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Article
Research
The association of leadership styles and nurses
well-being: a cross-sectional study in healthcare
settings
Ibtissam Mohamad Sabbah, Tahanie Tarek Ibrahim, Rania Hani Khamis, Hajar Ahmad-Majed Bakhour,
Sanaa Mohamad Sabbah, Nabil Sami Droubi, Hala Mohamad Sabbah
Corresponding author: Ibtissam Mohamad Sabbah, Faculty of Public Health, Lebanese University, Saida, Lebanon.
ibtissam.sabbah@gmail.com
Received: 11 Jul 2019 - Accepted: 12 Jul 2020 - Published: 24 Aug 2020
Keywords: Transformational leadership, SF-12v2 health survey, multifactor leadership questionnaire 5X short form,
well-being
Copyright: Ibtissam Mohamad Sabbah et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access
article distributed under the terms of the Creative Commons Attribution International 4.0 License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Cite this article: Ibtissam Mohamad Sabbah et al. The association of leadership styles and nurses well-being: a cross-
sectional study in healthcare settings. Pan African Medical Journal. 2020;36(328). 10.11604/pamj.2020.36.328.19720
Available online at: https://www.panafrican-med-journal.com/content/article/36/328/full
The association of leadership styles and nurses School of Literature, Humanities and Social
well-being: a cross-sectional study in healthcare Sciences, Lebanese University, Beyrouth, Lebanon,
settings 4Faculty of Economic Sciences and Business
Administration, Lebanese University, Nabatieh,
Ibtissam Mohamad Sabbah1,&, Tahanie Tarek Lebanon
1 2
Ibrahim , Rania Hani Khamis , Hajar Ahmad-Majed &
1 2,3 Corresponding author
Bakhour , Sanaa Mohamad Sabbah , Nabil Sami
Droubi1, Hala Mohamad Sabbah4 Ibtissam Mohamad Sabbah, Faculty of Public
Health, Lebanese University, Saida, Lebanon
1Faculty of Public Health, Lebanese University,
Saida, Lebanon, 2Institute of Social Science,
Lebanese University, Saida, Lebanon, 3Doctoral
Ibtissam Mohamad Sabbah et al. PAMJ - 36(328). 24 Aug 2020. - Page numbers not for citation purposes. 1
Article
Abstract life, providing not only income but also a sense of
engagement, role identification, physical and
Introduction: the nurses´ perception of their mental stimulation [5], and staff wellbeing in the
supervisors´ leadership styles has a substantial modern workplace. The current challenges facing
impact on their well-being. Effective leadership in healthcare systems, in relation to the shortage of
health care is crucial in improving and enhancing health professionals, require managers and
the effectiveness of health care systems. This study leaders to learn different leadership styles and
aims to assess the leadership styles of nurse staff empowerment strategies [6]. Effective
leaders as perceived by employees, and to explore leadership in health care is crucial in improving
the relationship between perceived leadership and enhancing the effectiveness and efficiencies of
styles and the quality of life of nurses in Lebanese health care systems [7]. Leadership has been
hospital settings. Methods: it was a cross-sectional described as the behavior of an individual when
study conducted in 2017 and involved a sample of directing the activities of a group toward a shared
250 nurses chosen randomly in eight hospitals. The goal [1]. Avolio and Bass [4] characterize the nurse
survey included questions on socio-demographic leaders as transformational, transactional, and
and health-related characteristics, Multifactor Laissez-faire. The transformational leaders
Leadership Questionnaire 5X Short Form, encourage subordinates to view problems from
and the Short Form Health Survey-12 V2 new perspectives, provide support and
(SF-12v2). Results: the managers used enough encouragement, communicate a vision, and
transformational leadership style, whereas they stimulate emotion and identification.
used fairly often transactional leadership. The Transactional leaders motivate subordinates
Laissez-faire style was adopted from time to time through the use of contingent rewards, corrective
by the managers. Male nurses perceive their actions and rule enforcement towards attaining
managers as transformational significantly more common goals [4]. The non-leadership subscale
than female nurses (2.94 vs. 2.73; p = 0.05). was Laissez-faire.
Transformational leadership style was statistically Nurses are the main professional component of
related to all scales scores of the SF-12v2 (p < the front-line staff in most health systems. Nursing
0.001) except the Social Functioning domain (p = managers play a leading role in hospital
0.42). The transactional leadership style was management. Major studies demonstrate a
associated with the Vitality scale scores (p < positive relationship between managers´
0.001). The physical (p < 0.05) and Emotional Role leadership styles and staff retention [8-10],
(p < 0.001) and the mental health summary staff development [11], job satisfaction [7, 12-14],
measure (p < 0.05) were lower in persons who organizational [15-17] and nurses´
perceived the leadership style of their manager as commitment [6], client satisfaction with nursing
Laissez-faire. Conclusion: this study highlights the care [18] and lower levels of job stress and
existence of a positive effect of leadership styles in burnout [2]. The decentralized style of
the wellbeing of nurses, and confirms that nursing management, flexible employment opportunities,
management has been identified as a challenge in and access to continuing professional
the Lebanese hospitals. development can improve both the retention of
Introduction nursing staff and patient care [8]. However,
replacing nursing positions, such as the nurse
The nurses´ perception of their supervisors´ manager, which requires strong leadership and at
leadership styles has a substantial impact on their least minimal management experience and
working lives [1], health [2, 3] and well-being [4]. training, with less-qualified health care personnel
Employment is an essential element of an adult´s has led to a devalued nursing role within
organizations [6]. Integration of research evidence
Ibtissam Mohamad Sabbah et al. PAMJ - 36(328). 24 Aug 2020. - Page numbers not for citation purposes. 2
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into clinical nursing practice helps nurses to working in hospitals in Tripoli and Saida were
provide high-quality patient care [19, 20], to meet eligible to participate in the study. Inclusion
development goals, and to deliver safe and criteria includes: 1) working as registered nurses,
effective care [8]. 2) has at least 3 months of experience at the
Nurses require leadership which provides direction current institution. A total of 260 were selected.
for a new generation of nurses in their daily Nurses were informed about the purpose of the
routine. Some will naturally adopt an effective study by a team of 2 trained interviewers and
leadership style, while others may find the were invited to participate. All nurses gave their
concept of leadership or seeing themselves as written consent to participate in the study. Also,
leaders difficult to understand [11]. It is of participants remained anonymous and individual
paramount importance to explore and fully results were kept confidential. A pilot study
understand the potential determinants of including 10 individuals was performed previously
psychological well-being in nurses [21-23]. Quality in order to pre-test the feasibility of the
of life (QOL) concept has been recognized as a questionnaire.
relevant measure of well-being in various healthy Sample size: the sample size was calculated
populations, including workers [24]. During the according to Bartlett, Kotrlik, and Higgins
last decade, research on transformation and table [31] using Cochran´s formulas, selecting an
transactional leaderships significantly increased in alpha level of 0.05, a margin of error of 0.05, and a
Arabic countries [1, 6, 10, 13, 17, 18] and population size approximately 8000 subjects (the
worldwide [7, 12, 14, 25-27]. Yet few studies have total number of nurses working in hospital sector
examined its potential positive effects on nurses´ was 8853 [32]). The sample size needed equal 262.
well-being [22, 28]. Few researchers have studied Data collection: the study questionnaire had three
the leadership characteristics of nurses managers sections.
in Lebanon [16, 29], and examined the quality of
nurses´ work environment [30] and no attempt Characteristics of the respondents: the first
has been done to determine the relationship part of the questionnaire consisted of
between management styles and nurses´ sociodemographic status, including age, gender,
wellbeing in a hospital setting. The purpose of this marital status, educational level, and job position.
cross-sectional, study is: (1) to assess the Data were also collected regarding the position of
leadership styles of nurse leaders as perceived by the direct leader, the type of hospital, the nursing
employees; (2) to examine the degree to which department, work experience in nursing, nurse´s
the leadership characteristics correlate with shifts, the intention to leave the work during the
specific outcomes of leadership behavior; and (3) next six months, and declared morbidity.
to explore the relationship between perceived
leadership styles and the quality of life of nurses at Multifactor Leadership Questionnaire 5X Short
work. Form (MLQ 5X Short Form): the second part
Methods consisted of the Arabic approved version of
Multifactor Leadership Questionnaire 5X Short
A cross-sectional study was conducted in the Form (MLQ 5X Short Form) to measure staff
governorate of North and the South of Lebanon. nurses´ opinions of their nurse managers. The
The data collection was conducted using self- questionnaire contains 45 items that measure nine
administered questionnaires between February characteristics of transformational, transactional,
and March 2017. Eight hospitals were selected to or passive/avoidant leadership styles and three
represent all Lebanese hospitals using a simple outcomes of leadership behaviors, which are extra
random sampling method. All consenting nurses effort (EF), effectiveness (EFF), and satisfaction
Ibtissam Mohamad Sabbah et al. PAMJ - 36(328). 24 Aug 2020. - Page numbers not for citation purposes. 3
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(SAT). Transformational leadership (TFL) includes Metric Inc., Lincoln, RI, USA). Permission was taken
the characteristics of idealized influence from the Quality Metric Incorporated to use the
(attributes) (IIA), idealized influence (behaviors) Arabic version. It is a generic instrument, brief and
(IIB), inspirational motivation (IM), intellectual reliable measure of overall quality of life (QOL)
stimulation (IS), and individual consideration (IC). status. This questionnaire contains 12 items
Transactional leadership (TAL) includes clustered to yield eight domains of QOL: physical
characteristics of contingent reward (CR) and functioning (PF), Physical Role (RP), Bodily Pain
management-by-exception (active) (MBEA). (BP), General Health (GH), Vitality (VT), Social
Passive/avoidant (LFL) characteristics include Functioning (SF), Emotional Role (RE) and Mental
management-by-exception (passive) (MBEP) and Health (MH). The SF-12v2 provides a physical
Laissez-faire leadership (LF) style. All of the component summary (PCS-12) score as well as a
leadership style scales have four items, Extra Effort mental component summary (MCS-12) score,
has three items, Effectiveness has four items, and which are derived from eight different subscales.
Satisfaction has two items. Each item is rated on a The SF-12 was designed to give a population mean
scale of 4 point Likert scale ranging from: 0 (not at MCS and PCS of 50 with a standard deviation of 10
all) to 4 (frequently, if not always) [4]. The MLQ 5X in a disease-free US population. We entered the
Short Form scale scores are average scores for the responses of SF-12v2 for each patient into the SF
items on the scale. Blank answers should not be website (SF Scoring Software V5 Setup). The
included in the calculation: if an item is left blank, Software computes the scores of all eight domains
divide the total for that scale by the number of and the PCS-12 and MCS-12. Each response
items answered. The average of the five category has a score value; scores are summed
Transformational scale scores determines an across contributing questions and expressed as a
overall Transformational score. A similar score ranged from 0 to 100 for each dimension, as
calculation with the TAL and LFL scale scores was well as for the PCS-12 and MCS-12. A higher score
performed. The perceived leadership styles, indicates a better state of well-being.
factors, and outcomes were interpreted as Statistical analysis: descriptive statistical analysis
following: the mean range of 4.00-3.21 = such as frequency count, percentage, mean,
frequently, if not always, from 3.20-2.41 = fairly median, and standard deviation (SD) was used to
often, 2.40-1.61 = sometimes, 1.60-0.81 = once in describe the research sample and responses to
a while, and 0.80-0.00 = not at all. Since its each scale. The differences between groups were
development, the MLQ 5X Short Form has tested with one way analysis of variance (ANOVA).
received extensive evidence of its reliability and Correlation between leadership styles, outcomes,
validity, and is commonly used in leadership and SF-12v2 scales score was analyzed using
research [4]. The scale has good reliability with Spearman´s correlation. The scoring of the SF-12v2
coefficients ranged from 0.73 to 0.94 [4]. The was conducted using the SF Scoring Software V5
external validity of the MLQ 5X Short Form has Setup. The SPSS 22.0 package (IBM SPSS Statistics,
also been established in previous studies USA) was used for the analysis of the data. All
conducted in health care organizations. In this tests of significance were two-tailed, p ≤ 0.05 was
study Cronbach alpha was 0.70 for all scales, considered to be the critical level of significance.
except for active management by exception, which
was 0.64 which demonstrates very good reliability
(an alpha of greater than 0.50) [24]. Results
SF-12v2 Health Survey (SF-12v2): the third part Of the 260 nurses who received an invitation to
measuring wellbeing was the short form of the participate, 250 (96.1%) completed a survey;
widely used 36-Item Short Form Health Survey 78.8% working in private hospitals.
(SF-36) called SF-12v2 Health Survey (Quality
Ibtissam Mohamad Sabbah et al. PAMJ - 36(328). 24 Aug 2020. - Page numbers not for citation purposes. 4
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