Nursing management at a Swedish university hospital

High turnover rate among nursing staff is a global problem and important for nurse managers to deal with. In order to help health care leaders to retain competent staff, it is important to improve the knowledge of the ways and the extent to which leadership behaviour relates to nurse job satisfaction and staff turnover. The nurse manager is as the head of the unit, a leader over part of the health care staff. The aim was to study the relationship between leadership behaviour of nurse managers and staff turnover considering creative work climate and intrinsic factors of job satisfaction. All four studies were conducted at the Karolinska Hospital in Stockholm. At the time of the study the hospital had about 5000 employees working with nursing care. There were 92 nurse managers and 77 of these were included. Ten subordinates of each included manager were randomly selected and invited to participate (n=770). All data for Studies I-III were collected at the same time in 2003. Leadership behaviour (I) was studied with a questionnaire called Change, Production and Employee (CPE). It s relation to creative work climate and job satisfaction was explored on individual level in study II. Two different questionnaires regarding creative work climate and job satisfaction were used together with the data from the CPE instrument. In Study III register data of actual staff turnover were used together with data from studies I and II. Analyses were related to each included manager based unit level. Study IV, conducted in 2004 explored perceptions about staff turnover. Five focus group discussions included 29 participants (head of departments, nurse managers and staff) and were con-ducted and the statements analyzed in order to identify categories of opinions. The categories were related to register data of actual staff turnover from the hospital follow up system (PREDO) The correlation between leadership behaviour and staff turnover was weak (-.12, Study III). Leadership behaviour of the nurse manager significantly correlates both on individual (II) and unit level (III) to creative work climate (.60, Study III) and job satisfaction (.60, Study III). When controlling for creative work climate the result showed only weak correlation between leadership behaviour and job satisfaction (.12, Study II). In turn, there is a relationship between job satisfaction and staff turnover (-.30, Study III). Three main groups of profiles were identified, invisible leader, middle of the road (middle) leader and super leader (I, II). In Study IV four major factors were identified as having a possible influence on staff turnover: intrinsic values of motivation , workload , unit size and leadership . Smaller units had lower staff turnover as well as out patient units and day care. In this context of nursing the direct relationships between leadership behaviour, including the dimension of change, and actual staff turnover was weak. The relationships between leadership behaviour and creative work climate, between creative work climate and job satisfaction and between job satisfaction and actual staff turnover indicate that the nurse manager plays a key role in developing a creative work climate that might increase nurses job satisfaction and by extension decrease staff turnover. According to the results it seems easier to achieve group cohesion, recognition and participation in units where a manager works close to the staff