Integrative Review

Leadership and nursing work

satisfaction: an integrative review
Liderança e satisfação no trabalho da enfermagem: revisão integrativa
André Almeida de Moura1
Andrea Bernardes1
Alexandre Pazetto Balsanelli2
Ariane Cristina Barboza Zanetti1
Carmen Silvia Gabriel1

Keywords Abstract
Leadership; Job satisfaction; Nursing Objective: To identify and analyze knowledge about the relationship between leadership and nursing job satisfaction.
team Methods: An integrative review of the MEDLINE, CINAHL, EMBASE, PubMed, Web of Science, and LILACS databases to answer the guiding
question: What knowledge was produced about the relationship between leadership and nursing job satisfaction in the period from 2011
to 2016? Searches were made to obtain articles, theses, dissertations, and reviews (systematic, narrative and integrative); opinion articles
Descritores and editorials were excluded. The searches were carried out between October 2016 and January 2017, using the inclusion criteria: primary
Liderança; Satisfação no trabalho; articles; full text available; written in English, Portuguese or Spanish; and published in the last six years (2011-2016). The extraction of study
Equipe de enfermagem results was carried out by two reviewers, who defined four thematic categories, with the purpose of analyzing the data obtained in the articles
and comparing them with the literature.
Results: Out of a total of 582 articles, 15 were selected; four categories were established: the use of the theoretical reference of leadership
in the construction of the articles; the use of instruments to measure leadership and job satisfaction, and the correlation between these
Submitted variables; the predominance of nursing leadership in the hospital setting; and the direct and indirect relationship between leadership and
May 2, 2017 job satisfaction.
Conclusion: The results showed that nursing leadership has a positive and significant impact on job satisfaction, and the need to develop this
Accepted
competency in nursing professionals was demonstrated.
August 21, 2017
Resumo
Objetivo: Identificar e analisar o conhecimento da relação entre liderança e satisfação no trabalho da enfermagem.
Métodos: Revisão integrativa nas bases de dados MEDLINE, CINAHL, EMBASE e LILACS para responder à pergunta norteadora: Qual é
o conhecimento produzido acerca da relação entre liderança e satisfação no trabalho da enfermagem no período de 2011 a 2016? Para
obtenção dos artigos, excluíram-se as teses, dissertações, revisões (sistemática, narrativa e integrativa), assim como artigos de opinião e
editoriais. As buscas ocorreram entre outubro de 2016 a janeiro de 2017, utilizando os critérios de inclusão: artigos primários; disponíveis na
íntegra; nos idiomas inglês, português e espanhol e; publicados nos últimos seis anos (2011-2016). A etapa de extração dos resultados dos
estudos foram realizadas por dois revisores, que estabeleceram quatro categorias temáticas, com a finalidade de analisar os dados obtidos
nos artigos, comparativamente com a literatura.
Resultados: Disposto de 582 artigos selecionou-se 15 sendo estabelecidas quatro categorias: o uso do referencial teórico de liderança na
construção dos artigos; a utilização de instrumentos para mensurar a liderança e satisfação no trabalho e correlação entre essas variáveis;
Corresponding author o predomínio da liderança da enfermagem no contexto hospitalar; e a relação direta e indireta entre liderança e satisfação no trabalho.
André Almeida de Moura Conclusão: Evidenciou-se que a liderança na enfermagem exerce uma relação positiva e significativa sobre a satisfação no trabalho
demonstrando a necessidade do desenvolvimento dessa competência nos profissionais de enfermagem.
Rua Prof. Hélio Lourenço, 3900,
14040-902, Ribeirão Preto, SP, Brazil.
[email protected]

DOI
http://dx.doi.org/10.1590/1982-
0194201700055
1
Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
2
Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Conflicts of interest: there are no conflicts of interest to declare.

442 Acta Paul Enferm. 2017; 30(4):442-50.

 Moura AA, Bernardes A, Balsanelli AP, Zanetti AC, Gabriel CS

Introduction tion through increased retention and the ability to

provide better quality care.(4)
In the current globalized scenario, where technolog- Considering the importance of this theme for
ical innovations and market demands are continu- nursing management, and that the most recent re-
ous, there is no room for keeping archaic (vertically views date from 2010,(3-4) a new update is needed in
and task-centered) management standards. These order to identify the knowledge produced and the
innovations and demands are transforming the existing gaps. Therefore, the present research aimed
workplaces and organizational cultures of health in- to identify and analyze the knowledge produced
stitutions. At the same time, all these changes have about the relationship between leadership and nurs-
led health professionals to learn new roles and de- ing job satisfaction.
velop skills such as teamwork, group coordination
and leadership.
Leadership is an essential competency for Methods
nurse professional practice in society and in the
contemporary labor market; therefore, through The present work consists of an integrative review
and from it, nurses guide their work process and of the literature(5) that judiciously used the six steps
lead their teams towards the achievement of shared recommended for carrying out an integrative re-
objectives.(1) view: 1) selection of the guiding question (What is
Currently, nursing studies focus on how this the knowledge produced about the relationship be-
competency influences individuals in organization- tween leadership and job satisfaction in nursing in
al culture, their work environments, patient-related the period from 2011 to 2016?); 2) determination
outcomes (patient satisfaction, adverse events), and of the inclusion and exclusion criteria, and a search
interactive relationships between leaders and those in the literature; 3) definition of the information to
they lead, for example, the relationship between be extracted, and categorization of studies; 4) eval-
leadership and job satisfaction. Research aimed at uation of studies included in the integrative review;
understanding this relationship is based on theories 5) interpretation of the results; and 6) presentation
of leadership.(2) of the review with a synthesis of the knowledge
Based on this aspect, a systematic review ana- produced.(6)
lyzed the relationship between leadership theories Searches were made to obtain articles, theses,
and the nursing workforce, as well as work envi- dissertations, and reviews (systematic, narrative and
ronment variables. We hypothesized a positive re- integrative); opinion articles and editorials were
lationship between certain leadership styles and job excluded. The following electronic databases were
satisfaction; that is, as leadership is performed and consulted: Latin American and Caribbean Health
experienced, there is an increase in job satisfaction. Sciences Literature (LILACS); National Library of
In addition, we also expected to find a positive re- Medicine of the U.S. National Institutes of Health
lationship between leadership and the variables: (PubMed), Web of Science; the Elsevier EMBASE;
organizational commitment, empowerment and and the Cumulative Index to Nursing and Allied
productivity; and a negative correlation between Health Literature (CINAHL). We used the con-
leadership and turnover and stress at work.(3) trolled descriptors present in: Health Sciences
The research supported these hypotheses, in- Descriptors (DeCS) - leadership, nursing, and job
dicating that nursing leadership has a significant satisfaction; and MeSH and Emtree - leadership,
impact on the work environment, and job satisfac- nursing, and job satisfaction. To cross-reference
tion and, consequently, on the performance and the terms, the Boolean logical operator “AND” was
motivation of professionals. The most satisfied and used to obtain as many articles as possible to answer
motivated nursing professionals in their work envi- the guiding question. The searches took place be-
ronment are, in turn, able to reward their organiza- tween October 2016 and January 2017, using the

Acta Paul Enferm. 2017; 30(4):442-50. 443

 Leadership and nursing work satisfaction: an integrative review

inclusion criteria: primary articles; available in full; using the quality tool for correlational studies devel-
written in English, Portuguese or Spanish; pub- oped by Cummings and Estabrooks(7), which eval-
lished in the last six years (2011-2016) - this period uates four areas of each study: research design, sam-
was chosen because there is a review of the previous pling, measurement and statistical analysis. It con-
period.(3) The extraction of the study results was car- sists of 13 items, and a total of 14 possible points: a
ried out by two reviewers, who established four the- point is assigned for each positive item, and one of
matic categories, with the purpose of analyzing the the items has a two-point score. Based on the evalu-
data obtained in the articles and comparing them ated points, the studies were considered: strong (10-
compared to the literature. 14), moderate (5-9), and weak (0-4).
The characterization of the articles is summa-
rized in chart 1, which shows that the production
Results on the subject was as follows. Regarding the quality
of the articles, they were distributed in moderate
Initially, 582 papers were found. After reading of (73.3%; n = 11), and strong articles (26, 6%, n =
titles and abstracts, analysis of the inclusion and ex- 4). The largest number of papers was developed in
clusion criteria, and eliminating duplicate articles, North and South America (Canada, n = 3, 20%;
40 articles remained. Of these, after reading the the United States, n = 3, 20%; and Chile, n = 1,
manuscripts in full, 15 articles were obtained that 6.6%). Regarding the distribution of the articles
responded to the guiding question of the study; the over the six years of publication analyzed, the high-
other 25 articles were excluded, since they did not er ratios were: 2016 (20%, n = 3); 2014 (20%, n =
approach the relationship between leadership and 3); 2012 (20%, n = 3); and 2013 (20% %, n = 3).
job satisfaction. Regarding the journals where the articles were pub-
The 15 papers presented correlation as their lished, 9 (60%) of the 15 articles were published in
method of study. They were reviewed and classified nursing journals.

Chart 1. Articles according to authorship, country and year of publication, research design, number of participants, article evaluation,
theoretical reference framework, tools used and research outcome
Design/Number of participants/ Leadership theoretical Data Collection instruments for
Author(s)/Country/Year Outcomes
Article evaluation reference leadership and job satisfaction
MEDLINE
Choi et al.(8)/Malaysia/2016 Correlational Study/n=200 nursing Transformational Multifactor Leadership Questionnaire Study analyses showed that empowerment mediated the
professionals/(strong-10/14) leadership (MLQ)/Scale described by Warr, Cook effect of transformational leadership on job satisfaction in the
and Wall nursing team. (p=0.001; t-value= 3.28).
Lin et al.(9)/Taiwan/2015 Correlational Study / n=651 Leadership MLQ Occupational Stress Indicator An indirect relationship was demonstrated between the
nurses/(moderate-9/14) transformational transformational leadership style and job satisfaction,
mediated by supervision support; (p<0.01; β=0.37).
Negussie and Demissie(10)/ Correlational study/n=175 nurses Transformational MLQ Minnesota Satisfaction Based on the transactional leadership style, it was found
Ethiopia/2013 (moderate- 9/14) leadership Questionnaire that only contingent reward was statically significant
and correlated with extrinsic satisfaction (β = 0.45; p
<0.01) (β = 0.32; p <0.05), while all five dimensions of
transformational leadership style were statistically significant
and correlated with intrinsic and extrinsic satisfaction at
work. Dimensions of transformational leadership and intrinsic
satisfaction: idealized influence (behavior) (β=0.32; p<0.01),
idealized influence (attribute) (β=0.29; p<0.01), inspiring
motivation (β=0.49; p<0.01), and individual considerations
(β=0.35; p<0.01); and extrinsic: idealized influence
(behavior) (β=0.19; p<0.05), idealized influence (attribute)
(β=0.21; p<0.05), inspiring motivation (β=0.19; p<0.05),
intellectual stimulation (β=0.42; p<0.05) and individual
considerations (β=0.17; p<0.05).
Lorber and Skela-Savič(11)/ Correlational study/ n=509 (with Does not describe Questionnaires structured by the Showed statistically significant association between job
Slovenia/2012 96 leader nurses & 413 nursing theoretical reference authors satisfaction and personal characteristics of leaders (p <
professionals)/(moderate-8/14) 0.001; β = 0.158), and leaders’ management skills (p <
0.000; β = 0.634).
continue...

444 Acta Paul Enferm. 2017; 30(4):442-50.

 Moura AA, Bernardes A, Balsanelli AP, Zanetti AC, Gabriel CS

...continuation.

Design/Number of participants/ Leadership theoretical Data Collection instruments for

Author(s)/Country/Year Outcomes
Article evaluation reference leadership and job satisfaction
CINAHL
Brewer et al.(12)/United Correlational study/n=1,037 Transformational Leadership scale adapted from Transformational leadership did not have a significant impact
States/2016 registered nurses starting in the leadership two other scales Job satisfaction on the intention to stay at the service (p=0.947) and on job
career/(moderate-8/14) described by Quinn and Staines satisfaction (p=0.125), but it was significantly associated
with organizational commitment (p=0.001).
Fallatah and Laschinger(13)/ Correlational study/n=93 newly Authentic leadership Authentic Leadership Questionnaire The supportive environment of professional practice
Canada/2016 graduated nurses (moderate-9/14) (ALQ) North Carolina Center for mediated the relationship between authentic leadership
Nursing - Survey of Newly Licensed and professional satisfaction of new graduate nurses (β =
Nurses 0.16; p <0.001). The results suggest that managers using
authentic leadership create supportive environments for
professional practice and are more likely to improve the
professional satisfaction of new graduate nurses.
Laschinger et al.(14)/ Correlational study/n=1.241 Resonant leadership Resonant Leadership Scale Global Resonant leadership had both a direct influence on job
Canada/2014 nurses/(moderate-8/14) Job Satisfaction Survey satisfaction (r = 0.43; β = 0.16; p <0.05) and an indirect
effect by creating a greater sense of empowerment and
subsequently less incivility and Burnout.
Roberts-Turner et al.(15)/ Correlational study/n =935 Transformational and Healthcare Environment Survey (HES) The results showed that both autonomy (transformational
United States/2014 registered nurses/(moderate-8/14) transactional leadership, β = 0.069; p = 0.002) and distributive
justice (transactional leadership, β = 0.047; p <0.001)
had significant positive effects on registered nurses’
job satisfaction, but the greater source of influence was
autonomy.
Abualrub and Alghamdi(16)/ Correlational study/n=308 Transformational and MLQ Job Satisfaction Survey It was observed that the transformational leadership style
Saudi Arabia/2012 registered nurses/(strong-11/14) transactional increased nurses’ job satisfaction level (r = 0.45; p <0.001);
the results also revealed that the perceived transactional
leadership style negatively influences nursing job satisfaction
(r = 0.14; p <0.01).
Wong and Laschinger(17)/ Correlational study/ n= 280 Authentic leadership ALQ Global Job Satisfaction Survey This study showed a positive association between authentic
Canada/2013 nurses/(strong-11/14) leadership and job satisfaction, mediated by structural
empowerment (β = 0.19; p <0.01) of experienced nurses
in acute care.
Havig et al.(18)/ Correlational study/444 nursing Leadership styles guided Leadership styles were determined by There was a significant correlation between job satisfaction
Norway/2011 employees, interviews and to tasks and relationship the selection of items present in three and task-oriented leadership styles (β = 0.55; (p = 0.11)
questionnaire for 13 nursing questionnaires: Instrument developed and relationships (β = 0.16; p = 0.07), with a stronger effect
directors and 40 nursing by Brayfield and Rothe on task orientation.
managers/
(strong-12/14)
Wang, Chontawan and Correlational study/ n=238 Transformational Leadership Practice Inventory (LPI) There was a positive and statistically significant correlation
Nantsupawt(19)/China/2012 nurses/(moderate-9/14) leadership Nurse Job Satisfaction Scale (NJSS) between the transformational leadership of nursing
managers and job satisfaction (r = 0.556; p <0.001).
Furtado, Batista and Correlational study/n=266 nurses Situational leadership Leadership Effectiveness and The relationship between leadership components and job
Silva(20)/Portugal/2011 (22 nursing managers and 244 Adaptability Description Questionnaire satisfaction was statistically significant for leadership profile
professionals of the nursing team)/ Instrument for job satisfaction was (p = 0.008), in particular.
(moderate-8/14) developed by the authors
EMBASE
Moneke and Umeh(21)/ Correlational study/n=137 Does not describe LPI Job satisfaction was one of the Job satisfaction was found to be positively and significantly
United States/2014 intensive care nurses/ 65 items on a sociodemographic correlated with various perceived leadership practices:
(moderate-5/14) questionnaire leaders who shape the path; leaders who inspire a shared
view; and leaders who empower others to act. Data analysis
also revealed a weak significant correlation between job
satisfaction and challenging leaders. Encouraging the heart
was not significantly correlated with job satisfaction (no p
value).
LILACS
Álvarez et al.(22)/Chile/2013 Correlational study/n=214 nurses/ Situational leadership SBDQ (Supervisory Behavior It showed a positive relationship between job satisfaction and
(moderate-7/14) Description Questionnaire) leadership styles described by the theory used in the study
Satisfacción Laboral, extracted from (χ2= 20.787; p<0.001).
the instrument of Instituto Nacional
de Seguridad e Higiene del Trabajo
de España

Discussion work of leadership; instruments used to measure lead-

ership and job satisfaction; nursing leadership in the
To analyze and discuss the identified articles, four cat- hospital setting; and the direct and indirect relation-
egories were created: the use of the theoretical frame- ship between leadership and nurse job satisfaction.

Acta Paul Enferm. 2017; 30(4):442-50. 445

 Leadership and nursing work satisfaction: an integrative review

The use of the theoretical leadership the situational leadership styles present in a given
framework group, strategies should be developed to minimize
Of the 15 selected studies, 13 (86.6%) presented certain gaps, and develop ways to promote lines of
the theoretical framework of leadership. In contrast, communication as a way to maximize feedback be-
a literature review developed in Brazil on nursing tween leaders and those they manage.(20)
leadership, among other results, found that only In addition to these findings, another study re-
21.05% of the articles selected presented a theoret- inforces the idea that situational leaders have the
ical basis of leadership. The authors of the review knowledge and skills to nurture the professional de-
pointed out that the deficit in nurses’ theoretical velopment of those they lead, while helping them
basis regarding leadership can be directly linked to to develop their knowledge of themselves and the
the low instrumentalization of these professionals context in which they carry out their practice.(25)
to perform it in their work environment, and also Two other articles utilized the authentic leader-
to the their low valorization in training.(23) ship framework,(13,17) which presents the idea that
Transformational leadership was present in sev- support for professional practice and empowerment
en articles. The Taiwanese authors contended that mediate the tole of authentic nurse leadership in job
the characteristics of transformational leaders stim- satisfaction. This leadership theory is characterized
ulate their managed employees to share the vision as a guide to effective leadership, and requires build-
and use it as motivational inspiration to achieve ing trust and healthier work environments. This
goals.(9) Research developed in China suggested that model has similarities with two others, the trans-
through transformational leadership, clinical nurses formational and resonant leadership models(3), em-
had a higher level of job satisfaction because they phasizing that the main characteristics of authentic
felt they could provide more meaningful service to leaders are honesty, integrity, and high ethical stan-
clients and the entire organization.(19) dards in the development of relationships between
In one of the studies conducted in the United those who lead and those who are led.(26)
States, transformational leadership had a large and The article that used the theoretical framework of
significant impact on the work environment, but resonant leadership, among its other results, report-
for leadership to be performed in nursing units, ed that the managers who integrated the resonant
some aspects needed to be taken into account, such leadership skills of empathy, relationship, listening
as organizational structures.(12) The point of conver- and response to concerns into their daily interac-
gence among the three U.S. surveys was that trans- tions with nurses created a respectful and friendly
formational leadership corresponded to a leadership atmosphere that promoted quality in the relation-
model that provided an approach to promoting or- ships between leaders and staff.(14)
ganizational and personal change.(24) The leadership framework based on task-ori-
The situational leadership framwork was used ented behaviors includes planning work activities,
in both the work developed by the Portuguese au- clarifying roles and objectives, and monitoring op-
thors(20) and the research developed in Chile.(22) In erations and performance. Relationship-oriented
the latter article, the authors pointed out that it is behavior, in its turn, is related to support, devel-
important to note that, as proposed by the situa- opment and recognition. The article that adopted
tional leadership model, there is a style of leader- this framework referred to a positive correlation be-
ship that is more appropriate for certain situations. tween job satisfaction and task-oriented leadership
(22)
According to this model, the style depends di- styles and relationships, with a stronger effect on
rectly on the level of preparation, that is, the levels task orientation.(18)
of maturity of the those who are led; in this model, Finally, no studies were found that established
the leader intends to influence those who are led, relationships between some contemporary leader-
in order to ensure the achievement of goals. The ship theories and job satisfaction. An example is
Portuguese article pointed out that depending on charismatic leadership (based on personal quali-

446 Acta Paul Enferm. 2017; 30(4):442-50.

 Moura AA, Bernardes A, Balsanelli AP, Zanetti AC, Gabriel CS

ties such as charisma, persuasion, personal power, The Leadership Practice Inventory, used in the
self-confidence, extraordinary ideas and strong con- article developed in the United States(21) and Chi-
victions) and leadership coaching (a model that en- na,(19) measures the perception of the transforma-
courages and motivates the managed individuals to tional leadership practices of the exemplary leader.
learn and maintain the level of readiness to perform This instrument has been used as an assessment
a given task). tool to measure leadership practices associated with
Further study is needed that utilizes the theoret- the transformational leadership style, as identified
ical frameworks needed to subsidize evaluations of by nursing leaders and their staff. It consists of 30
leadership; this way, the relationship between this questions, and is organized in five distinct domains:
competency and job satisfaction will have a stron- to challenge the process; to inspire a shared vision;
ger theoretical foundation. In addition, we must to allow others to act; to model the path; and to
highlight the importance of creating theories that encourage the heart.(21) The instrument assesses
respond to the needs of the Brazilian scenario, and behaviors in each of the five dimensions/practices
proposing methodological designs that include sev- described above, with six questions for each of the
eral world centers to support this theme. leadership practices; the responses are arranged on
a scale of 1 to 10. In addition, the instrument has
Instruments used to measure leadership high internal consistency, test-retest reliability, and
and job satisfaction high reliability of specific subscales.(24)
This category was established because of the impor- The Authentic Leadership Questionnaire pres-
tance of identifying the main instruments used to ents a 16-item scale divided into four subscales
evaluate these two variables, as in the review per- that reflect the components of authentic leader-
formed in Canada.(3) Except for two studies(11,15), ship: relational transparency, moral perspective,
all others used a specific instrument for each vari- balanced processing, and self-awareness. The re-
able. The instruments for measuring leadership that sponses are measured on a five-point Likert scale
were more used in the research were the Multifactor of 0 to 4 points; the highest scores reflect more
Leadership Questionnaire (n = 4, 26.6%), followed authentic leadership.(26)
by the Authentic Leadership Questionnaire (n = 2, As for the instruments applied to measure job
13.3%) and the Leadership Practice Inventory (n = satisfaction, a number of questionnaires were iden-
2, 13.3%). Two of these three instruments sought tified. A systematic review of the reliability and
to highlight aspects regarding the exercise of trans- validity of measurement scales of job satisfaction
formational leadership (MLQ and LPI), while the reiterates the importance of the conceptual basis of
Authentic Leadership Questionnaire addresses au- satisfaction and the validation of content, because
thentic leadership. job satisfaction can be interpreted in different
The Multifactor Leadership Questionnaire was ways. The literature shows that, although some re-
developed in the 1990s, and distinguishes leadership searchers have theorized about more or less specific
styles perceived in the transformational and trans- work factors that are relevant to job satisfaction,
actional dimensions. This questionnaire consists of there is no gold standard indicating which aspects
the dimensions of transformational leadership (ide- of work should be taken into account when job
alized influence, inspiring motivation, intellectual satisfaction is measured. In addition, seven instru-
stimulation and individualized consideration) and ments are listed that meet the defined criteria for
transactional leadership (contingent reward, active reliability and validity.(28)
and passive exception management), as well as con-
taining items regarding laissez-faire leadership.(27) Nursing leadership in the hospital setting
Of the four manuscripts that used this instrument, The hospital environment was present in 9 of the 15
two used the whole instrument (10,16) and the other articles (60%). In this setting, in many situations,
two used part of it.(8,9) nurses assume the status of managers, and they need

Acta Paul Enferm. 2017; 30(4):442-50. 447

 Leadership and nursing work satisfaction: an integrative review

preparation to assume their role as leaders. This is tonomy of nursing leaders, which has the potential
a basic condition for: seeking transformations in to empower teams.(32)
daily practice; aiming at ensuring quality of care Regarding the other two aspects (supervised
provided to patients; and reconciling organizational support and support of professional practice) men-
goals with the needs of nursing teams.(29) Therefore, tioned above that mediate the relationship between
leadership is a vital element in the hospital setting leadership and job satisfaction, it is important to
and in the care provided to patients. mention research that reinforces the importance of
There was a diversity among the hospitals an- establishing an environment of professional sup-
alyzed. The Brazilian study should be highlighted, port and supervised support. When analyzing the
which showed that, regardless of the characteristics expectations of nursing teams in face of leadership,
of the hospitals, the leading nurses reported sim- the interviewed professionals mentioned that future
ilar difficulties in positioning themselves before leaders need to be people who allow frank and open
nursing teams and when facing conflict manage- communication, have the capacity to recognize and
ment.(30) In addition, a study with nurses in inten- attend to the needs of teams, know how to give sup-
sive care units found that belonging to private and port when needed, and seek harmony in the work
public hospitals did not interfere with the exercise environment, working for the union and integra-
of their leadership.(31) Moreover, due to the num- tion of the group and ensuring the satisfaction of
ber of articles in the hospital environment, there is those led.(33)
a need to explore this relationship in other health- Ten other studies(10,11,14-16,18,20-22,34) showed positive
care settings. and significant, direct correlations between the differ-
ent leadership styles analyzed and job satisfaction; that
The direct and indirect relationship be- is, as leadership is exercised and perceived, there is an
tween leadership and job satisfaction increase in job satisfaction. The influence of leader-
Based on the statistical analyses in the articles, it ship style in the work environment is well-known, be-
was found that empowerment mediated the effect cause it can lead to synergy or disintegration of teams.
of transformational leadership on job satisfaction Therefore, it is up to leaders to rethink the way they
in nursing teams,(8) as well as on authentic leader- lead their groups, as well as whether their attitudes
ship and job satisfaction.(17) In another study, the follow their professional trajectories and those of the
indirect relationship between transformational organization to which they belong.(35)
leadership and job satisfaction took place through However, one of the articles observed that trans-
supervised support.(9) The supportive environment formational leadership did not have a significant im-
of professional practice mediated the relationship pact on the intention of employees to remain in the
between authentic leadership and professional sat- service, or on job satisfaction, but it was significant-
isfaction of new graduate nurses in Canada.(13) In ly associated with organizational commitment.(12)
view of these findings, one can observe that the re- However, this review observed that leadership has a
lationship between leadership and job satisfaction positive effect on the work environment, specifical-
occurs through another variable, such as empow- ly on job satisfaction, evidenced by the number of
erment, supervised support, and support of profes- articles in which this relationship is demonstrated,
sional practice. and by the statistical analyses present in them.
Regarding nursing empowerment, it should be
highlighted that leaders in this profession have op-
portunities to make a difference in health system Conclusions
reforms through effective development of leader-
ship. Moreover, based on the evidence, the use of This integrative review shows that nursing lead-
the theoretical framework of empowerment is rec- ership exerts a positive influence on job satisfac-
ommended, as well as strategies to promote the au- tion, whether or not this is mediated by another

448 Acta Paul Enferm. 2017; 30(4):442-50.

 Moura AA, Bernardes A, Balsanelli AP, Zanetti AC, Gabriel CS

11. Lorber M, Skela Savič B. Job satisfaction of nurses and identifying factors of
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supportive professional practice environments on new graduate nurses
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