Characteristics of Nurse Directors That Contribute to High Registered Nurse Satisfaction Scores

Saturday, 29 July 2017

Debra A. Burke, DNP, MBA
Massachusetts General Hospital, Boston, MA, USA


Attracting and retaining Registered Nurses (RN) is essential to ensure excellence in patient care delivery. Research studies have identified many factors that contribute to job satisfaction and impact RN retention. A supportive practice environment, strong nurse manager support, and an emphasis on quality all impact nurse satisfaction (Kelly, McHugh & Aiken, 2011; Smith, Hood, Waldman & Smith, 2005). Additionally, good communication, respect and feeling cared for have been identified as positive attributes of Nurse Directors (NDs) that RNs value (Feather, Ebright, Bakas, 2015).

Many satisfaction surveys are quantitative and provide clinical areas with scores, but the details behind those scores are missing. Despite what is known about RN satisfaction, there is a lack of research exploring perspectives of both the RNs and the NDs in settings where job satisfaction is reportedly positive.

The purpose of this study was to explore Registered Nurse and Nurse Director perceptions of positive ND characteristics that contribute to high work environment satisfaction scores.

Of note, at the study hospital, nurse director is synonymous with the term nurse manager.


This was a qualitative study, utilizing one-on-one interviews with NDs (n=9) and RNs (n=9). Interview questions utilized an appreciative inquiry framework intended to identify strengths, best practices and successes of NDs.

Thirty three units were invited to participate from a variety of clinical areas, all of which scored higher than benchmark on the Practice Environment Scale of the Nursing Work Index (PES-NWI) quantitative survey in the component of "Nurse Manager ability, leadership and support of nurses" in an acute care hospital (Lake, 2002).

Qualitative content analysis of transcribed audiotapes was conducted. Two reviewers identified themes within each ND and RN group. Across case analysis was also conducted to identify congruency between groups.


Four themes describing leadership were identified within the Registered Nurse sample; empowerment, visibility, role modeling, and passion for excellence. Within the Nurse Director group, four themes were also identified; empowerment, visibility, role modeling and authentic presence. 

Characteristics identified describe transformational leadership styles of Nurse Directors. Characteristics identified support previous studies about qualities of exemplary leaders; however there is strong correlation between the views of the RNs and NDs in this study; which is different from other studies.


Although leadership characteristics may vary by Nurse Director, RN and ND participants in this study cohort identified similar themes representative of leadership attributes and behaviors that contribute to RN satisfaction.

This study enhances our understanding of the quantitative scores on the PES-NWI survey and is critically important to our need to understand what contributes to RN satisfaction. Findings suggest ways NDs may effectively influence RN satisfaction. The consensus between RNs and NDs in this study suggests strong alignment.

Findings have the potential to guide nurse executives in hiring prospective ND candidates by ensuring they identify characteristics important to RNs. These results may help inform leadership development programs for existing and future NDs.