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Transformational Leadership Style, Structural Empowerment and Staff Outcomes in Nursing Home Settings.

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Title: Transformational Leadership Style, Structural Empowerment and Staff Outcomes in Nursing Home Settings.
Authors: Niinihuhta M; Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.; University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland., Terkamo-Moisio A; Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.; Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland., Kvist T; Department of Nursing Science, University of Eastern Finland, Kuopio, Finland., Häggman-Laitila A; Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
Source: Nursing open [Nurs Open] 2026 Jun; Vol. 13 (6), pp. e70646.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: John Wiley & Sons, Inc Country of Publication: United States NLM ID: 101675107 Publication Model: Print Cited Medium: Internet ISSN: 2054-1058 (Electronic) Linking ISSN: 20541058 NLM ISO Abbreviation: Nurs Open Subsets: MEDLINE
Imprint Name(s): Original Publication: [Hoboken, NJ] : John Wiley & Sons, Inc., [2014]-
MeSH Terms: Nursing Homes*/organization & administration , Leadership* , Empowerment*, Workplace/psychology ; Workplace/standards ; Humans ; Finland ; Cross-Sectional Studies ; Surveys and Questionnaires ; Job Satisfaction ; Female ; Male
Abstract: Aim: This study aimed to describe transformational leadership style, structural empowerment, and staff outcomes and associated factors. A further aim was to explore factors that potentially explain commitment to the workplace and the profession in the context of nursing homes.
Design: An explorative cross-sectional study design with two datasets.
Methods: The target group consisted of staff working in 24-h, long- or short-term care in Finnish nursing homes. Data were collected between November 2022 and April 2023 through a survey, including background questions and two instruments: The Transformational Leadership Scale and the Conditions for Work Effectiveness Questionnaire II for structural empowerment. The data were analysed by descriptive and multivariate statistical methods.
Results: A total of 97 nurse leaders (response rate 76%) and 503 care personnel (response rate 21%) participated. Transformational leadership, work-related well-being, overall health, and job satisfaction were rated as good. Nurse leaders reported higher scores than care personnel. Nurse leaders assessed their structural empowerment as moderate. They rated opportunity and information as the strongest dimensions of structural empowerment, while resources were the weakest dimension. Care personnel reported a lack of opportunities to participate in decision-making and to advance their careers. For nurse leaders, factors explaining commitment to their current workplace were work-related well-being and commitment to the profession, while for care personnel these were valuing one's own work, nurse leaders' transformational leadership, work-related well-being, and commitment to the profession. The factors explaining care personnel's commitment to the profession were work-related well-being, valuing one's own work, and commitment to the current workplace.
Conclusion: Transformational leadership and structural empowerment appear to be important factors associated with positive staff outcomes in nursing home settings. Nursing homes are complex and currently understudied environments, highlighting the need for further research to explore different associations and potential explanatory factors in this context.
(© 2026 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)
References: Abel, S. E., and M. W. Hand. 2018. “Exploring, Defining, and Illustrating a Concept: Structural and Psychological Empowerment in the Workplace.” Nursing Forum 53, no. 4: 579–584. https://doi.org/10.1111/nuf.12289.
Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons. 2012.
Al Sabei, S. D., O. Al‐Rawajfah, R. AbuAlRub, L. J. Labrague, and I. A. Burney. 2022. “Nurses' Job Burnout and Its Association With Work Environment, Empowerment and Psychological Stress During COVID‐19 Pandemic.” International Journal of Nursing Practice 28, no. 5: e13077. https://doi.org/10.1111/ijn.13077.
Alilyyani, B., M. S. Kerr, C. Wong, and D. Y. Wazqar. 2022. “An Integrative Review of Nursing Leadership in Saudi Arabia.” Nursing Open 9, no. 1: 140–155. https://doi.org/10.1002/nop2.1117.
Buffet, M.‐A., R. L. Gervais, M. Liddle, and L. Eeckelaert. 2013. “Well‐Being at Work: Creating a Positive Work Environment. Literature Review.” In European Agency for Safety and Health at Work. Publications Office of the European Union.
Chao, S. F. 2019. “Does Geriatric Nursing Staff Burnout Predict Well‐Being of LTC Residents?” Geriatric Nursing 40, no. 4: 360–366. https://doi.org/10.1016/j.gerinurse.2018.12.010.
Cummings, G. G., K. Tate, S. Lee, et al. 2018. “Leadership Styles and Outcome Patterns for the Nursing Workforce and Work Environment: A Systematic Review.” International Journal of Nursing Studies 85: 19–60. https://doi.org/10.1016/j.ijnurstu.2018.04.016.
Cziraki, K., C. Wong, M. Kerr, and J. Finegan. 2020. “Leader Empowering Behaviour: Relationships With Nurse and Patient Outcomes.” Leadership in Health Services 33, no. 4: 397–415. https://doi.org/10.1108/LHS‐04‐2020‐0019.
Dall'Ora, C., J. Ball, M. Reinius, and P. Griffiths. 2020. “Burnout in Nursing: A Theoretical Review.” Human Resources for Health 18, no. 1: 41. https://doi.org/10.1186/s12960‐020‐00469‐9.
De Almeida, H., and A. Orgambídez. 2019. “Workplace Empowerment and Job Satisfaction in Portuguese Nurses: An Explicative Model.” Health Care Manager 38, no. 3: 220–227. https://doi.org/10.1097/HCM.0000000000000265.
Farag, A., S. Tullai‐McGuinness, M. K. Anthony, and C. Burant. 2017. “Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?” Journal of Nursing Administration 47, no. 1: 8–15. https://doi.org/10.1097/NNA.0000000000000430.
Field, A. 2013. Discovering Statistics Using IBM SPSS Statistics. Sage.
Finnish Institute for Health and Welfare. 2024. “Status of Elderly Services in 2023: The Planned Number of Service Hours for Home Care Clients Is Achieved in Half of the Units.” https://www.julkari.fi/handle/10024/148876.
Finnish National Agency for Education. 2025. “Vocational Qualification in Social and Health Care”.
Finnish National Board on Research Integrity TENK. 2021. “Guidelines for Ethical Review in Human Sciences.” https://tenk.fi/en/advice‐and‐materials/guidelines‐ethical‐review‐human‐sciences.
Frangieh, J., and T. Jones. 2022. “Factors Facilitating or Inhibiting the Capacity for Effective Leadership Among Front‐Line Nurse Managers: A Scoping Review.” Journal of Nursing Management 30, no. 7: 2653–2669. https://doi.org/10.1111/jonm.13776.
Friganović, A., P. Selič, B. Ilić, and B. Sedić. 2019. “Stress and Burnout Syndrome and Their Associations With Coping and Job Satisfaction in Critical Care Nurses: A Literature Review.” Psychiatria Danubina 31: 21–31.
Gibson, D. M., and J. Greene. 2020. “State Actions and Shortages of Personal Protective Equipment and Staff in U.S. Nursing Homes.” Journal of the American Geriatrics Society 68, no. 12: 2721–2726. https://doi.org/10.1111/jgs.16883.
Grabbe, L., M. K. Higgins, M. Baird, P. A. Craven, and S. San Fratello. 2020. “The Community Resiliency Model to Promote Nurse Well‐Being.” Nursing Outlook 68, no. 3: 324–336. https://doi.org/10.1016/j.outlook.2019.11.002.
Holland, P., T. L. Tham, C. Sheehan, and B. Cooper. 2019. “The Impact of Perceived Workload on Nurse Satisfaction With Work‐Life Balance and Intention to Leave the Occupation.” Applied Nursing Research 49: 70–76. https://doi.org/10.1016/j.apnr.2019.06.001.
Hult, M., A. Terkamo‐Moisio, P. Kaakinen, et al. 2023. “Relationships Between Nursing Leadership and Organizational, Staff and Patient Outcomes: A Systematic Review of Reviews.” Nursing Open 10, no. 9: 5920–5936. https://doi.org/10.1002/nop2.1876.
Jafari, F., N. Salari, A. Hosseinian‐Far, A. Abdi, and N. Ezatizadeh. 2021. “Predicting Positive Organizational Behavior Based on Structural and Psychological Empowerment Among Nurses.” Cost Effectiveness and Resource Allocation 19, no. 1: 38. https://doi.org/10.1186/s12962‐021‐00289‐1.
Jarden, R. J., M. Sandham, R. J. Siegert, and J. Koziol‐McLain. 2020. “Intensive Care Nurses' Well‐Being: A Systematic Review.” Australian Critical Care 33: 106–111. https://doi.org/10.1016/j.aucc.2018.11.068.
Kelly, L. A., C. Lefton, and S. A. Fischer. 2019. “Nurse Leader Burnout, Satisfaction, and Work‐Life Balance.” Journal of Nursing Administration 49, no. 9: 404–410. https://doi.org/10.1097/NNA.0000000000000784.
Khatatbeh, H., A. Pakai, T. Al‐Dwaikat, et al. 2022. “Nurses' Burnout and Quality of Life: A Systematic Review and Critical Analysis of Measures Used.” Nursing Open 9, no. 3: 1564–1574. https://doi.org/10.1002/nop2.936.
Kvist, T., A. Voutilainen, V. Eneh, R. Mäntynen, and K. Vehviläinen‐Julkunen. 2019. “The Self‐Organizing Map Clustered Registered Nurses' Evaluations of Their Nurse Leaders.” Journal of Nursing Management 27, no. 5: 981–991. https://doi.org/10.1111/jonm.12758.
Labrague, L. J., D. M. McEnroe‐Petitte, M. C. Leocadio, P. Van Bogaert, and G. G. Cummings. 2018. “Stress and Ways of Coping Among Nurse Managers: An Integrative Review.” Journal of Clinical Nursing 27, no. 7–8: 1346–1359. https://doi.org/10.1111/jocn.14165.
Laschinger, H. K. 2012. Conditions for Work Effectiveness Questionnaire I and II. User Manual. Western University.
Lee, S. E., L. Hyunjie, and S. Sang. 2023. “Nurse Managers' Leadership, Patient Safety, and Quality of Care: A Systematic Review.” Western Journal of Nursing Research 45, no. 2: 176–185. https://doi.org/10.1177/01939459221114079.
Mabona, J. F., D. Van Rooyen, and W. Ten Ham‐Baloyi. 2022. “Best Practice. Recommendations for Healthy Work Environments for Nurses: An Integrative Literature Review.” Health SA 27: a1788. https://doi.org/10.4102/hsag.v27i0.1788.
Marufu, T. C., A. Collins, L. Vargas, L. Gillespie, and D. Almghairbi. 2021. “Factors Influencing Retention Among Hospital Nurses: Systematic Review.” British Journal of Nursing 30, no. 5: 302–308. https://doi.org/10.12968/bjon.2021.30.5.302.
McDonald, J. H. 2014. Handbook of Biological Statistics. Sparky House Publishing.
Moloney, W., J. Fieldes, and S. Jacobs. 2020. “An Integrative Review of How Healthcare Organizations Can Support Hospital Nurses to Thrive at Work.” International Journal of Environmental Research and Public Health 17, no. 23: 8757. https://doi.org/10.3390/ijerph17238757.
Niinihuhta, M., and A. Häggman‐Laitila. 2022. “A Systematic Review of the Relationships Between Nurse Leaders' Leadership Styles and Nurses' Work‐Related Well‐Being.” International Journal of Nursing Practice 28, no. 5: e13040. https://doi.org/10.1111/ijn.13040.
Niinihuhta, M., A. Terkamo‐Moisio, T. Kvist, and A. Häggman‐Laitila. 2022a. “Nurse Leaders' Work‐Related Well‐Being‐Relationships to a Superior's Transformational Leadership Style and Structural Empowerment.” Journal of Nursing Management 30, no. 7: 2791–2800. https://doi.org/10.1111/jonm.13806.
Niinihuhta, M., A. Terkamo‐Moisio, T. Kvist, and A. Häggman‐Laitila. 2022b. “A Comprehensive Evaluation of Factors Affecting Nurse Leaders' Work‐Related Well‐Being.” Leadership in Health Services Ahead‐Of‐Print 35, no. 3: 460–474. https://doi.org/10.1108/LHS‐12‐2021‐0098.
Patrician, P. A., D. Bakerjian, R. Billings, et al. 2022. “Nurse Well‐Being: A Concept Analysis.” Nursing Outlook 70: 639–650. https://doi.org/10.1016/j.outlook.2022.03.014.
Saleh, M. O., N. F. Eshah, and A. H. Rayan. 2022. “Empowerment Predicting Nurses' Work Motivation and Occupational Mental Health.” Open Nursing 8: 23779608221076811. https://doi.org/10.1177/23779608221076811.
Sammut, R., O. Griscti, and I. J. Norman. 2021. “Strategies to Improve Response Rates to Web Surveys: A Literature Review.” International Journal of Nursing Studies 123: 104058. https://doi.org/10.1016/j.ijnurstu.2021.104058.
Seabra, P., J. Lopes, M. E. Calado, and M. L. Capelas. 2019. “A National Survey of the Nurses' Mental Health ‐ The Case of Portugal.” Nursing Forum 54, no. 3: 425–433. https://doi.org/10.1111/nuf.12350.
Shiyab, W., C. Ferguson, K. Rolls, and E. Halcomb. 2023. “Solutions to Address Low Response Rates in Online Surveys.” European Journal of Cardiovascular Nursing 22, no. 4: 441–444. https://doi.org/10.1093/eurjcn/zvad030.
Spence Laschinger, H. K., A. Nosko, P. Wilk, and J. Finegan. 2014. “Effects of Unit Empowerment and Perceived Support for Professional Nursing Practice on Unit Effectiveness and Individual Nurse Well‐Being: A Time‐Lagged Study.” International Journal of Nursing Studies 51, no. 12: 1615–1623. https://doi.org/10.1016/j.ijnurstu.2014.04.010.
Spencer, C., and S. McLaren. 2017. “Empowerment in Nurse Leader Groups in Middle Management: A Quantitative Comparative Investigation.” Journal of Clinical Nursing 26, no. 1–2: 266–279. https://doi.org/10.1111/jocn.13426.
Ta'an, W. F., J. Alhurani, E. Alhalal, T. N. Al‐Dwaikat, and I. Al‐Faouri. 2020. “Nursing Empowerment: How Job Performance Is Affected by a Structurally Empowered Work Environment.” Journal of Nursing Administration 50, no. 12: 635–641. https://doi.org/10.1097/NNA.0000000000000951.
Timmins, F., G. Ottonello, F. Napolitano, et al. 2023. “The State of the Science‐The Impact of Declining Response Rates by Nurses in Nursing Research Projects.” Journal of Clinical Nursing 32, no. 7–8: e9–e11. https://doi.org/10.1111/jocn.16597.
Valle, R. B. L. R. D., A. P. Balsanelli, M. Taminato, H. Saconato, and R. Gasparino. 2021. “The Relationship Between the Authentic Leadership of Nurses and Structural Empowerment: A Systematic Review.” Revista da Escola de Enfermagem da U.S.P 55: e03667. https://doi.org/10.1590/S1980‐220X2019029003667.
Vázquez‐Calatayud, M., and M. C. Eseverri‐Azcoiti. 2023. “Retention of Newly Graduated Registered Nurses in the Hospital Setting: A Systematic Review.” Journal of Clinical Nursing 32, no. 19–20: 6849–6862. https://doi.org/10.1111/jocn.16778.
World Health Organisation. 2020. “State of the World's Nursing Report—2020.” https://www.who.int/publications‐detail‐redirect/9789240003279.
Xu, G., X. Zeng, and X. Wu. 2023. “Global Prevalence of Turnover Intention Among Intensive Care Nurses: A Meta‐Analysis.” Nursing in Critical Care 28, no. 2: 159–166. https://doi.org/10.1111/nicc.12679.
Grant Information: HEL 2022-006042 T 13 00 02 VTR/ERVA
Contributed Indexing: Keywords: leadership; nurse leader; nursing home; nursing staff outcomes; older people care; structural empowerment; transformational leadership style; work‐related well‐being
Entry Date(s): Date Created: 20260623 Date Completed: 20260623 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13287093
DOI: 10.1002/nop2.70646
PMID: 42333032
Database: MEDLINE
Description
ISSN:2054-1058
DOI:10.1002/nop2.70646