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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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 2
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 3
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 4
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 5
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 6
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 7
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?
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 8
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 9
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 10
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).
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 11
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 12
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).
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 13
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 14
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).
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 15
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 16
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 17
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).
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 18
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 19
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 20
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 21
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 22
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 23
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 24
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 25
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 26
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 27
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 28
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 29
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 30
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 31
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.
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 32
_____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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 33
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 34
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
UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL PAGE 35
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