Self-evaluation and evaluation of nursing leaders Leadership Styles*

Objective: to evaluate the concordance between the leadership styles self-evaluated by the Nursing managers and evaluated by their subordinates in a private hospital. Methodology: an observational, cross-sectional, quantitative, and analytical study, with population of 31 managing nurses and 125 subordinates. Herman Bachenheimers instrument of Situational Leadership was employed, adapting it to the subordinates. The concordance between self-evaluation and evaluation by the subordinates was analyzed in the four leadership styles (Directing, Guiding, Participating, Delegating), with the Kappa coefficient statistical test, test statistic (Z) >1.96, 95% confidence interval and PASW Statistics, version 18. Results: the self-evaluation of the Nursing managerial staff has a tendency for the Guiding Style and, according to the evaluation by their subordinates, there is a minimum difference among the four styles. Their concordance is low, but significant, with 19.3%. It was identified that the subordinates perceive that they possess the necessary competences to autonomously perform the tasks assigned, and that there is trust and assertive communication between both groups, which facilitates knowledge exchange. Conclusion: the Nursing managers and their subordinates perceive various leadership styles, and concordance is low. To attain superior leadership styles, the subordinates must develop autonomy and empowerment.


Introduction
It is but a challenge to keep professionals with sufficient competences to occupy leadership roles, since "the Nursing professionals who hold Leadership roles must be able to influence on the mechanisms for the adoption of decisions that establish priorities, as well as to allocate resources to attain health" (1) ; likewise, "the lack of managerial and leadership ability at all levels of the health system is more frequently cited as a determinant obstacle to improving care quality, expanding the health services, and attaining the development goals of the millennium" (2)(3) .
On the other hand, "to achieve the 2030 Sustainable Development Objectives and to address a whole series of challenges, including the worldwide scarcity of Nursing staff, it is necessary that the national Nursing leaders of the world work together to formulate a strategy for long-term sustainable development, promoting the progress of the Nursing science, the development of the Nursing course, the advance of industrial Nursing, and the improvement of people's general health" (4) .
It is also acknowledged that the Nursing leaders are "integral actors not only in the provision of quality medical care, but also in operational excellence in various medical care environments" (5) ; in addition, it is considered that "leadership plays a fundamental role in the nurses' lives and requires strong, coherent, and well-informed leaders" (1) . Therefore, well-prepared leaders are required who are able to assume the corresponding role, influence on their subordinates (the individuals who are responsible for the direct care provided to the patients), and favor conducts and behaviors in the health staff; these conditions are fundamental so that the Nursing practice can advance to a leadership with a favorable and participative behavior which generates a working atmosphere that eases teamwork with good communication, respect and team autonomy, thus actively including their personnel in the decisions, for a humanized and good quality management practice (1) .

The Situational Leadership model proposed by
Hersey & Kenneth H. Blanchard, identified as the Situational Leadership Theory (SLT), emerges from the basic principle that the leaders must adapt to the situation prevailing in the organization, that is to say, if the situation changes, the leaders must be able to change and adapt to this new situation in order to attain the goals and objectives that have been set out; their efficiency for their subordinates to be well-directed and to identify them as a guide who generates trust will depend on that. This leadership style is defined as the process of influencing on the activities of an individual or group in the efforts to attain goals in a given situation, attributing special relevance to the situation in which each leader can have a preferred style (6) .
This model implies the integration of two dimensions: task or relationship conduct (similar to those defined by the University of Ohio), according to the different situations experienced. The first refers to the communication from the leaders to their subordinates in a detailed manner regarding the tasks to be performed, indicating specifications that leave no room for doubts; the second refers to bilateral communication, in order to offer support not only in relation to the assigned task but also to situations relating to personal emotions, health, and communication among peers, since the leaders listen, guide, and support their subordinates (3) .
According to these two behavioral dimensions, the leaders have two possibilities (high or low) in the four leadership styles (Directing, Guiding, Participating, Delegating); in the first, they monitor, give specific instructions, and closely supervise performance, are little encouraging and very governing; in the second, they explain to their subordinates aspects referring to the decisions made and allow them to clarify situations; the third style is characterized by sharing ideas, making suggestions, and conveying confidence to the subordinates so that they take risks and, in the fourth, they transfer responsibility for the decisions and their materialization, there is autonomy and trust, and the subordinates are duly qualified and trained (7) .
In this style, the behavior that the leaders adopt with their subordinates regarding the tasks is of paramount importance, since an harmonic and dynamic work environment where interaction is enabled both among the subordinates and between subordinates and leaders is required by public and private institutions, integrating professional nursing staff with sufficient competences, efficient and prepared to act as leaders, capable of managing adequately with reliability and innovation (1) , in addition to being able to successfully face the changes required by the situation; to such end, they must have the skill and ability to modify their style as necessary (8) .
The leaders have indicated that it is difficult to solve conflicts and to carry out their leadership activities (1) , there is a tendency in the leaders to perform tasks instead of having their subordinates perform them (9) , and the main activities are those regarding the accomplishment of the task (7) , leaving to a second place the relationships with the subordinates, which becomes more noticeable with the high workloads which are the result, among other causes, of the demands from the institutions, the need to meet the established goals, and the diversity of characteristics in terms of aptitudes, www.eerp.usp.br/rlae 3 Castillo ALR, Padilla MER, Hernández DG.
attitudes, and capabilities of the personnel under their charge (1) .
There is not enough data referring to the evaluations conducted on the Nursing managers by their subordinates, although the results of a research study show that only three of the four learning styles are frequently used, which, according to their frequency of use and in descending order, are the following: Delegating, Guiding, and Directing (10) . It is believed that this situation can be related to the managers' control scope, which has undergone an expansion due to the reduction in the number of intermediate managers in their organizational structure, thus extending the control space (10) .
However, society does not value the leadership process (1) ; on the other hand, assuming leadership is no guarantee as to its efficacy (11) but, in addition to influencing on the direct care provided to the patients, it also exerts an influence on other important aspects like administration, education, decision-making, and peer autonomy, among others (1) . In view of the aforementioned, for Nursing leaders to provide quality care, they must possess certain characteristics, such as the competences which allow for teamwork (2) , combined with the need to analyze the current preparation of the nursing professionals to exercise leadership; but not only that, they must also wonder if they are seen as prepared to adapt to different leadership styles according to the situation and to verify if there is concordance between their self-evaluations and the evaluations by their subordinates.
One of the theories that can contribute for the Nursing leaders to visualize different perspectives and, in doing so, favor their own professional development and that of their subordinates, as well as the managerial skills, is Johari's window; according to this theory, it is recommended that the best area where Nursing managerial staff can be found is the free area, since it allows exchanging information among peers and subordinates, thus favoring interpersonal relationships, among other beneficial aspects to attain the institution's goals and objectives (12) .
It is for this reason that, when solving those questions in future studies, it could direct the strengthening of the quantitative trend on leadership and its styles according to the SLT, as well as it would bolster the theoretical and empirical knowledge of the existing concordance between the leader, the subordinate, and Johari's window, which could go beyond what some authors have expressed directed to the relation with negative feelings (13) , proactive personality (14) , satisfaction (15) , innovation leadership predictors, and self-esteem in the subordinates (16) .
The purpose of this study was to evaluate the concordance between the leadership styles selfevaluated by the nursing managers and evaluated by their own subordinates in a private hospital.

Method
This is an observational, cross-sectional, quantitative, and analytical study, conducted in a private hospital in the city of San Luis Potosí, Mexico. The target population was made up by 31 managing nurses and 125 of their subordinates; in turn, 30 of these leaders participated as subordinates.
The criteria for inclusion considered were the following: leaders with a managerial position, with no age limit, with a minimum of 6 months in their current positions; regarding the subordinates, they had to have a leader at the managerial level, with no age limit, and a minimum of 1 month working with the leader; both had to accept to participate and voluntarily sign the informed consent. Finally, the exclusion criteria contemplated were the following: leaders and subordinates who were on vacation, on disability leave, or those who have not participated voluntarily in the research. Chiefs, and Shift Managers) and to their corresponding subordinates; in the second, the instrument was applied to the leaders to evaluate the manager and, in the third, the second instrument "seen by the subordinates" was applied to evaluate the leader who has to be assessed by the subordinate. In all the cases, the applications were responsibility of the lead researcher and, before applying the instrument, the participants were given the informed consent form; the instrument was applied after they signed such form.
Data capture was performed in Excel and, for their processing, they were exported to PASW Statistics, version 18, in Spanish. Relative and absolute frequencies were estimated in the qualitative variables and, for the quantitative ones, some measures of central tendency and dispersion were estimated. To evaluate the concordance between the leaders' self-evaluation and the evaluation by the subordinates with respect to the four leadership styles (Directing, Guiding, Participating, and Delegating), the Kappa coefficient statistical test was used, observing that the test statistic (Z) was higher than 1.96; in order to consider a significant concordance, such criterion is similar to p<0.05, when working with a 95% confidence interval. Table 1       Delegating. These findings were consistent with those of a study conducted in Mexico (18) and with studies from Colombia (7) and Spain (19) , a fact that signals that there has not been any change for an extended period of time.  (20)(21) , as well as show concern for the personal development of each subordinate (1) . The participative style focuses on communication and on the relationships with the subordinates so as to achieve better results in health and to overcome the challenges inherent to the profession (3,7,(20)(21) ; and, for the delegative style, this is only possible when the subordinates possess a high level of preparation and when they are sufficiently motivated to perform the task, since the leader includes them in a task in a more direct manner (22) and knows that they have the necessary skills and knowledge to perform it (7) .

Results
Therefore, the leaders are agents for transformation and need to work hard with their subordinates training them in their job positions, so that they can perform autonomously, solve conflicts, and make decisions (22)(23)(24) , thus managing to empower them in the assigned and delegated activities (9,(23)(24) . The aforementioned would promote the subordinates to be labeled as "leaders" (25) of their own process in providing direct quality care.
However, it is essential that the institutional policies, as well as the managers of each institution, present a transformational view to attain the high leadership styles and outstanding performance in the achievement of the objectives set out (1) . However, these results that have been detected differ from others published, where the subordinates report needing a Guiding leadership style (high in direction and in support), but that the most frequent leadership style they receive is Delegating, followed by Guiding and Participating (33%), and by Directing (3%).
That is to say, 42% reported the Delegating leadership style (low in direction and in communication), and only 13% mentioned needing it. The possible explanation for this reality is that the managers are very sensitive to the exclusive use of the managerial behaviors (10) and that, during the 1980s and 1990s, many corporations reduced the number of intermediate managers in their organizational structures, thus extending the control scope for which several managers are responsible (10) .
On the other hand, there is low, positive, and confidence in the leader, and higher levels of favorable work in the employee (10) . Consequently, and due to the aforementioned, the institution can be benefited, since the necessary tasks to fulfill its mission will present more probability of success if there is concordance in www.eerp.usp.br/rlae 7 Castillo ALR, Padilla MER, Hernández DG.
the perceptions between the leaders' self-evaluation and the evaluation by their subordinates.
There is evidence signaling that, as the congruence of the managers' perceptions on their own competences increases, self-development needs decrease with time; which might induce us to think that, when employing appropriate feedback measures (26) , increasing selfknowledge as well as the knowledge of the subordinates, of the task to be performed, of the institution, and of the general setting, the concordance level might improve (22) .
The non-concordance detected in the managerial staff (80.7% of the population), is justified as an obvious indicator according to another study (13) for two reasons, increases, so does the gap between self-esteem and the qualifications of others (26) .
The discrepancies between the findings can be the result, at least in part, of the instrument employed, of the characteristics of the population, of the methodology used, of diverse incentives, and of safeguarding against negative consequences when giving honest evaluations (26) by the subordinates, elements that must be mitigated and considered in future studies.
What matters here is the contribution that could be made from the results obtained with the SLT and from the contributions of the communicational model, Johari's window (12) , since low concordance is situated in the "ideal window, the free area", that is, both the leader and the subordinate that coincide with the leadership styles evaluated are in this area. Working on interpersonal learning will expand the free area and will reduce the other areas of this model (12) ; for this reason, the institution will have to generate important changes, work on the level of trust between the two groups with criteria of giving and receiving feedback, consequently, the tendency is lower for the collaborators to misinterpret or project wrong personal and work meanings on the leader's behavior (12) . The "blind area" between both groups must be avoided, since it hinders the improvement of the necessary interpersonal relationships to attain the higher leadership styles set forth by this situational theory; for this reason, the leaders must expand the "free area" and broaden its action radio together with their subordinates.
To the extent that access to information is enabled, the subordinates will feel more capable and with more

Conclusion
It is necessary to work on the strengthening of the interpersonal relationships between the leader and