The influence of authentic leadership on newly graduated nurses’ experiences of workplace bullying, burnout and retention outcomes: A cross-sectional study

https://doi.org/10.1016/j.ijnurstu.2012.05.012Get rights and content

Abstract

Background

Retaining skilled and engaged nurses is critical during a time of shortage, however growing reports of workplace bullying threaten nurses’ health and wellbeing, especially the transition of newly graduated nurses entering the profession. High rates of burnout and turnover among new nurses puts additional strain on limited financial resources in healthcare organizations and can compromise the quality of care provided to patients.

Objectives

The purpose of this study is to test a model linking authentic leadership to new graduate nurses’ experiences of workplace bullying and burnout, and subsequently, job satisfaction and intentions to leave their jobs.

Methods

This study employed a cross-sectional survey design with 342 new graduate nurses (defined as less than two years of practice experience) working in acute care hospitals in Ontario, Canada. Participants completed a questionnaire with measures of authentic leadership, workplace bullying, burnout, job satisfaction and turnover intentions. The model was tested using path analysis techniques within structural equation modeling.

Results

The model fit indices suggested that the original hypothesized model did not adequately fit the data (χ2 = 33.59, df = 5, p = .000, χ2/df = 6.72, IFI = .937, CFI = .937, RMSEA = .130), thus an additional theoretically justified direct path from authentic leadership to job satisfaction was added, which improved the fit substantially (χ2 = 5.26, df = 4, p = .261, χ2/df = 1.32, IFI = .997, CFI = .997, RMSEA = .030). Authentic leadership had a negative direct effect on workplace bullying, which in turn had a direct positive effect on emotional exhaustion. Authentic leadership also influenced job satisfaction indirectly through bullying and emotional exhaustion. Authentic leadership, workplace bullying and emotional exhaustion all had significant direct effects on job satisfaction, which in turn, was related to lower turnover intentions.

Conclusions

The findings from this study demonstrate the fundamental importance of authentic leadership in creating supportive working environments. An authentic leadership style may reduce the probability of a unit culture of workplace bullying developing, contributing to a nursing workforce that is less burned out, more satisfied with their job, and ultimately, less likely to leave their position.

Introduction

Recently, the World Health Organization (WHO) identified the worldwide increase in workplace bullying as a serious threat to nurses’ health and wellbeing and has identified the need to eliminate workplace violence as a high priority (WHO, 2010). In nursing, several studies have reported increasing levels of workplace bullying in the general nursing population (Hutchinson et al., 2008, Quine, 2001) and more recently among new graduate nurses (Laschinger et al., 2010, McKenna et al., 2003, Simons, 2008). Previous research has demonstrated a link between bullying and workplace psychosocial factors, such as role conflict, social climate, and work control (Einarsen et al., 1994, Vartia, 1996). This phenomenon poses a threat to the successful transition of new nurses to the graduate role and may increase attrition from the nursing workforce, adding to the current shortage of nurses.

New graduate nurses are particularly vulnerable to negative workplace behavior that negatively impacts their job and career satisfaction and their mental and physical health. Worklife issues that threaten new graduate retention are a concern for nurse administrators (Beecroft et al., 2008, Kovner et al., 2009) given reports of turnover rates as high as 60% in the first year of employment (Beecroft et al., 2001, Bowles and Candela, 2005, Brewer et al., 2011). Researchers have expressed concern that many new graduates may actually leave the profession altogether as a result of stressful working conditions (Griffin, 2005, Scott et al., 2008). As a large cohort of the nursing workforce approaches retirement, a cadre of new nurses who find their work fulfilling is essential for sustaining the nursing workforce and for ensuring that nursing resources are available to provide high quality patient care in the future. Thus, every effort must be made to create working conditions that are welcoming to newcomers and support the positive transition from the student to graduate role.

Successful new graduate transition is facilitated by positive work environments, characterized by constructive working relationships among nurses and respect for learning needs of newcomers to the profession (Scott et al., 2008). Yet, increased demands of current workplaces are stressful for nurses who report high levels of burnout and absenteeism (Greco et al., 2006, Laschinger et al., 2004). Even more alarming, Cho et al. (2006) found that 66% of new graduate nurses reported severe burnout, and Rudman and Gustavsson (2011) found that 50% of Swedish newly graduated nurses experienced a significant increase in burnout and subsequent intentions to leave the profession in their second year of practice. The cost of replacing a new graduate nurse is high, both in financial and organizational productivity terms (Beecroft et al., 2001, Brewer et al., 2011, Lindsey and Kleiner, 2005). Indeed, Brewer et al. (2011) estimated the system cost of the 15% first year new graduate turnover rate found in their study of American hospital nurses to be approximately $728 million in 2007.

Effective strategies for preventing bullying are dependent on the quality of working environments that are created by nurse leaders. Organizational effects on employees are influenced by the behaviors of leaders as a result of the way they manage the job context and job content (Leka et al., 2010). Research in the general management field has shown that leadership, particularly a negative or nonsupportive leadership style, is an important factor in the prevalence of workplace bullying (Agervold and Mikkelsen, 2004, Hauge et al., 2007, Hauge et al., 2011, Skogstad et al., 2007). On the other hand, authentic leadership, a relationship-focused style of leadership, has been found to be related to outcomes not likely to occur in bullying environments, such as, organizational citizenship behaviors (Walumbwa et al., 2008), a supportive work group (Wong and Cummings, 2009), and group spirit or ‘esprit’ (Henderson and Hoy, 1983). However, few studies have examined the relationship between leadership behaviors and the prevalence of workplace bullying in nursing (Tomey, 2009). Given the key role of nursing leaders in creating positive work environments that promote retention and job satisfaction (Duffield et al., 2009, VanOyen Force, 2005, Weberg, 2010), a study that examines the relationship between nursing leadership behaviors and the prevalence of workplace bullying and its effects is warranted. The purpose of this study is to test a model linking authentic leadership to new graduate nurses experiences of workplace bullying and burnout, and subsequently, job satisfaction and intentions to leave their jobs.

Our theoretical framework integrated Avolio et al.’s (2004) authentic leadership model, Einarsen et al.’s (1998) notion of workplace bullying, and Leiter and Maslach's (2004) burnout model to examine workplace factors that influence new graduate retention outcomes. Authentic leadership is a positive relationship-focused leadership style that emphasizes self-awareness, honesty and transparency, behavioral integrity, and consistency (Avolio et al., 2004). In fact, authentic leadership has been posited as a “root construct” or key ingredient of other positive forms of leadership (Avolio and Gardner, 2005) and theorized to influence performance through emphasis on people's strengths rather than weaknesses (Wong and Cummings, 2009). Authentic leadership is “a pattern of transparent and ethical leader behavior that encourages openness in sharing information needed to make decisions while accepting input from those who follow” (Avolio et al., 2009, p. 424). Authentic leaders build trusting work environments that engage followers through four types of behaviors: balanced processing, relational transparency, internalized moral perspective, and self-awareness (Walumbwa et al., 2008). Balanced processing refers to behaviors of leaders who try to gather and analyze all relevant data and viewpoints, both positive and negative, before making important decisions. Relational transparency involves being open with others, sharing thoughts and feelings and encouraging others to share their ideas, challenges and opinions. Internalized moral perspective, refers to self-regulation that is guided by internal moral standards and values resulting in behaviors and decisions consistent with those values. Finally, authentic leaders show self-awareness by acknowledging their own strengths and weaknesses and understanding how they affect others. According to Avolio et al. (2009), authentic leaders create conditions that foster trust and promote employee identification with leaders and the organization thereby building confidence and accomplishing work goals and culminating in increased employee and organizational performance. Authentic leaders demonstrate a sense of genuine caring for employees and for open and honest dialogue about what is and is not working well in their work relationships based on ethical and moral standards.

There is empirical support for Avolio et al.’s (2004) authentic leadership in both the general management and nursing literature. In the management literature, authentic leadership is a significant predictor of job satisfaction and organizational commitment (Walumbwa et al., 2008) and satisfaction with one's supervisor (Peus et al., 2011). In nursing, authentic leadership has been linked to greater trust in management, empowerment, work engagement, and higher ratings of patient care quality (Wong et al., 2010). Authentic leadership behavior promotes positive relationships between leaders and employees which results in higher employee engagement and work satisfaction (Giallonardo et al., 2010).

We could find no published studies linking authentic leadership practices to workplace bullying, although the influence of other similar leadership styles on bullying has been studied. In a sample of over 10,000 employees in a variety of occupations in Norway, Hauge et al. (2011) found that when employees considered their leaders to be fair and supportive they reported fewer incidences of workplace bullying. They suggest that unsupportive and unfair leadership practices are likely to create an unfavorable work climate that may encourage bullying because of ambiguous standards about acceptable behavior in the workplace. Their results demonstrated unit level leadership effects on employees’ shared perceptions of bullying on their unit. These findings highlight the role of unit managers in setting the standards for acceptable behaviors on their unit, and reinforce the role of unit leadership in creating a positive climate that does not tolerate bullying. Hauge et al.’s (2011) notion of leadership as fair and supportive behavior with followers is consistent with Avolio et al.’s (2004) authentic leadership model.

It is therefore reasonable to expect that authentic leaders could create work environments that do not condone bullying. Bullying often occurs in stressful work environments that frustrate employees’ efforts to accomplish their work goals for a variety of reasons, including role overload, unrealistic expectations, and role ambiguity (Hauge et al., 2007, Hauge et al., 2011, Skogstad et al., 2007). These conditions seem less likely when nursing leaders consistently interact with followers in an open transparent manner and demonstrate integrity in their decision-making behavior. Previous research has shown that authentic leadership is related to greater employee engagement (Giallonardo et al., 2010, Wong et al., 2010), which has been associated with lower levels of burnout and higher job satisfaction in numerous studies (Christian et al., 2011, Schaufeli and Bakker, 2004). It is possible that authentic leadership practices may discourage bullying by building employee engagement.

Bullying in the workplace has been described as ‘a situation where someone is subjected to social isolation or exclusion, his or her work and efforts are devalued, he or she is threatened, derogatory comments about him or her are said behind his or her back, or other negative behavior aimed to torment, wear down, or frustrate occur’ (Kivimaki et al., 2000, p. 656). Bullying has been linked to negative work outcomes in a variety of occupational groups including nursing (Einarsen et al., 1998, Quine, 2001, Sá and Fleming, 2008, Simons, 2008). A study of Norwegian nurses found that nurses classified as bullied had significantly higher levels of burnout, lower job satisfaction and psychological well-being than non-bullied nurses (Einarsen et al., 1998). Similar research by Sá and Fleming (2008) showed that approximately one out of six Portuguese nurses had been a victim of bullying and experienced significantly higher burnout as a result. In another study, nurses who reported being bullied were more likely to have lower job satisfaction, a higher propensity to leave their job, clinical levels of anxiety, and depression (Quine, 2001). Recently work has begun to focus on new graduate nurses. Simons (2008) found that 31% of new graduate nurses in their US sample experienced bullying at work and that bullying was significantly related to intent to leave their jobs. Laschinger et al. (2010) found a similar rate of bullying in a sample of Canadian new graduate nurses (33%). In that study, bullying was significantly related to burnout and workplace empowerment. Workplace bullying threatens new graduates’ transition to their new roles and consequently their job satisfaction, and may lead to their leaving the field. Clearly, strategies to prevent workplace bullying are required to promote the retention of this valuable human resource. Nursing leadership plays an important role in putting strategies in place to prevent bullying and subsequent burnout of new graduate nurses. It is important that unit managers work closely with staff to develop anti-bullying policies and to ensure that they are enforced.

Burnout is a well-documented psychological response to chronic job stressors (Maslach, 2004). Burnout consists of three components—emotional exhaustion, cynicism and personal efficacy—however; emotional exhaustion is considered the core element of burnout (Leiter et al., 1998, Leiter and Maslach, 2004, Maslach and Leiter, 1997). Recent research on burnout in the new graduate population is particularly disturbing. Cho et al. (2006) found that 66% of new graduates experienced severe burnout, primarily related to disempowering workplace conditions. Similar findings were observed in a recent study by Laschinger et al. (2010), suggesting that this phenomenon continues to be a problem. Burnout results in increased absenteeism which can lead to lower levels of patient care quality (Michie and Williams, 2003). Therefore, the onus is on nurse leaders to create work environments that discourage burnout.

A recent Australian study of hospital nurses found that younger new graduate nurses were at higher risk for burnout and that support from supervisors was a significant predictor of low levels of emotional exhaustion (Spooner-Lane and Patton, 2007). Other studies have linked burnout to heavy workloads in nursing, and one study linked nurse burnout to higher patient mortality (Aiken et al., 2002). Vahey et al. (2004) also found that supportive management was related to lower levels of emotional exhaustion in hospital work environments and Balogun et al. (2002) found that support from supervisors and colleagues were fundamentally important factors influencing burnout. These results demonstrate the detrimental effects of burnout in the nursing profession in general and for new graduate nurses in particular. Given the pivotal role new nursing graduates play in sustaining the future nursing workforce, identifying leadership behaviors that reduce the likelihood of workplace bullying and burnout is important.

The primary outcomes of interest in this study were new graduate nurse retention factors, specifically job satisfaction and job turnover intentions. Using meta-analytic procedures Griffeth et al. (2000) demonstrated that intention to turnover was the best predictor of actual turnover across studies. Job dissatisfaction, while not highly prevalent among new graduate nurses (Giallonardo et al., 2010, Kovner et al., 2009, Ulrich et al., 2010), when present, has been linked to many negative organizational outcomes including poor working relationships and high turnover intentions (Ulrich et al., 2010). These findings suggest that paying attention to working conditions that promote job satisfaction is an important strategy for retaining new nurses. Despite moderate levels of job satisfaction, turnover intentions are alarmingly high in the first years of practice. In a study of nurses with less than two years of experience Scott et al. (2008) found that 45% intended to leave their current position within the next three years, comparable to Beecroft et al. (2008) who reported that 35% intended to leave their position within the next year. A Canadian study by Lavoie-Tremblay et al. (2008) found the new graduate nurse job turnover intention rate to be as high as 62%. New graduates’ reasons for leaving their current position include poor management, a lack of challenges, desire for experience in a new clinical area, and stressful working conditions (Kovner et al., 2007, Lavoie-Tremblay et al., 2008). Given the high rates of turnover reported in these studies and the resulting loss of skilled labor and high cost to health care organizations, strategies for retaining new nurses are crucial to the success of the profession. Several studies have shown that positive leadership styles are significant predictors of nurses’ job satisfaction (Giallonardo et al., 2010, Weberg, 2010).

Section snippets

Specific aims

The aim of this study was to test a model linking new graduate nurses’ perceptions of their immediate supervisor's authentic leadership behaviors to their experiences of workplace bullying and burnout in Canadian hospital work settings, and ultimately to job satisfaction and turnover intentions (see Fig. 1). Based on our theoretical framework and previous research from the nursing and management literature, we predicted that higher levels of authentic leadership would be associated with lower

Participants

The demographic profile of the sample is presented in Table 1. The majority of nurses were female (92%), averaging 28 years of age and 1.04 years nursing experience. All responders were baccalaureate prepared. Most worked on either medical–surgical units (55%) or critical care units (23%) on a full time basis (62%) and part-time basis (28%). Most (64%) worked between 20 and 39 h per week. This demographic profile is similar to provincial statistics for nurses within 5 years graduation (CIHI, 2009

Discussion

The results of this study support the proposition that nursing leaders’ authentic leadership behaviors are associated with new graduates’ experiences of bullying, burnout, job satisfaction, and job turnover intentions within the first two years of practice. Authentic leadership was an important factor influencing nursing retention outcomes by decreasing the likelihood of bullying and burnout, thereby improving new nurses’ job satisfaction and lowering turnover intentions. Bullying was

Conclusions

The results of this study highlight the importance of leadership for creating healthy work environments that may discourage workplace bullying and the development of burnout, that lead to negative work attitudes that threaten new graduate retention. The results suggest that efforts should be made to assist nurse managers in developing and implementing authentic leadership practices as part of a strategy for eliminating workplace bullying and burnout in nursing work environments. Supportive work

References (93)

  • M. Agervold et al.

    Relationships between bullying, psychosocial work environment and individual stress reaction

    Work & Stress

    (2004)
  • L.H. Aiken et al.

    Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction

    The Journal of the American Medical Association

    (2002)
  • J. Arnetz et al.

    Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers

    Journal of Advanced Nursing

    (2000)
  • Avolio, B.J., Gardner, W.L., Walumbwa, F.O., 2007. Authentic Leadership Questionnaire. Available: www.mindgarden.com...
  • B.J. Avolio et al.

    Leadership: current theories, research, and future directions

    Annual Review of Psychology

    (2009)
  • J.A. Balogun et al.

    Prevalence and determinants of burnout among physical and occupational therapists

    Journal of Allied Health

    (2002)
  • P.C. Beecroft et al.

    Turnover intention in new graduate nurses: a multivariate analysis

    Journal of Advanced Nursing

    (2008)
  • P.C. Beecroft et al.

    RN internship: outcomes of a one-year pilot program

    Journal of Nursing Administration

    (2001)
  • P.M. Bentler et al.

    Significance tests and goodness-of-fit in the analysis of covariance structures

    Psychological Bulletin

    (1980)
  • K.A. Bollen

    Structural Equations with Latent Variables

    (1989)
  • C. Bowles et al.

    First job experiences of recent RN graduates

    Journal of Nursing Administration

    (2005)
  • C.S. Brewer et al.

    Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals

    Journal of Advanced Nursing

    (2011)
  • M.W. Browne et al.

    Single sample cross-validation indices for covariance structures

    Multivariate Behavioral Research

    (1989)
  • Canadian Institute for Health Information, 2009. Workforce Trends of Regulated Nurses in Canada 2009. Ottawa, ON....
  • J. Cho et al.

    Workplace empowerment, work engagement and organizational commitment of new graduate nurses

    Nursing Leadership

    (2006)
  • M.S. Christian et al.

    Work engagement: a quantitative review and test of its relations with and contextual performance

    Personnel Psychology

    (2011)
  • D.A. Dillman

    Mail and Internet Surveys: The Tailored Design Method

    (2007)
  • A. Duquette et al.

    Factors related to nursing burnout: a review of empirical knowledge

    Issues in Mental Health Nursing

    (1994)
  • K.M. Eigel et al.

    Authentic development: leadership development level and executive effectiveness

  • S. Einarsen et al.

    The negative acts questionnaire: development, validation, and revision of a measure of bullying at work

  • S. Einarsen et al.

    Bullying, burnout and well-being among assistant nurses

    Journal of Occupational Health and Safety: Australia and New Zealand

    (1998)
  • S. Einarsen et al.

    Bullying and harassment at work and their relationships to work environment quality—an exploratory study

    European Work and Organizational Psychologist

    (1994)
  • A. Fink

    How to Sample in Surveys

    (1995)
  • F.J. Fowler

    Survey Research Methods

    (1993)
  • L.M. Giallonardo et al.

    Authentic leadership of preceptors: predictor of new graduate nurses’ engagement and job satisfaction

    Journal of Nursing Management

    (2010)
  • P. Greco et al.

    Leader empowering behaviours, staff nurse empowerment and work engagement/burnout

    Nursing Leadership

    (2006)
  • M. Griffin

    Awareness of nurse-on nurse abuse helps resolve problem

    Association of Perioperative Registered Nurses Management Connections

    (2005)
  • J.R. Hackman et al.

    Development of the job diagnostic survey

    Journal of Applied Psychology

    (1975)
  • L.J. Hauge et al.

    Leadership and role stressors as departmental level predictors of workplace bullying

    International Journal of Stress Management

    (2011)
  • L.J. Hauge et al.

    Relationships between stressful work environments and bullying: Results of a large representative study

    Work & Stress

    (2007)
  • J.E. Henderson et al.

    Leader authenticity: the development and test of an operational measure

    Educational and Psychological Research

    (1983)
  • H. Hoel et al.

    Bullying is detrimental to health, but all bullying behaviours are not equally damaging

    British Journal of Guidance and Counselling

    (2004)
  • R.H. Hoyle et al.

    Writing about structural equation models

  • L. Hu et al.

    Cut-off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives

    Structural Equation Modeling

    (1999)
  • M. Hutchinson et al.

    The development and validation of a bullying inventory for the nursing workforce

    Nursing Researcher

    (2008)
  • View full text