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Abstract: Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. Purpose: To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. Methods: The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (N = 278) were nurse managers. The data were analysed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. Results: The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients,' relatives' and nurse managers' needs. Conclusions: Nurse managers exhibited leadership styles oriented to maintenance, focussing more on the 'doing the job' than on managing the decision-making in ethical dilemmas.
Keywords: ethical dilemma, nurse manager, leadership
Nursing leadership at all levels is a major issue (Sandstrom, Borglin, Nilsson, & Willman, 2011). Leaders, and the way leadership is performed, have an important role in nursing management. Nurse managers find themselves at a crossroads in the challenging healthcare ethical environment (Cooper, Frank, Gouty, & Hansen, 2002; Drach-Zahavy & Dagan, 2002) because they make decisions that are related to nursing quality, patient satisfaction, finance allocation, ethical climate, professional dignity and so forth.
Nurse managers work in a health care context of high pressure, uncertainty and rapid change. They face unprecedented challenges on a daily basis (Dignam et al., 2012), and are being challenged by many demands and issues (Anthony et al., 2005). To confront these demands and challenges, they must have the ability to make decisions based on ethics (Raines, 2000). Moreover, there is a need to recognise the complex interconnectivity between decision-making, leadership, and ethical dilemmas in the nursing management context. For nurse managers, coping with leadership in a context of ethical dilemmas is difficult. Often, nurse managers cannot act according to their own personal values and norms. This generates tensions between the nurse manager's personality, organisation, patients and other actors in the real world of healthcare management (Goethals, Gastmans, &...