Journal of Nursing Management, 2016

Is nurse managers’ leadership style related to Japanese staff

nurses’ affective commitment to their hospital?

YOSHIMI KODAMA R N , M S N 1, HIROKI FUKAHORI RN, PhD

2
, KANA SATO RN, PhD
3
and
TOMOKO NISHIDA R N , P h D 4
1
PhD Student, Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo
Medical and Dental University, Tokyo, 2Associate Professor, Department of System Management in Nursing, Graduate
School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, 3Associate Professor, Graduate School
of Nursing, Miyagi University, Sendai and 4Associate Professor, Japanese Red Cross College of Nursing, Tokyo, Japan

Correspondence KODAMA Y., FUKAHORI H., SATO K. & NISHIDA T.

(2016) Journal of Nursing Management
Yoshimi Kodama Is nurse managers’ leadership style related to Japanese staff nurses’
1-5-45 Yushima affective commitment to their hospital?
Bunkyo-ku
Tokyo 113-8519 Aim To determine if nurse managers’ leadership style is related to Japanese staff
Japan nurses’ affective commitment to their hospital.
E-mail: [email protected] Background In Western countries, nurse managers’ transformational leadership
style has been found to increase staff nurses’ affective commitment to their
hospital. However, there are few studies examining this relationship in the
context of acute care hospitals in Japan.
Methods Staff nurses completed measures of their nurse managers’ perceived
leadership style and factors related to their own affective commitment. The
association between affective commitment and perception of leadership style was
assessed with multiple logistic regression.
Results Of 736 questionnaires distributed, 579 (78.9%) were returned, and data
from 396 (53.8%) fully completed questionnaires were analysed. The intellectual
stimulation aspect of transformational leadership positively increased staff nurses’
affective commitment (odds ratio: 2.23). Nurse managers’ transactional and
laissez-faire leadership styles were not related to affective commitment among
staff nurses.
Conclusions The intellectual stimulation aspect of transformational leadership
may increase the retention of staff nurses through enhanced affective
commitment.
Implications for nursing management To increase staff nurses’ affective
commitment to their hospital, we suggest that hospital administrators equip nurse
managers with intellectual stimulation skills.
Keywords: affective commitment, leadership, nurse manager, transactional leadership,
transformational leadership

Accepted for publication: 20 March 2016

2012, American Association of Colleges of Nursing

Introduction
2014). The International Council of Nurses (2006)
In recent years, a nurse shortage has been experienced indicated two main reasons for this shortage: a high
worldwide (Canadian Federation of Nurses Unions turnover rate due to poor work environments and

DOI: 10.1111/jonm.12392
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Y. Kodama et al.

burnout (Chan et al. 2013), and low recruitment due conducted in Western countries (Cummings et al.
to an ageing workforce, the shortage of a financial 2010, Germain & Cummings 2010). We believe that
source for new recruits into the profession and diversi- the results of studies conducted in Western countries
fication of career selection among women (Interna- may not be applicable to Asian countries, including
tional Council of Nurses 2006, World Health Japan, because of differing cultural contexts. Some
Organization 2013). The high turnover rate of nurses studies on leadership have indicated that the cultural
should be addressed in order to maintain a high qual- context affects the leadership style (Dorfman et al.
ity of nursing care in clinical settings despite the nurse 1997, Den Hartog et al. 1999); for example, Asian
shortage worldwide. leaders tend to emphasise group harmony, which is
A key factor in the strategy for preventing turnover associated with collectivism, while Western leaders
is the employees’ affective commitment to their organ- focus on values associated with individualism (Dorf-
isation, which is defined by Meyer and Allen (1991) man et al. 1997, Den Hartog et al. 1999). Further-
as ‘the employees’ emotional attachment to, identifica- more, nurse managers in Japan have less authority than
tion with, and involvement in the organisation’ (p. do those in Western countries (Oku et al. 2010, Yoder-
67). After finding that a high level of affective com- Wise 2011). Additionally, it is unclear which aspects of
mitment is related to high employee retention, Meyer the nurse managers’ leadership, based on Bass and Rig-
et al. (2002) explored the factors that influence this gio’s (2006) theory, are the most effective in increasing
variable and discussed strategies to increase affective staff nurses’ affective commitment. No studies have
commitment to the organisation. The superior’s examined the relationships among the components of
high-quality leadership was identified as one of the Bass and Riggio’s (2006) three leadership styles and
influential factors (Meyer et al. 2002). Similarly, the staff nurses’ affective commitment. Al-Hussami (2008)
high-quality leadership skill of nurse managers examined the relationship between transformational
affected the increasing affective commitment of staff leadership and affective commitment, and between
nurses (Cummings et al. 2010, Cowden et al. 2011). transactional leadership and affective commitment, but
Therefore, developing nurse managers’ leadership did not explore the relationships among the compo-
skills is important for strengthening affective commit- nents of each leadership style and the staff nurses’
ment and improving the work environment. affective commitment. Identifying which leadership
Bass and Riggio’s Full Range of Leadership Model style has the greatest influence on staff nurses’ affective
(2006) comprises three styles of leadership. Transfor- commitment will help hospital administrators to
mational leadership involves managers motivating fol- develop strategies to prevent turnover.
lowers to exceed expectations, and inducing high
levels of follower satisfaction and commitment within
Aim
the group and the organisation. Transactional leader-
ship involves the leader rewarding or disciplining a The purpose of this study was to determine if nurse
follower, depending on the adequacy of the follower’s managers’ leadership style is related to Japanese staff
performance in carrying out a task or achieving an nurses’ affective commitment to their hospital.
agreed objective. Finally, laissez-faire leadership hap-
pens when ‘the necessary decisions are not made [and]
actions are delayed’ (Bass & Riggio 2006, p. 9). Methods
Among these styles, transformational leadership is
Design and participants
thought to be the most effective way to increase affec-
tive commitment among employees (Bamberg et al. This cross-sectional survey was conducted at four
2008). Previous studies (Loke 2001, Avolio & Bass mid-sized acute care hospitals, with around 300 beds
2004, Al-Hussami 2008) focused on nursing staff have each, in Kanto, Japan, which were selected using con-
shown that nurse managers’ transformational leader- venience sampling. We contacted the nurse directors
ship is a positive predictor of staff nurses’ affective and explained our aim and procedure to those who
commitment. were interested in the study; four nurse directors sub-
Research into the relationship between nurse man- sequently agreed to participate, and through them, we
agers’ leadership and staff nurses’ affective commit- gained access to the staff nurses. Novice and part-time
ment is required in an Asian cultural context, because nurses were excluded from this study, as they were
most previous research, with the exception of a study still undergoing training and/or had little contact with
conducted in Singapore (Loke 2001), has been the nurse managers.

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 Nurse manager’s leadership

Data collection Instruments

The data were collected between July and August According to the conceptual framework, the question-
2012 using a self-administered questionnaire dis- naire was developed. We confirmed the face validity
tributed to 736 staff nurses, along with a cover letter of all instruments with the assistance of four nursing
explaining the purpose and procedures of the study management researchers, a nursing sciences researcher
and stating that participation was voluntary and and 11 Master’s-level nursing students.
anonymous. A response rate of 78.9% was obtained,
with 579 questionnaires returned. Of these, 183 were Affective commitment among staff nurses
excluded due to missing data; consequently, we anal- We measured affective commitment among staff
ysed data from 396 (53.8%) participants. Return of nurses by using the Affective Commitment Scale,
the questionnaire was regarded as providing informed which was developed by Meyer and Allen (1991) and
consent to participate in the study. then translated it into Japanese and the validity and
reliability were confirmed by Takahashi (1999). The
questionnaire consists of eight items, with responses
Ethical considerations made on a scale ranging from 0 (strongly disagree) to
The Internal Review Board of Tokyo Medical and 3 (strongly agree), with higher scores indicating
Dental University approved this study (1242), which greater affective commitment to the organisation.
was carried out in accordance with the Code of Ethics Cronbach’s alpha was 0.77 in this study.
of the World Medical Association (Declaration of
Helsinki 2013). Leadership styles of nurse managers
In order to measure components of the leadership
styles of nurse managers, we used the Multifactor
Conceptual framework Leadership Questionnaire Form 5X–Short (MLQ;
We referred to Meyer and Allen’s three-component Avolio & Bass 2004). The MLQ consists of 36 items
model (1991) and Bass and Riggio’s (2006) theory to and measures transformational (five components with
develop a conceptual framework for this study. Meyer 20 items), transactional (three components with 12
and Allen (1991) proposed a three-component model items) and laissez-faire (one component with four
of organisational commitment, comprising affective, items) leadership styles. Details of these three leader-
continuance and normative types of commitment. ship styles are explained below. The MLQ assesses
Among these components, we adopted affective com- staff nurses’ perceptions of their nurse managers’ lead-
mitment alone for our conceptual model because it ership styles, with responses to each item ranging from
has been found to be associated with better staff 0 (not at all) to 4 (frequently, if not always). The item
retention (Meyer & Allen 1991, Meyer et al. 2002). scores for each component of leadership style are
Our conceptual model had four components, summed and divided by the total number of items to
namely, ‘affective commitment of staff nurses’ as the calculate the mean score. A higher score indicates a
dependent variable, ‘leadership style of nurse man- higher inclination toward that particular leadership
agers’ as the independent variable and ‘factors related style.
to the affective commitment of staff nurses’ and ‘de- The five components of transformational leadership
mographics of staff nurses’ as the control variables. were as follows: idealised influence (attributed), which
The leadership style of nurse managers consisted of refers to the leader’s charisma and sense of ethics; ide-
the three styles described in the instruments section. alised influence (behaviour), which refers to whether
Factors related to affective commitment of staff nurses the leader emphasises the importance of having a mis-
consisted of ten factors that were determined accord- sion; inspirational motivation, which refers to the lea-
ing to previous research on factors related to staff der promoting the idea of an attractive future and
nurses’ affective commitment (Meyer et al. 2002, achievable goals to motivate his/her followers to
Gregg 2005, Nanba et al. 2009, Nohmi et al. 2010). work; intellectual stimulation, which refers to the lea-
We adopted this concept in order to control for fac- der encouraging his/her followers to question conven-
tors known to confound the relationship. The demo- tional practices or ideas; and individual consideration,
graphics of staff nurses comprised the variables which refers to the leader paying attention to each of
described below in the instruments section. his/her followers’ needs.

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Journal of Nursing Management 3
Y. Kodama et al.

The three components of transactional leadership (nor at all) to 4 (frequently, if not always). Items details
were as follows: contingent reward, whereby the leader are shown in Table 1. Four nursing management
provides followers with material or psychosocial researchers and a nursing sciences researcher discussed
rewards when performance is high or goals are achieved; the content validity of the extracted items while devel-
active management-by-exception, whereby the leader oping these.
actively monitors deviance from standards and prevents To measure organisational justice, we used the 11-
mistakes from occurring; and passive management-by- item Japanese version of the organisational justice
exception, whereby the leader waits for deviance or mis- questionnaire (translated by Shibaoka et al. 2010),
takes to occur before taking corrective action. which was originally developed by Colquitt (2001).
Laissez-faire leadership consists of only one compo- The response options for each item range from 0
nent, laissez-faire. (strongly disagree) to 4 (strongly agree). The validity
The MLQ has good to excellent internal consistency and reliability of this questionnaire has been con-
(a > 0.80) (Bass & Riggio 2006) and high fit statistics firmed by Shibaoka et al. (2010).
based on confirmatory factor analysis (goodness-of-fit
index = 0.91, adjusted goodness-of-fit index = 0.90, Table 1
Measurement of factors related to the affective commitment of staff
root mean squared error of approximation = 0.04) nurses
(Avolio & Bass 2004); however, there is no valid and
Cronbach’s
reliable Japanese version. Therefore, we undertook the a
translation of this instrument in this study, using the
back-translation procedure recommended by Brislin Motivation for occupation* 0.79
1. You are motivated to work in the nursing profession
(1986). We obtained permission to do so from Mind 2. You are working toward a goal
Garden, the consulting company in the United States Satisfaction with salary* –
1. Your salary corresponds to your workload
that holds the copyright for the MLQ. Cronbach’s Satisfaction with welfare* –
alpha coefficients were confirmed to be adequate in this 1. You are satisfied with the welfare provided by the
study. Specifically, for the five transformational leader- hospital
Commitment to hospital’s mission* 0.70
ship subscales, alphas ranged from 0.73 to 0.87, for the 1. You are committed to the hospital’s mission
three transactional leadership subscales from 0.72 to 2. The hospital ensures the quality of care and
0.85, and for the laissez-faire subscale it was 0.83. service
Opportunities for career development* 0.73
1. You can effectively utilise your experience in this
Factors related to the affective commitment of staff hospital
nurses 2. There are many opportunities to develop your
abilities in this hospital
To measure the ten factors related to affective commit- 3. You can learn professional skills and knowledge in
ment that we identified in our literature review, we used this hospital
Self-investment* –
an organisational justice questionnaire (Shibaoka et al. 1. When you consider the effort invested to date, it
2010) and also developed original items to measure the would be a waste to quit your job
other nine factors because there are no valid existing Peer support† 0.83
1. You have a colleague who listens to your worries
Japanese measures for assessing these. Factors assessed 2. You have a colleague who thinks you are a
comprise motivation for occupation (two items from competent nurse
Gregg 2005); satisfaction with salary (one item from 3. You have a colleague who provides you with
knowledge and information that is useful for your work
Nanba et al. 2009, and Nohmi et al. 2010); satisfaction 4. If you are unable to do something alone, a
with welfare (one item from Nanba et al. 2009); com- colleague is willing to help you
Relationship with doctors‡ –
mitment to the hospital’s mission (two items from
1. Doctors collaborate with nurses
Gregg 2005, Nanba et al. 2009, and Nohmi et al. Relationship with patients‡ 0.85
2010); opportunities for career development (three 1. You have good relationships with patients
2. You have good relationships with the families of
items from Gregg 2005, Nanba et al. 2009, and Nohmi patients
et al. 2010); self-investment (one item from Meyer Organisational justice§ (Shibaoka et al. 2010) 0.95
et al. 2002); relationship with doctors (one item from
*Higher scores indicate greater satisfaction, motivation and self-invest-
Nohmi et al. 2010); relationship with patients (two ment.
items from Gregg 2005, and Nohmi et al. 2010), and †
Higher scores indicate more support from colleagues.
‡

peer support (four items from Ida 2004). Responses to Higher scores indicate better relationships with patients and doctors.
§
This is an 11-item questionnaire. Not all items are included in this
each of these items were made on a scale that ranged table. Higher scores indicate that the organisation makes fairer deci-
from 0 (strongly disagree) to 3 (strongly agree), or 0 sions and rewards the employee.

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4 Journal of Nursing Management
 Nurse manager’s leadership

We also examined the internal consistency of the Table 2

Characteristics of staff nurses (n = 396)
factors that consisted of multiple items. The internal
consistencies were acceptable, with Cronbach’s alpha Median Range
coefficients ranging from 0.70 to 0.95 (see Table 1).
Age (years) 30 22–62
Years of work experience as a nurse (years) 7.4 1–37.3
Demographics of staff nurses Tenure at the hospital (years) 2.4 0–30
Monthly overtime (hours) 7.0 0–160
The nurses were asked to provide demographic char-
The frequency of working night 5.0 0–15
acteristics of age, gender, years of work experience as
a nurse, tenure at the hospital, marital status, basic n %
nursing education, monthly overtime and frequency of
Gender
working night shifts. Female 372 93.9
Male 24 6.1
Marital status
Statistical analysis Married 159 40.1
Unmarried 237 59.9
We calculated descriptive statistics for all variables Education
using SAS version 9.2 (SAS Institute, Cary, NC, USA) 3 years certificate 393 74.0
Diploma 47 11.9
and performed two-tailed significance tests. The level Bachelor 46 11.6
of significance level was set at 0.05. Other 10 2.5
Logistic regression analysis was conducted because
the dependent variable of affective commitment was
Table 3
not normally distributed. Therefore, we dichotomised
Descriptive statistics of affective commitment and factors related to
the scores as 0 = lower affective commitment and affective commitment
1 = higher affective commitment. Moreover, we
Median Range
dichotomised the continuous independent variables
using the median. Affective commitment 10 1–21
Factors related to the effective commitment of staff nurses
We analysed the data in three steps. At Step 1, a chi- Motivation for occupation 3 0–6
square (v2) test was performed to examine the associa- Satisfaction with salary 1 0–3
tions among affective commitment and the independent Satisfaction with welfare 1 0–3
Commitment to hospital mission 3 0–6
variables. Variables were included in the multiple logis- Opportunities for career 4 0–9
tic modelling process if an association had a value of P Relationship with patients 5 0–8
Relationship with doctors 2 0–4
less than 0.20 (Hosmer & Lemeshow 2000). Step 2
Peer support 11 0–16
involved the examination of multicollinearity via a cor- Organisational justice 22 0–44
relation matrix. No high correlations were found Self-investment 1 0–3
Leadership styles of nurse managers
among the independent variables. At Step 3, we con- Transformational leadership
ducted a stepwise multiple logistic regression to identify Idealised influence (attributed) 2.00 0–4
the association between the leadership style of the nurse Idealised influence (behaviour) 1.75 0–4
Inspirational motivation 1.50 0–4
managers and staff nurses’ affective commitment. Intellectual stimulation 2.00 0–4
Individual consideration 1.75 0–4
Transactional leadership
Contingent reward 1.75 0–4
Results Active management-by-exception 2.25 0–4
Passive management-by-exception 1.00 0–4
Descriptive statistics Laissez-faire
Laissez-faire 1.00 0–4
The demographic characteristics of staff nurses are
presented in Table 2. The median age was 30 years,
and median years of work experience as a nurse and The participants’ scores for the leadership styles
tenure at the hospital were 7.4 years and 28.5 of nurse managers are shown in Table 3. The high-
months, respectively. Most respondents were female est scores (2.0) were gained on the idealised influ-
(93.9%) and 59.9% were unmarried. Descriptive ence (attributed) and intellectual stimulation
statistics of affective commitment and factors related transformational leadership subscales. Further, the
to affective commitment are shown in Table 3. The highest score (2.25) of all subscales across the three
median score for affective commitment among staff leadership styles was for active management-
nurses was 10 (range = 1–21). by-exception.
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Journal of Nursing Management 5
Y. Kodama et al.

commitment and eight variables in the multiple logis-

Univariate analysis of affective commitment and tic regression model. Specifically, marital status, odds
related variables ratio (OR) = 2.07, 95% confidence interval (CI)
The results for the relationship between affective com- [1.21–3.56]; motivation for occupation, OR = 4.48,
mitment and the independent variables were as fol- 95% CI [2.59–7.77]; commitment to hospital mission,
lows: among the demographic variables, age OR = 2.21, 95% CI [1.27–3.85]; opportunities for
(P = 0.0299) and marital status (P = 0.0041) showed career development, OR = 2.20, 95% CI [1.23–3.95];
significant correlations with affective commitment. In organisational justice, OR = 1.75, 95% CI [1.02–
addition, all antecedent variables of affective commit- 2.99]; peer support, OR = 1.82, 95% CI [1.10–3.19];
ment and leadership styles, except for passive manage- and self-investment, OR = 2.86, 95% CI [1.61–5.10]
ment-by-exception, showed significant correlations were significantly and positively related to affective
with affective commitment. Work experience commitment. Furthermore, the intellectual stimulation
(P = 0.1200) and passive management-by-exception aspect of transformational leadership was significantly
(P = 0.0828) were both under the minimum required and positively related to affective commitment,
P value of 0.20. Therefore, the following variables OR = 2.23, 95% CI: [1.31–3.80]. In contrast, transac-
were included in the regression model: work experi- tional and laissez-faire leadership styles were not
ence, marital status, motivation for occupation, satis- related to affective commitment.
faction with salary, satisfaction with welfare, This model was found to have acceptable goodness-
commitment to hospital mission, opportunities for of-fit, given the lack of statistical significance on the
career development, relationship with patients, rela- Hosmer and Lemeshow (2000) test (P = 0.7612).
tionship with doctors, peer support, organisational
justice, self-investment and leadership style.
Discussion
This is the first study to identify which components of
Multiple logistic regression model of affective nurse managers’ leadership style are associated with
commitment
staff nurses’ affective commitment to the hospital at
As shown in Table 4, there were statistically signifi- which they work. Our results revealed that the nurse
cant positive associations between affective managers’ transformational leadership aspect of

Table 4
Multiple logistic regression for affective commitment

Affective commitment† (n = 396)

Variable* b SE Wald v2 OR 95% CI Pr > v2

Characteristics Marital status Married 0.73 0.28 6.93 2.07 (1.21–3.56) 0.0085
Unmarried ref
Factors related to the affective Motivation for occupation ≥3 1.50 0.28 28.68 4.48 (2.59–7.77) <0.0001
commitment of staff nurses <3 ref
Commitment to hospital mission ≥3 0.79 0.28 7.83 2.21 (1.27–3.85) 0.0051
<3 ref
Opportunities for career development ≥4 0.79 0.30 7.04 2.20 (1.23–3.95) 0.0080
<4 ref
Organisational justice ≥22 0.56 0.27 4.17 1.75 (1.02–2.99) 0.0410
<22 ref
Peer support ≥11 0.63 0.27 5.32 1.82 (1.10–3.19) 0.0210
<11 ref
Self-investment ≥1 1.05 0.29 12.78 2.86 (1.61–5.10) 0.0004
<1 ref
Leadership styles TFL: Intellectual stimulation ≥2 0.80 0.27 8.69 2.23 (1.31–3.80) 0.0032
<2 ref

ref, Reference category; TFL, transformational leadership.

*Variables included in the model were age, years of work experience as a nurse, marital status, motivation for occupation, satisfaction with salary, sat-
isfaction with welfare, commitment to hospital mission, opportunities for career development, relationship with patients, relationship with doctors, peer
support, organisational justice, self-investment, leadership styles.
†
Variables were chosen in the modelling process if an association had P < 0.20 in univariate analysis. A stepwise multiple logistic regression was con-
ducted, with inclusion and exclusion criteria set at P < 0.20.

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6 Journal of Nursing Management
 Nurse manager’s leadership

intellectual stimulation had a significant influence on communication styles that are most effective for
affective commitment among these staff nurses, even increasing motivation. Inspirational motivation involves
though the Japanese nurse managers’ cultural context a leader talking enthusiastically and strongly about
differs from that of the Western nurse managers goals (Bass & Riggio 2006); however, Japanese people
examined in these previous studies. The results indi- value a communication style that is more aligned with
cate that nurse managers’ intellectual stimulation may harmony (Dorfman et al. 1997). The collectivist cul-
affect the retention of staff nurses through improved tural orientation may be another reason why individual
affective commitment. In contrast, the transactional consideration was not related to Japanese staff nurses’
and laissez-faire leadership styles that were included in affective commitment. Asian people often prioritise the
Bass and Riggio’s (2006) model were not related to group’s goal over their own goals (Dorfman et al.
affective commitment in this study. 1997), and this preference in regard to communication
A possible reason for the relationship we found style might affect the influence of leadership style.
between intellectual stimulation and staff nurses’ turn- Nurse managers’ transactional and laissez-faire lead-
over is that the participants in our study might highly ership styles were also not related to affective commit-
value interactions with nurse managers with high ment among staff nurses in this study. Contingent
intellectual stimulation. Noda (2010) stated that Japa- rewards in transactional leadership mean that nurse
nese staff nurses were very interested in receiving edu- managers assign rewards when staff nurses achieve
cation from nurse managers, such as showing goals (Bass & Riggio 2006). Casida and Parker (2011)
expertise in nursing and questioning traditional nurs- stated that nurse managers’ contingent rewards (e.g.
ing practices. That is, the Japanese staff nurses in our pay bonus or salary) might relate to staff nurses’ moti-
survey might have regarded intellectual stimulation vation and be results based. Nurse managers must
from nurse managers as a high-quality form of educa- have an evaluation standard for nurses’ performance
tion that promoted their own expertise. In Japan, when using contingent rewards in transactional leader-
there are few opportunities for staff nurses to obtain ship (Casida & Parker 2011). However, there are no
advanced nursing skills and knowledge in clinical set- such standards in Japan (Matsuoka 2004) and the
tings, and few hospitals have implemented continuing clinical nurse’s salary is mainly determined by senior-
education for in-service senior staff nurses (Oyamada ity, without consideration of their performance.
2009). Further, many nurses feel that entering gradu- Therefore, contingent rewards may not be effective in
ate school for a higher degree would be difficult increasing staff nurses’ affective commitment in Japan.
because of a lack of money and the long distance Finally, our finding that laissez-faire leadership was
required to travel to university (Ozawa et al. 2009). not related to affective commitment is consistent with
Thus, we believe that nurse managers’ high intellectual Bass and Riggio’s (2006) theory.
stimulation is attractive to staff nurses who are highly
motivated to learn.
Limitations
In this study, components of transformational leader-
ship other than intellectual stimulation, such as ide- There are several limitations in this study. First, the
alised influence, inspirational motivation and nature of the convenience sample used limits the gen-
individualised consideration, were not related to staff eralisability of the results. Participants in the present
nurses’ affective commitment. These findings are not study were nurses at mid-sized acute care hospitals in
consistent with Bass and Riggio’s (2006) theory. We a metropolitan area, but nurse managers’ leadership
posit that idealised influence was not related to Japa- styles and staff nurses’ affective commitment may be
nese staff nurses’ affective commitment because they different in university hospitals and hospitals that do
might not expect nurse managers to be strong or charis- not provide acute care services. Therefore, future stud-
matic leaders. This is owing to Japanese people’s ten- ies could use larger samples from other areas and
dency to emphasise group harmony and collective types of hospital, to ensure that participants are more
decision making (Dorfman et al. 1997). Additionally, diverse. Second, although our study found that nurse
Dorfman et al. (1997) stated that charisma is important managers’ intellectual stimulation increased affective
for top-level rather than middle-level managers in commitment among staff nurses, it remains unclear
Japan. Our finding that inspirational motivation was exactly how the managers achieved this increase; thus,
not related to Japanese staff nurses’ affective commit- further qualitative research on nurse managers’ leader-
ment might be due to a cultural difference in the ship practices is needed.

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Journal of Nursing Management 7
Y. Kodama et al.

Implications for nursing management Source of funding

Nurse managers in health-care organisations must The authors did not receive any funding for this paper.
prevent staff nurses’ turnover in order to maintain a
high quality of nursing care. Our results indicate
Ethical approval
that nurse managers’ intellectual stimulation
increased affective commitment among staff nurses, The Internal Review Board of Tokyo Medical and
which might lead to preventing turnover. We recom- Dental University (1242) approved this study.
mend that nurse managers engage in reflection,
which is effective for reconsidering problems and
Acknowledgements
questioning assumptions, in order to increase their
intellectual stimulation competency (Roberts 2008, There are no contributors to the article. There is no
Kuennen 2015). The process of reflective practice conflict of interest and source of funding.
involves learning from positive or negative experi-
ences (Yoder-Wise 2011), and affords nurse man-
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