurse should not be considered efficient enough to lead every assigned task on their own. In such a case, the nurses that are new to the profession should be provided with supervision by the managers playing the role of leaders, or in order cases, 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 the justified compensation from them so that they would be able to manage their living at ease. Results of the study have shown that the role of line managers in the satisfaction level of nurses is the most important as they consider them as their mentors and seek guidance from them. Therefore, in such as it can be concluded that the managers are required to work on their leadership skills to increase the overall performance of the organization leading to the satisfaction level of nurses.
Another aspect that has been observed in this study is that the managers can also influence their nurses as they believe that they are their role model and respects them. They can use it as an opportunity and design the tasks based on 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, it is needed that the managers should be providing their input side by side so that the nurses would be able to assure that the steps they are taking are according to the expectations of their managers. This model would be helpful for the managers to increase the performance of their teams.
However, the satisfaction level of the nurses is also dependent on the input being provided by the HR department that whether the organization is considering their expectations in a justified manner or not. In such a case, where the employees are not being 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 to that, the study has also evaluated whether there is any impact of the years of experience of the managers on the satisfaction level of the nurses and the results have shown that there is no impact of the years of experience on the satisfaction of nurses. Therefore, it makes clear that it is not necessary to have experienced managers in the organization but it is also possible that the inexperienced managers who understand the concepts of managing human capital would be able to increase the satisfaction among the nurses.
Recommendations and Managerial Implications
In this study, transformational and transactional leadership styles have been studied that how these leadership styles affect the behavior of the nurses in Qatar in terms of increasing their satisfaction level among them. Based on the findings of the study 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 but also for the nurses to enhance their performance resulting in terms of better performance in the healthcare sector.
Trust among the nurses from the managers should be built to make them feel that they are valued by the organization and they are also important to the managers.
It is also recommended that the nurses should be empowered at their jobs and for that particular reason they may be assigned the tasks and they should have the liberty to execute them in their way.
Their expectation from the organization should also be considered such as sufficient support from managers and justified compensation as well.
Managers should also focus the team building among the nurses which would help them to communicate with each other and develop their communication skills resulting in terms of improved communication at their job.
Limitation and Future Work
When it comes to discussing the limitations of the study it can be observed that the results of the study are specifically focused on the nursing profession and the data was collected from the Qatar healthcare sector. Therefore, the findings are implied to the nurses that are working in Qatar. In addition to that, the results of the study can be applied for a few years as the global environment has been continuously emerging and it makes it clear that there are chances that the behavioral changes may also occur and affect the findings of the study. For future work, it is recommended that the researcher may use a similar model in different countries and different context such as focusing on any other profession. It is also possible that the future researcher may also include more leadership styles to be evaluated for the same target population of the study.
References
Hahne, J.M., Biessmann, F., Jiang, N., Rehbaum, H., Farina, D., Meinecke, F.C., Müller, K.R. and Parra, L.C., 2014. Linear and nonlinear regression techniques for simultaneous and proportional myoelectric control. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 22(2), pp.269-279.
McShane, B.B., Gal, D., Gelman, A., Robert, C. and Tackett, J.L., 2019. Abandon statistical significance. The American Statistician, 73(sup1), pp.235-245.
Schober, P., Boer, C. and Schwarte, L.A., 2018. Correlation coefficients: appropriate use and interpretation. Anesthesia & Analgesia, 126(5), pp.1763-1768.
APPENDIX
Leadership Style & the Impact on Nurse's Professional Satisfaction Questionnaire
Part 1 Demographic Information: Please tick one box for each item |
1)Gender: (a) Male (b) Female 2)Nationality: (a) Qatari (b) Arabic (c) Asian (d) Others: Please Indicate: ………. 3)Level of Education: (a) Diploma (b) Undergraduate degree BSN (c) Master’s degree (d) Other Qualification 4)Age (a) 25 - 35 (b) 36 - 45 (c) 46 - 55 (d) Above 56 Years 5)Years of experience (a) 5 - 10 (b) 11 - 15 (c) 16 - 20 (d) More than 20 years 6)Job position: (a) Staff Nurse (b) Charge Nurse (c) Head Nurse (d) Director of Nursing |
ITEMS | 1 Strongly Disagree | 2 Disagree | 3 Neutral | 4 Agree | 5 Strongly Agree | |
1 | My line manager encourages me to set and achieve my objectives. | |||||
2 | My line manager motivates me for self-development. | |||||
3 | My line manager does not appreciate our contribution. | |||||
4 | I feel motivated to work beyond my assigned duties in the department because I feel appreciated by my line manager. | |||||
5 | My line manager is strict and does not support the self-development of the staff. | |||||
6 | My line manager motivates me to be creative and innovative. | |||||
7 | My line manager trusts his/her team | |||||
8 | My line manager sets goals for employees to work on. | |||||
9 | My line manager is a manager, rather than a leader. | |||||
10 | My line manager is a role model to follow. | |||||
11 | My line manager is expecting benefits from me while he helps me to complete the task. | |||||
12 | I expect recognition and compensation from my Line manager. | |||||
13 | My line manager follows the punitive measures rather than the measures. | |||||
14 | I highly respect and trust my line manager. | |||||
15 | If I fail to complete my task my line manager will support me to finish the tasks. | |||||
16 | I consider my line manager to be my mentor. | |||||
17 | My line manager sets the work objectives and guides us on how to achieve them. | |||||
18 | My line manager encourages me to update my current knowledge. | |||||
19 | I don’t think that my line manager is interested in staff’s career development. | |||||
20 | My line manager always talks optimistically about the future and how to develop the staff’s career path. | |||||
21 | My line manager conveys his satisfaction only when the staff achieves the goals set by him. | |||||
22 | My line manager often seeks team opinion when he/she makes decisions. | |||||
23 | I am unhappy with my duties and responsibilities assigned by the leader. | |||||
24 | I am happy as there is an opportunity to grow professionally. | |||||
25 | I feel that my income is decent for my role | |||||
26 | I am satisfied with the benefits package offered by HR. | |||||
27 | Our leader is very well recognizing the teamwork. | |||||
28 | My leader restricts me as a team player. | |||||
29 | My current role empowers me. | |||||
