Effect of Head Nurses' Leadership Styles on Their Nurses' Turnover Intention at Minia General Hospital

Introduction

Leadership is important in every institution as a result of its overarching effects on the accomplishment of organizational objectives, policies, programs and plans (1). Leadership is a social influence process in which the leader seeks the voluntary participation of subordinates in an effort to reach organization's goals (2). Thus, every organization needs leadership, because through the behavior and actions of the leader, the goals and objectives of the organization can be accomplished (3). 

In organizations, leaders can act as enablers, making and this possibly help the organization to deal with complex organizational problems and accomplish more through others. The development and the success of the leaders are constructed by their personal lifelong experiences and the choices they make along their life (4). Today's organizations need effective leaders who understand the complexities of the rapidly changing global environment. Also, if the task is highly structured and the leader has agood relationship with the employees, there will be the high effectiveness of the employees in the work such as their work engagement, job satisfaction, and retention (5).

Moreover, nurses' retention is one of the main concerns in the healthcare system, especially in times of chronic nursing shortages. In the last 10 years, many countries have invested heavily in resolving this phenomenon and shifted towards evidence-based practice, which has resulted in the need to study the relationships among staffing turnover, nurse satisfaction, quality, and adequacy of care(6). Also, it was asserted that nursing turnover is a dangerous outcome because, it is linked to the loss of individual and organizational performance, significant reduction in the quality of care, increase in the workload of the staff members who survived the turnover, and loss in their morale and further turnover(7)..

Employee turnover is a major problem for all organizations, as loss of employees leads to lose skill and knowledge. Due to the negative consequences of employee turnover, managers are often pressured to influence employees in order to stay in the work (8). Thus, the pressure to retain employees increases because the employment relationship is voluntary and managers are often not certain if employees will stay (9). Therefore, leadership, have been identified as an important factor that influencing turnover development among new graduate nurses (10). In addition, nurses’ perceptions of positive leadership have been associated with the leader's ability to decrease and manage turnover of staff (11).

Significance of the study

It was observed that when head nurses had poor leading and managing of their staff nurses, it had negatively influence on nurses' motivation as well as affected directly on nurse job satisfaction and turnover intention. Thus, the retention of qualified nurses is vital only if health organizations survive this and provide more advantages to their staff. Moreover, it was observed that many nurses are dissatisfied with their conditions, career, development opportunities and participation in decision making. Therefore, this dissatisfaction affected many nurses in which pushing them to change their present position and career through enrollment in open educational programs such as commerce or lows to work in an administrative job at their hospitals.

Furthermore, Raman (2010) stated that 94 % of nurses tended to be more satisfied and decrease turnover intention rate with the head nurses' democratic leadership style (12). In addition, in Egypt Abou –Elhassan (2004) conclude that the degree of committed staff nurses to their hospital had a high level with a democratic leadership behavior and affected on nurses committed to 87 %(13).

Aim of the study

The aim of the current study was to determine the effect of head nurses leadership style on their nurses' turnover intention at Minia General Hospital.

Research Questions

• What is the head nurse's leadership style that affects their nurses' turnover intention?

Subjects and Methods

Research Design:

A descriptive research design was utilized to achieve the aim of the current study.

Setting:

The study was conducted at Minia General Hospital .All units were included in the study.

Subjects:

The subjects of the current study consisted of (232), it was a convenience sample of staff nurses who working in the units during the period of data collection at Minia General Hospital.

Tools of Data collection:

Two tools were used for the data collection

 Tool (1): The leadership style questionnaire:

This questionnaire was developed by Kurt Lewins, (1939) (14). It consists of 30 items, each item has five responses ranging as (Almost always true 5 , Frequently true 4 ,  Occasionally true 3 , Seldom true 2 , Almost never true  1 ).

Tool (2):  Turnover intention Questionnaire:

This questionnaire was developed by Hinshaw& Atwood, (1984) (15) to measure turnover intention among nurses. This questionnaire contains 12 items using Likert –format with 5 responses (1) strongly disagree, (2) disagree, (3) uncertain, (4) agree, (5) strongly agree

Personal data sheet was attached with tools to get information about nursing staff. It was including nurse code, gender, age, area of work, years of experience.

Tools Validity and reliability

The tools were tested for the content validity by a jury of (5) experts in the field of nursing administration; two assistant professors of nursing administration at Faculty of Nursing, Minia University; and three assistant professors at Faculty of Nursing, Assuit University and the required necessary modifications were done for their clarity, wording length, format, and overall appearance. Internal consistency the questionnaires were assessed with the Cronbach's alpha coefficient. Cronbach's alpha coefficient of 0.00 indicates no reliability and a coefficient of 1.00 indicates perfect reliability. The Cronbach’s alpha test. (tool I α=0. 816, tool II α=0.821).

Pilot study:

A pilot study was conducted on 10% of participants, which equal 23 nurses ascertain the clarity, comprehensiveness and applicability of the tools, as well as served to estimate the time required for filling the questionnaire sheets which was 30 minutes. The process of pilot study took two weeks. The necessary modifications were done, and apilot study was excluded from the study subjects.

Ethical consideration:

• Approval to conduct the study was obtained from the medical and nursing directors of the hospital and the head nurses of the units after explaining the aim of the study.
• The participants were informed that their participation in the study is completely voluntary and there was harm if they choose not to participate and no individual information is shared outside of the researcher.
• Informed consent was obtained from each participating staff nurse after explaining the nature and benefits of the study.
• Each assessment sheet was coded and staff nurses names appeared on the sheets for the purpose of anonymity and confidentiality.

Data collection procedure:

• An official letter was granted by the director of the hospital and director of nurses. This letter was including a brief explanation about the purpose of the study.
• The researcher interviewed staff nurses to explain the nature and purpose of the study.
• Data collection tools were introduced for nurses to be filled.
• The researcher stays with the nurses until questionnaires completed to ensure objectivity of the responses, and to check that all items answered.
• Data collection and tabulation taken a period of four months approximately from (The first August 2017 to end Novumber2017).

Statistical design:

Upon completion of data collection, the data were scored, tabulated and analyzed through data entry and analysis by computer using the "statistical package for Social Sciences" version 21.  Data were presented using descriptive statics in the form of percentages, frequency, mean and standard deviation. Inferential statistical tests of significance, such as Friedman's ANOVA, Pearson correlation, and independent t-test were used to identify group differences and the relations among the study variables. The p value >0.05 indicates non-significant result while. The p value 0.05 indicates significant result and is highly significant at (p<0.01) level

Results:

Figure (1) Distribution staff nurses, according to their age in Minia General Hospital

Figure (2) Distribution staff nurses, according to their sex in Minia General Hospital

Figure (3) Distribution staff nurses, according to their areas of work in Minia General Hospital

Figures (1, 2 and 3) showed the personal characteristics of the staff nurses including age, sex and areas of work by number and percentage. As regards to age,  about more than fifty percent of staff nurses (56%) in the age group from 20-30 years ,followed by (31.4%)  in age group between 31-41 , while the lowest percentage of staff nurses in age group more than42 years (15.5%), with a mean score (31.9 + 7.87). According to sex, about two third percent of staff nurses (62.9%) were female, while the remaining present were male (37.1%).

Regarding to areas of work, the study cover 14 areas of work with different percentage of staff nurses; the highest number of staff nurses were in outpatient clinics (12.5%), followed by Intensive Care Unit (11.2 %), followed by Operations unit (10.3%), and followed by Emergency unit (9.9%), while the lowest number of staff nurses were in toxins and sterilization (4.3%) respectively.

Table (1) Comparison between mean scores of head nurse leadership style as perceived by staff nurses (n=232) in Minia General Hospital

**high statistical significance (P=0.000)

Table (1) indicated the mean score of each style, which shows that the highest mean score was related to autocratic leadership style ( 37.14+ 12.14) followed by mean score of delegative leadership style by mean score (22.22 + 11.52) and finally mean score of  participative style (17.59+ 6.79), with highly statistically differences. 

Table (2) Mean scores of turnover intention among the staff nurses (N=232) in Minia General Hospital

**high statistical significance (P=0.000)

 Table (2) showed that there were third quarter of the staff nurses were intending to leave with mean+ SD (27.53+ 2.81) and one quarter of them were intending to stay with mean+  SD (10.22+ 2.31). With total turnover intention mean +SD (37.92 + 2.05).

Table (3) Correlation between leadership styles and turnover intention in Minia General Hospital

**high statistical significance (P=0.000)

Table (3) showed appositive correlation between autocratic style and turnover intention (.622), negative correlation between participative style and turnover intention (-.235), and negative correlation between delegate style and turnover intention (-.488).