الفهرس 
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Abstract
Leadership style of first- line nurse managers is an important component that assures organizational quality health care services, patient satisfaction, and financial performance. Moreover, nurses’ perception of their first line nurse managers’ leadership styles may influence nurses’ quality of care and their ability to manage patients’ health needs appropriately. Healthcareorganization is facing many challenges and issues which impact all practice settings. Both first -line nurse managers and staff nurses play crucial roles in overcoming the challenges that face healthcareorganization today. Staff nurses are intimately involved in providing care to their patients but not always involved in the decisions which impacting on delivery of care. when staff nurses are not engaged and empowered in their work, they are more likely to become dissatisfied in their job resulting in increased turnover (Robert & Vandenberghe, 2021). First -line nurse managers’ leadership plays a fundamental role in generating better results for health organizations especially for patients. The ability of first-line nurse managers to allocate duties and responsibilities to the nursing staff team directly affects the workplace, interfering with staff nurses’ relationships and the sharing of information and skills among staff nurses on the same team (Richardson, Storr, 2010).
First -line nurse managers’ leadership styles are believed to be important determinant of nurses’ job satisfaction and retention. As a result of a worldwide nursing shortage, maldistribution of health workforce, increasing healthcare costs and expanding workload, it has become important to examine the role of first- line nurse managers’ leadership styles on staff outcomes. Leadership styles of first –line nurse managers can have can have a positive effect on the staff nurses′ engagement and empowerment, resulting in increased intent to stay and performance (Cowden & Cummings, 2012; Wong &Giallonardo, 2013).
Aim of the study
The present study aims to identify the correlation between first –line nurse managers′ leadership style and staff nurses ′structural empowerment, work engagement and intent to stay.
Setting:
This study was conducted in all inpatient’s medical units (24 units) and surgical units (15 units) at Alexandria Main University Hospitals, as it is the largest hospital, contained a large number of beds and staff nurses with different qualifications. It provided different services &specialties. It treats & receives large number of patients from different countries &governorates. The capacity of all medical and surgical units was 1370 beds. classified as follow 614 beds in medical care units and 756 beds in surgical units.
The number of medical units included in this study was 24 namely: cardiovascular male, cardiovascular female, renal male, renal female, GIT male, GIT female, Hepatology male, Hepatology female, geriatric male, geriatric female, Diabetes Mellitus male, Diabetes Mellitus female, Rheumatology and Immunity disease male, Rheumatology and immunity disease female, chest disease male, chest disease female, hematology male, hematology female, dermatology male, dermatology female, endocrine male, endocrine female, tropical male and tropical female. Whereas, 15 surgical units included in the study namely: neurology, vascular, hepatic, head and neck, cardio thorax, neurosurgery, plastic, colon and rectum, GIT, ophthalmology, oncology, otorhinolaryngology, children surgery, urology (male& female), and children urology.
Subjects:
The study subjects included all staff nurses with 6 months experience and more who provided direct and indirect care to patients, and who worked in the previously mentioned units and available at the time of data collection. The subjects included in the study were (N= 340) nurses that were identified to take part in the survey. They were distributed as follows: (145) in medical units and (195) in surgical units, and divided into the following categories: Professional nurses (n=7), technical nurses(n=133), & practical nurses(n=200).
Tools of the study:
Four tools were used to conduct this study.
Tool 1: The Multifactor Leadership Questionnaire 5X Short Form
This tool was developed by Avolio &Bass (2004). It was adopted to measure three major leadership styles as perceived by staff nurses ; transformational, transactional and laissez –faire leadership styles of the first line nurse managers. The instrument contained (45) items with 4 scales, (3 leadership styles) and (one outcomes of leadership styles). The first scale included: Transformational leadership style with (5sub-scales) consists of: Idealized influence attributes (4 items) ; idealized influence behavior (4 items) ; inspirational motivation (4 items) ; intellectual stimulation (4 items), and individual consideration (4 items). The second scale including: Transactional leadership style consists of (3 sub- scales), namely contingent reward (4 items) ; management by exception (active, 4 items), and management by exception (passive, 4 items). The third scale included: Laissez- faire leadership style consists of (4 items) and finally leadership outcomes which comprised from (3sub-scales) namely extra effort (3 items) ; effectiveness (4 items), and satisfaction (2 items). The responses were measured on 5 points – Likert scale ranging from (1) strongly disagree to (5) strongly agree.Cronbach′s alpha Coefficient for internal consistency reliability of the tool was (0.95).
Tool 2: Conditions of Work Effectiveness Questionnaire (CWEQ Ⅱ)
This tool was developed by (Laschinger et al., 2001), it was adopted to measure nurses ’perception of structural empowerment in work place. It consists of (21 items) & six dimensions namely: access to opportunity (3 items) ; support (3 items) ; information (3 items) ; resources (3 items) ; formal power (3 items) ; informal power (4 items), and (2 items) to measure global empowerment. Responses to all items were measured on a 5-point Likert scale ranging from (1) none to 5 (a lot). The overall score ranging from (21-105), low scoring of empowerment ranging from (21-45), indicated that subjects perceived themselves as having low empowerment, moderate scoring of empowerment ranging from (46-76), and high scoring of empowerment ranging from (77-105), indicated that subjects perceived themselves as highly empowered. Cronbach′s alpha Coefficient for internal consistency reliability of the tool was (0.74).
Tool 3: Utrecht Work Engagement Scale (UWES)
This tool was developed by Schaufeli and Bakker (2002) and then updated by them in (2006). It was adopted to measure work engagement of participating nurses; it consists of 9 items classified into three dimensions namely: vigor, dedication, and absorption. Each dimension was composed of three items. For purpose of ease response, the scale was adapted from seven-point Likert scale to 5-point Likert scale ranging from (0) never to (4) always. The overall score level ranging from (0 to 36). Low scoring of work engagement ranging from (0 -11), indicated that subjects perceived themselves as having lower engagement in work, moderate scoring of work engagement ranging from (12-23), and high scoring of work engagement ranging from (24 -36)), indicated that subjects perceived themselves as having higher engagement in work. Cronbach′s alpha Coefficient for internal consistency reliability of the tool was (0.90).
Tool 4: Intent to stay
This tool was developed by Mayfield (2007) It was adopted to measure nurses’ intention to stay in the organization. It consists of 7 items ; three items reflect positive intention; four items reflect negative intention. The reversed score was used for negative statement. Responses were measured on 5- point Likert scale ranging from (1) strongly disagree to (5) strongly agree. The overall score ranging from (7 to 35), low scoring of intent to stay ranging from (7-15), moderate scoring of intent to stay ranging from (16-25), and high scoring of intent to stay ranging from (26-35). Cronbach′s alpha Coefficient for internal consistency reliability of the tool was (0.79).
In addition, nurses ′demographic & working characteristics questionnaire was designed by the researcher to describe the sample. The variables to be collected included: age, gender, level of education, years of experiences in nursing work, years of experiences in current position, years of experiences in the organization, working shift, working hours per shift.
Method:
The research was submitted to the Ethical Research Committee, Faculty of Nursing, Alexandria University for ethical approval.
An official permission to collect the necessary data for the study was obtained from the Vice-Dean Faculty of Nursing, University of Alexandria directed to the administrative authorities of the Main University Hospital after explanation of the aim of the study.
The tools were translated into Arabic, and tested for their content validity by jury of five experts in the field of the study from Faculty of Nursing, Alexandria University and some statements are reworded. They were one professor and two lecturers of nursing administration department, two professors of Medical and Surgical Department.
The tools were tested for their internal consistency, reliability using Cronbach′s alpha Coefficient which proved to be strongly reliable.
A pilot study was carried out on 5 % of nurses (n=17) that were not included in the study sample, in order to check and ensure the clarity, applicability and feasibility of the tools; identify obstacles and problems that may be encountered during data collection and estimate the time needed to fill the questionnaire. In the light of the findings of the pilot study, no change occurred in the tools and the tools were put in the final form.
Data collection:
Data collection for this study was conducted through self-administered questionnaire. It was hand delivered to the study subjects in the work settings and the needed instructions were given before the distribution of the questionnaire, for completion of the questionnaire each study subjects consumed approximately (15-20 minutes). the data collected in a period of 2 months from 28 September 2021 to 25Novamber 2021.
The following were the most important results of the present study:
• Nearly three quarters of nurses (72.4%) perceived that; first line nurse managers had high level of transformational leadership style. however, it can be seen that, 92.1% perceived that first line – nurse manager had moderate level of transactional leadership style. while lowest percentage of nurses perceived that; first-line nurse manager had a low level of laissez faire leadership style (80.3%).
• There was a significant positive high correlation between transformational style and total outcomes where (r=0.796, p=0.000*) respectively, whereas there was a significant positive low correlation between transactional style and total outcomes where (r=0.105, p=0.054*). also, there was a significant moderate negative correlation between laissez faire style and total outcomes where (r= -0.699, p=0.000*) respectively.
• Also, half of staff nurses (50.0%) had moderate level of structural empowerment, whereas only 2.1 % had low level of their structural empowerment.
• Furthermore, two third of nurses (70.9%) had high level of work engagement, whereas 6.8% of nurses had low level of work engagement.
• Also, more than half of nurses (61.8%) had high level of intent to stay, on other hand 13.8% of participated nurses had low level of intent to stay.
• Moreover, there was a statistically significant positive high correlation between overall transformational leadership style and overall structural empowerment & its related dimensions where (p= 0.000*, r= 0.754) respectively.
• Also, there was statistically significant positive moderate correlation between overall transformational leadership style and overall work engagement & its related dimensions where (p= 0.000*, r= 0.575) respectively.
• There was a statistically significant positive moderate correlation between overall transformational leadership style with all dimensions and nurses ′intent to stay where (p=0.000*, r= 0.698).
• However, there was no statistically significant correlation between overall transactional leadership style and overall structural empowerment where (p= 0.384).
• There was no statistically significant correlation between overall transactional leadership style and nurses′ intent to stay where p (0.521).
• There was no statistically significant correlation between overall transactional leadership style and nurses′ intent to stay where p (0.521).
• Also, there was highly statistically significant positive low correlation between overall transactional leadership style and overall work engagement & its related dimensions where (p = 0.017**, r= 0.129).
• There was there was statistically significant negative correlation between each of structural empowerment, work engagement and intent to stay and laissez-faire leadership style.
• There was statistically significant positive high correlation between overall dimensions of structural empowerment and nurses′ intent to stay where p (0.000*, r = 0.806).
• There was statistically significant positive moderate correlation between work engagement & its related dimensions and nurses′ intent to stay where p (0.000*, r = 0.644) respectively.
• There was statistically significant moderate correlation between overall dimensions of work engagement and overall dimension of structural empowerment where p (0.000*, r= 0.562).
• Also, there was statistically significant difference between the different study variables and some nurses’ demographic characteristics as follow:
There was statistically significant difference between level of transformational leadership style of first line –nurse manager and nurses′ demographic characteristics in the term of nurses′ age, working unit, years of experience since graduation, years of experience in the working hospital, years of experience in the working unit.
There was statistically significant difference between nurses’ demographic characteristics and level of transactional leadership style of first –line nurse manager in the form of working unit, years of experiences since graduation, years of experience in the working unit and working hours.
There was statistically significant difference between nurses’ demographic characteristics and level of and level of laissez- faire style of first –line nurse manager in term of years of experience.
There was statistically significant difference between nurses’ demographic characteristics and level of structural empowerment in term of age, gender, working unit, years of experience.
There was statistically significant difference between nurses’ demographic characteristics and levels of work engagement in term of nurse’s age, gender, working unit, years of experience.
There was statistically significant difference between nurses’ demographic characteristics and levels of intent to stay in term of age, gender, working unit, years of experience.
Recommendations were given focused on the results of the present study to addressing leadership style of first -line nurse manager and improve staff nurse’s structural empowerment, work engagement and their intention to stay. For the nursing administrators Providing a healthy work environment that characterized with open communication through conducting a schedule for staff meeting and workshops with their managers to improve the ability of the manager to consider structural empowerment and work engagement. Providing training program, workshops and conferences for nurse’s manager that focuses effective leadership style and interpersonal skills that most effective and efficient way to promote nurses’ performance and the success of the health care organization. For the first -line nurse managers Conducting frequent meeting and open discussion with staff nurses to identify their needs and problems, discuss issues related to their clinical practice as well as facilitate their participation in decisions making regarding to their work environment and patient to improve their satisfaction, self- esteem & intent to stay. Building trust in their nursing staff, inspire power and pride in their nursing staff, by going beyond their own individuals interests and focusing on the interests of the group and be a role model for nursing staff. Using effective and supportive leadership style that enhance staff nurses ′ work engagement, structural empowerment and intention to stay through sharing goals and mutual understanding of what is right and important, provide vision of what is possible and how to attain them and enhance meaning and promote positive expectations about what needs to be done.