Effective Leadership Style, Nurses’ Satisfaction, and Intention to Stay toward Achieving Quality Improvement: Conceptual Framework ()
1. Introduction
The healthcare sector is undergoing significant transformations, driven by evolving patient needs, technological advancements, and the imperative for quality improvement. Effective leadership within healthcare settings plays a critical role in enhancing nurses’ job satisfaction and retention, essential components for maintaining a sustainable workforce and ensuring high-quality patient care. In particular, the Asir region of Saudi Arabia is experiencing rapid healthcare development, exemplified by the Asir Health Cluster’s efforts to modernize infrastructure and implement patient-centred care models aligned with Saudi Vision 2030.
Recent studies underscore the pressing challenges healthcare organizations face regarding nurse retention and leadership effectiveness. Nurse managers have increasingly employed professional protection strategies to mitigate nursing negligence and bolster staff morale, reinforcing the necessity of effective leadership in addressing contemporary issues within the nursing profession (Khodayarimotlagh et al., 2022) [1]. The broader responsibilities of nurse leaders, including setting clear expectations and fostering open communication, are pivotal for cultivating a positive work environment (American Nurses Association [ANA], 2024) [2].
Nurse retention has emerged as a critical issue for healthcare systems globally, particularly considering increasing demand for nursing services in the wake of ongoing shortages (Pressley & Garside, 2023) [3]. The complexities surrounding patient safety are further compounded by leadership dynamics, with transformational leadership identified as a key factor in enhancing nurse retention and addressing the multifaceted challenges present in healthcare settings (Ystaas et al., 2023) [4]. This highlights the interconnectedness of leadership style, job satisfaction, and patient outcomes, emphasizing the urgent need for effective leadership to navigate these challenges (Nwaorgu, 2021) [5].
The COVID-19 pandemic has exacerbated existing nurse retention issues, revealing vulnerabilities within the healthcare workforce that predate the crisis (Massachusetts Health Policy Commission, 2023) [6]. Surveys indicate that the pandemic has intensified stressors leading to burnout and turnover intentions among nurses, underscoring the immediate need for innovative leadership approaches. Nurse-led innovation has emerged as an empowering strategy to address these challenges, enabling nurses to proactively adapt to evolving healthcare demands and anticipate future organizational (Elbus et al., 2024) [7].
Beyond that, nursing education needs to change to reflect current values and trends in order to prepare upcoming medical professionals to handle the challenges of the healthcare industry (American Association of Colleges of Nursing, 2021) [2]. In the current climate, compassionate, collective, and transformational nursing leadership is essential for supporting nursing leaders in delivering quality care while managing the pressures inherent in the profession (Pattison & Corser, 2022) [8].
Given the complexities of the healthcare environment, understanding the qualities of effective leadership within nursing and the strategies employed by nurse managers is paramount for improving nurse retention practices and overall healthcare leadership. This study aims to explore the impact of various leadership styles on nurses’ job satisfaction and intention to stay, with the overarching goal of enhancing workforce sustainability and quality improvement in healthcare settings, particularly in the Asir region.
To guide this study, the following research question has been formulated: How do different nursing leadership styles influence nurses’ job satisfaction and their intention to stay within healthcare organizations in the Asir Health Cluster? By addressing this question, the research seeks to contribute valuable insights that can inform leadership training programs and strategies for improving nurse retention and patient care quality.
The conceptual framework presented in this study provides a foundation for future empirical research and interventions aimed at improving nurse retention and quality of care within the Asir region’s healthcare landscape. Leadership styles play a crucial role in shaping nurses’ job satisfaction and their intention to stay, directly impacting healthcare outcomes in the Asir Health Cluster. By prioritizing transformational, participative, and authentic leadership, healthcare institutions in this region can create an environment that supports workforce sustainability and enhances patient care quality. Future studies should explore the practical applications of this framework, examining how leadership interventions can be tailored to different healthcare settings within the Asir Health Cluster to maximize their impact on workforce stability and quality improvement.
Ultimately, the Asir Health Cluster is positioned to benefit significantly from the insights provided by this conceptual framework. By implementing effective leadership strategies that foster job satisfaction and retention, the region can ensure a committed nursing workforce dedicated to delivering high-quality healthcare services. As the healthcare system in the Asir region continues to evolve in line with the goals of Saudi Vision 2030, this framework serves as a valuable guide for enhancing both workforce sustainability and the overall quality of care in the Asir Health Cluster.
2. Theoretical Framework
This framework is grounded in established theories of leadership and organizational behaviour, specifically emphasizing transformational and participative leadership styles (Nunnally & Bernstein, 1994) [9]. These leadership styles have been identified as effective in mitigating common challenges in the nursing profession, such as high turnover rates, burnout, and job dissatisfaction. Transformational leadership inspires and motivates employees by fostering a shared vision, encouraging innovation, and promoting professional development. Participative leadership, on the other hand, emphasizes collaboration and shared decision-making, increasing nurses’ sense of value and engagement in their roles.
The mediating role of nurses’ job satisfaction is central to this framework, as it directly correlates with their commitment to the organization and overall quality improvement efforts (Al Yahyaei et al., 2022) [10]. The framework integrates elements of motivation, organizational support, and continuous quality improvement, providing a comprehensive perspective on how leadership practices can create a sustainable and satisfied nursing workforce. By focusing on leadership approaches that foster engagement and retention, healthcare institutions can achieve long-term improvements in patient care and organizational efficiency.
The theory of workforce sustainability, proposed by Ehnert (2009) [11], emphasizes balancing organizational productivity with the long-term well-being, development, and retention of employees through sustainable human resource management practices.
The Saudi Arabian healthcare system has experienced significant growth and development over the past few decades, becoming one of the most advanced in the Middle East. However, alongside this growth, the sector has faced numerous challenges, including a high demand for services, workforce shortages, and the need for continuous quality improvement. The Saudi Vision 2030, a strategic framework aimed at reducing the country’s dependence on oil and diversifying its economy, has placed a strong emphasis on improving healthcare services. This includes not only the expansion of healthcare infrastructure but also the enhancement of service quality and patient outcomes through effective leadership and workforce management (Almalki et al., 2020) [12].
Leadership within healthcare organizations is a critical determinant of overall organizational effectiveness and quality improvement. Effective leadership is essential in creating a positive work environment, enhancing employee satisfaction, and ensuring high-quality patient care. In the context of Saudi Arabia, where the healthcare system is rapidly evolving, understanding the impact of leadership styles on key outcomes such as employee satisfaction and retention is crucial. Studies have shown that leadership styles can significantly influence nurses’ job satisfaction and their intention to remain with an organization, both of which are directly linked to the quality of care provided (Alshahrani & Baig, 2021; Al-Dossary et al., 2022) [13] [14].
Nurses, as the largest group of healthcare professionals, play a pivotal role in the delivery of healthcare services. However, the profession is characterized by high turnover rates, which can undermine the continuity and quality of patient care. In Saudi Arabia, nurse turnover has been a persistent issue, exacerbated by factors such as work-related stress, limited professional development opportunities, and dissatisfaction with leadership (Albalawi et al., 2024) [15]. Given the critical role that nurses play in the healthcare system, addressing these challenges through effective leadership is essential for achieving the goals of Vision 2030.
Research indicates that transformational leadership, which emphasizes motivation, empowerment, and support, is particularly effective in enhancing job satisfaction and reducing turnover intentions among nurses (Gebreheat et al., 2023) [16]. Conversely, transactional leadership, which focuses on performance-based rewards and penalties, may not foster the same level of commitment or satisfaction among staff (Alshammari et al., 2023) [17]. Understanding how these leadership styles affect nurses’ job satisfaction and their intention to stay can provide valuable insights for healthcare organizations aiming to improve both employee retention and patient care quality.
This study seeks to explore the influence of different leadership styles on achieving quality improvement in the Saudi Arabian healthcare industry, with a specific focus on the mediating roles of nurses’ satisfaction and their intention to stay. By examining these relationships, the research aims to contribute to the body of knowledge on healthcare leadership and offer practical recommendations for enhancing organizational performance and healthcare quality in Saudi Arabia.
3. Definition of Terms
1) Leadership Styles:
Transformational Leadership: A leadership approach that inspires and motivates employees through a shared vision, fostering innovation and promoting an environment of collaboration and personal development. Transformational leadership is associated with higher job satisfaction and improved organizational outcomes, particularly in the healthcare sector (Alshahrani & Baig, 2021) [13].
Transactional Leadership: A leadership style focused on the exchange process between leaders and followers, where compliance is obtained through rewards and penalties. Transactional leadership is typically associated with maintaining routine performance and achieving short-term goals, often lacking the long-term employee engagement seen in transformational leadership (Al-Dossary et al., 2022) [14].
Charismatic Leadership: Servant leadership is a leadership philosophy where the leader’s primary focus is on serving and empowering others, particularly their team members. This approach prioritizes the well-being, development, and success of the team, fostering a supportive and collaborative work environment. Servant leaders emphasize empathy, ethical stewardship, and the growth of individuals within the organization, seeking to create a strong sense of community and mutual respect. The servant leadership model is especially relevant in fields like healthcare, where leaders who prioritize the needs of their team can significantly enhance job satisfaction and organizational outcomes (Eva et al., 2019; Parris & Peachey, 2021) [18] [19].
Strategic Leadership: Strategic leadership refers to the ability of leaders to influence and guide their organizations towards achieving long-term goals and objectives. This leadership style focuses on aligning organizational resources, capabilities, and actions with a broader vision for future success. Strategic leaders are characterized by their foresight, ability to anticipate changes in the external environment, and their skill in creating and implementing strategies that ensure the organization’s sustainability and competitive advantage. In addition to vision and planning, strategic leaders prioritize adaptability, innovation, and the effective execution of strategic initiatives across all levels of the organization (Schoemaker, Krupp, & Howland, 2018) [20].
Authentic Leadership: Authentic leadership is a leadership style that emphasizes transparency, ethical behavior, and a deep sense of self-awareness in leaders. Authentic leaders are genuine in their actions and decisions, guided by a strong set of internal values and a commitment to integrity. They focus on building trust and credibility with their followers by being consistent in their words and actions, openly sharing information, and encouraging open communication. Authentic leadership is associated with higher levels of employee engagement, job satisfaction, and overall organizational performance, as it fosters a culture of trust and ethical behavior within the organization (Gardner et al., 2021; Avolio & Walumbwa, 2020) [21].
2) Quality Improvement:
The ongoing process of enhancing healthcare services to increase efficiency, effectiveness, and patient safety. Quality improvement initiatives in healthcare are driven by the need to achieve better patient outcomes, reduce errors, and optimize the use of resources, particularly in alignment with broader goals like Saudi Vision 2030 (Alnajim, 2024) [22].
3) Job Satisfaction:
A measure of how content employees are with their job roles, encompassing factors such as work environment, leadership, compensation, and professional development. In the context of nursing, job satisfaction is critical for maintaining a committed workforce and ensuring high-quality patient care (Alshahrani & Baig, 2021; (Gebreheat et al., 2023) [13] [16].
4) Retention:
The likelihood that employees will remain in their current positions within an organization. In healthcare, nurses’ intention to stay is influenced by factors such as job satisfaction, leadership style, and organizational support, and is crucial for reducing turnover rates and maintaining continuity of care (Albalawi et al., 2024) [15].
Table 1. Theory of leadership styles.
Concept |
Definition |
Transformational Leadership |
Inspires and motivates employees through a shared vision, fostering innovation and collaboration while promoting personal development. Associated with higher job satisfaction and improved organizational outcomes in healthcare. |
Transactional Leadership |
Focuses on the exchange process between leaders and followers using rewards and penalties. Primarily associated with maintaining routine performance and achieving short-term goals, with limited long-term engagement. |
Charismatic Leadership |
A leadership approach emphasizing personal charm and inspiration, significantly influencing team morale and productivity. |
Strategic
Leadership |
Involves guiding organizations toward long-term goals through
vision, adaptability, and effective execution of strategies, ensuring
sustainability and competitive advantage. |
Authentic
Leadership |
Emphasizes transparency, ethical behavior, and self-awareness,
fostering trust, credibility, and open communication. Associated with higher employee engagement and job satisfaction. |
4. Discussion
The relationship between leadership styles and workforce sustainability is crucial, especially for enhancing nurses’ job satisfaction and retention in healthcare settings. Research indicates that transformational and participative leadership styles significantly contribute to a positive work environment, promoting job satisfaction and reinforcing nurses’ intention to stay in their roles. These styles effectively cultivate cultures of trust and empowerment, which are essential for addressing the high turnover rates in the nursing profession, as shown in Table 1.
However, it is important to acknowledge that not all leadership approaches yield uniformly positive outcomes. While transformational leadership aligns well with long-term engagement strategies, the role of transactional leadership should not be dismissed. Evidence suggests that transactional leadership can be effective in improving short-term performance metrics, particularly in high-pressure situations such as staffing shortages or acute care scenarios. In such contexts, transactional leadership can drive immediate compliance and performance through structured rewards and penalties. This indicates that while transactional leadership may not foster the long-term engagement necessary for workforce sustainability, it can provide valuable support in situations requiring rapid results.
Moreover, the relationship between leadership styles and job satisfaction is complex and not strictly linear. For instance, in organizations where transactional leadership is employed, job satisfaction levels may initially increase due to the immediacy of rewards. However, this effect may wane over time as the lack of intrinsic motivation becomes evident. This underscores the importance of evaluating the long-term implications of leadership styles, rather than focusing solely on short-term outcomes.
Participative leadership, characterized by collaborative decision-making, emerges as another critical factor in enhancing nurses’ engagement and job satisfaction. When nurses feel that their input is valued, their commitment to the organization strengthens, ultimately leading to improved patient care outcomes. This leadership approach not only fosters a sense of belonging among nurses but also provides healthcare organizations with diverse perspectives that can inform quality improvement initiatives.
Importantly, the framework highlights that effective leadership must adapt to the complexities of the healthcare environment. Given the ongoing challenges such as workforce shortages and increasing patient demands, a hybrid approach that integrates elements of both transformational and transactional leadership may be particularly advantageous. Such an approach allows organizations to harness the strengths of each style—using transformational leadership to inspire and engage nurses, while employing transactional methods to ensure performance during critical periods.
It is also essential to recognize the potential drawbacks of leadership styles. For example, an overreliance on transactional leadership may lead to burnout and disengagement among nurses in the long term. This emphasizes the need for healthcare leaders to be mindful of the dynamic interplay between different leadership styles and their varying impacts on job satisfaction and retention.
In conclusion, the findings advocate for a balanced perspective on leadership in nursing. While transformational and participative leadership styles are indispensable for long-term workforce sustainability and quality improvement, the strategic use of transactional leadership can effectively address immediate challenges. Future research should continue to explore these nuances, examining how a blended leadership approach can be structured to meet the diverse needs of the nursing workforce and enhance organizational outcomes in the ever-evolving healthcare landscape.
5. Conceptual Framework
The proposed conceptual framework integrates leadership styles, job satisfaction, and intention to stay as critical factors in workforce sustainability and quality improvement. Effective leadership fosters a supportive work environment, leading to increased job satisfaction and retention among nurses. The framework suggests that transformational, participative, and authentic leadership styles are particularly effective in achieving these outcomes. By addressing job satisfaction and retention through leadership strategies, healthcare organizations can create a resilient and high-performing workforce dedicated to continuous quality improvement.
Figure 1. Conceptual framework outline illustrating the relationship between independent variables and dependent variables.
The conceptual framework shown in Figure 1 for this study outlines the relationships between leadership styles, nurses’ satisfaction, and retention within healthcare settings in Saudi Arabia. This framework is designed to guide the research by hypothesizing how these variables interact and collectively influence organizational outcomes.
The framework begins with leadership styles as the independent variable, encompassing a lot of leadership styles will be used. Each of these leadership styles is expected to have a unique impact on nurses’ satisfaction and their intention to stay within their organizations. Transformational leadership involves leaders who inspire and motivate their employees by creating a vision and encouraging innovation. This style is anticipated to have a strong positive effect on both job satisfaction and intention to stay, fostering an environment where nurses feel valued and supported (Goens & Giannotti, 2024) [23]. Servant leadership focuses on serving others, prioritizing the needs of employees, and empowering them to achieve their full potential. This leadership style is likely to enhance job satisfaction and retention by creating a caring and supportive work environment (Al-Dossary, 2021) [14]. Strategic leadership emphasizes long-term vision and aligning the organization’s resources with its goals. Strategic leaders are expected to improve nurses’ satisfaction and intention to stay by ensuring that organizational objectives are clear and that employees understand how their roles contribute to these objectives (Al Yahyaei, A., Hewison, A., Efstathiou, N., & Carrick-Sen, D. (2022) [10]. Transactional leadership, based on a system of rewards and penalties, may effectively maintain routine operations but might not significantly enhance job satisfaction or retention in the long term compared to more transformational or servant leadership styles. (Dong, 2023) [24].
The framework also includes nurses’ satisfaction as a mediating variable. Job satisfaction reflects how content nurses are with their roles, the leadership they experience, and their work environment. Satisfied nurses are more likely to remain in their positions, which in turn positively impacts their intention to stay and contributes to quality improvement within the organization (Alsadaan et al., 2023) [25]. Nurses’ intention to stay is another key mediating variable in this framework. It reflects the likelihood that nurses will continue working in their current roles within the organization. This variable is influenced by both leadership styles and job satisfaction, with higher levels of satisfaction leading to a stronger intention to stay. Retaining experienced and satisfied nurses is critical for maintaining high standards of care and ensuring the continuity of quality improvement efforts (Al Yahyaei et al., 2022) [10].
Finally, nurses’ retention is the dependent variable in this framework, representing the outcome of interest. Quality improvement includes the effectiveness of healthcare services, patient outcomes, and overall organizational performance. The framework posits that leadership styles influence quality improvement indirectly through their impact on nurses’ satisfaction and their intention to stay. Effective leadership, which fosters satisfaction and retention, is expected to lead to significant improvements in the quality of healthcare services provided (Almalki, Fitzgerald, & Clark, 2020) [11].
This conceptual framework integrates various leadership theories with organizational behaviour concepts to provide a comprehensive understanding of how different leadership styles influence key outcomes in healthcare. By hypothesizing the direct and mediating effects of these variables, the framework serves as a guide for the study’s methodology and analysis, ultimately aiming to enhance quality improvement in Saudi Arabian healthcare institutions.
6. Recommendations
To enhance the applicability of the findings from this study, several recommendations for leadership interventions are proposed, aimed at cultivating effective leadership styles identified in the conceptual framework. A vital step is the development of comprehensive training programs focused on transformational leadership principles. These programs should emphasize essential skills such as vision creation, motivational techniques, and the promotion of innovation, utilizing workshops, mentorship, and peer learning opportunities to empower leaders in inspiring and supporting their teams. Additionally, conducting workshops centred on participative leadership techniques is crucial, as these sessions encourage shared decision-making and collaboration among nursing staff. By honing communication skills, conflict resolution, and strategies for involving nurses in organizational decisions, such initiatives will foster a greater sense of belonging and engagement among nursing professionals. Moreover, cultivating authentic leadership qualities through self-reflection exercises, ethical decision-making training, and transparency will promote an environment characterized by trust and collaboration, further enhancing team dynamics.
Establishing formal mentorship programs that connect experienced leaders with emerging nurse leaders is another important recommendation, providing guidance on career development and professional growth opportunities. Implementing recognition and reward systems can also significantly enhance job satisfaction and retention by celebrating the contributions and achievements of nurses, reinforcing the value of their work within the organization. Furthermore, developing structured feedback mechanisms will allow nurses to voice their opinions on leadership effectiveness and workplace conditions, with regular surveys and focus groups yielding valuable insights that enable leaders to adapt their approaches. Finally, encouraging leaders to actively participate in quality improvement initiatives will reinforce the connection between effective leadership, job satisfaction, and positive patient care outcomes. By training leaders to understand and implement quality improvement methodologies, organizations can engage all staff in these vital processes. Through these targeted interventions, healthcare organizations can create a supportive and engaging work environment that enhances nurses’ job satisfaction and retention while contributing to the continuous improvement of patient care quality.
7. Conclusion
The conceptual framework presented in this study provides a foundation for future empirical research and interventions aimed at improving nurse retention and quality of care. Leadership styles play a crucial role in shaping nurses’ job satisfaction and their intention to stay, directly impacting healthcare outcomes. By prioritizing transformational, participative, and authentic leadership, healthcare institutions can create an environment that supports workforce sustainability and enhances patient care quality. Future studies should explore the practical applications of this framework, examining how leadership interventions can be tailored to different healthcare settings to maximize their impact on workforce stability and quality improvement.