Relationships Between Transformational Leadership and the Nursing Practice Environment: A Cross-Sectional Study

Healthcare services require an adequate number of skilled healthcare personnel, an optimal practice environment, and the best possible leadership skills to ensure that the necessary services are provided in a high-quality and economical manner. Hence, the aim of this study was to describe nursing staff perceptions of the nursing practice environment and transformational leadership, as well as explore whether they are related to each other.

A quantitative cross-sectional study involving 292 nurses from two Finnish university hospitals was conducted. The nursing practice environment was assessed using the Practice Environment Scale of Nursing Work Index, while transformational leadership was assessed using the Transformational Leadership Scale.

The participating nurses rated the practice environment at 2.58 (out of 5), which reflects good conditions. None of the subscales associated with transformational leadership reached an excellent level, i.e., a score of ≥ 4 out of 5. All the PES-NWI and TLS subscales showed statistically significant linear relationships. Nurses' perceptions of participation in healthcare organizations were most strongly associated by the actions of nurse directors. The practice environment and transformational leadership were also found to be associated with nurses' evaluations of overall quality of the nursing.

The results suggested that nursing leadership in specialized healthcare must focus more on improving feedback and rewards, as these aspects received the lowest evaluations from the nurses. Also, nurse directors in Magnet-aspiring hospitals should increase their interaction and visibility among nurses, as well as expand their role in organizations, if they wish to contribute to improving the practice environment. Strong transformational leadership and an excellent practice environment can promote the nursing quality.

The findings may help healthcare organizations and nurse leaders identify aspects of leadership and working conditions that warrant attention when developing the nursing practice environment and leadership practices.