“Leadership of frontline nurses working in University Medical Centers and the association with nurse reported quality of patient care: a cross-sectional study”

Abstract

ABSTRACT Background: Frontline nurses need to show stronger leadership competencies to improve healthcare and accomplish change. Because of more dynamic and complex healthcare, nurses need to quickly and independently take more responsibility and accountability. Leadership competencies of nurses seems to be important to improve quality of care. A common leadership style is transformational leadership shortly defined as; building trust, encouraging others, innovative thinking and coaching others. Before improving quality, more insight in perceptions of nurses of delivered care is needed. Nurse reported quality of care (NRCQ) offers a reliable indication of quality of care. Aims: To investigate leadership styles and practices of frontline nurses in Dutch University Medical Centers, the association with nurse reported quality of care and influencing factors of the association. Method: A quantitative cross-sectional survey was conducted, among 3470 nurses working on various wards in five University Medical Centers. Leadership was measured with Multifactor Leadership Questionnaire (MLQ) and Leadership Practice Inventory (LPI). NRCQ was measured using a four-item instrument. To determine Influencing factors, nurse and ward characteristics were obtained. Results: In total 655 nurses were included. Frontline nurses preferably use transformational leadership style (M=44.6, SD=5.3). On the LPI the highest leadership practices were found on “enabling others to act” (M=7.6, SD=1,3) and “model the way” (M=7.1, SD=1,0). A weak association was found between transformational leadership and NRQC (Pearson’s correlation r=0.087, p=0.026). Conclusion and recommendation: Frontline nurses use transformational leadership style and practices during their daily work. However, finding show that there is room for development of leadership of frontline nurses and education is recommended. Leadership as well as quality of care appear to be complex concepts and further research is needed to understand different influencing factors between both concepts, to understand and improve nursing care.