Effect of authentic leadership and mindfulness educational program on nursing managers' competencies: a quasi-experimental study

Authentic leadership (AL) has become one of the most important leadership approaches in light of recent societal changes globally. Modern organizations require leaders who: possess high ethical standards, are aware of their abilities, and are fair in their decision-making process by creating integrity in the workplace [1, 2]. Authentic leadership defined as a pattern of leader behavior that draws upon and promotes both positive psychological capacities and a positive ethical climate, to foster greater self-awareness, an internalized moral perspective, balanced processing of information, and relational transparency on the part of leaders working with subordinates, fostering positive self-development [3].

Zhang et al. [4] classified authentic leadership outcomes as: 1. Follower attitudinal outcomes: positively related to subordinates' psychological empowerment, work engagement, psychological capital, psychological safety, job autonomy, organizational commitment, and job satisfaction. On another hand, authentic leadership is negatively related to stress, emotional exhaustion, and cynicism [2]. 2. Follower behavioral outcomes: authentic leadership has an effect on two key work behaviors: increasing organizational citizenship behaviors (OCB) “which refers to individual behavior that is discretionary, not directly or explicitly recognized by the formal reward system”. And decreasing counterproductive work behaviors (CWB) “which refers to behavior that has a detrimental effect on organizations and their members”. 3. Leader-related outcomes: authentic leadership enhances the ability of leaders to perform their duties (leader effectiveness) and the quality of their exchange relationship with subordinates.

Authentic leaders are characterized by openness, integrity and have positive psychological traits such as trust, optimism and high morality. Additionally, authentic leaders effectively handle change and help employees cope [5]. On another hand, Frasier [6] describes authentic leaders as positive, ethical, values-driven, and collaborative, and in displaying these behaviors, they earn the trust and respect of their followers and influence follower performance.

Fry and Kriger [7] suggest that the greatest obstacle to experiencing reality authentic leadership is over-emphasis on the thinking mind, which creates an opaque screen of concepts, labels, judgments and definitions that blocks all true relationship, and that this over-emphasis decreases when attention is focused on the present. These characteristics suggest that mindfulness – which consists of putting aside personal filters to establish direct contact with experience and responding to that experience in a less-automatic, more-flexible way [8]. According to Nübold et al. [9] one factor that has been theorized to show a strong conceptual link to authentic leadership is mindfulness, and treat mindfulness as a personal antecedent to and a holistic means of training authentic leadership. Mindfulness promotes authenticity by allowing self-discovery and self-awareness, leading to more self-concordant goal setting.

Theoretically, Mindfulness-based interventions and authentic leadership are connected in that both emphasize self-awareness [10, 11]. Increased self-awareness of thoughts, emotions, and values developed through participating in Mindfulness-based interventions can foster a greater sense of autonomy in the leader, ultimately resulting in a more unified and self-determined, authentic sense of self [12, 13]. Pérez et al. [14] defined mindfulness as an approach to experiencing everyday life by directing attention and awareness to the present moment without judgment. Mindfulness is often associated with meditation, the practice of focusing on a chosen object of attention such as breath; however, the conceptualization of mindfulness practice extends beyond meditation or breathing techniques [15, 16].

According to Goestjahjanti et al. [3] the benefits achieved by practicing mindfulness leadership are: 1. self-awareness: knowing internal status, preferences, resources, and intuitions. 2. self-management: turning compulsion into a choice, managing, impulses, resources, and intuitions. 3. motivation: knowing what is important to self, aligning with leader values, cultivating resilience. 4. empathy: awareness of the feelings of others, cultivating connection and trust. 5. Social skills: cultivating communication skills especially listening, engaging skillfully with conflict, and leading with compassion.

As a leader, nursing managers (also called Head Nurses) are responsible for maintaining the link between an institution's administrative mission and the nurses who provide nursing care in the clinical unit, as well as being in charge of efficient patient care activities by ensuring that subordinate nurses are qualified for the tasks allocated to them. This is one of the reasons why their roles are considered the most complex in healthcare institutions [17]. To do their duties, they must promote the growth of mindset, adhere to a code of ethics, be open, transparent, and honest in their interactions, be genuine, and instill a work culture of personal growth, clarity, accountability, and innovation [18].

Competencies are attributes underpinning behavior, which at the individual level are a combination of knowledge, skills, and abilities where skills are outcomes of continuous learning and practice supported by a person’s abilities [19]. In the same context, managerial competence is described as a combination of knowledge, skills, abilities, and behaviors that an employee uses in an organization [20]. Ofei, Paarima, and Barnes [21] classified the managerial competencies as technical, conceptual, and human relationship competencies.

As a result of increased self-awareness, nurse managers reported success in transforming organizational culture, improvement in emotional intelligence, better managerial competencies, minimized psychological and physical impairment due to stress [16]. In this context, the current study aimed to examine the effect of implementing an educational program about authentic leadership and mindfulness on nurse managers' competencies, and determine if there was a positive relation between developing a mindful authentic leader and improving their technical, conceptual, and human relationship competencies.

The current study was directed to explore the effect of an educational program about authentic leadership and mindfulness on nursing managers' competencies in the hospital. According to the present study findings, there was statistically significant positive relation between the educational program with the nurse managers’ scores of authentic leadership, mindfulness, and managerial competencies immediately post-program and after three months of the program implementation. In fact, the program helped those nurse managers in performing their leadership skills effectively, and providing them the opportunity to engage in open conversations, evaluate and value different points of view, share their experiences with others, and learning from others’ stories. According to Elmawla et al. [18] being authentic nurse manager is hard work and takes years of experience in leadership roles. Training program will shorten the period of nurse managers developing authentic leadership by connecting them with truth, creative ideas, journey of self-discovery and sharing experiences. Along the same line, Ali et al. [22] studied the effect of an authentic leadership educational program for head nurses on staff nurses' organizational commitment among 32 nurse managers at Benha University Hospital and found that a statistically significant improvement in the studied head nurses’ mean score regarding their attitude toward authentic leadership thorough program phases. The improvement included the dimensions of self-awareness, internalized moral perspective, balanced processing, relational transparency post-program, and follow-up after the program compared to pre-program scores as reported by head nurses. Also, Dietl and Reb [31] found that a short mindfulness practice (i.e., a 10-minute focused breathing exercise) increased leaders’ felt authenticity, and that leader trait mindfulness was positively related to follower-rated authentic leadership.

Concerning nurse managers’ knowledge regarding authentic leadership and mindfulness, the findings of the current study demonstrated that there were highly statistically significant differences between scores of the studied nurse managers’ knowledge regarding authentic leadership and mindfulness in the three study phases. In the pre-program phase, the highest percent of the studied nurse managers had a poor level of authentic leadership which improved to good level immediately post- and after 3 months of the program implementation. This may be due to the most of nurse managers did not attend previous training programs about authentic leadership style and don't recognize the importance of authentic leadership. Although almost all participants' knowledge scores improved after the program was implemented; most head nurses demonstrated a high level of authentic leadership practice. It's possible due to their active involvement and interest in the program sessions and frequent review of their knowledge. As asserted by Ali et al. [22]; and Aboelenein, and Mostafa [23] the training programs regarding authentic leadership were considered a new trend in Egyptian nurses' culture.

This result agreed with Aboelenein, and Mostafa [23] who studied the effect of an educational program about authentic leadership for head nurses on staff nurses' resilience and innovation behavior among 54 nurse managers at the Tanta International Teaching Hospital and found that the studied nurse managers' knowledge and authentic leadership style levels were low pre-program implementation while, they had higher scores with statistically significant differences post-program implementation. Also, Hassan et al. [32] studied the effect of an authentic leadership training program of head nurses on creativity and motivation of nurse staff among 36 nurse managers at Mansoura University hospital and revealed that there were highly statistically significant differences in a total of head nurses about authentic leadership style knowledge at the three times of the program (pre-test, immediately post-, and three months after the program implementation).

Regarding the studied nurse managers’ authentic leadership levels, the current study results elaborated that there were statistically significant differences between authentic leadership levels among the studied nurse managers at the three phases of the program. As noticed, the highest percent of nurse managers had low authentic leadership level preprogram regarding self-conscious domain improved to two thirds of them had high level immediately post and half of them had high level after three months of the program implementation. This result explains how the present leadership educational program based on mindfulness effected positively on the studied nurse managers’ self-awareness which increase knowledge of one’s strengths, weaknesses, values, beliefs and emotions, as well as their impact on others [33].

Moreover, the present study findings revealed that there was statistically significant variation in authentic leadership levels regarding domains of balanced treatment of information at the three phases of the program (pre, immediately and, three months post the program implemented), which reflects improvement in the nurse managers’ dealing with others by unbiased openness to differing perspectives on oneself and questioning of one’s positions [8]. This result was supported by Nübold et al. [9] who concluded that by reducing negatively biased cognition, leadership training based on mindfulness may enhance balanced processing of the studied managers. Also, it was observed that there was significant improvement regarding relationship transparency domain, the study findings revealed increased nurse managers’ capacity for displaying empathy and more ability to build more supportive relationships through an improved understanding of others. This result indicates the enhancement in the studied nurse managers’ revealing information, thoughts and sincere emotions to others through engagement in the current program activity. The study conducted by Dietl, & Reb [31] found that managers’ who participated in authentic leadership training based on mindfulness practices were showed increasing in their ethical perspective and relational transparency.

The current study's findings also revealed that there was statistically significant improvement in nurse managers’ ethical perspective scores immediately post and after three months of the program implementation. This result indicted that the educational program increased nurse managers internalized moral perspective, i.e., a process of self-regulation guided by moral values and standards forming the basis for decision making and undertaking action [9]. This finding in the same line with Tan, Peters, & Reb [12] who described that the mindfulness-based leadership training (MBLT) can support leaders in developing clarity regarding their values and purpose in life and enable them to act according to their personal beliefs and truth, supporting ethical perspective.

These Findings are consistent with results reported by Elmawla et al. [14] who studied the effect of an educational program about authentic leadership and mindfulness factors on head nurses practice self–evaluation among 70 nurse managers at Elmenshawy General Hospital and Kafer El sheikh General Hospital, and indicated that there was a statistically significant improvement of total practice of mindfulness and each of observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience factors immediate and three months post program than preprogram. And clarifies that, nurse managers’ training in mindfulness practice and meditation techniques improved their ability to focus and concentrate on any task at hand and improved their functioning with subordinates and patients, as well as had a positive effect on their physical and mental workability.

Regarding managerial competencies of the studied nurse managers as perceived by staff nurses as followers, teasing apart leaders’ and followers’ perceptions is essential in order to determine whether a behavioral or attributional perspective of authentic leadership is more valid. Thus, in order to fully capture and understand the role of mindfulness for authentic leadership, it would be desirable to consider both followers’ and leaders’ perspectives of authentic leadership simultaneously [9], also, as a positive outcome of the present study, the participation of staff nurses in assessing nurse managers' competencies pre- and post-authentic leadership program indirectly affected nurses’ perceptions of interpersonal justice via authentic leadership.

The present findings indicated that nearly three-quarters of the studied nurse managers had low managerial competencies preprogram in all tested skills as perceived by their staff nurses. The lowest percentage was regarding technical skills followed by conceptual skills. This finding further strengthens the fact that nurse managers in Egypt are not appointed based on clinical proficiencies of each specialty but based on educational certificates only, without testing their technical skills in each department. This would increase conflict and emotional stress during work, which negatively affects nurse managers’ mindfulness. According to Ofei, Paarima, and Barnes [21] technical skills are needed by nurse managers for supportive supervision to ensure that things are done right, and the right thing is done through the transfer of adequate knowledge, skills, and attitude or competencies. Another rationale for these findings may be that they had a higher responsibility and were loaded during the morning shift. However, it might be a lack of confidence in their ability and a lack of self-belief. Also, these results were supported by Abd-Elmoghith, and Abd-Elhady [34] Who assessed nurse managers' competencies and their relation to their leadership styles among 65 nurse managers at the Oncology Center -Mansoura University, and revealed that slightly less than half of nursing managers had a low level of competency.

The results of the current study indicated there were statistically significant variations in nurse managers’ managerial competencies scores regarding human relationship skills as perceived by staff nurses in the three study phases. It was noticed that preprogram the most of staff nurses reported that the nurse manager has small extent the ability to market care and urges teamwork, which improved post-program and after three months of the program to the most of them reported that the nurse director has large extent the ability to market care and urges teamwork. In this context, authentic leadership can serve as a positive role model for subordinates in the workplace. Before making a decision, authentic leaders prefer to encourage employees' independent thinking and expressive behavior. On the other hand, authentic leadership fosters trust and personal support among employees, boosting self-efficacy and meeting competency requirements [35]. In the same direction with the current results Mashavira, & Chipunza [36] who found that there was strongly positive effect of authentic leadership training on managers’ skills regarding building constructive relation with their subordinate especially improve teamwork and supporting their self-efficacy.

Furthermore, the current results presented that there were statistically significant differences in nurse managers’ scores regarding conceptual skills as perceived by staff nurses at the study three phases. As evidence, pre-program about three quarters of staff nurses reported that the nurse manager has small extent the ability to analyze effectively and plan strategically, which improved post and after three months of the program to the most of them reported that the nurse director has large extent the ability to analyze effectively and plan strategically. These findings agreed with Gunawan et al. [37] who concluded that there was statistically significant improvement in the managers conceptual competencies after refining of their managerial core competencies through implementation of authentic leadership training.

Relation between study variables, the present results there was a significant statistical relation between the studied nurse managers’ authentic leadership level and their mindfulness and competencies immediately post-program and after three months of implementation the educational program. This result can be positively extended to nurses’ work attitudes via authentic leadership. Along the same line, Elmawla et al. [18] found a positive relation between nurse managers’ mindfulness and their knowledge, while there was a positive relation non-significant relation between nurse managers’ authentic leadership and their knowledge. Also, Nübold et al. [9] confirmed a positive relation between leaders’ trait mindfulness and authentic leadership as rated by both followers and leaders, and showed that the intervention increased authentic leadership via gains in leaders’ mindfulness.