Positive aspects of authentic leadership in nursing work: integrative review

Aspectos positivos del liderazgo auténtico en el trabajo de enfermería: revisión integrativa

ABSTRACT

Objective:

To identify and analyze the existing scientific production on the positive aspects of authentic leadership in the nurse’s work process.

Method:

This is an integrative literature review. The databases used were Scientific Electronic Library Online; Latin American and Caribbean Literature on Health Sciences; and National Library of Medicine - National Institutes of Health.

Results:

In this study, 17 articles were selected for analysis; 1 study (6%) was published in a national journal, and 16 (94%) were international studies. Of the 17 (100%) articles studied, 11 (65%) were developed in Canada. The hospital environment was present in the 17 (100%) articles.

Final considerations:

Authentic leadership has several positive aspects that significantly influence the nurse’s work process, such as engagement and job satisfaction, retention of new nurses, organizational commitment, among others.

Descriptors:
Leadership; Nurse; Nursing team; Nursing Supervision; Management

RESUMEN

Objetivo:

Identificar y analizar la producción científica existente sobre los aspectos positivos del liderazgo auténtico en el proceso de trabajo del enfermero.

Método:

Se trata de una revisión integrativa de la literatura. Las bases de datos utilizadas han sido Scientific Electronic Library Online; Literatura Latinoamericana y de Caribe en Ciencias de la Salud; y National Library of Medicine - National Institutes of Health.

Resultados:

En esto estudio, han sido seleccionados 17 artículos para análisis; 1 estudio (6%) ha publicado en periódico nacional, y 16 (94%) son estudios internacionales. De los 17 (100%) artículos estudiados, 11 (65%) han sido desarrollados en Canadá. El ambiente hospitalario estuvo presente en los 17 (100%) artículos.

Consideraciones finales:

El liderazgo auténtico presenta diversos aspectos positivos que influencian significativamente el proceso de trabajo del enfermero, como el compromiso y satisfacción en el trabajo, retención de nuevos enfermeros, comprometimiento organizacional, entre otros.

Descriptores:
Liderazgo; Enfermero; Equipe de Enfemería; Supervisión de Enfermería, Gestión

RESUMO

Objetivo:

Identificar e analisar a produção científica existente sobre os aspectos positivos da liderança autêntica no processo de trabalho do enfermeiro.

Método:

Trata-se de uma revisão integrativa da literatura. As bases de dados utilizadas foram Scientific Electronic Library Online; Literatura Latino-Americana e do Caribe em Ciências da Saúde; e National Library of Medicine - National Institutes of Health.

Resultados:

Neste estudo, foram selecionados 17 artigos para análise; 1 estudo (6%) foi publicado em periódico nacional, e 16 (94%) eram estudos internacionais. Dos 17 (100%) artigos estudados, 11 (65%) foram desenvolvidos no Canadá. O ambiente hospitalar esteve presente nos 17 (100%) artigos.

Considerações finais:

A liderança autêntica apresenta diversos aspectos positivos que influenciam significativamente o processo de trabalho do enfermeiro, como o engajamento e satisfação no trabalho, retenção de novos enfermeiros, comprometimento organizacional, entre outros.

Descritores:
Liderança; Enfermeiro; Equipe de Enfermagem; Supervisão de Enfermagem; Gestão

INTRODUCTION

Increasingly, nurses are required to have an impact on care through their behavior as a leader⁽¹⁾. Thus, given the current scenario, the nurse needs to develop care and management skills, with leadership being an essential competence in the search for better organizational practices^(2-3). It is necessary to understand that leadership is not a position, but a competence⁽¹⁾.

The nurse is responsible for supervising the provision of patient care. For this to be adequate, there is a need to develop skills already in the training of health workers. It is important for nurses to act in decision making, in establishing a non-verticalized communication process, in managing services, in the process of continuing education for professionals, as well as in exercising leadership⁽⁴⁾.

There is still a gap in the knowledge of how leadership is able to make a difference in nursing relationships, that is, it is not known exactly the mechanisms capable of influencing more effective and supportable results. In addition, there is no definitive nursing theory capable of directing best practices to nursing care and providing a fruitful work environment⁽⁵⁾.

However, in the hospital context, authentic leadership gains space with regard to the commitment of the team members based on an understanding of their role within the institution, making the climate conducive to both leaders and team members.

In relation to the authentic leadership process, two notable aspects are observed: the essential role of the authentic leader in the coherence of one’s actions; and the influence of followers on proactive, ethical and responsible behavior. Still, the importance of building an environment of trust and integrity that supports the knowledge management processes is highlighted⁽⁶⁾.

The theory of authentic leadership is defined by Avolio, Walumbwa and Weber (2009)⁽⁷⁾ as a process that results in positive performances on the part of leaders and followers, giving rise to self-development. In addition, the authors add that it is necessary to examine how authentic leadership is viewed in different cultures and situations, whether it conceives the basis of good leadership, whether it is participatory, inspiring and motivating.

OBJECTIVE

To identify and analyze the existing scientific production on the positive aspects of authentic leadership in the nurse’s work process.

METHODS

It is an integrative literature review, that is, a work whose purpose is to summarize, in a systematic way, knowledge of studies on a certain theme for a better coverage of a phenomenon or health problem⁽⁸⁾.

The study used the six steps to carry out the integrative review: 1) selection of the guiding question (What are the positive aspects of authentic leadership in the nurse’s work process?); 2) determining the inclusion and exclusion criteria and searching the literature; 3) definition of information to be extracted and categorization of studies; 4) evaluation of studies included in the integrative review; 5) interpretation of results and; 6) presentation of the review with synthesis of the knowledge produced⁽⁹⁾.

It was carried out from June to September 2018. Articles were searched for in the databases: Scientific Electronic Library Online (SciELO); Latin American and Caribbean Literature in Health Sciences (LILACS); e National Library of Medicine - National Institutes of Health (PubMed).

The Health Sciences Descriptors (DeCS) were used to query the controlled descriptors for the SciELO and LILACS databases, namely: Leadership, Nurse and Management. Uncontrolled descriptors (keywords) were also used, with the purpose of broadening the search on the desired theme, since, in this, words not registered as descriptors in health sciences are found, namely: Authenticity, Nursing, Authentic and Authentic Leadership.

In the PubMed database, the controlled descriptors of the Medical Subject Headings (MeSH), which comprise: Leadership and Nursing. The uncontrolled descriptors were: Authentic and Authentic Leadership.

In the databases using the descriptors in Portuguese, seven searches were carried out using the combination in the following format: Liderança AND Autêntica; Liderança Autêntica AND Autenticidade; Autenticidade AND Liderança; Autenticidade AND Enfermagem; Autenticidade AND Enfermeiro; Liderança Autêntica AND Enfermagem; Liderança AND Enfermeiro AND Autêntico. In the base that uses the descriptors in English, searches were made using the combination in the following format: Authentic Leadership AND Nursing.

It should be noted that the free search field was used to cover a larger number of studies involving the theme, without determining the period of publication of the studies.

The inclusion criteria for selecting studies were: being an original article; available in Portuguese and English; no limits related to the year of publication. Initially, 104 articles were found (Figure 1). For the selection of the sample, the titles and abstracts were read by the researcher, and the non-relevance of the study resulted in their exclusion. The excluded studies were not related to the theme “authentic leadership in nursing”.

Figure 1
Flow of data analysis and selection of studies, Brazil, 2018

The selected articles were read in full; and, later, part of them were excluded for not answering the study question of this research. Thus, the final sample was composed of 17 articles.

To identify the level of evidence of the studies, the instrument validated by Ursi was used⁽¹⁰⁾, that contemplates the evaluation stage using the reference of levels of evidence⁽¹¹⁾, which has seven levels, depending on the study design: Level I - systematic reviews or meta-analysis of randomized controlled clinical trials (RCCT); Level II - at least one RCCT; Level III - well-designed clinical trials, without randomization; Level IV - case-control or cohort; Level V - systematic review of qualitative or descriptive studies; Level VI - a single descriptive or qualitative study; Level VII - opinion of authorities and/or expert committee reports. Levels I and II are considered to be strong evidence; III and IV, moderate evidence; and V to VII, weak scientific evidence.

RESULTS

In this study, 17 articles were selected for analysis that answered the research question, as shown in Figure 1. As for the year of publication, it varied from 2010 to 2018.

It is evident that 1 study⁽¹²⁾ was published in a national journal, and 16 (94%) were international studies. Next, the synthesis of the articles (Chart 1) according to the title; authorship, country and year of publication; research design, objective and outcome.

Chart 1
Synthesis of articles according to the title; authorship, country and year of publication; research design, number of participants, research objective and outcome, Brazil, 2018

Titles	Authors/Country/Year	Research design	Objective	Outcomes
Authentic leadership and personal and professional profile of nurses	Carvalho et al. Brazil, 2016(12).	Quantitative correlational study. Application of a personal and professional profile instrument and the Authentic Leadership Questionnaire (Self) instrument. Analysis of data using descriptive statistics. Study population was 69 nurses.	To verify the association of authentic leadership with the personal and professional profile of nurses	Nurses presented characteristics of authentic leaders. Self-awareness was more valuable in nursing assistants than in clinical nurses. The other variables did not show significant relationships.
A thematic analysis of self-described Authentic Leadership behaviors among experienced nurse executives.	Alexander, Lopez. USA, 2018(13).	Qualitative, descriptive study. Semi structured interview. Thematic Analysis. Study with 17 nursing leaders.	To understand the behaviors that experienced nurses use to create healthy work environments.	All participants agreed on the importance of healthy work environments and their role in creating them. The behaviors described by the participants corroborate the categories of authentic leadership.
The influence of authentic leadership on safety climate in nursing.	Dirik, Intepeler. Turkey, 2017(14).	Quantitative study. The Authentic Leadership Questionnaire e o Safety Climate Survey was used. Hierarchical regression analysis. Study with 350 nurses in three Turkish hospitals.	The study analyzed the nurses' perception of authentic leadership and a climate of security; and examined the contribution of authentic leadership to the security climate.	The security climate was significantly and positively correlated with authentic leadership, which is able to increase positive perceptions of the security climate.
The effects of authentic leadership, organizational identification, and occupational coping self-efficacy on new graduate nurses' job turnover intentions in Canada.	Fallatah, Laschinger, Read. Canada, 2017(15).	Quantitative study. Analysis of secondary data from a cross-sectional study. Used tools: Authentic Leadership Questionnaire (ALQ), Personal Identification (PI), Organizational Identification (OI), Occupational Coping Self-Efficacy (OCSE) e Job Turnover Intentions (JTO). Analysis using structural equation modelling. Population of 998 recently graduated nurses.	To examine the influence of authentic leadership on new nurses' job rotation intentions through their personal identification with the leader, organizational identification and self-efficacy in occupational coping.	Authentic leaders have the ability to influence the work attitudes and behavior of their followers. Authentic leadership plays an essential role in retaining new nurses. Raises confidence in your ability to manage work-related challenges and brings positive results to recently graduated nurses and the organization.
Authentic leadership and its impact on creativity of nursing staff: A cross sectional questionnaire survey of Indian nurses and their supervisors.	Malik, Dhar, Handa. India, 2016(16).	Quantitative study. Data collected through questionnaires: Authentic Leadership, Knowledge Sharing Behaviour, Information Technology usage e Employees Creativity. Confirmatory Factor Analysis and hypothesis tests - Process. Sample of 405 nurse staff and 81 supervisors.	To examine the relationship between authentic leadership and employee creativity, while determining the mediating effect of knowledge-sharing behavior and the moderating effect of the use of information technology on this association.	Authentic leadership was positively linked to employee creativity. Knowledge sharing is mediated by the relationship between authentic leadership and employee creativity, and the use of information technology acts as a moderator between employee knowledge sharing and creativity behavior.
Authentic leadership and thriving among nurses: the mediating role of empathy.	Mortier, Vlerick, Clays. Belgium, 2016(17).	Quantitative, cross-sectional study. Used the Authentic Leadership Inventory (ALI) questionnaires, Quantitative, cross-sectional study. Uses Prosperity Scale and Emotional Intelligence Scale. Hypotheses tested through hierarchical regression analysis. Sample of 360 nurses or questionnaires.	To investigate the relationship between perceived authentic leadership and the dimensions of prosperity (learning and vitality) among nurses and the role of empathy in this relationship.	The results showed a positive association between authentic leadership and the dimensions of prosperity studied. The positive association between learning and authentic leadership was not explained by the empathy of the leader.
Linking Nurses' Perceptions of Patient Care Quality to Job Satisfaction.	Laschinger, Fida. Canada, 2015(18).	Quantitative, cross-sectional study. Instruments used were Authentic Leadership, Work Effectiveness-II (CWEQ-II), Nursing Work Index- Revised (NWI-R), a single item Bhow and Health Professionals 'Job Satisfaction. Descriptive statistics and reliability of the scales were analyzed. Structural equation modelling. Sample of 723 nurses.	To test the connection between authentic leadership, structure, professional support, quality of patient care and job satisfaction.	Authentic leaders play an important role in creating work environments that support professionals, promote high quality care and job satisfaction.
The effects of authentic leadership, six areas of work life, and occupational coping self-efficacy on new graduate nurses' burnout and mental health: A cross-sectional study.	Laschinger, Borgoni, Read. Canada, 2015(19).	Quantitative, cross-sectional study. Instruments used were Authentic Leadership Questionnaire, Areas of Work life Scale, Occupational Coping Self-Efficacy Scale, subscales Maslach Burnout Inventory-General Survey e Symptoms Scale of the General Health Questionnaire. Descriptive statistics and reliability of the scale were analyzed. Structural equation modelling with maximum likelihood estimation. Total of 1,009 nurses with less than three years of experience.	To test a model that unites authentic leadership, areas of professional life, self-efficacy, occupational coping, burnout and mental health among recent graduates, in addition to the validity of the concept of interpersonal tension at work as a facet of burnout.	Authentic leadership had a positive effect in areas of professional life, an effect on self-efficacy in occupational coping, resulting in less stress and less mental health problems.
The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration.	Regan, Laschinger, Wong. Canada, 2016(20).	Quantitative design, non-experimental predictive analysis. Instruments used were Conditions of Work Effectiveness Questionnaire-II (CWQ-II), Authentic Leadership Questionnaire (ALQ), Nursing Work Index-Revised (NWI-R) e o Interprofessional Collaboration Scale (IPCS). Multiple hierarchical regression analysis. Total of 220 experienced nurses.	To examine the influence of structural factors of empowerment, authentic leadership and professional nursing environments on the perceptions of experienced nurses on interprofessional collaboration.	Structural strengthening, authentic leadership and a nursing practice environment can improve enhanced interprofessional collaboration (IPC).
The influence of authentic leadership and empowerment on nurses' relational social capital, mental and job satisfaction over the first year of practice.	Read, Laschinger. Canada, 2015(21).	Longitudinal quantitative design. Instruments used were Authentic Leadership Questionnaire (ALQ), Conditions of Work Effectiveness II (CWEQ-II), Areas of Work life Scale, Community Subscale, Mental Health Inventory-5 and Unnamed. Modelling analysis of structural equations with maximum probability estimate. Total of 191 nurses graduated less than two years ago.	To examine the theoretical model that tests the effect of authentic leadership, empowerment structure and relational social capital on mental health and job satisfaction of nurses in the first year of practice.	Authentic leaders, by creating structurally strong work environments, promote relational social capital among new nurses, leading to positive health and retention results at work, as well as a positive effect on job satisfaction.
Authentic Leadership, performance, and job satisfaction: The mediating role of empowerment.	Wong, Laschinger, Canada, 2013(22).	Quantitative design, non-experimental predictive analysis. Authentic Leadership Questionnaire, Conditions of Work Effectiveness Questionnaire, Global Job Satisfaction Survey and General Performance Scale. Structural equation modelling analysis. Sample of 280 nurses.	To test a model that links the authentic leadership of managers with nurses' perceptions of structural empowerment, performance and job satisfaction.	The more managers are seen as authentic, the more nurses perceive structural empowerment, the greater job satisfaction and performance.
Authentic leadership and nurse-assessed adverse patient outcomes.	Wong, Giallonardo. Canada, 2013(23).	Quantitative study, secondary analysis of data collected in a cross-sectional study. Instruments used: Authentic Leadership Questionnaire (ALQ), Trust in Management Scale, Areas of Work life Scale (AWS). Nursing Quality Indicators. Structural equation modelling analysis. Sample with 280 nurses.	To test a model by examining the relationships between authentic leadership, nurses' trust in their manager, areas of professional life and assessment of adverse patient outcomes.	Nurses who see their managers as having a high level of authentic leadership have greater confidence, congruence in the areas of professional life and lower frequencies of adverse effects on patients.
Simulations in nursing practice: toward authentic leadership.	Lishchinsky. Israel, 2014(24).	Qualitative study; used the database based on the Grounded Theory. Sample with 50 nurses from ten health institutions in Israel.	To explore nurses' ethical decision making in team simulations and identify the benefits of these simulations for authentic leadership.	Team simulation as a training tool can lead to authentic leadership among nurses.
The influence of authentic leadership and areas of work-life on work engagement of registered nurses.	Bamford, Wong, Laschinger. Canada, 2013(25).	Quantitative study, secondary analysis of data collected from a non-experimental predictive analysis. Instruments used were the Authentic Leadership Questionnaire (ALQ), Areas of Work life Scale (AWS) and Utrecht Work Engagement Scale. Multiple hierarchical regression analysis and measurement. Sample with 280 nurses working in intensive care.	To examine the relationships between nurses' perceptions of the authentic leadership of nursing managers; general correspondence of the person-job in the six areas of life at work; and engagement at work.	Nurses reporting to managers who demonstrate higher levels of authentic leadership report greater correspondence between person and job in the six areas of professional life and greater engagement at work.
Authentic Leadership, empowerment and burnout: a comparison in new graduates and experienced nurses.	Laschinger, Wong, Grau. Canada, 2013(26).	Quantitative study, secondary analysis of data from two studies. Authentic Leadership Questionnaire (ALQ), Conditions of Work Effectiveness Questionnaire-II (CWEQ –II) and Maslach Burnout Inventory-General Survey. Structural equation modelling analysis. Samples with 342 recently graduated nurses, 273 nurses with more than two years of experience.	To examine the effect of authentic leadership and structural strengthening on the emotional exhaustion and cynicism of recently graduated and experienced intensive care nurses.	The authentic behavior of the leader is important for nurses providing structurally strengthening conditions in the work environment, regardless of the level of experience.
Authentic Leadership of preceptors: predictor of new graduate nurses' work engagement and job satisfaction.	Giallonardo, Wong, Iwasiw. Canada, 2010(27).	Quantitative design, non-experimental predictive. Instruments used: Authentic Leadership Questionnaire (ALQ), Utrecht Work Engagement Scale, Index of Work Satisfaction Scale (IWS). Multiple hierarchical regression analysis and measurement. Sample with 170 nurses graduated less than three years ago.	To examine the relationships between the recently graduated nurses and the perception of the authentic leadership of the preceptor; Engagement; and job satisfaction.	The study supports the link between authentic leadership, work engagement and job satisfaction.
Authentic leadership and nurses' voice behavior and perceptions of care quality.	Wong, Laschinger, Cummings. Canada, 2010(5).	Quantitative design, non-experimental predictive analysis. Instruments used were Authentic Leadership Questionnaire (ALQ), Personal and Social Identification, Trust in Management Scale, Utrecht Work Engagement Scale (UWES) short version, Voice Subscale da Helping and Voice Behaviours Scale, one item from the International Survey of Hospital Staffing and Organization of Patient Outcomes. Structural equation modelling analysis. Sample with 280 nurses working in intensive care.	To test the theoretical model of connection between authentic leadership with team nurses, trust in their manager, engagement at work, vocal behavior and perceived quality in the care provided at the unit.	The results suggest that authentic leadership and trust in the manager play a role in promoting trust, engagement at work, vocal behavior and perceived quality of care.

Of the 17 (100%) articles studied, 11 (65%) were developed in Canada, with 9^{(5,15,18-22,25-26)} of these they presented a common author. The hospital environment was present in 17 (100%) of the articles.

Regarding the methodological design, 2 studies^(13,24) presented qualitative analysis of the data, and 15 presented quantitative approach with non-experimental design. Therefore, in the evaluation of the studies, the 17 presented Level VI of evidence, that is, weak evidence.

DISCUSSION

This is a recent topic, especially when related to health organizations and nursing professionals. Authentic leadership was introduced by Fred Luthans and Bruce Avolio in 2003. In the nursing area, there was a greater impact from the study by Walumbwa et al. (2008)⁽²⁸⁾, with research developed at the University of Western Ontario, Canada, as cited: Wong, Laschinger and Cummings (2010)⁽⁵⁾, Giallonardo, Wong and Iwasiw (2010)⁽²⁷⁾, Wong and Giallonardo (2013)⁽²³⁾.

Due to the changes that occur in nursing and health services, mainly in hospitals, it has been increasingly important for nurses to develop skills in management and leadership functions. Effective management is an essential aspect in the role of the leader, as it ensures good communication and teamwork⁽²⁹⁾.

Still, based on the results presented, it is emphasized that the 15 (100%) studies with a non-experimental quantitative approach used the Authentic Leadership Questionnaire (ALQ). It consists of an instrument created with the objective of measuring the authenticity of the leader, including its ethical, moral, behavioral and organizational characteristics, developed by the authors Bruce J. Avolio, Willian L. Gardner and Fred O. Walumbwa, in 2007 in the USA. It was validated by Walumbwa et al. (2008)⁽²⁸⁾, with 16 questions that aim to assess the four dimensions of authentic leadership: Relational Transparency, Moral Perspective, Balanced Processing and Self-Awareness.

In order to properly discuss the articles, three categories were created: Engagement at work and organizational commitment; Influence of the authentic leader and the benefit for the followers; Authentic leadership and recently graduated nurses.

Work engagement and organizational commitment

This category brings notes about the importance of authentic leadership for the engagement of professionals at work.

A study⁽⁵⁾ performed a test of the relationship between authentic leadership and nursing work. The relationship was measured by personal identification with the manager, social identification with the work unit, trust in the manager and engagement at work. The study pointed out that the authentic leadership of nursing managers was directly and indirectly related to increased trust in the manager, as well as to greater engagement at work, which was directly and positively related to the quality of care.

This is corroborated by the study⁽²⁷⁾ that supports the link between authentic leadership, engagement at work and job satisfaction, so that when recently graduated nurses are guided by tutors who demonstrate high levels of authenticity, they feel more engaged at work and more satisfied. Authentic leadership plays a positive role in creating nursing work environments that promote job satisfaction for nurses⁽⁽¹⁸).

Still, there are works on authentic leadership and positive results that the authentic leader brings to the organization. Study⁽¹²⁾ shows that authentic leadership can positively affect the attitudes and behaviors of employees, being adequate to promote expressions of engagement at work, behavior of organizational citizenship and performance of employees who do more than expected in an organization⁽³⁰⁾. Therefore, this behavior is linked to the increase in productivity of the organization and, consequently, customer satisfaction, cost reduction and improvement of turnover rates and absenteeism⁽³¹⁾.

When the nurse has a relationship of trust with their managers, there is an emotional commitment on the part of the nurse, contentment at work and higher quality of care⁽³⁰⁾. Regarding knowledge management, a study⁽³²⁾ concludes that authentic leadership contributes to building organizational relationships based on transparency, openness and trust.

Lanzoni and Meirelles (2011)⁽³³⁾ see a tendency towards authentic and participative leadership, since, for the authors, organizations that present solid leadership have a greater bond and less employee turnover, fewer conflicts, greater involvement of people in the work process and better use of resources in the search for best results in health.

Authentic leadership had significant influences on nurses’ organizational commitment and job satisfaction through autonomy. In order to increase organizational commitment and job satisfaction for nurses, it is necessary to build effective strategies to improve the authentic leadership of the nursing manager, in addition to developing educational training programs for nurses⁽³²⁾.

Influence of the authentic leader and the benefits for the head

Wong e Laschinger’s (2013) study⁽²²⁾ established a link between authentic leadership and areas of work life with patient-related outcomes. Therefore, the authenticity perceived in the figure of the manager is positively associated with the nurses’ perceptions, resulting in greater gratification in the six areas of life at work: workload; control; rewards; community; justice; values. Still, nurses who perceive greater correspondence between people and work report a significantly lower incidence of adverse outcomes for patients, while nurses who have a more negative view of the work environment and less correspondence between people and work experience an increase in adverse outcomes for patients⁽²³⁾. This study corroborates that of Cummings et al. (2010)⁽³⁴⁾, according to which the leader who is perceived as open, honest and transparent with his own feelings generates greater satisfaction in the work of nurses.

In this sense, when new nurses show a sense of community, which is a relational social capital, they experience less mental health symptoms, also greater job satisfaction⁽²¹⁾.

Nurses who see their leader as self-aware, transparent, ethical, and including the team in decision making perceived in their work support, information, resources and opportunities for learning and growth and, consequently, greater support for professional practices such as autonomy, control over the practice and collaboration between doctor and nurse. Still, authentic leaders influence the quality of patient care and nurses’ job satisfaction⁽¹⁸⁾.

A study demonstrated the positive association between authentic leadership and the dimensions of prosperity studied (learning and vitality). Nursing managers’ empathy permeates the relationship between authentic leadership and vitality⁽¹⁷⁾.

Malila, Lunkka, Suhonem (2017)⁽³⁵⁾, in order to map relevant research on authentic leadership, identified studies that highlighted the positive effects that authentic leadership has on health organizations. The review exposed the themes “well-being at work”, “quality of patient care” and “work environment”, with well-being at work being a more widely disseminated research topic. It should be noted that if there is no well-being, several problems can occur, such as burnout and increased turnover⁽³⁶⁾. On the other hand, if the team shows well-being at work, it can result in increased creativity, optimism and confidence. Authentic leadership can also have a positive impact on the health team⁽¹⁶⁾.

In relation to personal psychological states, psychological capital was highlighted, which includes optimism, personal, social and organizational identification, as well as trust, which includes trust in the manager, organization or co-worker, central concepts in the theory of authentic leadership⁽³⁶⁾.

Cunha et al. (2013)⁽³⁷⁾ mention that psychological capital can be promoted by management and leadership actions and that authentic leadership is an important precedent in this regard. It is up to the leaders to develop their ethical action and competence in a transparent relationship with the followers. Thus, interactions between leaders and followers in the relationship of authentic leaders are important in building positivity.

With regard to job satisfaction, this was associated with authentic leadership in eight of the nine studies analyzed by Alilyyani, Wong and Cummings (2018)⁽³⁶⁾, in addition to topics such as career satisfaction, engagement at work, among others. In addition, two studies presented well-being positively associated with authentic leadership, such as vitality and psychological well-being. The study found research that showed direct and indirect aggregations between authentic leadership and staff outcomes, including attitudes and behaviors. However, few results have directly associated authentic leadership with patients, such as the quality of care and adverse events.

Even so, the present integrative review finds that authentic leadership has positive effects with regard to the work of nurses, especially to engagement in work.

Authentic leadership and recently graduated nurses

For both experienced nurses and recent graduates, organizational contexts and positive leadership are important for improving interprofessional collaboration⁽²⁰⁾.

Authentic leadership behaviors play a role in creating positive results for recently graduated students, showing lower levels of burnout⁽¹⁸⁾. The use of authentic leadership in the behavior of managers can positively influence the occupational self-efficacy of recently graduated nurses. Among these, those who perceived the leader as self-conscious, transparent, ethical and inclusive in relation to decision-making also noted positive issues related to workload, control, rewards, sense of community and congruence of values. That said, there are positive relationships between leaders and followers; authentic leaders promote a sense of community, fairness, respect, which are linked to the values of recently graduated nurses⁽¹⁹⁾.

Another study, which linked authentic leadership in the population of recently graduated nurses with their leader, with the organization, self-efficacy of occupational coping and work rotation intentions, obtained as a result that authentic leaders play a fundamental role in improving the retention of new nurses⁽¹⁵⁾.

Thus, the authentic behavior of the leader is important for nurses, as it provides structurally strengthening conditions in the work environment, regardless of the level of experience⁽²⁶⁾.

Study limitations

The study’s limitation is the fact that only articles available online were included.

Contributions to the field of Nursing

Due to the changes that occur in nursing and health services, it has been increasingly important for nurses to develop skills in management and leadership roles.

There is a need to study leadership in the context of the nurse’s work. Many leaders are focused on tasks and need to create strategies to develop a favorable environment, greater cooperation among workers, achievement of goals and especially quality of patient care.

New managerial models, as well as contemporary leadership theories and models, need to be encouraged so that the creation of listening devices for users and workers is emphasized. Health needs are dynamic, determining that health services and management are adequate and capable of creating also dynamic strategies, appropriate to meet health needs. Authentic leadership is considered an innovative theory, especially in the national scenario, and should be disseminated and used in different health scenarios.

FINAL CONSIDERATIONS

The results of this integrative literature review show that authentic leadership has several positive aspects that significantly influence the work process of nurses. Such positive aspects, such as greater engagement and job satisfaction, retention of new nurses, greater organizational commitment, in addition to a link with the personal psychological state, should be highlighted in health institutions.

This study found that there are few national articles linked to the positive aspects of authentic leadership related to nurses and that there is a preponderance of the hospital context. There is also a lack of studies on the relationship between authentic leadership and the benefits for patient care.

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Edited by

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Alexandre Balsanelli

Publication Dates

• Publication in this collection
  07 Aug 2020
• Date of issue
  2020

History

• Received
  09 July 2019
• Accepted
  10 May 2020