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UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 1

Charge Nurses’ Leadership Styles on Confidence

Level and Intent to Delegate Tasks

A Research Paper

Presented to the

University of Santo Tomas- The Graduate School

In Partial Fulfillment of the

Requirements for the Course

Research Methodology

Michael Erick Virtucio, RN

May 2015


TABLE OF CONTENTSPage

Title page 1Table of Contents 2Research Proposal Endorsement Form 3Certificate of English Editing 4Abstract 5

Chapter I The ProblemIntroduction 6Statement of the problem. 7Objectives 8Significance of the study 9Definition of terms 10

Chapter II Theoretical BackgroundReview of literature 11Synthesis of literature reviewed 12Hypothesis 13

Chapter III MethodologyResearch design 14Research setting 14Sampling technique 14Study population 14Instrumentation 15Data collection 17Statistical analysis 17

References 19AppendicesLetter to the Respondents 20Consent Form 21Timetable for Research 22Budgetary Requirements 23Curriculum Vitae 24

Title of the thesis/dissertation proposalCharge Nurses’ Leadership Styles on Confidence

Level and Intent to Delegate Tasks


Office for Graduate ResearchThe Graduate School, University of Santo TomasManila

Research Proposal Endorsement Form

Program of study: Masters in Health Professions Education

Michael Erick V. Virtucio APRIL 2015 Degree Candidate Date

Director: I have reviewed and fully endorse the proposal manuscript attached herewith for evaluation. We look forward to a robust and thorough review of this manuscript and welcome the necessary changes, if any, to execute the proposed study.

Thank you.

______________________________ ____________________Research Advisor DateSignature over printed name

UST: SO27-00-FO03


Office for Graduate ResearchThe Graduate School, University of Santo TomasManila

English Editing Certification Form

This is to certify that I have edited this thesis/dissertation manuscript entitled

and have found it thorough and acceptable with respect to grammar and composition.

_____________________________________ Signature over printed name

_____________________________________Affiliation

_____________________________________Date

Charge Nurses’ Leadership Styles on

Confidence Level and Intent to Delegate Tasks

prepared by

Michael Erick V. Virtucio

UST: SO27-00-FO06


ABSTRACT

Leadership is a process by which a person influences a certain group of people to achieve their

common goal. To achieve goals, a leader should be the decision maker, facilitator, critical

thinker and role model while subordinates are involved by the process of delegation (House,

1996).

This study will investigate and describe the relationship of leadership styles and on confidence

level and intent to delegate tasks. It is a cross sectional design that will be completed at Chinese

General Hospital and Medical Center (CGHMC). The respondents will include hospital’s charge

nurses in which convenience sampling will be used to gather data.

This study aims to help nurses be aware of their knowledge and skills in facilitating unlicensed

assistive personnel to achieve quality outcomes by recalling rules and responsibility in delegating

this study may provide. It can be used as a basis for effective leadership style that can be implied

in nursing profession/filed. It may also be a catalyst for more discourse and subsequent

investigations directed in identifying and examining variables and experiences.

Charges nurses will answer Path Goal Leadership Questionnaire (PGLQ) that was

developed by Indivik (1985) to identify their leadership styles and Confidence Level and Intent

to Delegate Scale (CIDS) to asses or measure their confidence level and intent to delegate patient

care tasks to unlicensed assistive personnel.

Collected data will be analyzed using Chi- square Probability test and Fisher’s Exact

Probability test with the set level of significance of 0.05 will be used to determine the

association between variables.

To further improve this study, it will be recommended to consider other factors such as gender,

age, total number of years of experiences and educational attainment of the respondents.

Addition to this, the presence of delegation in the field or institution and education together with

nursing practices and laws should be considered as extraneous variables.

Keywords: Charge nurses, Leadership styles, Confidence level, intent to delegate, Delegation


CHAPTER ITHE PROBLEM

Introduction

Traditionally, charge nurses assumed complete care of the patients’ needs unassisted by

ancillary personnel, such as unlicensed assistive personnel (UAP), clinical nursing assistants or

nurses' aides (Huston, 1996). Many charge nurses had difficulties in developing their skills

needed to delegate patient care appropriately to others. Today, the presence of more patients

getting sick, fewer charge nurses, numerous cost and budgetary restrictions (Lookinland, 2005)

changes the face of health care. To solve some of these issues, healthcare organizations are

utilizing the services of nurses’ aides who provide direct patient care that are consistent with

national standards of practice and state nurse practice acts. While the presence of nurses’ aides

in health care organizations was intended to alleviate the demands placed on charge nurses, they

are also burdened with the responsibility of supervising the direct patient care provided by

nurses’ aides in addition to their clinical nursing responsibilities. In 1992, American Nurses

Association (ANA) defined delegation as "the transfer of responsibility for the performance of an

activity from one individual to another while retaining accountability for the outcome". Charge

nurses require both clinical and delegation leadership skills. (Kleinman & Saccomano, 2006).

Unfortunately, charge nurses are often poorly prepared to perform either delegation or

supervision activities (Hutson, 1996).

While few staff nurses may be born with the ability to intuitively delegate and lead, most

must learn these skills through educational experiences. Since it is the charge nurse who holds

the ultimate responsibility for delegating tasks to nurses’ aides (Kleinman & Saccomano, 2006),

the charge nurses’ leadership style may impact delegation. Thus, a key feature of the charge

nurse and nurses’ aide’s relationship may rest on the leadership style of the charge nurse. The

charge nurses need to lead in a manner that influences and motivates the unlicensed assistive

personnel (UAP). In addition, charge nurses can be empowered into a leadership role which

promotes positive outcomes while at the same time an effective delegator.


Similarly, Path-Goal theory (House, 1971 cited in House and Mitchell, 1974) proposes

that the leader should inspire followers by enabling them to see how their task-related

performance could assist in achieving their mutually agreed upon goals. House and Mitchell

(1974) contend that considerate and respectful leaders inspire their subordinates to achieve

positive and effective results.

At present, the role development of charge nurse has focused on clinical practice with

little attention to the decision-making role. The leadership role and its inherent delegation to

other staff (UAPs) are sorely missing. There are gaps in the literature related to the charge

nurses’ ability and comfort level in the delegation process. Since leadership style is a key

component of decision-making success, it becomes possible to assume that leadership style is a

key indicator of the success or failure of the charge nurse ability to manage unlicensed assistive

personnel (UAPs) effectively. The charge nurses’ leadership style may be the key to successful

delegation.

Statement of the Problem

The study intends to answer these questions:

1. According to Path Goal Leadership Questionnaire, what is the frequent leadership style used by the charge nurses in 3A and 3B (Obstetrics and Gynecology Ward), 4B and 5B (Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and Annex Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical Center?

2. According to Confidence and Intent to Delegate Scale, what is the confidence level and intent to delegate task among charge nurses in 3A and 3B (Obstetrics and Gynecology Ward), 4B and 5B (Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and Annex Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical Center?

3. Is there an association between leadership style and confidence level and intent to delegate task among charge nurses in 3A and 3B (Obstetrics and Gynecology Ward), 4B and 5B (Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and Annex Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical Center?


Purpose of the Study

General objective

The purpose of the study is to describe the nature and the correlation, between the

leadership style and confidence level and intent to delegate tasks of the charge nurses in Chinese

General Hospital and Medical Center.

Specific Objectives

To identify the frequently used leadership style using Path Goal Leadership

Questionnaire among charge nurses in 3A and 3B (Obstetrics and Gynecology Ward), 4B

and 5B (Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex

Up and Annex Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital

and Medical Center.

To measure the confidence level and intent to delegate patient care tasks using

Confidence and Intent to Delegate Scale among charge nurses in 3A and 3B (Obstetrics

and Gynecology Ward), 4B and 5B (Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5,

MS6, MS7, MS8, Annex Up and Annex Down JKL, OPQR (Medical-Surgical Ward) of

Chinese General Hospital and Medical Center.

To correlate the leadership styles and confidence level and intent to delegate tasks among

charge nurses in 3A and 3B (Obstetrics and Gynecology Ward), 4B and 5B (Pediatric

Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and Annex

Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical

Center.


Significance of the Study

This study is a potential tool for the following:

For the charge nurses who are the participants in the study, the study will inform them

about their leadership styles and measurement of their confidence level and intent to delegate

patient care tasks using Path-goal Theory Questionnaire and Confidence Level and Intent to

Delegate Questionnaire, respectively. Charge nurses could be able to know their different

leadership styles present in the nursing field and profession which can affect performance,

satisfaction and their motivation for the entire team. They can recall the rules and responsibility

in delegating, thus, the study will help them to improve in facilitating unlicensed assistive

personnel.

For researchers/students, the study will help them to evaluate leadership styles on

confidence level and intent to delegate among the charge nurses of Chinese General Hospital and

Medical Center that will orient them to different leadership styles that can be used in nursing

profession/field. Researchers can infer effective leadership styles that can be applied in nursing

profession/field by having this study as a basis.

For future research, the study may serve as a catalyst for more discourse and subsequent

investigations directed at identifying and examining variables and experiences that contribute to

the charge nurses’ confidence level and intent to delegate patient care tasks.

Scope and Limitation

The study seeks to identify leadership styles and confidence level and intent to delegate

task, and the association between the two, among charge nurses at Chinese General Hospital and

Medical Center. Factors such as time constraint, convenience, and environment while answering

the questionnaires may serve as extraneous variables to the study. As this study focuses on

leadership styles, some factors such as gender, age, number of experiences and educational

attainment of charge nurses may also be considered to affect confidence level and intent to


delegate patient care task. Addition to these, presence of delegation in the field or institution and

education could also be extraneous variables.

This study will be limited only to charge nurses of CGHMC and due to small sample size

findings may not be generalizable to all.

Definition of Terms

Accountability- The quality or state of being accountable; an obligation or willingness to accept

responsibility or to account for one's actions (Merriam-Webster, Incorporated, 2011).

Delegation - It is an ability of a nurse to transfer authority and responsibility of a nursing task to

unlicensed assistive personnel while the nurse continues to be accountable for the outcomes

(American Nurses Association [ANA], 2007).

Leadership – It is a management skill that focuses on the development and deployment of

vision, mission and strategy as well as the creation of the motivated workforce (American Nurses

Association [ANA], 2007).

Registered Nurse (RN) - They are the patient’s care giver; they may be a superior (e.g. charge

nurses) or a subordinate (e.g. staff nurses).

- A graduate trained nurse who has been licensed by a state authority

after qualifying for registration (Merriam-Webster, Incorporated, 2011).

Unlicensed Assistive Personnel - Health care workers who are not licensed but are

prepared to provide certain elements of patient care under the supervision of a registered

nurse; Unlicensed Assistive Personnel include patient care technicians, nurses' aides, and

certified nursing assistants. (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier).

http://www.merriam-webster.com/dictionary/account

http://www.merriam-webster.com/dictionary/accountable


CHAPTER II

THEORETICAL BACKGROUND

Review of Literature

Leadership

Leadership was first technically defined as a point of polarization of cooperation (Chapin

1924 cited in Marquis and Huston 2008). To Northouse (2013), leadership is a process whereby

an individual influences a group of individuals to achieve a common goal. It becomes clear that

there is no single definition broad enough to encompass the total leadership process (Marquis

and Huston, 2008). Leaders are actually the ones who have the title to lead but job title alone

does not make a person a leader. Only the person’s behavior determines if he or she occupies a

leadership behavior (Marquis and Huston 2008). Leaders are in front, moving forward, taking

risks, and challenging the status quo. Theories about leadership in early years focused on its

broad conceptualization such as the traits and behavior of a leader but researches nowadays focus

more on leadership as a process of influencing others within an organizational culture and the

interactive relationship of the leader and follower. Leadership theory has been dynamic; that is,

what is known and believed about leadership continues to change over time (Marquis and Huston

2008).

While many different leadership theories have emerged, most can be classified as one of

eight major types: Great Man Theory which states that great leaders are born, not made; Trait

Theory which assumes that people inherit certain qualities and traits that make them better suited

to leadership; Contingency Theory which focuses on particular variables related to the

environment that might determine which particular style of leadership is best suited for the

situation; Situational Theory which proposes that leaders choose the best course of action based

upon situational variables; Behavioral Theory which is based upon the belief that great leaders

are made, not born; Participative Theory which suggests that the ideal leadership style is one that

takes the input of others into account; Management Theory ,also known as Transactional Theory,

which focuses on the role of supervision, organization and group performance; and lastly,

Relationship Theory, also known as Transformational theory, which focuses on the connections


formed between leaders and followers (About.com.Psychology cited in

http://psychology.about.com/od/leadership/p/leadtheories.htm)

The path-goal theory can best be thought of as a process in which leaders select

specific behaviors that are best suited to the employees' needs and the working

environment so that they may best guide the employees through their path in the

obtainment of their daily work activities (goals) (Northouse, 2013). Path-goal theory

suggests that depending upon subordinates, and situations, different leadership behaviors will

increase acceptance of leader by subordinates; level of satisfaction; and motivation to high

performance. House (1971) claims that there are four different types of leadership, First is

Directive Leadership wherein the leader gives specific guidance of performance to subordinates.

Second is Supportive Leadership wherein a friendly and concerned leader is involved.

Participative Leadership is the third wherein the leader consults with the subordinates and

considers their suggestions. Last to be included is Achievement-oriented Leadership and that is

wherein the leader sets high goals and expects subordinates to have a high level performance.

Nursing requires strong, consistent and knowledgeable leaders who are visible, inspiring

others and supporting professional nursing practice. Leadership plays a pivotal role in the lives

of nurses. It is an essential element for quality professional practice environments where nurses

can provide quality nursing care. Key attributes of a nurse leader include being: an advocate for

quality care, a collaborator, an articulate communicator, a mentor, a risk taker, a role model and

a visionary. As a leader, decisions are made and subordinates are involved by the process of

delegation. It is to foster employee involvement and employee empowerment to enable the

“team” members to contribute their best effort at work (Healthfield, 2011).Leadership is a shared

responsibility. Nurses in all domains and at all levels should maximize their leadership potential

to form strong networks and relationships that ultimately result in excellence in nursing practice

(Canadian Nurses Association cited in

http://www.cna-nurses.ca/CNA/practice/leadership/default_e.aspx).


Delegation

“Delegation” means an authorization granted by a licensee to a licensed or unlicensed

individual to perform selected acts, tasks, or functions which fall within the scope of practice of

the delegator and which are not within the scope of practice of the delegatee and which, in the

absence of the authorization, would constitute illegal practice of a licensed profession (Michigan

Nurses Association, 2010).

Delegation is the act of asking another person to complete a task. Delegation is defined as

the ability of the nurse to transfer the responsibility of a nursing task to an unlicensed person

while the nurse continues to be accountable for the outcomes (American Nurses Association

[ANA], 2007). In the nursing field, delegation is the process of transferring a selected task to

another individual who is competent to perform the selected task. One of the most complex

nursing skills is that of delegation. It requires sophisticated clinical judgment and final

accountability for patient care. The process of delegating nursing care often includes complex

legal and clinical issues related to the necessary education and supervision of unlicensed

personnel (Selekman, 2006). There are five rights in delegating: first is right task, one that is

delegable for a specific patient; second is right circumstances which includes appropriate patient

setting, available resources, and other relevant factors considered; third is right person on

delegating the right task to the right person to be performed on the right person; fourth, right

direction/communication, includes clear, concise description of the task, including its objective,

limits and expectations; and lastly, right supervision, appropriate monitoring, evaluation,

intervention, as needed, and feedback (National Council of State Boards of Nursing, Inc., 1995

cited in Resha, 2010).

Nurses need to obtain the skills necessary to train, supervise, and determine the

competency of others performing nursing tasks because the nurse is accountable for all actions

performed by the unlicensed assistive personnel. Nurses delegate responsibly when they

determine that the unlicensed assistive personnel has the appropriate training and competency to

perform a task safely before delegating a task (Resha, 2010). To be liable enough, nurses possess

the skills to make these determinations and to educate and supervise others.


As professionals, nurses are held accountable by patients, nursing employers, the board

of nursing, and the civil and criminal court system, if an allegation of unprofessional, unethical,

illegal, unacceptable or inappropriate nursing conduct, actions, or responses, arise during

delegation. The nurse must apply rational reasoning that involves applying knowledge, skills,

attitudes and values for the purpose of making a decision that affects patient care. The nurse

must always be aware that accountability retains when transferring the responsibility of

performing of a care task from one individual to another. Generally this means the Registered

Nurse is physically present or immediately available while the task is being performed, or, if not

on site, the RN has the ability to direct through various means of communication, whether

written or verbal.

Delegation requires time to establish trust between all parties, including the nurse and the

unlicensed assistive personnel before it occurs. Thus, building trusting relationships fosters an

environment in which all involved in the delegation can gain an appreciation of the complexity

of delegation and the various responsibilities of each of the team members involved in the

process of delegation. These trusting relationships ultimately enhance the safety and

appropriateness of care provided (Resha, 2010). To build this trust, nurses need to gain the

respect of all members of the team in meeting unlicensed assistive personnel healthcare needs

and in turn to have confidence in the abilities of the entire health team (Broussard, 2007).

The scope of practice of nurses is further defined by the Wisconsin Administrative Code,

N6, Standards of Practice of the Registered Nurse and Licensed Practical Nurse. The law goes on

to define the responsibilities involved in the process of delegation of a nursing task to someone

less skilled. Delegation of a nursing task involves assessment of the knowledge and skill level of

those supervised, providing direction, assistance, observation and monitoring of those supervised

and evaluation of the outcome of the performed task. The decision to delegate the nursing task is

based on the nurse’s assessment of the complexity of the nursing task and care, predictability of

the critical thinking status of the unlicensed assistive personnel and the educational preparation

and demonstrated abilities of the staff without a health care license (Gallagher, 2009).


Synthesis of Related Literature

Leadership is a process by which a person influences a certain group of people to achieve

their common goal. It is said to be dynamic and changes over time. Theories about leadership in

early years focused on its broad conceptualization such as the traits and behavior of a leader but

researches nowadays focused more on leadership as a process of influencing others within an

organizational culture and the interactive relationship of the leader and follower. According to

House (1996) a leader can affect the performance, satisfaction and motivation of a group by

actions and effective leadership behavior depends on situational factors which included the

subordinates’ personality and the characteristics of the environment. Accordingly, four types of

leadership can be identified: Directive Leadership wherein the leader gives specific guidance of

performance to subordinates; Supportive Leadership wherein a friendly and concerned leader is

involved; Participative Leadership is the third wherein the leader consults with the subordinates

and considers their suggestions; and Achievement-oriented Leadership wherein the leader sets

high goals and expects subordinates to have a high level performance. Leadership is said to be

affected by the maturity of the leader, the characteristics of the subordinates and the environment

or the workplace. Leaders are said to be the decision maker, facilitator, critical thinker and role

model. As a role model, the person in the place of the leader should be responsible enough and

possess behavior that makes him or her “leader”. One factor of being a leader is the ability to

delegate a task, whether it is considered complex or simple, to its subordinates. As a leader,

decisions are made and subordinates are involved by the process of delegation. It is to foster

employee involvement and employee empowerment to enable the “team” members to contribute

their best effort at work (Healthfield, 2011).

“Delegation” means an authorization granted by a licensee to a licensed or unlicensed

individual to perform selected acts, tasks, or functions which fall within the scope of practice of

the delegator and which are not within the scope of practice of the delegatee and which, in the

absence of the authorization, would constitute illegal practice of a licensed profession (Michigan

Nurses Association, 2010). In delegation, the one who delegates must have the important aspects

such as the knowledge, skills and attitude. The one who delegates must also know the legal


aspects. The process of delegating nursing care often includes complex legal and clinical issues

related to the necessary education and supervision of unlicensed personnel (Selekman, 2006).

Conceptual Framework

Path-goal theory assumes that leaders are flexible and can therefore change their style as

situations require. This theory consistently reminds the leaders that their main role as a leader is

to assist the subordinates in defining their goals and then to assist them in accomplishing those

goals in the most efficient and effective manner. This theory gives a guide map to the leaders

about how to increase subordinates satisfaction and performance level.

In this study, the leadership styles used by the charge nurses that will be measured using

the Path Goal Leadership Questionnaire (PGLQ) will be correlated to their confidence and intent

to delegate task that will be measured using the Confidence and Intent to Delegate Scale (CIDS).

This study that will be conducted in the 3A and 3B (Obstetrics and Gynecology Ward), 4B and

5B (Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and

Annex Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical

Center will be guided by House’s Path Goal Theory discussed above. Leadership effectiveness

will mean willingness of nurse assistants to assist the charge nurses and their proper execution of

the task given to them. Leadership effectiveness would also indicate client satisfaction as they

will be the receiver of care or task delegated to the nurse assistants. This leadership

effectiveness will be affected by the leadership styles, employee contingencies and

environmental contingencies. For the employee contingencies, these pertain to the skills and

experience of the nurse assistants in accomplishing the task delegated to them by the charge

nurses. In short, it refers to the ability of the receiver of orders to fulfill those duties assigned to

him/her. For the environmental contingencies, these refer to the difficulty of the task made by the

charge nurses and the team collaboration within the area/ward. Example, before a charge nurse

delegates a certain task to a nurse assistant, he/she will first consider if the task is simple or if the

nurse assistant has enough knowledge on how to execute the task properly. Another

consideration that the charge nurse may consider before delegating may be the relationship

between him/her and the nurse assistant because if they are in good terms, there is a higher


possibility that certain tasks will be delegated. Lastly, before delegation, the charge nurse will

use a particular leadership style that might depend on his/her personality or situation.

Path Goal Theory

Path Goal theory was developed by Robert House in 1971 and was reformulated it in

1996. It is rooted in the expectancy theory of motivation which explains the behavioral process

of why individuals choose one behavioral option over another and how they make decisions to

achieve the end they value. In short, the motivation of the behavior selection is determined by the

desirability of the outcome. With Path Goal theory, perception of employees regarding the

expected efforts and performance from them is greatly affected by their leader’s behavior. In this

theory, leaders help his/her group members gain rewards by clarifying the paths to goals and

eliminating the hindrances to the performance. Leaders do this by providing the information,

support and other resources needed by the member to accomplish the task.

Leadership Styles

Directive leader- A leader tells subordinates exactly what they are supposed to do. It

characterizes a leader who tells subordinates about their task, including what is expected

of them, hoe it is to be done, and time line for the completion of particular task. He also

sets standards of performance and defines clear rules and regulations for subordinates

(Northouse, 2013). Directive behavior is appropriate when task is complex or ambiguous,

formal authority is strong and the work group provides job satisfaction (Lussier and

Achua, 2010).

Supportive leader - A leader shows concern for subordinates’ wellbeing and personal

needs. Supportive leadership consists of being friendly and approachable as a leader and

includes attending to the well-being and human needs of subordinates (Northouse, 2013).

Supportive leadership is appropriate when task is simple, formal authority is weak, and

the work group does not provide job satisfaction (Lussier and Achua, 2010).


Participative leader- Consults with subordinates about decisions. A participative leader

consults subordinates, obtains their ideas and opinions and integrates their suggestions

into decision making (Northouse, 2013). Participative leadership is appropriate when

subordinates don’t want autocratic leadership, have internal locus of control, and follower

ability is high; when task is complex, authority is either weak or strong, and satisfaction

from co-workers is either high or low (Lussier and Achua, 2010).

Achievement-oriented leader- Sets clear and challenging goals for subordinates. The

leader establishes a high standard of excellence for subordinates and seeks continuous

improvement. Further leader shows a high degree of confidence in subordinates

(Northouse, 2013). Achievement-Oriented leadership is appropriate when followers are

open to autocratic leadership, have external locus of control, and follower’s ability is

high; when task is simple, authority is strong, and job satisfaction from co-workers is

either high or low (Lussier and Achua, 2010).

Hypotheses

There is a significant relationship between leadership style and confidence level and

intent to delegate patient care task among charge nurses in Chinese General Hospital and

Medical Center.


CHAPTER III

METHODOLOGY

Research Design

A correlational, quantitative type of research will be used in the study. It will employ a

non-experimental, cross sectional survey design that will determine the relationship between the

leadership style and confidence level and intent to delegate among charge nurses in Chinese

General Hospital and Medical Center.

Research Setting

The study will be conducted in 3A and 3B (Obstetrics and Gynecology Ward), 4B and 5B

(Pediatric Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and Annex

Down JKL, OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical Center, a

non-stock, non-profit organization with 600 bed capacity located at 286 Blumentritt St., Sta.

Cruz, Manila.

Sampling Technique

The study will use a non-probability convenience sampling due to the situation in which

in each area/ward of Chinese General Hospital and Medical Center, almost always there will

always be 4 staff nurses and 1 UAP on duty, usually 2 of those 4 staff nurses are charge nurses.

Study Population

Subjects that will be included in the study will be based on the following criteria: four

current charge nurses each from areas 3A, 3B, 4A, 4B, 4C, 5A, 5B, 5C, Annex Up, Annex Down

JKL/OPQR, N4, N5, N6, MS5, MS6, MS7 and MS8 in Chinese General Hospital and Medical

Center, aged 25-50 years old, either male or female and with clinical experience as a charge

nurse for at least 2 years.


Instrumentation

Path-Goal Leadership Questionnaire

The leadership style will be measured by the Path-Goal Leadership Questionnaire

(PGLQ) (Indivik, 1985). It is developed by House and Dressler (1974). It provides a quantitative

measure of leadership style (Directive, Participative, Supportive and Achievement-Oriented)

using 7 point 20 item Likert scale. Each range has a designated labels 1 = never, 2 = hardly ever,

3 = seldom, 4 = occasionally, 5 = often, 6 = usually, and 7 = always.

Each of the four leadership style has its assigned 5 questions from PGLQ. For directive

leadership style, questions will be from numbers 1, 5, 9, 14 and 18*, for supportive leadership

style, questions will be from 2, 8, 11*, 15 and 20, for participative leadership style, questions

will be from numbers 3, 4, 7*, 12 and 17 and for achievement-oriented leadership style,

questions will be from 6, 10, 13, 16* and 19. As the respondent evaluates each question by

assigning a number from 1 to 7, each leadership style has a possible range of scores from 5 to 35.

For all leadership styles the higher the score, the more predominant the leadership style.

As stated above, each leadership style has one asterisked (*) item. The asterisk signifies

that the item is reversed scored. Each respondent will receive a total score for each of the four

leadership styles and will be assigned to the leadership style group in which he or she has the

highest score.

Based on lndvik's (1985) report, the PGLQ has been found to have good validity and

reliability indexes. lndvik (2008) measured the reliability of the PGLQ based on responses from

497 nursing staff and their subordinates. Using Cronbach's Alpha, the reported internal

consistency of the four leadership styles assessed by the PGLQ is: directive .83, supportive .84,

participative .80, and achievement oriented .87 which is considered appropriate for non-

experimental investigations. The validity of PGLQ was addressed by reporting the findings from

a factor analysis (principal components with varimax rotation). lndvik stated that these analyses

confirmed that the conceptual grouping of leadership styles was supported by the data. Indivik

stated that secondary loadings were not more than 50% of the primary factor loadings, which

were reported at a minimum of .40. As Indvik’s given values to this analysis, the report

concluded that all scales emerged conceptually impact.


Confidence and Intent to Delegate Scale

The tool, Confidence and Intent to Delegate Scale (CIDS), will be used to measure

nurses’ confidence level and intent to delegate tasks. It is developed by Parsons in 1999. The

CIDS includes 16 items of which the first seven questions required nominal responses while

questions from 8 through 16 ask respondents to evaluate different aspects of their willingness to

delegate using a 10 point Likert scale. Scales with labels such as ”never”, “not correct”, “not

likely" or “no confidence” refer to the value of 1 and the phrases "many times a day," "highly

correct", "more likely" or “highly confident” refer to the value of 10. The ratings 2 through 9 do

not have any assigned labels. For each of the confidence items, participants were instructed to

circle only one of the 10 responses (Saccomano, 2008).

A total confidence in delegating score was calculated for each person by summing the

responses to ClDS items 8,10,11,12 and 13. Items 1 to 7, 9, 14, 15 and 16 were asked to confirm

if there is presence of delegation. As each of these statements was measured on a scale ranging in

value from 1 to 10, the possible range of total ClDS scores represents values between 5 and 50.

Parsons (1999) reported the internal reliability of the CIDS based on the responses from a

convenience sample of 87. Reliability was assessed using the Cronbach’s alpha and yielded an

overall reliability average of .95 (Parson, 1999 cited in Saccomano, 2008). Although Parsons

(1999) reported the reliability of the CIDS, she did not provide validity information regarding

this tool. Content validation of this type allows the researcher to ensure that the survey will

adequately capture the appropriate information necessary to address the posed research

questions.

Demographic Profile

A demographic profile will be included in the study to elicit information about

respondents’ gender, age, total number of years of nursing experience in the clinical setting, and

educational attainment.


Data Collection

The collection of the data will begin with the proposal of the study to the chief nurse of

the Chinese General Hospital and Medical Center. Letters of permission will be sent to the chief

nurse and to the head nurses for their approval. Once approved, request letters will be addressed

to the charge nurses from 3A and 3B (Obstetrics and Gynecology Ward), 4B and 5B (Pediatric

Ward), 4A, 4C, 5A, 5C, N4, N5, N6, MS5, MS6, MS7, MS8, Annex Up and Annex Down JKL,

OPQR (Medical-Surgical Ward) of Chinese General Hospital and Medical Center for their

approval. After setting the sampling criteria, convenience sampling will be utilized to identify

the participants’ availability. Then, the intent and procedure of the study will be discussed to the

identified participants. Consent forms will be distributed to the respondents and once the

respondents’ consented, questionnaires will be distributed and instructions will be given. If

incase a respondent does not want to participate in the study, the researcher will look for the next

available charge nurse (passing the inclusion criteria) who will be willing to participate in the

study. The collected questionnaires will be checked for the completeness or appropriateness of

answers. The data gathered will be compiled and analyzed. For the interpretation of results, the

data will be categorized based on leadership styles and frequency table will be made.

Statistical Analysis

First, leadership style used by each charge nurse will be identified. The Path Goal

Leadership Questionnaires (PGLQ) provides quantitative measure of leadership styles (Directive,

Participative, Supportive, and Achievement-Oriented) using 7 point 20 items Likert scale. Each

range has its designated score labels, 1=never, 2=hardly ever, 3=seldom, 4=occasionally,

5=often, 6=usually, and 7= always. Each of the 4 leadership styles has its assigned 5 questions

from PGLQ. For directive leadership style, questions were from numbers 1, 5, 9, 14, and 18*.

For Supportive leadership style, questions were from 2, 8, 11*, 15, and 20. For Participative

leadership style, questions were from numbers 3, 4, 7*, 12, and 17 and for Achievement-

oriented leadership style, questions were from numbers 6, 10, 13, 16*, and 19. As the

participants score each question, each leadership style has a possible range of scores from 5 to

35. Each leadership style has one asterisked (*) item. The asterisk (*) signifies that the item will

be scored reversely. Respondents will receive a total score for each of the 4 leadership style


question and were proposed to the leadership group in which one has the highest score. Then,

results will be placed in a frequency distribution table to determine the most dominant leadership

style. Measures of central tendency including mean, median, mode and standard deviation will

also be computed.

Second, Confidence and Intent to Delegate Scale (CIDS) will be used to measure nurses’

confidence level and intent to delegating tasks. The ClDS includes 16 items of which the first

seven questions required nominal responses while questions from 8 through 16 ask respondents

to evaluate different aspects of their willingness to delegate using a 10-point Likert scale. Scale

labels such as "never", "not correct", "not likely" or “no confidence” refer to the value of 1 and

the phrases "many times a day," "highly correct", "more likely" or “highly confident” refer to the

value of 10. The ratings 2 through 9 do not have any assigned label unlike the ratings of one and

ten. For each of the confidence items, participants will be instructed to circle only one of the 10

responses (Saccomano, 2008). A total confidence in delegating score will be calculated for each

person by summing the responses to ClDS items 8, 10, 11, 12 and 13. As each of these

statements will be measured on a scale ranging in value from 1 to 10, the possible range of total

ClDS scores represents values between 5 and 50. Then, to determine the most common range of

scores in the CIDS, the median will be computed, grouping the scores into two. Results will then

be placed in a frequency distribution table. Then, to know if there is a relationship between the

CIDS scores and leadership styles, the contingency table will be used since the levels of

measurement of data in PGLQ and CIDS are nominal and ordinal, respectively.

Lastly, to test for the hypotheses that a relationship between the two variables really

exist, x2 test of association and Fisher’s Exact Probability Test will be used.


References

Books

Marquis, B. & Huston, C. (2008). Leadership roles and management functions

in nursing. Wallnut Street, Philadelphia: Lippincott Williams & Wilkins.

Northouse, P. (2013). Leadership Theory and Practice. Thousand Oaks: Sage Publications,

Inc.

Selekman, J. (2006). School nursing: A comprehensive text. Philadelphia: F.A.Davis, Company.

Heathfield, S. (2011). Delegation as a leadership style. The New York TimesCompany

Journals

Lussier , R. N., and Achua, C. F. (2010). Leadership, Fourth Edition, South-Western Cengage

Learning: Mason,USA

Huston, C. (1996). Unlicensed assistive personnel: A solution to dwindling health care resources

or the precursor to the apocalypse of nursing. NursingOutlook, 44, (2), 67-73.

House, R. (1971). A path goal theory of leader effectiveness. Administrative

Science Quarterly, 16, 321 -338.

House, R. (1997). Path-goal theory of leadership: Lessons, legacy, and a reformulated theory.

Leadership Quarterly, 7 (3),323-352.

House, R. J., & Mitchell, R. R. (1974). Path-goal theory of leadership. Journal of Contemporary

Business, 3, 81-97.

Indivik, J. (2008). A Path-Goal Theory Investigation of Superior Subordinate Relationship

Kleinrnan, C. S., & Saccomano, S. J. (2006). Registered nurses and unlicensed assistive

personnel alliance. The Journal of Continuing Education in Nursing, 37, (4), 162-1 70.

Lookinland, S., Tiedeman, M., & Crosson, A. ( 2005). Nontraditional models

of care delivery. Journal of Nursing Administration, 35, (2): 74-80

OTHERS

http://knowledge.wharton.upenn.edu/papers/674.pdf

http://knowledge.wharton.upenn.edu/papers/674.pdf

http://humanresources.about.com/bio/Susan-M-Heathfield-6016.htm


American Nurses Association [ANA], 2007 cited in

HTTP:// www.healthsystem.virginia.edu/e-learning/principlesdelegation.pdf

Michigan Nurses Association cited

inhttp://currentnursing.com/nursing_management/delegation.html

Resha cited in

http://www.anf.org.au/pdf/policies/G_Delegation_RNs_RMs.pdf

Saccomano cited in http://domapp01.shu.edu/depts/uc/apps/libraryrepository.nsf/resourceid/

013DD72A4B4A4F52852575770044D39D/$File/Saccomano-Scott-J_Doctorate.PDF?Open

Appendix A

http://domapp01.shu.edu/depts/uc/apps/libraryrepository.nsf/resourceid/013DD72A4B4A4F52852575770044D39D/$File/Saccomano-Scott-J_Doctorate.PDF?Open

http://domapp01.shu.edu/depts/uc/apps/libraryrepository.nsf/resourceid/013DD72A4B4A4F52852575770044D39D/$File/Saccomano-Scott-J_Doctorate.PDF?Open

http://www.anf.org.au/pdf/policies/G_Delegation_RNs_RMs.pdf

http://currentnursing.com/nursing_management/delegation.html

http://www.healthsystem.virginia.edu/e-learning/principlesdelegation.pdf


LETTER TO THE RESPONDENTS

UNIVERSITY OF SANTO TOMAS

THE GRADUATE SCHOOL

Dear Respondents,

I, Michael Erick V. Virtucio UST Graduate School student will be conducting a study

entitled, “Charge Nurses’ Leadership Styles on Confidence Level and Intent to Delegate Tasks”

in partial fulfillment of my requirement for the course, Research Methodology.

With this, I would like to ask for your participation by way of answering the attached

questionnaires which will consume approximately 10-15 minutes of your time. Your

participation is voluntarily and you may withdraw from this study at any time you want without

penalty or consequence. The information you will provide will be kept confidential and will only

be used for the purpose of the study.

Thank you for your kind consideration on this matter.

Sincerely yours,

Michael Erick V. Virtucio, RN

Appendix B


CONSENT FORM

UNIVERSITY OF SANTO TOMAS

THE GRADUATE SCHOOL

No.___________

I,________________________________ of ________________________ (area/ward)

agree to participate in the study entitled “Charge Nurses’ Leadership Styles on Confidence Level

and Intent to Delegate Tasks” conducted by Michael Erick V. Virtucio, UST Graduate School

student.

The purpose of the study has been explained to me. I fully understand that my

participation is voluntary and I may withdraw from this study at any moment without any

consequences. I am also aware that the information I will be providing will be kept confidential

and I will not be identified in any report or presentation in the study.

_________________________ ________________________

Signature over Printed Name Date

APPENDIX C

CONFIDENCE AND INTENT TO DELEGATE QUESTIONNAIRE

1. Have you ever been exposed to the concept of delegation; the transfer of responsibility for the

performance of an activity from one individual to another. (The delegator retains the

responsibility for actions/outcomes of the delegate.)

[ ] YES [ ] NO

*If yes, please answer questions 2 and 3, if no please proceed to question 4.


2. Please indicate in all situations in which you were exposed to delegation material that

exposed you to delegation decision making?

[ ] Nursing school [ ] Continuing education conference

[ ] On the job training [ ] Staff development in the work setting

[ ] Others: ____________ [ ] Post Graduate Education

3. Please indicate approximately what percentage of your nursing school

Education included knowledge about or education on delegation.

[ ] 0-9% [ ] 50-59%

[ ] 10-19% [ ] 60-69%

[ ] 20-29% [ ] 70-79%

[ ] 30-39 [ ] 80-89%

[ ] 40-49 [ ] 90-100%

4. Do you currently or have you in the past used delegation skills on your nursing unit in this

hospital?

[ ] YES [ ] NO

5. Have you read the scope function/ job description of the unlicensed assistive

personnel/nursing assistants/orderlies/aides as permitted in your hospital/ institution

[ ] YES [ ] NO

6. Is the job description for unlicensed assistive personnel/ nursing assistants/ orderlies/ aides

consistent with his/her scope of practice on your unit?

[ ] YES [ ] NO

7. Do you know your legal responsibility when supervising unlicensed assistive

personnel/nursing assistants/orderlies/aides

[ ] YES [ ] NO


For numbers 8-16, please encircle your answer.

8. How confident are you with delegating to unlicensed assistive personnel/nursing

assistants/orderlies/aideswhile at work?

1 2 3 4 5 6 7 8 9 10

No

Confidence

Highly

Confident

9. How often do you utilize delegation in your daily nursing practice?

1 2 3 4 5 6 7 8 9 10

Never Many

times/day

10. Do you feel the delegation decisions you make are likely to be correct based on your

educational preparation?

1 2 3 4 5 6 7 8 9 10

Not Correct Highly

Correct

11. Do you feel the delegation decisions you make are likely to be correct based on your nursing

experience?

1 2 3 4 5 6 7 8 9 10

Not

Correct

Highly

Correct


12. "Based on what you learned in your educational preparation," are you likely to use

delegation decision making?

1 2 3 4 5 6 7 8 9 10

Not Likely More

Likely

13. "Based on your nursing clinical work experience," are you likely to use delegation decision

making?

1 2 3 4 5 6 7 8 9 10

Not Likely More

Likely

14. Are you more likely to utilize delegation skills in your daily practice with unlicensed

assistive personnel/nursing assistants/orderlies/aideswith whom you more regularly work the

same shift as compared with those with whom you don't share shifts with regularly?

1 2 3 4 5 6 7 8 9 10

Not Likely More

Likely

15. Are you more likely to delegate to unlicensed assistive personnel/nursing

assistants/orderlies/aideswithwhom you perceive to have a higher level of job competence than

to those with whom you perceive to be of lower job competence?

1 2 3 4 5 6 7 8 9 10

Not Likely More

Likely


16. Are you more likely to delegate to unlicensed assistive personnel/nursing

assistants/orderlies/aideswith whom you have a greater level of general communication than to

those with whom you don't share much communication?

1 2 3 4 5 6 7 8 9 10

Not Likely More

Likely

APPENDIX D

PATH-GOAL LEADERSHIP QUESTIONNAIRE

INSTRUCTIONS: This questionnaire contains questions about different styles of path-goal

leadership. Indicate how often each statement is true of your own behavior.

Key: 1 = Never 5 = Often

2 = Hardly ever 6 = Usually

3 = Seldom 7 = Always

4 = Occasionally

_____1. I let subordinates know what is expected of them.

_____2. I maintain a friendly working relationship with subordinates.

_____3. I consult with subordinates when facing a problem.

_____4. I listen receptively to subordinates' ideas and suggestions.

_____5. I inform subordinates about what needs to be done and how it needs to be done.

_____6. I let subordinates know that I expect them to perform at their highest level.


_____7. I act without consulting my subordinates.

_____8. I do little things to make it pleasant to be a member of the group.

_____9. I ask subordinates to follow standard rules and regulations.

_____10. I set goals for subordinates' performance that are quite challenging.

_____11. I say things that hurt subordinates' personal feelings.

_____12. I ask for suggestions from subordinates concerning how to carry out assignments.

_____13. I encourage continual improvement in subordinates' performance.

_____14. I explain the level of performance that is expected of subordinates.

_____15. I help subordinates overcome problems that stop them from carrying out their

tasks.

_____16. I show that I have doubts about their ability to meet most objectives.

_____17. I ask subordinates for suggestions on what assignments should be made.

_____18. I give vague explanations of what is expected of subordinates on the job.

_____19. I consistently set challenging goals for subordinates to attain.

_____20. I behave in a manner that is thoughtful of subordinates' personal needs.

Appendix C

Timetable for Research

Research Objective April May June July August Sept

Writing of Proposal


Approval of Adviser

Submission of Proposal

Research Colloquium

Data Gathering

Data Analysis

Formulation of

Conclusion

Publication

Defense

Appendix D

Budgetary Requirements

Category Details Amount

Supplies Paper 5,000

folders

ink

photocopy


Transportation 2,000

Meals 10,000

Miscellaneous Tokens for respondents 5,000

Fees Statistician 5,000

English editor 1,000

advisement 5,000

Research Assistants 8,000

TOTAL 41,000

Appendix E

Curriculum Vitae

Michael Erick V. Virtucio, RN

EDUCATIONAL ATTAINMENT

College: Chinese General Hospital College of Nursing and Liberal Arts (CGHCNLA)

Bachelor of Science in Nursing (BSN) – 2008-2012


Secondary: Andres Soriano Junior Memorial School – 2004-2008

Primary: Andres Soriano Junior Memorial School – 1997-2004

Affiliations:

Chinese General Hospital and Medical Center

Staff Nurse (Adult Medical and Surgical, Oncology Station) – January 2014-present

Philippine Nurses Association (PNA) – Member since 2013

Licenses and Trainings:

Philippine Nurse Licensure Examination – 2012

Association of Nursing Service Administrators of the Philippines (ANSAP) Intravenous Therapy

license – 2013

Basic Life Support Training (Chinese General Hospital and Medical Center) – 2013

Advance Cardiac Life Support Training (Chinese General Hospital and Medical Center) – 2013

Sample Thesis Format (1)

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