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Int J Nurs Stud. 2009 Sep;46(9):1236-44. doi: 10.1016/j.ijnurstu.2009.03.001. Epub 2009 Apr 5.

The mediating effects of team and self-efficacy on the relationship between transformational leadership, and job satisfaction and psychological well-being in healthcare professionals: a cross-sectional questionnaire survey.

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National Research Centre for the Working Environment, Denmark.



The importance of transformational leadership for the health and well-being of staff in the healthcare sector is increasingly acknowledged, however, there is less knowledge about the mechanisms that may explain the links between transformational leaders and employee health and well-being.


To examine two possible psychological mechanisms that link transformational leadership behaviours to employee job satisfaction and well-being.


Cross-sectional study design.


The study took place in two elderly care centers in large Danish local government. Staff were predominantly healthcare assistants but also nurses and other healthcare-related professions participated in the study.


274 elderly care employees completed the questionnaire. Surveys were sent to all employees working at the centers. 91% were female, the average age was 45 years.


A questionnaire was distributed to all members of staff in the elderly care centers and where employees were asked to rate their line manager's leadership style and were asked to evaluate their own level of self-efficacy as well as the level of efficacy in their team (team efficacy) and their job satisfaction and psychological well-being.


Both team and self-efficacy were found to act as mediators, however, their effects differed. Self-efficacy was found to fully mediate the relationship between transformational leadership and well-being and team efficacy was found to partially mediate the relationship between transformational leadership and job satisfaction and fully mediate the relationship between transformational leadership and well-being.


Within the pressurised environment faced by employees in the healthcare sector today transformational leaders may help ensure employees' job satisfaction and psychological well-being. They do so through the establishment of a sense of being in control as individuals but also as being part of a competent group.

[Indexed for MEDLINE]

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