Authentic leadership in nurses’ professional practice: an integrative review

El liderazgo auténtico en el ejercicio profesional del enfermero: una revisión integradora

ABSTRACT

Objectives:

to identify the primary constructs concerning authentic leadership and its relevance for nurses’ professional practice.

Methods:

integrative literature review conducted between 2015 and 2020 in LILACS, SciELO, and PubMed databases.

Results:

the United States published most of the 31 studies analyzed, with eight studies (25.8%), followed by Canada with seven studies (22.6%), and Brasil with five (16.1%). Most studies adopted a quantitative approach (77.41%), and 96.8% presented weak evidence. Three categories emerged: Work Engagement/Job Satisfaction and Organizational Commitment; Healthy Work Environment; and Intention to Quit the Job and Mental Exhaustion.

Final Considerations:

authentic leadership positively contributes to management and nursing care practice, promoting healthy work environments, structural empowerment, greater work engagement, and organizational commitment, decreasing absenteeism and mental exhaustion.

Descriptors
Leadership; Professional Practice; Nurse; Health Management; Professional Ethics

RESUMEN

Objetivos:

identificar los principales constructos adoptados sobre el liderazgo auténtico y su relevancia para la práctica profesional del enfermero.

Métodos:

revisión integradora de la literatura en el período de 2015 a 2020, en las bases de datos: LILACS, SciELO y PubMed.

Resultados:

de los 31 estudios analizados, los países que más publicaron fueron Estados Unidos, con 08 estudios (25,8%), Canadá con 07 (22,6 %) y Brasil con 05 (16,1%); hubo predominio de estudios de abordaje cuantitativo (77,41%) y 96,8% presentaron nivel de evidencia débil. Surgieron tres categorías para discusión: Compromiso/Satisfacción en el Trabajo y Comprometimiento organizacional; Ambiente de Trabajo Saludable; Intención de Salir del Empleo y Desgaste Mental.

Consideraciones Finales:

el liderazgo auténtico contribuye positivamente en la gestión y práctica del cuidado del enfermero, proporcionando ambientes de trabajo más saludables, empoderamiento estructural, mayor compromiso con el trabajo y comprometimiento organizacional, además de contribuir para la disminución de las tasas de ausentismo y desgaste mental.

Descriptores:
Liderazgo; Práctica Profesional; Enfermera; Gestión e Salud; Ética Profesional

RESUMO

Objetivos:

identificar os principais construtos adotados sobre a liderança autêntica e sua relevância para a prática profissional do enfermeiro.

Métodos:

revisão integrativa da literatura no período de 2015 a 2020, nas bases de dados: LILACS, SciELO e PubMed.

Resultados:

dos 31 estudos analisados, os países que mais publicaram foram Estados Unidos, com 8 estudos (25,8%), Canadá com 7 (22,6 %) e Brasil com 5 (16,1%); houve predomínio de estudos de abordagem quantitativa (77,41%), e 96,8% apresentaram nível de evidência fraca. Emergiram três categorias para discussão: Engajamento/Satisfação no trabalho e comprometimento organizacional; Ambiente de trabalho saudável; Intenção de sair do emprego e desgaste mental.

Considerações Finais:

a liderança autêntica contribui positivamente na gestão e na prática do cuidado do enfermeiro, proporcionando ambientes de trabalho mais saudáveis, empoderamento estrutural, maior engajamento no trabalho e comprometimento organizacional, além de contribuir para diminuição das taxas de absenteísmo e desgaste mental.

Descritores:
Liderança; Exercício Profissional; Enfermeiro; Gestão em Saúde; Ética Profissional

INTRODUCTION

Scientific and technological advancements lead to numerous changes in the health field and the economic, social, political, ethical, and philosophical spheres(¹). This context includes hospital facilities, a complex and changing environment that constantly changes work processes and requires nurses to acquire a differentiated profile with greater flexibility, expanded knowledge repertoire, and technical skills to meet the institution’s and patients’ requirements, to produce quality care results(¹-²).

Nurses deal with difficult decisions in their daily practice, and attitudes are needed to enable care, mainly because nurses are responsible for supervising healthcare delivery. For this reason, nurses are essential in decision-making processes and in establishing horizontal communication and managing services(²).

Nurses’ leadership involves strengthening, coordinating, and connecting the nursing staff’s activities to produce care. Nurses are the primary workers responsible for empowering the team to achieve such a goal(²-³).

In this context, authentic leadership is highlighted, about which studies gradually advance in health and nursing fields. Authentic leadership positively influences the establishment of healthy work environments that promote job satisfaction and directly influences work engagement, behaviors, the development of organizational citizenship, and improved performance(⁴).

Consequently, the authentic leadership model predicts that leaders display authentic behaviors recognized by subordinates and the organization. An authentic leader contributes to the development of employees, promotes positive emotions, and establishes relationships characterized by transparent work environments(⁴-⁵).

Additionally, the quality of healthcare as a direct or indirect product of the work environment in the health or nursing field indicates the need to improve practice settings based on managerial strategies. However, authentic leadership is seldom addressed by studies in the nursing field, so further research is needed to understand how authentic leadership can be developed and which factors influence its practice among nurses(⁶-⁷).

Thus, the importance of this study lies in the conspicuous need to recognize the constructs adopted by researchers regarding authentic leadership and its relevance for nurses’ practice, considering that the reunion and synthesis of such information constitutes a body of knowledge that enables a deeper understanding about it in the nursing context. Additionally, this study is expected to support future studies and discussions regarding authentic leadership to direct the professional nursing practice through scientific knowledge.

OBJECTIVES

To identify the primary constructs regarding authentic leadership and its relevance for nurses’ professional practice.

METHODS

This is an integrative literature review, the purpose of which is to systematically and orderly gather the results of research regarding a given topic to deepen knowledge and provide health workers a consistent and comprehensive overview of relevant data, keeping professionals updated and encouraging discussions that lead to changes in their practice(⁸).

This study was based on a six-stage structured model: determining a theme (guiding question, objectives, and keywords); 2) sampling and searching the literature (inclusion and exclusion criteria, databases search, and studies selection); 3) categorizing data (extraction of information, database organization); 4) assessing the studies included (inclusion and exclusion criteria); 5) interpreting results (discussion); 6) synthesizing knowledge (synthesis of evidence)(⁸).

This study was conducted between May and August 2020 in the following databases: Scientific Electronic Library Online (SciELO); Latin American and Caribbean Literature in Health Sciences (LILACS), National library of medicine - National Institutes of Health (PubMed).

The controlled descriptors provided by Health Sciences Descriptors (DeCS) used in the SciELO and LILACS databases were: leadership, professional practice, and nursing. In addition, a non-controlled descriptor (keyword) was also used to expand the search: authentic leadership. The controlled descriptors provided by Medical Subject Headings (MeSH) used in the PubMed database were leadership and nursing, and the non-controlled was authentic leadership.

The search in the databases using descriptors in Portuguese was based on the following formats: [(Liderança) AND (Liderança Autêntica)]; [(Liderança Autêntica) AND (Enfermagem)]; [(Liderança Autêntica) AND (ética profissional)], and [(“Authentic Leadership”) AND (Nursing)]; [(Authentic) AND (Nursing)]; [(“Authentic Leadership”) AND (Leadership)] were used in the databases using descriptors in English.

After completing the search, all articles were exported to the Mendeley reference manager, and duplicate articles were discarded. The eligibility criteria were: articles addressing authentic leadership, with this term appearing in the title, abstract, or keywords; original articles with full texts in Portuguese or English, published between 2015 and 2020. Finally, studies whose full access was unavailable or articles that did not answer the research question were excluded.

The Melnyk and Fineout-Overholt(⁹) categorization system was used to identify the studies’ level of evidence. Seven levels are considered depending on the study’s design: 1 - systematic reviews and meta-analysis of randomized controlled clinical trials (RCTs); 2 - at least one RCT; 3 - well-designed clinical trials, without randomization; 4- case-control or cohort study; 5 - systematic review of qualitative or descriptive studies; 6 - a single descriptive or qualitative study; 7- expert opinion. Levels 1 and 2 are considered strong evidence; 3 and 4, moderate evidence; and 5 to 7 represent weak scientific evidence.

The search in the databases resulted in 80 scientific articles. First, pre-selection involved reading the titles and abstracts and excluding duplicate articles; 51 remained. Next, the full articles were read. Twenty were excluded because, despite mentioning the descriptors, they did not meet the inclusion criteria and objectives. Hence, 31 studies were included in the review, as shown in Figure 1.

Figure 1
PRISMA flowchart regarding the selection of articles, Brazil, 2021(¹⁰)

RESULTS

A total of 31 studies were analyzed, and the United States was the country with the most papers, 8 (25.8%), followed by Canada with 7 (22.6%), and Brazil with 5 (16.1%). Studies with a quantitative approach predominated (77.41%), followed by qualitative (16.1%) and mixed (6.5%) studies. All the studies conducted in Brazil were of a quantitative nature (100%).

As for the instruments used to collect data, the Authentic Leadership Questionnaire (ALQ) was adopted by 75% of the quantitative studies and 50% of the mixed studies.

Most studies adopted the ALQ likely because not only was it developed before the Authentic Leadership Inventory (ALI) and grounded ALI’s development, there were factors such as previous publications, its applicability, and consolidation(⁵-⁸,¹¹-¹²). ALQ was devised to measure leader authenticity, considering ethical, moral, behavioral, and organizational characteristics. Bruce J. Avolio, Willian L. Gardner, and Fred O. Walumbwa developed the instrument in 2007 in the United States, and Fred O. Walumbwa, Bruce J. Avolio, Willian L. Gardner, Tara S. Wernsing, and Suzanne J. Peterson validated it in 2008.

Regarding the studies’ evidence level, one out of 32 studies presented a level of evidence 4, three studies presented a level of evidence 5, and 27 studies presented a level of evidence 6; hence, 96.8% presented weak evidence.

Chart 1 presents an overview of the studies addressed here according to Title; Authors, Country of Origin, Year: Study design; and Outcome.

Chart 1
Synthesis of papers according to title; authorship; country of origin; year of publication; study design; the number of participants, objective, and outcome, Brazil, 2020

Title	Authors/ Country/Year	Objective	Study design	Outcome
Liderança autêntica e perfil pessoal e profissional de enfermeiros	Carvalho et al. Brazil, 2016(3)	To verify the association between authentic leadership and the personal and professional profile of nurses.	Correlational quantitative study (N=69 nurses). The Authentic Leadership Questionnaire (Self) was used.	The nurses presented characteristics of authentic leaders. Self-awareness scores were much higher among nurse practitioners than clinical nurses.
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(4)	To test a model addressing authentic leadership and areas of work life, occupational coping self-efficacy, burnout, and mental health among newly graduated workers.	Cross-sectional quantitative study (N= 1,009 nurses). The following instruments were used: Authentic Leadership Questionnaire (ALQ), Areas of Worklife Scale, Occupational Coping Self-Efficacy Scale, Maslach Burnout Inventory-General Survey subscales, and the Symptoms Scale of the General Health Questionnaire.	Authentic leadership positively affected work-life areas and occupational coping self-efficacy, resulting in decreased burnout and fewer mental health problems.
Modelo de Liderança Autêntica: concepção teórica e evidências de validade do Authentic Leadership Questionnaire (ALQ) para o Brasil	Cervo et al. Brazil, 2018(5)	The objective was to present additional evidence of ALQ for the Brazilian work-life context.	Quantitative study addressing leaders (N = 437) and subordinates (N = 1329) working in organizations in southern Brazil. ALQ was applied in its self-reported and hetero-evaluation versions.	The subordinates validated authenticity based on constant attitudes and behaviors that portray coherence between the leaders’ authentic behavior and speech. When the socio-demographic variables (age, education, and income) were significant, they presented a weak magnitude and did not explain the variance in authentic leadership.
Liderança autêntica entre profissionais de enfermagem: conhecimento e perfil	Mondini et al. Brazil, 2020(11)	To identify nursing professionals’ knowledge regarding leadership models and assess authentic leadership among them.	Analytical, quantitative study (N=84 nursing workers). Two instruments were used: a socio-demographic questionnaire addressing questions on leadership and the Authentic Leadership Questionnaire.	The nurses obtained high authentic leadership scores while nursing technicians obtained low scores. Being in a leadership position and constantly updating positively influenced authentic leadership behavior. The results show a need to seek knowledge regarding authentic leadership to value the team’s ethical standards and improve trust ties and job satisfaction.
The influence of empowerment authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration	Regan; Laschinger; Wong Canada, 2016(12)	To examine the influence of the structural factors of authentic leadership empowerment and professional practice environments on nurses’ perceived interprofessional collaboration.	Quantitative study, non-experimental predictive analysis (N=220 nurses). The following instruments were used: Conditions of Work Effectiveness Questionnaire-II (CWQ-II), Authentic Leadership Questionnaire (ALQ), Nursing Work Index-Revised (NWI-R) e o interprofessional Collaboration Scale (IPCS).	Structural strengthening, authentic leadership, and the nursing practice environment can promote enhanced interprofessional collaboration (IPC).
Authentic Nurse Leadership Conceptual Framework Nurses’ Perception of Authentic Nurse Leader Attributes	Giordano-Mulligan; Eckardt United States, 2019(13)	To develop the conceptual framework of authentic leadership as a nursing instrument and identify the nurses’ perceptions regarding their leaders’ authentic attributes.	Quantitative study (N=309 nurses). The following instruments were used: Authentic Nurse Leadership Questionnaire (ANLQ) and the Authentic Leadership Questionnaire (ALQ)	Nurse leaders who embody authentic leadership attributes such as courage, moral ethics, self-awareness, relational wholeness, shared decision-making, and caring are true leaders who can support a healthy work-life and enhanced professional engagement.
Authentic leadership and mindfulness development through action learning	Baron, Louis Canada, 2016(14)	To assess a three-year training program based on action learning principles concerning its effectiveness in promoting authentic leadership.	Mixed method study. Data were collected through a quasi-experimental sequential cohort (N=143 participants) and interviews with 24 managers. The Authentic Leadership Questionnaire (ALQ) and the Conscious Attention Awareness Scale were used.	The results suggest that a leadership development program based on action learning principles can foster the development of authentic leadership and mindfulness.
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)	To examine the influence of authentic leadership on recently hired nurses’ turnover intention.	Quantitative, cross-sectional study (N=998 nurses). Electronic questionnaires were sent by e-mail, including the Authentic Leadership Questionnaire (ALQ), Relational Identification Scale, Organizational Identification Scale, Occupational Coping Self-Efficacy Questionnaire, and Turnover Intention Scale.	The results suggest that new graduate nurses whose personal and organizational identification development is facilitated by authentic leaders are more likely to present occupational coping self-efficacy, lowering their intentions to quit employment/nurse turnover.
Liderança Autêntica: uma Análise Temática Teórica do Discurso do Líder Brasileiro Contemporâneo	Campos; Javier; Rueda Brazil, 2019(16)	To investigate the congruence between the authentic leadership theory and the speech of the contemporary Brazilian leader.	This qualitative study used structured interviews to collect data and thematic analysis for data interpretation.	The reports enabled discriminating between the typical speeches of authentic and non-authentic leaders. The conclusion was that the findings contribute to the construct development and provide insights for the continuing research in the field; longitudinal studies are suggested.
Validity evidences regarding the Authentic Leadership Inventory	Novaes; Ferreira; Martins. Brazil, 2019(17)	To assess the internal structure and convergent validity of the Authentic Leadership Inventory.	Quantitative study (N=548 workers). Data were collected online using The Authentic Leadership Inventory.	Initial evidence of validity recommends the future use of the Authentic Leadership Inventory in Brazilian investigations to assess the impact of this leadership style on workplace well-being.
The Relationship Between Authentic Leadership, Performance and Intention to Quit the Job of Nurses	Özer et al. Turkey, 2019(18)	To examine the relationships between the nurses’ perception of their authentic leadership, intention to quit their jobs, and employee performance.	Quantitative study (N=189 nurses). The Authentic Leadership Questionnaire (ALQ) and the Scale for the Intention to Quit was used. Statistical analyzes were performed using SPSS v20.0.	It is believed that nurses’ performance increases due to adopting authentic behavior, treating workers equally, and listening to all the staff members before making decisions; their intention to quit their jobs is also expected to decrease.
Preparing Nurse Managers for Authentic Leadership	Frasier, Nora USA, 2019(19)	To analyze the impact of a pilot program addressing leadership development on the nurse managers’ adoption of authentic leadership behaviors.	Quantitative, cross-sectional study with a voluntary cohort (N=16 nurse managers). The Authentic Leadership Questionnaire (ALQ) Self and Rater and a demographic questionnaire were used.	The pilot program improved nurse managers’ authentic leadership behaviors. The managers perceived greater levels of self-awareness, and direct reports evidenced a positive shift in the use of authentic leadership behaviors.
A Thematic Analysis of Self-described Authentic Leadership Behaviors Among Experienced Nurse Executives	Alexander; Lopez. USA, 2018(20)	To understand the behaviors experienced nurses adopt to create healthy work environments.	Qualitative, descriptive study with 17 nursing leaders. Semi-structured interviews and Thematic Analysis were used.	All the participants agreed on the importance of healthy work environments and their role in creating them. The behaviors described by the participants corroborate the authentic leadership categories (self-awareness, relational transparency; moral and ethical perspectives; and balanced information processing).
Integration of Authentic Leadership Lens for Building High Performing Interprofessional Collaborative Practice Teams	Shirey; White-Williams; Hites. USA, 2019(21)	To discuss the integration of authentic leadership to facilitate the construction of high-performing Interprofessional Collaborative Practice (IPCP) teams.	Longitudinal action research based on experience with implementing an innovative IPCP model to improve health outcomes. The Collaborative Practice Assessment Tool (CPAT) and Patient Satisfaction Questionnaire were used.	An innovative IPCP team care model is an effective approach to improving health outcomes and care transitions. The value of using authentic leadership to guide the development of an IPCP team cannot be underestimated.
Linking Nurses’ Perceptions of Patient Care Quality to Job Satisfaction	Laschinger Fida. Canada, 2015(22)	To test the connection between authentic leadership, structure, professional support, quality of patient care, and job satisfaction.	Cross-sectional, quantitative study (N= 723 nurses). The 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.	Authentic leaders are essential in creating work environments that support professionals and promote high-quality care and job satisfaction.
Authentic Leadership and Creativity: Moderated Meditation Model of Resilience and Hope in the Health Sector	Anwar; Abid; Waqas. Pakistan, 2020(23)	To investigate the relationship between authentic leadership/leaders/ subordinates, and creativity through the mediating role of resilience.	Quantitative research addressing 684 nurses at three different points in time. The Authentic Leadership Questionnaire (ALQ) and a questionnaire addressing creativity and resilience were used.	This study identified the impact of authentic leadership on creativity via resilience and hope. Authentic leadership positively influences nurses’ hope.
The influence of authentic leadership on safety climate in nursing	Dirik; Intepeler Turkey, 2017(24)	To analyze nurses’ perceptions regarding leadership and the safety climate.	Quantitative survey with 350 nurses using the Authentic Leadership Questionnaire (ALQ) and Safety Climate Survey.	Authentic leadership was identified with a strategy to promote a positive perception of safety climate.
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(25)	To examine the theoretical model that tests the effect of leadership authenticity, empowerment structure, and relational social capital on the nurses’ mental health and job satisfaction.	Longitudinal quantitative design (N= 191 nurses). The following instruments were used: the Authentic Leadership Questionnaire (ALQ), Conditions of Work Effectiveness II (CWEQII), Areas of Worklife Scale, Community Subscale, Mental Health Inventory-5, and Unnamed.	When authentic leaders create structurally healthy work environments and foster relational social capital among newly hired nurses, they promote positive health outcomes and job retention and positively influence job satisfaction.
Authentic Leadership: Practices to Promote Integrity	Hughes, Vickie USA, 2018(26)	To discuss Social and Emotional intelligence and social awareness as aesthetic qualities that leaders apply in leadership situations.	Descriptive study addressing 108 nursing students and 126 hospital managers in the US Midwest.	Authentic leadership characteristics linked to emotional and social intelligence enhance a holistic approach by recognizing experiences during leadership situations and improving employees’ work engagement.
Relationship between authentic leadership and nurses’ intent to leave: The mediating role of work environment and burnout	Lee; Chiang; Kuo. China 2019(27)	To explore the mediating effects of the work environment and burnout on the relationship between authentic leadership and nurses’ intention to quit their jobs.	Cross-sectional, quantitative study (N=946 nurses). The Authentic Leadership Questionnaire (ALQ) and Scale of the Nursing Work Index (PES-NWI), Nursing Practice Environment Scale (C-NPES), Maslach Burnout Inventory-Human and Services Survey (MBI-HSS) were used.	Authentic leadership can affect nurses’ intention to quit their jobs, in which the work environment and burnout are important mediators. Therefore, managers should adopt authentic leadership practices and make efforts to improve the work environment and decrease burnout and the nurses’ intention to quit their jobs.
Authentic leadership and thriving among nurses: the mediating role of empathy	Mortier; Vleric; Clays Belgium, 2016(28)	To examine the relationship between perceived authentic leadership and two prosperity dimensions (learning and vitality) among nurses.	Quantitative and cross-sectional study (N=360 nurses). The Authentic Leadership Inventory (ALI), the questionnaire developed by Wong and Law (2002) on emotional intelligence, and the Scale by Porath et al. were used.	Nursing managers implementing Authentic leadership improve nurses’ prosperity at work. Furthermore, empathetic nursing managers seem to promote the vitality of their nurses.
The Effect of Nurse’s Emotional Labor on Turnover Intention: Mediation Effect of Burnout and Moderated Mediation Effect of Authentic Leadership	Na; Park. Korea, 2019(29)	To investigate the effect of nurses’ emotional work on turnover intention mediated by burnout and examine the moderate mediating effect of authentic leadership.	Quantitative study (N=227 nurses). The Authentic Leadership Questionnaire (ALQ), Emotional Work Scale [ELS], and de Maslach Burnout Inventory (MBI) were used.	Authentic leadership had a moderate mediating effect on the relationship between surface acting and turnover intention, which was mediated by emotional exhaustion. The findings suggest that by establishing strong authentic leadership, nurses reduce their turnover intention and burnout.
Psychometric properties of Authentic Leadership Self-Assessment Questionnaire in a population-based sample of Polish nurses	Panczyk et al. Poland, 2019(30)	Adapt and assess the psychometric characteristics of the Polish-language version of the Authentic Leadership Self-Assessment Questionnaire (ALSAQ) intended to be used among nurses.	Quantitative, cross-sectional study in which ALSAQ was administered to a representative group of 3,299 nurses for cultural, linguistic adaptation, and instrument validation.	Authentic leadership skills in nursing practice are characterized by their specificities, an aspect indicated in the ALSAQ validation. It can be considered reliable for nursing professionals to self-assess leadership skills. The standards identified help to measure authentic leadership strengths and weaknesses.
Developing Authentic Leadership Voice: Novice Faculty Experience	Patterson et al. EUA, 2020(31)	To identify the perceptions of the nursing faculty of a leading voice within the academy on authentic leadership development.	Descriptive qualitative study addressing 14 novice faculty members. The thematic analysis proposed by Vaismoradi, Jones, Turunen, and Snelgrove was used.	The mentoring program contributed to behavioral changes in the leaders’ trajectory. Finding their authentic leadership voices contributed to developing relationships with organizations, learning to work with other professors, and discussing leadership initiatives.
Be(com)ing Real: a Multi-source and an Intervention Study on Mindfulness and Authentic Leadership	Nübold; Quaquebeke Hülsheger Germany Serbia, USA Austria, 2020(32)	Test the cross-sectional relationship between a leader’s mindfulness and authentic leadership in subordinates.	Mixed method, cross-sectional study, and multicenter field experiment. The Attention And Awareness Mindfulness Scale (MAAS) and Authentic Leadership Invent (ALI) were used.	Both studies emphasize the benefits of selecting leaders who already have high levels of mindfulness. The results suggest that mindfulness training can be a valuable tool to improve authentic leadership behaviors, and promote improved performance among subordinates.
Authentic leadership, happiness at work and affective commitment: An empirical study in Cape Verde	Semedo; Coelho; Ribeiro Cape Verde 2019(33)	To investigate the relationship between perceptions of authentic leadership and affective commitment through the mediating effect of happiness at work.	Quantitative, cross-sectional study (N= 543 participants). The Authentic Leadership Questionnaire (ALQ) and Daniels’ Instrument of the scale Meyer were used.	Authenticity can enhance employees’ positive emotions to develop their affective commitment toward the organization. Authentic leadership behaviors are essential in encouraging employees to develop improved emotional bonds at work.
Authentic leadership, job satisfaction and organizational commitment: The moderating effect of nurse tenure	Baek; Han; Ryu Korea, 2019(34)	To examine associations between managers’ authentic leadership, job satisfaction, and organizational commitment.	Quantitative, cross-sectional, secondary study using survey data (N=1,118 nurses). The Johnson-Neyman method was used along with the Authentic Leadership Questionnaire (ALQ) and an organizational commitment questionnaire.	The nurses’ perception regarding their manager’s authentic leadership revealed a positive relationship between job satisfaction and organizational commitment and the managers’ authentic leadership as perceived by the nurses. The leaders’ authentic behaviors helped nurses find meaning at work and increase their commitment to 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, Hand India, 2016(35)	To examine the relationship between authentic leadership and employee creativity.	Quantitative study (N=405 nurses and 81 supervisors). Data was collected through Authentic Leadership (ALQ), Knowledge Sharing Behaviour, Information Technology usage, and Employees Creativity.	Authentic leadership was positively linked to employee creativity, and the relationship between authentic leadership and creativity mediated knowledge sharing.
Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities	Bernardes et al. Canada, 2020(36)	To investigate the relationships between flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities.	Quantitative, observational cross-sectional study (N=226 nurse managers). The Quality Improvement Implementation Survey II and the Authentic Leadership Questionnaire were used.	Quality improvement through accreditation is related to organizational culture and authentic leadership. Flexible organizational cultures influence the adoption of authentic leadership and participatory management model and improve quality.
Emotional intelligence and authentic leadership among Saudi nursing leaders in the Kingdom of Saudi Arabia	Alshammari Pasay-An Gonzales Torres, Saudi Arabia, 2020(37)	To determine the correlation between nursing leaders’ emotional intelligence and authentic leadership and socio-demographic characteristics influencing emotional intelligence and authentic leadership.	Study with a quantitative comparative-correlational approach (N= 152 nurse leaders) with cluster sampling. The Authentic Leadership Questionnaire and the Emotional Intelligence Questionnaire were used.	The total emotional intelligence score was strongly and positively related to authentic leadership. Age and years of experience were significant factors explaining the variation in emotional intelligence, while gender, age, and years of experience in the current position were significant in explaining the variation in authentic leadership.
Clinical Nurses’ Perceptions of Authentic Nurse Leadership and Healthy Work Environment	Raso, Fitzpatrick, Masick, USA, 2020(38)	To determine the relationship between the clinical nurses’ perceptions regarding authentic leadership and their unit’s work environment.	Cross-sectional, correlational and descriptive study (N= 254 clinical nurses). The Authentic Nurse Leadership Questionnaire and the Critical Elements of a Healthy Work Environment Survey were used.	There was a moderate correlation between authentic leadership and a healthy work environment. In this new nursing care model based on authentic leadership, caring is an attribute frontline nurses value. Therefore, one should develop authentic leadership to improve nursing work environments and ensure patient and workforce outcomes.

DISCUSSION

This analysis enabled identifying scientific elements that contributed to the emergence of three categories: Work Engagement/Job Satisfaction and Organizational Commitment; Healthy work environment; Intention to quit the job and mental exhaustion.

Work Engagement/Job Satisfaction and Organizational Commitment

This category concerns the importance of authentic leadership for the professionals’ level of work engagement based on: a) organizational nature: organizational commitment and job satisfaction, both related to the organizational climate in general and psychological capital; b) personal/intrinsic nature: moral and ethical issues, courage, self-awareness, and emotional intelligence; and c) relational nature: relational integrity and relational social capital.

Novaes, Ferreira, and Gabardo-Martins(¹⁷) conducted a quantitative study with workers from public and private organizations and verified that authentic leadership positively influences individuals, directly impacting their job satisfaction and work engagement.

Maziero et al.(³⁹) performed an integrative literature review to identify and analyze current scientific publications addressing the positive aspects of authentic leadership influencing the nurses’ work process, showing that authentic leadership has several positive aspects that significantly affect the nurses’ work process, such as greater work engagement and job satisfaction, retention of new nurses, and organizational commitment.

These results are corroborated by Giordano-Mulligan and Eckardt(¹³), who concluded that nurse leaders who incorporate attributes of authentic leadership, such as courage, moral ethics, self-awareness, relational integrality, shared decision-making result in more satisfied professionals and greater work engagement.

By creating structurally strong work environments, authentic leaders promote relational social capital among nurses in their first year of professional practice, leading to positive results such as organizational commitment, retention, and job satisfaction(¹²).

By addressing nursing students and managers, Hughes(²⁶) shows that authentic leadership characteristics enhance the holistic approach by recognizing experiences during leadership situations and improving the employees’ work engagement.

Miao, Humpherey, and Qian(⁴⁰) performed a meta-analysis to examine the relationship between emotional intelligence and authentic leadership and the moderators affecting this relationship. The authors concluded that emotional intelligence is significantly and positively related to authentic leadership. Emotional intelligence enables leaders to use effective leadership styles, such as authentic leadership.

Baek, Han, and Ryu(³⁴) conducted a study with nurses to verify associations between the nursing managers’ authentic leadership with job satisfaction and organizational commitment. The study shows that the nurses’ perceptions regarding their managers’ authentic leadership had a positive relationship with job satisfaction and organizational commitment. Authentic leader behaviors help novice nurses find meaning in their jobs while encouraging their commitment to the organization.

Studies on authentic leadership are related to the positive results an authentic leader promotes within organizations; that is, when nurses establish a relationship of trust with management, work as authentic leaders, and are highly committed and satisfied with their jobs, their actions contribute to increasing the quality of care delivery and safety practices in hospital organizations(⁴-⁶).

Healthy work environment

This category grounds the discussions on work and behavioral constructs, such as a healthy work environment and authentic behavior.

Raso(⁴¹) concluded that authentic leaders are anchored by their core internal values and a deep sense of self; they know where they are and what issues are the most important. Hence, their positive relationships with employees lead to positive individual and organizational results, creating a healthy work environment.

Alexander and Lopez(²⁰) developed a qualitative study with nursing leaders and verified that all the participants agreed on the importance of a healthy work environment and their role in establishing it. In addition, the leaders’ authentic behaviors such as self-awareness, balanced processing, and transparent actions led to ties of trust with subordinates and promoted a safer and healthier work environment that reflected the quality of professional practice.

Authentic leaders are essential in creating healthy work environments that promote high-quality care and job satisfaction. Hence, it is vital to present an expanded definition of authentic leaders and discuss the mechanisms through which authentic leaders create a healthy work environment for professional practice(¹²).

Doherty(⁴²) refers to the Theory of Authentic Leadership Empowerment (TALE) and emphasizes how a nurse’s personal history, values, ethics, and the organizational structure, interact and influence the development of authentic leaders. Integrating TALE in nursing practice allows for developing and supporting authentic leaders who can positively impact the care provided to patients and management within organizations.

Additionally, authentic leadership initiatives and authentic behavior positively affect nurses’ absenteeism and customer and employee satisfaction and improve nursing quality indicators(²⁹).

Intention to quit the job and mental exhaustion

The constructs that support the discussions in this category are linked to occupational stress: mental exhaustion and Burnout.

Özer et al.(¹⁸) examined the relationship between the nurses’ perception of their authentic leadership and intention to quit their jobs, verifying that the adoption of authentic behaviors and the establishment of authentic relationships reflect improved professional performance and trust in the leaders and decreased intention to quit.

The results reported by Fallatah, Laschinger, and Read(¹⁵) suggest that authentic leaders who facilitate the development of personal and organizational identification of novice nurses are more prone to present occupational coping self-efficacy, which, in turn, reduces their intentions to quit their jobs.

Another factor that is key to retaining nurses in their jobs is job satisfaction. Nurses’ autonomy to provide care according to their knowledge and experience has consistently been a strong predictor of job satisfaction and decreased nurse turnover(⁴).

It is also important to note that authentic leadership moderates the relationship between professional practice and turnover intention mediated by physical and mental exhaustion. The results suggest that nursing leaders’ strong, authentic leadership helps decrease their intention to quit their jobs and Burnout(²⁹).

Authentic leadership positively affects areas of professional life and occupational coping self-efficacy, resulting in lower levels of burnout and fewer mental health problems(¹²).

In general, authentic leadership may influence nurses’ intention to quit their jobs, with the work environment and Burnout mediating this influence. From this perspective, managers should adopt authentic leadership practices and make an effort to improve the work environment, decreasing nurses’ Burnout and their intention to quit their jobs(²⁷).

Study limitations

Limitations include the fact that only studies available online were included in this review and that only three databases were consulted, which represents part of the universe of existing studies.

Contributions to the nursing field

Future studies, including in-depth analyses of authentic leadership, can contribute to the nursing field, with repercussions for nursing practice and the formulation of more effective management practices intended to improve health care.

Authentic leadership is a recent and innovative theory that needs to be disseminated to encourage a reflection of the results this type of leadership can generate for the professionals’ quality of life in the work environment, in addition to sharing different experiences with peers, producing knowledge concerning authentic leadership in the nursing/health field.

Furthermore, the results reported by the studies analyzed here show a need to further discuss this subject in the nursing field.

FINAL CONSIDERATIONS

Authentic leadership positively influences the organizational climate and relational social capital, promoting healthier work environments, greater organizational commitment, job satisfaction, and work engagement, decreasing nurses’ absenteeism, mental exhaustion, Burnout, and intention to quit their jobs.

Additionally, authentic leadership improves relational integrity and instills in leaders and subordinates courage, moral and ethical values, self-awareness, and emotional intelligence through authentic behaviors, which are positively reflected in professional practice.

However, the studies indicate a need to more deeply analyze this subject and obtain a better scientific understanding of how authentic leadership can be developed. Effective strategies are needed to implement authentic leadership in nursing and provide training programs directed to nurses.

Most studies addressing authentic leadership adopted an empirical research model with a quantitative approach; few studies presented a qualitative or mixed approach. None of the Brazilian studies adopted a qualitative approach or mixed methods.

Thus, although the results of several empirical studies were statistically relevant, there is a lack of qualitative and mixed studies describing experiential situations in the context of authentic leadership.

REFERENCES

• ¹
  Balsanelli AP. Liderança em enfermagem: Desafios e possibilidades. Acta Paul enferm. 2017;30(1):3-4. https://doi.org/10.1590/1982-0194201700001
  » https://doi.org/10.1590/1982-0194201700001
• ²
  Soares MI, Camelo SHH, Resck ZMR, Terra FS. Nurses' managerial knowledge in the hospital setting. Rev Bras Enferm. 2016;69(4):676-83. https://doi.org/10.1590/0034-7167.2016690409i
  » https://doi.org/10.1590/0034-7167.2016690409i
• ³
  Carvalho AGF, Cunha ICKO, Balsanelli AP, Bernardes A. Liderança autêntica e perfil pessoal e profissional de enfermeiros. Acta Paul Enferm. 2016;29(6):618-25. https://doi.org/10.1590/1982-0194201600087
  » https://doi.org/10.1590/1982-0194201600087
• ⁴
  Laschinger HKS, Borgogni L, Consiglio C, Read E. The effects of authentic leadership, six areas of worklife, and occupational coping self-efficacy on new graduate nurses’ burnout and mental health: a cross-sectional study. Int J Nurs Stud. 2015;52(6):1080-9. https://doi.org/10.1016/j.ijnurstu.2015.03.002
  » https://doi.org/10.1016/j.ijnurstu.2015.03.002
• ⁵
  Cervo CS, Natividade JC, Mónico LSM, Pais L, Santos NR, Hutz CS. Modelo de Liderança Autêntica: concepção teórica e evidências de validade do Authentic Leadership Questionnaire (ALQ) para o Brasil. Psychol. 2018;61(2): 7-29. https://doi.org/10.14195/1647-8606_61-2_1
  » https://doi.org/10.14195/1647-8606_61-2_1
• ⁶
  Laschinger HKS, Smith LM. The influence of authentic leadership and empowerment on new-graduate nurses’ perceptions of interprofessional collaboration. J Nurs Adm. 2013;43(1):24-9. https://doi.org/10.1111/jonm.12288
  » https://doi.org/10.1111/jonm.12288
• ⁷
  Mauricio LFS. Professional nursing practice in critical units: assessment of work environment characteristics. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1424.2854
  » https://doi.org/10.1590/1518-8345.1424.2854
• ⁸
  Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm. 2008;17(4):758-64. https://doi.org/10.1590/S0104-07072008000400018
  » https://doi.org/10.1590/S0104-07072008000400018
• ⁹
  Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In. Melnyk BM, Fineout-Overholt, E. Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24 p.
• ¹⁰
  Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372 (71). https://doi.org/10.1136/bmj.n71
  » https://doi.org/10.1136/bmj.n71
• ¹¹
  Mondini CCSD, Cunha ICKO, Trettene AS, Fontes CMB, Bachega MI, Cintra FMR. Authentic leadership among nursing professionals: knowledge and profile. Rev Bras Enferm. 2020;73(4). https://doi.org/10.1590/0034-7167-2018-0888
  » https://doi.org/10.1590/0034-7167-2018-0888
• ¹²
  Regan S, Laschinger HKS, Wong CA. The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration. J Nurs Manag. 2016;24(1):54-61. https://doi.org/10.1111/jonm.12288
  » https://doi.org/10.1111/jonm.12288
• ¹³
  Giordano-Mulligan M, Eckardt S. Authentic nurse leadership conceptual framework: nurses' perception of authentic nurse leader attributes. Nurs Adm Q. 2019;43(2):164-74. https://doi.org/10.1097/NAQ.0000000000000344
  » https://doi.org/10.1097/NAQ.0000000000000344
• ¹⁴
  Baron L. Authentic leadership and mindfulness development through action learning. J Manag Psychol. 2016;31(1):296-311. https://doi.org/10.1108/JMP-04-2014-0135
  » https://doi.org/10.1108/JMP-04-2014-0135
• ¹⁵
  Fallatah F, Laschinger HKS, Read EA. The Effects of Authentic Leadership, Organizational Identification, and Occupational Coping Self-efficacy on New Graduate Nurses’ Job Turnover Intentions in Canada. Nurs Outlook. 2017;65(2): P172-183. https://doi.org/10.1016/j.outlook.2016.11.020
  » https://doi.org/10.1016/j.outlook.2016.11.020
• ¹⁶
  Campos MI, Rueda FJ. Authentic leadership: a theoretical thematic analysis of the contemporary Brazilian leader’s speech. Paidéia. 2019;29:e2924. https://doi.org/10.1590/1982-4327e2924
  » https://doi.org/10.1590/1982-4327e2924
• ¹⁷
  Novaes VP, Ferreira M, Gabardo-Martins LMD. Validity evidences regarding the Authentic Leadership Inventory. Estud Psicol. 2019;36(180058). https://doi.org/10.1590/1982-0275201936e180058
  » https://doi.org/10.1590/1982-0275201936e180058
• ¹⁸
  Özer Ö. The relationship between authentic leadership, performance and intention to quit the job of nurses, hospital topics. 2019;97(3):73-9. https://doi.org/10.1080/00185868.2019.1614893
  » https://doi.org/10.1080/00185868.2019.1614893
• ¹⁹
  Frasier N. Preparing nurse managers for authentic leadership: a pilot leadership development program. J Nurs Adm. 2019;49(2):79-85. https://doi.org/10.1097/NNA.0000000000000714
  » https://doi.org/10.1097/NNA.0000000000000714
• ²⁰
  Alexander C, Lopez RPA. Thematic analysis of self-described authentic leadership behaviors among experienced nurse executives. J Nurs Adm. 2018;48(3):38-43. https://doi.org/10.1097/NNA.0000000000000568
  » https://doi.org/10.1097/NNA.0000000000000568
• ²¹
  Shirey MR, White- Williams C, Hites L. Integration of authentic leadership lens for building high performing interprofessional collaborative practice teams. Nurs Adm Q. 2019;43(2):101-12. https://doi.org/10.1097/NAQ.0000000000000339
  » https://doi.org/10.1097/NAQ.0000000000000339
• ²²
  Laschinger HKS, Fida R. Linking nurses’ Perceptions of Patient care Quality to Job Satisfaction. JONA. 2015;45(5):276-83. https://doi.org/10.1097/NNA.0000000000000198
  » https://doi.org/10.1097/NNA.0000000000000198
• ²³
  Anwar A, Abid G, Waqas A. Authentic leadership and creativity: moderated meditation model of resilience and hope in the health sector. Eur J Investig Health Psychol Educ. 2020;10(1):18-29. https://doi.org/10.3390/ejihpe10010003
  » https://doi.org/10.3390/ejihpe10010003
• ²⁴
  Dirik HF, Intepeler S. The influence of authentic leadership on safety climate in nursing. J Nurs Manag. 2017;25(5):392-40. https://doi.org/10.1111/jonm.12480
  » https://doi.org/10.1111/jonm.12480
• ²⁵
  Read EA, Laschinger HKS. The influence of authentic leadership and empowerment on nurses' relational social capital, mental health and job satisfaction over the first year of practice. J Adv Nurs. 2015;71(7):1611-23. https://doi.org/10.1111/jan.12625
  » https://doi.org/10.1111/jan.12625
• ²⁶
  Hughes V. Authentic Leadership: Practices to Promote Integrity. J Christ Nurs.2018;35(2):E28-E31. https://doi.org/10.1097/CNJ.0000000000000491
  » https://doi.org/10.1097/CNJ.0000000000000491
• ²⁷
  Lee HF, Chiang HY, Kuo HT. Relationship between authentic leadership and nurses' intent to leave: the mediating role of work environment and burnout. J Nurs Manag. 2019;27(1):52-65. https://doi.org/10.1111/jonm.12648
  » https://doi.org/10.1111/jonm.12648
• ²⁸
  Mortier AV, Vlerick P, Clays E. Authentic leadership and thriving among nurses: the mediating role of empathy. J Nurs Manag. 2016;24(3):357-65. https://doi.org/10.1111/jonm.12329
  » https://doi.org/10.1111/jonm.12329
• ²⁹
  Na SY, Park H. The effect of nurse's emotional labor on turnover intention: mediation effect of burnout and moderated mediation effect of authentic leadership. J Korean Acad Nurs. 2019;49(3):286-97. https://doi.org/10.4040/jkan.2019.49.3.286
  » https://doi.org/10.4040/jkan.2019.49.3.286
• ³⁰
  Panczyk M, Jaworski M, Iwanow L, Cieślak I, Gotlib J. Psychometric properties of Authentic Leadership Self-Assessment Questionnaire in a population-based sample of Polish nurses. J Adv Nurs. 2019;75(3):692-703. https://doi.org/10.1111/jan.13922
  » https://doi.org/10.1111/jan.13922
• ³¹
  Patterson BJ, Dzurec L, Sherwood G, Forrester DA. Developing Authentic Leadership Voice: Novice Faculty Experience. Nurs Educ Perspect. 2020;41(n1):10-5. https://doi.org/10.1097/01.NEP.0000000000000494
  » https://doi.org/10.1097/01.NEP.0000000000000494
• ³²
  Nübold A, Van Quaquebeke N, Hülsheger UR. Be(com)ing Real: a multi-source and an intervention study on mindfulness and authentic leadership. J Bus Psychol.2020;35:469-88, 2020. https://doi.org/10.1007/s10869-019-09633-y
  » https://doi.org/10.1007/s10869-019-09633-y
• ³³
  Semedo AS, Coelho A, Ribeiro N. "Authentic leadership, happiness at work and affective commitment: an empirical study in Cape Verde". Europ Business Rev. 2019;31(3):337-51. https://doi.org/10.1108/EBR-01-2018-0034
  » https://doi.org/10.1108/EBR-01-2018-0034
• ³⁴
  Baek H, Han K, Ryu E. Authentic leadership, job satisfaction and organizational: the moderating effect of nurse tenure. J Nurs Manag. 2019;27(8):1655-63. https://doi.org/10.1111/jonm.12853
  » https://doi.org/10.1111/jonm.12853
• ³⁵
  Malik N, Dhar RL, Handa SC. Authentic leadership and its impact on creativity of nursing staff: a cross sectional questionnaire survey of Indian nurses and their supervisors. IJNS. 2016;63:28-36. https://doi.org/10.1016/j.ijnurstu.2016.08.004
  » https://doi.org/10.1016/j.ijnurstu.2016.08.004
• ³⁶
  Bernardes A, Gabriel CS, Cummings GG, Zanetti ACB, Leoneti AB, Caldana G, et al. Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities. Rev Bras Enferm. 2020;73(Suppl 5):e20190732. https://doi.org/10.1590/0034-7167-2019-0732
  » https://doi.org/10.1590/0034-7167-2019-0732
• ³⁷
  Alshammari F, Pasay-An E, Gonzales F, Torres S. Emotional intelligence and authentic leadership among Saudi nursing leaders in the Kingdom of Saudi Arabia. J Prof Nurs. 2020;36(6):503-9. https://doi.org/10.1016/j.profnurs.2020.04.003
  » https://doi.org/10.1016/j.profnurs.2020.04.003
• ³⁸
  Raso R, Fitzpatrick JJ, Masick K. Clinical nurses' perceptions of authentic nurse leadership and healthy work environment. J Nurs Adm. 2020;50(9):489-94. https://doi.org/10.1097/NNA.000000000000092
  » https://doi.org/10.1097/NNA.000000000000092
• ³⁹
  Maziero VG, Bernardes A, Righetti EAV, Spiri WC, Gabriel CS. Positive aspects of authentic leadership in nursing work: integrative review. Rev Bras Enferm.2020;73(6):e2019-0118. https://doi.org/10.1590/0034-7167-2019-0118
  » https://doi.org/10.1590/0034-7167-2019-0118
• ⁴⁰
  Miao C, Humphrey RH, Qian S. Emotional intelligence and authentic leadership: a meta-analysis. Leadership Organ Develop J. 2018;39(5):679-90. https://doi.org/10.1108/LODJ-02-2018-0066
  » https://doi.org/10.1108/LODJ-02-2018-0066
• ⁴¹
  Raso R. Be you! Authentic leadership. Nurs Manag. 2019;50(5):18-25. https://doi.org/10.1097/01.NUMA.0000557619.96942.50
  » https://doi.org/10.1097/01.NUMA.0000557619.96942.50
• ⁴²
  Doherty DP, Hunder Revell SM. Developing nurse leaders: toward a theory of authentic leadership empowerment. Nurs Forum. 2020;55(3):416-24. https://doi.org/10.1111/nuf.12446
  » https://doi.org/10.1111/nuf.12446

Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho

ASSOCIATE EDITOR: Hugo Fernandes

Publication Dates

• Publication in this collection
  17 Oct 2022
• Date of issue
  2022

History

• Received
  23 Jan 2022
• Accepted
  09 July 2022