Nurses’ perceptions of leadership style in hospitals: a grounded theory study

Aim. This paper explores the leadership style of hospital managers. Background. Leadership has been widely studied in nursing from the perspective of nurses’ psychological strain caused by nursing leadership. There is, however, little contained in the Western and Eastern literatures on the leadership style of hospital managers and certainly no study has explored managers’ leadership style in Taiwanese hospitals from the nurses’ stance. Design. Grounded theory. Methods. A sample of 28 nurses from seven teaching hospitals in Taiwan, Republic of China was selected through theoretical sampling. A multi‐step analytic procedure based on the grounded theory approach was used to analyse the qualitative data. Results. The Chinese culture was found to affect the leadership style of Taiwanese hospital managers. They had extreme power and led nurses in a hierarchical manner. Nurse managers followed the autocratic leadership style of their hospital managers. The main category found in this study was thus hierarchical leadership. Conclusions. The Confucian principles of authoritarianism and obedience were found to be part of the Taiwanese hospitals’ organisational cultures and strongly impacted on the managers’ leadership style. Hospital managers’ treatment of doctors and nurses was dependent on their social rankings. Nurses’ lowly ranking fed into these enculturated managerial tendencies of using power and obedience thus increasing psychological strain on nurses. Relevance to clinical practice. Managers of the hospitals demonstrate power and misuse obedience through their leadership style, resulting in deterioration of nurses’ work environment. Nurses’ managers are not given enough power by the hospitals in Taiwan. Subsequently, nurses feel themselves the lowest and most powerless subordinates. This study reveals that the Chinese cultural burdens are embedded in the leadership of Taiwanese hospitals. These findings enhance the knowledge of leadership and add to the understanding of managerial attitudes in Chinese hospitals located worldwide.