Date of Award


Degree Name

PhD Nursing


leadership, magnet hospitals, non-magnet hospitals, nursing, nursing managers


Purpose: This research evaluated relationships among hospital types (Magnet versus non-Magnet), nurse manger leadership attributes, and staff registered nurse autonomy. Hypothesis: Magnet hospital status would be related to positive nurse manager leadership attributes which would be related to greater clinical nurse autonomy and nurse manager leadership would mediate relationships between hospital status and clinical nurse autonomy. Conceptual Basis and Background: Structural Contingency Theory modified in the Nursing Systems Outcomes Research model was the research model for conceptualizing the structure-environment-effectiveness relationship. Critical Social Theory (CST) provided the conceptual/motivational basis for this study, a lens through which to frame the question. Clinical nurse autonomy is characteristic of hospitals noted for good patient outcomes and excellent nursing care. Research demonstrates that leadership attributes of nurse managers are related to increased nurse autonomy and positive patient outcomes. Magnet hospitals have been found to have superior nurse executive attributes, greater nurse autonomy, and high-quality nursing care and to generate better patient care outcomes than non-Magnet hospitals. Design and Methods: This study employed a pre-experimental, cross-sectional correlational design. Two groups (nursing managers and staff registered nurses) represented Magnet and non-Magnet hospitals. These two types of hospitals were matched on 12 criteria for a total of 388 hospitals. Statistical power analyses demonstrated sufficient power for detecting down to between medium effects and large effects for the 104 units included. Chief Nursing Officers, nursing managers and staff registered nurses were contacted via email addresses or phone numbers. Measurements were demographic questions, and assessments for leadership actions (Nurse Managers' Actions Scale, Mrayyan, 2004) and clinical autonomy (Autonomy Scale developed by Blegen, Goode, Johnson, Maas, Chen & Moorhead, 1993). Results: There were no mean differences between hospital types. There was a relationship between manager leadership attributes and nurse clinical autonomy and this relationship was dependent on Magnet status. Implication: This type of research will help identify leadership traits and attributes that empower nurse autonomy, which is related to better nurse recruitment, nurse job satisfaction, nurse retention, and patient outcomes, and it will evaluate the role of Magnet hospital status in these relationships. It may also enable developing alternative praxis-based approaches.

Document Type

Dissertation: Open Access



Included in

Nursing Commons