Journal of Nursing Management, 2016

Is nurse managers’ leadership style related to Japanese staff

nurses’ affective commitment to their hospital?

YOSHIMI KODAMA R N , M S N 1, HIROKI FUKAHORI RN, PhD

2
, KANA SATO RN, PhD
3
and
TOMOKO NISHIDA R N , P h D 4
1
PhD Student, Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo
Medical and Dental University, Tokyo, 2Associate Professor, Department of System Management in Nursing, Graduate
School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, 3Associate Professor, Graduate School
of Nursing, Miyagi University, Sendai and 4Associate Professor, Japanese Red Cross College of Nursing, Tokyo, Japan

Correspondence KODAMA Y., FUKAHORI H., SATO K. & NISHIDA T.

(2016) Journal of Nursing Management
Yoshimi Kodama Is nurse managers’ leadership style related to Japanese staff nurses’
1-5-45 Yushima affective commitment to their hospital?
Bunkyo-ku
Tokyo 113-8519 Aim To determine if nurse managers’ leadership style is related to Japanese staff
Japan nurses’ affective commitment to their hospital.
E-mail: kodama.y.kanr@tmd.ac.jp Background In Western countries, nurse managers’ transformational leadership
style has been found to increase staff nurses’ affective commitment to their
hospital. However, there are few studies examining this relationship in the
context of acute care hospitals in Japan.
Methods Staff nurses completed measures of their nurse managers’ perceived
leadership style and factors related to their own affective commitment. The
association between affective commitment and perception of leadership style was
assessed with multiple logistic regression.
Results Of 736 questionnaires distributed, 579 (78.9%) were returned, and data
from 396 (53.8%) fully completed questionnaires were analysed. The intellectual
stimulation aspect of transformational leadership positively increased staff nurses’
affective commitment (odds ratio: 2.23). Nurse managers’ transactional and
laissez-faire leadership styles were not related to affective commitment among
staff nurses.
Conclusions The intellectual stimulation aspect of transformational leadership
may increase the retention of staff nurses through enhanced affective
commitment.
Implications for nursing management To increase staff nurses’ affective
commitment to their hospital, we suggest that hospital administrators equip nurse
managers with intellectual stimulation skills.
Keywords: affective commitment, leadership, nurse manager, transactional leadership,
transformational leadership

Accepted for publication: 20 March 2016

2012, American Association of Colleges of Nursing

Introduction
2014). The International Council of Nurses (2006)
In recent years, a nurse shortage has been experienced indicated two main reasons for this shortage: a high
worldwide (Canadian Federation of Nurses Unions turnover rate due to poor work environments and

DOI: 10.1111/jonm.12392
ª 2016 John Wiley & Sons Ltd 1
Y. Kodama et al.
burnout (Chan et al. 2013), and low recruitment due
to an ageing workforce, the shortage of a financial
source for new recruits into the profession and diversi-
fication of career selection among women (Interna-
tional Council of Nurses 2006, World Health
Organization 2013). The high turnover rate of nurses
should be addressed in order to maintain a high qual-
ity of nursing care in clinical settings despite the nurse
shortage worldwide.
A key factor in the strategy for preventing turnover
is the employees’ affective commitment to their organ-
isation, which is defined by Meyer and Allen (1991)
as ‘the employees’ emotional attachment to, identifica-
tion with, and involvement in the organisation’ (p.
67). After finding that a high level of affective com-
mitment is related to high employee retention, Meyer
et al. (2002) explored the factors that influence this
variable and discussed strategies to increase affective
commitment to the organisation. The superior’s
high-quality leadership was identified as one of the
influential factors (Meyer et al. 2002). Similarly, the
high-quality leadership skill of nurse managers
affected the increasing affective commitment of staff
nurses (Cummings et al. 2010, Cowden et al. 2011).
Therefore, developing nurse managers’ leadership
skills is important for strengthening affective commit-
ment and improving the work environment.
Bass and Riggio’s Full Range of Leadership Model
(2006) comprises three styles of leadership. Transfor-
mational leadership involves managers motivating fol-
lowers to exceed expectations, and inducing high
levels of follower satisfaction and commitment within
the group and the organisation. Transactional leader-
ship involves the leader rewarding or disciplining a
follower, depending on the adequacy of the follower’s
performance in carrying out a task or achieving an
agreed objective. Finally, laissez-faire leadership hap-
pens when ‘the necessary decisions are not made [and]
actions are delayed’ (Bass & Riggio 2006, p. 9).
Among these styles, transformational leadership is
thought to be the most effective way to increase affec-
tive commitment among employees (Bamberg et al.
2008). Previous studies (Loke 2001, Avolio & Bass
2004, Al-Hussami 2008) focused on nursing staff have
shown that nurse managers’ transformational leader-
ship is a positive predictor of staff nurses’ affective
commitment.
Research into the relationship between nurse man-
agers’ leadership and staff nurses’ affective commit-
ment is required in an Asian cultural context, because
most previous research, with the exception of a study
conducted in Singapore (Loke 2001), has been
2 Journal of Nursing Management
conducted in Western countries (Cummings et al.
2010, Germain & Cummings 2010). We believe that
the results of studies conducted in Western countries
may not be applicable to Asian countries, including
Japan, because of differing cultural contexts. Some
studies on leadership have indicated that the cultural
context affects the leadership style (Dorfman et al.
1997, Den Hartog et al. 1999); for example, Asian
leaders tend to emphasise group harmony, which is
associated with collectivism, while Western leaders
focus on values associated with individualism (Dorf-
man et al. 1997, Den Hartog et al. 1999). Further-
more, nurse managers in Japan have less authority than
do those in Western countries (Oku et al. 2010, Yoder-
Wise 2011). Additionally, it is unclear which aspects of
the nurse managers’ leadership, based on Bass and Rig-
gio’s (2006) theory, are the most effective in increasing
staff nurses’ affective commitment. No studies have
examined the relationships among the components of
Bass and Riggio’s (2006) three leadership styles and
staff nurses’ affective commitment. Al-Hussami (2008)
examined the relationship between transformational
leadership and affective commitment, and between
transactional leadership and affective commitment, but
did not explore the relationships among the compo-
nents of each leadership style and the staff nurses’
affective commitment. Identifying which leadership
style has the greatest influence on staff nurses’ affective
commitment will help hospital administrators to
develop strategies to prevent turnover.
Aim
The purpose of this study was to determine if nurse
managers’ leadership style is related to Japanese staff
nurses’ affective commitment to their hospital.
Methods
Design and participants
This cross-sectional survey was conducted at four
mid-sized acute care hospitals, with around 300 beds
each, in Kanto, Japan, which were selected using con-
venience sampling. We contacted the nurse directors
and explained our aim and procedure to those who
were interested in the study; four nurse directors sub-
sequently agreed to participate, and through them, we
gained access to the staff nurses. Novice and part-time
nurses were excluded from this study, as they were
still undergoing training and/or had little contact with
the nurse managers.
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Data collection
The data were collected between July and August
2012 using a self-administered questionnaire dis-
tributed to 736 staff nurses, along with a cover letter
explaining the purpose and procedures of the study
and stating that participation was voluntary and
anonymous. A response rate of 78.9% was obtained,
with 579 questionnaires returned. Of these, 183 were
excluded due to missing data; consequently, we anal-
ysed data from 396 (53.8%) participants. Return of
the questionnaire was regarded as providing informed
consent to participate in the study.
Ethical considerations
The Internal Review Board of Tokyo Medical and
Dental University approved this study (1242), which
was carried out in accordance with the Code of Ethics
of the World Medical Association (Declaration of
Helsinki 2013).
Conceptual framework
We referred to Meyer and Allen’s three-component
model (1991) and Bass and Riggio’s (2006) theory to
develop a conceptual framework for this study. Meyer
and Allen (1991) proposed a three-component model
of organisational commitment, comprising affective,
continuance and normative types of commitment.
Among these components, we adopted affective com-
mitment alone for our conceptual model because it
has been found to be associated with better staff
retention (Meyer & Allen 1991, Meyer et al. 2002).
Our conceptual model had four components,
namely, ‘affective commitment of staff nurses’ as the
dependent variable, ‘leadership style of nurse man-
agers’ as the independent variable and ‘factors related
to the affective commitment of staff nurses’ and ‘de-
mographics of staff nurses’ as the control variables.
The leadership style of nurse managers consisted of
the three styles described in the instruments section.
Factors related to affective commitment of staff nurses
consisted of ten factors that were determined accord-
ing to previous research on factors related to staff
nurses’ affective commitment (Meyer et al. 2002,
Gregg 2005, Nanba et al. 2009, Nohmi et al. 2010).
We adopted this concept in order to control for fac-
tors known to confound the relationship. The demo-
graphics of staff nurses comprised the variables
described below in the instruments section.
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management
Nurse manager’s leadership
Instruments
According to the conceptual framework, the question-
naire was developed. We confirmed the face validity
of all instruments with the assistance of four nursing
management researchers, a nursing sciences researcher
and 11 Master’s-level nursing students.
Affective commitment among staff nurses
We measured affective commitment among staff
nurses by using the Affective Commitment Scale,
which was developed by Meyer and Allen (1991) and
then translated it into Japanese and the validity and
reliability were confirmed by Takahashi (1999). The
questionnaire consists of eight items, with responses
made on a scale ranging from 0 (strongly disagree) to
3 (strongly agree), with higher scores indicating
greater affective commitment to the organisation.
Cronbach’s alpha was 0.77 in this study.
Leadership styles of nurse managers
In order to measure components of the leadership
styles of nurse managers, we used the Multifactor
Leadership Questionnaire Form 5X–Short (MLQ;
Avolio & Bass 2004). The MLQ consists of 36 items
and measures transformational (five components with
20 items), transactional (three components with 12
items) and laissez-faire (one component with four
items) leadership styles. Details of these three leader-
ship styles are explained below. The MLQ assesses
staff nurses’ perceptions of their nurse managers’ lead-
ership styles, with responses to each item ranging from
0 (not at all) to 4 (frequently, if not always). The item
scores for each component of leadership style are
summed and divided by the total number of items to
calculate the mean score. A higher score indicates a
higher inclination toward that particular leadership
style.
The five components of transformational leadership
were as follows: idealised influence (attributed), which
refers to the leader’s charisma and sense of ethics; ide-
alised influence (behaviour), which refers to whether
the leader emphasises the importance of having a mis-
sion; inspirational motivation, which refers to the lea-
der promoting the idea of an attractive future and
achievable goals to motivate his/her followers to
work; intellectual stimulation, which refers to the lea-
der encouraging his/her followers to question conven-
tional practices or ideas; and individual consideration,
which refers to the leader paying attention to each of
his/her followers’ needs.
3
Y. Kodama et al.
The three components of transactional leadership
were as follows: contingent reward, whereby the leader
provides followers with material or psychosocial
rewards when performance is high or goals are achieved;
active management-by-exception, whereby the leader
actively monitors deviance from standards and prevents
mistakes from occurring; and passive management-by-
exception, whereby the leader waits for deviance or mis-
takes to occur before taking corrective action.
Laissez-faire leadership consists of only one compo-
nent, laissez-faire.
The MLQ has good to excellent internal consistency
(a > 0.80) (Bass & Riggio 2006) and high fit statistics
based on confirmatory factor analysis (goodness-of-fit
index = 0.91, adjusted goodness-of-fit index = 0.90,
root mean squared error of approximation = 0.04)
(Avolio & Bass 2004); however, there is no valid and
reliable Japanese version. Therefore, we undertook the
translation of this instrument in this study, using the
back-translation procedure recommended by Brislin
(1986). We obtained permission to do so from Mind
Garden, the consulting company in the United States
that holds the copyright for the MLQ. Cronbach’s
alpha coefficients were confirmed to be adequate in this
study. Specifically, for the five transformational leader-
ship subscales, alphas ranged from 0.73 to 0.87, for the
three transactional leadership subscales from 0.72 to
0.85, and for the laissez-faire subscale it was 0.83.
Factors related to the affective commitment of staff
nurses
To measure the ten factors related to affective commit-
ment that we identified in our literature review, we used
an organisational justice questionnaire (Shibaoka et al.
2010) and also developed original items to measure the
other nine factors because there are no valid existing
Japanese measures for assessing these. Factors assessed
comprise motivation for occupation (two items from
Gregg 2005); satisfaction with salary (one item from
Nanba et al. 2009, and Nohmi et al. 2010); satisfaction
with welfare (one item from Nanba et al. 2009); com-
mitment to the hospital’s mission (two items from
Gregg 2005, Nanba et al. 2009, and Nohmi et al.
2010); opportunities for career development (three
items from Gregg 2005, Nanba et al. 2009, and Nohmi
et al. 2010); self-investment (one item from Meyer
et al. 2002); relationship with doctors (one item from
Nohmi et al. 2010); relationship with patients (two
items from Gregg 2005, and Nohmi et al. 2010), and
peer support (four items from Ida 2004). Responses to
each of these items were made on a scale that ranged
from 0 (strongly disagree) to 3 (strongly agree), or 0
4 Journal of Nursing Management
(nor at all) to 4 (frequently, if not always). Items details
are shown in Table 1. Four nursing management
researchers and a nursing sciences researcher discussed
the content validity of the extracted items while devel-
oping these.
To measure organisational justice, we used the 11-
item Japanese version of the organisational justice
questionnaire (translated by Shibaoka et al. 2010),
which was originally developed by Colquitt (2001).
The response options for each item range from 0
(strongly disagree) to 4 (strongly agree). The validity
and reliability of this questionnaire has been con-
firmed by Shibaoka et al. (2010).
Table 1
Measurement of factors related to the affective commitment of staff
nurses
Cronbach’s
a
Motivation for occupation* 0.79
1. You are motivated to work in the nursing profession
2. You are working toward a goal
Satisfaction with salary* –
1. Your salary corresponds to your workload
Satisfaction with welfare* –
1. You are satisfied with the welfare provided by the
hospital
Commitment to hospital’s mission* 0.70
1. You are committed to the hospital’s mission
2. The hospital ensures the quality of care and
service
Opportunities for career development* 0.73
1. You can effectively utilise your experience in this
hospital
2. There are many opportunities to develop your
abilities in this hospital
3. You can learn professional skills and knowledge in
this hospital
Self-investment* –
1. When you consider the effort invested to date, it
would be a waste to quit your job
Peer support† 0.83
1. You have a colleague who listens to your worries
2. You have a colleague who thinks you are a
competent nurse
3. You have a colleague who provides you with
knowledge and information that is useful for your work
4. If you are unable to do something alone, a
colleague is willing to help you
Relationship with doctors‡ –
1. Doctors collaborate with nurses
Relationship with patients‡ 0.85
1. You have good relationships with patients
2. You have good relationships with the families of
patients
Organisational justice§ (Shibaoka et al. 2010) 0.95
*Higher scores indicate greater satisfaction, motivation and self-invest-
ment.
†
Higher scores indicate more support from colleagues.
‡
Higher scores indicate better relationships with patients and doctors.
§
This is an 11-item questionnaire. Not all items are included in this
table. Higher scores indicate that the organisation makes fairer deci-
sions and rewards the employee.
ª 2016 John Wiley & Sons Ltd
 Nurse manager’s leadership

We also examined the internal consistency of the Table 2

Characteristics of staff nurses (n = 396)
factors that consisted of multiple items. The internal
consistencies were acceptable, with Cronbach’s alpha Median Range
coefficients ranging from 0.70 to 0.95 (see Table 1).
Age (years) 30 22–62
Years of work experience as a nurse (years) 7.4 1–37.3
Demographics of staff nurses Tenure at the hospital (years) 2.4 0–30
Monthly overtime (hours) 7.0 0–160
The nurses were asked to provide demographic char-
The frequency of working night 5.0 0–15
acteristics of age, gender, years of work experience as
a nurse, tenure at the hospital, marital status, basic n %
nursing education, monthly overtime and frequency of
Gender
working night shifts. Female 372 93.9
Male 24 6.1
Marital status
Statistical analysis Married 159 40.1
Unmarried 237 59.9
We calculated descriptive statistics for all variables Education
using SAS version 9.2 (SAS Institute, Cary, NC, USA) 3 years certificate 393 74.0
Diploma 47 11.9
and performed two-tailed significance tests. The level Bachelor 46 11.6
of significance level was set at 0.05. Other 10 2.5
Logistic regression analysis was conducted because
the dependent variable of affective commitment was
Table 3
not normally distributed. Therefore, we dichotomised
Descriptive statistics of affective commitment and factors related to
the scores as 0 = lower affective commitment and affective commitment
1 = higher affective commitment. Moreover, we
Median Range
dichotomised the continuous independent variables
using the median. Affective commitment 10 1–21
Factors related to the effective commitment of staff nurses
We analysed the data in three steps. At Step 1, a chi- Motivation for occupation 3 0–6
square (v2) test was performed to examine the associa- Satisfaction with salary 1 0–3
tions among affective commitment and the independent Satisfaction with welfare 1 0–3
Commitment to hospital mission 3 0–6
variables. Variables were included in the multiple logis- Opportunities for career 4 0–9
tic modelling process if an association had a value of P Relationship with patients 5 0–8
Relationship with doctors 2 0–4
less than 0.20 (Hosmer & Lemeshow 2000). Step 2
Peer support 11 0–16
involved the examination of multicollinearity via a cor- Organisational justice 22 0–44
relation matrix. No high correlations were found Self-investment 1 0–3
Leadership styles of nurse managers
among the independent variables. At Step 3, we con- Transformational leadership
ducted a stepwise multiple logistic regression to identify Idealised influence (attributed) 2.00 0–4
the association between the leadership style of the nurse Idealised influence (behaviour) 1.75 0–4
Inspirational motivation 1.50 0–4
managers and staff nurses’ affective commitment. Intellectual stimulation 2.00 0–4
Individual consideration 1.75 0–4
Transactional leadership
Contingent reward 1.75 0–4
Results Active management-by-exception 2.25 0–4
Passive management-by-exception 1.00 0–4
Descriptive statistics Laissez-faire
Laissez-faire 1.00 0–4
The demographic characteristics of staff nurses are
presented in Table 2. The median age was 30 years,
and median years of work experience as a nurse and The participants’ scores for the leadership styles
tenure at the hospital were 7.4 years and 28.5 of nurse managers are shown in Table 3. The high-
months, respectively. Most respondents were female est scores (2.0) were gained on the idealised influ-
(93.9%) and 59.9% were unmarried. Descriptive ence (attributed) and intellectual stimulation
statistics of affective commitment and factors related transformational leadership subscales. Further, the
to affective commitment are shown in Table 3. The highest score (2.25) of all subscales across the three
median score for affective commitment among staff leadership styles was for active management-
nurses was 10 (range = 1–21). by-exception.
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Journal of Nursing Management 5
Y. Kodama et al.

commitment and eight variables in the multiple logis-

Univariate analysis of affective commitment and
related variables
The results for the relationship between affective com-
mitment and the independent variables were as fol-
lows: among the demographic variables, age
(P = 0.0299) and marital status (P = 0.0041) showed
significant correlations with affective commitment. In
addition, all antecedent variables of affective commit-
ment and leadership styles, except for passive manage-
ment-by-exception, showed significant correlations
with affective commitment. Work experience
(P = 0.1200) and passive management-by-exception
(P = 0.0828) were both under the minimum required
P value of 0.20. Therefore, the following variables
were included in the regression model: work experi-
ence, marital status, motivation for occupation, satis-
faction with salary, satisfaction with welfare,
commitment to hospital mission, opportunities for
career development, relationship with patients, rela-
tionship with doctors, peer support, organisational
justice, self-investment and leadership style.
Multiple logistic regression model of affective
commitment
As shown in Table 4, there were statistically signifi-
cant positive associations between affective
tic regression model. Specifically, marital status, odds
ratio (OR) = 2.07, 95% confidence interval (CI)
[1.21–3.56]; motivation for occupation, OR = 4.48,
95% CI [2.59–7.77]; commitment to hospital mission,
OR = 2.21, 95% CI [1.27–3.85]; opportunities for
career development, OR = 2.20, 95% CI [1.23–3.95];
organisational justice, OR = 1.75, 95% CI [1.02–
2.99]; peer support, OR = 1.82, 95% CI [1.10–3.19];
and self-investment, OR = 2.86, 95% CI [1.61–5.10]
were significantly and positively related to affective
commitment. Furthermore, the intellectual stimulation
aspect of transformational leadership was significantly
and positively related to affective commitment,
OR = 2.23, 95% CI: [1.31–3.80]. In contrast, transac-
tional and laissez-faire leadership styles were not
related to affective commitment.
This model was found to have acceptable goodness-
of-fit, given the lack of statistical significance on the
Hosmer and Lemeshow (2000) test (P = 0.7612).
Discussion
This is the first study to identify which components of
nurse managers’ leadership style are associated with
staff nurses’ affective commitment to the hospital at
which they work. Our results revealed that the nurse
managers’ transformational leadership aspect of

Table 4
Multiple logistic regression for affective commitment

Affective commitment† (n = 396)

Variable* b SE Wald v2 OR 95% CI Pr > v2

Characteristics Marital status Married 0.73 0.28 6.93 2.07 (1.21–3.56) 0.0085
Unmarried ref
Factors related to the affective Motivation for occupation ≥3 1.50 0.28 28.68 4.48 (2.59–7.77) <0.0001
commitment of staff nurses <3 ref
Commitment to hospital mission ≥3 0.79 0.28 7.83 2.21 (1.27–3.85) 0.0051
<3 ref
Opportunities for career development ≥4 0.79 0.30 7.04 2.20 (1.23–3.95) 0.0080
<4 ref
Organisational justice ≥22 0.56 0.27 4.17 1.75 (1.02–2.99) 0.0410
<22 ref
Peer support ≥11 0.63 0.27 5.32 1.82 (1.10–3.19) 0.0210
<11 ref
Self-investment ≥1 1.05 0.29 12.78 2.86 (1.61–5.10) 0.0004
<1 ref
Leadership styles TFL: Intellectual stimulation ≥2 0.80 0.27 8.69 2.23 (1.31–3.80) 0.0032
<2 ref

ref, Reference category; TFL, transformational leadership.

*Variables included in the model were age, years of work experience as a nurse, marital status, motivation for occupation, satisfaction with salary, sat-
isfaction with welfare, commitment to hospital mission, opportunities for career development, relationship with patients, relationship with doctors, peer
support, organisational justice, self-investment, leadership styles.
†
Variables were chosen in the modelling process if an association had P < 0.20 in univariate analysis. A stepwise multiple logistic regression was con-
ducted, with inclusion and exclusion criteria set at P < 0.20.

ª 2016 John Wiley & Sons Ltd

6 Journal of Nursing Management

intellectual stimulation had a significant influence on
affective commitment among these staff nurses, even
though the Japanese nurse managers’ cultural context
differs from that of the Western nurse managers
examined in these previous studies. The results indi-
cate that nurse managers’ intellectual stimulation may
affect the retention of staff nurses through improved
affective commitment. In contrast, the transactional
and laissez-faire leadership styles that were included in
Bass and Riggio’s (2006) model were not related to
affective commitment in this study.
A possible reason for the relationship we found
between intellectual stimulation and staff nurses’ turn-
over is that the participants in our study might highly
value interactions with nurse managers with high
intellectual stimulation. Noda (2010) stated that Japa-
nese staff nurses were very interested in receiving edu-
cation from nurse managers, such as showing
expertise in nursing and questioning traditional nurs-
ing practices. That is, the Japanese staff nurses in our
survey might have regarded intellectual stimulation
from nurse managers as a high-quality form of educa-
tion that promoted their own expertise. In Japan,
there are few opportunities for staff nurses to obtain
advanced nursing skills and knowledge in clinical set-
tings, and few hospitals have implemented continuing
education for in-service senior staff nurses (Oyamada
2009). Further, many nurses feel that entering gradu-
ate school for a higher degree would be difficult
because of a lack of money and the long distance
required to travel to university (Ozawa et al. 2009).
Thus, we believe that nurse managers’ high intellectual
stimulation is attractive to staff nurses who are highly
motivated to learn.
In this study, components of transformational leader-
ship other than intellectual stimulation, such as ide-
alised influence, inspirational motivation and
individualised consideration, were not related to staff
nurses’ affective commitment. These findings are not
consistent with Bass and Riggio’s (2006) theory. We
posit that idealised influence was not related to Japa-
nese staff nurses’ affective commitment because they
might not expect nurse managers to be strong or charis-
matic leaders. This is owing to Japanese people’s ten-
dency to emphasise group harmony and collective
decision making (Dorfman et al. 1997). Additionally,
Dorfman et al. (1997) stated that charisma is important
for top-level rather than middle-level managers in
Japan. Our finding that inspirational motivation was
not related to Japanese staff nurses’ affective commit-
ment might be due to a cultural difference in the
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management
Nurse manager’s leadership
communication styles that are most effective for
increasing motivation. Inspirational motivation involves
a leader talking enthusiastically and strongly about
goals (Bass & Riggio 2006); however, Japanese people
value a communication style that is more aligned with
harmony (Dorfman et al. 1997). The collectivist cul-
tural orientation may be another reason why individual
consideration was not related to Japanese staff nurses’
affective commitment. Asian people often prioritise the
group’s goal over their own goals (Dorfman et al.
1997), and this preference in regard to communication
style might affect the influence of leadership style.
Nurse managers’ transactional and laissez-faire lead-
ership styles were also not related to affective commit-
ment among staff nurses in this study. Contingent
rewards in transactional leadership mean that nurse
managers assign rewards when staff nurses achieve
goals (Bass & Riggio 2006). Casida and Parker (2011)
stated that nurse managers’ contingent rewards (e.g.
pay bonus or salary) might relate to staff nurses’ moti-
vation and be results based. Nurse managers must
have an evaluation standard for nurses’ performance
when using contingent rewards in transactional leader-
ship (Casida & Parker 2011). However, there are no
such standards in Japan (Matsuoka 2004) and the
clinical nurse’s salary is mainly determined by senior-
ity, without consideration of their performance.
Therefore, contingent rewards may not be effective in
increasing staff nurses’ affective commitment in Japan.
Finally, our finding that laissez-faire leadership was
not related to affective commitment is consistent with
Bass and Riggio’s (2006) theory.
Limitations
There are several limitations in this study. First, the
nature of the convenience sample used limits the gen-
eralisability of the results. Participants in the present
study were nurses at mid-sized acute care hospitals in
a metropolitan area, but nurse managers’ leadership
styles and staff nurses’ affective commitment may be
different in university hospitals and hospitals that do
not provide acute care services. Therefore, future stud-
ies could use larger samples from other areas and
types of hospital, to ensure that participants are more
diverse. Second, although our study found that nurse
managers’ intellectual stimulation increased affective
commitment among staff nurses, it remains unclear
exactly how the managers achieved this increase; thus,
further qualitative research on nurse managers’ leader-
ship practices is needed.
7
Y. Kodama et al.
Implications for nursing management
Nurse managers in health-care organisations must
prevent staff nurses’ turnover in order to maintain a
high quality of nursing care. Our results indicate
that nurse managers’ intellectual stimulation
increased affective commitment among staff nurses,
which might lead to preventing turnover. We recom-
mend that nurse managers engage in reflection,
which is effective for reconsidering problems and
questioning assumptions, in order to increase their
intellectual stimulation competency (Roberts 2008,
Kuennen 2015). The process of reflective practice
involves learning from positive or negative experi-
ences (Yoder-Wise 2011), and affords nurse man-
agers the chance to reconsider their behaviour or
beliefs. One possible opportunity that hospital
administrators could provide to improve nurse man-
agers’ reflection skills is a formal education system
for certified nurse administrators and certified nurse
specialists (Japanese Nursing Association 2011), or
encouraging regular attendance at academic or pro-
fessional conferences regarding nursing management
or in the nurses’ area of interest. Nurse managers
can access updated knowledge and gain new insight
in these ways, which will allow them to obtain
sources of intellectual stimulation for their staff
members.
The implications described above might be applica-
ble to nurse managers in Asian countries and Asian
communities within Western countries, considering
the cultural similarities in factors such as communica-
tion style across many Asian people. Our results might
help nurse managers in Asian communities within
Western countries with planning for how best to
retain staff nurses by using high-quality leadership
skills. Replication of our study on leadership styles
should be conducted in other Asian countries in order
to examine the generalisability of our results in this
context.
Conclusion
Our study showed that Japanese nurse managers’
intellectual stimulation was positively related to
Japanese staff nurses’ affective commitment to their
hospital. Our results indicate that there are both
similarities and differences between Western and
Asian countries in terms of the most effective leader-
ship style to use in order to reduce staff nurses’
intention to leave the hospital at which they cur-
rently work.
8 Journal of Nursing Management
Source of funding
The authors did not receive any funding for this paper.
Ethical approval
The Internal Review Board of Tokyo Medical and
Dental University (1242) approved this study.
Acknowledgements
There are no contributors to the article. There is no
conflict of interest and source of funding.
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