Problem Statements


Currently, there is no proper study on the type of leadership styles practiced in the hospital context by nurse managers in Malaysia. The study on which style of leadership is more effective in helping to improve the working motivation among nurses are also still not well-recorded in Malaysia. Out of 520 article that being review by researcher 210 article discussing on leadership style only 20 articles discussing about leadership skill. The appropriate style of guidance provided by nurse managers in Malaysia also remains blurred, although they are aware of its benefits; hence there is a need to explore existing styles of leadership. Findings could form the basis for establishing a well-structured system for training effective and efficient leadership skills among nursing managers before being promoted as one.

Many factors lead to decreased of working motivation among nurses. Baljoon, Banjar, & Banakhar, (2018) conducted a study to examine nurses' work motivation and factors affecting it. This study founded that there are many factors give impact to nurses' work motivation, such as nurses' age, years of experience, autonomy, educational level, and administrative positions were also found as personal characteristics that affect nurses' work motivation level. Moreover, nurses' empowerment, work engagement, pay and financial benefits, supervision, promotion, contingent rewards, supportive relationship (co-workers), communication and nature

Nurses who feel less motivated to work, they will leave the job and try to find other alternatives to stay in their careers. Countries in Southeast Asia, including Malaysia, are facing problems of maldistribution of health workers, and in rural areas are often understaffed due to job dissatisfaction and burn out (Kanchanachitra et al., 2011).

Job dissatisfaction was a significant predictor of having an intention to leave nursing career among nurses in Malaysia, and this situation motivated them to do so (Ramoo, Abdullah, & Piaw, 2013). Due to this situation researcher would like to know whether the nurses at the study location also faced problems with motivation to work in relation to the leadership styles of their leaders.

Leadership is the process of influencing others to understand and to decide on what needs to be done and how to do it, and the process of facilitating individual and collective efforts to attain shared objectives. This description shows the importance of leadership, which is an essential function of management that aims to optimize efficiency and achieve corporate goals. Effective clinical leadership has repeatedly been identified as a critical component in providing quality care and safe environments in clinical settings. The importance of good leadership in health care is becoming increasingly apparent. Leadership styles and skill give a big impact on staff working motivation.

According to a study done by Al-Yami et al. (2018), nurse managers’ leadership styles in Saudi Arabia were having a strong relationship with nurses’ organisational commitment. Using a survey design, the Multifactor Leadership Questionnaire and the Organisational Commitment Questionnaire were distributed to 219 nurses and nurse managers from two hospitals in Saudi Arabia. Researcher found that

Transformational leadership was the most likeable leadership style. After controlling for the influence of manager, nationality and hospitals, transformational leadership was the strongest contributor to organisational commitment. Perceptions of both transformational and transactional leadership styles increased with age for nurse managers and nursing staff. They concluded that by Introducing the Full Range of Leadership model to the Saudi nursing workforce could help to prepare Saudi nurses for positions as nurse managers and leaders. As an implication for nursing management, it was found that the study gave an insight into the type of leadership that is best suited to the dynamic and changing health care system in Saudi Arabia. It is possible that transformational leaders could influence and induce positive changes in nursing.

Nurse managers are responsible for supervising nursing staff in a hospital or clinical setting. They oversee patient care, make management and budgetary decisions, set work schedules, coordinate meetings, and make decisions about personnel. In medical dictionary, (2009) nurse manager is a nurse who responsible for a unit in a hospital, nursing home, or ambulatory care setting. The nurse manager supervises staff performance and patient care. Nurse manager also have a task to lead nursing team in doing their nursing task. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and

health systems management, and education are also key nursing roles (ICN, 2002).

Meanwhile, International nursing council define nurse as a person who cares for the sick or infirm specifically: a licensed health-care professional who practices independently or supervised by a physician, surgeon, or dentist and skilled in promoting and maintaining health. In Malaysia a nurse manager is a promoted staff from nurse entry grade U29 to nurse manager with grade U32 and will be involved with management task among team.

In Oxford dictionary (2016), the definition of a nurse is the profession or practice of providing care for the sick and infirm. According to the role definition of the Israeli Ministry of Health, nurse coordinators define as a person who accompany patients across the continuum of care, serve as advocates for patients and their families, and help them navigate the healthcare system and provide patients’ education (Monas et al., 2017). In Malaysia registered nurse is a healthcare staff who is responsible to carry out all the nursing care and also treatment that ordered by a physician to particular patient. A nurse in a teaching hospital has additional tasks such as involvement with teaching and learning together with medical and nursing students.

Yew et al. (2020) in their study on work satisfaction among nurses in a private hospital aims to examine job satisfaction and its contributing factors among nurses in a Malaysian private hospital. A survey was carried out on 209 nurses in a Malaysian private hospital. The Index of Work Satisfaction (IWS) developed by Stamps was adopted to measure the level of job satisfaction among nurses. Researcher founded that the overall IWS was 11.7 and nurses below 30 years old had lower IWS than those aged 30 and over. The study also showed that the low level of job satisfaction

among nurses was reflected by the lowest scores on pay, task requirements, and organizational policies, all in the second quartile of satisfaction level. This study concluded that there was low job satisfaction among nurses from a private hospital, especially with the low pay. Nurses are more concerned with aspects that affect their personal well-being directly. Hence, hospital management should consider a more attractive remuneration, as well as other incentives to increase job satisfaction among the nurses. This work satisfaction is close related with their work motivation.

On other hand, a study on Motivation and Job Performance among Nurses in the Health Tourism Hospital in Malaysia by Hee et al., (2016) , intended to examine nurses’ motivation and job performance in the health tourism hospital in Malaysia.

Administered on-site method was used to collect data from 180 respondents in a health tourism hospital. The result of this study indicated that intrinsic motivation was positively and significantly related to nurses’ job performance. The researcher suggested that the finding of this study should be used as a baseline data to urge the hospital management to turn to intrinsic rewards instead of extrinsic rewards to motivate their nurses. Realistically, intrinsic rewards are less costly and more effective in enhancing nurses’ performance. Career development, job enrichment and providing greater autonomy were among the ways to increase nurses’ job performance. In addition, the researcher also suggested that implementing

A university teaching hospital, by definition, is an institution that provides clinical education and training to future and current doctors, nurses and other health professionals in addition to delivering medical care to patients, as well as carrying out medical research. In Malaysia, currently there are five such hospitals: University Malaya Medical Centre (UMMC), Hospital Canselor Tuanku Muhriz (HCTM) also previously known as Universiti Kebangsaan Malaysia Medical Centre, Hospital Universiti Sains Malaysia (Hospital USM), International Islamic University Malaysia Medical Centre and Universiti Teknologi Mara Teaching Hospital. To ensure a more cohesive and direct transmission of the ministry’s vision and the spirit of collegiality.

The Public University Teaching Hospital Consortium was created under the ministry as reported by Ruzana, (2018). However, in this study, only 2 teaching hospitals were selected as a study location due to time limitation. In early part, plan to collect data from Universiti Malaya Medical Centre (UMMC), Hospital Canselor Tuanku Muhriz (HCTM) and Hospital Universiti Sains Malaysia(Hospital USM) however the requirement to do data collection is researcher have to appoint another co-supervisor for each centre and need to pass through ethic committee for each university so researcher decide to collect data in 2 centre Hospital Canselor Tuanku Muhriz (HCTM) and Hospital Universiti Sains Malaysia (Hospital USM) because time constraint and researcher need to complete the data collection within time frame given by JePem Universiti Sains Malaysia. In term of hospital selected in this study, researcher choose teaching hospital instead of government hospital due to after comparing the job descriptions for nurses in teaching hospital and government

hospitals and found that there some additional tasks for nurses in teaching hospital related to teaching and learning activities(Ghawadra et al., 2019).

Almost 520 literatures are reviewed by researcher and researcher is interested to study further to investigate about what was the relationship between leadership styles and subordinates working motivation. This study aims to assess nurse manager leadership styles and nurses working motivation in teaching hospitals because in teaching hospital there are extra job descriptions among this population compare to nurse manager and nurses in government hospital.