[Virtual Presenter] This study examined the perceptions and satisfaction of nurses towards their superiors’ transformational leadership in health care facilities in Hyderabad, Sindh. The findings revealed an unsatisfactory level of satisfaction. Data was collected from two renowned hospitals in Hyderabad by means of questionnaires. The sample size was 92 and the results showed that nurses were not satisfied with their superiors' transformational leadership. Factor analysis of the results highlighted certain areas that need to be improved when it comes to transformational leadership. These results suggest that further research is needed to explore ways of fostering effective leadership in health care facilities.. 

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Research Article 
 
NURSES’ PERCEPTION AND SATISFACTION TOWARDS SUPERIORS’ TRANSFORMATIONAL 
LEADERSHIP IN HEALTH CARE FACILITY AT HYDERABAD SINDH 
 
1, *Zohaib Hassan Memon and 2Aftab Ahmed 
 
1Institute of Mathematics and Computer Science, University of Sindh, Jamshoro, Pakistan 
2Peoples Nursing School Liaquat University of Health Sciences Jamshoro, Pakistan 
 
Received 24th July 2019; Accepted 20th August 2019; Published online 30th September 2019 
 
 
Abstract 
Background and Objective: Leadership plays an important role to influence the staffs towards the patients’ outcome in health facilities. Current 
study was aimed to assess the perception and satisfaction towards supervisors’ transformational leadership in Health care facility. Methodology: 
The cross-sectional method was adopted in present study. Data was collected using questionnaires. Questionnaires are circulated among the two 
(2) renowned Hospitals of Hyderabad, Sindh. The sample size of the survey is 92. The questionnaire based on the various factors which 
influence the perception and satisfaction of the subjects. Results and Conclusion: Nurses are not satisfied towards superiors in terms of 
Transformational Leadership. Based on results it is recommended that affected areas should be improved, further more studies should be needed 
 on the factors identified through factor analysis. 
Keywords: Transformational Leadership, Perceptions towards Nursing Superiors, Expectations towards Nursing Superiors, Transformational 
Leadership in health facility. 
*Corresponding Author: Zohaib Hassan Memon 
 
 
INTRODUCTION  
 
National Library of Medicines U.S (United State) defined 
Health Facility as Social Institution; Hospitals, Clinics and 
Specialized Care Units that provide health care to the 
individuals and community. The quality of that facility is 
depend on human resources (Specialized Doctors, Nurse 
Managers, nursing staff, paramedic & non paramedic staff) and 
Material resources (Medical equipments etc) that are used to 
improve patients’ outcomes. Nurses play an important role in 
these health facilities to provide care to patients in primary, 
secondary 
tertiary 
level 
by 
collaboration 
of 
health 
professionals, in this way, having qualities of leadership in 
Nurse Managers or Nurse Supervisors make them able to 
create supportive and safe environment for the patients 
(Higgins and Elizabeth, 2015). In Specialized health care units, 
Superiors; Nurse Managers, Nurse Supervisors, Senior Staff 
Nurses, Matrons carry responsibilities to manage their wards 
by motivating and encouraging staffs to perform duties 
efficiently and effectively. Leader is one who influences 
individuals to achieve a task, empowering nurses and make 
them feel sense of responsibility, commitment and motivation 
which ultimately increase patients’ outcomes (Albagawi et al., 
2017). Nurse Managers use different leadership styles; 
Autocratic, 
Democratic, 
Lazierfair, 
Transactional, 
Transformational etc. Transformational leadership defined as 
skills which stimulate individuals to achieve goal by creating 
morality and motivation among them (Vesterinen et al., 2012). 
Transformational leadership is associated with organization 
and individual outcomes by stimulating self actualization, self 
esteem and generating sense of self sacrifice for their 
organizational 
goals. 
These 
leaders 
have 
high 
self 
determination and self confidence (Khan et al., 2016). Nurse 
Supervisors, having transformational leadership skills can 
motivate and encourage sub-ordinates for self growth, 
commitment towards organizational goals and self sacrifice for 
Institute’s goal over personal goals.  
 
The term superior in this study refers to qualified Staff Nurse, 
Nurse Supervisor or Nurse Manager who is accountable for 
managing the ward. The purpose of the study is to assess the 
qualities of Transformational leadership among Superiors, 
Supervisors or Nurse Managers of two Hospitals of Hyderabad 
sindh. 
 
Literature review 
 
Higgins, 2015, The Study researcher tested the hypothetical 
model to investigate the influences of nurses’ perception of 
their managers’ transformational leadership behaviour. This 
model was based on theoretical and research in management 
and nursing literature. The study research suggests nurse 
Managers should have knowledge and skills for creating 
positive response among the nursing staff so that healthcare 
unit can provide safe and effective health care to the patients. 
Hintea, 2009, Hintea and other researchers analyzed the 
functions of management and leadership in healthcare unit 
through pilot study in Romania to see how leadership is 
perceived by the medical staff. Study research reveals the 
significant variability among managers’ perception on 
leadership styles and its staff. Ismail, 2010, The study research 
measured the relationship between transformational and 
transactional leadership styles and individual outcomes, 
consisting of 118 questionnaires collected from employees of 
US subsidiary firm in East Malaysia. The proposed study 
declares satisfactory among the individuals and leadership 
styles of their Leaders. 
 
Khan, 2016, the study research reveal the different types of 
Leadership theories which are: 
 
1. Great-Man Theory: According to great man theory 
leaders are born and are superhuman as in nature. 
 
2. Trait Theory: This theory is based on two traits 
emergent traits; hereditary and effectiveness traits; 
achieved by life experience. 
 
International Journal of Innovative Science and Medical Research 
Vol. 01, Issue 01, pp.004-006, September, 2019 
Available online at http://www.ijismr.com

[Audio] Transformational leadership is essential for any organization to succeed, particularly in the healthcare sector. This study aimed to determine nurses' perceptions and satisfaction of their superiors' transformational leadership in both public and private hospitals in Hyderabad, Sindh. A descriptive design and semi-structured questionnaire were used to survey 92 nurses, asking questions about the relevant theoretical approach including contingency, style and behavior, process, and transactional leadership. Results showed that transformational leadership plays an important role in motivating and inspiring nurses to perform their best. Nurses reported that their superiors had a positive attitude, respected them, and encouraged them to succeed. However, a disparity in perceptions and satisfaction levels was observed between public and private hospitals. The findings of this study highlight the importance of transformational leadership in healthcare, and suggests potential further research.. 

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3. Contingency Theories: According to this theory 
person become leader due to internal and external 
environment. It is also known as Situational Leadership 
as intermediate between task-oriented and relationship 
oriented. 
 
4. Style and Behavior Theory: According to this theory 
the person achieve some leadership skills which enable 
him to perform as a Leader. Three principal leadership 
styles of this theory are democratic, Laissez faire and 
autocratic. 
 
5. Process Leadership Theory: This theory introduced 
new term “Servant Leadership”. According to this 
theory the person who is servant by nature can be leader 
for his follower as he focuses on social issues and raise 
voice for his followers. 
 
6. Transactional Theory: This type of leadership is often 
known as contingent-reward leadership. In this type of 
leadership leader influences his followers and give 
reward on achieving the objectives 
 
7. Transformational Theory: This theory is different 
from previous theories due to involvement of the 
followers in activities related towards the organization. 
The leader empowers followers by motivating and 
positive attitude. 
 
MATERIALS AND METHODS 
 
The Descriptive study was used to determine the perception 
and satisfaction of superiors’ Transformational Leadership of 
two; Public and Private Health facilities of Hyderabad Sindh
92 Nurses were selected; 28 from Private Hospital 
Government Hospital. A cross sectional study design was used 
to gather information from Nurses. The questionnaire 
to collect the information from respondents. Questionnaire was 
semi structured in format with 22 items. The questionnaire 
contains two parts. First part was consisted of demographic 
information like Hospital name, Qualification, Gender, Age etc 
whereas the second part of questionnaire contains the 
information regarding different statements about superiors/
Nurse Managers/ Nurse Supervisors/ in order to find out t
perception 
and 
satisfaction 
towards 
Transformational 
Leadership 
styles 
of 
Superiors/Nurse 
Managers/Nurse 
Supervisors of two Health Facilities. Descriptive statistics 
based on frequency and graphs. SPSS- v.22 and Microsoft 
Excel were used to analyze and interpret the data.
 
RESULTS AND DISCUSSION 
 
The number of nurses surveyed is 92. The questionnaire 
designed on the basis of different factors to be observed for the 
perception and satisfaction of the respondents.
Figure 1 indicates Demographic Profile of Respondents across 
two Health Facilities and Table 2 and Figure 
wise Distribution of Respondents. From the Demographic 
Profile, nurses were age group of 17 – 22(60%), 23
30-36(8%) and 37-43(2%). Majority of nurses were between 
17 to 22 years. The main factors which were analyzed through 
questionnaires were superiors’ self determination and self 
confidence, assigning challenging tasks to subordinates, sense 
of creativity, trustful network of superiors, reward and 
 International Journal of Innovative Science and Medical Research
According to this theory 
person become leader due to internal and external 
uational Leadership 
oriented and relationship 
According to this theory 
the person achieve some leadership skills which enable 
him to perform as a Leader. Three principal leadership 
s of this theory are democratic, Laissez faire and 
is theory introduced 
According to this 
theory the person who is servant by nature can be leader 
n social issues and raise 
This type of leadership is often 
reward leadership. In this type of 
leadership leader influences his followers and give 
This theory is different 
from previous theories due to involvement of the 
followers in activities related towards the organization. 
The leader empowers followers by motivating and 
was used to determine the perception 
and satisfaction of superiors’ Transformational Leadership of 
of Hyderabad Sindh. 
Private Hospital and 64 from 
s sectional study design was used 
to gather information from Nurses. The questionnaire was used 
Questionnaire was 
semi structured in format with 22 items. The questionnaire 
nsisted of demographic 
name, Qualification, Gender, Age etc 
whereas the second part of questionnaire contains the 
information regarding different statements about superiors/ 
Nurse Managers/ Nurse Supervisors/ in order to find out the 
perception 
and 
satisfaction 
towards 
Transformational 
Leadership 
styles 
of 
Superiors/Nurse 
Managers/Nurse 
Supervisors of two Health Facilities. Descriptive statistics 
v.22 and Microsoft 
interpret the data. 
The number of nurses surveyed is 92. The questionnaire 
designed on the basis of different factors to be observed for the 
perception and satisfaction of the respondents. Table 1 and 
Figure 1 indicates Demographic Profile of Respondents across 
Figure 2 shows Age-
wise Distribution of Respondents. From the Demographic 
22(60%), 23-29(30%), 
43(2%). Majority of nurses were between 
17 to 22 years. The main factors which were analyzed through 
questionnaires were superiors’ self determination and self 
confidence, assigning challenging tasks to subordinates, sense 
work of superiors, reward and 
recognition, empowering the staff, good communication skills, 
helps staff in critical situation, open environment to share ideas 
and motivation for organizational goals.
 
Table 1. Demographic profile of 
 
Health Facilities 
Private Hospital 
Government Hospital
Total 
 
 
Figure 1. Demographic profile of respondents
 
Table 2. Age-Wise Distribution of Respondents
 
Age Range 
17 – 22 
23 – 29 
30 – 36 
37 – 43 
Total 
 
 
Figure 2. Age-wise distribution of respondents
Table 3 and Figure 3 shows nurses are Strongly Agree 
12(13%), Agree 19(20%), Neutral 8(8%), Disagree 16(18%) 
and Strongly Disagree 37(41%), Precisely Strongly Agree &
Agree 31 (33% from 100%), Neutral 8(8% from 100%) and 
Strongly Disagree and Disagree 53(59% from 100%).
 
Table 3. Overall perception and satisfaction towards 
Transformational Leadership
 
Responses 
Strongly Agree 
Agree 
Neutral 
Disagree 
Strongly Disagree
Total 
 
It significantly indicates that nurses in two said hospitals are 
dissatisfied with the Superiors’ Transformational Leadership 
styles. The result of this study confirms that Transformational 
Leadership skills are not possessed by the most of superiors 
28
64
Demographic Profile of Respondents
Journal of Innovative Science and Medical Research, Vol. 01, Issue 01, pp.004-006, September
recognition, empowering the staff, good communication skills, 
helps staff in critical situation, open environment to share ideas 
and motivation for organizational goals. 
Demographic profile of Respondents 
 
Respondents 
28 
Government Hospital 
64 
92 
 
Demographic profile of respondents 
Wise Distribution of Respondents 
Respondents 
55 
28 
07 
02 
92 
 
wise distribution of respondents 
 
Table 3 and Figure 3 shows nurses are Strongly Agree 
12(13%), Agree 19(20%), Neutral 8(8%), Disagree 16(18%) 
and Strongly Disagree 37(41%), Precisely Strongly Agree & 
33% from 100%), Neutral 8(8% from 100%) and 
Strongly Disagree and Disagree 53(59% from 100%). 
Overall perception and satisfaction towards 
Transformational Leadership 
Respondents 
12 
19 
8 
16 
Strongly Disagree 
37 
92 
It significantly indicates that nurses in two said hospitals are 
dissatisfied with the Superiors’ Transformational Leadership 
styles. The result of this study confirms that Transformational 
Leadership skills are not possessed by the most of superiors 
Demographic Profile of Respondents
Private Hospital
Government 
Hospital
September, 2019 
005

[Audio] Results of this study showed that nurses in health facilities of Hyderabad, Sindh are not pleased with the sort of transformational leadership style adopted by their supervisors. Factor analysis indicated absence of knowledge about work protocols and also a safe setting to share their opinions and issues with their supervisors. It is necessary to better these circumstances to inspire and motivate staff to reach organizational objectives. In addition, new models of learning must be implemented to keep nurses current with the latest developments in the medical field. In addition, workshops should be held to boost the competency of Nurse Managers and Nurse Supervisors.. 

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which is vital component for motivating and encouraging the 
staff towards the Organizational Goal. It reveals that most of 
nurses are not aware about the protocol of work nor they have 
given open environment to share ideas and issues to the 
supervisors. 
 
 
 
Figure 3. Overall perception and satisfaction towards superiors’ 
transformational leadership 
 
Conclusion 
 
Most of nurses in said health facilities are not satisfied with 
Superiors’ 
Transformational 
Leadership 
styles. 
It 
is 
recommended that affected areas should be improved. Further 
studies should be needed on the factors identified through 
factor analysis. 
 
Recommendation 
 
Leadership plays an important role to influence the staffs 
towards the patients outcome in health facilities. New models 
of learning should be implemented to polish the nurses’ 
knowledge and skills as new technology and techniques have 
been emerged in medical field. Furthermore workshops should 
be conducted in every health facility to enhance the 
competency of Nurse Managers and Nurse Supervisors. 
 
Limitations 
 
It was cross-sectional study with limited time and respondents 
belonging to only 2 health facilities. If this study form 
conducted longitudinally and taken large number of 
participants from different hospitals then the expected result 
would be more reliable. 
 
REFERENCES 
 
Albagawi, B., Laput, V., Pacis, C. and Al-Mahmoud, T. 2017. 
Nurses’ Perceptions of Nurse Manager Leadership Styles. 
American Journal of Nursing Research, 5(1), 22-31. 
Amestoyl S C, Backes V M S, Thofehrn M B, Martini J G, 
Meirelles H S, Trindade L D L. 2013. “Nurses' perception 
of the teaching-learning process of leadership” Texto & 
Contexto - Enfermagem Apr./June 2013 vol.22 no.2 Print 
version ISSN 0104-0707. http://dx.doi.org/10.1590/S0104-
07072013000200024. 
Călin, H., Cristina M. and Tudor, T. 2009. Leadership and 
management in the health care system: Leadership  
 
 
 
 
 
 
perception in Cluj county children's hospital, Transylvanian 
Review of Administrative Sciences, 27E/2009 pp. 89-104. 
Chaves LDP, Mininel VA, Silva JAM, Alves LR, Silva MF, 
Camelo 
SHH. 
Nursing 
supervision 
for 
care 
comprehensiveness. Rev Bras Enferm [Internet]. 2017; 
70(5):1106-11. [Thematic Edition “Good practices and 
fundamentals of Nursing work in the construction of a 
democratic society”] DOI: http://dx.doi.org/10.1590/0034-
7167-2016-0491. 
Christine Marie Shush, 2012. “Supervisory Styles and 
Satisfaction: Genetic Counseling student and graduate 
views” Genetic Counseling Department of Genetics Case 
Western Reserve University August, 2012 pp 1-139. 
Gonsalvez C J, Hamid G, Savage N M, Livni D. 2017. “The 
Supervision Evaluation and Supervisory Competence 
Scale: 
Psychometric 
Validation” 
The 
Australian 
Psychological Society, V. 52, 94–103. 
Higgins and Elizabeth, A. 2015. The Influence of Nurse 
Manager Transformational Leadership on Nurse and 
Patient Outcomes: Mediating Effects of Supportive 
Practice 
Environments, 
Organizational 
Citizenship 
Behaviours, Patient Safety Culture and Nurse Job 
Satisfaction, Electronic Thesis and Dissertation Repository. 
3184. 
Ismail A, Hamran M, Mohamad H A, Rafiuddin N M Zhen K 
W 
P. 
2010. 
“Transformational 
and 
Transactional 
Leadership Styles as a Predictor of Individual Outcomes” 
Theoretical and Applied Economics Volume XVII (2010), 
No. 6(547), pp. 89-104. 
Ismail, A., Mohamad, M.H., Mohamad, H.A., Rafiuddin, N.M. 
and 
Zhen, 
K.W.P. 
2010. 
Transformational 
and 
Transactional Leadership Styles as a Predictor of Individual 
Outcomes, Theoretical and Applied Economics Volume 
XVII (2010), No. 6(547), pp. 89-104. 
Khan Z A, Nawaz A, Khan I. 2016. “Leadership Theories and 
Styles: A Literature Review” Journal of Resources 
Development and Management An International Peer-
reviewed Journal Vol.16, ISSN 2422-8397. 
Khan, Z.A., Nawaz, A., Khan, I. 2016, Leadership Theories 
and Styles: A Literature Review, Journal of Resources 
Development and Management ISSN 2422-8397 An 
International Peer-reviewed Journal Vol.16, 2016 
Neyland, Leslie, "The evaluation of supervision among school 
counseling internship supervisors" (2015). Theses and 
Dissertations. 
2036. 
htp://utdr.utoledo.edu/theses-
dissertations/2036. 
Robert J. 2000. Alban-Metcalfe and Beverly Alimo-Metcalfe 
“The 
transformational 
leadership 
questionnaire” 
Leadership & Organization Development Journal, 21/6, 
280–296. 
Student Perceptions of Research supervision (SPORS) 
Supervisor Questionnaire The University of Western 
Australia. Retrieved from. http://www.postgraduate.uwa. 
edu.au. 
Vesterinen, S., Suhonen, M., Isola, A., Paasivaara, L. 2012. 
Nurse Managers’ Leadership Styles in Finland, Nursing 
Research and Practice, vol. 2012, Article ID 605379, pages, 
2012. https://doi.org/10.1155/2012/605379. 
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zohaib article two b

Scene 0

Transformational leadership is essential for any organization to succeed, particularly in the healthcare sector

This study aimed to determine nurses' perceptions and satisfaction of their superiors' transformational leadership in both public and private hospitals in Hyderabad, Sindh

A descriptive design and semi-structured questionnaire were used to survey 92 nurses, asking questions about the relevant theoretical approach including contingency, style and behavior, process, and transactional leadership

Results showed that transformational leadership plays an important role in motivating and inspiring nurses to perform their best

Nurses reported that their superiors had a positive attitude, respected them, and encouraged them to succeed

However, a disparity in perceptions and satisfaction levels was observed between public and private hospitals

The findings of this study highlight the importance of transformational leadership in healthcare, and suggests potential further research.

avatar

Results of this study showed that nurses in health facilities of Hyderabad, Sindh are not pleased with the sort of transformational leadership style adopted by their supervisors

Factor analysis indicated absence of knowledge about work protocols and also a safe setting to share their opinions and issues with their supervisors

It is necessary to better these circumstances to inspire and motivate staff to reach organizational objectives

In addition, new models of learning must be implemented to keep nurses current with the latest developments in the medical field

In addition, workshops should be held to boost the competency of Nurse Managers and Nurse Supervisors.