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Leadership, Followership, and the Context: An Integrative Examination of Nursing Leadership in Uganda

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TITLE Leadership, Followership, and the Context: An Integrative Examination of Nursing Leadership in Uganda
 
RESEARCHER Rose Clarke Nanyonga
School of Nursing
Yale University
Unpublished doctoral dissertation: May, 2015

OBJECTIVE
The purpose of this study was to assess the leadership ability of nurses in leadership positions in Ugandan hospitals.

METHODOLOGY
Surveys were collected from nurses in leadership (response rate 57%, n=120) and staff (response rate 60%, n=360) from three hospital types: private-for-profit (47%), private not-for-profit (28%), and public hospitals (25%) in Kampala, Uganda. Respondents provided demographic information, and completed the LPI, Denison’s Organizational Culture Survey (Denison et al., 2006), and a measure of centralization/decentralization (organizational structure) adapted from Ferrell (1988). Respondents in both groups were primarily females (82%). The typical respondent was between the ages of 25-35 years, held a registered nursing certificate, with 5-10 years of job tenure, having received some formal leadership training. Internal reliability for the overall LPI was .95 for head nurses and .97 for their observers. For Model, internal reliability was .74, Inspire was .83, Challenge was .73, Enable was .82, and Encourage was .82 for head nurses. On the LPI-Observer, internal reliability was .86 for Model, .88 for Inspire, .85 for Challenge, .84 for Enable, and .88 for Encourage.

KEY FINDINGS
Model was the leadership practice reported most frequently used by head nurses, followed by Challenge, Encourage, Inspire, and Enable. The same rank order was reported by their constituents, although their average scores were significantly lower than those provided by their leaders. While there was a statistically significant difference in self-reported leadership scores based on the type of hospital where head nurses worked (public hospitals were higher frequency than from the two types of private hospitals), no other demographic variable was statistically significant (age, gender, level of education, leadership training, job tenure, leadership tenure, organizational tenure, or level of management).

Organizational culture influenced leadership practices, with specific cultures such as Involvement and Mission contributing to greater frequency of use of the leadership practices. Organizational structure (centralization) did not influence the use of the five leadership practices.

The author observes: “health care organizations and nurses in leadership need to be acutely aware of their own environment and how it influences the ability of nurses in leadership to engage in leadership practices of highly successful leaders. A leadership environment that encourages personal growth, involvement in day-to-day decisions, a sense of direction and clear performance expectations, is also likely to enable leaders in inspiring others, leading change initiatives, fostering collaboration, strengthening others and yielding greater leadership outcomes” (p. 127). Furthermore, she notes: “Finally, this is the first use of the LPI to measure leadership practices of nurses in sub-Saharan Africa. The LPI shows robust consistency reliability from a leader-observer perspective in measuring the leadership practices of nurses in leadership in this context” (p. 132).

Leadership, Followership, and the Context: An Integrative Examination of Nursing Leadership in Uganda

Download a Printer Friendly Version (PDF)
 
TITLE Leadership, Followership, and the Context: An Integrative Examination of Nursing Leadership in Uganda
 
RESEARCHER Rose Clarke Nanyonga
School of Nursing
Yale University
Unpublished doctoral dissertation: May 2015

OBJECTIVE
The purpose of this was to describe the leadership practices among head nurses in hospitals in Uganda, compare their responses with those of their staff, and identify demographic, cultural and structure factors that might influence leadership behaviors.

METHODOLOGY
The target population was the nursing workforce in Uganda and selection was based on accessible populations of nurses in leadership and staff from hospital types in Kampala, with 120 head nurses completing the LPI-Self (64% response rate; and they were asked to obtain LPI-Observer responses from staff nurses (N=360; 77% response rate); an Organizational Culture Survey (Denison et al., 2006), a measure of Organizational Structure (essentially centralization/decentralization; Ferrell, 1988), along with providing demographic information. The typical head nurse was female (83%), between the ages of 25-35 years (46%), RNs (63%), with 5-10 years of job tenure (58%) but less than 5 years of leadership tenure (51%), with less than five years of organizational tenure (52%), working in a private-not-for-profit hospital (47%), with some formal leadership training (77%). In this sample 47 percent worked in a private-for-profit hospital, 28 percent in private-not-for-profit hospital, and 25 percent in a public hospital type. Internal reliability coefficients for the head nurses (LPI-Self) were .74 Model, .83 Inspire, .73 Challenge, .82 Enable, .82, and for staff nurses (LPI-Observer) the internal reliabilities were .86 Model, .88 Inspire, .85 Challenge, .84 Enable, and .88 Encourage.

KEY FINDINGS
The most frequently used leadership practice for head nurses was Model, followed by Challenge, Encourage, Inspire, and Enable. This same rank order was found for observer data from staff nurses. The average frequency scores of head nurses were all significantly higher than those reported by staff nurses. There were statistically significant correlations between the head nurses and staff nurses on each of the leadership practices.

MANOVA was conducted to assess the association between demographic variables: Age, gender, level of education, leadership training, tenure (job tenure, leadership tenure and organizational tenure), rank (level of management), and hospital type and leadership practices reported by head nurses.

There was a statistically significant difference in leadership scores based on the type of hospital where head nurses worked; no other demographic variable was statistically significant. Private-not-for-Profit hospital type head nurses scored significantly lower versus both Private-for-Profit and Public hospital types for Model, Inspire, Challenge, Enable, and Encourage. Furthermore, the average scores on all five leadership practices were significantly higher for Public hospital versus Private-for-Profit hospital types.

Regression analysis on each of the five leadership practices with hospital type (private-for-profit and private-not-for-profit) and Organizational Culture/Structure (involvement, consistency, adaptability, mission, and centralization) were statistically significant with R2 values around 0.40.

The author notes: “This is the first study to describe self-reported leadership practices of head nurses in Uganda and in sub-Saharan Africa. In general self- reported leadership scores were above average on the LPI” (p. 113). “In this study the type of hospital where head nurses worked systematically affected the frequency to which head nurses reported using any of the five leadership practices. Notable differences by hospital type were observed between head nurses working in the public hospital type versus those working in Private-for-Profit and Private-not-for-Profit hospital types, as well as between head nurses working in Private-for-Profit versus Private-not-for-Profit hospital types. In general, head nurses working in public hospital type rated themselves higher on all leadership practices. In comparison, head nurses working in Private-for-Profit hospital type tended to perceive themselves as engaging in these leadership behaviors less frequently versus head nurses in the Private-not-for-Profit hospital types respectively” (p. 123). “A leadership environment that encourages personal growth, involvement in day-to-day decisions, a sense of direction and clear performance expectations, is also likely to enable leaders in inspiring others, leading change initiatives, fostering collaboration, strengthening others and yielding greater leadership outcomes” (p. 127). “The presence and adequacy of leadership ability (as measured by the LPI), the significant association between self-reported leadership practices and perceptions of the head nurse’s leadership practices by staff (followers), as well as the significant association between leadership practices and contextual elements in this study, all seem to support the conceptual model underpinning this study” (p. 130).

The author concludes: “Finally the LPI-Self showed good internal consistency reliability for this sample. This is the first study to use the LPI to measure leadership practices of nurses in leadership in Uganda and sub-Saharan Africa. The psychometric properties of internal consistency reliability were consistent with other studies measuring the leadership practices using the LPI (Kouzes & Posner, 2002; Posner & Kouzes, 1993; Tourangeau, 2004). Results support the robustness of the LPI for measuring leadership behaviors and support its use in the present study. Leadership scores on the LPI were not affected by demographic factors (age, gender, level of education [including leadership training] and tenure). Empirical studies examining nurses in leadership in sub-Saharan Africa are noticeably absent in current literature. Reliability of scientific measures, such as the LPI, serves as a means for generating robust leadership theory and research interventions that promote evidenced-based leadership interventions. Empirically supported nursing leadership measures are also crucial in shifting attention to the leadership needs while providing a structured view of what nurses in leadership need to do (practices they need to adopt) to achieve shared goals” (pp. 130-131).

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