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ONTINUING
DUCATION SERIES

CE Objectives and Evaluation Form appear on page 186.

Elaine McGuire
Susan M. Kennerly

Nurse Managers as
Transformational and
Transactional Leaders
Executive Summary
In an era when nurse managers are both critical to and
responsible for retention and
performance, leadership style
is critical to achieve both outcomes.
Transformational leaders move
beyond the management of
transaction to motivate performance beyond expectations through the ability to
influence attitudes.
In a comparison of nurse manager and staff nurse assessments of leadership style,
nurse managers rated themselves as more transformational than their staff perceived.
Staff nurses who perceived
their manager as more transformational also demonstrated a higher organizational
commitment.
While transformational leaders are more effective, nurse
manager performance standards are often rooted in
transactional characteristics.
Nurse managers can be
taught transformational leadership skills including establishing clear expectations, creating a shared vision, and ultimately inspiring stronger
organizational commitment.

LEADERSHIP SKILLS and

abilities of nurse managers
have long been recognized
as making a critical contribution to the smooth operation of
inpatient units and the success of
acute care hospitals. Their leadership role is increasingly gaining
attention in relation to their contributions to staff attitudes and relationships. The first-line nurse manager is positioned in close proximity to the work itself and to the nursing staff engaged in patient care.
Thus, the way the manager implements the leadership role can have a
significant impact on the work environment and organizational commitment. The nurse manager who
positively influences the work environment and fosters the staffs organizational commitment stimulates
greater achievement at the unit level
and enhances the organizations
competitive advantage. Exactly how
this occurs and the nature of the
leadership behaviors exercised by
the nurse manager is not welldefined. This research clarifies the
link between the nurse managers
use of transformational and transactional leader behaviors and the
development of organizational commitment by registered nurse staff.
Many of the complex demands
faced by todays health care leaders
at the top of the organization are

HE

NURSING ECONOMIC$/July-August 2006/Vol. 24/No. 4

also present at the unit manager

level. As organizations grow, the
distance between the chief nursing
officer and the RN staff widens.
Nursing staff must increasingly
rely on the nurse managers clinical
expertise and leadership abilities,
making the leadership role of the
unit manager pivotal to unit performance. The falling dominoes
effect discovered by Bass,
Waldman, Avolio, and Bebb, (1987)
supports the notion that leadership
style and abilities cascade from one
level to another in an organization.
Acute care hospital nurse staffs
experience organizational and
unit-based benefits from the cascading effects of leadership at the
top. However, the unit-based nurse
managers close proximity to the
work of patient care and day-to-day
leadership intervenes in this transaction. This dual leadership influence raises questions about organizational commitment and the role
and placement of the leader. How
does organizational commitment
ELAINE McGUIRE, PhD, MBA, RN, CNAABC, is Vice President, Patient Care
Services, and Chief Nursing Officer,
TriHealth, Cincinnati, OH.
SUSAN M. KENNERLY, PhD, RN, is an
Associate Professor, College of Nursing,
University of Cincinnati, Cincinnati, OH.

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develop? Where is the leader best

positioned in the organization to
have an optimal impact on RN staff
commitment? What is the influence of nurse managers transformational and transactional leadership behaviors on the degree of
organizational commitment held
by staff?

Review of Literature
Most of the research conducted
to date has focused on the role of
nurse leaders in upper-level positions in the health care organization (McDaniel & Wolf, 1992;
Stordeur, Vandenberghe, & Dhoore,
2000). A decrease in the availability of RNs needed to sustain and
replenish the current workforce
has triggered a new look at the
nurse leaders role throughout the
organization. Most recently, the
role of nurse managers and executives has been re-examined to better understand which leader is best
positioned in the organization to
exert the most positive influence
on nursing staff relationships
(Ohman, 1999).
Organizations turn to the
leader for solutions to workforce
and other resource issues that will
help the organization achieve and
maintain a competitive advantage.
Nursings current interests in organizational leadership are focused
on recruiting, retaining, and motivating staff and ensuring patient
safety. The nurse leaders role is
pivotal to achieving these outcomes and to rebuilding the trust
and respect that staff must have in
managers at all levels of the organization (Laschinger & Finegan,
2005). Maintaining a positive work
environment and building a team
effort are key to achieving patient
safety (Institute of Medicine, 2004).
Positive health care work environments must be in place to attract
and retain staff (Walters, 2005). The
current shortage of RNs at the bedside magnifies the importance of
having strong, clear, supportive,
and inspirational leadership across
the health care organization.
The interdependence of man-

180

Nurse Managers as Transformational and Transactional Leaders

agerial leadership and staff organizational commitment has been

documented in the literature since
as early as the mid-1950s. The
exact nature of this interdependence is still not well understood
even though it has been studied
from a variety of perspectives in
industry, education, and health
care situations. As more has been
learned about the characteristics of
leadership, leadership theory has
evolved from Trait Theory in the
1930s to the Contingency and
Situational Theories of the 1960s
and to Transformational Theory in
the 1980s. The early work of Burns
(1978), Bennis and Nanus (1985),
and Bass (1985) stimulated interest
in the concepts of transformational
and transactional leadership and
the relationship that emerges
between leader and follower. The
theory of Transformational and
Transactional Leadership (Bass,
1985) offers a framework through
which managers can further develop their own knowledge and abilities about leading others and provides the model needed for shaping staff commitment and the work
environment.
Bass Model of the Full Range
of Leadership (1998) implies that
all leaders display both transformational and transactional characteristics, only in differing amounts.
Transformational leaders use
ideals, inspiration, intellectual
stimulation, and individual consideration to influence the behaviors and attitudes of others (Bass &
Avolio, 2000). Hater and Bass
(1988) were intrigued with the
potential impact such a leader
could have on the competitive
positioning of the organization.
The ability of transformational
leaders to move followers beyond
their own self-interest was particularly noteworthy in their study of
54 top-performing managers.
Transformational leaders stimulated follower commitment to a
shared vision and goals. Followers
were stimulated to approach old
problems in new ways. Followers
were especially influenced by

leaders who were admired and

trusted and expended specific
effort to meet the followers needs
and wants.
Figure 1 depicts the relationship that develops between follower and organization when a particular leadership style predominates
(McGuire, 2003). For example,
when a transformational leader
demonstrates charismatic behaviors and uses inspirational motivation to persuade others, that leader
is also capable of rousing followers
to exert additional effort on behalf
of the organization (Bass, 1985).
The followers positive sense of
self-worth and value leads to
enhanced job satisfaction, job performance, and organizational commitment. Leaders who can provide
intellectual stimulation can engage
followers in more creative problem
solving and out of the box thinking to produce results that are more
likely to provide the organization a
competitive advantage. When
transactional components are predominantly used in leading individuals, followers are more likely
to engage in behaviors that fulfill
contract requirements and place
limits on organizational commitment and job satisfaction such that
the status quo is maintained.
Unlike transformational leadership, transactional leadership is a
style of leadership focused on contingent reward of followers. The
transactional leader sets goals,
gives directions, and uses rewards
to reinforce employee behaviors
associated with meeting or exceeding established goals. Transactional
leaders emphasize process in setting goals and giving directions and
strive to compromise, manipulate,
and control the situation and followers. According to Bass (1985),
the rewards used by the transactional leader include praise and
recognition, merit increases, promotions, bonuses, or honors. These
rewards can be given or withheld
according to employee performance. The ultimate outcome of
such contingent reward behavior is
enhanced role clarity, job satisfac-

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Nurse Managers as Transformational and Transactional Leaders

Figure 1.
The Relationship Between Primary Leadership Style and Organizational Outcome

Leader

Follower
Behaviors

Charismatic
Inspirational
motivation
Intellectual stimulation
Individualized
consideration

Shared vision
Increased self-worth/
self-esteem
Challenging/
meaningful work
Coached/mentored
Feels valued

Transactional
Leadership

Contingent reward
Management-byexception (active)
Management-byexception (passive)

Fulfills the contract

I work/you pay me
Errors are corrected
reactive/retrospective

Laissez-faire
Leadership

A non-transaction

Nothing happens
No followers because
there is no leader

Transformational
Leadership

Organizational Outcome

Results in a Competitive
Advantage

Increased loyalty
Increased organizational
commitment
Increased job satisfaction
Increased morale
Increased job performance

Maintains the
Status Quo

Work is supervised and

completed according to
specifications
Deadlines are met
Limited job satisfaction for
employees
Low to stable levels of
organizational commitment

Contributes to
Organizational Demise

No decisions made
Responsibilities ignored
No purposeful interactions

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tion, and improved performance.

Laissez faire leadership, as
reflected in Figure 1, indicates an
absence of leadership. When this
leadership style is used, literally
nothing happens. Decisions are not
made, actions are not carried out,
and responsibilities are ignored
(Bass, 1998). There is no significant
purposeful interaction between the
leader and employees, so a group
of followers does not form. Laissez
faire leadership is ineffective in
promoting purposeful interaction
and contributes to the organizations
demise.
The effective leader achieves a
balance between transformational
and transactional behaviors, thus
creating a leadership style that
matches the needs of followers.
The leader can then help followers
to realize greater individual and
organizational achievements (Bass,
1998). Followers who feel more
self-confident and involved, have a
sense of belonging, and share a
common sense of direction tend to
emerge as committed and loyal
employees of the organization. The
strength or degree of this commitment is reflected by a strong value
in and acceptance of the organizations goals and values. There is a
readiness to expend considerable
effort on behalf of the organization
and a strong desire to remain a
member of the organization.

Purpose
The purpose of this study was
to explore the transformational and
transactional leadership characteristics of nurse managers in relation
to the organizational commitment
of RNs working on their respective
unit(s). Each managers predominant leadership style was self-identified and then re-examined in contrast to staffs perceptions of the
leadership style used.

Research Questions
1. What is the relationship between the nurse managers selfassessment and the RNs
assessment of the manager as it
relates to transformational and

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Nurse Managers as Transformational and Transactional Leaders

transactional leadership characteristics?

2. What is the relationship
between the RNs perception of
the nurse managers transformational and transactional
leadership characteristics and
the degree of organizational
commitment demonstrated by
the same RNs?
3. What is the relationship between the self-assessed transformational and transactional
leadership characteristics of
the nurse manager and the
degree of organizational commitment demonstrated by the
RNs reporting to that nurse
manager?
This descriptive correlational
study examined the relationship
between two key variables: the
leadership style of nurse managers
and the organizational commitment of staff nurses. Similarities and
differences in nurse manager and
staff nurse perceptions of leadership characteristics were also
explored.

tion. The sample was predominantly female (94%) and between

the ages of 36 and 55. The managerial experience of the group
showed a wider variation ranging
from as few as 6 months to as long
as 33 years. The majority of nurse
managers (76%) held either a baccalaureate or masters degree in
nursing. Over half (59%) of the
nurse managers had operational
responsibility for more than one
nursing unit and supervised an
average of 64 employees. The nurse
managers often managed multiple
specialty areas and multiple cost
centers.
The staff nurse sample consisted of 500 RNs who had worked at
least 6 months on their current
nursing unit. Similarly, this sample
was predominantly female (94%)
with more than two-thirds of the
staff nurses between 36 and 55
years of age. Unlike the nurse manager sample, the majority of the
staff nurses (57%) held either a
diploma or associate degree in
nursing. Seventy-percent worked
on the day shift generally in fulltime (68%) positions.

Sample

Data Collection

The chief nursing officers of 21

not-for-profit hospitals with greater
than 150 beds located in the
Midwest region of the country
were contacted to obtain permission to include nurse managers of
their respective acute care nursing
units in the study. Eleven of the 21
eligible hospitals agreed to participate. A convenience sample comprised 63 nurse managers who had
been in their current position for at
least 6 months. Each manager had
24-hour accountability and directed, planned, coordinated, and controlled the operational activities
and personnel for one or more
patient care areas. For a nurse manager to be a participant in this
research, at least 5 of their 15 or
more direct-report RN staff also
had to agree to participate.
The nurse manager samples
demographic characteristics reflected the general nursing popula-

The chief nursing officers of 21

nonprofit hospitals were provided
an abstract of the proposed study
and a letter requesting their hospitals participation. Once each chief
nurse agreed that the study could
be conducted in their hospital all
requirements of the respective
facilitys institutional review board
were met prior to data collection at
11 participating hospitals. The data
collection period extended over 4
months.
Local meetings were held with
nurse managers to ask them to participate and to invite their staff
nurses to do likewise. To become
an actual study participant a nurse
manager also had to have a minimum of five staff nurses participating in this study. Of the 119 nurse
managers originally agreeing to
join the study, only 63 (53%) met
the staff nurse participation
requirement.

Methodology

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All materials, such as cover letters, demographic forms, and questionnaires were prepared in
advance of site meetings and distributed to the nurse managers.
Similar packets were also given to
the nurse managers for distribution
to their staff nurses who agreed to
participate. Each study participant
received a cover letter that provided an overview of the study,
including the risks and benefits of
participation
and
provisions
regarding confidentiality and
anonymity. Completion and return
of the survey questionnaire indicated consent to participate. A coding
system was employed to preserve
anonymity and permit the grouping of data in the aggregate.

Measurement Instruments
All participants completed a
demographic form that included
specific questions related to work
and organizational factors. The
Multifactor Leadership Questionnaire (MLQ) Form 5X (Bass &
Avolio, 2000) was used to measure
transformational and transactional
leadership characteristics. This 45item questionnaire with 12 subscales uses a frequency rating with
scoring that ranges, for this study,
from 1 (not at all) to 5 (frequently, if
not always). Prior confirmatory factor analysis, the goodness of fit
index, and reliability scores (Bass &
Avolio, 2000) indicated that the
MLQ is both a reliable and valid
instrument for measuring transformational and transactional leadership characteristics. When scored,
the resulting values indicate the
leadership characteristics most frequently used and the predominant
leadership style. Two versions of
the MLQ were used in this study.
The leader form was completed by
the nurse managers as a self-assessment, while the staff nurses used
the rater form to assess the leadership characteristics of their managers.
The organizational commitment of the staff nurse participants
was measured using the Organizational Commitment Questionnaire

(OCQ) developed by Porter and

Smith (Mowday, Steers, & Porter,
1979). The OCQ is a 15-item, easyto-complete survey that uses a
seven-point Likert-like response
scale (strongly disagree to strongly
agree) (Cook, Hepworth, Wall, &
Warr, 1989). A higher score indicates greater organizational commitment. Internal consistency reliability, test-retest reliability, convergent validity, discriminant
validity, and predictive validity
support the OCQ as a reliable and
valid tool. Reliability scores generally ranged from 0.82 to 0.93
(Mowday et al., 1979).

Findings and Results

Research Question 1. This
research question addressed the
relationship between the nurse
managers self-assessed leadership
characteristics and the staff nurses
assessment of their managers leadership characteristics. Table 1 presents the descriptive statistics for
the MLQ by group. As might be
expected, nurse managers rated
themselves higher on transformational leadership than did their
staff nurses. Managers mean
scores on the MLQs transformational subscales ranged from 3.89
to 4.28, indicating their self-perceptions of being highly transformational. Conversely, staff nurses
rated their managers to be somewhat more transactional than did
the managers themselves. It should
be acknowledged, however, that
this type of self-report bias is
known to sometimes occur in correlational studies.
Findings suggest that nurse
managers may struggle somewhat
with the concept of transformational leadership. Also, the work
environment itself may affect the
nurse managers ability to fully
exercise transformational leadership behaviors. Hospitals and
health care organizations, by
nature, tend to be bureaucratic
organizations where transformational leadership may not be fostered to the greatest degree possible.
Philosophically, nurse managers

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may be strong proponents of

Transformational Leadership Theory,
but are unable to demonstrate such
leadership characteristics in actual
practice. If an organization rewards
managers for performance measures of a transactional nature,
such as productivity, cost management, and policy compliance, there
is little, if any, motivation for exerting the efforts necessary to develop
transformational characteristics.
Conducting research in highly
structured military settings led
Masi and Cooke (2000) to similar
conclusions. Their research indicated that the cultural climate
found in bureaucracies may inhibit
leadership style from influencing
unit-level norms (Masi & Cooke,
2000).
Research Question 2. Significant correlations, ranging from
r = 0.393 to -0.202 (p<0.01), were
found between the staff nurses
scores on the MLQ and the OCQ.
All subscales on the MLQ demonstrated statistically significant correlations except for the transactional subscale labeled managementby-exception (active). These results
were consistent with Transformational
Leadership Theory except for the
positive correlation (r=0.370) between contingent reward, a transactional characteristic, and organizational commitment.
Idealized influence, also called
charismatic leadership, was the
transformational leadership characteristic to show the strongest positive correlation (r=0.393, p<0.01)
with organizational commitment.
Such leaders are admired and
respected by their followers, and
above all are trusted by others
(Bass, 1998). Staff nurses are more
likely to respond favorably to role
models that demonstrate integrity
and strong ethical and moral values. Nurses are also more likely to
commit to organizations that
espouse similar values and have
exhibited these values in actions
and not just words. Contingent
reward was noted in a similar fashion in other research studies
(Ohman, 2000; Stordeur, Dhoore, &

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Nurse Managers as Transformational and Transactional Leaders

Table 1.
Descriptive Statistics for Measurement Instruments by Group
Nurse Manager Group (n=63)
Instrument

Staff Nurse Group (n=500)

SD

Range *

SD

Range *

Idealized Influence (A)

3.89

0.59

1.00-4.75

2.90

0.72

0.75-3.75

Idealized Influence (B)

4.12

0.55

2.50-5.00

3.73

0.91

0.50-5.00

Inspirational Motivation

4.13

0.53

2.25-5.00

3.97

0.87

0.75-5.00

Intellectual Stimulation

4.12

0.53

2.25-5.00

3.47

0.99

0.75-5.00

Individualized Consideration

4.28

0.44

3.00-5.00

3.58

1.06

0.00-5.00

Contingent Reward

3.92

0.44

2.75-5.00

3.73

0.99

0.75-5.00

Management-by-Exception (A)

2.67

0.62

1.25-4.25

2.87

0.93

0.50-5.00

Management-by-Exception (P)

2.01

0.58

1.00-3.25

2.14

0.92

0.00-5.00

Laissez-faire

1.80

0.63

1.00-3.25

1.80

0.86

0.50-4.75

Extra Effort

3.86

0.64

1.00-5.00

3.61

1.17

0.00-5.00

Effectiveness

4.13

0.47

2.50-5.00

3.87

1.03

0.00-5.00

Satisfaction

4.18

0.56

1.50-5.00

3.97

1.09

0.00-5.00

MLQ Total Score

160.13

11.88

119.0-180.0

150.98

26.93

63.0-198.0

MLQ Transformational Subscales:

MLQ Transactional Subscales:

Additional Subscales:

* Possible range of scores = 1 (lowest) 5 (highest)

Vandenberghe, 2001; Stordeur et

al., 2000). Given the current emphasis health care organizations
place on rewards and recognition
as a means for retaining staff nurses, it is not surprising that contingent reward would be positively
correlated with staff nurse organizational commitment.
Research Question 3. Pearsons
product-moment correlation revealed no significant correlation
between the nurse managers selfassessed leadership characteristics
and the degree of organizational
commitment demonstrated by their
staff nurses. Although some transformational characteristics, notably
inspirational motivation and intellectual stimulation, showed statistically significant (p<0.05) results,
the correlations were too weak to
draw any inferences (r = 0.0306
and 0.0133 respectively).
This lack of correlation supports the concept that although
some managers may believe them-

184

selves to demonstrate certain leadership characteristics, if this belief

is not shared by their staff nurses, a
difference in perception occurs.
This disparity may result from a
number of things, including role
differences, past work experiences,
and previous interactions with
other management personnel.
Such findings might suggest
that when leadership characteristics are identified through selfassessment versus observation, little can be deduced from this selfexamination as it relates to organizational commitment of others.
Perceptions of ones own managerial strengths, talents, or in this
case, leadership characteristics,
may have little or no relationship
to the behaviors demonstrated by
those who are direct reports.
Although the correlations were
too weak to draw any substantive
conclusions, the positive direction
of the correlation between inspirational motivation and organiza-

tional commitment is in keeping

with Transformational Leadership
Theory. Followers tend to be drawn
to leaders who are naturally enthusiastic, optimistic, and can envision a more attractive future state
(Bass, 1998).
Intellectual stimulation showed
statistically significant results but
was negatively correlated with staff
nurse organizational commitment
(r = -0.111, p<0.01). This finding is
not in keeping with Transformational Leadership Theory. The
leader who possesses this leadership characteristic would likely
challenge direct reports to think
out of the box, and to use creative
problem-solving techniques when
confronted with the need to find
solutions (Bass, 1998). Given the
hectic pace found on most nursing
units today, nurse managers may be
forced to move from problem to
problem with little time for identifying long-term solutions. This scenario may suggest that nurse man-

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Nurse Managers as Transformational and Transactional Leaders

agers have become more adept at

putting out fires on their own
rather than engaging staff in reframing questions and approaching
problems from a new perspective.

Nursing Management Implications

Performance standards for
nurse managers require them to be
accountable for transactional
processes such as budgets, productivity, and quality monitoring,
while at the same time displaying
transformational characteristics by
acting as coach, mentor, and leader.
On the best of days, these job
expectations are challenging for
even the most experienced nurse
managers. To maintain stability in
an uncertain health care environment, nurse managers who can
effectively handle the transformational/transactional duality of their
role are vitally important to the
smooth operation of any nursing
unit. Since transformational leadership characteristics can be taught
and learned (Bass, 1998), organizations have a significant opportunity to develop the type of leaders
who can positively interact with
first-line employees. Nurse executives must be advocates for leadership education that emphasizes the
four main components of transformational leadership to provide
nurse managers with a solid foundation for professional growth and
development.
Nurse managers can be taught
how to establish clear expectations
and how to challenge staff in a
meaningful fashion. By creating a
shared vision for the nursing unit,
staff nurses become committed to
pursuing common goals and interests. Staff nurses will follow the
leadership of nurse managers who
can inspire and motivate them to
perform beyond basic expectations
and can engender a sense of team
spirit across the nursing unit on all
shifts.
Nurse manager job responsibilities have traditionally included
directing, planning, coordinating,
and controlling the activities and
personnel on one or more nursing

units. However, todays hospital

environment calls for managers
who have the ability and desire to
coach and mentor staff (Shiparski,
2005). Transformational leaders
prefer to coach staff rather than
control their behaviors (Bass,
1998). In doing so, they create a
supportive climate where individual differences are recognized,
two-way communication is promoted, and effective listening
skills are valued (Bass, 1998).
Nurse executives can play a significant role in guiding and supporting nurse managers as their coaching skills develop and mature.
This studys findings validate
that transformational nurse leaders
promote a higher sense of commitment in their followers. To develop
a committed nursing staff, nurse
executives should develop, promote, and hire individuals into
nurse manager positions who
demonstrate a balance of leadership characteristics which are
more transformational than transactional. Employing charismatic
nurse managers who have high
ethical and moral character and
integrity and exhibit risk-taking
behaviors is an absolute plus at a
time when corporate compliance,
conflict of interest, and unethical
business practices are scrutinized
closely. Nurse executives who
recruit and retain a committed
workforce bring a competitive
advantage to their organizations,
foster a healthier work environment, and gain a personal sense of
accomplishment and success. $
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