Leadership Styles And The Job Satisfaction Of Nurses

Published Date: 23 Mar 2015 Last Modified: 05 May 2017

Every day nurses have the responsibility for the health as well as the well being of their patients and therefore to ensure a continuity of the patient care each every nurses on a unit work tougher to ensure that they achieve the shared goals. The cohesive team thus work diligently to promote then patent health, safety and recovery and to achieve such unity nursing manager coordinates and supervises all the interactions that go on between all the team members he is in charge of (Longerich, et al 2003). Nurse leaders may be nurses mangers who are responsible for one nursing unite or a nurse executive held responsible for all the in-patient nursing units. Nurse steam leaders achieve their roles by applying the various nursing leadership style which include: transformational, transactional as well as dynamic leadership. A combination of more than one leadership style is often considered more effective but a single type also serves the intended purpose depending on the situation that the leader is in (Mahoney, 2001).

Background

The nursing professionals faces one of the greatest challenges of developing future leaders as powerful leadership skills are required all nurses i.e. those responsible for providing direct acre to those in the top management position for example anyone looked upon as an authority ranging from a nurses taking care of a patient to those responsible for giving assistance to others. All of them are considered s leaders. Another difficult that faces leadership for health care professionals is that most of the leadership theories were not developed based on the healthcare context but rather with in the business context then applied to healthcare.

A clinical nursing leader is involved in direct patient care as well as offers a continuous improvement of the care by influencing others. Leaders have skills, task which they utilize to as an attitude that inform behavior leading to consistent superior performance with long-term benefits to all those involved. Leader s not alloy control other but are more of visionaries who serve to helping employees to lead, plan, organize and control their activities (Jooste, 2004).

In the past decade shelf life of leaders in the health service has halved and instead of working in environments that encourage creative thinking especially about the future of health care there is one that consists of vast paper trails that are characterized by motions masquerading as activity. Thus the luxuries of personal lives for the senior staff are tumbled upon especially in some of the healthcare organizations where 60- hours working in a week has become quite normal. This situation has made some health care staff to no longer work for patients but rather to be motivated by pronouncements from government representatives , media expose an even on the latest scandal regarding misuse of public money (Woolnough, 2002).

Health care system has witnessed different parts of the health organization focus on different things which is often marred with poor coordination across the various departments with objectives being sandwiched between keeping costs down with efforts to increasing patient services. Such in-coordination as been felt by the hospital administrators especially at times when demands for administrative services increases and thus administrative jobs are cut.

Making choices require certain amounts of freedom, thought, actions, time for weighing options, as well as time for reviews of such decision, unfortunately in health cares leaders lack such luxuries as the reliable, easily accessible and relevant information they require to make decision is often not unavailable. Further more resources and time that is essential for such responsibilities is missing and this affects much of the health care leaders who are driven by gut feeling which is linked to strong sense of personal values regarding what is right, just and reasonable(Outhwaite, 2003).

Irrespective of the countries which healthcare leaders operate they are always expected to fulfill the following roles: being a diplomat, a visionary, politician, conflict resolver, coach, figure head as well as a human being failure to which no leader can claim to the title. as a matter of fact most leaders face the pressures of sharing a little pieces of themselves with anyone that ask for it, in addition to that healthcare leaders face real dilemmas regarding several issues like ways of radically changing their organizations without any guarantees of success despite the well planned changes and being able to accept the consequences of their actions, working with political agendas or legislations which they disagree with and also accept the consequences, apportioning of resources of the available as fairly as possible while also accepting the consequences, saying no when they want to say yes and also accept the consequences ,trying to act ethically yet sometimes leading to failures and knowing that despite their selfless effort someone some how cries foul. In addition to that healthcare leaders are faced with challenges of making decision like making choices regarding decisions on acting on absolute principle or creative several flexible responses, to keep particular services or to discard them, having a open organization and developing closer ties with the service users yet at same time having little or no control over the eventual outcomes, to continue to lead or not (Outhwaite, 2003).

Failure to act in decisive manner by healthcare leaders may lead to general delay action for instance lack of medical and nursing action in the review of requested treatment in admission leads to inaction on the part of delivering the treatment. The pivotal role of the leader may be overshadowed by fear of unjust critism which result to delayed decision which its ultimate consequence of having to deal with sense of failure and guilt.

Leadership

Leadership can be defined as the process of influencing others, meeting goals by obtaining the co-operation from those around them and acquiring the resources to achieve their goal. To be a leader you must make a decision to act; doing so requires skill, knowledge, energy, vision and self-confidence (Tappen, 2001). On the other hand, leadership may not be obvious or visible process of influencing others, but the very leadership features within the individual may trigger other people to act according the leading person. Carney (1999) defines leadership as persuading others to pursue a common goal by setting aside individual concerns, while Marquis & Huston (2000) states that "leadership is made up of authority and accountability." They define authority as the power one has to direct the work of others and accountability as well as the moral responsibility that comes with the position of leadership. Majority of existent theories pays attention to leadership as a personal feature which is more or less helpful when achieving goals within the organization and not for individual goals. However, this paper work would focus on both parts as leadership in nursing field requires the same amount of attention to the work of organization and the individual as well. In other words, if adding all definitions together, we get the idea that leadership involve influence on others, authority, achievement of goals through command work and the leader's moral responsibility. The basic question is how the leader arranges his / her priorities, the job of staff, atmosphere, etc.

Leadership theories

Trait theory

Much has been written about the differing leadership styles and theories over the last seventy years. Many leadership theories have evolved over the last century starting with 'Trait theory'. It is based on the assumption that some people possess personality traits which single them out as natural leaders and those who possess such traits should be nurtured into leadership positions (Marquis& Huston, 2000). However, this theory was abandoned by the 1940's as no set of consistent traits could be identified and thus research focused on the behavior and attitudes of managers based on the assumption that leadership styles are based on specific behavior. (Sellgren et al, 2006) Nowadays, many ideas of trait theory are rejected as psychology studies provided evidence that leadership though appears as every individual's feature is not that helpful when trying to nurture it so this theory now has only historical rather than practical importance.

Behavioral theory

Research on leadership has shifted focus from leadership traits to leadership behavior (Bass, 1981 cited in McNeese-Smith, 1996). Behavioral theories particularly focus on what a leader does (Whitehead et al, 2007). This approach was adopted from the 1950's onwards following two major studies by American universities. It looked at what a leader does and what he / she should do, what is leader's role when facing certain problems, the behavior exhibited by leaders and the influence of leadership style on a group's performance. Research into behavioral theory was based on the premise that each leader has a style based on their personality, they experience and education (Ekvall, 1992 cited in Sellgren et al, 2006). Also, the theory was interested on leader's interaction in group work, and how members of the group react to each other and especially, the leading figure. For further analysis, the leader's behavior can be separated into three main leadership styles - Authoritarian, democratic and Laissez-faire (Tappen, 2001). Leadership style is related to the amount of control or freedom which the leader affords to the group (McCarthy, 1998).

Authoritarian

Authoritarian leaders keep most of the authority and make most of the decisions without much consultation with the group. Autocratic leadership style does not allow group participation and does not nurture creativity. This may have the effect of de-motivating the team members in the long term (Whitehead et al, 2007). In some cases it can even be said that autocratic leader does not even 'need' a group work; all what matters is group's ability to follow the 'orders'. Authoritarian style can however, be useful in situations where group participation would be counter-productive or where rapid decisions need to be made. Still, rapid decisions do not guarantee success, so this type of leadership in many cases is rarely acceptable.

There are certain researchers nowadays who examine the leadership and leader's behavior of important historical figures. They draw a conclusion that many presidents, politicians and generals of the past were good authoritarian leaders as the very lifestyle back then were based on social status and the power within the society (Whitehead et al, 2007). Education also played an important role and the good leader was the one who could lead the whole nation to success by making decisions on his own. Fortunately or not, nowadays this type of leadership is often treated as unacceptable behavior rather than type of leadership.

Democratic

This style of leadership takes the opinions of the group into account. The decision making is shared with the group paying attention to every single critique and comment from other members of the group. This style encourages group participation and exercises general, rather than close supervision. (Carney, 1999) In other words, it is all seen in the very word 'democratic'; the leader within the group is seen as more important figure than everyone else, but the leader himself / herself is responsible for creating a feeling of equality; work in such group usually would be followed by friendly and positive atmosphere as every individual in the group would be seen in many cases as more important figure than the very problem they are solving. Possible drawbacks may be that democratic leaders are only strong when every individual feels strong in the group, but some leaders are not capable of withstanding their opinion if it may damage the atmosphere within the group. Despite that, these cases are rarely discussed as after such incidents the authority of the leader may be 'diminished' and the group would be searching for other leading figure.

Laissez - faire

In this style the leader allows the group to determine their own way of working and does not provide much direction, feedback or decision making. This type of leader is passive and non-directive; he / she provide little support for the group and in fact may turn requests for help and support back to the group in general (Tappen, 2001). Some groups require 'passive' leader, who in a way will took all responsibility, but actions and decisions would be made by other people in the group. It does not necessarily suggest that this kind of leadership is provoked by group members; the leader should be conscious about the situation and accept that. Some behavior researchers and psychologists even points out that this type of leadership requires more psychological knowledge and personal strength than others; not many people would allow such freedom for the group without being afraid to accept full responsibility of their actions (Tappen, 2001).

In more recent times, research carried out by Kouzes & Posner (1988) and Bass (1995) showed interesting results about leadership behaviors. They studied over 1,300 leaders and have identified five different leadership behaviors:

Challenging the process: these are leaders who are innovative and experimental; their work should be a challenge.

Inspiring a shared vision: Intuitive leaders who picture the future and enlist others to become involved;

Enabling others to act: these are empowered and supportive leaders who build trust and team work;

Modeling the way: Leaders who act as role models, setting a good example and practicing what they preach;

Encouraging the heart: Leaders, who support their followers, recognize and reward their accomplishments, though some researchers nowadays questions methods of leading the group through rewards (especially material).

These leadership behaviors are very useful and can be used as independent variables to measure both the manager's opinion of their style of leadership and that which is perceived by those they manage. This in turn can be used as an indication of employee's satisfaction with their manager's style.

Situational leadership theory

This leadership theory is based on the premise that leadership style should be determined by the situation or the individuals involved (Marquis & Huston, 2009). The differing leadership styles of situational leadership proposed by Hersey et al (1997) are based on the maturity or readiness of the follower. They set out four levels of readiness ranging from low (unable or unwilling) to high (able, willing and competent) and depending on the level of the follower the leader's style is directive, coaching, supportive or delegate in approach. There would be helpful to present an example which would illustrate this theory better. For example, the leader who is working with group of people which is known to him / her would follow absolutely different steps or provide different behavior when working with other group of people which he / she has not met before. That is because new people would consciously or not question presented leader's authority, their working methods may contradict the methods by which leader chooses to act, etc. In other words, this theory focuses on the new direction which was not discussed before - the conflict between group members and leader when facing certain new issues, or anything at all what is innovative and not known how to deal with. Situational leadership stresses out the importance of leader's actions in new situations where group work has to be organized very carefully (Hersey, 1997).

Charismatic Theory (Transactional and Transformational leadership styles)

New leadership styles have developed in more recent times and that involves the transactional leadership and transformational leadership, both of which are part of Charismatic theory (Rafferty, 1993). In rapidly growing health sector, these kinds of leadership are especially notable up to the present day. Transactional leadership is characterized by bargaining, it emphasizes the organizations goals while recognizing the rewards that people value. Once goals have been achieved the leader rewards those who helped to achieve them (Lindholm et al 2000, Carney 1999). It seems as a very fair method - to focus on goals rather than rewards; the sequence of actions is very strict, showing that efforts would be rewarded only if they were effective. Transformational leadership has charisma as its focus. The leader provides the vision, instilling a sense of pride in achievements, while gaining trust and respect from the group. Transformational leadership raises both leader and follower to a high level of motivation and morality as both shares a common value according to Burns (1978) who coined the term. In other words, both leader and the follower are on the same level, the main distinction is who leaded who to such level. To shortly sum up, this theory basically was called charismatic as leader must be able to build up the strategy consciously and think ways of how group can effectively be included into achievement of necessary goals.

Servant leadership

One of the more recent leadership concepts is Servant leadership. This style is very different to traditional views of management where the organizations needs take precedence. Servant leadership is concerned with service to the follower as opposed to engaging followers to support organizational goals (Stone et al, 2004). Servant leaders take into account their followers needs first and this in turn empowers them to achieve organization's goal. This also sometimes brings problem of inequality in light as the leader's needs and the follower's would be of very different level. Thus, one side could feel in a way 'used' but in many cases feelings would not be considered that important as many problems are solved in formal style and achievement of goals is the only satisfactory solution. This theory was called servant for various reasons very few literature provides the origin of such concept, as the fact that organization's word is always the last, is quite natural itself (Carney, 1999).

To sum up these kinds of leadership theories, the short evolution of leadership studies it is seen that analysis provides numbers of exceptions, and ambiguities. Every theory and every type of leadership can be understood and interpreted differently considering every individual. Leadership is necessary in group work to achieve certain goals, but nothing can guarantee or provide an easy pattern to do so. However, after this discussion we now would be focusing on another part of this paper analysis; in what forms leadership appears in nursing field and how leadership styles can help to achieve personal or institutional goals and bring satisfaction for the job.

Leadership styles in Nursing

What is clear from the literature is that no one style of management and leadership is consciously used within nursing as a specific method to cope with certain issues that nurses and ward managers are facing. However, what emerges is that predominantly health care has moved away for the traditional autocratic style and towards a combination of transactional and transformational leadership. A study of 71 Irish Health Managers carried out by Armstrong (1999) found that over half used transactional and transformational leadership. The reasons are quite obvious. The period of time shows that the research is quite new and nowadays autocratic leadership is usually interpreted negatively. Transactional and transformational leadership, however are more effective in nursing field as such kind of leadership showed great success in institutional work (Avolio, 1988). Nurses in general, aims to helping people, and these two styles of leadership are emphasize the co-operation with other people; group work and care for others is extremely important to get successful results. Nowadays in nursing field other models are rarely seen as effective and though it can be said that democratic leadership is also very common, it usually appears in the group of nurses excluding their direct leader - the employer. Democratic leadership often occurs where leader is not the one with higher status, but the one which is 'chosen' by the group as the most reliable or so on (Bass, 1995).

In a study carried out by Lindholm et al (2000) he found that more than half of managers interviewed exhibited a combination of both transactional and transformational leadership styles and these managers appeared to experience fewer management problems, less resistance to change and greater support from other professional groups within health care. What is not really acceptable is that these studies do not provide enough information about minorities, who are using different leadership styles. Although, it is only natural to state that leaders who uses different methods or have mixed qualities, often are said to be better than those who can be applied only to one pattern.

The Hay group, an international management consultancy firm which carried out a study of leadership styles in seven NHS trusts in Brittan sets out six leadership styles which are prevalent in nursing (Kenmore, 2008):

Directive: A leader who instructs staff on what to do without consultation, this often seems as autocratic style, though also can be the transactional or transformational leadership style leader;

Visionary: The leader who provides long term guidance and vision for the future, the team work is important and especially the trust for a leader;

Affiliative: This leader creates harmony within the team as other way the achievement of goals would be not as effective as needed; this style is especially good if the certain group is going to co-operate in the future, they would find ways to achieve goals effectively together as a team;

Participative: A leader who generates ideas and develops staff commitment; it is an active leader who also works in a group though he / she clearly 'states' who is the leader;

Pace-setting: This leader promotes high standards and task accomplishments as he / she finds the reward as the best way to motivate his group; statistics show that money as motivation is not the most important part for job satisfactory, but still this kind of leaders are quite common;

Coaching: A leader who promotes self-development and further education; it is a sort of investment in group for facing future tasks; also very effective if the team would work together for a long period of time.

The Hay group found that the most effective ward managers are flexible in their approach and used a variety of these leadership styles in order to get the best performance from their staff (Kenmore, 2008). However there is no comparative study of leadership styles carried out within Irish nursing on this scale which identifies an opportunity for further research in order to gain better understanding in the Irish context.

In Ireland the National Clinical Leadership Programme (2008) was set up by the Office of the Nursing & Midwifery Services Directory (ONMSD) to assist nurse managers to develop leadership skills which support the new and expanded ways of delivering quality patient care. This programme was adopted from the Royal College of Nursing's (RCN) Clinical Leadership Programme framework which aims to develop transformational leadership qualities in participants (Clinical Leadership Pilot Evaluation Report, 2008). The theoretical framework focuses on:

Learning to self manage

Developing effective relationships

Patient focus

Networking

Political Awareness

This leadership programme has since been developed further by the ONMSD to become the National Leadership Development Project. This project has developed competencies which promote clinical leaders. These, the ONMSD believe, are the key to providing better care and developing leadership within nursing. This pilot project commenced in March 2011 with the completion date set for 2012. (NLDP, 2010). So far, this project received positive reviews by many researchers of health care studies and the nurses themselves.

Defining Job satisfaction - history and current thoughts

Job satisfaction is defined by Locke (1969) as: "a pleasurable or positive emotional state resulting from the appraisal of one's job or job experience." It is described as a positive affective orientation towards employment by Muller & McCloskey (1990). Job satisfactory is a crucial factor which influences individual's personal appearance in his / her work sphere which can result in increasing or decreasing effectiveness in job duties.

As a formal area of research, job satisfaction did not really exist until the mid 1930's although there was a good deal of qualitative research and theorizing about the concept of job satisfaction. These included Freud (1922) who felt that morale acted to suppress negative tendencies, encouraging personal sacrifice and commitment to group goals. Janet (1907) theorized that repetitive work encouraged one to dwell on negative thoughts and cause obsessive thinking. Historically, researchers were interested in job satisfaction as a means of increasing productivity. Scientific management theory assumed that above all things, workers value economic incentives and would be willing to work harder for economic incentives. Taken these two opinions into account it is seen that the lack of personal or moral satisfaction still was not discussed widely.

This led to the Hawthorne studies which were carried out by Professor Elton Mayo from the Harvard Business School between 1927 and 1932. This study began by examining the effect of physical conditions on productivity, however in the course of his investigations he became convinced that factors of a social nature were affecting job satisfaction and productivity. This study revealed that the feelings and attitudes of workers affected production rates and this led to him introducing an interview programme to assess the nature of the relationship between methods of supervision and workers attitudes. As a result of these interviews it became apparent that small changes in work conditions temporarily increase productivity but further investigations reveled that this increase resulted, not from the changes in conditions, but from the knowledge that workers were being observed. In other words when interest was shown in workers their productivity increased but when this interest was withdrawn, the productivity fell. This later became known as the Hawthorne effect. This research provided strong evidence that people work for other purposes than pay as well and sparked a wave in research into other factors which affect job satisfaction.

After these studies and thoughts about job satisfactory, numbers of tools for measuring job satisfaction appear. One of the most commonly used is Maslow's theory of human needs (1954). Maslow asserted that human needs emerge sequentially according to a hierarchy of five need levels: physiological, safety, affiliation, achievement and esteem and self-actualization. Maslow argued that the satisfied need was not a motivator of behavior and therefore the importance of higher needs increases as lower needs are satisfied. This was followed by Herzberg et al (1959) who went on to develop a theory of job satisfaction based on Maslow's hierarchy and concluded that not all factors increase satisfaction. They conclude that there was a relationship between job satisfaction and certain work behaviors as well as between job dissatisfaction and other work behaviors. Hertzberg concluded that satisfaction and dissatisfaction were two totally different phenomena which develop from distinct sources and had differing initial and long term effects on behavior. Hertzberg also found that the factors related to good feelings towards one's job were achievement and recognition, the nature of the work itself, responsibility, advancement and salary. The bad feelings towards the job stemmed from company policy and administration, technical supervision, the question of payment, interpersonal relationships with supervisors and working conditions. Hertzberg's basic proposition is that workers are driven by two different factors; hygiene and motivation factors. Hygiene needs related to the physical and psychological environment in which the work is done while motivational factors relate to the nature and the challenge of the work itself. However, there has been severe criticism of Hertzberg's theory due to its lack of empirical support as well as the very idea of job satisfactory did not provide examples of fairly different job spheres.

The job satisfaction of nurses

There is a wealth of literature relating to job satisfaction in general management literature and to a lesser extent, in nursing literature. From the moment when job satisfaction became a field of psychological interest, numbers of considerable researches has been done on various aspects of job satisfaction. One of the most notable studies was carried out by the Hay group and it would be mentioned further.

Job satisfaction is not easily defined mostly because it means different things to different people. Job satisfaction is multifaceted and can be affected by both internal and external factors. Atchison (2003) lists pay as the most important external factor but states that internal factors such as a good boss, professional development and a nurturing work environment are even more important. This is borne out by the extensive study carried out by the Hay group (1999) of over 500,000 employees in 300 locations where they found that employees rated pay and benefits in only 10th position in the reasons for employee satisfaction. According to Atchison (2003), pay checks are entitlements and not motivators. The only time a pay check is motivating is when there is a threat of loss of the pay check. Atchison (2003) states, that job satisfaction to nurses is unique as what motivates nurses is not so much pay and conditions but rather the well-being of the patient and a sense of "a job well done". What is more, not payment, but the patient is one of the most important figures in nurses' job. Even when the patient outcome is not positive a nurse may feel a sense of satisfaction having met the patients needs spiritually, physically and psychologically. This is defined by the Hay group (1999) as "Meaningful work, making a difference" and is cited as the 3rd most common reason given by employees for wanting to stay with a company. Pay ranked at only 10th place as a reason for staying, though this may vary in other countries depending on nursing conditions, economy, etc. This research lists ten reasons overall (Hay group, 1999):

Career growth, learning and development

Exciting work, challenging

Meaningful work, making a difference

Great people

Being part of a team

Good boss

Recognition for job well done

Autonomy, sense of control over one's work

Flexible work hours and dress code

Fair pay and benefits

This is re-iterated by Lebbin (2007) who says that many people who work in health care are motivated by improving the health and well-being of their patients. He goes on to state that staff dissatisfaction cannot be fixed by increasing pay and benefits but by the organization addressing its primary goal which is 'caring'.

Blegin (1993) found that factors affecting employee satisfaction were: employer commitment, communication with supervisors, autonomy, recognition, and peer communication. This study also found that stress and routinization negatively affected employees satisfaction. Basically, if an employee meets constant stress in work place or the job becomes as a routine, the changes are necessary, and the payment is rarely a solution for these kinds of problems.

The sources of nurse's satisfaction include working conditions, interactions, remuneration, self growth, praise and recognition, control, job security and leadership styles according to Lu et al (2005) having carried out an extensive literature review. However, Tovey & Adams (1999) found from their research that clinical grade differences of nurses reflect differing sources of job satisfaction and dissatisfaction. They point out that job satisfaction and dissatisfaction is often treated differently within each group of nurses and especially within individuals. That is why they go on to suggest that different measurement tools are needed to accurately reflect as much differences as possible.

Not surprisingly, the job satisfaction usually has an effect on service user's satisfaction, patient outcomes, staff turnover and morale. According to McNeese-Smith (1996) caregivers provide better care when they are satisfied and committed to their employer. If a nurse gains satisfaction from the work she / he is doing, when the stress would become absent, jobs would be done in no rush and patient needs would become a priority as the caretakers who are facing the stress would not be able to pay that much attention to the patient as otherwise. Commitment to the employer is also very important. Employer is normally seen as the leader for group of nurses, so successful teamwork and positive atmosphere is necessary to be created for staff members.

Measurement tools for job satisfaction

The measurement of job satisfaction is a difficult system of collecting data, responses of nurses, questionnaires, etc. During the period when job satisfaction became a field of interest, numbers of measurement tools were invented. Mostly they are helpful to gather statistics which should lead to better job conditions, though not all of these tools are quite effective. For example, the Job-in General Scale (JIG) was developed by Smith et al (1990) to measure job satisfaction. It contains 18 responses for employees to describe their feelings towards the job. Responses include: positive responses such as "makes me content" or "worthwhile" to negative responses such as: "waste of time" to "rotten". There, each response is given a score of 1 if positive, 2 for a question mark or 3 if negative. This allows the auditor to rate the overall satisfaction of the respondent numerically. This tool was later criticized for obscure and not detailed data; also it does not consider reasons why nurses find their job satisfactory or not.

There are many different measures of job satisfaction and they vary greatly but according to Zangaro & Soeken (2005) the Index of Work Satisfaction (IWS) up to date is considered the most suitable for measuring nurses' job satisfaction. This tool uses 5 variables to measure job satisfaction and so far the results using this specific tool provide the most comprehensive information:

Pay: remuneration and periphery benefits received;

Autonomy: the amount of freedom, independence and initiative permitted or required (although, it should not be forgotten that loyalty to employer is also very important);

Task requirements: the amount of activities that must be completed as part of the job, nurses' duties;

Organizational policies: policies and procedures set out by administration;

Interaction: The amount of opportunities for both formal and informal meeting during work time in the work place.

However, the earlier mentioned Hay group uses a bit different method to measure job satisfactory. There are no strict or fixed variables presented, although analyzing specific literature, it was found that Hay group pays more attention to organization affectivity and individual's feelings, without speaking much about payment, for example. The Hay group points out that the most important thing for each nurse in their job is the feeling of personal progress (2008). So, if comparing Hay group's opinion to these 5 variables presented by the Index of Work Satisfaction, autonomy, task requirements and interaction may be the crucial point which describes positive attitude towards the nursing job and other factors would be considered of minor importance.

Moumtzoglou (2010) conducted a literature review prior to constructing a satisfaction scale for Greek nurses and found the sources of job satisfaction to be similar throughout the literature and common elements devised includes: interaction and recognition, leadership styles and organizational policy, self growth and responsibility, remuneration and finally the work itself.

Leadership skills and the abilities of nurse manger have long being recognized to make critical contribution to smooth operation of the inpatient unites as well as to contribute to the success of acute care hospitals. Thus their leadership is increasing gaining attention especially as it pertains to their contribution to staff attitudes and relationships. considering the fact that that first line nurse managers are positioned in a close proximity to the wok itself as well as to the nurse engaged in the patient care make sits critical in the way the manager implements the leadership roles which are bound to have significant impact on the working environment and organizational. Therefore nurse manger that influence the work environment positively fosters the organization's commitment of the staff stimulating greater achievement at the unit level hence enhancing the organizations competitive advantage.

Effect that leadership styles have on job satisfaction of nurses

While there are many literature focusing on leadership in nursing area and the factors which affect nurse's job satisfaction, there are very few which explain how certain leadership styles implies positive or negative effect on job satisfaction. Thus despite the effects that leadership styles have on employees' job satisfaction there are other factors which also have a great influence and these other factors includes personal behavior factors that react to leadership.

A study carried out by McNeese (1996) found out that leadership behavior partially accounts for the job satisfaction of employees and that organizational culture, types of patients, quality of care, organizational use of power, communication between management, even medical equipment and peers played a significant part. One of the fundamental factors that serve to show that leadership in nursing may not be the lone positive term is that each individual has their own behavioral patterns and that every person has features of leadership despite not being natural leaders (Bass, 1995).

Nurses' job is actually not the type of work which signals a high social status as every nurse, for instance ward managers may feel that their profession status does not provide a high level; thus leadership in nursing field is a field which talks about leadership among the 'middle class' of hospital's staff (Kenmore, 2008). Those who are more interested in their casual duties, and care of their patients, may be more satisfied with their job if they do not want to became leaders or be treated like ones among other colleagues. For others it may be an uneasy issue, as they presumably have other considerations like getting a pay raise, promotion or other possible bonuses that goes with being a leader. This way, duties and tasks would not be done with that level of satisfaction as the nurse would be consciously or not trying to achieve the goals her / his leadership features are leading to. And it may not be always possible considering the mentioned status of nurse; though nurses may differ in many ways, the very word in world of medicine is often considered to show lower status than comparing to doctors, surgeons, and so on (McNeese, 1993). However, it should not be forgotten that a group of nurses may have few 'leaders' in the team or none at all; this also brings problems an many misunderstandings as well as confrontations as the group may become a dysfunctional system. The job of such group would be led by stress, unreliability and it would be felt by patients, whatsoever (Kenmore, 2008).

Another factor that may affect nurse's job satisfaction as the culture of the organization includes more staff members with lower or higher status in specific task. Those whose individuality signals strong leadership features but their professional status does not provide freedom to express their leadership, may be stuck in constant dissatisfaction with their work in one way or another (payment, relationships, care of patients, ). So to say, leadership is not only a positive thing within the organization, as there would always be members who want to be leaders in one sphere or another. The real leader which has the highest status must be aware of such issues and should be able to control his / her organization so it could function and work properly and more efficiently (Kouzes, 1988).

On the other hand, certain leadership styles within nurses' staff may be very beneficial for the whole organization. Usually, the democratic style of leadership is considered to be the most effective as nurses do not have visual power the leader but they may be able to organize the group work and increase group's confidence. Nurses, who are said to be democratic leaders, would always pay attention to their colleagues, their opinions, comments and critique by doing this, the patient is treated as a very important figure; usually with the leading nurse guaranteeing that everything is done for the care of the patents needs (Fradd, 2004).

More 'problematic' leader within nurse group would be an authoritarian style leader. Though it is good and valuable personal feature, authoritarian leaders usually does not participate much in group work and make most of the decisions by themselves. Such leadership style is often misunderstood and mistaken for bad behavior rather than a type of personality; thus often bringing problems amongst colleagues as a its regarded as a bad way to working in a group (McNeese, 1993).

Remembering what was said before, it is known that this kind of leadership also has numbers of advantages, but again, considering the real status of the nurse and how it affects the atmosphere among colleagues it is often painted in negative colors. The next leadership style to be taken into account is earlier mentioned laissez - faire. Unfortunately, though such leadership style exists, it is not really possible to state that laissez-faire leadership style can appear in groups of nurses. Laissez - faire explains that leader in such group is more passive figure where other members can solve problems on their own, although leader still remains responsible for their work. In nursing field this phenomenon is uncommon because laissez - faire often is visible in groups where all members have the same status, so to speak - the leader must be the one who is the most active (by making decisions, by reaching his / her goals, etc.)

To leave institutions aside, we should discuss one of the most fundamental factors which bring job satisfaction to nurses. The needs of patient, plays major role in this particular discussion as it is seen by many studies carried by famous researchers and presented above. Without paying attention to specific leadership styles, every ward manager must treat their patient with professional care. That is their main goal, excluding all payment or job atmosphere questions (Lu, 2005). Good leader in would arrange his / her duties where the patient's needs would be a top priority and other duties would only complement them. However, leadership styles may have influence on patient, as nurses with strong autocratic leadership features may be not able to maintain positive relationships with their colleagues, so certain problems can appear this way. Shortly, nurses who possesses democratic, transformational and transactional leadership features provides better conditions for their patients, and satisfied patient brings satisfaction to the nurse (Lu, 2005). Basically, the satisfactory of patient suggests what leadership styles within nurses are most helpful to achieve their professional aims.

To sum up shortly, these are examples which explain that leadership occurs in every minor situation within each staff group, but there are numbers of factors to be taken into account. To study all these things, it would be beneficial to take some sort of example and try to use measurement tools to see how leadership style occurs in every specific example; does it bring positive or negative result and feedback from colleagues and patients (or employer) and also, how it affects the very individual, does it make the nurse happy about the job or not. Every different study of such cases can bring very interesting and different results.

Conclusion

Based on the research its clear that leadership occurs in nursing field in many different ways and sometimes we have in mind the nurses' direct employer as a leader, but in other cases it can be a colleague who has the same social and professional status, but personal features may signal trust and control of the situation. Sometimes leadership as phenomenon influences nurses' performance greatly. Effects of leadership may have strong or poor motivation in increasing the level of productivity of the employees in the organization. More so, working in a group with a leader is one of the crucial factors that can be used to measure the levels of job satisfaction. Another fundamental factor is the patient in that without providing the patient with professional care; no nurse can be fully satisfied with the job. Most notable conclusions which could be drawn after this discussion is that payment is far from being the priority which brings satisfaction for job, and usually it is more of moral and psychological elements that creates a good atmosphere and the possibility to be seen as reliable worker caring for patients. Although, there is no one general theory or measurement tool which can provide accurate answers when studying such field, basic elements always remain the same despite the time period or the place of work.

Research Question: What are Impacts of Leadership Styles Used by Healthcare Professionals on the Job Satisfaction of Nurses?