The influence of nurse manager leadership behaviors and unit work climates on work environment and patient outcomes

Tolentino, Luz R.

Sunday, 17 November 2013: 3:05 PM

Luz R. Tolentino, MSN, BSN, RN, NEA-BC¹
Mitchell J. Neubert, PhD, BS²
Emily M. Hunter, PhD, MA, BA²
(1)Office of the Chief Nursing Officer, Baylor Health Care System, Dallas, TX
(2)Department of Management and Entrepreneurship, Hankamer School of Business, Baylor University, Waco, TX

Learning Objective 1: Describe leadership behaviors that positively influence the work environment and nursing practice.

Learning Objective 2: Differentiate servant leadership from directive leadership and the impact on work environment and patient outcomes.

Leadership behavior is an important influence on the nursing work environment and patient care. This study investigated the influence of servant leadership, directive leadership behavior, and unit work climates on work environment, nursing staff and patient outcomes. A sample of 1485 staff nurses across 157 units of a multi-facility healthcare organization completed a survey assessing their manager's leadership behavior and individual outcomes. The leadership ratings were aggregated to the unit level and compared to unit-level work environment, nursing staff and patient outcome data. In regressions, including both servant leadership and directive behavior, higher levels of servant leadership behavior were significantly associated with nurse reports of higher job satisfaction, organizational commitment, and lower emotional exhaustion. Higher levels of directive behavior were significantly associated with organizational commitment, helping and innovative behavior, and less incivility. Higher levels of servant leadership also were significantly associated with higher unit Practice Environment Scale (PES) scores from the National Nursing Database for Quality Indicators (NDNQI) RN Survey, last-shift-worked nurse satisfaction, patient satisfaction scores, and lower hospital-acquired pressure ulcers. Directive behavior was not significantly associated with work environment or patient outcome data. Higher levels of servant leadership also were significantly associated with unit-level virtuous, ethical, and service climates, which in turn were all associated with higher PES scores, with virtuous climate having the strongest influence. Servant leadership and directive leadership contribute to positive outcomes for nurses, the work environment, and patients; but most of the strongest effects are best explained by servant leadership. Implications for leadership and establishing the appropriate work climate will be discussed.

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