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Leadership Style and Motivation in Health Care


There are two major factors that influence an individual performance within any given setting and these are leadership in place and individual motivation (McCutcheon 2004). There are also theories that try to explain what motivates people to perform better and what contributes to their behavioral changes. Motivation refers to the level to which relentless efforts are directed towards achieving goals and objectives of a particular institution or organization. The effort here must be defined relative to the goals being pursued and this must continue until the task is completed (McGuire 2003).

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Individuals get motivated by a number of factors including remuneration and other forms of benefits which are also known as extrinsic motivation. Motivation can also be accrued from kind of task being undertaken and this type of motivation is known as intrinsic motivation ( McGuire 2003). Abraham Maslow came up with five categories of need that influences motivation in an individual.

Each and every person will always strive to satisfy these needs preferentially (from the most basic to the most fulfilling need). These needs in their order of priority are physiological needs, safety needs, relationship needs, self-esteem needs, and lastly self-actualization needs. McClelland’s theory of needs classifies motivational needs as need for achieving a certain goal, need for affiliation, and need for power (Ulrich et al. 2007).

According to Maslow, individuals will be motivated to fulfill whichever need is that is most pressing, or most powerful, for them at a given time. The priority of a need depends on the individual’s current situation and recent experiences. Starting with physical needs, which are most basic, each need must be at least partially satisfied before the individual desires to satisfy a need at the next higher level (Upenieks 2003).

The practical implications of this theory for motivation in organizations are many. The basic, physiological needs of employees must be satisfied by a wage sufficient to feed, shelter, and protect them and their families satisfactorily, and a safe working environment must be provided before managers offer incentives designed provide employees with esteem, feelings of belonging, or opportunities to grow. Security needs require job security, freedom from coercion or feelings of arbitrary treatment, and clearly defined regulations (Vandenberghe et al. 2002).

In the modern organization, both physiological and security needs are usually (but not always) met satisfactorily. The need to belong and be loved, most strongly in relation to one’s family, can also be satisfied in social contexts through friendship and being “one of the gang” at work. The work environment is a social environment, and unless employees feel that they are an integral part of the organization, they will be frustrated by an unmet need to belong and will be unlikely to respond to higher-order opportunities or incentives. (Urden & Monarch 2002)

Maslow described two types of esteem needs—the desire for achievement and competence and the desire for status and recognition. In organizational terms, people want to be good at their jobs; they also want to feel that they are achieving something important when they perform their jobs. Leaders have many ways of fulfilling both types of esteem needs in subordinates by providing challenging work assignments, performance feedback, performance recognition, and personal encouragement and by involving subordinates in goal setting and decision-making (Tourangeau & McGilton 2004).

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When all other needs have been adequately met, according to Maslow, employees will become motivated by the need for self-actualization. They will look for meaning and personal growth in their work and will actively seek out new responsibilities. Maslow stresses that individual differences are greatest at this level. For some individuals, producing work of high quality may be a means for self-actualization, while for others, developing creative, useful ideas serves the same need. By being aware of the different self-actualization needs of subordinates, managers can use a variety of approaches to enable subordinates to achieve personal as well as organizational goals (Tourangeau & McGilton 2004).

David McClelland related these concepts directly to business drive and management. McClelland’s research indicated that a strong need for achievement was related to how well individuals were motivated to perform their work tasks. The need for achievement can be defined as a desire to excel or to succeed in competitive situations. In his research, McClelland found that people with a high need for achievement have several characteristics of interest to managers: They like taking responsibility for solving problems; they tend to set moderately difficult goals for themselves and to take calculated risks to achieve their goals; they place great importance on feedback on how well they are doing (Stordeur et al. 2000).

Therefore, those with high achievement needs tend to be highly motivated by challenging and competitive work situations. Conversely, people with low achievement needs tend to perform poorly in competitive or challenging work situations. There is considerable evidence of the correlation between high achievement needs and high performance. McClelland himself, for example, found that people who succeeded in competitive occupations were well above average in achievement motivation. Successful leaders, who presumably operated in one of the most competitive of all environments, had a higher achievement need than other professionals. McClelland later reported considerable success in teaching adults to increase their achievement motivation and, in turn, to improve their work performance (Stordeur et al. 2000).

For managers, these findings highlight the importance of matching the individual and the job. Employees with high achievement needs thrive on work that is challenging, satisfying, stimulating, and complex. They welcome autonomy, variety; and frequent feedback from supervisors. Employees with low achievement needs prefer situations of stability; security; and predictability. They respond better to considerate than to impersonal high-pressure supervision and look to the workplace and co-workers for social satisfaction (McGuire 2003).

McClelland’s research also suggests that managers can, to some extent, raise the achievement-need level of subordinates by creating the proper work environment—permitting their subordinates a measure of independence, increasing responsibility and autonomy, gradually making tasks more challenging, and praising and rewarding high performance. High achievement needs can also be fuelled by an individual’s fear of failure. Managers may be strongly motivated to take action by their fear of failing to meet personal or organizational goals and by the fear of possible public embarrassment when these failures are recognized. Conversely, for some individuals, fear of success can be a motive. Such people fear the stress and burden of their success and the envy and dislike it may awaken in others (McGuire 2003).

Leadership can be defined as an influence that a specific person exercises upon the goal attainment of others in an organizational context. Leaders have either a positive or a negative influence on other people’s performance within an organization. Leaders belief and confidence on their subordinates builds a strong belief, therefore creates an empowerment and independence among the junior members. Studies shoe that there are two categories of leaders, those who wield influence on others and those who are point of these influence. Flourishing leadership depends mainly on the surrounding and conditions under which these dynamics takes place (McCutcheon 2004).

There are leaders who earn their profile through their technical and academic qualifications or by having been accepted by his cohorts. This is known as an emergent leader. On the others hand, there are leaders who are offered power to exert influence by being appointed into a certain position known as assigned leader. Both of these leaders serve distinct functions but must have the capability to offer social and emotional support to their juniors (McCutcheon 2004).

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They must also have the ability to offer direction and help to their followers in completing a certain task. Studies show that successful leadership must have the capability to recognize and use suitable strategies for a particular task at the right time. Leadership that is confused regarding the mission and vision of an organization can not respond appropriately to the social and emotional needs of the group or solve conflicts within the group, thus can not influence the individual performance positively (McGuire & Kennerly 2006).

Shortage and many a times lack of competent officers during the 2nd world war led to the quest for leaders. After the war, the search for individual characters which befits leaders escalated. Even though there were a number of characteristics of leaders that were found, confusion to whether personality made up a good leader or opportunity to lead generated leadership characteristics arose. The principal weakness in the behavioral approach to leadership identification was the failure to take into consideration the task ahead, followers, and the environmental factors. Study of the emergent leaders can give a hint on the qualities of good and successful leadership (McCutcheon 2004).

This is because emergent leaders hold their position through qualification and their appeal to the group. The position of an emergent leader is always safe as long as their juniors remain influenced by their personal traits and the work condition. Should the above conditions change or the group find s other external influence, the leader might find himself support from the group thus depression his/ her leadership role. Therefore, the role of an emergent leader solely depends on their performance and any trace of failure or faltering may result into lack of support from the juniors. Loss of support may result to either being dethroned incase of political leaders or being replaced by a more qualified person (McGuire & Kennerly 2006).

The emergent type of leadership is very common in communal groups, organizations, in matters of politics and mass-oriented leadership. This type of leaders are always responsible for pushing the group’s agenda and can only retain the sit as long as the followers are satisfied by the works he has done. Since people’s needs are dynamic in nature, maintaining their support is not an easy task. On the other hand, assigned leaders acquire their power and influence from external sources, and mostly are given power to allocate tasks, and reward or punish the group based on their performance (McCutcheon 2004).

Rewards handed out for successful individuals may include material benefits, and preferential treatment. Reward system that compliments an individual’s need can be a great source of motivation. However, leaders who have no authority to reward their subjects may be tempted to give compliments or admiration and even make promise that they cannot fulfill. This often may lead to lack of motivation, loss of loyalty, disagreements, and finally result to a dysfunctional entity (Leach 2005).

Punishment may entail assigning unfavorable tasks, hold back promotions or pay rise and other forms of benefits. At its best, punishment may have limited effect on productivity of an organization. Contrary, are viewed as random and not dependent on the conduct or performance of the group and can be misused by the leadership for retaliation. Leaders who use punishment as the only source of motivation always resort to establishing the level of unbecoming conduct and issuing punishment for the same (Upenieks 2003).

Leadership style and Motivation in Health care (Nursing)

Leadership in Nursing is very important since it ensures safety and quality health care for the people in a particular hospital. Studies have shown high level of health care standards in Magnetic hospitals as compared to non-magnetic hospitals. Success in Magnetic hospitals is attributed to the consistency with transformational leadership. Studies in the US established that about 100.000 deaths in the hospitals were as a result of errors in the healthcare. These created anxiety among the American public thus calling for government action to ensure a lot of efforts are focused towards quality and safety of healthcare (Newhouse & Mills 2002). In response to these studies, other recommendations relating to patient’s safety and changing of the working environment for Nurses were also released to help the government in safeguarding quality and safety in healthcare (McGuire & Kennerly 2006).

The above recommendations have been successfully applied in Magnetic hospitals. Magnetic hospital is a term used to represent hospitals that were able to effectively hire and retain professional Nurses despite of the relative shortage of the Nurses. Studies have also demonstrated that besides positive outcome from the Nursing staff, Magnetic hospitals have shown positive clinical results in term of quality and safety of the patients. Studies have also shown low mortality rate in these hospitals which is majorly attributed to the services offered by the Nursing staff(McGuire & Kennerly 2006).

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One of the main differences between the Magnetic and non-magnetic hospitals lies on the quality of the Nursing leadership. In a Magnetic hospital, Director of Nursing is responsible for the whole hospital while the head nurse is culpable for nursing practice within a particular unit in the hospital. Upaniek (2003) made frequent reference to the role of Nurse Manager and its considerable significance in developing and maintaining a magnetic hospital environment.

According to Upaniek (2003) the contribution and actions of the Nursing managers in the initial Magnetic hospitals was very pivotal to their success. Nurse Managers were very instrumental in staff satisfaction, retention and development. They were also chief supporters and resourceful persons for the nursing staff. They were very knowledgeable and helpful thus nurtured positive relationship with the entire nursing staff which boosted the staff participation inn the hospital work.

Kouzes & Posner (2002) attempted to establish the nursing staff viewpoint on the significance of the Nurse Manager support to the hospital. Support in this case referred to meeting of the staff’s expectation and offering essential support to enable the nursing staff carry out their duties in a professional manner. In their study to establish leadership and managerial characteristics that made Nurse Managers outstanding, they found out that leadership traits were more indicative of support than the managerial traits. The study confirmed that nurse managers in the magnetic hospitals employed leadership traits as compared to those in non-magnetic or aspiring magnetic hospitals. The study also identified the same trend in staff nurse position on the performance of the nurse manager in nurturing teamwork.

Leach (2005) acknowledges the role of the nursing managers as an integral part of the delivery of soaring quality health care in hospitals. McCutcheon (2004) in his study established the relationship between the nurse manager’s style of leadership and the safety of the hospitals. However, there is no study that have compared the traits or behaviors of a nurse manger in the Magnetic and non-magnetic hospitals or scrutinized the theoretical basis of this leadership in magnetic and non-magnetic entities. A number of studies have assessed transformational leadership in nursing executives and established the importance of the nurse leaders on nursing staff’s commitment, satisfaction, and effectiveness (Leach 2005).

There is a strong perception in the nursing staff regarding the nursing leadership in the magnetic hospitals as compared to the non-magnetic or emerging magnetic hospitals. Studies have also shown that excellent relationship between the nursing directors and the unit heads/ nursing managers results to favorable staff outcome. This finding demonstrates that regardless of the setting, the relationship between the top nursing management themselves and the junior staff members is very crucial for the success of the organization’s performance (McGuire & Kennerly 2006).


Of all the functions, leadership involves managers most directly with subordinates. Thus, leading is a central part of the manager’s role, which involves working with and through others to achieve organizational goals. To a large extent, a manager’s leadership ability—that is, a manager’s ability to motivate, influence, direct, and communicate with subordinates—will determine the his/her effectiveness and the success of the entire organization. Motivation is a very important factor for leaders to understand, since leaders must channel their juniors’ motivation so they will achieve personal and organizational goals. However, people’s abilities and role perceptions are also important factors in how well they will perform.

Characteristics of the work situation, particularly the actions of leaders, have a strong impact on motivation. Proper application of behavior modification techniques, which are based on operant conditioning principles, has been found effective in improving employee performance and satisfaction. Behavior modification, or learning theory, suggests that behavior that is followed directly by reward is reinforced and tends to be repeated, while unrewarded or punished behavior tends not to be repeated (Newhouse & Mills 2002).

Leadership in Nursing is very crucial as it ensures safety and quality health care for the public in hospitals. Studies have shown high level of health care standards in Magnetic hospitals as compared to non-magnetic hospitals Success in Magnetic hospitals is attributed to the consistency with transformational leadership. Good leadership in hospital especially nursing leadership nurtures positive relationship with the entire nursing staff which boosted the staff participation inn the hospital work. Consequently, means better health care and reduced mortality rates in the hospitals(Newhouse & Mills 2002).


Kouzes, J.M. & Posner, B. Z. (2002) The Leadership Challenge, Third Edition. San Francisco, Jossey-Bass.

Leach, L. S. (2005) Nurse executive transformational leadership and organizational commitment. Journal of Nursing Administration, 35 (5), 228-237.

McCutcheon, A.S. (2004) Relationships between leadership styles, span of control and outcomes, unpublished doctoral dissertation. Toronto, University of Toronto.

McGuire, E. C. (2003) Transformational and transactional leadership characteristics of nurse managers in relationship to the organizational commitment of registered nurse followers, Unpublished doctoral dissertation. Cincinnati, University of Cincinnati.

McGuire, E. & Kennerly, S.M. (2006) Nurse Managers as transformational and transactional leaders. Nursing Economics, 24 (4), 179-185.

Newhouse, R.P. & Mills, M.E.C. (2002) Enhancing a professional environment in the organized delivery system: Lessons in building trust for the nurse administrator. NursingAdministration Quarterly, 26 (3), 67-75.

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Ulrich, B.T., Woods, D., Hart, K.A., Lavandero, R., Leggett, J., Taylor, D. (2007) Critical care nurses’ work environments: Value of excellence in beacon units and magnet organizations. Critical Care Nurse, 27 (3), 68-77.

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Urden, L.D. & Monarch, K. (2002) The ANCC Magnet Recognition Program: Converting.

Research findings into action. In McClure, M.L. & Hinshaw, A.S. (Eds.). Magnet Hospitals Revisited: Attraction and retention of professional nurses (pp. 103-115). Washington, D.C, American Nurses Publishing.

Vandenberghe, C., Stordeur, S. & D’hoore, W. (2002) Transactional and transformational leadership in nursing: Structural validity and substantive relationships. European Journal of Psychological Assessment, 18 (1), 16-29.

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