Leadership styles amongst charge nurse managers

Abstract

Background: Ward-level leadership plays a critical role in shaping registered nurse (RN) experience, workforce stability and patient safety. Charge Nurse Managers (CNM) occupy a pivotal leadership position within acute healthcare settings; however, limited empirical research has examined how CNM personality traits and leadership behaviours influence both staff experience and measurable organisational outcomes.

Objective: The objective of this study was to examine the relationship between CNM leadership style and personality traits, and their association with RN experience, RN retention, and medication-related adverse events at the ward level.

Participants: Participants included 15 Charge Nurse Managers employed across inpatient wards and rural facilities within Health New Zealand (Te Whatu Ora) Waikato district. The sample represented 50 percent of CNMs within the district. Ward-level data relating to RN turnover and medication adverse events were included for the corresponding clinical areas.

Methods: A sequential mixed-methods design was employed. Phase One involved semi-structured qualitative interviews exploring CNM leadership experiences and role perceptions. Phase Two utilised the ‘Big Five’ personality inventory to assess CNM personality traits. Phase Three involved analysis of routinely collected ward-level key performance indicator data, including RN retention and medication adverse events over a 12-month period. Data were integrated using a triangulation approach to support interpretive depth and methodological rigour.

Results: Findings indicated that conscientiousness and emotional stability were the personality traits most strongly associated with positive leadership outcomes. CNMs demonstrating higher levels of these traits were associated with more positive RN experiences, higher retention rates and lower medication adverse event rates. Qualitative findings highlighted psychological safety, emotional regulation and leadership consistency as key mechanisms linking personality and leadership behaviour to outcomes. Leadership effectiveness emerged as a developmental process shaped by personality foundations, experiential growth, and leadership role transition.

Conclusion: This study contributes to nursing leadership literature by linking CNM personality traits to both staff and patient outcomes and by proposing a Roadmap to Health Leadership framework that conceptualises leadership effectiveness as an evolving, context-dependent trajectory. The findings support leadership development approaches that are reflective, evidence-informed, and sensitive to the complexity of ward-based healthcare environments.