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

Document Type : Original articles


1 B.Sc. Nursing

2 Professor in Nursing Administration, Department, Faculty of Nursing, Minia University

3 Lecturer in Nursing Administration, Department, Faculty of Nursing, Minia University


Background: Head nurses are the important portion in nursing administration. The responsibilities of head nurses are to manage the nurses properly and provide the best quality of care to the patients. Thus, the provision of the supportive leadership can retain the employees in the long run and better health care services can be ensured. Aim of the Study: The aim of the current study was to determine The effect of head nurse's leadership style on their nurses' turnover intention at the Minia General Hospital. Research Question: Is the head nurse's leadership style affecting their nurses' turnover intention? Research Design: A descriptive correlational research design was utilized to achieve the aim of the current study. Setting: The study was conducted at Minia General Hospital. Sample: The subjects of the study consisted of (232) staff nurses working in Minia General Hospital. Tools of data collection: included two tools; first tool: the leadership style questionnaire; second tool: turnover intention questionnaire. Results: there was a positive correlation between autocratic style and turnover intention. Furthermore, about the third quarter of staff nurses had an intention to leave the hospital. Conclusion: the result indicated that the dominantly style by head nurses was an autocratic leadership style that lead to a high desire of staff nurse turnover intention.


Engy Boles Adly Henen*; Sahar Ahmed Abood**; Rasha Mohammed Nagib***

* B.Sc. Nursing

** Professor in Nursing Administration, Department, Faculty of Nursing, Minia University

*** Lecturer in Nursing Administration, Department, Faculty of Nursing, Minia University

Corresponding author: Engy Boles Adly henen Email:Engyboles144@yahoo.com



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.



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



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





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


Leadership style

Mean + SD

F value



+ SD

Autocratic style


+ 12.14



Delegative style     


+ 11.52



Participative style


+ 6.79



**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




Mean+   SD



-Intention to stay



10.22+ 2.31



-intention to leave



27.53+ 2.81

Total turnover intention scores

37.92 + 2.05

**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




Participative style



turnover intention

Autocratic Style                  



































turnover intention










**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).




 Nurse Managers have the unenviable responsibility of ensuring that nursing staff are engaged and perform their duties to the best of their abilities. And, they should maintain an environment that can conducive to maximize nurses’ potentials which can resulting in retention and can be a by-product of an effective leadership style. Nurse is a trained person who provides care for the sick and injured people especially in the hospital.

All health institutes (hospitals) need the trained highly experienced and efficient nurses who can provide the effective care to the patients. The hospital is an institute which delivers medical, surgical treatment and nursing care to patients. In the hospital, head nurse is one who directly responsible for the supervision of the clinical aspects of nursing cares, and has to play different roles at a time (16).

 The current study showed that about two third percent of staff nurses (62.9%) were female, this result might be attributed to the fact that the majority of nurses who graduated from secondary diploma school and clinical institute complete in the faculty of Nursing were females and society view about the nursing occupation is appropriate to females more males. And more than fifty percent of staff nurses (56%) in the age group from 20-30 years.

As Regards to area of work, the study cover 14 different area of work with different percentage staff nurses which include " Outpatient clinics: 12.5%, Intensive Care Unit: 11.2 %, Operations: 10.3%, Emergency: 9.9%, Dialysis: 9.1%, Neonates: 7.3%, Surgical: 5.6%, Orthopedic: 5.6%, Pediatric: 5.2%, Burns: 5.2%, Medical: 4.7%, Obstetric: 4.7%, Toxins: 4.3 % and finally Sterilization: 4.3% respectively.

This study revealed that the head nurses followed autocratic style in their leadership with Mean + SD (37.14+ 12.14), this may be due to that head nurses like to retain the final decision making authority within their department. And, this is a result due to the head nurses' believe as if they didn't do that, they were lost their control on staff nurses. Also, this believes because they didn't have enough experience in management and they may have no training program on leadership and how to lead staff members.

In addition, this is may be due to that the  nursing leaders  at Minia hospital  face more restrictions from their hospital managers and physicians such as; limited their authority, had not fully displayed conviction, and limited confidence in their commitments, which have an adverse effect on her/ his department. Also, in Minia general hospital, the head nurses influenced by culture, education system that the manager went through, or the organizational environment and leadership style which in turn may influence employees’ decision either to leave or stay with the organization.

These findings were consistent with the work of the S.P.A (2010) which concluded that autocratic leaders have absolute power over their subordinates and the latter have little opportunity to make suggestions (1). Also this confirmed by a study conducted by (Murari, 2011) which reported that most leadership styles used among participant and the authority management styles followed was autocratic leadership shipstyle (17).

In contrast, the finding of (Jandaghi & Matin, 2009) who reported that nurse managers in successful companies had used the transformational style and they are acting strongly in their organizations. In addition, the leaders' have allocated the time to their personnel, training, and the developing skills among employee (18).

Moreover, this study denoted that the majority of staff nurses had an agreement with high percentage (75%) in intention to leave the present place with Mean + SD (27.53+2.81) and one quarter of staff nurses have an intention to stay with Mean + SD (10.22+ 2.31).

From the researcher point of view, this result may be due to many of reasons such as the shortage of nurses and improper work environment, work overload, and excessive work hours with poor leadership styles which affect in the relationship between head nurses and staff nurses.

In addition, this result may be due to the dominant autocratic leadership style used by nurse managers which could affect the staff nurses. Therefore, they feel that her/his nurse manager not help their staff to overcome obstacles in daily basis, neglected the needs of them in order to achieve their performance goals, within rigid rules and procedure, and only can encourage to get things done.

  It was confirmed by Asegid, Belachew and Yimam (2014) (19) which showed that majority of respondents (84.3%) had an intention to leave the organization. In the similar spirit, Hassan and Elhosany (2017) (20) who revealed that less than two thirds of staff nurses who working in Shubra General Hospital had positive turnover intention. In addition, the study conducted in Suez Canal university hospital which reported that, there was less than three quarters of staff nurses working in the hospital had an intention to leave their job (20).

Moreover, the study showed a positive correlation between autocratic leadership style and turnover intention, negative correlation between participative style and turnover intention, and negative correlation between delegative style and turnover intention. These findings may be due to that, the dominant style utilized by the majority of nurse managers was an autocratic leadership style which leads to a high percentage of staff nurses who have turnover intention, whereas staff nurses are not allowed to make any decisions unless it is approved by head nurses, and they do not consider suggestions made by their nurses, because they not have the time for her subordinate. Also, head nurse likes the power that her leadership position holds over subordinates.

This result is consistent according to Dotse and Asumeng (2014) and Ballard (2012) found a significant positive association between autocratic management style and employee turnover intention (21, 22). On the contrary, Wells and Peachey (2011) who reported a significant negative correlation between management style and turnover intention, and the employees may remain with the organization when they perceive their managers as being autocratic (23).

There are contrasting views about the effectiveness of an autocratic leadership style, according to (Fox, 2006). The result of another study suggests that an autocratic leadership style is not linked to high employee intention to leave. These studies told that the autocratic management style is suitable for quick decision-making, but employees perceive themselves as valuable to the organization when they are consulted before decisions are made on matters that affect them. And exclusion from decision-making disempowers employees and they may consider job opportunities outside the organization (24).

Donoghue & Castle, (2009) and Ghosh et al. (2013) emphasized that employees choose to remain in the organization when they are empowered to make decisions because they view themselves as part of the organization (25, 26). Also, this study showed negative correlation between delegative style and turnover intention.

This finding is confirmed by Levac, (2013) who argued that there is a significant negative association between a laissez-faire management style and employee's intention to remain in the organization (27). In contrast, the studies conducted by Ballard, (2012) and Bernhard and O’Driscoll (2011) who reported that laissez-faire management style is positively related to turnover intention, indicating that if employees perceive their managers’ styles as laissez-faire, they are more likely to leave the organization(22, 28).






It can be concluded from current study that, the majority of staff nurses in Minia general hospital agree that the most dominantly styles of head nurses was autocratic leadership style. In addition, the finding of this study denoted that the majority of staff nurses indicate that there was an agreement with high percentage (75%) in intention to leave the organization. Also, it can be concluded that there were a positive correlation between autocratic style and turnover intention.



  • There should be a designing training program for head nurses continued to improve effective leadership style
  • Hospital administration must remove all organizational factors that hinder the decision making process or generate conflict and create a healthy work environment and culture
  • Establish an evaluation system to assess head nurses managerial competencies before recruitment.
  • Undergraduate curriculum should include in-depth application of content related to different leadership style especially transformational leadership style.
  • There should be a collaboration between faculty of nursing and hospital management to practice the appropriate leadership style at the first line manager level
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