Topic: The Influence of Transformational Leadership on Job Satisfaction and

Burnout among Nurses in the UK: A Systematic Review

CHAPTER 1

INTRODUCTION

1.1 Introduction

Burnout has emerged as a pressing global concern, particularly affecting

professionals in caregiving roles such as physicians and nurses. Nurses across all
levels are exiting their positions and the profession due to the pervasive stress and
burnout they experience. This can be characterized by prolonged work-related
stress, posing significant challenges to the efficacy of healthcare organizations
worldwide (Javier & Vazquez, 2013). It adversely impacts nurses' health and fosters
job dissatisfaction, potentially resulting in subpar care or absenteeism. Burnout
affects nurses both psychologically and physically, manifesting as depersonalization,
diminished personal accomplishment (PA), and emotional exhaustion (EE), with
workload identified as a primary contributing factor.

Due to its profound implications for organizational and employee-related outcomes

like productivity, attrition rates, and retention, job satisfaction has been extensively
studied as a concept (Eslami and Gharakhan, 2017). It encompasses both
satisfaction and dissatisfaction regarding one's job, as outlined by Spector (2009),
who defined it as "the extent to which people like (satisfaction) or dislike
(dissatisfaction) their jobs." However, job satisfaction extends beyond merely positive
feelings, encompassing factors such as work pressure that can influence individual-
work relationships. A concept analysis conducted by Castaneda and Scanlan (2014)
identified three key attributes of job satisfaction in nursing: autonomy, interpersonal
relationships, and patient care. Consequently, job satisfaction in nursing can be
understood as the degree to which nurses feel satisfied or dissatisfied with their work
concerning these attributes. Although job satisfaction, particularly in healthcare
settings like nursing in hospitals, can be identified and measured, this definition
primarily reflects an affective reaction to a job stemming from the comparison of
actual outcomes with desired, expected, and deserved outcomes.
Transformational leadership, as outlined by Avolio (2011), encompasses four key
dimensions: idealized attributes, inspirational motivation, intellectual stimulation, and
individual consideration. Idealized attributes involve leaders serving as role models
for ethical behavior, fostering trust, and instilling pride and respect among
employees. Inspirational motivation entails leaders inspiring a clear sense of purpose
and vision among followers, encouraging them to pursue personal growth and
satisfaction. Intellectual stimulation involves challenging assumptions and promoting
creativity and innovation among followers. Various factors influence nurse job
satisfaction, including work environment factors such as team support, leadership
skills, and clear responsibilities, as well as motivation factors such as opportunities
for personal and professional development and nurse recognition for job well done.

1.2 Background

Leadership within the nursing domain is recognized as a crucial tool for addressing
workplace challenges, including burnout. The prevalence of work-related stress
leading to burnout underscores the importance of empowering and supportive
leadership. Effective leadership can foster a conducive work environment by
promoting psychological empowerment, organizational commitment, and workplace
empowerment. Various factors underscore the need for this review, forming the
basis for exploring different themes. Elements such as job satisfaction among staff
nurses, absenteeism, intention to leave, the quality of the working environment,
leadership effectiveness, patient satisfaction, and the quality of care provided by
nurses are all influenced—both positively and negatively—by nursing leadership.

1.2.1 Job satisfaction

Job satisfaction is commonly defined as the extent to which an individual enjoys their
assigned tasks or their overall job, reflecting their positive orientation and emotional
attachment to their work. In nursing, burnout has been identified as a significant
factor influencing job satisfaction, with research indicating a direct and negative
correlation between the two. Various studies have demonstrated that job satisfaction
serves as a reliable indicator for predicting burnout rates among nurses, suggesting
that low job satisfaction tends to coincide with high levels of burnout, whereas high
job satisfaction is associated with lower levels of burnout. Researchers have utilized
measurement tools such as the Job Satisfaction Questionnaire and the Maslach
Burnout Inventory (MBI) to assess the relationship between job satisfaction and
burnout. In the United Kingdom, the predominant autocratic leadership style
contributes to job dissatisfaction among nurses, as leaders exert full control over
decisions without soliciting input from nurses, leading to disempowerment.
Investigating the potential linkage between these concepts is crucial for further
understanding and addressing workplace dynamics.

1.2.2 Absent from work

The association between burnout and absenteeism is evident, as heightened

burnout levels lead to increased absenteeism from work. Absenteeism contributes to
staff shortages within healthcare organizations, as highlighted by Nyathi and Jooste
(2008), while Akpabio et al. (2015) emphasize the responsibility of nursing leaders to
implement measures to minimize burnout and address absenteeism issues.
Furthermore, staff shortages resulting from absenteeism are linked to elevated
workloads for substitute nurses, impacting the overall quality of patient care
(Kurcgant et al., 2015). Work overload exacerbates work-related stress among
nurses, contributing to burnout and further exacerbating absenteeism rates
(Portoghese et al., 2014). This creates a significant challenge in the healthcare
sector, necessitating nurse leaders and managers to be well-versed in strategies to
manage absenteeism effectively.

1.2.3 Leave intention

Intention to leave the profession may arise among nurses due to unfavorable
working environments leading to burnout. Masum et al (2016) highlight that nurses
are less inclined to leave their current position if they experience high job
satisfaction. Effective leadership is crucial in preventing nurses from wanting to leave
the profession, as noted by Ellis and Bach (2015), who identify poor leadership and
management as common reasons for nurses resigning. Nurses contemplating
leaving may compromise patient care quality, underscoring the ethical responsibility
of leaders to ensure optimal care through effective nurse management to mitigate
burnout levels (Lagerlund et al., 2015; NMC, 2015).
1.2.4 Work environment

The working environment significantly influences the quality of patient care provided.
Ellis and Bach (2015) ascertain that inadequate working environments for nurses
can lead to burnout and job dissatisfaction. There exists a direct correlation between
work-related stress and the quality of the nursing environment, where improved
conditions result in lower stress levels among nurses (Ellis & Bach, 2015). Effective
leaders and managers in healthcare organizations play a pivotal role in maintaining a
positive working environment, thereby ensuring nurse job satisfaction (Akpabio et al,
2015). Leadership styles exert either a positive or negative impact on the work
environment, subsequently influencing nurse job satisfaction (Balsanelli & Cunha,
2014). Davies (2013) contends that health organizations with effective leadership
foster low turnover rates, minimal conflicts, and positive relationships among
healthcare providers, contributing to a conducive working environment and high
nurse job satisfaction. Ultimately, nursing leaders bear the responsibility of
employing effective leadership and management styles to cultivate a supportive and
satisfying work environment, thus promoting nurse job satisfaction.

1.3 Research question

Is transformational leadership style effective in increasing job satisfaction and

decreasing burnout among nurses in the UK?

1.4 Aim and objectives

1.4.1 Aim

Identify whether the implementation of transformational leadership styles effectively

increases job satisfaction and reduces burnout among nurses in the UK.

1.4.2 Objective

Determine the correlation between transformational leadership and burnout in nurses

Investigate the impact of transformational leadership on job satisfaction among

nurses

Identify the effect of transformational leadership to increases job satisfaction and

reduces burnout among nurses in the UK