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Healthcare Setting in Honk Kong

Staff retention is crucial to any organization. The impacts of staff retention go beyond the financial costs that are costs intrinsic in recruitment, selection, training of new employees. High retention rates are key issues that are being highlighted (Moustakas, 1994). Neuman (2006) argues that employee retention has some positive implications to an organization. When employees have a feeling that they are being supported, their retention rates are usually due to an increase in job satisfaction. According to (Moustakas 1994) when workers obtain positive support from their leaders at work, absenteeism rates reduce. Thus, changing the psychological environment at the workplace is a way of reducing absenteeism.

According to Neuman (2006), support is built in an organization when a positive relationship is built. This requires that mutual respect is created and maintained. Leaders should treat employees as individuals who make a substantial contribution; hence, there should be effective leadership styles to enhance interpersonal relationship and conflict management. The best application of the term leadership refers to a position held within an organization. However, most of the definitions used are not appropriate in studying organizational behavior. Leadership is an incremental influence, which an individual exerts over another, with routine directives. The strategy used by effective leaders can be used to inspire others to pursue excellence and to extend them and to go beyond the workplace requirements by generating creative and innovative ideas (Moustakas 1994). Leadership styles have dynamic effects on individuals and organizational interaction. An excellent leader inspires the potential of subordinates and efficiency to achieve organizational goals. Thus, leadership styles can influence the empowerment of the nursing staff and the realization of goals in the health care setting (Neuman (2006).

Statement of the Problem

Conducting a research on leadership styles of front-line management and retention of the nursing staff is an essential activity of finding solutions for employees. Leadership styles within the healthcare setting can be examined by understanding the relationship between the management and planning. Hospital authorities rely on the presence of the nursing staff during the regular management of hospitals. The most often mentioned factors that influence turnover that will be discussed in this study include management, personal development and training of the workers, as well as, personal development for new challenges. However, on a closer analysis, it is evident that effective nurse leadership underpins all the factors that lead to turnover of nursing staff. Nurse leaders should create a working environment that is supportive and motivating to nursing staff in order to enhance staff retention. Therefore, this research may be beneficial to hospital administrators in providing education to nurse managers on effective leadership styles and how it affects the nursing staff turnover, as well as, job satisfaction. The lack of satisfaction among nurses contributes to increased turnover rates and the shortage of nurses in the healthcare facility.

Concerns related to the complex issue of the relationship between leadership style and nursing turnover is a significant challenge to healthcare leaders in all healthcare sectors. For instance, voluntary turnover has been shown to be influenced by many inter-related factors. Previous studies proved that there are negative effects on nurses, patients and the entire healthcare setting. From a negative perspective, these are factors such as supervisors support work pressure, as well as, poor cohesion and autonomy that may affect nurse retention rates both directly and indirectly (Moustakas 1994).

Poor morale is among the leading reasons to an increase in absenteeism among nursing staff. This topic I a contentious issue, since leadership styles are of paramount benefit to organizations because effective leadership stems from the need to motivate employees and maintain their involvement in organizations that they serve. Thus, the comment of nurses in this study will support the emphasis on a supportive and friendly workplace environment. Leadership styles are particularly crucial in enhancing employee retention that forms part of job satisfaction (Robbins & Judge 2009).

The following research questions will form the basis of this study

  1. How do frontline managers’ leadership styles associate with staff nurse turnover and retention.
  2. What are the frontline line managers’ leadership qualities that motivate and entice nurses to retain, and remain in their workplace environment?
  3. What are some of the perceptions of nurses on frontline managers that influence their decision to remain or quit their workplaces?

The following research objectives will form the basis of this study

  1. To investigate the characteristics of frontline leaders that influence retention and turnover of nurses.
  2. To examine the perception of leaders on

The following hypothesis will be tested based on the study’s subject matter

H1. There is a relationship between perceived leadership styles of the front-line management on nursing staff retention and turnover.

H2. Front-line management leadership qualities generally affect nursing staff retention and the rationale for leaving employment.

H3. Effective leadership style of front-line management fosters job satisfaction by developing appropriate work environments in which nurses are encouraged to work.

Relation to previous research

Nursing turnover is an important factor that influences the performance and profitability of most organizations. Previous studies have demonstrated that nurses rate their nature of the professional relationship with hospital administrators and leaders, forming one of the main reasons of staying in a healthcare workplace environment (Linz 2003). A study conducted by Yukl (1994) also ascertained that nurses would remain in a healthcare setting that has a positive relationship. Thus, good leadership among health professionals is a key factor that creates a friendly and supportive atmosphere for the staff. According to a study conducted by Yukl (1994) also ascertained that positive support from supervisors reduce absenteeism and sick leaves among nursing staff; hence, this may be an added effect of increasing retention rates in the long-term.

Previous studies have also demonstrated that increased job satisfaction increases retention rates (Ross, 2001). An earlier discussion on the implementation of effective leadership styles and job satisfaction may be enhanced, since participative management style improves job satisfaction. A previous study conducted in Hong Kong indicated that a good relationship to superiors was an important indicator of the incidence of health complains and job satisfaction. According to Linz (2003), aspects such as employee empowerment learn to function autonomously. Thus, specific management strategies such as effective leadership styles can enhance job satisfaction.

In another discussion, Yukl (1994) recommended that nurse leaders should conduct an inventory of their employees based on the age profile, and other related issues. He added that nursing staff should be held to leadership style expectations. This also focused on the health policies and the dominant factors that consider patient safety. In the healthcare setting, nurse leaders should consider employee needs and the differences in leadership style, which involves contexts of motivation and leadership interaction, and communication, as well. The results of previous studies depict truth that fuels awareness (Linz (2003). In the Hong Kong nursing care, effective leadersip styles should be promoted therefore, promote effective leadership strategy that contribute to the grounding of nursing, in spite of workplace pressure.

Theoretical framework

Job satisfaction is a cause of behavior that consists of satisfaction with different aspects of the work conditions. Satisfaction is the extent to which the nursing staffs like their assigned tasks. The link between job satisfaction and retention rates is a thoroughly examined variable in most retention studies. The topic of leadership styles, job satisfaction and retention has generated a lot of research (Linz 2003).

Transformational approach examines the relationship between a leader and the subordinates and has been emphasized as the most effective method in managing hospitals. Based on this study, nurse leaders’ leadership styles are independent variables. For instance, the transformational leadership style includes the dimensions of idealized influence, either attributed or idealized influence (behavior). The other aspect of leadership is the transactional approach, which includes a process to pursue cost benefit analysis to meet the current material and psychological needs in return for contracted services. Transactional leadership is an independent variable that embodies the dimensions of laissez-faire, and others. On the other hand, job satisfaction and nursing staff retention have components of work relations, benefits, professional work environment, as well as, role enactment.

Robbins et al (2001) claimed that transformational leaders are based at the last stage at of the leadership process, since nurse leaders organize work according to personal values; hence, they motivate the subordinate by integrating the values into the group. Based on the theory, nurse leaders and staff should follow one another to the highest level of motivation as well as morality. Thus, the fundamental key of this theory is the capability of the nurse leader to motivate nurses to accomplish their tasks. In the healthcare setting, nurse leadership is an important factor that affects job satisfaction and the turnover rates of nursing staff either positively or negatively.


Studies about the economic impact of nurse turnover have been compromised due to inconsistent definitions and measurements. Leaders have a greater challenge to select the correct leadership style to implement for each staff, team, and situation, as well. In addition, the same leadership style may be less effective in some situations. For instance, a transactional leader will focus on the daily aspects of planning, with task-oriented leadership styles (Keller 2006).

Robbins et al (2001) claimed that situational leadership style is vital when the development levels of the followers are different. During the implementation of change, the most appropriate leadership style is the transformational leadership (Bass 1995). According to Hammed (2002), hospitals would attract and retain more qualified nurses, if the nursing staff is provided open communication channels. Consequently, nursing staff retention can be achieved in a health care setting with enough nurse leaders present. This will make the nurses accomplish their tasks more successfully, and obtain greater job satisfaction. According to Hammed (2002), decentralized decision-making increases an individual’s control of their work environment, because it supports autonomy and decision-making. Furthermore, it also improves relationships. A study conducted by Schriber and Gutek (1987) reported effective, and supportive leadership to be the encouraging factors the turnover rates for the nursing staff. The behaviors of nurse leaders are depicted by the nursing staff comments. Comprehending the importance of retention rates creates opportunities for new challenges and staff development.

Keller (2006) also argued that improved opportunity, information and resources leads to employee empowerment and enhances job satisfaction among the nursing staff. Therefore, the best workplace environment is where the nurses are provided needed training and support to succeed in the market place, and where plans exist to build capacity (Keller 2006). However, nursing staffs need to be challenged within their capability (Linz 2003). He added that, one of the important reasons that nurses vacate hospitals is due to the perceived lack of career development, during practice. Therefore, hospitals management should invest in mentoring programs and employee training and development programs. Organizations should offer training and development courses that allow staff to manage change effectively. The best courses should consider leadership management among others. Training is important because it enables employees to ensure a decentralized decision-making, which in turn improves employee motivation. Some studies conducted in Hong Kong show that many nurses’ performance are greatly hampered, together with their colleagues in healthcare setting.

Proposed methodology

The methodology that the study will deploy will include the design, sample and setting of the population, most appropriate instruments to be used in data collection, the procedures to be used, data analysis, as well as, the study limitations. The methodology is consistently connected to social constructiveness. This case demands that participants develop their experience subjective meaning. The participants are needed to develop their personal perception that relates to leadership factors affecting their attitudes and motivating factors making them stick to the workplace. Both primary and secondary research will be conducted for the study. In the primary research, the researcher will survey front line management and nursing staff to determine how front-line leadership styles impact nursing staff retention. The researcher will develop a questionnaire to be mailed through electronic media. The questionnaires will have a 5-point Likert Scale, as well as, ranking of the questions. The secondary sources will be derived from published articles and business journals, well as, theses that are related to studies on organizational administration and dealing with staff retention. The secondary sources will be beneficial for this study since they are already condensed and organized. The researcher will use qualitative methodology to collect data by administering self-administered structured questionnaires sent to selected nurses and front-line management within Baptist Hospital. The study will allow the identification of data availability, where further refinement of data definition of variables may be required. The impacts of leadership strategies on the nursing staff retention and creation of supportive and proper healthcare setting are justified by the results. Other crucial information obtained by examining retention in the nursing staff records. The presentation of data will be conducted graphically, in a tabular manner to allow an easy understanding of results. The semi-structured questionnaires will be used to obtain the views or perceptions of nurses regarding their profession, and leadership styles.


The paper will highlight factors making nursing staffs remain at their work place environments and its relation to leadership styles and action in Hong Kong’s hospitals. The objective behind the study is to investigate how improving job satisfaction, providing employee challenges and enhancing opportunities for the development of nursing staff are ultimately the responsibility of effective styles of leadership on the employees turnover and retention intention. According to the factors that influence staff retention, the study projects that job satisfaction among other factors influence nursing staff retention among nurses. The study will examine transformational and transactional leadership styles of the nurse leaders and the impact on nurses’ retention in the hospital under study. The importance of this study will be favorable for the healthcare setting, as it will make it possible for hospitals to recruit and retain the nursing staffs through interpersonal leadership skills within hospitals. This is a contentious issue that is supported by strengthening management and other studies that found out that enhancing nursing staff turnover rates is critical in a healthy and positive workplace culture that encourages teamwork and continuous personal development and training and flexible scheduling (Keller 2006). It is vital to understand that increased nursing staff retention is due to a combination of various factors. Nurse leaders with effective leadership styles should select a combination of factors that will be necessary in their specific institutions, since, there is no range of combinations of standard strategies that will fit all hospitals. The researcher anticipates that the findings of the study will support the hypothesis, since most hospital settings exhibit a strong relationship between front-line management and leadership styles. Finally, the study will illustrate the discussion, conclusion recommendations for further research in this topic.

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