Document Type

Journal Article

Publication Title

Journal of Advanced Nursing






School of Business and Law




Parr, J. M., Teo, S., & Koziol‐McLain, J. (2020). A quest for quality care: Exploration of a model of leadership relationships, work engagement, and patient outcomes. Journal of Advanced Nursing, 77(1), 207-220.


© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd Aim: To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes. Design: A cross-sectional survey design. Methods: Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM). Results: The final model was an excellent fit to the data (χ2 (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (β = 0.28, p < 0.001), reduced falls rates (β = −0.14, p < 0.05) and better patient satisfaction (β = −0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (β = 0.20, p < 0.01). Perceived organization support (β = 0.40, p < 0.001) and leader–member exchange (β = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (β = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether. Conclusion: Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes. Impact: This investigation into a real-world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.