Journal of Nursing Management, 2011, 19, 1047–1057

Leadership and job satisfaction among Azorean hospital nurses:

an application of the situational leadership model

LUÍS CARLOS DO REGO FURTADO B N , M B A , M S c 1, MARIA DA GRAÇA CÂMARA BATISTA BA, MSc, PhD
2

and FRANCISCO JOSÉ FERREIRA SILVA B A , M S c , P h D 2

1
Registered Scrub Nurse, Central Operating Theatre, Divino Espı́rito Santo Hospital EPE and 2Assistant Professor,
Economics and Management Department, Azores University, Azores, Portugal

Correspondence C A R L O S D O R E G O F U R T A D O L . , D A G R A Ç A C Â M A R A B A T I S T A M . & J O S É F E R R E I R A S I L V A F . (2011)

Luı́s Carlos do Rego Furtado
Central Operating Theatre
Hospital do Divino Espı́rito Santo
de Ponta Delgada EPE
Grotinha
9500–370 Ponta Delgada
São Miguel Island (Azores)
Portugal
E-mail: furtado_luis@sapo.pt
Journal of Nursing Management 19, 1047–1057
Leadership and job satisfaction among Azorean hospital nurses: an application
of the situational leadership model
Aims The aim of this study was to describe nurse managersÕ leadership behaviours,
comparing them with staff nursesÕ perceptions of their leaderÕs leadership, as well as
to determine if leadership components affect job satisfaction among staff nurses.
Background Understanding the leadership phenomenon using a detailed theoretical
framework, such as the situational leadership model, allows for the deconstruction
of leadership into small segments, thereby producing a vast but detailed picture
of the process involved in leading people.
Method This quantitative, descriptive, inferential and correlational study involved
the participation of 266 nurses (managers and staff) from two public Portuguese
Azorean hospitals.
Instruments The Leadership Effectiveness and Adaptability Description question-
naire, developed by Hersey and Blanchard, was used to assess leadership behav-
iours. A job satisfaction instrument, developed by the authors, was also used to
determine staff nursesÕ satisfaction.
Results The study revealed important differences between nurse managers and staff
nurses regarding the perception of leadership components. Low levels of job satis-
faction among staff nurses were detected. It was also found that some leadership
components are related to staff nursesÕ satisfaction.
Conclusions Nurse managers must be aware of their leadership, applying appro-
priate styles, thereby developing their staff nursesÕ skills while promoting their
professional satisfaction.
Implications for nursing management Leadership is a complex process that is not
separable from job satisfaction. Promoting effective leadership through formal
training among nurse managers may translate into having more satisfied nurses,
better nursing care, and stronger leadership.
Keywords: job satisfaction, leadership, leadership behaviours, management, nursing

Accepted for publication: 1 May 2011

DOI: 10.1111/j.1365-2834.2011.01281.x
ª 2011 Blackwell Publishing Ltd 1047
L. Carlos Do Rego Furtado et al.
Introduction
Hospitals and health-care providers are adjusting to
environmental changes and redirecting their manage-
ment policies based on a new paradigm. Balsanelli and
Cunha (2006) contended that, despite rapid organiza-
tional and social transformations, technology still can-
not replace the need to guide people to achieve a
particular objective. Human capital remains the orga-
nizationÕs most valuable asset.
In Portugal, the health-care industry has lacked
leadership for several years, which has raised many
doubts about system sustainability and brought the
entire social security system to the brink of collapse. As
the largest professional group in the Portuguese health
system, nurses play a very important role in its man-
agement and, consequently, its efficiency.
According Tannenbaun et al. (1970) and Tannenb-
aun and Schmidt (1973), leadership is the interpersonal
influence exercised in a given situation through a pro-
cess of communication in order to reach a given goal.
Yura et al. (1981) argued that nursing leadership is the
process by which an individual (a nurse) influences the
actions of others in determining and pursuing objec-
tives, defining actions and planning in a dynamic sce-
nario. Bass (1999) argued that the leaderÕs charisma and
inspiration trigger employees to promote organizational
outcomes; in nursing, such leadership translates into
real health benefits for patients and in professional
satisfaction. In this context, nurses can motivate their
peers to engage in attitudinal and behavioural changes
that the Portuguese health system needs in order to get
back on track again. However, it must not be forgotten
that Portugal is experiencing a genuine social problem,
and condemning public health providers to failure will
put many citizens at great health risk, with all the
consequences that may stem from that.
Rice et al. (1985) sought to explain why individuals
differ in terms of work characteristics related to job
satisfaction, focusing on salary, promotion opportuni-
ties, management proximity and the degree of control
that the individual maintains over tasks. Despite the
recognition of the influence of individual characteristics
on expectations toward work and personal achieve-
ments, researchers generally agree that job satisfaction
can be achieved only through effective leadership.
Little research has been conducted by Portuguese
nurses, especially in the domains of leadership and job
satisfaction, despite the Portuguese Board of NursingÕs
recommendation for research on these particular topics.
No known studies on these matters have been con-
ducted in the Azores Islands; as a result, no concrete
1048
actions can be taken to promote staff nurse satisfaction
through effective leadership.
Background
This section is organized according to the two main
themes addressed in this article, namely, leadership and
job satisfaction, as well as the main core concepts of the
research.
The situational leadership model
Jesuı́no (2005) asserted that several definitions of lead-
ership exist, arguing that, in addition to the concept of
leadership, there should be an understanding of the
concepts of power and authority. Miguel et al. (2008)
defined leadership as a process whose essence lies in the
ability to influence subordinates in a non-unidirectional
way.
According to Hersey and Blanchard (2005), the
situational leadership model is based on the interplay of
three essential characteristics: (1) the level of guidance
or direction that the leader provides, (2) the level of
socio-emotional support provided by that same leader,
and (3) the subordinateÕs maturity level. One of the
main concepts of this model is maturity, which is the
degree of ability and willingness that subordinates show
to take responsibility for a specific task.
Hersey and Blanchard (2005) defined four basic lea-
dership styles in their model (S1, S2, S3 and S4), ranging
from Ôhigh task orientationÕ and Ôlow socio-emotional
supportÕ (leaders who demonstrate strong supervision
and control behaviours over their employees) to the
opposite end of the spectrum; this transition gradually
occurs as the employee acquires higher levels of matu-
rity. According to the authors, leadership style reflects a
leaderÕs pattern of behaviour in influencing others, al-
though the leaderÕs perception of that pattern may differ
from the perception of his or her subordinates. The
comparison between self-perception and othersÕ per-
ception is useful as it can translate the actual style of
leadership in terms of the degree of rapprochement
between these two perceptions. This theoretical model
also covers the concepts of versatility (leaderÕs capabil-
ity of switching between styles according to a specific
situation), range of style (number of different styles that
a leader can exhibit) and leadership adaptability (the
leaderÕs own capacity for changing style from a situ-
ation to another, but in an efficient way). Analysing
perceptionsÕ differences is very important and can be
graphically represented in the ÔJohari WindowÕ (Hersey
& Blanchard 2005). Little (2005) defined the four
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057
 Leadership and job satisfaction among Azorean nurses

quadrants of the Johari Window as public area, Core concepts

blind area, private area and unknown area. Using
Leadership style refers to a leaderÕs behavioural pattern,
the information from the different leadershipsÕ per-
which combines task behaviour and socio-emotional
ception and the Johari Window the researcher can
behaviour. The leader progresses from S1 (Ôdetermin-
define the gap between leadersÕ and followersÕ concept
ingÕ) through the intermediate styles S2 (ÔpersuadingÕ)
of leadership.
and S3 (ÔsharingÕ), finally arriving at S4 (ÔdelegatingÕ).
The expansion of the Johari Window is conditioned
This development occurs as the leader moves from
by feedback and demonstration effects. According to
strong oversight and low socio-emotional support to a
Galpin (1995) and Clayton (2008), the feedback pro-
stage in which tight supervision is maintained, but
cess corresponds to the degree to which individuals who
stronger relationship behaviours exist. In the third
interact with the leader are willing to share their per-
phase, supervision is significantly reduced as positive
ceptions as well as the extent to which the leader at-
reinforcement and rewards for good performance
tempts to understand the feedback contained in verbal
emerge. During the last stage, supervisory behaviours
and nonverbal communication. Demonstration is the
decline and default to relationship behaviour by leaders
extent to which the leader is willing to share informa-
in highly matured groups.
tion about him or herself with other members of the
A subordinateÕs maturity, according to Gates et al.
organization.
(1976), goes through a similar progression, from M1
(Ôlow maturityÕ) to M2 (Ômedium-low maturityÕ), fol-
Professional satisfaction lowed by M3 (Ômedium-high maturityÕ), and culminat-
ing in M4 (Ôhigh maturityÕ). During this progression,
All human behaviour is oriented to satisfying needs
different leadership styles are essential to the subordi-
(McGregor 1973). From birth to death, the individual is
nateÕs smooth adaptation to each development stage.
engaged in constant efforts to meet various needs, some
Hersey and Blanchard (1982) referred to leadership
complex and even conflicting. Oliveira (1999) indicated
versatility as the extent to which a leader can vary his
that satisfaction derives from a set of feelings, positive
or her leadership style and classified it into four cate-
or not, regarding with whom the work is done; that
gories: Ôwithout versatilityÕ (only one style of leader-
satisfaction typically refers to the attitudes of a single
ship), Ôweak versatilityÕ (two styles of leadership),
employee, but it may also be a general feeling of a group
Ômoderate versatilityÕ (three styles of leadership) and
of employees.
Ôstrong versatilityÕ (four styles of leadership). Hersey
According to Cavanagh (1992), nursesÕ job satis-
and Blanchard (1981) related leadership adaptability
faction is vital for health organizations. Job satisfac-
to the extent to which leaders are able to vary their
tion is an inherent feature of work and, as such, is
style appropriately in a specific situation; they classi-
valued in a very particular way; for nurses, job satis-
fied leadersÕ adaptability as either effective or ineffec-
faction is related to the physical, mental, and emo-
tive. Hersey and Blanchard (2005) further stated that a
tional effort needed to perform their tasks. Cavanagh
leadership profile is made up of a basic style (domi-
(1992) further stated that nursesÕ job satisfaction
nant) and a support style, resulting in six different
directly reflects the quality of care provided to the
profiles: S1–S2, S1–S3, S1–S4, S2–S3, S2–S4 and S3–S4.
patient. Meanwhile, Mrayyan (2006) found that nur-
These profiles are the result of the possible combina-
sesÕ positive job satisfaction relates to better care
tions between the primary, or dominant styles, and the
outcomes, organizational efficiency and reduced waste
alternative, or support, styles.
of skilled human capital.
Cortese (2007) argued that management practices
should be revised to promote nursesÕ job satisfaction The study
based on three key areas: (1) training, (2) the dynamics
Aims
of the organization and organizational culture, and (3)
research. No easy solutions exist to the question of how This study sought to determine the leadership styles of
to promote satisfaction among nurses, yet research in nurse managers according to their perceptions as well as
this area seems to agree on one thing: that employers staff nursesÕ perceptions of them. Another objective of
must ensure that these professionals carry out their the study was to determine the level of job satisfaction
business in a healthy environment and that their needs among nurse managers and staff nurses, comparing
and aspirations are met, resulting in improved perfor- them with each other. Finally, the study attempted
mance with consequent health gains. to verify whether the different components of the

ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057 1049
L. Carlos Do Rego Furtado et al.
situational leadership model have any impact on job
satisfaction of staff nurses.
Method
This quantitative study used descriptive, inferential
(Wilcoxon, Student t, and one-way A N O V A tests) and
correlational statistics to establish relations with a sta-
tistical value between perceptions of leadership and the
different levels of job satisfaction.
Hypothesis
According to Cervo and Bervian (2002), hypotheses are
developed to guide research by temporarily explaining a
phenomenon until facts are confirmed or refuted. The
assumptions reflect an attempt to preview the relation-
ship between two or more variables. The construction
of the hypotheses for the current study was based on the
literature, and the hypotheses are presented as follows.
• Hypotheses 1: self and othersÕ perception differ in
regard to:
(a) Dominant leadership styles
(b) Alternative leadership styles
• Hypotheses 2: self and othersÕ perceptions differ for
nurses who have worked in a unit for <1 year in re-
gard to:
(a) Dominant leadership styles
(b) Alternative leadership style
• Hypotheses 3: nurse managersÕ and staff nursesÕ scores
differ in regard to:
(a) Leadership versatility
(b) Leadership adaptability
Hypotheses 1, 2, and 3 are based on KleinmanÕs
(2004) work, which compared leadersÕ and followersÕ
perceptions of leadership behaviours. This study
implemented the same type of research, adjusting it to
reflect the leadership profile, versatility, and adaptabil-
ity. The work of Graeff (1997), Avolio and Bass (1999),
and Wehbe and Galvão (2005) is also reflected in these
hypotheses.
• Hypothesis 4: nurse managersÕ and staff nursesÕ job
satisfaction-related values differ
Hypothesis 4 is based on CavanaghÕs (1992) study.
Cavanagh (1992) argued that nurses with different
1050
work roles may have significantly different job satis-
faction levels. As head nurses have different roles from
their subordinates, this hypothesis aims to determine
whether any differences exist in the overall satisfaction
levels of these two groups.
• Hypothesis 5: staff nursesÕ job satisfaction is inde-
pendent from:
(a) Working in shifts
(b) Working overtime
Burke (2003) and Zeytinoglu et al. (2007) conducted
studies to determine the impact of personal experience,
organizational efficiency, and workload on nursesÕ job
satisfaction. This is the context from which Hypothesis
5 emerged.
• Hypothesis 6: staff nursesÕ job satisfaction is inde-
pendent from:
(a) Leadership profile perception
(b) Leadership versatility perception
(c) Leadership adaptability perception
Hypothesis 6 was based on the findings of Newman
et al. (2002) and Tallman (2007), which demonstrated
that staff nurses value their managersÕ leadership
behaviours, although these behaviours may or may not
promote their own job satisfaction.
Ethical considerations
Ethical approval was obtained.
Population and sampling
The study was conducted in two public hospitals in the
Azores (Portugal). These two health-care facilities em-
ploy a total of 720 registered nurses. The study popu-
lation did not include nurses who worked in operating
theatres and outpatient services, therefore, the target
population was 451 registered nurses.
The researchers distributed 451 questionnaires in the
two hospitals, collecting a total of 289 instruments. Of
these, 23 questionnaires were considered invalid because
they were not filled out completely. The final sample
included 266 nurses (22 nurse managers and 244 staff
nurses). The overall participation rate was 58.9%.
Instrumentation
The instrument developed to collect data for this study
was organized in three distinct sections: (1) demo-
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057

graphic and work-related questions, (2) leadership
effectiveness and adaptability description (LEAD), and
(3) job satisfaction. Because the LEAD instrument was
originally written in English, it was initially translated
by two different specialists; the two resulting transla-
tions were then blindly reviewed by a third specialist to
ensure that no decontextualization occurred and that
questions kept their intrinsic meaning.
Demographic and work-related questionnaire
This section of the questionnaire included the collection
of information regarding gender, age group, qualifica-
tions and professional category, weekly hours of
workload, and work arrangements (rotating schedule
and/or extra shifts) as well as information on the type of
employment contract.
Leadership effectiveness and adaptability description
instrument
This instrument was developed and validated by Her-
sey and Blanchard and has been broadly used all over
the world in several studies and translated into dif-
ferent languages, including Portuguese. Its results and
internal consistency do not raise any questions or
doubts. It has a strong theoretical support, developed
by the authors, and covers the aspects of self and peer
application. Using it and the proper grids for its
analysis and interpretation makes it possible to deter-
mine the style, profile, versatility and adaptability of
an individualÕs leadership. The instrument consists
of 12 questions; each one has four different scenarios
of response. The respondent must fit into the scene
and transpose it into his or her own reality, then
choose a response that reflects his/her behaviour or, if
evaluating superiors, choose a response that reflects
their behaviour.
Job satisfaction questionnaire
The instrument for determining job satisfaction
among nurses was developed and validated by the
authors after being applied in a small sample with
similar characteristics to the sample used in the final
application. The instrument consisted of 100 closed
questions with a Likert scale, where one corresponded
to total lack of job satisfaction and five to the max-
imum job satisfaction. The values obtainable by
applying the questionnaire could range between 0 and
100%. For operationalization purposes, the variable
for job satisfaction was arranged into groups: Ôno
satisfactionÕ (<50%), Ôlow satisfactionÕ (50–70%),
Ômoderate satisfactionÕ (70–85%) and Ôstrong satis-
factionÕ (‡85%).
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057
Leadership and job satisfaction among Azorean nurses
Data collection
Before the final implementation of the questionnaire,
the instrument was tested on a sample of 30 individuals
with similar characteristics to those in the final sample.
This procedure allowed the researchers to reformulate
some questions and structure the questionnaire as effi-
ciently as possible.
The average duration for completing the question-
naire was 40 minutes, which could have led to some
index of exhaustion among the respondents.
Each questionnaire was accompanied by an enve-
lope; researchers were responsible for collecting the
completed questionnaires at the end of the 2-week
period in which they were completed (May 1–15,
2010).
Data analysis
Analysing the collected data is essential to the success of
any research work. To ensure an effective statistical
analysis, the authors used the Statistical Package for the
Social Sciences 15.0 software (Azores University, Ponta
Delgada City, São Miguel Island, Azores - Portugal) for
Windows.
After checking for outliers and missing data, the
descriptive analysis was initiated using absolute and
relative frequencies, central tendency and dispersion
measures. The hypotheses were then tested according to
their statistical properties. To compare medians of the
two populations under study, the Wilcoxon non-
parametric test was used. The Student t-test and
one-way A N O V A were used as parametric tests. For the
application of parametric tests, the Ôjob satisfactionÕ
variable was verified for normality and homogeneity
using Kolmogorov–SmirnovÕs and LeveneÕs tests.
Results
The final sample consisted of 22 nurse managers and
244 staff nurses. The average head nurse is female,
nearly 47 years of age, with 26 years of professional
experience, including 12 years of experience in man-
agement and 8 years as the head of the current ward.
The average staff nurse is also a female, 31 years old,
with 7.5 years of professional experience and an aver-
age length of stay in the current ward of 5 years. Most
nurse managers have a degree in nursing and a spe-
cialization. Among the staff nurses, the clear predomi-
nance is a nursing degree as the base qualification. Head
nurses work, on average, 42 hours per week (2 hours
more than their employees); the overwhelming majority
1051
L. Carlos Do Rego Furtado et al.

of staff nurses work in shifts. An extensive diversity of translates nursesÕ job satisfaction. The individual values
employment contract situations exists, but most have a were recoded into a categorical variable, as previously
permanent and full-time link. stated (Table 2).
Head nurses were asked about the management Table 1
training they had received (Figure 1), and they reported Sample distribution according to the perception of the different situ-
an acceptable level of training in only two items (Ôper- ational leadership model components
formance evaluationÕ and Ônursing care managementÕ). Nurse managers Staff nurses
The remaining items indicated levels of around 50% Variables n (%) n (%)
and, in some cases, <50%. Slightly more than 9% of Leadership styles
nurse managers had no formal qualifications for the Dominant
post in which they worked. S1 1 (4.5) 42 (17.2)
S2 14 (63.6) 119 (48.8)
S3 7 (31.8) 48 (19.7)
Situational leadership model componentsÕ S4 – 16 (6.6)
No style – 19 (7.8)
perception Total 22 (100) 244 (100)
Alternative
A similar tendency existed between head nurses and S1 4 (18.2) 59 (24.2)
staff nurses regarding leadership components, particu- S2 8 (36.4) 74 (30.3)
larly regarding the most frequently mentioned domi- S3 10 (45.5) 77 (31.6)
S4 – 14 (5.7)
nant style (S2), alternative style (S3), profile (S2–S3), and No style – 20 (8.2)
versatility (moderate). In terms of adaptability, head Total 22 (100) 244 (100)
nurses tended to rate themselves as ÔeffectiveÕ whereas Leadership profiles
S1–S2 5 (22.7) 75(30.7)
their staff nurses tended to consider their leadershipÕs
S1–S3 – 12 (4.9)
adaptability as ÔineffectiveÕ (Table 1). S1–S4 – 10 (4.1)
The study also looked at the core competencies re- S2–S3 17 (77.3) 96 (39.3)
quired to be a head nurse and found a similar pattern S2–S4 – 7 (2.9)
S3–S4 – 11 (4.5)
between leaders and followers, although some differ- No style – 33 (13.5)
ences emerged between these two groupsÕ vision of what Total 22 (100) 244 (100)
is really important to lead a team of nurses and be the Leadership versatility
No versatility(1 style) – –
head of a hospital ward (Figure 2). The importance of Weak versatility (2 styles) 2 (9.1) 36 (14.8)
Ôinterpersonal abilitiesÕ showed a consensus between Moderate versatility (3 styles) 15 (68.2) 134 (54.9)
head nurses and staff nurses. However, a considerably Strong versatility (4 styles) 4 (22.7) 74 (30.3)
Total 22 (100) 244 (100)
large difference occurred related to ÔintegrityÕ and Ôspe-
Leadership adaptability
cific training in managementÕ; staff nurses rated these as Effectiveness
less important meaningful leadership attributes than Ineffective 2 (9.1) 24 (90.2)
head nurses did. Effective 20 (90.9) 220 (9.8)
Total 22 (100) 244 (100)

Perception of job satisfaction Staff nurse Nurse manager

Energy/Vitality 38.3%
22.7%
Preliminary data obtained from the questionnaires re- Stress tolerance 44.3%
31.8%
flect a determined percentage, from 0 to 100%, that Self-confidence 52.9%
50.0%
54.5%
Emotional maturity 59.1%
56.1%
Integrity 72.7%
Organizational structure/Administrative process 31.8% Achievament nedd 4.9%
0.0%
Material resources management 59.1% Low affiliation need 13.5%
0.0%
Personnel calculation and allocation 54.5%
Persuasion ability 13.5%
Recruitment and selection 45.5% 13.6%
84.8%
Staff integration 50.0% Interpersonal abilities
86.4%
Performance evaluation 95.5% Cognitive abilities 60.2%
45.5%
Nurse care management 72.7% 35.7%
Technical abilities 45.5%
Global quality management 40.9%
Management 52.0%
Internal auditing 4.5% specific trainning 72.7%
Without management training 9.1%

Figure 1 Figure 2
Sample distribution according to management training received by Sample distribution according to core competencies to be a head
head nurses. nurse.

1052 ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057
 Leadership and job satisfaction among Azorean nurses

Table 2 staff nurses would be different; this hypothesis was

Sample distribution according to job satisfaction
subjected to a Student t-test (Table 3).
Nurse managers Staff nurses The rejection of H0 supports H4: the average level of
Variables n (%) n (%) job satisfaction of head nurses was higher than that
Job satisfaction found among staff nurses (71.7% vs. 66.0%).
No satisfaction, <50% 1 (4.5) 9 (3.7) Hypothesis 5 (H5) was also subjected to a Student
Weak satisfaction, 50–70% 7 (31.8) 143 (58.6) t-test in order to verify whether a rotating schedule
Moderate satisfaction, 70–85% 13 (59.1) 88 (36.1)
Strong satisfaction, £ 86% 1 (4.5) 4 (1.6) or extra shifts affected job satisfaction among staff
Total 22 (100) 244 (100) nurses (Table 4).
The results clearly indicate that the considered inde-
pendent variables have no impact on staff nursesÕ job
Significant differences in job satisfaction were iden-
satisfaction. Therefore, H0 was not rejected in both
tified between head nurses and staff nurses. Head
scenarios.
nursesÕ average levels are higher than those of staff
Hypothesis 6 (H6), concerning the relationship be-
nurses. Their job satisfaction level was predominantly
tween situational leadershipÕs components and staff
Ômoderate,Õ followed by Ôlow,Õ while staff nursesÕ job
nursesÕ job satisfaction, breaks down into three subsets:
satisfaction tended to be Ôlow,Õ followed by Ômoderate.Õ
profile (a), versatility (b) and adaptability (c). The first
Some staff nurses reported Ôno satisfaction.Õ
two subsets were analysed using a one-way A N O V A test

Inferential analysis Table 4

Student t-test results to determine the influence of rotating schedule
Inferential analysis is intended to validate or reject the and extra shifts in staff nurseÕs job satisfaction
research hypotheses in order to provide consistency and
Hypothesis 5
robustness to the studyÕs findings. Several hypotheses
were subjected to statistical tests (parametric and non- Variables Mean (%) SD P Decision
parametric). In all cases, the null hypothesis (H0) was (a)
assumed to indicate the non-existence of a significant Rotating schedule
statistical relationship between the variables. No 64.5 10.3 0.340 Not reject H0
Yes 66.3 10.3
Hypotheses 1, 2, and 3 were tested using the Wilco- (b)
xon test. These hypotheses aimed to determine whether Extra shifts
head nursesÕ and staff nursesÕ perceptions regarding No 66.4 10.6 0.416 Not reject H0
Yes 65.3 9.8
situational leadership components were similar or not.
The test results indicated that, in the vast majority of H0, null hypothesis.
the wards, significant differences occurred between self
and othersÕ perceptions. The only exception was found Table 5
in staff nurses working in a specific ward for <1 year; in One-way A N O V A test results to determine the impact of leadershipÕs
such cases, perceptions tended to coincide. Thus, H0 profile and versatilityÕs perception in staff nurseÕs job satisfaction
was rejected in the majority of the tested cases. Hypothesis 6
In addition to aspects related to leadership, job sat-
Variables Mean (%) SD F P Decision
isfaction raised the drafting of research hypotheses.
Hypothesis 4 (H4) was based on the assumption that the (a)
Profile
average level of job satisfaction among head nurses and
S1–E2 63.6 10.3 7.400 0.000* Reject H0
S1–E3 61.4 11.3
Table 3 S1–E4 56.3 14.1
Student t-test results for the mean comparison of job satisfaction S2–E3 70.0 8.5
between nurse managers and staff nurses S2–E4 66.0 9.6
S3–E4 57.0 10.1
Hypothesis 4
(b)
Group Mean (%) SD P Decision Versatility
Weak 66.9 11.3 0.288 0.750 Not reject H0
Nurse managers 71.7 10.0 0.015* Reject H0 Moderate 66.2 10.3
Staff nurses 66.0 10.3 Strong 65.4 9.9

H0, null hypothesis. H0, null hypothesis.

*Significant at P < 0.05. *Significant at P < 0.05.

ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057 1053
L. Carlos Do Rego Furtado et al.

(Table 5), while the third was analyzed using a Student Discussion
t-test (Table 6).
The qualifications of head nurses are in accordance with
After running the one-way A N O V A test, it was deter-
the Portuguese Nursing BoardÕs (Available at: http://
mined that leadershipÕs profile seems to have an impact
www.ordemenfermeiros.pt, accessed 22 April 2010)
on staff nursesÕ job satisfaction. In other words, profile
recommendations. However, some management posi-
S2–S3 is associated with higher average values of job
tions are held by nurses appointed directly by the hos-
satisfaction when compared with other profiles. Thus,
pitalsÕ board of directors. When such appointments are
H0 was rejected. In subsets H6b and H6c, no statistically
not combined with management-specific training, pro-
significant relationships were found. Thus, H0 was not
cess failures in operational management can occur.
rejected in either situation.
Training for skills in this area is an investment that
complements the head nurseÕs academic degree and
Correlational analysis professional specialization.
A large investment in training was made in areas such
Some correlations were also established between staff
as performance evaluation and nursing care manage-
nursesÕ job satisfaction and certain variables using the
ment; however, significant deficits existed in other
Spearman coefficient (Table 7).
important areas necessary to the efficient functioning of
Using the correlation matrix, three associations were
health-care facilities, including recruitment, selection,
established, with positive signal and poor intensity,
personnel integration and organizational structure as
between the variables Ôjob satisfactionÕ and Ôage groups,Õ
well as administrative processes. The Portuguese
Ôtime in the professional categoryÕ and ÔleadershipÕs
Nursing Board (2010, Available at: http://www.orde
profile.Õ
menfermeiros.pt) issued a document identifying the
primary training and research needs among Portuguese
nurses. Although leadership was included, no reference
Table 6 was made about specific training for head nurses. As
Student t-test results to determine the influence of leadershipÕs
found in this study, other areas exist in which nurse
adaptability in staff nurseÕs job satisfaction
managers need training in order to ensure efficiency and
Hypothesis 6 promote satisfaction among staff nurses. Training can-
Adaptability Mean (%) SD P Decision not be separated from daily practice, and a strategic
(c)
formation plan should be drawn up between the pro-
Ineffective 64.6 11.8 0.464 Not reject H0 fessional regulation entity and the Portuguese Ministry
Effective 66.2 10.2 of Health.
Considering the requirements for becoming a nurse
H0, null hypothesis.
manager, as advocated by Frederico and Leitão (1999)
and Gaspar et al. (2000), failing to train these profes-
sionals in the necessary management and leadership
Table 7 skills is harmful to health organizations. Pereira (1997)
Correlation matrix results of Spearman test relating the dependent stated that, as health management is a serious matter, it
variable Ôjob satisfactionÕ with the independent variables Ôage
groupsÕ, Ôtime at current professional categoryÕ and Ôleadership must be performed by seasoned professionals and not
profileÕ by amateurs. Lambert (2003) added that leaders should
Correlation matrix
be permanent learners subjected to continuing educa-
tion programmes in order to develop their potential and
Job satisfaction 0.131 Age groups continuously improve their leadership skills (Munari &
0.041*
244 Bezerra 2004).
0.127 Time at current The prevalence of a strong supervision leadership
0.048* professional category behaviour (S2) in the sample, rather than a socio-
244
0.169 Leadership profile
emotional support behaviour, is not surprising as the
0.008** staff nurse group was relatively young and generally
244 inexperienced, thus needing closer supervision. How-
ever, this style is supported by alternative styles that do
Data sequence: coefficient significance and cases.
*Correlation has significance at P < 0.05. not focus entirely on supervision (S3) and seems ad-
**Correlation has significance if at P < 0.01. justed to staff nursesÕ maturity stage. This is reflected in

1054 ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057

the profile predominately identified by head nurses and
staff nurses (S2–S3), which will enhance employeesÕ
development through positive reinforcement. Shilling
(2007) argued that a perfect match should exist among
how the leader sees himself or herself, the reality of his
or her staff and the situation or context in which he or
she operates to promote behavioural adequacy rather
than the forced adaptation of behaviours. Leaders – in
this specific context, nurse managers – need to develop
strategies in order to acquire a real perception of their
leadership and to determine if this is shared by their
followers and, if not, why not. This is a most complex
exercise and comes only with time and experience
possible only with structured training programmes.
The hospital environment is open to constant change,
requiring head nurses (leaders) to have higher levels of
versatility in order to maximize efficiency. The results of
this study are similar to what is theoretically recom-
mended for hospitals, and the prevalence of a moder-
ately versatile leadership shows that versatility is not in
itself a potential concern. Being able to demonstrate a
relatively large spectrum of possible leadership styles is
a clear advantage in hospital settings, making it a very
interesting finding and a fact that is proved for Azorean
hospital nurse managers. Kosinska and Niebró (2003)
also observed that nurses must assume different roles
and adjust them to sudden and unexpected scenarios in
the environments in which they operate.
With regard to the effectiveness of leadership (adapt-
ability), an almost complete discrepancy emerged be-
tween the perceptions of head nurses and staff nurses.
Head nurses reported that their leadership adaptability
was effective whereas the staff nurses disagreed. This is a
potentially dangerous situation as, according to Jooste
(2004), head nurses are facing a paradigm shift in health
care that requires adaptation to new realities in order to
lead and influence those under their supervision. Without
a common vision, these paradigm shifts cannot produce
the desired results. Once again, differences between
perceptions are harmful to the cohesion and internal
structure of nursing teamsÕ. The nurse manager is the key
element of the team. When the nurse manager assumes
his or her leadership to be effective but followers perceive
the opposite, the seeds for a misunderstood and mis-
trusted leadership are sown, ultimately leading to failure.
This study also identified competencies considered
essential for being a nurse manager. The most fre-
quently referenced competencies were Ôinterpersonal
skills,Õ Ômanagement-specific trainingÕ and ÔintegrityÕ,
although head nurses attributed greater significance
to management training than did staff nurses. Accord-
ing to Jiang et al. (2008), head nurses, department
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057
Leadership and job satisfaction among Azorean nurses
directors, and top management must understand that a
range of essential behaviours and skills are needed to
perform operational management. Mentioning this is-
sue is not the same as recommending the removal of
those individuals who do not fit the ideal profile; rather,
managers need to reinforce the idea that training is
essential and a key element.
Inferential analysis concerning situational leadership
components (styles, versatility, and adaptability) re-
vealed a gap between the perceptions of the two groups.
This gap may result from distortions of the feedback
mechanisms. Strategies should be developed to enhance
the communication lines in order to maximize feedback
and expand the public area of the Johari Window.
Periodic team meetings to discuss what is effective, less
effective or bad in the ward should be organized every
2 weeks or, alternatively, during periods suitable for all
nursing team. Such discussion will enhance the feedback
mechanisms, resulting in a shared vision between both
head nurses and staff nurses.
These differences in leadership perception have al-
ready been studied and reported in the literature. For
example, Kleinman (2004) found discrepancies between
head nursesÕ self-perceptions and the perceptions of
those who interacted directly with them. Other studies,
such as those of Galvão et al. (1998) and Wehbe and
Galvão (2005), showed less pronounced differences
regarding only leadership styles; nevertheless, they sta-
ted that the two main key abilities a nurse manager
should hold are communication and organization when
defining priorities.
The only test that showed total agreement between
head nursesÕ self-perceptions and otherÕs perceptions
concerning dominant and alternative leadership styles
occurred when the staff nursesÕ sample was limited to
only those who had worked in a specific ward for
<1 year. This situation may have stemmed from the fact
that, during this short period, integration and sociali-
zation processes require greater proximity to the head
nurse, thereby enhancing mutual knowledge.
Other findings revealed average levels of job satis-
faction for head nurses and lower levels for staff nurses.
This situation can have an adverse impact on the care
provided to patients as lower levels of job satisfaction
can lead to feelings of emotional detachment from the
employer, resulting in a decreased quality of health
care. It was also verified that working in shifts and
working double shifts did not have a significant impact
on employee satisfaction, perhaps because these are
considered to be part of the job in nursing. Lower rates
of job satisfaction among staff nurses were described by
Curtis (2007) and Cortese (2007), who pointed out that
1055
L. Carlos Do Rego Furtado et al.
the lack of prospects for career development, relational
problems with other professional classes and the inter-
action with patients and their families were the major
causes. In Portugal, the lack of continuous professional
development may be one of the main reasons for dis-
satisfaction among staff nurses. The country is still
undergoing an important process of career definition
and regulation but nurses still feel that nothing concrete
is being achieved. Consequently, the feeling of impo-
tence and distrust in the future grows and may further
promote low job satisfaction.
Regarding the relationship between leadership com-
ponents and job satisfaction, only the leadershipÕs pro-
file, in particular, S2–S3, was statistically significant.
This may have resulted because of the fact that the vast
majority of individuals in the workplace have average
levels of maturity, requiring a profile that combines
average levels of task and relationship behaviours. This
is considered to be the Ôsafe profileÕ and appears to be a
promoter of job satisfaction. Cortese (2007) also de-
scribed this finding, showing that a leader can be a
strong satisfaction-promoter when he or she knows
how to use influence appropriately, combining follow-
ersÕ needs and leadership behaviours.
In the correlation analysis, the relationship between
job satisfaction and the Ôage groupÕ and Ôtime in the
professional categoryÕ variables may result from the fact
that, overall, older nurses occupy higher professional
categories, especially under the system of automatic
career progression (used in Portugal). As a result, they
receive higher salaries than their peers in earlier stages
of their careers. It should be no surprise that individuals
who have received promotions and salary increases and
who are near the top of their careers report higher levels
of job satisfaction when considering salary as the major
promoter of job satisfaction.
The correlation between the leadership profile and
job satisfaction makes sense because nursing requires a
high level of critical assessment and decision-making
skills at all stages of a patientÕs therapeutic process;
therefore, leadership styles that are based on socio-
emotional support behaviours and less on structure and
task supervision are more likely to enhance staff nursesÕ
satisfaction.
Job satisfaction, particularly among nurses and other
health-care professionals, cannot be solely explained by
high wages. Other variables, particularly those related
to the social recognition of the professional group or
even autonomy in making decisions in practice, are
often deemed to be important predictors for job satis-
faction among staff nurses (Cortese 2007). Further re-
search on this particular topic must be conducted.
1056
Conclusion
Understanding leadership and leadersÕ and followersÕ
perceptions of its dimensions, as well as its relationship
with job satisfaction, is important for operational,
middle and top management. This study determined the
need to invest in head nursesÕ training in order to im-
prove management efficiency in hospital wards.
Significant effort must be made to decrease the dif-
ferences between head nursesÕ self-perception and that
of their staff nurses so that a common language can be
shared within wards. This effort will only be possible
when hospital boards and all relevant forces that have
influence in regulating nursing practice in Portugal
realize that training is the key element for ensuring
strong and empowered leaders, with true and recog-
nized authority among their followers as well as legiti-
mate leaderships. As previously stated in this article,
most nurse managers have a specialized degree. For a
long time, nurses have returned to nursing schools to
earn specialized degrees just to achieve a management
position because such degrees were the main require-
ment for the position. However, this was the wrong
path. The Portuguese Nursing Board should try to dis-
sociate specialization from management, because nurse
specialists exist to provide specialized nursing care in
the various domains, and instead create a new special-
ization in management. This solution would solve the
lack of training among head nurses and give them
legitimate recognition by their followers while freeing
nursing specialists to provide specialized nursing care.
By reinforcing the importance of leadership in hos-
pitals, this study has demonstrated the strong impact of
the leaderÕs profile on their staffÕs satisfaction level.
Promoting leadership behaviours that enhance job sat-
isfaction among staff nurses will lead to improvements
in service quality and result in health gains for the
population. It will also improve efficiency during diffi-
cult times, such those faced by the Portuguese economy,
as well as the sustainability of the social security
systems.
Conflict of interest
The authors declare that there are no conflicts of
interests.
Source of funding
This research received no specific grant from
any funding agency in the public, commercial or
not-for-profit sectors.
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 1047–1057

Ethical approval
Ethical approval was obtained from the Ethic Com-
mittee of the hospitals where the study was held.
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