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Abstract
The importance of leadership to our healthcare system is underscored by several challenges: increasing pressures of a large aging population, health and safety concerns associated with stressful work environments, upcoming retirements of current leaders, and projected workforce shortages. Effective leadership is needed to build healthy work environments that promote patient safety and to recruit and retain staff, but research is needed to determine the actual mechanisms by which leadership behaviours influence outcomes. The overall aim of this doctoral research was to examine the influence of authentic leadership on the work outcomes of nurses and other healthcare providers. It is comprised of four papers, two of which are empirical studies. The first paper is a systematic literature review the relationship between nursing leadership and patient outcomes. The findings suggest evidence supporting a positive relationship between transformational nursing leadership styles and improved patient outcomes. In the second paper, the theoretical contribution and relevance of the emerging authentic leadership theory (Avolio et al.,2004) to the advancement of nursing leadership practice and research are assessed. The third paper examines a model that links authentic leadership behaviours with trust in management and perceptions of supportive group and work outcomes, including voice behaviour (speaking up), self-rated job performance, and burnout in clinical and nonclinical staff groups. The fourth paper is an investigation of a set of methodological issues that arose during the testing of the leadership model and offers some general guidance for others who are learning to work with structural equation modeling. The combined findings of these papers show that nursing leadership has an important influence on patient and staff outcomes. Authentic leader behaviours, relational transparency, balanced processing, ethical behaviour, supportiveness, and empowerment had significant but differential effects on trust in management, voice, performance, and burnout in the two groups examined. However, the effect estimates must be interpreted with caution because only the clinical model fit the data, and there were also important model specification issues, including a collinearity problem in the clinical sample, few significant indirect effects for the intervening mechanisms, and the possibility of other alternative causal specifications.
