The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal. / Thesis (Ph.D.)-University of Natal, Durban. 1998.

Rapid and chaotic changes in health care have created a need for a new type of nursing leadership. Many leadership theories have been studied and adopted by nursing. However, historical approaches to leadership will not help nurses thrive in the current health care arena.The purpose of this study was to describe a case example of nursing leadership using a topical life history of one exceptional nurse leader. The topical life history describes two representative periods in an exemplary nurse leader's life to fully describe an insider's perspective of leadership. This definition, which includes the participant's interactions with her self, others, and her environment during two significant periods during her life, will be used as the initial case for the future collection of multiple case examples in an effort to develop a definition of nursing leadership.Nursing leadership was defined, based on the interpretation of interview transcripts, as: Hard work, vision, communication, coaching/facilitating, strong values, proactivity, and charisma. Findings support various leadership theories and identified two core categories previously poorly defined in nursing leadership literature: Hard work and street smarts. Implications for nursing research, education, and practice have been identified. Recommendations for use of this study as a case example to stimulate classroom discussion have been made. Additional recommendations for further research in the areas of hard work and street smarts have also been made. / School of Nursing

America's health care industry is in a state of crisis. Nursing administrators are in the position to facilitate change in institutions. One aspect of nursing which has remained constant is high turnover rates. The high turnover rates have been linked to job dissatisfaction. One method of reducing turnover is to provide greater job satisfaction to staff nurses. Job satisfaction has been connected with management style (Lucas, 1991; Price & Mueller, 1981; Volk & Lucas, 1991).This study described the impact of head nurse management style on staff nurse job satisfaction. Likert's (1967) System 4 management theory was utilized as the framework in the study. All staff nurses and head nurses from three Central Indiana hospitals were given the opportunity to participate in the study. Participants completed two questionnaires, one from Price and Mueller's (1981) work on turnover to determine job satisfaction and one from Likert and Likert's (1976) work to determine management style.Data analysis was conducted to describe any variations between staff nurse experience of head nurse management style and staff nurse job satisfaction. Differences between head nurse and staff nurse description of management style were also examined. There were no identified risks as participation was voluntary and did not affect the employment status of any individual.Results of the study demonstrated agreement with previous research findings. When management style is closer to participative (system 4), greater job satisfaction is expressed. Recommendations are to provide management training and training in communication and self-awareness for head nurses, and to form unit based committees designed to achieve greater staff input in decisions affecting the unit functioning.Benefits of the study include identification of the management style which leads to improved staff nurse job satisfaction. Equipping nurse administrators with information regarding desirable management style to employ for staff nurses to experience greater job satisfaction, and training present managers in that management style are also possible benefits from the study. / School of Nursing

In balancing the divergent needs of staff, patients, families, support services and upper management, the nurse middle manager (NMM) in the acute care hospital faces daily stresses in dealing with the demands of the management role. The purpose of the study was to identify the relationship between hardiness, a stress resistance buffer, and coping effectiveness among NMMs. The conceptual framework used in the study was Lazarus' theory of stress and coping. The study was based on a descriptive correlational comparative design. The instruments used were: (a) the Health Related Hardiness Scale (HRHS), measuring hardiness; (b) the .Jalowiec Coping Scale (-JCS), measuring coping mechanisms and coping effectiveness; and (c) a demographic data form, describing the sample. A convenience sample of 201 (37.2X) NMMs representing 31 Indiana acute care hospitals participated in the study. Confidentiality of the subjects was maintained throughout the study. A Pearson r correlation, used to analyze the data of the HRHS and .JCS, indicated a weak: positive relationship at a significant level (r=.2S; p=':.OO1) between hardiness and coping effectiveness. Descriptive statistics wereused to determine that the most frequently used coping mechanisms were confrontive, optimistic, and self-reliant. No relationship was identified between hardiness and age (r=-.07; p=.33). No differences were identified between: (a) hardiness and present level of NMM educational preparation, and (b) hardiness and NMMs that reported 'adequate' and 'inadequate' social support (work and family). It was concluded that NMMs in the study had a high level of hardiness. A lower level of coping effectiveness (mean ;: effectiveness score, 3.30) indicated the use of a limited number of coping mechanisms, which may be the result of limitations in the work setting. The low correlation between hardiness with coping effectiveness may be the result of: (a) a low level of coping effectiveness, or (b) the use of a limited number of coping mechanisms resulting from limitations in the work setting. Confrontive, optimistic, and self-reliant coping mechanisms may be the most appropriate styles in the work setting for NMMs. The use of healthy coping mechanisms by the NMMs may be the result of the programs supporting the transition from clinician to manager provided by the participating hospitals. Organizations should plan strategies to help NMMs (both established and those new to the position) develop a sense of commitment to the organization, a feeling of challenge from the job demands, and a plan to provide control of the responsibilities of the position in order to sustain the present high levels of hardiness for the NMMs. / School of Nursing

This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing�s perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on August 28, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Anna M. McDaniel (Chair), Mary L. Fisher, Patricia R. Ebright, Bradley N. Doebbeling. Includes vita. Includes bibliographical references (leaves 140-154).

Thesis (M.N.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Nursing, Nursing. Title from pdf file main screen (viewed on April 28, 2010). Includes bibliographical references.

Performance Management and Development System (PMDS) is a process of harnessing human and material resources within an organisation to ensure maximum performance to achieve the desired results of improved quality of health service delivery. This study explored and described the ontological experiences of nurses of all categories with contracting and doing performance reviews in a public hospital in the Eastern Cape Province. Purposive sampling approach was used to recruit all categories of nurses Data was collected through unstructured, individual, in-depth interviews with professional nurses and focus group interviews with lower categories. Techs eight step data analysis method was employed to analyse data. Major findings were related to lack of supervisor cooperation, shortage of resources, difficulty in calculating the scores, lack of understanding the tool, time constraints and paperwork which results in the tool being viewed as time consuming. Positive findings were that experiences such as improved relations resulting from spending time with supervisors during performance review sessions. Guidelines were developed, based on the findings, to empower both nurse clinicians and the supervisors in the implementation of the PMDS. , / Health Studies / D. Litt. et Phil. (Health Studies)

M.Cur. (Nursing Management) / Assertiveness is the ability to express oneself and one’s rights without violating the rights of others (http: www.naidex.co.uk/page.cfml/link). The need for assertiveness is widely acknowledged in different work settings, and in order to manage the stress of working as part of a team every day, one has to become assertive. Acquiring and using assertiveness involves a simple and effective technique whose main object is to promote and maintain one’s personal health, self-esteem and healthy relationships with other people (Booyens, 2005:395). In the course of her work as a nurse manager in an academic hospital, the researcher became aware in an academic hospital setting that some professional nurses and nurse managers in an academic hospital setting were lacking assertive behaviour in their interactions and relationships with their colleagues. The purpose of the study was to explore and describe the kinds of assertive behaviour of professional nurses and nurse managers in the nursing units of two academic hospitals in the Pretoria region, in order to identify guidelines for effective assertive behaviour in such contexts. In this study a quantitative, descriptive and explorative design was used in order to obtain information from permanent professional nurses and nurse managers working in units of two academic hospitals in Pretoria. All of the nurse managers (n = 80) in these units were included in the study as the total sample. Four hundred and forty (n = 440) professional nurses and eighty (n = 80) nurse managers were eligible to participate in the study. Simple random sampling of the professional nurses was conducted to obtain a sample (n = 110). The method of data collection was a self-administered, structured questionnaire whose purpose was to explore and describe the assertive behaviour of professional nurses and nurse managers in academic hospital settings in the Pretoria region (Burns & Grove, 2005:398).Validity and reliability were ensured by using the principles of Riley, Wood, Clark, Wilkie and Szivas (2004:126) as well as the principles of Goddard and Melville (2001:46). Ethical standards for nurse researchers were adhered to. Descriptive statistics were arrived at by using SPSS (Version 20)