Head nurse leadership impact : a study of head nurse self- perceptions of leadership, environmental substitutes for leadership, and selected indices of head nurse effectiveness in teaching hospitals

The study had its roots in the increased concern with productivity and the economics of health care delivery prompted by the current period of economic decline and retrenchment. The purpose of the study was to determine whether there were behaviors of head nurses which were related to head nurse effectiveness and whether there were situational factors in the hospital environment which mediated between head nurse leadership behaviors and effectiveness. Five major issues were considered in the study: 1) the importance of the leader's ability to adapt his or her leadership style to situational demands; 2) the relationship between leader attitudes toward leadership behaviors and effectiveness; 3) the relationship between environmental substitutes for leadership and leader effectiveness; 4) the identification of leader behaviors or qualities characteristic of effective leaders; and 5) the attempt to measure and determine the affect of magnetic leader behavior. The Climate Impact Profile System (Performax Systems International, Inc.) and the Leadership Opinion Questionnaire measured head nurse impact modes and attitudes. The Revised Substitutes for Leadership Questionnaire measured situational moderating factors. Leadership effectiveness was viewed as a composite entity measured by the Group Descriptions Questionnaire (staff work group perceptions), a supervisory rating of quality of unit nursing care, and unit percent compliance with standards of patient care as measured by the Medicus quality assurance module and/or institutionally developed or adapted methods. Fifteen hypotheses were developed and were considered in sets of three, each set containing an hypothesis for each indicator of effectiveness. Hypothesis testing was at the .05 level of significance. Five hundred forty four staff members, 77 head nurses, and 19 nursing supervisors in five (two large, one mid-sized, and two small) hospitals comprised the convenience sample. Major study findings revealed that as in other leadership studies leaders scored high in both task and relation behaviors. When the Medicus quality measure was used as the dependent variable results of hypothesis testing using regression analysis were consistently in the expected direction although in most cases were not statistically significant. Use of the internally developed or adapted system produced inconsistent results and findings were not statistically significant. All units were found to score high in incidence of substitutes for leadership which was shown to have a significant moderating effect on the relationship between leader behavior and attitudes and effectiveness. In an atmosphere high in leadership substitutes, supportive behaviors were positively related to effectiveness and structuring behaviors negatively related. The Magnetic impact mode appeared to be negatively rather than positively related although the latter findings were not statistically significant. Implications for nursing administrators seeking to evaluate head nurse effectiveness and to increase staff productivity are discussed and recommendations for further research are listed.