INNOVATIVE LEADERSHIP AND RETENTION

42
Appendix A

Evidence Table
Citation
Abualrub, R.,
(2011).
The impact of
leadership styles
on nurses’
satisfaction and
intention to stay
among Saudi
nurses.
Country: Saudi
Arabia
Funding: Saudi
Ministry of
Health
Bias: None noted

Theoretical
Framework
Organizational
Dynamics
Paradigm of
Nurse Retention

Study Design
Design: DC
Purpose:
To examine the
impact of
leadership styles
of nurse managers
on Saudi nurses’
job satisfaction
and their intent to
stay at work.

Sample/Setting
N = 308;
Total sent = 600
Return rate = 51.3%
Demographics: All
RNs ;
(means NR)
Age: 71% 20-29
G: 56% female
MS: 53% single
Ed: 52% diploma
Exp:49% 1-3 yrs in
current position
Shift: 50% day
Dpt: Variety
including 21% in ED
Setting: 6 public
hospitals, Western
Region Saudi Arabia
Inclusions: RN
license & practicing
RN; at least 6 months
in current job;
working under direct
supervision of NM
Exclusions: NR
Attrition: NR

Major Variables
IV: LP/S
DV1: JS
DV2: ItS

Measurement
MLQ: 45 items, 15 Likert scale;
α = 0.87
JSS: 36 items, 1-5
summated rating
scale; α = 0.73
McCain’s ItS
Scale: 5 items, 1-5
rating scale;
α = 0.80

Data Analysis
SPSS v. 17.0
Pearson
correlation;
Hierarchical
regression;
Descriptive
statistics

Findings
CI = 0.05, power
0.80.
+ corr TfL & JS (r
= 0.45, p <0.001)
- corr TaL & JS (r
= -0.14, p <0.01)
+ corr JS & ItS (r
= 0.15, p < 0.01)
Relation of TfL to
ItS and TaL to ItS
insignificant
JS score: m =
3.69 (SD = 0.49)
TfL: m = 3.43
(SD = 0.82)
TaL: m = 2.98
(SD = 0.57)
ItS: m = 3.24 (SD
= 1.04)
Regression
Analysis: 32% JS
explained by
nursing exp (Std β
= 0.21,p < 0.05),
TfL (Std β= 0.43,
p < 0.01), and
TaL (Std β= 0.30, p < 0.01)
5% ItS explained
by JS (Std β=
0.17, p <0.05)

Decision for use
LOE: VI
Strengths: Sample
size meets CI/power
requirement; findings
supported by other
studies; ED RNs in
sample.
Weaknesses:
Convenience sample;
conducted at 6
government health
institutions where
NM have limited
authority
Conclusions: TfL
improves JS, while
LP/S does not impact
ItS
Feasibility: LOE is
useable - NM can
develop TfL skills as
low risk intervention
to improve staff JS
and potentially RN
retention. Cost for
education and
interventions will
vary. Leader buy-in
may be a challenge.

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Cowden, T.,
(2011).
Leadership
practices and staff
nurses’ intent to
stay: A systematic
review.
Country: Canada
Funding: No
funding was
received
Bias: None noted

Theoretical
Framework
Anticipated
Turnover Model;
Conceptual Model
of Behavioral
Intentions;
Conceptual Model
of Intent to Stay;
Determinants of
Nurse Intention to
Remain
Employed Model;
Kanter’s Theory
of Structural
Empowerment;
Model of Nursing
Turnover;
Nursing Systems
Outcomes;
Organizational
Dynamics
Paradigm of
Nurse Retention;
Psychosocial
Work
Environment

Study Design

Sample/Setting

43
Major Variables

Design: SR

n= 23

IV: LP/S

Purpose:
Describe the
findings of a
systematic review
of studies that
examine the
relationship
between
managers’
leadership
practices and staff
nurses’ intent to
stay in or to leave
their current
position.

Type:
Quan = 22
Qual = 1

DV: ItS/ItL

Quality rev Quan:
n = 13 moderate
n = 9 strong
Inclusion criteria:
Peer-reviewed
research; English
language publication;
published 1985-2010;
meas. NM LP; meas.
ItS; meas. 1 or more
factors contributing
to ItS.
Exclusion criteria:
Not specific to RNs;
Attrition: NR

Measurement

Data Analysis

LP/S:
MLQ – 4 studies
Nurse Work Index
– 3 studies
Kim, Price,
Mueller, &
Watson tool – 2
studies
LP/S meas.
embedded in 14
studies. α = 0.61
– 0.94 for all tools

Hierarchical
regression,
Descriptive
statistics, Multiple
regression,
ANOVA, Tukey
post-hoc test,
Pearson
correlation,
Logistic
regression, Chisquare test,
Fisher’s exact
test, Linear
regression, Factor
analysis, t-tests

ItS: 11 different
tools, α = 0.56 –
0.97
Qual: Used
researcher
developed
questions/analysis
Tools reported as
valid via previous
findings, factor
loading, factor
analysis,
Pearson’s
correlations, Chisquare and expert
review.

Qual: Content
analysis, common
themes/categories

Findings
8 common LP/S
identified across
studies as
impacting ItS:
1. TfL style
2. Manager
characteristics
3. NM Power
4. NM Influence
5. Supervisor
support
6. NM Decision
making style
7. Trust
8. Praise &
recognition

Decision for use
LOE: V
Strengths: Good
quality studies;
consistent findings
across studies; shows
evolution of
leadership practices
Weaknesses: Large
time span for 23
studies (1989 –
2010), with different
emphasis in earlier
studies and
variability in defining
leadership; lack of
theoretical
framework in some
studies
Conclusions: LP/S
influences ItS, with
TfL or relational
leadership
approaches showing
greatest impact.
Feasibility: LOE is
useable - NM can
develop Tfl skills and
create a supportive
work environment to
influence ItS as a low
risk strategy. Cost for
education and
interventions will
vary. Leader buy-in
may be a challenge.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Cummings, G.,
(2010).
Leadership styles
and outcome
patterns for the
nursing workforce
and work
environment: A
systematic
review.
Country: Canada
Funding: None
stated
Bias: None noted

Theoretical
Framework
Transformational
and Transactional
Leadership;
Leadership
Practices;
Situational
Leadership
Model; Path Goal
Theory;
Consideration and
Initiation;
Kanter’s
Organizational
Empowerment
Theory

Study Design

Sample/Setting

44
Major Variables

Design: SR

n = 53 total studies

IV: LP/S

Purpose:
To systematically
review the
multidisciplinary
literature to
examine the
relationships
between various
styles of
leadership and
outcomes for the
nursing workforce
and their work
environments.

All studies used
correlational, nonexperimental, crosssectional designs

DV1: JS
DV2: OC &
ItS/ItL
DV3: H&W
DV4: WE
DV5: Prod

Quality:
n = 31 medium
n = 22 strong
Inclusion criteria:
Published 1985 –
2009; English
language; Peerreviewed research;
meas. leadership by
nurses; meas. 1 or
more outcomes of
NL; examined
relationship between
leadership and
outcomes for nursing
workforce or work
environment.
Exclusion Criteria:
Qual; grey literature;
did not meet
inclusion criteria
Attrition: NR

Measurement

Data Analysis

Findings

MLQ – 17 studies
LP/S Inventory –
5 studies
Leadership
Behavior
Description
Questionnaire – 8
studies
Leadership
Effectiveness
Description – 2
studies
Leader EP
Behaviors – 2
studies

Pearson
correlational,
Regression
analysis, Chisquare, Fischer’s
exact test,
ANOVA,
Multiple
regression,
Hierarchical
regression, Other
correlations,
Linear regression,
Descriptive
statistics,
MANOVA
regression,
Structural
equation
modeling, t-test,
Spearman rank
order,

5 themes
identified:
1. Highest JS
associated with
relational
focused/TfL (22
studies) and
lowest with task
focused/TaL (10
studies)
2. Higher OC
with TfL (10
studies), lower
OC with TaL (5
studies). Higher
ItS and retention
with TfL (7
studies)
3. Better H&W
with TfL (7
studies) and
worse with TaL (4
studies.
4. Greater EP
with TfL (6
studies), Better
WE with TfL (6
studies)
5. Higher Prod
with TfL (13
studies), lower
Prod with TaL (6
studies)

19 used researcher
developed
instrument

Decision for use
LOE: V
Strengths: Most
studies used
theoretical
framework (87%);
large number of
studies included
Weaknesses:
Common weakness
of studies related to
sampling, design and
analysis; only 64% of
studies had response
rate of 60% or greater
Conclusions:
Relational-focused
leadership
practices/TfL led to
much more frequent
and encouraging
outcomes than taskfocused leadership
practices/TaL.
Feasibility: LOE is
useable, but needs
more research.
Relationship and
mechanisms of action
for specific LP/S and
outcomes is undertheorized. Research
indicates enough
positive relationships
for NM to act.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Duffield, C.
(2010).
Nursing unit
managers, staff
retention and the
work
environment.
Country:
Australia
Funding: New
South Wales
Health; Grant-inaid for Scientific
Research; Grant
for International
Collaborative
Research
Bias: None noted

Theoretical
Framework
Situational
Leadership Model

Study Design
Design: DC
Purpose:
Examine the
impact of
leadership
characteristics of
nursing unit
managers, as
perceived by staff
nurses, on staff
satisfaction and
retention.

Sample/Setting
N = 2141; Response
rate 80.3%
Setting: Randomly
selected 94 units,
from 21 hospitals in 2
Australian states
Demographics:
Licensure:
RN = 1559
CNS = 29
LPN = 582
ES: 1107 FT, 696 PT
Inclusion: All nurses
on selected wards
invited.
Exclusion: 3 units
excluded for
incomplete data.

45
Major Variables
IV: LP/S
DV1: JS
DV2: SwN
DV3: ItL

Measurement
Nursing Work
Index-Revised: 49
items, only used
12 items on LP/S,
1-4 scale;
α = 0.80.

Data Analysis
SPSS v.16
Regression
analysis

Findings
CI = 0.05, power
NR
6 LP/S items
increase JS:
1. Praise &
recognition,
β=1.47, p<0.01
2. NM philosophy
of patient care,
β=1.26, p<0.01
3. NM “good”
leaders, β=1.17,
p<0.05
4. Flexible
schedule, β=1.16,
p<0.05
5. NM engage
staff to control
costs, β=1.16,
p<0.05
6. NM highly
visible/accessible,
β=1.15, p<0.05

Decision for use
LOE: VI
Strengths: Large
sample size; good
response rate; results
align with other
studies
Weaknesses:
Characteristic “good”
NM not defined;
secondary analysis of
data collected in 2
other studies
Conclusions: NM
who consult with
staff and provide
positive feedback
increases JS and
SwN. Praise and
recognition are
characteristics of
TfL.

Attrition: NR
2 LP/S items
increase SwN:
1. Praise &
recognition,
β=1.40, p<0.01
2. NM philosophy
of patient care,
β=1.29, p<0.01
2 LP/S items
decreased ItL:
1. Praise &
recognition,
β=0.83, p<0.01
2. NM “good”
leaders, β=0.80,
p<0.01

Feasibility: LOE
useable - NM
developing a LP/S of
providing praise and
recognition is a low
risk/low cost strategy
to influence JS, SwN
and ItL. Leader buyin may be a
challenge.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Moneke, N.,
(2013).
How leadership
behaviors impact
critical care nurse
job satisfaction.
Country: USA
Funding: none
identified
Bias: none noted

Theoretical
Framework
Maslow’s
Hierarchy of
Needs; Dual
Factor Theory;
Domain of
Leadership
Practices

Study Design
Design: DC
Purpose:
Determine the
factors influencing
critical care
nurses’ perception
of their overall job
satisfaction.

Sample/Setting

46
Major Variables

Initial N = 137
N = 112 (81.7%)

IV1: LP/S
IV2: OC

Setting: critical care
units (including ED)
in large, acute care,
nonprofit in New
York City.

DV1: JS
DV2: OC

Demographics:
Means not reported:
Age: 40.8% 29-38
G: 77% Women
Ed: 56.6% BSN
Exp: 34.9% <4yrs,
31.7% 5-9 yrs, 20.6%
10-14 yrs.
ES: 90.6% FT
Shift: 48.8% day
Inclusion: RNs;
employed at least 6
months
Exclusion: NM,
CNS, NP, NA; 25
(18%) incomplete
surveys
Attrition: NR

Measurement
LP/S Inventory:
30 items/5
domains of LP/S,
1-10 Likert scale;
α = 0.91 – 0.95.
OC Questionnaire:
18 items, 1-7
Likert scale;
α = 0.86.
Job in General
Questionnaire: 18
items,
yes/no/cannot
decide;
Α = 0.87.

Data Analysis
Pearson
correlation,
Multiple
regression,
ANOVA

Findings
CI = 0.05, power
NR
+ corr LP/S & JS
(r = 0.24, p
=0.01)
+ corr OC & JS (r
= 0.66, p = 0.00)
+ corr LP/S & OC
(r = 0.25, p =
0.001)
Regression
analysis of G,
Age, Exp, Ed and
JS did not
produce
statistically
significant
relationships.
ANOVA for
impact of
specialty
certification,
specialty area,
title, shift, ES and
JS were not
statically
significant.

Decision for use
LOE: VI
Strengths: Good
response rate and
sample size; finding
strongly align with
previous studies
Weaknesses:
Voluntary
participants from 1
healthcare setting,
decrease
generalizability; OC
is used as IV and DV
Conclusions: Critical
care RNs are likely to
have higher JS and
OC when they have
leaders who engage
in 5 domains
identified in LP/S
Inventory: challenge
the process, inspire
shared vision, enable
other to act, model
the way, and
encourage the heart
(all of which are
components of TfL).
Feasibility: LOE
usable - NM
implementing
practices is a low risk
strategy to inf JS and
OC. Leader buy-in
may be challenge.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Raup, G., (2008).
The impact of ED
nurse manager
leadership style
on staff nurse
turnover and
patient
satisfaction in
academic health
center hospitals.
Country: USA
Funding: none
identified
Bias: CEUs and
$15 gift certificate
provided to all
volunteer
participants

Theoretical
Framework
Transformational
and Transactional
Leadership; Full
Range Leadership
Model

Study Design
Design: DC
Purpose: Examine
the impact of
leadership styles
used by ED nurse
managers in
academic health
centers on nurse
turnover and
patient
satisfaction.

Sample/Setting
N= 45
NM = 15
RN = 30
Setting:
EDs at academic
hospitals throughout
USA; 98 potential
sites, 15 sites (15.3%)
completed study:
Mountain – 3
North Central – 1
North East – 1
South Atlantic – 2
South Central - 8
Demographics:
TfL Age: 48.8
TaL Age: 40.3
TfL Exp NM: 9.6 yrs
TaL Exp NM: 4.4 yrs
NM G: 12 female
NM Ed: 9 BSN, 6
Masters
No information
provided on staff
RNs.
Inclusion: ED NM &
2 randomly selected
direct report RNs per
NM; Academic
Hospitals
Exclusion: 8 sites
(35%) with
incomplete data
Attrition: NR

47
Major Variables
IV: LP/S
DV1: TO
DV2: PS

Measurement
MLQ: 45 items, 15 Likert scale;
α NR
Research defined
ED NM role
survey: 10 items,
scale NR; α NR

Data Analysis
Fischer’s exact
test

Findings
CI = 0.05, power
NR
80% (12 0f 15)
NM use TfL.
Impact of TfL vs
TaL on TO and
PS was not
statistically
significant due to
limited sample
size.
Trend LP/S on
TO:
TfL = 12.97% TO
TaL = 29.31%
TO.
No trend
identified LP/S
on PS:
TfL = 76.68% PS
TaL = 76.5% PS

Decision for use
LOE: VI
Strengths: States
MLQ confirmed as
reliable and valid
instrument for meas.
TfL; used ED RNs &
NM only for sample
Weaknesses: Small
sample size (only
15.3% of possible
locations); Voluntary
sample may increase
bias; Limited
reliability/validity
information
provided;
Conclusions: While
study did not find
statistically
significant impact of
LP/S on TO or PS,
the identified trend
towards potential
significance of lower
TO with TfL is
supported by other
research.
Feasibility: LOE is
usable. Taking these
results into
consideration with
other studies, ED NM
can have confidence
to act, practicing TfL
behaviors to
influence ED staff
TO as a low cost
strategy.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Sawatzky, J.,
(2012).
Exploring the key
predictors of
retention in
emergency
nurses.
Country: Canada
Funding: Dr.
Paul H.T.
Thorlakson
Foundation Fund
Bias: none noted

Theoretical
Framework
Conceptual
Framework for
Predicting Nurse
Retention

Study Design
Design: C-S
Survey, Mixmethod
Purpose: To
explore and
describe the
influencing and
intermediary
factors which
predict the
retention of nurses
working in
emergency
departments.

Sample/Setting
N= 261
Setting:
12 adult ED in
Manitoba, Canada

48
Major Variables

Measurement

IV1: IF (LP/S,
WE, Demo)
IV2: IM (JS, EG,
CS, CF, BO)

For IF:
Perceived Nurse
Working
Environment: 42
items, 1-4 Likert
scale;
α = 0.56 – 0.91.

DV: ItL
Demographics:
Age: 41.1
G: 89% female
Ed: 54% Diploma
Exp: 15.5 yrs
ED Exp: 10.2 yrs
ES: 37% FT
Shift: 92% rotating
MS: 73% married
Income: 48%
>$100K combined
Children: 68% yes
Caregiver: 22% yes
Inclusion: FT & PT
ED RNs
Exclusion: NM; Per
Diem/Casual RNs

For IM:
JS, 1 item, 1-5
Likert scale;
α NR.
Engagement
Composite
Questionnaire, 6
items, 1-5 Likert
scale; α = 0.93.
Professional
Quality of Life: 30
items, 10 items
each addressing
CS, CF, & BO, 15 Likert scale;
α = 0.80.

Attrition: NR
Price and
Mueller’s ItL; 1
item, 1-5 Likert
scale; α NR.

Data Analysis
SAS v.9
ANOVA, Logistic
regression models

Findings
CI = 0.05, power
NR
IF & IM
Relationships:
EG pred for JS,
CS, CF & BO (all
p <0.001)
LP/S pred for JS (
p<0.001)
WE pred for CS
& CF (p = 0.01)
Demo (MS, Ed)
and WE inverse
pred for BO (p =
0.01)
IM/IF relation to
ItL current
position:
Low EG
(p<0.001), DemoPT ES (p=0.002),
High BO
(p=0.009) DemoIncome <$100K
(p=0.02)

Decision for use
LOE: VI
Strengths: Large
sample, specific to
ED RN retention
Weaknesses:
Theoretical
framework had not
been tested;
voluntary sample
may provide biased
results; did not
clearly define all
variables
Conclusions: EG key
factor for ED RN
retention.
Feasibility: LOE
usable - ED NM can
develop LP/S to
increase EG as a
strategy to improve
ED RN retention.
Low risk strategy,
cost will vary
depending on
intervention to
increase EG.

ItL Nursing:
Low CS
(p<0.001), DemoHigher Age (p<
0.001), DemoIncome <$100K
(p=0.001)

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Van den Heede,
K., (2011).
Effective
strategies for
nurse retention in
acute hospitals: A
mixed method
study
Country:
Belgium
Funding:
European Union’s
Seventh
Framework
Programme
Bias: none noted

Theoretical
Framework
Organizational
Dynamics
Paradigm of
Nurse Retention;
Grounded Theory

Study Design
Design:
Sequential Mixed
Method: C-S data
and grounded
theory
methodology
Purpose: Examine
the impact of
nursing practice
environments,
staffing and on
reported intent to
leave and best
practices being
implemented to
retain nurses.

Sample/Setting
N= 3186
m response
rate/hospital = 72%
Setting:
Quan: 272 randomly
selected nursing units
in 56 Belgian acute
care hospitals, 4-6
units/hospital.
Qual: 6 hospitals; 3
highest ItL and 3
lowest ItL
Demographics:
Age: 38
Exp: 15 yrs
G: 90% female
Inclusion: All
Belgian acute
hospitals invited; RN
providing direct
patient care;
Exclusion: RN on
maternity, extended
sick or study leave;
Attrition: NR

49
Major Variables
IV1: ST
IV2: Ed
IV3: WE
(LP/S,RL, PAR)
DV: ItL
Qual Themes:
T1: TfL
T2: EP
T3: PP
T4: IN
T5: QoC

Measurement
Organizational
Profile Survey
used as part of the
RN4CAST study
(which included
12 European
countries):
Provided bed size,
teaching status,
and technology
level; no further
details provided.
Practice
Environment
Scale of the
Nursing Work
Index: 32 items, 14 Likert scale;
α = 0.71 – 0.84.
Researcher
developed
questions for
Qualitative Study
interviews focused
on WE, JS, BO,
ItL

Data Analysis
SAS v.9.2
Logistic
regression
analyses using
Generalized
Estimation
Equation
approach.
Qual: Items
mapped to 5
Magnet Hospital
components,
performed by 1
researcher and
validated by 2
other researchers.

Findings
CI = 0.05, power
NR
Quan analyses:
ST inf ItL (p <
0.03) m patientto-RN ratio =
10.40 (SD=1.71)
WE inf ItL
(p < 0.001)
Ed did not inf ItL
Qual analyses:
For high
performing
hospitals:
T1: TfL is LP/S
T2: Higher RN
EP & a flat
management
structure.
T3:93% (versus
80%) RN satisfied
with PP.
T4:89% (versus
66%) satisfaction
with IN &
learning
opportunities
T5: RNs
perception of
QoC - 93%
“good” or
“excellent”
(versus 65%);
95% (versus 67%)
would
recommend
hospital to
family/friends

Decision for use
LOE: VI
Strengths: Large
sample size, good
response rate; mix
method provides
greater understanding
of data; Findings
align with other
studies showing
Magnet accredited
hospitals have better
WE.
Weaknesses: Not all
Magnet components
were fully covered;
Qual study on
Flemish hospitals
only
Conclusions: WE &
ST inf ItL. Hospitals
with low ItL rates
mirror organization
features promoted by
the Magnet
Recognition program.
Feasibility: LOE
usable. The process
of obtaining Magnet
hospital accreditation
can be considered an
effective strategy to
improve RN
retention. Process
can be labor intensive
and costs will vary.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Yeh-Ju Lin, B.,
(2010).
The role of leader
behavior in
hospital-based
emergency
departments’ unit
performance and
employee work
satisfaction.
Country: Taiwan
Funding:
National Health
Research Institute
Bias: none noted

Theoretical
Framework
Systematic Model
for EDs (author
developed)

Study Design
Design: C-S
Purpose: Explore
how the behaviors
of a hospital-based
ED leader relate to
unit performance
and employees’
work satisfaction.

Sample/Setting
ED N = 112
N = 1344 completed
questionnaires
(12/ED; 4 staff
completing 3
instruments)
Setting: Hospitalbased ED throughout
Taiwan
Demographics:
Individual
demographics not
provided.
Inclusion: All 385
ED NM were invited;
4 randomly selected
by birthday ED staff
(2 MD, 2 RN) from
each completed 3
surveys
Exclusion: NR
Attrition: NR

50
Major Variables
IV: LP/S
DV1: Prod
DV2: JS

Measurement
Researcher
designed
questionnaires:
ED Leadership
Questionnaire: 10
items, 1-5 Likert
scale;
α = 0.84 – 0.88.
ED Unit
Performance
Questionnaire: 9
items, 1-5 Likert
scale;
α = 0.92.
ED Employee
Satisfaction
Questionnaire: 1
item, scored 0 –
100;
α NR

Data Analysis
Structural
equation model

Findings
CI = 0.05, power
NR
Task-oriented
LP/S + related to
Prod (y = 0.58, p
<0.001)
Both Taskoriented (y =
0.27, p <0.05) &
Employeeoriented LP/S (y
= 0.30, p <0.05) +
related to ED RN
JS
Neither type of
LP/S related to
ED MD JS

Decision for use
LOE: VI
Strengths: Large
sample, population
ED staff
Weaknesses: Used
hospital-based EDs
only; Equal weight to
ED MD and RN
responses; Prod used
subjective meas
(employee ratings);
Results differ from
majority of other
studies.
Conclusions: Taskoriented LP/S
supports ED
performance by
establishing welldefined goals and
how to achieve them.
Both LP/S support
ED RN JS by
enhancing
communication,
autonomy & group
cohesion.
Feasibility: LOE
usable - ED NM can
consider a
combination of LP/S
to inf ED RN JS and
Prod. Cost will vary
by intervention. Buyin should be easier as
both LP/S have
merits.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION
Citation
Young-Ritchie,
C., (2009).
The effects of
emotionally
intelligent
leadership
behavior on
emergency staff
nurses’ workplace
empowerment and
organizational
commitment.

Theoretical
Framework
Author created
model integrating
Kanter’s Theory
of Structural
Power and
Goleman’s
Emotional
Intelligence

Study Design
Design:
Predictive, nonexperimental C-S
Purpose: Explore
the relationship
among leadership
behavior,
workplace
empowerment and
commitment.

Sample/Setting

51
Major Variables

N = 206

IV : LP/S

Setting: Ontario,
Canada; RNs
recruited via College
of Nurses registry list

DV1: EP
DV2: OC

Measurement
Emotional
Competency
Inventory 2.0: 72
items, 1-5 Likert
scale;
α = 0.99.

Demographics:
Age: 39.6
G: 95.1% female
Exp: 15.9 yrs
ED Exp: 9.5 yrs
ES: 67% FT
Ed: 75.1% diploma

Conditions of
Work
Effectiveness
Questionnaire: 18
items, 1-5 Likert
scale;
α = 0.87.

Inclusion: Acute
care hospital ED
RNs; FT and PT; <6
months in ED; 283
eligible RNs invited

Three-Component
Model Employee
Commitment
Survey: 6 items,
1-7 Likert scale;
α = 0.79.

Country: Canada
Funding: none
identified
Bias: none noted

Exclusion: RN no
longer working in
ED;
Attrition: NR

Data Analysis
SPSS v.13.0
Descriptive
statistics and
reliability
analyses, Path
analysis, Pearson
correlation

Findings
CI = 0.05, power
= 0.80, Effect size
= 0.13 (N = 77
needed)
Perception of
LP/S as
emotionally
intelligent (EI): m
= 3.43, SD = 0.70
(moderate).
Perception of EP:
m = 18.36, SD =
3.22 (moderate).
OC: m = 4.27, SD
= 1.30
(moderate).
EI LP/S has
strong
relationship to EP
(r= 0.53, p <
0.05) and OC (r=
0.50, p < 0.01)
Demo not
significantly
related to
perceived EI
LP/S, EP or OC.

Decision for use
LOE: VI
Strengths: Large
sample; population
ED staff only
Weaknesses:
Voluntary
participants have
potential for bias
responses
Conclusions: EI
LP/S support greater
ED RN EP and in
turn, greater OC. OC
has been shown to be
a key retention factor.
Feasibility: LOE
usable - EI LP/S is
associated with TfL;
NM developing their
EI can benefit their
staff by increasing
EP and OC, which in
turn can improve
retention. This can
be a low risk
strategy. Leader buyin may be a
challenge.

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION

52
Appendix B

Synthesis Table
Author:
Year
Systematic Review
(LOE: V)
Descriptive Study
(LOE: VI)
Country

Sample size (people
or articles)
% of RNs
% ED Staff
% of G is Female
Age:
▪ Range

Abualrub

Cowden

Cummings

Duffield

Moneke

Raup

Sawatzky

2011

2011
X

2010
X

2010

2013

2008

X

X

Australia

USA

X
Saudi
Arabia

Canada

Canada

308

23

53

100
21
56

NR
NR
NR
NR

NR
NR
NR
NR

74
NR
NR
NR

71%
20-29

X

X

X

X

X

USA

Canada

Belgium

Taiwan

Canada

261

3186

112

206

100
NR
77

100
100
80

100
100
89

NR
NR
90

50
100
NR
NR

100
100
95

TfL=49
TaL=40

41

38

41%
29-38

NR

NR

NR

NR

52%
57%
NR

NR

NR
75%

60%

NR

NR

49%
1-3

NR

40

54%

TfL=9.6
TaL=4.4

▪ As nurse
% FT ES

2010

YoungRitchie
2009

Descriptive Information
2141
112
45

▪ Mean
Education:
▪ Diploma
▪ BSN
Years of experience:
▪ Position

Yeh-Ju Lin

2012

Van den
Heede
2011

NR

NR

52

35%
<4
91

NR

16

15

37

NR

16
NR

67

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;

INNOVATIVE LEADERSHIP AND RETENTION

Author:

Abualrub

Cowden

Cummings

Leadership
Practice/Style
▪ Specified
TfL as LP/S
Organizational
Commitment
Work Environment
Job Satisfaction
Engagement
Burnout
Staffing
Education

X

X

X

X

X

X

Job Satisfaction

↑

Intent to Stay
Intent to Leave

↑

Organizational
Commitment
Health & Wellness
Work Environment
Productivity
Satisfied w/ Nursing
Turnover
Patient Satisfaction
Empowerment

53

Duffield

Moneke

Raup

Independent Variables/Interventions
X
X
X
X

Sawatzky

Van den Heede

Yeh-Ju Lin

YoungRitchie

X

X

X

X

X

X

X

X
X
X
X
X

X

X
X
Dependent Variables/Outcomes: ↑ = increased; ↓ = decreased
↑
↑
LS/P ↑
EG ↑
OC ↑
LP/S ↑
↑

Task-focused
LP/S ↑
Emp-focused
LP/S ↑

↑
↓

↑

EG ↓
PT ES ↑
BO ↑

“Good” LP/S↓
“Poor” ST ↑
“Poor” WE ↑
Ed: No impact

LS/P ↑

↑

↑
↑
↑

Task-focused
LP/S ↑
↑

WE ↓
Not Sig
Trend ↓
Not Sig
↑

KEY: BO-burnout; BSN-Bachelor degree; Ed-education; ED-emergency department; EG-engagement; Emp-employee; ES-employment status; FT-fulltime; G-gender; LP/S-leadership practices or
style; NR-not reported; OC-organizational commitment; Prod-productivity/performance; PT-part time; RN-Registered Nurse; Sig-significant; ST-nurse staffing/ratios; TaL-transactional leadership;
TfL-transformational leadership; TO-turnover; WE-work environment;