Nursing Inquiry 2013; 20(1): 11–22
Feature
Transformational leadership in
nursing: towards a more critical
interpretation
Marie Hutchinsona and Debra Jacksonb
Cross University, Lismore, NSW, bUniversity of Technology, Sydney, NSW, Australia
aSouthern
Accepted for publication 14 August 2012
DOI: 10.1111/nin.12006
HUTCHINSON M and JACKSON D. Nursing Inquiry 2013; 20: 11–22
Transformational leadership in nursing: towards a more critical interpretation
Effective nurse leadership is positioned as an essential factor in achieving optimal patient outcomes and workplace enhancement. Over the last two decades, writing and research on nursing leadership has been dominated by one conceptual theory, that
of transformational leadership. This theoretical framework has provided insight into various leader characteristics, with research
findings presented as persuasive evidence. While elsewhere there has been robust debate on the merits of the transformational
model of leadership, in the nursing literature, there has been little critical review of the model and the commonly used assessment instruments. In this article, we critically review more than a decade of nursing scholarship on the transformational model
of leadership and its empirical evidence. Applying a critical lens to the literature, the conceptual and methodological weaknesses of much nursing research on this topic, we question whether the uncritical adoption of the transformational model has
resulted in a limited interpretation of nursing leadership. Given the limitations of the model, we advocate embracing new ways
of thinking about nursing leadership.
Key words: leadership, nursing, transformational leadership.
For more than two decades, there has been an intense focus
upon nursing leadership, yet, despite this, there remains considerable concern about failures of nursing leadership affecting
both clinical outcomes and the quality of the work environment for nurses (Garling 2008; Jackson et al. 2012). Given
such concerns, it is imperative that any consideration of nursing leadership is both robust and critical. Transformational
leadership has been widely adopted in nursing, yet this adoption has been largely uncritical, and evidence into its efficacy in
terms of clinical outcomes and workplace quality remains
unconvincing. In this article, we critically review more than a
decade of nursing scholarship on the transformational model
of leadership and its empirical evidence.
At the core of much theorising on leadership has been an
interest in understanding the characteristics of successful lead-
Correspondence: Dr. Marie Hutchinson, Senior Lecturer, School of Health and
Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480,
Australia. E-mail: <marie.hutchinson@scu.edu.au>
2012 Blackwell Publishing Ltd
ers and their capacity to influence organisational culture and
follower behaviour (Smirich 1983; Parry and Proctor-Thomson
2003; Linstead 2004). What began as a philosophical concern
to understand the values, ethics and morality of leader characteristics and how these are enacted by leaders to motivate individuals to focus upon interests other than their own (Alvesson
and Wilmott 1992) has increasingly shifted to focus on the
charismatic traits of leaders and how these can influence productive emotions and behaviours in followers (Bass and Avolio
1994; Pfeffer 2007). Transformational leader attributes such as
dynamism, self-confidence, inspiration, emotional intelligence
and symbolism have come to be associated with successful leadership (Derckz De Casterle et al. 2008; Lee, Coustasse and Sikula 2011).
A plethora of empirical research suggests the benefits of
transformational leadership are significant (Bass 1999; Bass
et al. 2003; Cummings et al. 2010). In the nursing context,
there has been considerable emphasis upon transformational leadership, with the model of Bass and his colleagues
H Hutchinson and D Jackson
(Bass 1999) most commonly employed (Cummings et al.
2010). Reflecting this dominance, a recent systematic review
of nursing leadership styles reported that 53% of the studies
reviewed had investigated transformational leadership
(Cummings et al. 2010).
THE THEORY OF TRANSFORMATIONAL
LEADERSHIP
The theory of transformational leadership (TFL) was initially
described by Burns (1978) who examined the characteristics
of political leaders and suggested that the differentiating features of management and leadership were the characteristics
and behaviours of leaders. For Burns (1978), follower behaviour was based upon reward for compliance (transaction) or
the motivation to meet higher order needs (transformation).
These concepts of transformation and transaction as features
of leadership were popularised by Bass and colleagues in
their theory of leadership (Avolio and Bass 1988; Bass and
Avolio 1994). Initially developed through an open-ended survey identifying the perceptions of 70 male executives who
described what they saw as the attributes of transformational
and transactional leadership styles (Hater and Bass 1988),
the model and resulting instrument were subsequently tested
on a sample of male military officers (Hater and Bass 1988).
Heavily influenced by notions of charisma and leader
influence, the model essentially defines three types of leader
behaviour: transformational, transactional and laissez-faire.
The transformational leader has been described as engaging
in a form of leadership that develops followers through creating a vision that provides meaning and motivation (Bass
1999). Communicating an attractive vision with enthusiasm
and confidence, transformative leaders are said to build a
strong sense of identification with the organisation and
persuade individuals to transcend their own self-interest.
Transformational leadership has been described as a
human-capital-enhancing resource management style (Zhu,
Chew and William 2005) as it seeks to motivate followers to
do more and perform beyond their own expectations (Hater
and Bass 1988). The liassez-faire leader is described as engaging in a passive leadership that is characterised as providing
little direction (Bass 1999).
Transactional leaders are said to achieve performance
when required through contingent rewards or negative feedback (Hater and Bass 1988). The focus of transactional leadership is upon structures, clarifying tasks and providing
rewards for extra effort or meeting the needs of followers
when they comply or meet expectations (Avolio and
Bass 1988). Achieving performance of followers through
contingent reward has been conceptualised as a lower order
12
leadership function. Although Burns initially conceptualised
transactional and transformational characteristics as functional components of leadership, the early work of Bass and
colleagues influenced the positioning of transformational characteristics as more desirable than transactional (Ward 2002;
Bass et al. 2003). More recently, interpretations have moved
back to understand contingent reward and active management
by exception as effective components of a ‘full’ model of leadership (Bass 2003; Hannah et al. 2008).
Over time, components Bass and colleague’s model and
the multifactor leadership questionnaire (MLQ) have been
conceptually refined into the current ‘full range’ of leadership model (1991) and its associated components. The MLQ
taps various components of transformational, transactional
and non-leadership characteristics (previously termed liassez-faire) along with three measures of leadership effectiveness. It is one of the most widely used and authoritative
instruments for establishing leadership style. The constructs
measured through the MLQ.
Influenced by Avolio and Bass (1998) transformational
model of leadership, Kouzes and Posner (1987) developed
their model of exemplary leadership. According to this theory, exemplary leaders demonstrate five leader characteristics and engage in behaviours that challenge the process,
inspire a shared vision, enable others to act, model the way
and encourage the heart (Kouzes and Posner 1987). Reflective of the model’s transformational foundations, exemplary
leaders are said to inspire a shared vision and motivate people to do their best. Modelling the way is one of the key
behaviours through which exemplary leaders enact leadership (Kouzes and Posner 2000). By setting an example for
others and engaging in visionary or exemplary behaviours
which motivate, encourage or enable followers, the transformative leadership processes can be replicated within work
teams. The relationships that exemplary leaders build with
followers are said to be focused upon transforming individuals within the organisation into leaders (Jackson and Parry
2011). Exemplary leaders are also said to take risks and have
a strong sense of vision for the future. In addition, they
engage in behaviours that ensure people work to agreed
standards and engage in goal setting and reward or praise
individual effort (Kouzes and Posner 2000).
The exemplary leadership theory of Kouzes and Posner
(2000) has several common characteristics with the model of
Bass and colleagues. Reflecting this similarity, in the Leadership Practices Inventory (LPI), the majority of leader behaviours can be characterised as either transformational or
transactional in nature (Zagorsek, Stanley and Markjo 2006).
The constructs measured through the LPI are summarised
in Table 2.
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Transformational leadership in nursing
It is generally accepted that the TFL has provided important insights into the nature of leadership and various workplace outcomes. However, like most theoretical frameworks,
it has a number of limitations that reduce its usefulness. We
believe it is timely to question whether the acceptance of the
transformational paradigm that has pervaded much nursing
research and scholarship has limited any critical examination of nursing leadership. Accordingly, in this article, we
critically review more than a decade of nursing scholarship
on the transformational model of leadership and its empirical evidence to illuminate future avenues of leadership
research.
For the purpose of the review, we examined research
employing transformational models of leadership in nursing
for the period 1992–2011. A search of electronic databases
for the terms transformational, leadership and nurs* in the
abstract, title and key words of manuscripts identified that
empirical studies of transformational leadership in the nursing context first appeared in the literature from 1992. Studies undertaken prior to this period employed a variety of
other leadership frameworks. The search identified 43
reported studies. Of the 38 quantitative studies identified
(noted in the reference list *), two tools were primarily
employed: the MLQ (n = 22) and the LPI (n = 10). In what
follows, we review the potential limitations of the transformation model of leadership and examine conceptual and methodological weaknesses that reduce the explanatory capacity
of much nursing research on this topic.
LIMITATIONS OF THE TRANSFORMATIONAL
MODEL
In reviewing the literature, particular attention was given to
assessing opinions and evidence regarding the theoretical
limitations of the transformational leadership model, the
generalisability and representativeness of the model and
research employing the model and the validity of common
measurement criterion. The following significant criticism
and limitations were identified: a dichromatic interpretation
of leadership; the focus upon charismatic and heroic leaders;
minimal attention or insight into leader integrity; the limited
examination of ‘dark’ or avoidant leader behaviours; the perpetuation of gendered and culturally exclusive understanding of leadership; and ambiguity regarding aspects of the
theoretical model and associated measurement instruments.
A dichromatic interpretation of leadership
The transformational framework proposed by Avolio and
Bass (1988) has largely evolved into a dichromatic theory of
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leadership, which focuses upon transformational and transactional leader characteristics. In this interpretation, leaders
are seen to maintain organisational functioning through
transactional or task-focused interactions, whereas transformational characteristics transmit and foster a commitment
to change (Bass 2003). Similarly, although Kouzes and
Posner (2000) proffer that the five leader characteristics
underpinning their theoretical model are reflective of a
more dispersed or relational interpretation of leadership; a
number of studies have identified a smaller set of leadership
characteristics that are largely focused upon visioning or
achieving change and task- or goal-focused leader behaviours
(Chen and Baron 2006; Zagorsek et al. 2006; Tourangeau
et al. 2010). These leader behaviours resonate closely with
Avolio and Bass (1988) transactional and transformational
interpretation of leadership.
With its focus on vision, norms and belief systems, the
transformational interpretation of leadership draws attention to cultural images of organisations and the transformation of follower behaviour. Leaders are seen to
communicate a vision and employ symbolism or motivate
and influence the behaviour of followers (Avolio and Bass
1988; Kouzes and Posner 2000). These types of symbolic and
emotionally appealing leadership behaviours are used to
explain how leaders motivate trust, commitment and performance in followers (Zagorsek et al. 2006). By serving as role
models, leaders are seen to promote values that foster commitment to organisational goals (Kouzes and Posner 2000).
Leadership is positioned as a sense-making process with leaders having the legitimate capacity to shape and interpret the
experience of followers (Hopfl 1992). In contrast, the transactional notion of leadership reflects a mechanistic image of
organisational behaviour, one that emphasises productivity,
attaining goals, minimising risk and maintaining function.
The two-dimensional images of leadership provided by
theoretical interpretations of leadership ground upon transformational interpretations offer a limited understanding of
the complex and paradoxical nature of organisations, leadership and organisational behaviour (Alimo-Metcalfe and
Alban-Metcalfe 2005).This interpretation of leadership gives
prominence to normative managerial views of leadership
and silences other possibilities for leadership. By framing
leadership as either transactional or transformative, concepts
such as power, politics, domination and resistance are largely
excluded from any discourse on leadership (Alvesson,
Willmott and Briarcliff 1992). Power is seen to be in the
hands of the leader, with leadership framed as a domino of
transformative processes. Such interpretations are grounded
in assumptions of organisational cohesion, and little
attention is directed towards understanding the place of
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H Hutchinson and D Jackson
internal dissent and leadership. Transformational and transactional interpretations fail to acknowledge that dissent is an
important feature of innovation or change and that dissent
is often a vital ingredient in balanced decision-making
(Toursih and Oinnington 2002).
A focus upon heroic and distant leaders
Initially developed from the opinions of military leaders and
observations of rebel leader success, the transformational
leadership model rests upon romanticised notions of heroic
and charismatic leadership (Graham 1988). Reflecting
heroic notions of leadership, the dominant concern is with
the vertical interpersonal power of leaders (Salancik and
Pfeffer 2003), their visionary and transformational influence
over the perceptions and behaviours of followers and the
relationship of these characteristics to workplace function
and productivity (Zhu et al. 2005).
In the nursing literature, there has been almost exclusive
focus directed towards understanding the transformational
characteristics of those in designated leadership roles. Transformation is largely cast as the prerogative of those in
‘distant’ leadership positions (Kleinman 2004; Chen and
Baron 2006) who are charged with shaping meaning, culture
and behaviour within organisations – while promoting or
enabling productive or adaptive behaviours in followers
(Leach 2005; Salinova 2011). The influence of transformational leaders upon followers has been likened to a domino
effect (Bass, Avolio and Goodheim 1987), with the charismatic leader causing a chain reaction of positive effect
(Murphy 2005) or the visionary leaders inspiring and
empowering individuals (Chen and Baron 2006). Although
Kouzes and Posner (2000) argue that credible leaders
develop capacity in others, nurse-researchers employing this
theoretical framework have continued to focus their attention upon examining the leadership of those in designated
leadership roles. There has been little attention directed
towards understanding how leadership may be enabled in
those not in formally designated leadership positions or how
organisational processes can be changed to liberate follower’s potential to lead (Jackson and Parry 2011).
Within the organisational behaviour literature, it is recognised that there are differences in the way that distant leaders are perceived compared to those who are in closer
proximity with employees (Shamir 1995). Typically, leaders
at executive levels have little face-to-face interaction with staff
and are therefore more likely to be rated by them on perceptions or impressions of their leadership style rather than
their actual performance. It has also been suggested that
those lower in the organisation may distort or over estimate
14
the transformational characteristics of leaders to achieve cognitive consistency in line with their own personal views
regarding leadership (Korman 1966). Conversely, employees
are more likely to be exposed to middle managers and form
a more accurate interpretation of their behaviour and rate
them less favourably with regard to transformational characteristics (McDaniel and Wolf 1992).
The distinction between distant leadership and close
leadership is particularly important when considering the
transformational or exemplary leadership paradigm (AlimoMetcalfe and Alban-Metcalfe 2005). It is feasible that
reported leadership characteristics may be an artefact of the
distance of leaders from followers. The more distant the leader, the higher the transformational perceptions of subordinates are likely to be (Avolio et al. 2004; Sosika, Juzbasich
and Uk Chun 2011), with these judgements not necessarily
reflective of actual leader performance. This may explain
the reported higher levels of transformational leadership for
nurse executives compared with the lower transformational
leadership ratings of unit managers reported in a number of
studies employing the MLQ (Kleinman 2004; McGuire and
Kennerly 2006), and the absence of a relationship between
leadership characteristics and job satisfaction employing the
LPI among care workers who rated leaders in roles such as
advanced practice nurses, educators and team leaders
(Tourangeau 2003). It is also recognised that attributional
distortions are more pronounced when respondents are
asked to rate unobservable variables related to the performance or character of another person (Schriesheim, Wu
and Cooper 2011). This may also be a factor in inflating
assessments of leader transformational characteristics.
As much of nursing research that has occurred to date
has focused upon executive level leaders, there is a risk of
confounding or failing to fully develop our understanding of
leadership, particularly middle level or more proximal leadership characteristics – such as clinical leadership in the
nursing context. Furthermore, the predominant focus upon
distant leaders fails to acknowledge that leadership can be
exhibited by individuals at any level of an organisation (Jackson 2008). The consequence of this partial conception of
leadership is the consolidation of two distinct streams of
thought with regard to leadership in the nursing context –
the leader who is in a designated position of authority and
charged with organisational transformation and the clinical leader (Stanley and Sherratt 2010; Patrick et al. 2011).
This perpetuates the assumption that leadership is fused
with or is part of management (Dunham-Taylor 2000; Kleinman 2004; Chen and Baron 2006; Malloy and Penprase
2010), and transformational or exemplary leadership is an
exclusive feature of those more senior in the organisation
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Transformational leadership in nursing
and possibly causing a view that the leadership occurring in
the clinical context is a lower order, different or less significant form of leadership.
Minimal attention to leader integrity
Burns (1978) conceptualised transformational leadership as
benefiting society, yet subsequent interpretations have largely failed to focus attention upon these broader leader
characteristics, such as concern for social justice, and instead
have focused attention primarily upon the development of
followers towards attainment of organisational goals (Bass
et al. 1987; Bass and Avolio 1994). However, Bass (2003) has
linked transformational leadership to the capacity to enact
moral behaviour through the constructs of intellectual stimulation and individual consideration. There have also been
suggestions that integrity and ethics are conceptually related
to transformational leadership (Parry and Proctor-Thomson
2002) and enabling trust and human dignity are characteristics of exemplary leadership (Kouzes and Posner 2000). Yet,
there is little empirical evidence of this relationship, and
integrity is not articulated specifically as a construct in the
transformational model. The LPI contains one item measuring trust; otherwise, leader integrity is implied through the
characteristics associated with the charismatic leader.
It is said that transformational and exemplary leaders
promote values such as honesty, loyalty and fairness, while
emphasising justice, equality, human dignity and human
rights (Kouzes and Posner 2000; Groves and LaRocca 2011).
Importantly, it is not clear from the transformational or
exemplary leadership models or associated MLQ and LPI
measurement instruments how the constructs of morality,
integrity or higher order ethical values and practices of leaders are differentiated (Parry and Proctor-Thomson 2002).
To counter arguments about the limitations of the
transformational theory and associated measurement instruments with regard to leader integrity, Bass has pointed to
the pervasive nature of integrity in the transformational
theory of leadership and suggested a distinction be made
between authentic transformational leadership that is ethical, and pseudo-transformational leadership that could lead
to potentially unethical behaviours (Bass and Steidlmeier
1999). Arguing for the ethical character of transformational
leaders, he notes that ‘self-aggrandising, fantasising, pseudotransformational leaders can be branded as immoral. But
authentic transformational leaders, as moral agents, expand
the domain of effective freedom, the horizon of conscience
and the scope for altruistic intention’ (Bass and Steidlmeier
1999, 215). Similarly, the theory of Kouzes and Posner
(2000) includes a focus upon leader characteristics that
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include dignity and respect, fostering co-operation and
modelling actions that align with espoused values. Reflective
of the dispersed concept of leadership, the LPI contains a
number of items that are relational in nature, yet leader
integrity is not clearly specified in any of the items and can
only be inferred through items that relate to dignity and
respect and cooperation. While both the transformational
and exemplary models of leadership claim to include a
focus upon leader integrity, it is not evident how this distinction can be made. There will potentially be leaders who
rate as transformational who are manipulative, destructive
or exploitative.
Transformational leadership traits and narcissistic leadership have been identified to share many similar characteristics, as identified by the MLQ’s idealised influence and
inspirational motivation subscales (Khoo and Burch 2008).
Thus, it is feasible that extreme self-confidence may be a feature of either inspirational motivation or narcissistic personality. Although transformational styles of leadership are
perceived to be associated with higher levels of integrity
(Parry and Proctor-Thomson 2002), and recently Zhu and
colleagues (2011) reported transformational leadership has
a positive effect on follower moral identity within organisations, it has also been suggested that leaders with integrity
do not necessarily demonstrate a particular leadership style
(Trapero and De Lozada 2010).
Limited examination of ‘dark’ or avoidant leader
behaviours
There has been considerable debate in the organisational
management literature about the dark side of charismatic
leadership (Bass 1999). It is feasible that, while transformational leaders may act with integrity and display behaviours
that resonate with their articulated vision, this does not discount that they may act unethically or engage in self-interested or immoral behaviours. In a study exploring the moral
reasoning of upper and lower level managers (n = 377),
Sosika and colleagues (2011) reported that, while managers
viewed themselves as transformational, many also possessed
low levels of cognitive moral reasoning that could lead to
unethical leadership behaviour. Further, it has been suggested that, depending on their vision and personal motivation, transformational leaders may lead followers
in unethical or immoral directions (Parry and ProctorThomson 2002). The inability of the transformational model
to identify leader characteristics that may be a threat to integrity and dignity is a significant limitation.
Reliance upon the transformational model by nurse
scholars and researchers has limited the examination of avoi15
H Hutchinson and D Jackson
dant leader behaviours to passive forms of laissez-faire avoidance (Horwitz et al. 2008; Cummings et al. 2010). There has
been little attempt to examine in detail the nature or consequences of avoidant leadership in the nursing workplace or
to determine the contextual factors that moderate the capacity to engage in various styles of leadership (Jackson et al.
2012). This is a limiting feature of nursing leader
research, particularly in the context of repeated quality and
safety scandals that have drawn attention to the dangers of
avoidant or reckless leadership in health-care (Johnstone
2004).
Absence of gender and cultural consideration
Historical and contemporary leadership theories, such as
those about transformational leadership, privilege stereotypical masculine notions of charismatic leadership (Smirich
and Calas 1995). Burns (1978) definition of transformational leadership, as well as the model and measurement
instrument refined by Bass (1999), was exclusively developed
from male populations. Thus, the absence of a balanced gender perspective in the development of the theory is said to
have largely excluded women’s voices from the discourse on
leadership (Kark 2004).
Recent evidence, however, suggesting that women
engage in transformational leadership at a higher rate than
their male counterparts (see, for instance, Eagly, Johannesen-Schmidt and van Engen 2003) is used to support the
adequacy of the transformational leadership model. It has
been demonstrated that including a substantial sample of
women in studies results in a markedly different interpretation of leadership. For instance, a UK grounded theory study
that was representative of women found that no single
dimension emerged that was related to leader charisma
(Alimo-Metcalfe and Alban-Metcalfe 2005). Instead, there
was a far greater emphasis upon the leader characteristics of
openness, humility and vulnerability. The most important
leadership factors that emerged in this study related to concern for others and their well-being, with integrity forming a
distinct factor in its own right.
In addition, while Bass and colleagues and Kouzes and
Posner claim universal applicability of their leadership models, the model and their concepts were derived from US
studies. Cultural values and beliefs influence what are considered legitimate and effective leader behaviours and characteristics. Outside of the United States, other cultures may
place less value on transformation and value leaders who
achieve pragmatic outcomes as reflected in Chen and Baron’s
(2006) study of nursing faculty in Taiwan who reported low
scores on all leadership scales in the MLQ and Ergeneli, Go16
har and Temirbekova (2007) study of Turkish leaders which
reported a significant and negative relationship with some
aspects of the LPI.
Ambiguity of characteristics in the theory and
related measures
Over time, a number of issues concerning the validity of the
factor structure and the scale construction of the MLQ and
LPI instruments have been raised (Avolio, Bass and Jung,
1999; Chen and Baron 2006). A repeated concern raised
regarding the MLQ has been its discriminant validity and
psychometric problems (Lievens, Van Geit and Coetsier
1997). These concerns relate to the generally high correlations among the transformational subscales, as well as the
transactional contingent reward subscale of the transactional
factor. Other concerns with the factor structure of the MLQ
relate to the transactional and laissez-faire subscales, with
suggestions the MBEP items be considered subscales of the
laissez-faire rather than transactional factor. Similarly, a number of authors have identified limitations with the factor
structure of the LPI, identifying a smaller number of factors
than theorised by Kouzes and Posner (Tourangeau 2003;
Chen and Baron 2006; Zagorsek et al. 2006; Tourangeau
et al. 2010).
The validity of the total instrument is based on the
strength of the validity of the underlying subscales (Wilson
2005). In the absence of a clear factor structure and the
reported high inter correlations between the factors in the
MLQ instrument, respondents may have difficulty differentiating the various components of the transformational subscales, which may lead to more global ratings (Lievens et al.
1997). Furthermore, the transformational leadership factor
and its associated subscales contain significantly more items
than the other components of the instrument. The much
larger number of items on the transformation leadership
component may influence respondent perceptions and
result in more favourable ratings. To address the issue of intercorrelation among the transformational subscales, it is
common for researchers to aggregate the subscales in the
MLQ to provide total scores of transformational, transactional and laissez-faire leadership (Stordeur, Vandenberghe
and D’hoore 2000; Suliman 2009). When summary scales
are created, Wilson (2005) observe that ‘the greater the
number of items on a subscale, the greater it’s potential ipso
facto in the estimated summary scale’ Problems associated
with high intercorrelations between items on the LPI have
led researchers to remove the majority of items measuring
leadership characteristics to force model fit in regression
analysis (Tourangeau et al. 2010).
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Transformational leadership in nursing
LIMITATIONS OF STUDY DESIGN IN THE
NURSING CONTEXT
The attractiveness of the transformational leadership theory
and the associated MLQ has given rise to numerous questionnaire ⁄ survey studies in the nursing context. A number of
systematic reviews document evidence for the various forms
of leadership and their differential effects on the nursing
workforce, intent to stay and patient outcomes (Wong and
Cummings 2007; Cummings et al. 2010; Weberg 2010;
Cowden, Cummings and Profetto-McGrath 2011).
Although the vast majority of nursing studies have been
cross-sectional convenience sample designs, assertions are
repeatedly drawn about the cause and effect relationship
between transformational leadership characteristics and
other variables studied (Stordeur et al. 2000). Furthermore,
few researchers acknowledge the potential limitations posed
by the structure of the MLQ or question whether the research
design may serve to inflate the significance of findings with
regard to transformational leadership (McGuire and Kennerly 2006; Failla and Stichler 2008; Suliman 2009). While some
nursing researchers acknowledge the issue of inter-correlation among subscales in the TFL component of the MLQ
(Stordeur et al. 2000), in the main, little critical attention has
been given by nurse research to considering the possible
impact of the construct validity of the MLQ scale on the generalisability and representativeness of research findings. Two
further issues that warrant consideration with regard to the
limitations of study design are the extent of common method
bias and attributional bias in nursing studies.
Common method bias
Increasingly, studies have sought to understand the relationship between transformational leadership and characteristics
of the nursing workforce. These studies have aimed to
increase our understanding of how transformational leadership predicts performance or positive work outcomes such as
staff nurse effort (Dunham-Taylor 2000; Stordeur et al.
2000), job satisfaction (Chen and Baron 2006; Failla and
Stichler 2008; Al-Hussami 2009), organisational support (AlHussami 2009), empowerment (Larrabee et al. 2003), leader
satisfaction (Stordeur et al. 2000) and personal accomplishment (Kanste 2008). An important limitation of the studies
of transformational leadership in nursing is that the majority
are based on examinations of leadership and work outcomes
from data collected at the same point in time and from the
same respondents. Common method bias in this methodology potentially undermines the validity of findings from
these studies.
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It is recognised that the effects of common source bias
inflate the relationship between transformational leadership
and other measured outcomes (Bass et al. 2003; Lindebaum
and Cartwright 2010). Demonstrating the extent of this bias,
a meta-analysis (Lowe, Kroeck and Sivasubramaniam 1996)
confirmed that common method bias significantly inflated
the relationship between transformational leadership and
outcomes reported across studies. Furthermore, Lindebaum
and Cartwright (2010) have demonstrated that stronger
methodological designs using multirater assessments of
transformational leadership and other measured outcomes
failed to identify the transformational relationships found in
previous studies that were characterised by common method
variance.
Using the same respondents to describe leader characteristics and the workplace ⁄ workforce outcomes of interest, the
issue of common method variance in the majority of studies
on transformational leadership in the nursing context
potentially inflates the correlations reported and draws into
question the validity of the reported findings. Given that serious reservations have been raised in terms of accepting
results from studies impacted by common method bias,
future studies need to examine validity issues, particularly
those that arise from linking leaders or follower’s perceptions of leadership characteristics with outcome variables.
Addressing this issue may require research designs such as
longitudinal studies examining the influence of leadership
characteristics upon dependent variables and collecting data
at different times and from different sources (Lindebaum
and Cartwright 2010).
Attributional distortions
A consistent finding in the literature is that executives and
managers overestimate their self-reported transformational
characteristics when compared to their followers reported
perceptions. This halo effect or attributional bias is recognised to influence ratings of the MLQ, with leader ratings of
transformational leadership potentially inflated (Kark 2004).
Studies examining the transformational characteristics of
nursing leaders, leader performance or leader impacts have
typically employed executive nurse or nurse manager selfreports of their own performance and the reported perceptions of staff nurses regarding leader characteristics. Several
of these studies report inflated or discrepant leader
self-assessment of transformational characteristics compared
to subordinate reports of the leader characteristics (McDaniel and Wolf 1992; Prenkert and Ehnfors 1997; DunhamTaylor 2000; Larrabee et al. 2003; Kleinman 2004; McGuire
17
H Hutchinson and D Jackson
and Kennerly 2006; Failla and Stichler 2008; Suliman 2009;
Malloy and Penprase 2010).
It has been suggested that the discrepancy in leader and
follower reports of transformational leadership can be
understood as the cascading effect of transformational leadership within an organisation (Murphy 2005). However, an
alternative interpretation is that self-reports of leadership
characteristics may have little or no relationships with actual
leadership behaviours as demonstrated by McGuire and
Kennerly (2006). A number of nursing studies have
addressed the issue of same-source ratings by collecting nonsame-source data from staff nurses or others in the organisation regarding the performance of leaders. It is important to
note that leader self-ratings are higher in the majority of
these studies, and correlations decrease in strength and significance once non-same-source ratings are considered. The
array of studies that infer from same-source rating in assessing
the strength of transformational leadership in the nursing
context is considerable. This poses problems in the interpretation of findings as they may be prone to method bias.
In light of the repeated observations that nurse leaders
provide inflated self-reports of their transformational characteristics when compared to reports by their followers (Bowles
and Bowles 2000; Dunham-Taylor 2000; Kleinman 2004;
McGuire and Kennerly 2006; Failla and Stichler 2008; Suliman 2009), and followers may overestimate the extent of distant leader transformational characteristics; studies
employing leader self-reports or distant leader reports of
transformational characteristics should be interpreted with
caution. The inclusion, and in some instance, primary reliance upon self-assessments of leadership characteristics
potentially overestimates the evidence regarding the extent
of transformational leadership in the nursing context. Similarly, biases due to the halo effect, social desirability biases
and same-source variance pose threats to the validity of studies and might produce misleading results.
DISCUSSION
It is now more than 20 years since the transformational paradigm was introduced into studies of leadership. Although
much research attention has been directed towards the
concept, it has evolved little over this time (Kark 2004).
Even though theory provides an essential guide to research,
the fact that research on nursing leadership has been largely influenced by Burns and Bass’s interpretations risks
perpetuating the assumption that consensus already exists
on the nature of nursing leadership, and as a consequence,
there is little need to empirically investigate alternative
understandings.
18
The transformational theory of leadership has focused
attention on the characteristics of leaders and their vertical
influence over followers. However, we know little about how
leadership is evoked across organisations, actual leadership
behaviours enacted in the nursing workplace, how context
influences leader behaviour or the interpretation of leader
behaviour or the dynamics within organisations that foster
leadership by those not in designated positions of leadership. It is increasingly evident that leadership occurs at all
levels of an organisation, reducing the importance of traditional charismatic, heroic and strategic interpretations of leader-led behaviour and change. The emergence of alternative
empirical models, such as servant leadership with its focus
on leader humility, self-awareness, transparency and moral
conduct (Dennis and Bocarnea 2005; Jackson 2008), authentic leadership that seeks to transcends charisma and symbolic
status (Avolio and Gardner 2005) and more proximal forms
of transformational leadership (Alimo-Metcalfe and AlbanMetcalfe 2005), suggests there is much about leadership that
remains largely unexplored in the nursing context.
Importantly, the potential darker or less romantic
features of leadership have been given little attention in the
nursing literature. The overly optimistic interpretations of
leadership favoured in nursing have meant that little
acknowledgement has been given to the fact that leaders can
do harm – either intentionally or unintentionally. Research
into bullying and wrong-doing within the nursing context
have identified the importance of considering the damaging
dimensions of negative leadership behaviours (Jackson et al.
2012), especially when they are linked to avoidant or corrupt
forms of nursing leadership (Hutchinson et al. 2009).
In nursing, there has been a predominant focus upon
understanding leadership in terms of what are good for the
leader rather than the follower. In the main, followers are
seen to play a passive role; they are the dependent variable
under the influence of leader characteristics and behaviours
(Jackson and Parry 2011). No attention has been given to
understanding followers as constructors of leaders, followers
as moderates of leader impact or follower as co-constructors
of leader success or failure.
As noted, there has been a tendency among nurses
researching leadership to repeatedly recycle the same methodological approach with little attention given to its limitations. Although there are methodological justifications for
repeating studies using the same instrument or methodology,
to largely ignore other interpretations of leadership risks narrowing rather than extending knowledge. Given the potential limitations of the transformational model and the design
limitations of many studies, it is possible that the claims
made by proponents regarding the extent of transforma 2012 Blackwell Publishing Ltd
Transformational leadership in nursing
tional leadership in nursing are overstated. In some
instances, assertions have been made that nursing leadership
styles are predominately transformational when the data presented provides alternative or less unambiguous explanations (Suliman 2009).
With leaders consistently rating their transformational
characteristics more highly than their followers, questions
must be raised as to whether nurse leaders really are as transformational as reported in studies. Rather than continuing
to measure leader self-reports and followers reported perceptions of leadership characteristics, it may be more fruitful for
future research to consider assessing the extent of actual
leadership behaviours rather than continuing to focus upon
perceptions of leadership. It has been suggested that leadership is best studied from the point of view of those who are
meant to be most affected (Harns and Crede 2010). In nursing, there has been a predominant focus upon understanding leadership for the good of the leader or followers.
CONCLUSION
We have sought to raise discussion on the potential limitations of the transformational model of leadership. Without
diminishing the contributions of previous research and writing, we believe it is timely to review the substantive nature of
the evidence for transformational leadership as it has been
applied in the nursing context. The emergence of studies
seeking to develop alternative interpretations of nursing
leadership illustrate that there are many aspects of leadership that remain unexamined and fruitful new avenues to
explore (Stanley 2008; Patrick et al. 2011). Much work
remains to be performed in expanding our conceptualisation of nursing leadership. It is clear that more attention
must be paid to ethics and values in leadership research, particularly the role of integrity.
Leadership failure has been associated with suboptimal
clinical outcomes and a poor-quality work environment for
nurses (Garling 2008). However, much nursing research and
scholarship in the area has had a narrow focus with a predominance of work on a single model – transformational
leadership. While there are a number of data-based papers
attempting to measure the effects of this leadership
approach in the clinical environment, theoretical weakness
in the model and limitations in research design mean that
convincing evidence remain weak. In view of the critical
importance of effective leadership to nurses and patients, it
is imperative that nurse-researchers and scholars are open to
embrace or lead new ways of thinking about leadership. We
suggest it is time for a more comprehensive and contemporary interpretation of nursing leadership, one which is cogni 2012 Blackwell Publishing Ltd
sant of the complexities and challenges of the healthcare
environment.
REFERENCES
*Al-Hussami M. 2009. Predictors of nurses’ commitment to
health care organizations. Australian Journal of Advanced
Nursing 26: 36–48.
Alimo-Metcalfe B and J Alban-Metcalfe. 2005. Leadership:
Time for a new direction? Leadership 1: 51–71.
Alvesson M, H Willmott and M Briarcliff. 1992. On the idea
of emancipation in management and organization studies. The Academy of Management Review 17: 432–43.
Alvesson M and H Wilmott. 1992. Critical management studies.
London: Sage Publications.
Avolio B and B Bass. 1988. Transformational leadership, charisma and beyond. In Emerging leadership vistas, ed J Hunt,
29–49. Lanham, MD: Lexington Books.
Avolio BJ, BM Bass and DI Jung. 1999. Re-examining the
components of transformational and transactional leadership. Journal of Occupational and Organizational Psychology
72: 441–62.
Avolio BJ and WL Gardner. 2005. Authentic leadership
development: Getting to the root of positive forms of
leadership. The Leadership Quarterly 16: 315–38.
Avolio BJ, W Zhu, W Koh and P Bhatia. 2004. Transformational leadership and organizational commitment:
Mediating role of psychological empowerment and moderating role of structural distance. Journal of Organizational Behavior 25: 951–68.
Bass B. 1999. On the taming of charisma: A reply to Janice
Beyer. Leadership Quarterly 10: 541–53.
Bass BM. 2003. Power to change: A conversation with Bernard M. Bass. Leadership in Action 23: 9–11.
Bass BM and BJ Avolio. 1994. Improving organizational effectiveness through transformational leadership. London: Sage.
Bass BM, BJ Avolio and L Goodheim. 1987. Biography and
the assessment of transformational leadership at the
world-class level. Journal of Management 13: 17–9.
Bass BM and P Steidlmeier. 1999. Ethics, character, and
authentic transformational leadership behavior. Leadership Quarterly 10: 181–217.
Bass B, BJ Avolio, DI Jung and Y Berson. 2003. Predicting unit
performance by assessing transformational and transactional leadership. Journal of Applied Psychology 83: 207–18.
*Bowles A and NB Bowles. 2000. A comparative study of
transformational leadership in nursing development
units and conventional clinical settings. Journal of Nursing
Management 8: 69–76.
19
H Hutchinson and D Jackson
Burns JM. 1978. Leadership. New York: Harper and Row, Publishers, Inc.
*Chen H and M Baron. 2006. Nursing directors’ leadership
styles and faculty members’ job satisfaction in Taiwan.
Journal of Nursing Education 45: 404–11.
Cowden T, G Cummings and J Profetto-McGrath. 2011.
Leadership practices and staff nurses’ intent to stay:
A systematic review. Journal of Nursing Management 19:
461–77.
Cummings GG, T MacGregor, M Davey, H Lee, CA Wong
and E Lo. 2010. Leadership styles and outcome patterns
for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies 47:
363–85.
Dennis RS and M Bocarnea. 2005. Development of the servant leadership assessment instrument. Leadership and
Organization Development Journal 26: 600–15.
Derckz De Casterle B, A Willemse, M Vershcueren and
K Milisen. 2008. Impact of clinical leadership development on the clinical leader, nursing team and care-giving
process: A case study. Nursing Management 16: 753–73.
*Dunham-Taylor J. 2000. Nurse executive transformational
leadership found in participative organizations. Journal of
Nursing Administration 30: 241–50.
Eagly AH, MC Johannesen-Schmidt and ML van Engen.
2003. Transformational, transactional, and laissez-faire
leadership styles: A meta-analysis comparing women and
men. Psychological Bulletin 129: 569–91.
Ergeneli A, R Gohar and Z Temirbekova. 2007. Transformational leadership: Its relationship to culture value
dimensions. International Journal of Intercultural Relations 31:
703–24.
*Failla KR and JF Stichler. 2008. Manager and staff perceptions of the manager’s leadership style. The Journal of
Nursing Administration 38: 480–7.
Garling P. 2008. Final report of the special commission of inquiry
into acute care services in NSW public hospitals. Sydney: NSW
Department of Health.
Graham JW. 1988. Transformational leadership: Fostering
follower autonomy, not automatic followership. In Emerging leadership vistas, eds JG Hunt, BR Baliga and CA Schriesheim, 73–9. Lexington Books: Lexington, MA.
Groves KS and MA LaRocca. 2011. An empirical study of
leader ethical values, transformational and transactional leadership, and follower attitudes toward corporate social responsibility. Journal of Business Ethics 103:
511–28.
Hannah ST, BJ Avolio, F Luthans and PD Harms. 2008.
Leadership efficacy: Review and future directions. The
Leadership Quarterly 19: 669–92.
20
Harns PD and M Crede. 2010. Emotional intelligence and
transformational and transactional leadership: A metaanalysis. Journal of Leadership and organizational Studies
17: 5–17.
Hater JJ and BM Bass. 1988. Superiors’ evaluations and subordinates’ perceptions of transformational and transactional leadership. Journal of Applied Psychology 73:
695–702.
Hopfl H. 1992. The making of the corporate acolyte: Some
thoughts on charismatic leadership and the reality of
organizational commitment. Journal of Management Studies 29: 23–33.
Horwitz IB, SK Horwitz, P Daram, ML Brandt, CF Brunicardi
and SS Awad. 2008. Transformational, transactional, and
passive-avoidant leadership characteristics of a surgical
resident cohort: Analysis using the multifactor leadership
questionnaire and implications for improving surgical
education curriculums. The Journal of Surgical Research
148: 49–59.
Hutchinson M, M Vickers, L Wilkes and D Jackson. 2009.
The worse you behave, the more you seem, to be
rewarded: Bullying in nursing as organizational corruption. Journal Employee Responsibilities and Rights Journal
21: 213–29.
Jackson D. 2008. Servant leadership in nursing: A framework
for developing sustainable research capacity in nursing. Collegian: Journal of the Royal College of Nursing Australia 15: 1–6.
Jackson B and K Parry. 2011. A very short fairly interesting and
reasonably cheap book about studying leadership. UK: Sage.
Jackson D, M Hutchinson, K Peters, L Luck and D Saltman.
2012. Understanding avoidant leadership in health care:
Findings from a secondary analysis of two qualitative
studies. Journal of Nursing Management. doi: 10.1111/
j.1365-2834.2012.01395.x.
Johnstone MJ. 2004. Patient safety, ethics and whistleblowing: A nursing response to the events at the Campbelltown and Camden hospitals. Australian Health Review 28:
13–9.
*Kanste O. 2008. The association between leadership behaviour and burnout among nursing personnel in health
care. Nursing Science 89: 4–8.
Kark R. 2004. The transformational leader: Who is (s)he? A
feminist perspective. Journal of Organizational Change Management 17: 166–76.
Khoo H and GSJ Burch. 2008. The ‘dark side’ of leadership
personality and transformational leadership: An exploratory study. Personality and Individual Differences 44: 86–97.
*Kleinman C. 2004. The relationship between managerial
leadership behaviors and staff nurse retention. Hospital
Topics 82: 2–9.
2012 Blackwell Publishing Ltd
Transformational leadership in nursing
Kouzes JM and BZ Posner. 1987. The leadership challenge: How
to get extraordinary things done in organizations. San Francisco: Jossey-Bass.
Korman AK. 1966. Consideration, initiating structure, and
organizational criteria. Personnel Psychology, 18: 349–60.
Kouzes JM and BZ Posner. 2000. Leadership practices inventory:
Psychometric properties. San Francisco, CA: Wiley.
*Larrabee J, A Michelle, CL Ostrow, ML Withrow, GR Hobbs
and B Christopher. 2003. Predicting registered nurse job
satisfaction and intent to leave. Journal of Nursing Administration 33: 271–83.
*Leach LS. 2005. Nurse executives transformational leadership and organizational commitment. Journal of Nursing
Administration 35: 228–37.
*Lee D, A Coustasse and A Sikula. 2011. Workplace injury
and absenteeism: Analysis of a National nursing assistant
survey. Health Care Management Review 36: 380–7.
Lievens P, FP Van Geit and P Coetsier. 1997. Identification
of transformational leadership qualities: An examination
of potential biases. European Journal of Work and Organizational Psychology 6: 415–30.
Lindebaum D and S Cartwright. 2010. A critical examination
of the relationship between emotional intelligence and
transformational leadership. Journal of Management Studies
47: 1317–42.
Linstead S. 2004. Managing culture. In Management and organization: A critical text, eds S Linstead and S Lilley, 93–122.
Basingstoke: Palgrave Macmillan.
Lowe KB, KG Kroeck and N Sivasubramaniam. 1996. Effectiveness correlates of transformational and transactional
leadership: A meta-analytic review. Leadership Quarterly 7:
385–425.
*Malloy T and B Penprase. 2010. Nursing leadership style
and psychosocial work environment. Journal of Nursing
Management 18: 715–25.
*McDaniel C and GA Wolf. 1992. Transformational leadership in nursing service: A test of a theory. The Journal of
Nursing Administration 22: 60–5.
*McGuire E and SM Kennerly. 2006. Nurse managers as
transformational and transactional leaders. Nursing
Economics 24: 179–85.
Murphy L. 2005. Transformational leadership: A cascading
chain reaction. Journal of Nursing Management 13: 128–36.
Parry KW and SB Proctor-Thomson. 2002. Perceived integrity of transformational leaders in organizational settings.
Journal of Business Ethics 35: 75–96.
Parry KW and SB Proctor-Thomson. 2003. Leadership, culture and performance: The case of the New Zealand
public sector. Journal of Change Management 3: 376–99.
2012 Blackwell Publishing Ltd
Patrick A, HK Spence Laschinger, C Wong and J Finegan.
2011. Developing and testing a new measure of staff
nurse clinical leadership: The clinical leadership survey.
Journal of Nursing Management 19: 449–60.
Pfeffer J. 2007. Human resources from an organizational
behavior perspective: Some paradoxes explained. Journal
of Economic Perspectives 21: 115–34.
*Prenkert F and M Ehnfors. 1997. A measure of organizational effectiveness in nursing management in relation
to transactional and transformational leadership: A study
in a Swedish country hospital. Journal of Nursing Management 5: 279–87.
Salancik GR and J Pfeffer. 2003. The organization as a political arena. In Central currents in organization studies, ed
S Clegg, 20–42. London: Sage Publications.
*Salinova M. 2011. Linking transformational leadership to
nurses’ extra-role performance: The mediating role of
self efficacy and work engagement. Journal of Advanced
Nursing 67: 2256–66.
Schriesheim CA, JB Wu and CD Cooper. 2011. A two-study
investigation of item wording effects on leader-follower
convergence in descriptions of the leader-member
exchange (LMX) relationship. The Leadership Quarterly
22: 881–92.
Shamir B. 1995. Social distance and charisma: Theoretical
notes and an exploratory study. Leadership Quarterly 6:
19–47.
Smirich L. 1983. Concepts of culture and organizational
analysis. Administrative Science Quarterly 28: 339–58.
Smirich L and M Calas. 1995. Introduction. In Critical perspectives on organization and management theory, eds L Smirich
and M Calais, xiii–xxix. Aldershot, UK: Dartmouth Publishing Company.
Sosika JJ, J Juzbasich and J Uk Chun. 2011. Effects of moral
reasoning and management level on ratings of charismatic leadership, in-role and extra-role performance of
managers: A multi-source examination. The Leadership
Quarterly 22: 434–50.
Stanley D. 2008. Congruent leadership: Values in action.
Journal of Nursing Management 16: 519–24.
Stanley D and A Sherratt. 2010. Lamp light on leadership:
Clinical leadership and Florence Nightingale. Journal of
Nursing Management 18: 115–21.
*Stordeur S, C Vandenberghe and W D’hoore. 2000. Leadership styles across hierarchical levels in nursing departments. Nursing Research 49: 37–43.
*Suliman WQ. 2009. Leadership styles of nurse managers in
multinational environment. Nursing Administration Quarterly 33: 301–9.
21
H Hutchinson and D Jackson
Tourangeau AE. 2003. Building nurse leader capacity. The
Journal of Nursing Administration 33: 624–6.
*Tourangeau AL, L Cranley, HK Spence Laschinger and
J Pachis. 2010. Relationships among leadership practices,
work environments, staff communication and outcomes
in long-term care. Journal of Nursing Management 18:
1060–72.
Toursih D and A Oinnington. 2002. Transformational leadership, corporate cultism and the spirituality paradigm:
An unholy trinity in the workplace? Human Relations 55:
147–72.
Trapero F and V De Lozada. 2010. Differences between the
relationship of integrity and leadership styles according
to the model of Bernard Bass. Estudios Gerenciales 26: 59–
75.
Ward K. 2002. A vision for tomorrow: Transformational nursing leaders. Nursing Outlook 50: 121–6.
Weberg D. 2010. Transformational leadership and staff
retention an evidence review with implications for
healthcare systems. Nursing Administration Quarterly 34:
246–58.
22
Wilson M. 2005. Subscales and summary scales issues in
health related outcomes. In Outcomes assessment in cancer:
Measures, methods and applications, eds J Lipscomb and
C Snyder, 465–79. London: Cambridge University Press.
Wong C and G Cummings. 2007. The relationship between
nursing leadership and patient outcomes: A systematic
review. Journal of Nursing Management 15: 508–21.
Zagorsek HS, S Stanley and J Markjo. 2006. Analysis of the
reliability of the Leadership Practices Inventory in the
item response framework. International Journal of selection
and Assessment 14: 180–91.
Zhu W, IK Chew and D William. 2005. CEO transformational
leadership and organizational outcomes: The mediating
role of human-capital enhancing resource management.
The Leadership Quarterly 16: 39–52.
Zhu W, RE Riggio, JB Avolio and JJ Sosik. 2011. The
effect of leadership on follower moral identity: Does
transformational ⁄ transactional style make a difference.
Journal of Leadership and Organizational Studies 18: 150–
63.
2012 Blackwell Publishing Ltd
Debra Jackson