Date of Graduation

Fall 12-11-2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Robin Buccheri, PhD, RN, FAAN

Second Advisor

Priscilla Javed, DNP, RN, FACHE



Problem. Transformational leadership (TL) represents the gold standard of leadership styles in contemporary healthcare organizations. The transformational leader's ability to motivate, influence, stimulate, inspire, and attend to followers' individual needs is an antecedent to job satisfaction, quality, and patient safety. The project aimed to improve TL constructs among frontline leaders (managers and assistant nurse managers). Based on the results of a needs assessment, these frontline leaders were provided an opportunity to improve their TL style.

Context. Leadership development is a strategic priority for a medium-sized medical center in a healthcare system in Northern California. Frontline leaders within patient care services (PCS) for this medical center strive to achieve job satisfaction and improve patient outcomes. Ten frontline leaders volunteered to participate in this evidence-based TL development program.

Interventions. The TL development program included didactic education on TL theory, inspirational motivation, idealized influence, and emotional intelligence (Bradberry & Greaves, 2009) during three four-hour sessions scheduled between February 10, 2020, to August 5, 2020. The pedagogy involved lectures, reflective practice, team coaching, action learning concepts, and adult learning principles.

Measures. The impact of the TL development program was appraised using a pre-post assessment with a modified Multifactor Leadership Questionnaire (MLQ™) 5X (Avolio & Bass, 2004). The MLQ™ 5X is a valid and reliable instrument that measures overall TL and five constructs: "idealized influence attributes (IIA), idealized influence behaviors (IIB), inspirational motivation (IM), intellectual stimulation (IS), and individual consideration (IC)" (Avolio & Bass, 2004, pp. 103-104). This appraisal included both self-assessment of participants and rater-assessment of participants by identified supervisors, peers, and subordinates.

Results. Statistical analysis for overall TL scores on the MLQ™ 5X revealed that participants’ self-assessed scores declined slightly from pre-intervention (M = 3.1, n = 10) to post-intervention (M = 2.9, n = 9). Conversely, the TL rater-assessed scores of participants increased from pre-intervention (M = 3.1) to post-intervention (M = 3.3). Subordinates rated participants' TL style higher than participants rated themselves at both pre-and post-intervention. Supervisors rated participants' TL style for all constructs lower at pre-intervention but higher at post-intervention.

Conclusions. The global coronavirus pandemic, societal unrest, and fires in the general area may have impacted participants' ability to view themselves during the project as improving transformational leaders. The MLQ™ 5X total mean score for supervisor ratings of participants improved from pre-intervention (M = 2.7) to post-intervention (M = 3.2). Post-intervention, supervisors perceived higher TL levels among those they supervise, based on their performance during a crisis. Specifically, supervisors’ mean scores for “encourages innovative thinking – intellectual stimulation (IS) and coaches and develops people – individual consideration (IC)” (Avolio & Bass, 2020b, p. 3) (M = 3.5) exceeded the participants’ self-rated scores (M = 3.0). The scores in these two constructs may reflect the frontline leaders' innovation and coaching during the pandemic. Participants reported feeling less confident in their TL acumen after learning about TL constructs during the program. Further research is required to design and implement effective, evidence-based leadership development programs and mitigate learning impediments.