The mean value of perceived leadership behaviour
was lower than the preferred in all three dimensions.
There is a lack in mean values between the leadership
behaviour that the subordinates prefer and the managers
can perform. Although it seems to be possible to
reach the preferred levels as there are 12 nurse managers
who are rated near the preferred mean values in
all three dimensions.
The two highest valued dimensions by the subordinates
in our study (employee and change), both in preferred
and in perceived leadership, represent the basis of
transformational leadership style. In some earlier leadership
theories a leader that was high performing in
both task and relation orientation was supposed to be
the most effective in all kind of situations (Blake &
Mouton 1982). The advocates for transformational
leadership prefer high performance in relation and
change to garden the followers (Bass & Avolio 1985,
Prenkert & Ehnfors 1997). Boumans and Landeweerd
(1993) found that the Netherlands nurses were most
satisfied if the nurse manager had a combination of
high-social/high-instrumental (task and production)
leadership. In that research only two dimensions of
leadership were studied and the dimension change orientation
was not included.
It was not possible in our study to identify all of the
10 leadership profiles that have been identified in the
other studies carried out with the CPE instrument
(Ekvall & Arvonen 1994, Ekvall 2002). These studies
comprised large samples of managers from different
organizations (industry, trade, transportation, service,
care, education, media and consultancy). Both male and
female managers were included. In our study only five
managers had values that were unequal in the three
dimensions according to standard deviation for the
mean value. All the others had equal values in all three
dimensions. This could depend on the fact that the
nurse managers are mostly fostered in the nursing
profession and this pattern becomes a part of their
behaviour. Their way to promote leadership is also as a
role model, which influences others to behave in a
similar way (Eagly & Johannesen-Schmidt 2003).
Fanslow (1984) described that leadership style was
related to a personal value system that has been formulated
by culture, society and life experience. Cook
(2001) identified five different types of effective nursing
leaders. In our study we have not investigated how
effective the different identified styles are.
Nursing is also a woman-dominated profession and it
is therefore natural that nurse managers are mostly
women because they are recruited from the profession.
In our study there were only three men among the
respondent nurse managers. In earlier research it is
shown that leadership style could be a gender issue
and that women are more inclined to use the transformational
leadership style (Bass et al. 1996, Eagly &
Johannesen-Schmidt 2003). On the contrary, in this
research none of the managers in our study were identified
as a transformational leader.
In our study there were nine managers that expressed
a more vague leadership style.
Hersey and Blanchard (1982) postulated that as the
level of maturity among followers increased, leadership
required less task orientation and less socio-emotional
support (Goldenberg 1990). That is, the more experienced
and motivated, the more independent the subordinates
will be of leader’s direction and support. Bass
(1985) calls this style laissez-faire and states that such
leadership style is not adequate in any situation.
In a recently published study, nursing managers
were asked what competencies they thought where
needed for nursing management in 2020 (Scoble &
Russel 2003). The key competence was identified as
leadership behaviour and specific items in the analysis
were transformational leadership, visioning and perseverance.
The educational training in nursing leadership is
about 5 weeks in Swedish nursing programmes
(Sverigesriksdag 1993). This 5-week education includes
leadership theories, laws and other regulations, quality
work, supervision, economy and organization (Sveriges
riksdag 1993).
At several universities there are health management
courses up to 60 weeks in duration. In these courses the
student learns about the political and organizational
system, about economics, quality improvement and
scientific methodology. Leadership behaviours suitable
for health care organization are poorly explored during
education and our study shows that there is a potential
for improvement.
Methodological considerations
Questionnaires have limitations (Ekvall 1992, Arvonen
2002). An advantage of the one used in the present
study is that both construct and predictive validity of
the instrument are demonstrated (Arvonen 2002).
Behaviour description questionnaires devised to study
leadership have been questioned by several researchers
since this tradition began. The main claim has been
that they measure the attitudes of subordinates
towards the leader and not real behaviour. The research
group at Ohio met the critique by presenting
studies which showed significant correlations between
subordinates who described the same leader (Ekvall
1992). The CPE questionnaire has been tested in
relation to influence of attitude. The change and production
dimension showed no correlations with attitude.
The employee dimension had a medium size
(0.40) coefficient, which is logical, because being
accepted and liked is a psychological drive in relationoriented
behaviour (Ekvall & Arvonen 1994). The
dropout rate was normal for this type of study and the
dropout analysis showed no selection bias.