qualitative research on transformational leadership

Transformational Leadership: A Qualitative Study for the Practical Usage

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• First Online: 23 April 2020
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• Nil Selenay Erden 7 &
• Murat Yaşlioğlu 8  

Part of the book series: Eurasian Studies in Business and Economics ((EBES,volume 13/2))

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The aim of this study is to clarify the transformational leadership behaviors, related with the four dimensions of the transformational leadership construct in order to increase the consistency between theoretically defined transformational leadership behaviors and actually observed ones. In this respect, items measuring the degree of transformational leadership capability of a leader were studied and ambiguous items were chosen. Twenty participants were asked to evaluate the meaning of those items; by asking their opinions about the “specific courses of action a leader takes to behave in that particular way.” Results, presented in detail, display that participant views were a valuable tool to make the fuzzy items more concrete. Study results also highlight the possibility that transformational leadership scale can and should be improved with additional in-depth investigation.

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Department of Organizational Behavior, Istanbul University, Istanbul, Turkey

Nil Selenay Erden

Department of Management, Istanbul University, Istanbul, Turkey

Murat Yaşlioğlu

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Faculty of Political Sciences, Istanbul Medeniyet University, Istanbul, Turkey

Mehmet Huseyin Bilgin

MUFG Union Bank, San Francisco, CA, USA

Hakan Danis

Faculty of Tourism, Istanbul Medeniyet University, Istanbul, Turkey

Ender Demir

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Ahmet Faruk Aysan

Appendix: Online Question Form

1.1 how do leaders transform their organizations, 1.1.1 your suggestions to merge theory with practice.

Transformational leaders have inspiring future visions. Those leaders share their visions with their followers. Basically they gain their followers’ respect and trust, and persuade them to share the vision. The vision includes leader’s dreams and it is the leader’s job to make those dreams come true, by acting as a change agent. The high expectations are communicated with enthusiasm, through individualized attention. The relationships with followers include coaching and increasing their potential by leading them to required mental models and behaviors that would foster the desired change.

The abovementioned definition seems blurry. We would like to make it more clear by identifying specific leader behaviors that would be expected from a transformational leader. Help us list those behaviors by reading each item below and writing your suggestions.

The leader expresses his/her confidence that we will achieve our goals.

How does a leader display confidence? What are the actions that a leader performs to display confidence?

I have pleasure in working with him/her.

Describe the leader that you would have pleasure working with and behaviors you expect from her/him.

The leader displays a sense of power and confidence.

How does a leader display sense of power and confidence? List the leader behaviors that would display power and confidence.

The leader emphasizes the importance of having a collective sense of mission.

How does the leader emphasize the importance of collective sense of mission? Can you list specific leader behaviors?

The leader specifies the importance of having a strong sense of purpose.

How does the leader emphasize the importance of having strong sense of purpose? Can you list specific leader behaviors?

The leader treats me as an individual rather than just a member of a group.

What are the courses of action that a leader takes to treat you as an individual?

The leader focuses me on developing my strengths.

What are the courses of action a leader takes to lead you toward developing your strengths?

The leader suggests new ways of looking at how we do our jobs.

What are the courses of action a leader takes to suggest new ways of looking at performing the jobs?

Name-Surname:

Your gender:

Your educational status:

Do you work with a transformational leader: () Yes () No.

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Erden, N.S., Yaşlioğlu, M. (2020). Transformational Leadership: A Qualitative Study for the Practical Usage. In: Bilgin, M., Danis, H., Demir, E., Aysan, A. (eds) Eurasian Business Perspectives. Eurasian Studies in Business and Economics, vol 13/2. Springer, Cham. https://doi.org/10.1007/978-3-030-40160-3_11

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Beyond transformational leadership in nursing: A qualitative study on rebel nurse leadership‐as‐practice

• Toekomstbestendige Gezondheidszorg
• Gezondheidseconomie

Research output : Contribution to journal › Article › Scientific › peer-review

Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also want to feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses’ experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between “bad” and “good” rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for “good” rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.

• CLINICAL LEADERSHIP
• focus groups
• nursing practice
• positive deviance

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• Open access
• Published: 13 January 2023

Transformational leadership in development of transformative education in nursing: a qualitative study

• Azam Ghorbani   ORCID: orcid.org/0000-0003-1240-745X 1 ,
• Nooredin Mohammadi 2 ,
• Zahra Rooddehghan 3 ,
• Fatemeh Bakhshi   ORCID: orcid.org/0000-0002-9238-0340 4 &
• Alireza Nikbakht Nasrabadi   ORCID: orcid.org/0000-0002-3970-4158 5  

BMC Nursing volume  22 , Article number:  17 ( 2023 ) Cite this article

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Regarding the dynamic and increasing needs of communities, changes in the education system are essential to train competent healthcare professionals. The study aimed to explore the experience of educational directors, teachers, and students to gain insight into the implementation of educational transformative programs.

A qualitative approach with the grounded theory method was applied in this study. Twenty-four participants were selected by using a purposive and theoretical sampling method. The data were collected from April 2019 to May 2020 in nursing schools of Tehran, through in-depth semi-structured individual face-to-face interviews and field notes. Collected data were analyzed by Corbin and Strauss’s (2015) approach.

In this study, transformational leadership was extracted as the core concept. The core concept emerged from four sub-concepts including transformative management; educational policy requirements; providing a platform and community-centered education.

Conclusions

Nurse educational directors need to achieve some competencies and capabilities for implementing transformative education in nursing schools. Also, achieving a transformative perspective by educational directors is essential.

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Transformation in the healthcare education system is inevitable which is required to make a balance between the healthcare educational system and community demands [ 1 , 2 ]. Several leading factors trigger educational organizations to begin transformational changes and reform the education system [ 3 ]. The main factors include ever-changing needs in the community, rapid advances in medical science, globalization, commercialization of higher education, and incompatibility between healthcare professionals’ qualifications and their competencies [ 1 , 2 ].

In addition, advanced new and emerging technologies are acknowledged as influential factors in the transformation of the education system [ 1 , 4 ]. The new generation of learners prefers technology-based communication. They expect their education to be integrated with technology and have become accustomed to high-tech learning environments [ 5 ]. Also, the evolution of psychological and educational theories has resulted in the development of human-centered learning methods [ 6 ]. During recent decades, education systems experienced major reforms related to the development of psychological and teaching–learning theories and the advancement of educational technology [ 2 ].

Accordingly, reforming the nursing education systems is required to address the development of the teaching–learning process and ever-changing healthcare needs in the communities [ 7 , 8 ]. Nurses play a key role in the health system. As a result, nurse educators must implement the required measures to transform and improve nursing education systems [ 9 ] and prepare students to deal with today’s complex and evolving healthcare settings [ 1 , 10 , 11 ].

Transformative education (TE) is a recommended strategy to improve the quality of education and health systems [ 1 , 11 ]. TE is an approach that claims to change the common concept of education which merely focus on transferring knowledge from the teacher to the learner [ 12 ]. The application of TE in higher education has led to knowledge construction, and ontological and epistemological transformation [ 13 ]. TE seeks to develop processes that result in long-lasting learning changes rather than immediate and dramatic change [ 14 ].

The TE approach is launched through a set of educational reforms such as adopting competency-based approaches, developing interprofessional education, promoting teamwork, and developing the teaching capabilities of faculty members [ 1 ]. According to Renigere [ 15 ], TE leads to the development of nursing education consistent with the global trend for transformation in education and learning [ 15 ]. Tsimane and Downing [ 16 ] mentioned that nursing students need to participate in self-directed learning and reflection. Teachers as well are required to move towards transformative changes by reducing traditional educational methods and strategies [ 16 ]. Bvumbwe and Mtshali [ 17 ] said transformation in nursing education is needed more than ever. If nurses want to act effectively and have a positive impact on patient outcomes and care, nursing education must be consistent with global changes and challenges [ 17 ].

As a need for today’s education, TE aims to empower learners to play an active role in all areas of social and professional life [ 18 ]. TE aims to train workforces who are qualified and apply global knowledge to provide context-based and international-oriented services. These workforces are competent to respond to the growing and ever-changing needs of the people [ 1 ]. In this regard, in Iran, the higher health education system recently has been launching a reform plan in the healthcare education system. This transformational program aimed to provide a comprehensive reform plan. The most important dimensions of this plan include foresight, moving towards third-generation universities to create social welfare, responsiveness, and justice-oriented education, promotion of professional ethics, the internationalization of medical science education, and the development of virtual education. Some new policies of this plan include the institutionalization of an accountable education approach in the health system, developing of equity in medical education, developing of technology-enhanced learning, networking in the medical education system, the institutionalization of professional ethics, improvement the workforce in higher education of health, and decentralization in the health education system [ 19 ].

Some elements of TE that are mentioned in these packages are the determination of the priorities of medical education based on national needs, the formulation of codes of practice, and instructions for the delegation of authority to the mega-regions. Before the division of medical sciences universities across Iran into 10 major regions, the power and governance were concentrated with the ministry of health. The creation of mega-regions was done for decentralization and to reduce the need for students to migrate to other cities for medical education. This project aims to develop medical science education, the organization of educational hospitals, and the development of medical science assessments [ 19 , 20 ]. At the university and school level, these packages and general policies lead to more detailed and practical programs such as the virtualization of exams or holding some virtual courses in the school, holding joint international university courses and scholarships for students, and accreditation programs [ 19 ].

TE requires the presence of transformational leaders. Leadership activities in educational processes affect the learning-teaching quality and educational outcomes [ 21 , 22 ]. Educational leaders have remarkable power to succeed in learners’ learning outcomes and educational reforms [ 23 ]. Literature emphasized that leadership behaviors and performance greatly impact the function of organizations and their outcomes [ 24 , 25 ]. Transformational leaders influence their employees by creating values such as honesty, loyalty, and fairness and emphasizing values such as justice, equality, and human rights and creating organizational changes [ 26 ]. Transformational leaders motivate their employees to cooperate and self-leadership with their charismatic personalities, behavior, and relationships. These leaders have an inherent motivation to sacrifice and consider the benefit of the larger society and the organization [ 27 ].

Based on the above-mentioned, this qualitative study explored the experience of educational directors, teachers, and students in terms of the implementation of educational transformative programs. The purpose of this study was to determine the role of transformational leadership in the formation of TE, as well as what approaches and strategies leaders use in the formation of TE to the ground and create a platform for the type of education and to face its obstacles and problems.

Study design

This is a qualitative study with a grounded theory approach that explored the process of transformative education formation. The study is directed by the symbolic interactionism viewpoint. The educational processes require interactions between the student and the teacher, the teacher and the educational directors, and the directors with each other. Symbolic interaction regards an individual’s perception of the world around them is created through interactions [ 28 ]. In symbolic interactionism, people play an active role and share their attitudes and responses to specific situations with group members and act according to their interpretation of that situation [ 29 ]. In the current research, our main assumption is in line with the symbolic theory. We tried to understand the process of formation of transformational education, the views of the participants, their interactions, their interpretation of TE, challenges, and problems, the strategies they choose, and the use cases of those strategies. Considering that the education process is interactive and a social phenomenon, therefore, grounded theory is a suitable research approach for this study. Grounded theory is a research approach that studies human phenomena in the context of social interactions as experienced by people [ 30 ]. Also, the Corbin and Strauss 2015 approach was used [ 31 ]. This study was conducted from April 2019 to May 2020 in nursing schools in Tehran. We followed the consolidated criteria for reporting qualitative research standards to report this study [ 32 ].

Participants and data collection

Study participants included the educational directors (vice-chancellors and deans), teachers, and nursing students (studying for an undergraduate bachelor’s degree, postgraduate master, and doctoral degree). Directors who conducted the programs for the above-mentioned reform and transformational packages at the university and the faculty, as well as teachers and students who participated in the programs were interviewed. The inclusion criteria were as follows: for educational directors, the experience with designing and implementing an educational transformative program; and regarding teachers or students, the experience with attending an educational transformative program or applying a new educational approach (such as virtual education). Initially, participants were recruited by purposive sampling. Then we used theoretical sampling to advance in-depth data gathering [ 31 , 33 ].

We conducted data collection using face-to-face semi-structured interviews, field-notes taking, and taking memos. The first author conducted one-on-one interviews using an interview guide. It was developed based on the study objectives. The interviews commenced by giving a brief introduction about the study to the participants. Then they signed a consent form. We informed participants that their partake is voluntary and that the data will be treated securely. They were assured have the option of refusing to answer any question and terminating participation at any time.

The main interview questions included: Describe your experience regarding the design and implementation of an educational transformative program. What facilitators and contributors applied? What challenges and barriers did you face? What strategies did you take to overcome them? Can you explain your experiences regarding attendance in a new teaching program (such as applying a new teaching method or changing the current program)? Have you used new educational approaches in your curriculum? Describe your experience. Then, probing and exploratory questions were asked to encourage further in-depth description and reflection [ 34 ]. The interview took place based on the interviewees’ compliance. Each interview lasted approximately one hour on average, ranging from 45 to 90 min. All interviews were audio-recoded and transcribed professionally. The first author recorded field notes and memos concurrent with data gathering. To prevent misinterpretation of the data and to complete their theoretical richness, the researcher started writing notes in the field immediately after each interview. Simultaneously with the analysis of the interview, the field notes were also analyzed.

Data analysis

Data were analyzed by the Corbin and Strauss 2015 approach [ 31 ]. This approach directs by the steps including identifying concepts, developing concepts, analyzing data for context, bringing the process into the analysis, and integrating categories [ 31 ]. MAXQDA10 was used to manage the data and to facilitate data analysis.

The process of achieving over 90 percent inter-rater reliability was accomplished in two steps: first, two first authors participated in coding five initial interviews independently and simultaneously. Then they met to compare coding results to achieve consensus and calculated the percentage of the agreement. Second, two coders continued the coding process independently and calculated the percentage of agreement by discussion in the meeting. The entire coding was consolidated through reviewing transcripts, codes, and emerging themes by the third author. The three first authors met to discuss comparing and completing code and themes and triangulate our perspectives. Eventually, all authors assembled to provide feedback on the results of the analysis.

Data collection, coding process, and constant comparison analysis continued until theoretical saturation was observed and no new insights were gained [ 31 , 33 ].

Rigour and trustworthiness

Considerations of rigor and trustworthiness were addressed by adopting Guba and Lincoln’s (1985) guidelines [ 35 ]. The credibility of our study is demonstrated by providing a thick description of the study protocol, theoretically sampling for a variety of clients’ perspectives, and using direct quotes from participants through the presentation of findings. Member-checking occurred by sharing and discussing findings with participants. They confirmed that the data were representative of their experience. The acceptable inter-rater agreement between coders supported peer-checking. Multiple researchers with experience in qualitative research methods in the research team reflected on the analyzed data to meet researcher triangulation requirements. We considered transferability by providing a rich description of data collection, analysis processes, and findings. By this method, we enhanced the applicability and generalizability of results in other similar contexts.

Ethical consideration

The project was approved by the institutional review board of the Tehran University of Medical Sciences (coded IR.TUMS.VCR.REC.1397.811).

Participants included 24 individuals (13 females and 11 males) of which four had educational director positions, 11 were teachers (faculty members) and nine were students in different educational levels. The average teaching and management experience were 13.87 ± 9.09 and 10.33 ± 6.80 years, respectively (Table 1 ).

Transformational leadership was extracted as the core category in this grounded theory and appeared as a core variable in the process of formation of TE. The main concern expressed by the participants was the difficulty of adapting and aligning with TE. It was related to various factors such as resistance of teachers and students, common use of traditional learning methods, lack of requirements for innovative education, limitation in empowerment, and educational policy-making deficiencies. Transformational leadership in the educational system, by applying the following strategies and approaches tries to eliminate challenges face by TE formation: transformative management; requirements on educational policymaking; providing a platform to transform education, and community-centered education.

Transformative management: to be transformational, the system first needs transformative managers. Management is the art and technique of effective and efficient use of material and human resources in planning, organizing, and guiding the organization to achieve its goals. The personal and professional performance of managers plays an important role in solving challenges and problems and achieving the goals of the organization.

“We need to optimistically manage conflicts. My motto was that the voice of the opposition should be heard. We can ask opponents to share their alternative views and plans…” (Educational director 3)

Participants emphasized positive attitude and belief toward change and being responsive as important factors to be a change agent manager to initiate innovative actions in the system.

“If university directors don’t carry the attitude to change, they don’t mind about its necessity for our system, or don’t take it into consideration as an opportunity, there is no obvious outcome!” (Educational director 2)

Transformative managers must have managerial characteristics and capabilities. Participants mentioned a wide range of competencies, including high emotional intelligence; being a forerunner, realistic, unidealistic, and energetic; having the courage for change, genius to discover and create opportunities. Based on the results of the study, other managerial abilities of transformative managers were situation analysis, conflict management, spending energy and time, seeking advice, and participatory management. Managers encourage their employees to be creative in solving problems. They motivate them to look at problems from different perspectives and implement innovative problem-solving techniques.

“We must act as change agents and accept challenges. We shouldn’t suppress disagreements, we need to optimistically manage conflicts, and benefit from their advantages. My motto was that the voice of the opposition should be heard. We can ask opponents to share their alternative views and plans… what they would do if they were in the administrative position?!” (Educational director 3) “Maybe it was the belief in transformations that guided me. I believed that there should be a change in our system, the grades were not real! Some teachers are committed to grading, while others are not! (Educational director 4)” “One of the main challenges in the way of implementing new educational programs and creating transformation is the lack of support and resistance of human resources. To overcome it, we need managers with a high political ability (Educational director 1)”

Requirements on educational policymaking: The next element to become a transformative leader and change the system is the quality of educational policies. Policymaking is of great importance and guides the functioning of education systems. Optimal educational policies are those which are scientific, accurate, futuristic, explicit, and accepted by their target community. Participants believed that the prerequisite toward innovative educational approaches is the alignment of policies with these programs. As a result, it will be supported by financial resources and appropriate context to apply innovative approaches.

“See, policies are principal! The system needs to develop active learning methods! in what way the budget is allocated for this field? how well policies are developed? to what degree it is included in the accreditations? I think it’s essential. The more attention innovative learning methods receive, the more teachers will appreciate its significance in teaching…” (Teacher 7). "Transformative programs must be based on needs and be formed in response to needs. We experienced a period of war in our country, and we tried to answer the need of that time… but from that time, we had to be forward-thinking. We were looking to develop higher education levels as well. We couldn’t stop just because we’re in wartime " (Educational director 2)

Another issue mentioned by the participants regarding the implementation of transformative programs was the necessity of planned and step-by-step actions to apply for new programs in the system. It takes time for revealing the explicit benefits of the change and attracting individuals’ participation.

“At first the program commenced, we faced with a lot of resistance… the time passed, and the teachers and the students become adapted… Its benefits became obvious. Its goal was to make a difference and individuals broke traditional manners!” (Educational director 4).

An example of a field note: "In the meeting of the internal surgery group that was held on the date of … at 11:30, changes were made in the educational program of the master's students. In the new program, these students are assigned to instruct nursing internships. In this program, according to the policy change, facilities are also considered, including the use of a skill lab for practice, the use of guidances, and the use of motivational factors to motivate master students, such as presenting a teaching certificate.

Providing a platform to transform education: Transformative leaders need the appropriate context and facilities to implement transformative programs. Necessary and important factors in the development and advancement of organizational goals are available resources, which include the workforce, financial support, physical resources, and infrastructures. One of the main characteristics of transformational leaders and managers is the ability to manage and use resources correctly to achieve the goals of the organization. Participants expressed that the provision of an appropriate structure, space, and adequate workforce, the allocation of sufficient time, and financial support as requirements for the implementation of innovative educational programs.

“…normally, any new and transformational action requires time-consuming substructures-building, need to expend considerable efforts to make this happen, and spending a lot of initial costs.” (Educational director 1)

Another participant stated:

“We are designing our educational programs by developed ones in the world, but they need facilities, and an experienced workforce to be implemented…” (Educational director 2) “The choice of the teaching method is largely not in my control, for example, my classroom has not a speaker! How it’s possible to show an educational video?! Or, for example, the video projector did not play the colors well, this greatly reduces the quality of the work!” (Teacher 4)

With the rapid development of science and technology, the issues related to science and technology have become more complex, diverse, and comprehensive. So, Interdisciplinary communication can be an effective way to exchange the knowledge and information needed. Another factor mentioned by the participants regarding preparing the platform for moving toward educational developments was the need to establish interdisciplinary interactions.

“Innovation in education requires interdisciplinary communication. For example, creating virtual content is completely interdisciplinary… there must be a person who is expert in content production… technical engineers who design and provide the software requirements… and educational program designers who design in what way we teach the content to achieve effective learning” (Educational director 1). “As a rule, because the generation has changed, their interests have changed, most of the students have become software-oriented, they are very fond of applications.” (Teacher 1)

Community-centered education: The requisites of transformational leadership are considering the characteristics, conditions, and needs of the community for which programs are designed. For the success of any program, acceptance, and adaptation of the target community with that program is essential. This requires developing programs based on the community’s needs.

“A transformative program must respond to the needs of the present and the future. The needs that exist in our system now, and the needs that may arise in the future.” (Educational director 2)

Another participant expressed:

“The student in the class seem to avoid listening! But they like to play with their phones! I think that sending an online movie to them might be useful… Can I engage them that way? We deal with an internet-oriented generation… well, we must use more virtual-based teaching methods!” (Teacher 1)

Based on the analyzed data using the grounded theory approach, we depicted the theory of the formation of transformative education (Fig.  1 ). Transformative education is a type of education that is forming in the educational system. Nursing education is also moving from a traditional and passive educational system to a transformative educational system. In this regard, students, teachers, and directors as stakeholders of the educational system feel difficulty to adapt with a transformative education. It is related to factors such as the common use of traditional methods, lack of innovative education requirements, and weakness in educational policy. To eliminate the challenging factors to adapt to transformative education and move toward it, the educational system uses strategies and approaches.

The theory of transformational leadership in formation of transformative education

One of these strategies is transformational leadership which provides the necessary context and facilities for transformation by transformative management and policymaking in the educational system. Empowerment and preparation of faculty members and students who are the major stakeholder of this education are necessary to achieve effective learning, which is one of the main goals of transformative education. Anticipating and being prepared for unexpected issues which the education system will face in the future are other strategies.

This study was conducted to determine the role of transformational leadership in the formation of TE in nursing education. In this study, the strategies and approaches that transformational leaders need for the formation of TE and facing its obstacles and problems were determined. According to the results, transformational leadership is a core variable in the process of the formation of transformative education. In educational institutions, leaders play an important role to achieve educational outcomes [ 21 , 22 ]. Leaders who apply a transformational leadership approach, motivate staff and learners [ 36 ], improve educational outcomes, and minimize concerns regarding learning outcomes [ 37 ]. To form a TE, transformational leaders use four strategies including transformational management strategies, educational policy requirements, providing a platform for educational transformation, and community-centered education. Transformational leadership is the cornerstone and main strategy for the formation of TE. This strategy manages the education system and provides the necessary facilities for transformation and overcoming problems and obstacles by considering the needs and demands of society.

The requisite for transformational leadership is transformative management. For transformationalism, the system initially requires transformative managers. They are concerned agents of change with managerial knowledge and skills. According to Puaca [ 38 ], leadership includes a set of professional activities and the competencies of managers are the core activity of the organization [ 38 ]. Eddy [ 39 ] stated, leadership competencies include a set of knowledge, skills, and abilities of a leader, which leads to the use of various methods by the leader to achieve the goals of the organization [ 39 ]. Therefore, leaders must be people-oriented, process-oriented, thoughtful, and correspondent leaders’ support and contribute to change [ 24 , 25 , 40 ]. Transformational leaders influence their employees and subordinates with inspiring power and are the starting point of transformation and change. Concerned with progress and improvement, they push their organization forward, create motivation, support change, and seek creative and innovative ideas.

Educational policies are the second most important element for transformational leadership in the system. If educational policies have a positive approach to change and support new programs and ideas, they create opportunities for change and progress for the system. These policies must be forward-looking, and progressive. Based on Sahu et al. [ 41 ], one of the roles and responsibilities of educational administrators is to provide a correct definition of the vision, mission, and policies of the institution [ 41 ]. According to Gambhir et al. [ 42 ], the policies and procedures of the organization affect the quality of education. The extent to which goals are achieved depends on how well the director’s competencies and self-evaluation policies are supervised [ 42 ] The lack of a specific policy in the field of the health system for the development of human resources has created inconsistencies and is considered a threat to the health system to achieve its goals [ 19 ]. Therefore, incorrect policy-making without foresight and research is the main obstacle against the currents of transformation, which can divert the orientation of transformation.

The next element for the transformational leadership of the educational system is to provide a platform to transform education. Transformational policies and programs will be implemented in case the appropriate context is prepared. Requirements for implementing transformative education included: adequate financial resources and support; creating a suitable educational structure and space; providing the necessary facilities and resources; and providing a sufficient number of teachers, clinical instructors, and a skilled teaching workforce. Gambhir, et al. [ 42 ] emphasized facilities, teachers and staff, financial resources, and financial stability as factors that affect the quality of education [ 42 ]. Various factors, including educational policies, budgets, regulatory mechanisms, etc., are effective in the quality of trained human resources in the health system [ 43 ]. Therefore, educational leaders must have the necessary competencies to plan and implement programs and manage the human, physical and financial resources of institutions [ 39 , 44 ]. Physical resources and educational facilities are effective factors in the quality of education, which are positively related to the learning outcomes of learners [ 42 ]. In the present study, the participants considered the lack of infrastructure and suitable educational facilities as obstacles to using the method. According to the study of Keshavarzi et al. [ 45 ], the lack of infrastructure and required technology was one of the obstacles to using virtual education [ 45 ].

The final extracted element was community-centered education. The findings of the study showed that educational programs must be community-based to become administered and accepted by stakeholders. Moreover, the psychological needs, values, and beliefs of society must be taken into consideration. Paying attention to the needs of the target community is effective even in choosing educational tools, including digital tools, and they must be adapted to the needs of the profession and educational program [ 46 ]. Literature show that context is one of the influential factors in the performance of leaders and the effectiveness of their leadership. Context affects not only the performance of leaders but also how leadership activities and efforts are coordinated [ 24 , 40 ]. Lai [ 47 ] stated that the atmosphere and culture of the institute is an effective factor influencing the adoption of leadership approaches in educational institutions [ 47 ]. Srisaen’s [ 48 ] study showed that differences in organizations affect leadership performance and different leaders adopt various approaches and strategies to meet different organizational needs [ 48 ]. The organization needs to be properly prepared for the process of transformation. The requirement is the existence of a suitable organizational culture that supports the change and the presence of managers who are concerned about change and transformation, and who prepare the organization’s atmosphere for these types of programs and transformations.

Limitations

One of the limitations of the study was the limited transformational and innovative policies and programs in the current educational program. This led to limited accessible and eligible participants. However, purposive sampling was used to reach informed participants and data saturation was achieved, and maximum sampling variation was done. To access the informed participants, the researcher contacted educational directives responsible for the transformation and innovation plan in the university, and teachers who were known for using novel educational methods, and students who participated in the classes of innovative professors. Also, each participant was asked to introduce appropriate other ones. Another limitation of the study, which exists in all qualitative studies, is the limitation in the generalizability of the study. To address this limitation, we provided a full explanation of the data collection and analysis process, the characteristics of the participants, and the context.

Suggestions for further research

Due to the limited study related to TE and its elements, further studies in other contexts and diverse educational communities and systems are recommended. The obtained model and theory should be implemented as a pilot in one of the nursing schools. Also, studies to review the proposed theory and model and the concepts obtained from this study in other contexts and countries are recommended. It is also suggested to explain the lived experiences of managers and educational policy makers in the implementation of transformative programs. This study was conducted in the context of nursing education. We may benefit from similar studies in other fields of medical and basic sciences.

Transformative education is a requirement for modern education to achieve qualified graduates and increase the efficiency and quality of the education system. According to the study findings, transformational leadership is one of the most important components for shaping the process of transformative education and the core variable. Transformational leadership is the main strategy for the formation of transformational education, which provides the necessary context and facilities for transformation through appropriate management and policymaking of the educational system. This leadership approach seeks to develop the system and staff, achieve goals, and improve educational outcomes. One of the important factors to move towards TE is the training and preparation of transformational leaders in the education system, who have a vision and attitude toward transformation and have the necessary knowledge and qualifications to guide the educational system and manage resources. Moreover, with the power of inspiration, these leaders can create the necessary motivation in employees and colleagues to achieve goals and improve educational outcomes. In addition, foresight and getting ready to manage the issues facing the educational system are also important elements for the formation of TE.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due some interviews contain information that reveals the identity of individuals but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank the Tehran University of Medical Sciences, for their fiscal support. We also express our gratitude to the participants and colleagues for their cordial help.

This research was financially supported by School of Nursing and Midwifery, Tehran.

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ANN, NM, and AG designed the project. AG managed the project and collected all the interviews and field notes. ANN, ZR, AG, and NM analyzed the qualitative data. AG, and FB were responsible for manuscript preparation. All authors contributed towards reviewing the paper before submission. The author(s) read and approved the final manuscript.

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Ghorbani, A., Mohammadi, N., Rooddehghan, Z. et al. Transformational leadership in development of transformative education in nursing: a qualitative study. BMC Nurs 22 , 17 (2023). https://doi.org/10.1186/s12912-022-01154-z

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Transformational Leadership Behaviors of School Principals: A Qualitative Research Based on Teachers' Perceptions

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• International Review of Administrative Sciences

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Qualitative Action Research: Integrating Transformational Leadership within a Traditional Chinese International Department

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International schools aim to provide students with a multicultural experience, equipping students with a global-minded education to succeed in future higher educational or professional careers abroad. For students to succeed in international schools, native and international staff members should have a well-rounded knowledge of professional attributes from Eastern and Western cultures. The purpose of the qualitative study using action research was to explore teachers' knowledge, perceptions, and adaptability toward integrating elements of transformational leadership within a current paternalistic leadership style at a high school international department in Southern China. The problem was the uncertainty regarding the knowledge, application, or comfort level of Chinese staff members in implementing transformational leadership, as employees are accustomed to a hierarchical leadership approach, limiting collaborative and creative abilities. The study consisted of semi-structured interviews with eight native and eight international teachers from the international department. A data analysis spiral was used to facilitate the analysis process in locating, creating, explaining themes, developing interpretations, and creating a visual representation of the acquired data. The interview data was used to facilitate implementation involving issues and concerns using transformational leadership. The results displayed positive results with Chinese and international teachers in collaborative and communicative practices for locating organizational improvement. The study recommends ensuring Chinese leaders provide encouragement and motivation throughout transformational leadership practices to empower teachers with self-confidence and assurance of involvement within a shared decision-making environment.

Keywords: transformational leadership, paternalistic leadership, international schools, China, Chinese education

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Quantitative systematic review of the transformational leadership style as a driver of nurses' organisational commitment

Xiong haoyan.

1 Nursing Department, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang China

David Waters

2 Brimingham City University, Birmingham UK

Huang Jinling

3 Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang China

Liu Qiongling

4 Nursing Faculty, Guangdong Medical College, Dongguan China

Associated Data

Data openly available in a public repository that issues datasets: Asiri et al., ( 2016 ); Al‐Yami & Watson, ( 2018 ); Al‐Hussami ( 2009 ); Brewer et al., ( 2016 ); Kodama et al., ( 2016 ); Lin et al., ( 2015 ); Xie et al. ( 2020 ).

To explore the association between nurses' perceptions of their nurse manager's transformational leadership style and nurses' organisational commitment.

Narrative systematic review.

Data Sources

The CINAHL Complete, MEDLINE, PubMed, Business Source Complete, Cochrane Library, along with OpenGrey t were systematically searched for observational studies written in English, between January 2009 and December 2020.

Review Methods

This systematic review is based on the guidelines of the Cochrane Handbook, and PRISMA‐P. Two reviewers independently selected studies. The quality of evidence was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for Cross‐Sectional Studies.

Seven cross‐sectional studies with 2885 participants were included. Six studies reported that the transformational leadership style was positively related to nurses' organisational commitment, and the remaining study reported a negative association.

Conclusions

Six studies were found that the transformational leadership style is a driver of nurses' organisational commitment. Only one study reported that transformational leadership style negatively associated with acute care nurses' organisational commitment. However, the negative finding is less valid, as the study data indicates that the nurse managers' ineffective transformational leadership style in the acute care unit or the culture influence, which may have influenced the results.

It provides the guideline, recommendation, and important evidence to support nursing managers adopting the transformational leadership style to promote nurse retention helping to alleviate the nursing shortage. This is beneficial to the well‐being of the nurse. Meanwhile, this can help the health organisation reducing the cost of nurses' turnover and recruiting new nurses. It is also good for address future ageing population healthcare problem in the long term.

1. INTRODUCTION

Nurse shortages are a global problem. In the US, it was predicted that there would be 0.8 million vacant nurse positions by 2020 (Hudspeth,  2013 ), and 0.59 million were predicted in Europe (Matrix Insight,  2012 ). Over the next decade, a shortage of 60,000 nurses is expected in Canada, a shortage of 90,000–109,500 is expected in Australia (Buchan et al.,  2013 ), and a shortage of 1.59 million is expected in China (Liu & Yunibhand,  2016 ). The rapid growth of the older population is also a global problem. The Royal College of Nursing (Great Britain) ( 2017 ) has highlighted that ageing populations will worsen the existing nurse shortages. Population ageing can increase the demands on healthcare services, shrink the healthcare workforce (as existing nurses get older) (Beard & Bloom,  2015 ), and make it more difficult to recruit sufficient young nurses in the future. Moreover, the healthcare demands of the older population will both increase and change, with studies pointing out that many age‐related diseases will increase, particularly circulatory, eye, and blood and blood‐forming organ diseases (Vrhovec & Tajnikar,  2016 ; Yeo et al.,  2016 ). This highlights that population ageing will increase the healthcare burden and worsen the existing nurse shortage.

To address the nurse shortage issue, a useful strategy is to increase the supply by increasing nurse training places and recruiting more nursing students; the other useful strategy is to ensure that the nurse retention rate is high (World Health organisation (WHO),  2006 ; Scott,  2017 ; European Commission,  2015 ). In recent years, many countries have increased the recruitment and training of new nurses. These strategies have had some positive effects. However, they may not be sufficient to address the predicted lack of nurses in the coming years because of the lack of adequate numbers of faculty to train new students (Duvall & Andrews,  2010 ) and because nursing is often not very appealing to young people due to it being underpaid (Coombs et al.,  2003 ). Therefore, more focus should be paid to retaining nurses if healthcare organisations hope to address the nurse shortages.

However, the percentages of existing nurses intending to leave their jobs is high (Aiken et al.,  2013 ; National Council of State Boards of Nursing,  2010 ), and nurses' intention to leave their jobs is directly related to the turnover rate (Takase et al.,  2015 ). Globally, many healthcare organisations' annual nurse turnover rates are as high as 20% (El‐Jardali et al.,  2009 ; Hayhurst et al.,  2005 ). Copanitsanou et al. ( 2017 ) highlight that high turnover is an important reason underlying the nurse shortages. Moreover, studies have concluded that.

organisational commitment (OC) is a major factor that can reduce nurse turnover (Meyer & Herscovitch,  2001 ; Somers,  2009 ; Takase et al.,  2015 ). Therefore, improving nurses' OC to reduce the turnover rate should be a primary focus.

2. BACKGROUND

Meyer et al. ( 2002 ) found that effective leadership has a positive influence on OC. Effective leadership skills among nurse managers increase nurses' OC (and leadership skills are also useful more generally in healthcare) (Cummings et al.,  2010 ). Effective leadership can improve the work environment by providing effective organisational support so that nurses' feel more valued in the team and their inner working lives are improved (Al‐Hamdan et al.,  2017 ; Sherman & Pross,  2010 ). A good work environment can improve job satisfaction and OC, thus helping to retain nurses (Aiken et al.,  2013 ; Copanitsanou et al.,  2017 ; Laschinger & Finegan,  2005 ; Li et al.,  2018 ). Nurse managers have the responsibility for promoting care, ensuring patient safety, enhancing the quality of nurses' working lives, and managing the change processes related to all nursing care duties (Everson‐Bates,  1992 ; McNeese‐Smith,  1997 ; Sullivan & Garland,  2013 ). Therefore, it is important for nurse managers to adopt an effective leadership style to strengthen OC in order to reduce nurse turnover and to ensure safe and high‐quality care.

The transformational leadership (TFL) style is the preferred leadership style among nurse managers (Ferguson,  2015 ). Transformational leadership has been the most influential leadership theory in recent decades (Judge & Piccolo,  2004 ). Transformational leadership (Bass,  1985 ) is a transformation process in which leaders inspire their followers to have the belief that they can reach exceptional achievements. Transformational leaders ' long‐term aims are to change and transform employees in their ways of thinking to achieve leadership effectiveness (Bass,  1985 ; Yukl,  1999 ). Therefore, the leader's transforming abilities are a key to the work of transformational leadership.

Transformational leadership is comprised of four components (Bass,  1985 ): (a) Idealised influence; (b) Inspirational motivation; (c) Individualised consideration; (d) Intellectual Stimulation. Idealised influence represents seeing the leader as a role model, thereby motivating the staff. Inspirational motivation represents leaders using the goals and sharing a vision to motivate the staff. Individualised consideration refers to leaders providing support to staff according to individuals' development needs, providing them with the greater opportunities to make decision, deal with challenges themselves, thereby helping them to achieve self‐actualization. When it comes to intellectual stimulation, this refers to leaders encouraging staff to solve difficult problems themselves and think critically, thereby helping them more creatively.

(Lussier & Achua,  2007 ).

Increasing nurses' OC is a major strategy to reduce the likelihood of nurses leaving their jobs (Meyer & Herscovitch,  2001 ; Somers,  2009 ; Takase et al.,  2015 ). Therefore, it is important to identify the association between this style and nurses' OC. There are many studies exploring the relationships between leadership styles and employees' OC. Most studies found that there is a positive relationship between them (Dai et al.,  2013 ; Luo et al.,  2017 ; Nguni & Denessen,  2006 ; Rowden,  2000 ; Yahaya & Ebrahim,  2016 ; Yousef,  2000 ). However, most of the research has been conducted in business and manufacturing settings, with fewer studies focusing on nurses. Therefore, the previous findings are not sufficient to show that there is a positive association between the two variables in the nursing care setting. Moreover, a study suggested that nurse executives' TFL style negatively affected OC (Leach,  2005 ). Therefore, the relationship between the TFL style and nurses' OC is unclear. Notably, there has been no systematic review on the relationship between nurse managers' TFL style and nurses' OC. Therefore, we synthesised and analysed related studies (the literature was searched from January 2009 to December 2020) to identify the relationship between them.

The aim of this systematic review was to synthesise and analyse information from the available quantitative studies on the association between nurses' perceptions of their nurse managers' TFL style and nurses' OC. The review question was: What relationship between nurse managers' TFL style and nurses' OC?

2.2. Design

This study involved a quantitative systematic literature review, and the synthesis of the findings is presented in a narrative way.

2.3. Search methods

To search for relevant studies achieving comprehensiveness of coverage and maintaining the precision of the records retrieved, the search strategy based on the MeSH keywords (nurses, transformational leadership, organisational commitment) to search the text word (free text), including all spelling variants (e.g. UK and US spelling), synonyms, abbreviations, relevant truncation, and wildcard, to expand the range of search terms (McGowan et al.,  2016 ). This research also used Boolean operators ‘OR’, and ‘AND’ to join the search term based on the logical relationship.

The search strategy in Table  1 was used to identify all relevant observational surveys published between January 2009 and December 2020 (to access the latest evidence) on CINAHL Complete, MEDLINE, PubMed, Business Source Complete, and Cochrane Library. In addition, it applied subject terms and English Language limitations in the search strategy.

The search strategy.

Hooton et al. ( 2007 ) highlight that the published studies are likely to may tend to report effective findings compared with grey literature including the unpublished study in a systematic review can help to avoid the reporting bias. Therefore, to gain as much information as possible and to minimise the reporting bias, the researchers (XHH and HUB) also searched on some valid websites, such as OpenSIGLE ( http://www.opengrey.eu/ ), to find the grey literature. To obtain as many studies as possible, the reviewers manually searched the reference lists of the eligible studies. In addition, to check that there were no similar reviews already underway, the reviewers also searched the PROSPERO systematic review database.

3. INCLUSION CRITERIA

3.1. participants.

As this review aimed to explore the relationship between TFL style and nurses' OC, the participants of interest were registered nurses.

3.2. Exposure factor

The nurses were exposed to nursing managers' TFL behaviour situations. The TFL style consists of idealised influence, inspirational motivation, individualised consideration, and intellectual stimulation (Bass,  1985 ). Therefore, the nurses in this review were exposed to the nurse managers' idealised influence, inspirational motivation, individualised consideration, and/or intellectual stimulation.

3.3. Outcomes

The primary outcomes of this review were nurses' OC, affective commitment (AC), continuance commitment (CC), or normative commitment (NC). As AC, CC, or NC to a particular organisation are encompassed by OC (Allen & Meyer,  1996 ; Mowday & Porter,  1979 ; Mowday & Steers,  1982 ), any study with results on OC, AC, CC, or NC were included in this review.

3.4. Types of studies

Only observational studies were included, as experimental trials were excluded owing to ethical issues. Sullivan and Garland ( 2013 ) suggest that an effective healthcare manager should adopt a suitable leadership style based on the specific situation. Clinical contexts are complex, so it is impossible to use only a single consistent type of leadership (Sullivan & Garland,  2013 ). Hill ( 2017 ) also highlights that combining using the situational leadership style allows nurse managers to adopt an appropriate style for different staff and dynamic environments, thereby motivating staff to work more effectively. Polgar and Thomas ( 2013 ) suggest that randomised controlled trials are not suited in certain complex situations. More specifically, it is not appropriate to force nurse managers in an intervention group to only use a TFL style and nurse managers in a control group to not use this style, as this would not allow them to take complex clinical situations into account. An inappropriate and ineffective leadership style negatively affects nurses' well‐being and the quality and safety of care, and it increases hospital costs (Al‐Hamdan et al.,  2017 ; Cummings et al.,  2010 ). Conducting an experimental trial may force nurse managers to adopt an inappropriate management style, which can harm the nurses, patients, and hospitals. This would violate the do no harm principle related to research participants, as detailed in Introduction to Research in the Health Sciences (Polgar & Thomas,  2013 ).

3.5. Language

In this systematic review, language was restricted to English.

3.6. Search outcome

The literature search was independently conducted by two reviewers (XHH and HHH). It yielded 80 studies (32 records from CINAHL Complete, 15 records from MEDLINE, 31 records from PubMed, seven from Business Source Complete, one records from Cochrane Library, zero from OpenGrey, and zero from PROSPERO).

3.7. Study selection

According to the Cochrane Handbook (Higgins & Green,  2011 ), this process is also best done by more than one author, which can help to reduce the risks of some eligible reports being discarded. Two reviewers (Xiong and Huang) independently conducted all study selection processes according to the selection criteria. When the agreement was not reached, other authors would be consulted. After removing duplicates in EndNote, 70 studies remained. After screening the titles and abstracts of the remained studies, there were 18 studies eligible for the criteria. After reading the full‐text versions of these 18 studies, seven were confirmed to meet the eligibility criteria, and the remaining 11 studies were excluded as seven of them cannot get the full text and the other four studies were not met the (PEO). No studies were identified based on manually searching the reference lists of the eligible studies. All these processes are shown in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flowchart (Shamseer et al.,  2015 ) in Figure  1 .

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flowchart.

3.8. Quality appraisal

The Joanna Briggs Institute (JBI) Critical Appraisal Tool for Cross‐Sectional Studies is a useful quality assessment tool that is well‐accepted by users (Munn et al.,  2014 ). The Critical Appraisal Checklist for Cross‐Sectional was applied to assess the bias, validity, limitations, and generality of cross‐sectional studies (Munn et al.,  2014 ). Therefore, this tool was used to assess the included studies' quality. Two independent reviewers (Xiong and Huang) conducted the critical appraisal and reached a consensus. When no consensus was reached, a third author would be consulted.

3.9. Data extraction

To reduce the error rate (Higgins & Green,  2011 ), two reviewers (XHH and HH) transparently and independently extracted the following data standardised data extraction tables developed in a pilot study: first author, year of publication, aims, study design; sample characteristics (sample selection; sample No.), study setting/context, measurement tools, reliability of the measurement tools, statistical analysis methods, and outcomes. When no consensus was reached, a third author would be consulted.

3.10. Synthesis

The included studies exhibited considerable clinical, methodological, and statistical heterogeneity. For example, the participants in four studies were all types of nurses (Al‐Yami & Watson,  2018 ; Brewer et al.,  2016 ; Kodama et al.,  2016 ; Lin et al.,  2015 ), while the studies by Al‐Hussami ( 2009 ), Al‐Yami and Watson ( 2018 ), and Xie et al. ( 2020 ) focused on only nursing home nurses, acute nurses, and aged care agency nurses, respectively, which caused clinical heterogeneity. Additionally, there were various sampling methods and study designs, and there were seven tools to assess TFL style, six tools to assess OC, and seven combinations of statistical methods to analyse the data, which caused large methodological and statistical heterogeneity. Higgins and Green ( 2011 ) suggest that the data synthesis in a systematic review should involve a narrative approach when the data cannot be combined or when the data exhibits large heterogeneity, because of the high risk of reaching a misleading conclusion when conducting a meta‐analysis in cases involving large heterogeneity. Therefore, the data synthesis in this review involved a narrative approach.

4.1. Characteristics of included studies

Seven cross‐sectional surveys were included in this review (Al‐Hussami,  2009 ; Al‐Yami & Watson,  2018 ; Asiri et al.,  2016 ; Brewer et al.,  2016 ; Kodama et al.,  2016 ;Lin et al.,  2015 ; Xie et al.,  2020 ). They all aimed to explore the relationship between TFL style and nurses' OC. However, the sample selection and study design varied. The samples in the studies by Al‐Hussami ( 2009 ), Lin et al. ( 2015 ), Asiri et al. ( 2016 ), and Al‐Yami and Watson ( 2018 ) were random but the former two studies used stratified random samples while the latter two did not. In contrast, the samples in the studies by Brewer et al. ( 2016 ), Kodama et al. ( 2016 ), and Xie et al. ( 2020 ) were convenience samples rather than random samples. Moreover, the study by Brewer et al. ( 2016 ) is a cross‐sectional study that was part of a 10‐year longitudinal panel study.

This review involved 2885 nurses, almost half of these participants ( n  = 1037) belonged to the study by Brewer et al. ( 2016 ). The study with the smallest sample size ( n  = 60) was by Al‐Hussami ( 2009 ). The sample sizes in the other five studies by Lin et al. ( 2015 ), Kodama et al. ( 2016 ), Asiri et al. ( 2016 ), Al‐Yami and Watson ( 2018 ), and Xie et al. ( 2020 ) were 651, 369, 332, 219, and 217, respectively (Table  2 ). Although all samples were nurses, they were from different nursing professions. The samples of Al‐Hussami ( 2009 )'s and Xie et al. ( 2020 )'s were aged care nurses; the samples of the Kodama et al. ( 2016 )'s and Asiri et al. ( 2016 )'s were acute nurses; the samples of the other three studies were different nursing professions (general, paediatric, dental, diabetic, Nursing home, etc).

Included study characteristics (Summary).

The participants worked in the USA (Al‐Hussami,  2009 ; Brewer et al.,  2016 ), Saudi Arabia (Al‐Yami & Watson,  2018 ; Asiri et al.,  2016 ), China (Lin et al.,  2015 ; Xie et al.,  2020 ), and Japan (Kodama et al.,  2016 ) (Table  2 ). Brewer et al. ( 2016 )'s samples were nursing staff from a whole country's different hospitals; Al‐Hussami ( 2009 )'s samples were nursing staff from 12 different hospitals. Al‐Hussami ( 2009 )'s and Kodama et al. ( 2016 )'s samples were from four different hospitals; Al‐Yami and Watson ( 2018 )'s samples were from two different hospitals; Asiri et al. ( 2016 )'s and Xie et al. ( 2020 )'s samples were from one medical institution. Thus, the participants in this review included participants that worked in western countries and others that worked in eastern countries.

4.2. Tools to evaluate TFL style

Seven tools were used to evaluate the exposure factor, that is, nurses' perceptions of their nurse managers' TFL style (Table  2 ). Al‐Hussami ( 2009 ) used the Multifactor Leadership Questionnaire (MLQ) Form 6 S (Bass & Aviolo,  1992 ) (Cronbach's α : 0.79–0.85). Lin et al. ( 2015 ) used the Multifactor Leadership Questionnaire (MLQ) (Bass & Avolio,  1994 ) (Cronbach's α : 0.975). Brewer et al. ( 2016 ) used the 6‐item Transformational Leadership Scale (TFLS) (Hammer et al.,  2012 ) (Cronbach's α : 0.917), which is based on a scale developed by Podsakoff et al. ( 1990 ). Kodama et al. ( 2016 ) used the Multifactor Leadership Questionnaire (MLQ) Form 5X‐Short (Avolio & Bass,  2004 ) (Cronbach's α : 0.72–0.87). Asiri et al. ( 2016 ) used the Multifactor Leadership Questionnaire (MLQ) (Avolio & Bass,  2004 ) (Cronbach's α : 0.94). Al‐Yami and Watson ( 2018 ) used the Multifactor Leadership Questionnaire (MLQ) (Bass,  1985 ) (Cronbach's α : >0.6). Xie et al. ( 2020 ) used the Transformational.

Leadership Questionnaire (TFLQ) (Chang and Lee,  2007 ) (Cronbach's α : 0.928).

4.3. Tools to evaluate OC

Six tools were used to evaluate the outcome, that is, nurses' OC (Table  2 ). Al‐Hussami ( 2009 ) used the organisational Commitment Questionnaire (OCQ) developed by Meyer et al. ( 1993 ) (Cronbach's α : 0.85). Lin et al. ( 2015 ) and Al‐Yami and Watson ( 2018 ) used the organisational Commitment Questionnaire (OCQ) developed by Mowday and Porter ( 1979 ) (Cronbach's α : 0.878 and 0.77, respectively). Brewer et al. ( 2016 ) used the organisational Commitment Scale (OCS) developed by Price (2001) (Cronbach's α : 0.863). Kodama et al. ( 2016 ) used the organisational Justice Questionnaire of Affective Commitment (ACQ) developed by Shibaoka et al. ( 2010 ) (Cronbach's α : 0.70–0.95). Asiri et al. ( 2016 ) used the organisational Commitment Scale (OCS) developed by Allen and Meyer ( 1996 ) (Cronbach's α : 0.79). Xie et al. ( 2020 ) used the organisational Commitment Questionnaire (OCQ) developed by Sjoberg and Sverke (2000) (Cronbach's α : 0.899).

4.4. Summary of the statistical analysis methods

The statistical methods varied among the seven studies (Table  2 ). Al‐Hussami ( 2009 ) used Pearson's correlation and multivariate linear regression. Lin et al. ( 2015 ) used Pearson's correlation and analysis of variance (ANOVA). Brewer et al. ( 2016 ) used correlation analysis and an ordered probit model (Greene,  2008 ). Kodama et al. ( 2016 ) used multivariate logistic regression. Asiri et al. ( 2016 ) used Pearson's correlation and stepwise multivariate linear regression. Al‐Yami and Watson ( 2018 ) used Pearson's correlation and hierarchical regression. Lastly, Xie et al. ( 2020 ) used structural equation modelling. The statistical tests (regression or other analyses) in each included study all indicated a good fit with the data.

4.5. Summary of study outcomes and data synthesis

All included studies demonstrate that there is a correlation between the transformational leadership style and nurses' organisational commitment. Six studies are finding that the transformational leadership style has a positive effect on nurses' organisational commitment (Al‐Hussami,  2009 ; Al‐Yami & Watson,  2018 ; Brewer et al.,  2016 ; Kodama et al.,  2016 ; Lin et al.,  2015 ). only Asiri et al. ( 2016 ) found that the association of the TFL style with nurses' OC in acute care units in Saudi Arabia was negative using Pearson's correlation analysis ( r  = − 0.113, p  ≤ 0.045), but was positive using Stepwise linear regression ( B  = 0.14 SE = 0.08 t  = 1.8 p  ≤ 0.074), although not significant. All the information were present in Table  2 .

The result of the quality assessment from JBI Cross‐sectional Critical Appraisal Tools of included articles is in Table  3 . Brewer et al. ( 2016 )'s study was considered high‐quality evidence because eight‐question of the JBI Cross‐sectional Tools were been considered in this study. Compared with these two studies, Al‐Yami and Watson ( 2018 )'s study was considered as low quality of evidence, because it found that two question JBI Cross‐sectional Tools were unclear, and the exposure was not measured validly and reliably. The other five studies of the review were considered moderate‐quality evidence because one or two questions JBI Cross‐sectional Tools were unclear.

Summary quality assessment.

5. DISCUSSION

Nurse shortages are a global issue and ageing populations will worsen the existing issues. The high turnover rates among nurses contribute to nursing shortages. Training and recruiting more nursing students cannot fully address this problem. More effort should be made to retain nurses. A major factor underlying the retention rate is nurses' organisational commitment, which is related to effective leadership. The transformational leadership style is the prevailing contemporary leadership style among nurse managers. However, it is controversial whether there is a positive or negative association between transformational leadership style and nurses' organisational commitment. Therefore, we conducted this review to find evidence to explore the relationship between transformational leadership style and nurses' organisational commitment, thereby providing some suggestions for nursing managers to adopt an appropriate leadership style and improve nurses' organisational commitment. Meanwhile, it can help the hospital reduce the cost of nurses turnover and recruit new nurses. Moreover, addressing the nursing shortage can help to deal with the ageing population's healthcare problem in the long term.

This review found seven studies met the included criteria. All included studies found that there was an association between the TFL style and nurses' OC. Six studies reported that the TFL style had a positive effect on nurses' OC (Al‐Hussami,  2009 ; Al‐Yami & Watson,  2018 ; Brewer et al.,  2016 ; Kodama et al.,  2016 ; Lin et al.,  2015 ; Xie et al.,  2020 ). Only one study found that the association of the TFL style with nurses' OC was negative using Pearson's correlation analysis, but was positive using Stepwise linear regression, although not significant (Asiri et al.,  2016 ).

Asiri et al. ( 2016 )'s samples were only from an acute care unit in Saudi Arabia, the results may only be generalizable to this unit or acute care nurses in Saudi Arabia. However, this negative finding was contrary to the other positive finding (Kodama et al.,  2016 ) in this review which also studied the acute nurses, but in Japan. These different results may be influenced by different cultural backgrounds. Furthermore, the study (Asiri et al.,  2016 ) reported that the mean score of the nurses' perceptions of their nurse managers' TFL level was 2.55 (SD = 0.75) (Asiri et al.,  2016 ). However, Bass and Avoliov (1997) reported that an effective TFL style required all component scores to be >3.0. This indicates that the nurse managers' TFL style in the study by Asiri et al. ( 2016 ) was not effective. Al‐Hamdan et al. ( 2017 ) and Aboyassin and Abood ( 2013 ) highlight that ineffective leadership styles negatively affect employees' OC. Therefore, the finding by Asiri et al. ( 2016 ) that there was a negative association between the TFL style and nurses' OC may have occurred because the nurse managers' TFL style was ineffective. Moreover, Asiri et al. ( 2016 )'s study was considered a piece of moderate‐quality evidence (Table  3 ). Therefore, further research is required to support this conclusion, due to the lack of primary studies or systematic reviews.

There were six positive findings on the association between the TFL style and nurses' OC in this review. Two positive findings were focused on aged care nurses (Al‐Hussami,  2009 ; Xie et al.,  2020 ). Both of them were moderate‐quality evidence (Table  3 ). Al‐Hussami ( 2009 ) had a small original sample size (only 60 participants were enrolled) and all the participants were four nursing home nurses working in the US. Xie et al. ( 2020 ) had 217 aged care nurses from one aged care agency. These two studies consistently found that the TFL style had a positive association with aged care nurses' OC.

The other three positive findings were from nurses from different nursing professions (general, paediatric, dental, diabetic, Nursing home, etc). One high‐quality piece of evidence (Table  3 ) (Brewer et al.,  2016 ) involved 1034 nurses from various US hospitals and various nursing professions who had been licensed for 7.5–8.5 years, the large number of participants from different hospitals across the whole of the US strengthens the study. One moderate‐quality evidence (Table  3 ) (Lin et al.,  2015 ) involved 651 nurses from 12 China hospitals and various nursing professions, the adequate sample size (this study was the second‐largest study), and the scientific sampling method make this study was strong. The other low‐quality evidence (Table  3 ) (Al‐Yami & Watson,  2018 ) involved 219 nurses from various nursing professions in two hospitals in Saudi Arabia. These three studies consistently found that the TFL style had a positive association with the nurses' OC. Consequently, these findings can be generalisable to China, Saudi Arabia, and the US. In addition, these threes studies' samples also included aged care nurses, though it cannot be known the exact percent for this group. Therefore, these three studies can also generalisable to aged care nurses.

The remaining study (Kodama et al.,  2016 ) found that the TFL style had a positive association with acute nurses ' OC in Japan. This moderate‐quality evidence (Table  3 ) involved 369 acute nurses. However, there was one study in this review (Asiri et al.,  2016 ) found that the TFL style had a negative association with acute nurses' OC in Saudi Arabia. As mentioned above, further research is needed to address this controversial problem, due to the lack of sufficient evidence.

5.1. Limitations

This study has several limitations. First, all included studies are cross‐sectional surveys; hence, the limitations of cross‐sectional surveys contribute to the limitations of this systematic review. A limitation of cross‐sectional surveys is that they only allow each participant to be assessed once, so changes over time cannot be assessed (Polgar & Thomas,  2013 ). However, OC is developed over a long time (Gao‐Urhahn & Jaros,  2016 ). The change process regarding nurses' OC cannot be recorded by cross‐sectional studies, though it can be recorded by longitudinal studies. Therefore, the cross‐sectional design of the included studies increases the risk of bias in this review.

Second, the exposure factor and the outcome were assessed using self‐administered questionnaires in all included studies. There is a risk that a participant may not report the actual behaviours witnessed or their individual experiences and feelings (Polgar & Thomas,  2013 ), for example, they may misunderstand a question or feel pressure from their nurse manager to answer in a certain way. This increases the risk of bias in this review. Additionally, as all the measurement tools assessed the participants ‘perceptions of the nurse managers’ TFL level or their feelings about OC, the answers were all subjective rather than objective. In addition, Al‐Yami and Watson ( 2018 ) used the MLQ (Bass,  1985 ) to assess the outcome, and the MLQ has questionable validity, which negatively affected the study validity.

Third, the sampling methods used in the included studies also contribute to the limitations of this review (Bettany‐Saltikov,  2012 ). Brewer et al. ( 2016 ), Xie et al. ( 2020 ), and Kodama et al. ( 2016 ) used convenience samples rather than random samples. Although Al‐Hussami ( 2009 ) used a stratified random sample, the study had the smallest sample size ( n  = 60), and only nursing home nurses were assessed. In addition, Asiri et al. ( 2016 ) only obtained their random sample from a single acute care unit, which negatively affected the results' generalisability. Moreover, the studies by Al‐Hussami ( 2009 ), Asiri et al. ( 2016 ), Xie et al. ( 2020 ), and Al‐Yami and Watson ( 2018 ) had unclear inclusion and exclusion criteria. Furthermore, Al‐Hussami ( 2009 ) did not discuss why five participants' data were missing. All these factors also contribute to bias in this review.

Fourth, the studies by Al‐Hussami ( 2009 ) and Asiri et al. ( 2016 ) did not provide details of research ethics committee approvalor participant informed consent, which increases the risk of ethical issues in this review.

5.2. Strengths of the review

The strengths of this review include involving a total of 2885 participants. The huge sample size contributes to the generalizability of this review. Moreover, this review included studies conducted in varied settings: three involved western countries (Al‐Hussami,  2009 ; Brewer et al.,  2016 ; Kodama et al.,  2016 ) and four involved eastern countries (Al‐Yami & Watson,  2018 ; Asiri et al.,  2016 ; Lin et al.,  2015 ; Xie et al.,  2020 ). This contributes to the generalisability of this review to both western and eastern countries.

6. CONCLUSION

In summary, all the included studies found there is an association between the TFL style and nurses' OC. Six studies consistently demonstrated that the TFL style was positively associated with nurses' OC, which is consistent with other studies in business (Dai et al.,  2013 ; Luo et al.,  2017 ). Only one study reported that the relationship between these two variables was negative in Pearson's correlation analysis, but was not significant positive in Stepwise linear regression; moreover, this study is not a strong evidence, and the finding may be due to the nurse managers' ineffective TFL style in the acute care unit or the culture influence. A further research is needed to address the whether the negative findings may be due to the nurse managers' ineffective TFL style or he culture influence.

AUTHOR CONTRIBUTIONS

All authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE ( http://www.icmje.org/recommendations/ )]:

• substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

• drafting the article or revising it critically for important intellectual content.

FUNDING STATEMENT

Conflict of interest statement.

No conflict of interest has been declared by the authors.

ACKNOWLEDGEMENTS

Haoyan, X. , Waters, D. , Jinling, H. , Qiongling, L. , & Sien, L. (2023). Quantitative systematic review of the transformational leadership style as a driver of nurses' organisational commitment . Nursing Open , 10 , 4160–4171. 10.1002/nop2.1671 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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