Task-Oriented Leadership as an Unfavorable Style: Examining the Relationship between Head Nurses’ Leadership Styles and Nursing Staff Satisfaction in a Comparative Study of Specialized and General Wards

Task-Oriented Leadership as an Unfavorable Style: Examining the Relationship between Head Nurses’ Leadership Styles and Nursing Staff Satisfaction in a Comparative Study of Specialized and General Wards | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Task-Oriented Leadership as an Unfavorable Style: Examining the Relationship between Head Nurses’ Leadership Styles and Nursing Staff Satisfaction in a Comparative Study of Specialized and General Wards Mohsen Kamali, Amirmohammad Atashinsadaf This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8230767/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background Leadership style is an essential factor influencing the satisfaction of nursing staff with supervision and their overall professional performance. This study aimed to examine the Relationship between Head Nurses’ Leadership Styles and Nursing Staff Satisfaction in a Comparative Study of Specialized and General Wards. Methods This cross-sectional study surveyed all nurses and head nurses in six hospitals affiliated with Zanjan University of Medical Sciences (Iran), comprising 1,354 participants from specialized and general wards. Data were collected using a demographic questionnaire, the Fiedler and Chemers Leadership Style Inventory, and a Supervisor Satisfaction Questionnaire. Analyses were performed using SPSS version 26, employing correlation, ANOVA, and regression analyses. Results At first, the study found that nurses in both specialized and general wards reported relatively high satisfaction with their head nurses. Also, the predominant leadership styles were integrated in specialized wards and relationship-oriented in general wards. However, in both wards, task-oriented leadership showed the lowest satisfaction scores. ANOVA and post-hoc tests confirmed that both integrated and relationship-oriented leadership styles resulted in significantly higher satisfaction compared to the task-oriented style. Regression analyses revealed that leadership styles accounted for 77% of the variance in specialized wards and 75% in general wards. Conclusion Understanding leadership styles can help optimize management structures and enhance the quality of health service delivery. Hospital administrators should pay close attention to this issue. Our findings indicated that one key factor influencing nurses’ satisfaction with their head nurses is the leadership style of those head nurses. Nurses were more satisfied with relationship-oriented and integrated leadership styles, whereas exclusive reliance on a task-oriented style was associated with lower satisfaction. Head Nurses Leadership Nurses Job Satisfaction Introduction Management plays a vital role in all areas of social activity [ 1 ]. In simple terms, it is the art of influencing and persuading people so that one person’s actions can lead to changes in others’ behavior and attitudes [ 2 ]. Managers set goals, guide their teams, and monitor performance to make sure those goals are met [ 3 ]. How they lead their teams—their leadership style —can significantly impact the results [ 4 , 5 ]. Over the years, scholars have identified numerous leadership styles, including autocratic, consultative, participative, servant, transformational, charismatic, and others [ 2 , 6 ]. A well-known classification from the University of Michigan categorizes these styles into three main types: relationship-oriented, task-oriented, and integrated [ 7 ]. Other styles often fall under one of these three categories. Relationship-oriented leadership focuses on the needs, feelings, and satisfaction of team members. Leaders create personal connections through open communication, delegating tasks effectively, and providing opportunities for people to grow. It is built on support, friendship, and trust [ 8 ]. Task-oriented leaders prioritize organizational goals, ensuring that everyone is clear about what needs to be done, when it needs to be done, and how it needs to be done. The integrated style combines both approaches, aiming to achieve tasks while also prioritizing the social and emotional well-being of staff [ 8 , 9 ]. Leadership—whatever its form—has a significant impact on efficiency, effectiveness, and overall productivity [ 10 , 11 ]. Every organization needs a leadership style that helps it reach its goals [ 12 ]. Hospitals, as the backbone of health care systems, especially require strong leadership [ 13 ]. This issue is fundamental in nursing, the largest workforce in healthcare, because nurses ensure continuity of care and improve patient health outcomes [ 14 ]. Head nurses work closely with other nursing staff, so their approach to leadership can influence the team more than almost any other managerial role. Recognizing their leadership style can help prevent conflicts and inefficiencies that reduce the quality of care [ 15 ]. Research in Iran and other countries has linked leadership style to many workplace outcomes—job satisfaction [ 2 , 16 , 17 ], creativity [ 18 , 19 ], burnout [ 20 , 21 ], intent to leave or migrate [ 22 , 23 ], stress [ 24 , 25 ], organizational commitment [ 26 , 27 ], quality of patient care [ 28 , 29 ], and motivation [ 30 , 31 ]. Most studies agree: leadership style matters. Among these outcomes, nurses’ job satisfaction stands out. It reflects how positively or negatively they feel about their work and influences other important results [ 32 ]. High job satisfaction is linked with better performance, commitment, morale, and enthusiasm for the profession, while low satisfaction can lead to absenteeism, resignation, poor service, burnout, and stress [ 33 , 34 ]. Job satisfaction depends on several factors, including salary, benefits, work climate, the nature of the job, supportive behavior, and relationships with colleagues and supervisors [ 35 ]. Unlike studies that examine job satisfaction in general, this research focuses specifically on nurses’ satisfaction with their head nurses, a key component of overall satisfaction [ 36 ]. The quality of nursing supervision is a crucial predictor of staff retention, well-being, and patient outcomes. Despite much research recognizing the fundamental role of head nurses’ leadership styles, a persistent knowledge gap remains regarding the differential impact of common styles—namely, relationship-oriented, integrated, and task-oriented—on staff satisfaction across diverse clinical settings. A granular understanding of this relationship is essential for developing evidence-based managerial policies in healthcare systems globally. Materials and Methods Design and setting(s) This descriptive–correlational study examined the relationship between head nurses’ leadership styles and the nursing staff satisfaction working in teaching and medical hospitals affiliated with Zanjan University of Medical Sciences, namely Ayatollah Mousavi, Valiasr, and Shahid Beheshti in Zanjan, Emdadi and Al‑Ghadir in Abhar, and finally Bu‑Ali Sina in Khorramdarreh during September 2024 to March 2025. Participants and Sampling Because hospital wards differ in their work environment—such as shift patterns, workload, and patient types—and some wards are found only in certain hospitals, the researchers decided to include every nurse and head nurse in their survey. This “census” approach helped reduce bias and make the results more widely applicable. Participation was limited to those with at least a bachelor’s degree in nursing and a minimum of six months’ experience in their current ward. The degree requirement ensured they had completed the “Nursing Management” course and possessed basic knowledge of the topic. Nursing assistants and staff without a bachelor’s degree were omitted. Initially, 1,548 nurses and head nurses were identified. For statistical convenience, the wards were classified—based on Ministry of Health definitions—into 31 specialized wards and 40 general wards. Tools/Instruments Data were collected using three instruments. The first was a demographic questionnaire for both nurses and head nurses, covering age, gender, marital status, education level, hospital, ward, shift type, work experience, job position, employment type, average monthly working hours, and average monthly overtime. Content validity was confirmed through expert review by 10 faculty members from the School of Nursing and Midwifery. The second was the Fiedler and Chemers Leadership Style Inventory (LSI), a standardized tool that identifies relationship-oriented, task-oriented, or integrated leadership styles. The Persian version comprises 18 items, rated on an 8-point Likert scale. In this study, participants in each ward completed the LSI, and the ward’s leadership style was determined by combining the head nurse’s score with the average score of nurses in that ward. Scores of 64 and above were classified as relationship‑oriented, scores of 57 or less as task‑oriented, and scores between 58 and 63 as integrated styles [ 37 ]. Reliability was verified with a Cronbach’s alpha of 0.90 in a pilot study involving 20 respondents; content validity was reconfirmed via review by 10 faculty experts. The third instrument was a researcher‑developed Supervisor Satisfaction Questionnaire, created to specifically assess satisfaction with head nurses rather than general job satisfaction. After analyzing 12 existing job satisfaction tools (including JSS, Herzberg, Spector, Minnesota, and Brayfield & Rothe), items related to leadership style were extracted, redundancies removed, and wording adjusted. The preliminary version underwent expert review by 20 faculty members, was refined in consensus meetings, and was quantitatively validated. The Supervisor Satisfaction Questionnaire demonstrated strong validity and reliability. Its overall Content Validity Ratio (CVR) was 0.98, well above the Lawshe benchmark, and the Content Validity Index (CVI) scores were high for all criteria: 0.89 for relevance, 0.93 for clarity, and 0.90 for simplicity [ 38 ]. In the test–retest analysis, the correlation coefficient was 0.792, and Cohen’s kappa reached 0.817, indicating good consistency in responses over time. Construct validity was confirmed with a Kaiser–Meyer–Olkin measure of sampling adequacy(KMO) of 0.824 and a significant Bartlett’s test (P < 0.05). Factor analysis (PCA with varimax rotation) identified five precise dimensions: Communication (4 items), Supportiveness (4 items), Fairness in task or shift allocation (4 items), Competence (4 items), and Empowerment (4 items), with strong factor loadings across items in each category. The completed questionnaire consisted of 20 items, each rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Total scores were grouped into low satisfaction (20–38), moderate satisfaction (39–57), and high satisfaction (58 and above). Data collection methods Because the study employed a census approach, data collection spanned almost six months, with researchers visiting each ward across all three shifts (morning, evening, and night) to maximize participation. After applying the inclusion criteria, 86 nurses were excluded because they had insufficient work experience. During the study period, 48 participants were excluded because they were on extended leave, 39 chose not to participate, and 21 submitted incomplete questionnaires. This action left a final sample of 1,354 nurses and head nurses for analysis. Data analysis Data were processed using SPSS version 22. Descriptive statistics—such as mean, standard deviation, frequency, and percentage—were used to summarize demographic information, leadership styles, and satisfaction levels. The Shapiro–Wilk test was used to check whether the data were normally distributed, and appropriate statistical tests were then applied based on the results. Inferential analyses were performed with Pearson correlation, independent t‑test, and one‑way ANOVA. Multiple linear regression was then used to identify predictors of supervisor satisfaction and estimate the contribution of each variable. Statistical significance was set at P ≤ 0.05, and results were presented in tables. Results Demographic characteristics evaluation Initially, our findings indicated that most head nurses in specialized wards were women (approximately 90%), and the majority were married (approximately 96%). Their mean (SD) age was 48.45 (3.23) years, and their mean (SD) work experience was 22.14 (4.86) years. A bachelor’s degree was the highest level of education for the majority (about 83%). All were employed permanently, and none were working under a contractual arrangement. More than 80% had fixed shifts, with the majority working morning shifts. Additionally, they worked an average of 156.96 ± 12.98 hours per month (including both regular hours and overtime), with a mean monthly overtime of 21.82 ± 10.55 hours. In this regard, head nurses in general wards generally shared a similar profile with specialized wards: most were female (85%) and married (95%). Their mean (SD) ages and work experiences were 42.50 (5.36) years and 21.65 (6.06) years, respectively. Bachelor’s degrees were also most common (75.92%), with all in permanent employment. Eighty percent worked fixed shifts. Average total work time and overtime were 160.77 ± 15.21 hours and 22.09 ± 8.34 hours per month, respectively. Approximately 70% of the nurses were female, and most (74%) were married. The largest age group was 30–40 years (58.49%). Most (56%) had between 5 and 15 years of work experience, with a mean of 13.54 ± 6.34 years. Eighty‑eight percent held a bachelor’s degree, and about 74% were in permanent status. Shift schedules were primarily rotational, and the average total work time was 170.75 ± 22.54 hours per month, including 58.46 ± 17.70 hours of overtime. In the continuing care setting, as in specialized wards, most nurses were female (approximately 80%) and married (64%). Nearly half (47%) fell into the younger age range of 20–30 years. Most had between six months and five years of work experience (36%). Bachelor’s degrees were held by approximately 91% of nurses, and 410 were in a permanent employment status. About 78% worked rotational shifts. Average total work time was 190.69 ± 24.24 hours per month, with 52.13 ± 16.16 hours of overtime. The demographic information of the participants in this study is presented in Table 1 , categorized by ward type and job position. Satisfaction with Head Nurses The evaluation results of nurses’ satisfaction with their head nurses in this study indicated that the mean satisfaction score in specialized wards was 74.77 ± 2.38, while in general wards it was 61.64 ± 3.01. The findings reflected a relatively high level of satisfaction with head nurses in both types of wards; however, the results of the independent t‑test revealed that the difference between the two groups was not statistically significant (Table 2 ). Table 1 The demographic information of the participants based on ward type and job position Variable Ward Position Category Frequency (%) Gender Specialized Head Nurse Male 3 (9.68%) Female 28 (90.32%) Nurse Male 218 (30.9%) Female 488 (69.1%) General Head Nurse Male 6 (15%) Female 34 (85%) Nurse Male 114 (19.76%) Female 463 (80.24%) Marital Status Specialized Head Nurse Single 1 (3.23%) Married 3 (96.77%) Nurse Single 183 (25.92%) Married 523 (74.08%) General Head Nurse Single 2 (5%) Married 38 (95%) Nurse Single 204 (35.36%) Married 373 (64.64%) Educational Level Specialized Head Nurse Bachelor 26 (83.87%) Master 5 (16.13%) Nurse Bachelor 628 (88.95%) Master 78 (11.05%) General Head Nurse Bachelor 37 (92.5%) Master 3 (7.5%) Nurse Bachelor 525 (90.99%) Master 52 (9.01%) Employment Status Specialized Head Nurse Permanent 31 (100%) Contractual 0 (0%) Nurse Permanent 528 (74.79%) Contractual 178 (25.21%) General Head Nurse Permanent 40 (100%) Contractual 0 (0%) Nurse Permanent 410 (71.06%) Contractual 167 (28.94%) Work Shift Specialized Head Nurse Fixed 25 (80.65%) Rotating 6 (19.35%) Nurse Fixed 166 (33.51%) Rotating 540 (76.49%) General Head Nurse Fixed 32 (82%) Rotating 8 (20%) Nurse Fixed 123 (21.32%) Rotating 454 (78.68%) In specialized wards, nurses ranked competence, empowerment, communication, supportiveness, and fairness as the main contributors to satisfaction, respectively. In general wards, the top satisfaction factors were communication, empowerment, competence, supportiveness, and fairness. Based on this, most nurses in specialized wards viewed their head nurses as capable leaders who granted autonomy and maintained strong and trusting communication. In general wards, most of them valued good communication and autonomy provided by their head nurses. Notably, supportiveness and fairness received the lowest scores in both ward types. Lack of adequate support during problems and unfair scheduling or task distribution were the primary sources of dissatisfaction. Table 2 The results of the Satisfaction with Head Nurses scores and its dimensions in specialized and general wards Satisfaction with Head Nurses Wards Mean SD Mean Difference P Communication Specialized 15.46 3.56 1.38 0.28 General 14.08 2.12 Supportiveness Specialized 14.29 4.31 3.51 0.19 General 10.78 3.33 Fairness Specialized 12.31 4.47 3.24 0.16 General 9.07 2.19 Competence Specialized 17.13 3.21 3.36 0.16 General 13.77 4.08 Empowerment Specialized 15.58 2.25 1.64 0.24 General 13.94 4.71 Total Specialized 74.77 2.38 13.1 0.061 General 61.67 3.01 Relationships between nurses’ demographics and their satisfaction with Head Nurses Pearson correlations revealed that in specialized wards, overall satisfaction scores were significantly related to age (r = 0.645, P = 0.001) and work experience (r = 0.516, P = 0.012). Also, independent t‑tests indicated significant differences by gender (P 0.05). Similar to specialized wards, in general, significant correlations were observed between satisfaction and age (r = 0.446, P = 0.042), work experience (r = 0.471, P = 0.029), total monthly work hours (r = 0.301, P = 0.010), and overtime (r = 0.610, P = 0.031). Satisfaction also varied significantly by gender (t = − 12.32, P = 0.003) and shift type (t = 16.50, P = 0.033), but not by marital status, education, or employment type (P > 0.05). These results indicate that nurses in both specialized and general wards felt increasingly satisfied with the performance of their head nurses as their age and work experience increased. Additionally, it is worth noting that female nurses and those with fixed shifts were more satisfied. In Table 3 , details of the relationship between satisfaction with head nurses by gender and work shift are provided. Table 3 Relationship between satisfaction with head nurses by gender and work shift Variable Ward Category Mean SD Standard Error df T P Satisfaction by Gender Specialized Male 71.09 7.93 0.53 704 -12.42 0.00 Female 78.45 7.50 0.35 General Male 56.97 8.80 0.80 575 -10.35 0.00 Female 66.33 6.31 0.31 Satisfaction by Work Shift Specialized Fixed 81.79 7.66 0.76 704 20.41 0.02 Rotating 67.76 10.82 0.46 General Fixed 66.34 3.20 0.28 575 16.5 0.03 Rotating 56.95 6.07 0.37 Leadership styles To assess the leadership style, the scores obtained from the questionnaire in each ward were first collected, and then the leadership style of each ward was calculated separately. Based on this procedure, our results showed that in specialized wards, the most common leadership style among head nurses was an integrated one (19 wards). In contrast, in general wards, the relationship was generally oriented (23 wards). The task-oriented leadership style was the least common overall, appearing in only nine of the 71 wards. Additionally, the results revealed that only the difference in the mean score of the integrated leadership style between specialized and general wards was statistically significant (P < 0.05). This result indicates that head nurses in specialized wards employed this leadership style more frequently than those in general wards. Table 4 presents the mean and standard deviation of the Leadership style scores for head nurses, categorized by specialized and general wards. Relationships between Head nurses’ demographics and Leadership styles On the other hand, our evaluation about the relationship between leadership styles and demographic characteristics of head nurses in specialized wards revealed that the task-oriented styles were more common among head nurses aged 30–40 with 10–20 years of experience, integrated styles among those aged 40–50 with 20–25 years of experience, and relationship-oriented styles among those aged 50–60 with 25–30 years of experience. In general wards, similar patterns emerged: task orientation was frequent among head nurses aged 30–40 with 10–20 years of experience, relationship orientation among those aged 40–50 with 20–25 years of experience, and integrated styles among those aged 50–60 with 25–30 years of experience. This trend suggests a shift from a task-oriented to a relationship-oriented approach as age and experience increase. Table 4 Mean (SD) score of Leadership styles of Head Nurses based on the hospital wards Leadership styles Wards Mean SD Mean Difference P Relationship-oriented Specialized 71.25 2.49 5.73 0.18 General 65.52 6.02 Task-oriented Specialized 59 4.08 9.6 0.25 General 49.40 4.77 Integrated Specialized 79.43 4.52 19.77 0.034 General 59.66 4.90 Relationship between Head nurses’ leadership style and satisfaction of nurses In line with the primary objective of the present study, after identifying the leadership styles of each ward (three styles) and determining nurses’ satisfaction levels, the ANOVA statistical test was employed for data analysis. As shown in Table 5 , our findings indicated significant differences in satisfaction scores across leadership styles in both specialized wards (F (2, 28) = 20.05, P < 0.05) and general wards (F (2, 37) = 18.28, P < 0.05). For a better understanding, the Post-hoc Tukey tests revealed that in specialized wards, satisfaction was highest with integrated leadership, followed by relationship-oriented leadership, and lowest with task-oriented leadership. Table 5 Comparison of nurses’ satisfaction scores across leadership styles in specialized and general wards Variables Wards leadership style F P Total Satisfaction with Head Nurses Specialized Relationship-oriented 20.05 0.019 Task-oriented Integrated General Relationship-oriented 18.28 0.022 Task-oriented Integrated However, in specialized wards, a statistically significant association was observed only between the relationship-oriented and task-oriented leadership styles, as well as between the integrated and task-oriented styles (P 0.05). This result suggests that both relationship-oriented and integrated leadership styles yielded higher levels of nurse satisfaction compared to the task-oriented style. In general wards, satisfaction was highest with relationship-oriented styles, followed by integrated styles, and lowest with task-oriented styles. Similarly, in these wards, a statistically significant relationship was observed only between the relationship-oriented and task-oriented leadership styles, as well as between the integrated and task-oriented styles (P 0.05). This finding indicates that both the relationship-oriented and integrated leadership styles resulted in higher levels of nurse satisfaction compared to the task-oriented style (Table 6 ). Table 6 Post-hoc Tukey test comparing nurses’ satisfaction across leadership styles in special and general wards Wards leadership style Mean Difference P Specialized Relationship-oriented Task-oriented 12.25 0.023 Integrated -8.18 0.061 Task-oriented Relationship-oriented -12.25 0.023 Integrated -20.43 0.005 Integrated Relationship-oriented 8.18 0.061 Task-oriented 20.43 0.005 General Relationship-oriented Task-oriented 16.12 0.012 Integrated 5.86 0.085 Task-oriented Relationship-oriented -16.12 0.012 Integrated -10.26 0.046 Integrated Task-oriented 10.26 0.046 Relationship-oriented -5.86 0.085 Multiple linear regression After adjusting for individual and occupational variables, the regression models for specialized wards significantly predicted satisfaction (F (3, 27) = 28.74, P < 0.05), with R² = 0.77, indicating that 77% of the variance in satisfaction was explained by leadership style. Regression coefficients showed positive associations for relationship‑orientation (B = 0.65) and integrated style (B = 0.87), and a negative association for task‑orientation (B = − 0.39). A one‑unit increase in relationship‑orientation or integrated style corresponded to increases of 0.65 and 0.87 units in satisfaction, respectively. In contrast, a one‑unit increase in task‑orientation corresponded to a decrease of 0.39 units. In general wards, the model also significantly predicted satisfaction (F (3, 36) = 32.28, p < 0.005), with an R² of 0.75. Relationship‑orientation (B = 0.57) and integrated style (B = 0.50) were positive predictors of satisfaction, while task‑orientation (B = − 0.25) was a negative predictor (Table 7 ). In summary, the regression analyses indicated that both relationship-oriented and integrated leadership styles had the most potent positive effects on nurses’ satisfaction. In contrast, the task-oriented style showed a negative association. This pattern was consistent across specialized and general wards, where leadership style significantly explained a large proportion of variance in satisfaction (77% and 75%, respectively). Table 7 Multiple linear regression results predicting nurses’ satisfaction across leadership styles in specialized and general wards Ward Predictor B F R2 P Specialized Relationship-oriented 0.65 28.74 0.77 0.00 Task-oriented -0.39 Integrated 0.87 General Relationship-oriented 0.57 32.28 0.75 0.00 Task-oriented -0.25 Integrated 0.50 Discussion This study aimed to examine the relationship between head nurses’ leadership styles—relationship-oriented, integrated, and task-oriented—and the satisfaction of nursing staff with their head nurses in teaching medical hospitals affiliated with Zanjan University of Medical Sciences. The results showed that in both specialized and general wards, the majority of nurses and head nurses were women, married, held a bachelor’s degree, and reported a moderate income level. Among head nurses, those in specialized wards were older and had more years of work experience than those in general wards. In line with their greater age and seniority, head nurses in specialized wards worked fewer total and overtime hours per month compared to their counterparts in general wards. However, in both ward types, most head nurses had fixed shifts and all were in permanent employment. Nurses in specialized wards also tended to be older, worked fewer total and overtime hours, and were more likely to hold permanent positions or a master’s degree. These patterns suggest that human resource management in the studied hospitals placed individuals with higher age, longer experience, and advanced education in the specialized wards—likely due to the greater complexity and sensitivity of the work, as well as the need for experienced staff to care for critically ill patients. The distribution of leadership styles varied between ward types. In specialized wards, integrated leadership was most common, followed by relationship-oriented and task-oriented styles. In general wards, relationship-oriented leadership dominated, followed by integrated and task-oriented styles. The relationship between the demographics of head nurses and their leadership style was significant (P < 0.05). In both ward types, younger head nurses with 10–20 years of experience preferred a task-oriented style. Head nurses with 20–25 years of experience opted for integrated leadership in specialized wards and relationship-oriented leadership in general wards. Those with 25–30 years of experience used relationship-oriented leadership in specialized wards and integrated leadership in general wards. These findings suggest that younger head nurses tend to focus more on organizational goals and task management. In contrast, those with longer experience view relationship-oriented or integrated styles as more suitable. Previous research has linked the use of relationship-oriented and integrated leadership to greater skill in managing stress through interpersonal connections, which is consistent with its prevalence among more experienced head nurses [ 39 ]. Analysis of satisfaction scores revealed that, in both specialized and general wards, the mean satisfaction with head nurses was high, as indicated by the study instrument. However, it was slightly higher in specialized wards. In specialized wards, competence was rated highest, while in general wards, communication was rated highest; fairness scored lowest in both settings. In specialized wards, nurses valued their head nurses’ ability, talent, and capacity for effective management, often viewing them as ideal leaders. In general wards, nurses most appreciated their head nurses’ ability to maintain good communication. In both contexts, dissatisfaction often stemmed from unfair monthly schedules or unequal task distribution. It is essential to recognize that satisfaction with the head nurse is distinct from overall job satisfaction—it represents just one dimension of job satisfaction, which also encompasses factors such as organizational climate, salary and benefits, nature of work, support, and relationships with colleagues. Inferential statistics revealed significant associations between job satisfaction and specific demographic variables (P < 0.05). Satisfaction was higher among nurses over 35 years old and those with more than 20 years of experience. This finding aligns with studies by Mamić [ 40 ], Matagi [ 41 ], Ghaleh [ 42 ], Medeni [ 43 ], and Antoine [ 44 ], which reported greater satisfaction among older staff members compared to their younger colleagues. Low age in nursing can be accompanied by unrealistic workplace expectations, limited cooperation from peers or supervisors, work-related stress, lower income, and increased total and overtime hours due to lack of seniority—all of which may directly or indirectly reduce satisfaction with head nurses and overall job satisfaction. Gender differences were also notable: female nurses reported higher satisfaction with their workplace and head nurse than their male counterparts, a finding supported by multiple studies [ 45 – 47 ]. This result may be explained by the compatibility of women’s dispositions with the caregiving nature of nursing, as well as working in environments where most staff and leadership are female—factors that can positively shape attitudes toward the profession, colleagues, and managers. In general wards, nurses with fewer total and overtime hours reported greater satisfaction, consistent with studies by Hellín Gil [ 48 ], Elsayed [ 49 ], and Geier [ 50 ]. Extended time on duty and prolonged separation from family may lower satisfaction with the profession and with head nurses, especially given their role in allocating workload and overtime. Nurses with fixed shifts were more satisfied than those with rotating shifts, a finding supported by prior research [ 51 – 54 ]. Fixed shifts enable better life planning and create a stable work routine, leading to higher satisfaction compared to irregular schedules and rotating shifts—especially those involving nights—that are often associated with gastrointestinal problems, sleep disorders, psychological symptoms, and cardiovascular issues [ 55 – 57 ]. These health impacts can themselves diminish job satisfaction and, by extension, satisfaction with the head nurse responsible for scheduling. Moreover, fixed shifts are often assigned to more experienced nurses, which can further explain the association with higher satisfaction. Inferential findings also revealed significant associations between satisfaction and leadership style in both specialized and general wards (P < 0.05). In specialized wards, satisfaction was highest with integrated leadership, followed by relationship orientation, and lowest with task orientation. In general wards, satisfaction was highest with a relationship-oriented approach, followed by an integrated style, with task-oriented approaches again being the lowest. In the specialized wards, nurses preferred leaders who balanced effective task management with strong interpersonal relationships. In contrast, leaders who focused solely on tasks—often younger and less experienced—were less well received. In general wards, leaders who prioritized human relationships or used an integrated approach were preferred, while task orientation was similarly unpopular. Overall, satisfaction with head nurses was higher under relationship-oriented and integrated leadership, and lower under task-oriented leadership. These findings are consistent with many previous studies reporting greater satisfaction with relationship-oriented and integrated styles compared to task-oriented approaches [ 58 – 63 ]. However, they contrast with some studies that identified task-oriented approaches as a better predictor of satisfaction through enhanced organizational oversight and ethical decision-making [ 64 – 66 ]. Strengths A significant strength of our study is the large and representative sample. We included almost all nurses working in the hospitals of Zanjan University of Medical Sciences. The large sample size strengthened our statistical results, making them more robust and facilitating easier generalization. Additionally, we collected all the data in person and face-to-face at the hospitals, which ensured that almost everyone participated and reduced the likelihood of mistakes from unanswered surveys. Furthermore, the tool we used to measure satisfaction with head nurses was special. We built it ourselves based on several trusted international surveys, which means it was accurate for the specific work culture of Iranian nurses. Limitations Because we employed a one-time, cross-sectional design, we could not determine whether the leadership style directly caused the satisfaction level. We only saw the relationship at a single moment. Since nurses completed self-report questionnaires, their answers may be influenced by factors such as a desire to appear favorable (social desirability bias). Additionally, the research was conducted only in hospitals in one province, so the findings may not be entirely applicable to other parts of Iran or globally. Finally, we did not account for other factors, such as the workload's intensity or the resources available on different wards, which might have subtly influenced the nurses’ opinions. Nursing implications Leadership style is a primary determinant of nurses’ supervisory satisfaction, with task-oriented leadership consistently associated with lower satisfaction in both specialized and general wards. Integrated leadership is more effective in specialized wards, whereas general wards show higher satisfaction under relationship-oriented leadership. Health-care administrators should prioritize leadership development initiatives that reinforce relational, supportive, and flexible competencies among head nurses. Structural issues—particularly workload equity, scheduling fairness, and availability of managerial support—require targeted policy interventions alongside leadership reforms. Further research is needed to examine contextual Conclusions Head nurses have an important role in nurses’ job satisfaction by interacting daily with staff. Their leadership style directly influences team function, job performance, and the alignment between individual and organizational goals. The results of this study show that nurses are more satisfied when their head nurse's leadership style aligns with the specific needs and working conditions of their ward. Nurses in specialized wards preferred an integrated leadership style that balances task completion with attention to interpersonal relationships. In general wards, nurses favored a relationship-oriented style, where empathy, open communication, and emotional support are central. In contrast, a task-oriented leadership style was associated with lower satisfaction in both ward types. This pattern suggests that when supervision becomes too strict and focused mainly on procedures, nurses may feel less empowered, less fairly treated, and less connected to their work environment. These findings highlight that leadership style is a key factor in both nurses’ well-being and the overall effectiveness of healthcare organizations. Hospital administrators should therefore avoid relying too heavily on task-focused leadership. Instead, they should encourage head nurses to adopt approaches that combine relational, supportive, and flexible behaviors. Practical strategies such as leadership training, mentoring programs, and regular performance feedback can help head nurses strengthen these human-centered leadership skills. Beyond leadership, the study also revealed other important sources of dissatisfaction — minimal managerial support and unequal distribution of duties and shifts. These issues require immediate attention from hospital management. Overall, to improve satisfaction and retention, head nurses should promote fairness in work schedules, provide consistent support, and act as advocates for their teams. A fair and supportive leadership climate fosters stronger trust, a greater sense of belonging, and higher commitment — all of which help maintain staff stability and ensure high-quality patient care. Abbreviations LSI Leadership Style Inventory CVR Content Validity Ratio CVI Content Validity Index KMO Kaiser–Meyer–Olkin Declarations Acknowledgements The authors would like to thank all the participants in the selected hospitals who helped to obtain the results. Author contributions MK: Supervision of data collection, Data analyzing, writing the initial draft, collating feedback, editing, and reviewing the final version. A.A: Conceptualization of study, data gathering, writing the initial draft, collating feedback, and reviewing the final version. Funding This study was funded by Zanjan University of medical sciences, which we thank sincerely. Data availability The data and materials that support the findings of this study are available on reasonable request from the corresponding author. Ethics approval and consent to participate This study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Zanjan University of Medical Sciences (IR.ZUMS.REC.1403.220) , and the hospital administrators granted permission to proceed. All participants received a clear explanation of the study, provided written informed consent, and were assured that all information would be kept confidential. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details Department of Nursing, Abhar School of Nursing, Zanjan University of Medical Sciences, Zanjan, Iran. References Benmira S, Agboola M. Evolution of leadership theory. BMJ leader. 2021:leader-2020-000296. Specchia ML, Cozzolino MR, Carini E, Di Pilla A, Galletti C, Ricciardi W, Damiani G. Leadership styles and nurses’ job satisfaction. Results of a systematic review. International journal of environmental research and public health. 2021;18(4):1552. Yu-Wen L, Chung-Fan N, Shu-Fen H, Shiow-Luan T, Heng-Hsin T. Effects of length of employment and head nurse leadership style on the clinical competency of staff nurses in Taiwan. Journal of Nursing Research. 2024;32(3):e331. Bwalya A. Leadership styles. Global Scientific Journal. 2023;11(8). Hundie ZA, Habtewold EM. The Effect of transformational, transactional, and laissez-faire leadership styles on employees’ level of performance: the case of hospital in Oromia Region, Ethiopia. Journal of healthcare leadership. 2024:67-82. Fischer T, Sitkin SB. Leadership styles: A comprehensive assessment and way forward. Academy of Management Annals. 2023;17(1):331-72. Ramos OAM, de Sá JAFTM, Gomes JMPA, Galvão AMNP, Gomes MJAR. Influence of leadership style on nurses’ structural empowerment: a cross-sectional study. Cogitare Enfermagem. 2025;30:e97126. Ali A, Siddiqui DA. How Relation-Oriented, Task-Oriented and Objective-Oriented Leadership Affect Employee Performance During the Pandemic: The Mediatory Role of Individual Job Autonomy, and Work Tension, as Well as Team Cohesiveness, Teamwork Tension, Complemented by Digital Maturity. Task-Oriented and Objective-Oriented Leadership Affect Employee Performance During the Pandemic: The Mediatory Role of Individual Job Autonomy, and Work Tension, as Well as Team Cohesiveness, Teamwork Tension, Complemented by Digital Maturity (April 28, 2023). 2023. Islam S, Schmidt GB. The Importance of Balance to Leadership. Elements of Leadership: Lessons from Avatar The Last Airbender: Emerald Publishing Limited; 2024. p. 9-19. Alghizzawi M, Megdadi Y, Al Shibly MS, Alkhlaifat BI, Alzeaideen K, Ali M. The impact of leadership style on improve performance: A comparative approach. Artificial intelligence and economic sustainability in the era of industrial revolution 50: Springer; 2024. p. 1341-54. Udin U. Leadership styles and sustainable performance. Multidisciplinary Reviews. 2024;7(8):2024171-. Costa J, Pádua M, Moreira AC. Leadership styles and innovation management: What is the role of human capital? Administrative Sciences. 2023;13(2):47. Aini Q, Dzakiyullah NR. Leadership styles in healthcare settings for hospital management and employee engagement. Integrative Biomedical Research. 2024;8(5):1-7. Kamaryati NP, Suyasa IGPD, Susanti NLPD, Dewi NMRC, Susanti NPA, Wahyu IMY. Leadership in Nursing: Styles, Challenges, and Barriers. Babali Nursing Research. 2024;5(4):631-49. Qtait M. Systematic review of head nurse leadership style and nurse performance. International Journal of Africa Nursing Sciences. 2023;18:100564. Al-Bashaireh AM, Aljawarneh Y, Khraisat OMA, Alblooshi K, Almesmari M, Alsaadi M, et al., editors. The Relationship Between Managers’ Leadership Styles and Registered Nurses’ Job Satisfaction and Work Engagement: A Cross‐Sectional Study in the United Arab Emirates. Nursing Forum; 2025: Wiley Online Library. Ismael H, Sleem W, Abd el-Ghani A. Relationship Between Transformational Leadership Style and Job Satisfaction among Nurse. Mansoura Nursing Journal. 2024;11(1):357-68. Abd El Muksoud NO, Metwally FG, Ata AA. Leadership behaviors and innovative work behaviors among nurses. Zagazig Nursing Journal. 2022;18(2):1-14. Labrague LJ, Toquero LM. Leadership styles and nurses' innovative behaviors: a systematic review. JONA: The Journal of Nursing Administration. 2023;53(10):547-53. Hall VP, White KM, Morrison J. The influence of leadership style and nurse empowerment on burnout. Nursing Clinics. 2022;57(1):131-41. Onan G, Sürücü L, Bekmezci M, Dalmış AB, Sunman G. Relationships Between Positive Leadership Styles, Psychological Resilience, and Burnout: An Empirical Study Among Turkish Teachers. Behavioral Sciences. 2025;15(6):713. Mozolová V, Tupá M. Migration intentions of nurses and nursing students from Slovakia: A study on drivers. Problems and perspectives in management. 2024;22(1):534. Suliman M, Almansi S, Mrayyan M, ALBashtawy M, Aljezawi M. Effect of nurse managers’ leadership styles on predicted nurse turnover. Nursing management. 2024;31(5). Pishgooie AH, Atashzadeh‐Shoorideh F, Falcó‐Pegueroles A, Lotfi Z. Correlation between nursing managers’ leadership styles and nurses' job stress and anticipated turnover. Journal of nursing management. 2019;27(3):527-34. Aslan M, Sönmez S, Deniz M. Leadership styles and work stress: the role of workplace climate and feelings of entrapment. Current Psychology. 2025:1-14. Oyewobi LO. Leadership styles and employees commitment: the mediating role of job satisfaction. Journal of Facilities Management. 2024;22(5):737-57. Borde PS, Arora R, Kakoty S. Linkages of organizational commitment and leadership styles: a systematic review. European Journal of Training and Development. 2024;48(1/2):41-66. Al-Rjoub S, Alsharawneh A, Alhawajreh MJ, Othman EH. Exploring the impact of transformational and transactional style of leadership on nursing care performance and patient outcomes. Journal of Healthcare Leadership. 2024:557-68. Raziq MM, Wazir R, Memon MA, Rice JL, Moazzam M. Empowering leadership, employee organizational commitment and organizational citizenship behavior: the roles of leader authenticity and trust. International Journal of Productivity and Performance Management. 2025;74(1):81-106. Calluso C, Devetag MG, editors. The impact of leadership preferences and personality traits on employees’ motivation. Evidence-based HRM: a Global Forum for Empirical Scholarship; 2025: Emerald Publishing Limited. Sokolic D, Croitoru G, Florea NV, Robescu VO, Cosac A. The effect of leadership styles on employee motivation and organizational performance in public sector organizations. Valahian Journal of Economic Studies. 2024;15(1):53-72. Baxi B, Atre D. Exploring Job Satisfaction: Understanding the Meaning, Importance, and Dimensions. J Manag Entrep. 2024;18:1-10. Memon AH, Khahro SH, Memon NA, Memon ZA, Mustafa A. Relationship between job satisfaction and employee performance in the construction industry of Pakistan. Sustainability. 2023;15(11):8699. Wong FMF. Job satisfaction in nursing: A qualitative inquiry into novice and experienced nurses' perspectives. Nurse Education in Practice. 2024;78:104018. Karaferis D, Aletras V, Niakas D. Determining dimensions of job satisfaction in healthcare using factor analysis. BMC psychology. 2022;10(1):240. Ghanbari R. Job satisfaction and its related factors in pre-hospital and hospital emergency nurses of Ahvaz Jundishapur university of medical sciences. Iranian Journal of Nursing Research. 2021;15(6):29-36. Reams LC. Fred Fiedler’s contingency model revisited: 30 years later. Filosofiya osvity Philosophy of Education. 2023;29(1):111-24. Polit DF BC, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing & health. 2007 Aug;30(4):459-67. Mujtaba B VP, Salamzadeh Y, Topaloglu E. Employee Stress Сaused by Socioeconomic Challenges: Task and Relationship Management as a Buffer to Mitigate the Stress Outcomes. SocioEconomic Challenges. 2025;9(2):190-206. Mamić M JT, Galić S, Jelinčić I, Mikšić Š, Lovrić B, et al. Influence of Personality Traits and Organizational Justice on Job Satisfaction among Nurses. Behavioral sciences. 2024;14(3):235. Matagi L BP, Baluku MM. Age, job involvement and job satisfaction as predictors of job performance among local government employees in Uganda. Journal of Organizational Effectiveness: People and Performance. 2022;9(3):489-505. Ghaleh RJ MH, Hosseinnataj A, Al‐Mamun F, Mamun MA. Job satisfaction and the role of self‐esteem and self‐efficacy: A cross‐sectional study among Iranian nurses. Nursing Open. 2024;11(6):e2215. Medeni V Mİ, Altunay G, Dikmen AU, İlhan MN. Job satisfaction, life satisfaction, and associated factors among hospital nurses: a cross-sectional study in Türkiye. Scientific reports. 2025;15(1):5738. Antoine L DS, Ahearn S. The Influence of Age and Gender on Work-Life Balance and Job Satisfaction among Department Chairs at Academic Health Centers. Open Journal of Leadership. 2024;13(3):279-89. Inayat W JKMAsojsaieotpoewipso, Peshawar. Education Research International. 2021;2021(1):1751495. Nadeem RN IZ, Sarfaraz B. Gender Differences in Job Satisfaction Among Bankers in Karachi. Pakistan Journal of Gender Studies. 2025:185-202. Zakariya YF WYJsomtAeitqtcots-eatmttMERJ. Hellín Gil MF RHJ, Ibáñez-López FJ, Seva Llor AM, Roldán Valcárcel MD, Mikla M, et al. Relationship between job satisfaction and workload of nurses in adult inpatient units. International Journal of Environmental Research and Public Health. 2022;19(18):11701. Elsayed AEM AA, Alshehri E, Sairafi RA, Hashem HA, Alsalmi HA, et al. Staffing levels, work schedules, required overtime, and turnover in acute care hospitals impact health care workers' burnout, intention to leave, and job satisfaction: A crosssectional study. Revista iberoamericana de psicología del ejercicio y el deporte. 2025;20(1):8-12. Geier N BgLD, Röbken H, Mertens A. Overtime and well-being among mid-level academic staff. Journal of Applied Research in Higher Education. 2025 May 20. Kim J LE, Kwon H, Lee S, Choi H. Effects of work environments on satisfaction of nurses working for integrated care system in South Korea: a multisite cross-sectional investigation. BMC nursing. 2024;23(1):459. Moreno-Martínez M S-MITAFoWE, Work Overload, Work Satisfaction, and Emotional Exhaustion and Their Effect on Healthcare Workers: A Cross-Sectional Study. InHealthcare 2025 Jan 16 (Vol. 13, No. 2, p. 162). MDPI. Poormoosa Y AM, Alizadeh A, Kalhor R. The effect of circadian on the productivity of nurses with the mediating role of quality of work life. BMC nursing. 2024;23(1):89. Bayati MM SA, Jamasbi MM, Tapak L. Servant leadership, work-life quality, and organizational citizenship behavior in nurses: a cross-sectional design. BMC nursing. 2025 May 19;24(1):561. Chang W-P PY-XIorsafnsosqonodaaslram-aC. Das M PSSw, sleep and well-being: a qualitative study on the experience of rotating shift workers. Management and Labour Studies. 2025;50(2):148-65. ;12:1-8. HTEoSWoOsPaPW-BANEiSHTijoph. Bakotić D BIOjalboapoejsEfCS. Ho DA TL, Ho MH. The Impact of People-Oriented Leadership Behavior on Employee Satisfaction in Small and Medium Enterprises in Vietnam. Journal of Organizational Behavior Research. 2023;8(1-2023):275-85. Hussain S UZEtIoP-OLSoUTJS, Motivation and Performance. Al-Aijaz Research Journal of Islamic Studies & Humanities. 2024;8(3):89-105. Khosroabadi T BB, Vakilifard H, Pourzamani Z. Evaluation of the organizational efficiency of audit firms based on leadership style. International Journal of Finance & Managerial Accounting. 2021;6(22):45-67. Hult M TMA, Kaakinen P, Karki S, Nurmeksela A, Palonen M, et al. Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews. Nursing open. 2023;10(9):5920-36. Njoku HI GRLsaeeitfioMsJoCRiB, Economics and Finance. 2023;5(2):35-51. Fletcher KA TS, Bedwell-Torres WL, Braun MT. Perceived Task-and Relationship-Oriented Leader Behavior on Followers’ Team-Oriented Attitudes. Psychological Studies. 2025:1-17. Al-Husseini N KS, Sarlab R. The Effect of the Task-Oriented Leadership Style of Coaches on the Moral Decision-Making of the Players of the Iraqi National Athletics Team with the Mediating Role of Team Satisfaction. Pakistan Journal of Life & Social Sciences. 2025 Jan 1;23(1). Khuong MN MTElbfpsspm, satisfaction and organizational commitment-evidence from Vietnam. Вопросы государственного и муниципального управления. 2022(5):45-64. 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In simple terms, it is the art of influencing and persuading people so that one person\u0026rsquo;s actions can lead to changes in others\u0026rsquo; behavior and attitudes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Managers set goals, guide their teams, and monitor performance to make sure those goals are met [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. How they lead their teams\u0026mdash;their \u003cem\u003eleadership style\u003c/em\u003e\u0026mdash;can significantly impact the results [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Over the years, scholars have identified numerous leadership styles, including autocratic, consultative, participative, servant, transformational, charismatic, and others [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A well-known classification from the University of Michigan categorizes these styles into three main types: relationship-oriented, task-oriented, and integrated [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Other styles often fall under one of these three categories. Relationship-oriented leadership focuses on the needs, feelings, and satisfaction of team members. Leaders create personal connections through open communication, delegating tasks effectively, and providing opportunities for people to grow. It is built on support, friendship, and trust [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Task-oriented leaders prioritize organizational goals, ensuring that everyone is clear about what needs to be done, when it needs to be done, and how it needs to be done. The integrated style combines both approaches, aiming to achieve tasks while also prioritizing the social and emotional well-being of staff [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLeadership\u0026mdash;whatever its form\u0026mdash;has a significant impact on efficiency, effectiveness, and overall productivity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Every organization needs a leadership style that helps it reach its goals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Hospitals, as the backbone of health care systems, especially require strong leadership [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This issue is fundamental in nursing, the largest workforce in healthcare, because nurses ensure continuity of care and improve patient health outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Head nurses work closely with other nursing staff, so their approach to leadership can influence the team more than almost any other managerial role. Recognizing their leadership style can help prevent conflicts and inefficiencies that reduce the quality of care [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch in Iran and other countries has linked leadership style to many workplace outcomes\u0026mdash;job satisfaction [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], creativity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], burnout [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], intent to leave or migrate [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], stress [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], organizational commitment [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], quality of patient care [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and motivation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Most studies agree: leadership style matters. Among these outcomes, nurses\u0026rsquo; job satisfaction stands out. It reflects how positively or negatively they feel about their work and influences other important results [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. High job satisfaction is linked with better performance, commitment, morale, and enthusiasm for the profession, while low satisfaction can lead to absenteeism, resignation, poor service, burnout, and stress [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Job satisfaction depends on several factors, including salary, benefits, work climate, the nature of the job, supportive behavior, and relationships with colleagues and supervisors [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Unlike studies that examine job satisfaction in general, this research focuses specifically on nurses\u0026rsquo; satisfaction with their head nurses, a key component of overall satisfaction [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The quality of nursing supervision is a crucial predictor of staff retention, well-being, and patient outcomes. Despite much research recognizing the fundamental role of head nurses\u0026rsquo; leadership styles, a persistent knowledge gap remains regarding the differential impact of common styles\u0026mdash;namely, relationship-oriented, integrated, and task-oriented\u0026mdash;on staff satisfaction across diverse clinical settings. A granular understanding of this relationship is essential for developing evidence-based managerial policies in healthcare systems globally.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and setting(s)\u003c/h2\u003e \u003cp\u003eThis descriptive\u0026ndash;correlational study examined the relationship between head nurses\u0026rsquo; leadership styles and the nursing staff satisfaction working in teaching and medical hospitals affiliated with Zanjan University of Medical Sciences, namely Ayatollah Mousavi, Valiasr, and Shahid Beheshti in Zanjan, Emdadi and Al‑Ghadir in Abhar, and finally Bu‑Ali Sina in Khorramdarreh during September 2024 to March 2025.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003eBecause hospital wards differ in their work environment\u0026mdash;such as shift patterns, workload, and patient types\u0026mdash;and some wards are found only in certain hospitals, the researchers decided to include every nurse and head nurse in their survey. This \u0026ldquo;census\u0026rdquo; approach helped reduce bias and make the results more widely applicable. Participation was limited to those with at least a bachelor\u0026rsquo;s degree in nursing and a minimum of six months\u0026rsquo; experience in their current ward. The degree requirement ensured they had completed the \u0026ldquo;Nursing Management\u0026rdquo; course and possessed basic knowledge of the topic. Nursing assistants and staff without a bachelor\u0026rsquo;s degree were omitted. Initially, 1,548 nurses and head nurses were identified. For statistical convenience, the wards were classified\u0026mdash;based on Ministry of Health definitions\u0026mdash;into 31 specialized wards and 40 general wards.\u003c/p\u003e\n\u003ch3\u003eTools/Instruments\u003c/h3\u003e\n\u003cp\u003eData were collected using three instruments. The first was a demographic questionnaire for both nurses and head nurses, covering age, gender, marital status, education level, hospital, ward, shift type, work experience, job position, employment type, average monthly working hours, and average monthly overtime. Content validity was confirmed through expert review by 10 faculty members from the School of Nursing and Midwifery. The second was the Fiedler and Chemers Leadership Style Inventory (LSI), a standardized tool that identifies relationship-oriented, task-oriented, or integrated leadership styles. The Persian version comprises 18 items, rated on an 8-point Likert scale. In this study, participants in each ward completed the LSI, and the ward\u0026rsquo;s leadership style was determined by combining the head nurse\u0026rsquo;s score with the average score of nurses in that ward. Scores of 64 and above were classified as relationship‑oriented, scores of 57 or less as task‑oriented, and scores between 58 and 63 as integrated styles [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Reliability was verified with a Cronbach\u0026rsquo;s alpha of 0.90 in a pilot study involving 20 respondents; content validity was reconfirmed via review by 10 faculty experts.\u003c/p\u003e \u003cp\u003eThe third instrument was a researcher‑developed Supervisor Satisfaction Questionnaire, created to specifically assess satisfaction with head nurses rather than general job satisfaction. After analyzing 12 existing job satisfaction tools (including JSS, Herzberg, Spector, Minnesota, and Brayfield \u0026amp; Rothe), items related to leadership style were extracted, redundancies removed, and wording adjusted. The preliminary version underwent expert review by 20 faculty members, was refined in consensus meetings, and was quantitatively validated. The Supervisor Satisfaction Questionnaire demonstrated strong validity and reliability. Its overall Content Validity Ratio (CVR) was 0.98, well above the Lawshe benchmark, and the Content Validity Index (CVI) scores were high for all criteria: 0.89 for relevance, 0.93 for clarity, and 0.90 for simplicity [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the test\u0026ndash;retest analysis, the correlation coefficient was 0.792, and Cohen\u0026rsquo;s kappa reached 0.817, indicating good consistency in responses over time. Construct validity was confirmed with a Kaiser\u0026ndash;Meyer\u0026ndash;Olkin measure of sampling adequacy(KMO) of 0.824 and a significant Bartlett\u0026rsquo;s test (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Factor analysis (PCA with varimax rotation) identified five precise dimensions: Communication (4 items), Supportiveness (4 items), Fairness in task or shift allocation (4 items), Competence (4 items), and Empowerment (4 items), with strong factor loadings across items in each category. The completed questionnaire consisted of 20 items, each rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). Total scores were grouped into low satisfaction (20\u0026ndash;38), moderate satisfaction (39\u0026ndash;57), and high satisfaction (58 and above).\u003c/p\u003e\n\u003ch3\u003eData collection methods\u003c/h3\u003e\n\u003cp\u003e Because the study employed a census approach, data collection spanned almost six months, with researchers visiting each ward across all three shifts (morning, evening, and night) to maximize participation. After applying the inclusion criteria, 86 nurses were excluded because they had insufficient work experience. During the study period, 48 participants were excluded because they were on extended leave, 39 chose not to participate, and 21 submitted incomplete questionnaires. This action left a final sample of 1,354 nurses and head nurses for analysis.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were processed using SPSS version 22. Descriptive statistics\u0026mdash;such as mean, standard deviation, frequency, and percentage\u0026mdash;were used to summarize demographic information, leadership styles, and satisfaction levels. The Shapiro\u0026ndash;Wilk test was used to check whether the data were normally distributed, and appropriate statistical tests were then applied based on the results. Inferential analyses were performed with Pearson correlation, independent t‑test, and one‑way ANOVA. Multiple linear regression was then used to identify predictors of supervisor satisfaction and estimate the contribution of each variable. Statistical significance was set at P\u0026thinsp;\u0026le;\u0026thinsp;0.05, and results were presented in tables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics evaluation\u003c/h2\u003e \u003cp\u003eInitially, our findings indicated that most head nurses in specialized wards were women (approximately 90%), and the majority were married (approximately 96%). Their mean (SD) age was 48.45 (3.23) years, and their mean (SD) work experience was 22.14 (4.86) years. A bachelor\u0026rsquo;s degree was the highest level of education for the majority (about 83%). All were employed permanently, and none were working under a contractual arrangement. More than 80% had fixed shifts, with the majority working morning shifts. Additionally, they worked an average of 156.96\u0026thinsp;\u0026plusmn;\u0026thinsp;12.98 hours per month (including both regular hours and overtime), with a mean monthly overtime of 21.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55 hours. In this regard, head nurses in general wards generally shared a similar profile with specialized wards: most were female (85%) and married (95%). Their mean (SD) ages and work experiences were 42.50 (5.36) years and 21.65 (6.06) years, respectively.\u003c/p\u003e \u003cp\u003eBachelor\u0026rsquo;s degrees were also most common (75.92%), with all in permanent employment. Eighty percent worked fixed shifts. Average total work time and overtime were 160.77\u0026thinsp;\u0026plusmn;\u0026thinsp;15.21 hours and 22.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34 hours per month, respectively. Approximately 70% of the nurses were female, and most (74%) were married. The largest age group was 30\u0026ndash;40 years (58.49%). Most (56%) had between 5 and 15 years of work experience, with a mean of 13.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34 years. Eighty‑eight percent held a bachelor\u0026rsquo;s degree, and about 74% were in permanent status. Shift schedules were primarily rotational, and the average total work time was 170.75\u0026thinsp;\u0026plusmn;\u0026thinsp;22.54 hours per month, including 58.46\u0026thinsp;\u0026plusmn;\u0026thinsp;17.70 hours of overtime. In the continuing care setting, as in specialized wards, most nurses were female (approximately 80%) and married (64%). Nearly half (47%) fell into the younger age range of 20\u0026ndash;30 years. Most had between six months and five years of work experience (36%). Bachelor\u0026rsquo;s degrees were held by approximately 91% of nurses, and 410 were in a permanent employment status. About 78% worked rotational shifts. Average total work time was 190.69\u0026thinsp;\u0026plusmn;\u0026thinsp;24.24 hours per month, with 52.13\u0026thinsp;\u0026plusmn;\u0026thinsp;16.16 hours of overtime. The demographic information of the participants in this study is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, categorized by ward type and job position.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSatisfaction with Head Nurses\u003c/h3\u003e\n\u003cp\u003eThe evaluation results of nurses\u0026rsquo; satisfaction with their head nurses in this study indicated that the mean satisfaction score in specialized wards was 74.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38, while in general wards it was 61.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01. The findings reflected a relatively high level of satisfaction with head nurses in both types of wards; however, the results of the independent t‑test revealed that the difference between the two groups was not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe demographic information of the participants based on ward type and job position\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (9.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (90.32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e218 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e488 (69.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (85%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114 (19.76%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e463 (80.24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.23%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (96.77%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e183 (25.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e523 (74.08%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e204 (35.36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e373 (64.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (83.87%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (16.13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e628 (88.95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (11.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e525 (90.99%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (9.01%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContractual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e528 (74.79%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContractual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e178 (25.21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContractual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e410 (71.06%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContractual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e167 (28.94%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eWork Shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (80.65%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRotating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (19.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e166 (33.51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRotating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e540 (76.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRotating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123 (21.32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRotating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e454 (78.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn specialized wards, nurses ranked competence, empowerment, communication, supportiveness, and fairness as the main contributors to satisfaction, respectively. In general wards, the top satisfaction factors were communication, empowerment, competence, supportiveness, and fairness. Based on this, most nurses in specialized wards viewed their head nurses as capable leaders who granted autonomy and maintained strong and trusting communication. In general wards, most of them valued good communication and autonomy provided by their head nurses. Notably, supportiveness and fairness received the lowest scores in both ward types. Lack of adequate support during problems and unfair scheduling or task distribution were the primary sources of dissatisfaction.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of the Satisfaction with Head Nurses scores and its dimensions in specialized and general wards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction with Head Nurses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWards\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSupportiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFairness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCompetence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmpowerment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eRelationships between nurses\u0026rsquo; demographics and their satisfaction with Head Nurses\u003c/b\u003e\u003c/h2\u003e \u003cp\u003ePearson correlations revealed that in specialized wards, overall satisfaction scores were significantly related to age (r\u0026thinsp;=\u0026thinsp;0.645, P\u0026thinsp;=\u0026thinsp;0.001) and work experience (r\u0026thinsp;=\u0026thinsp;0.516, P\u0026thinsp;=\u0026thinsp;0.012). Also, independent t‑tests indicated significant differences by gender (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and shift type (P\u0026thinsp;=\u0026thinsp;0.024), but no associations with total work hours, overtime, or education (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similar to specialized wards, in general, significant correlations were observed between satisfaction and age (r\u0026thinsp;=\u0026thinsp;0.446, P\u0026thinsp;=\u0026thinsp;0.042), work experience (r\u0026thinsp;=\u0026thinsp;0.471, P\u0026thinsp;=\u0026thinsp;0.029), total monthly work hours (r\u0026thinsp;=\u0026thinsp;0.301, P\u0026thinsp;=\u0026thinsp;0.010), and overtime (r\u0026thinsp;=\u0026thinsp;0.610, P\u0026thinsp;=\u0026thinsp;0.031). Satisfaction also varied significantly by gender (t = \u0026minus;\u0026thinsp;12.32, P\u0026thinsp;=\u0026thinsp;0.003) and shift type (t\u0026thinsp;=\u0026thinsp;16.50, P\u0026thinsp;=\u0026thinsp;0.033), but not by marital status, education, or employment type (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These results indicate that nurses in both specialized and general wards felt increasingly satisfied with the performance of their head nurses as their age and work experience increased. Additionally, it is worth noting that female nurses and those with fixed shifts were more satisfied. In Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, details of the relationship between satisfaction with head nurses by gender and work shift are provided.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between satisfaction with head nurses by gender and work shift\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSatisfaction by Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-12.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-10.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSatisfaction by Work Shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e20.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRotating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRotating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLeadership styles\u003c/h2\u003e \u003cp\u003e To assess the leadership style, the scores obtained from the questionnaire in each ward were first collected, and then the leadership style of each ward was calculated separately. Based on this procedure, our results showed that in specialized wards, the most common leadership style among head nurses was an integrated one (19 wards). In contrast, in general wards, the relationship was generally oriented (23 wards). The task-oriented leadership style was the least common overall, appearing in only nine of the 71 wards. Additionally, the results revealed that only the difference in the mean score of the integrated leadership style between specialized and general wards was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This result indicates that head nurses in specialized wards employed this leadership style more frequently than those in general wards. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the mean and standard deviation of the Leadership style scores for head nurses, categorized by specialized and general wards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRelationships between Head nurses\u0026rsquo; demographics and Leadership styles\u003c/h2\u003e \u003cp\u003eOn the other hand, our evaluation about the relationship between leadership styles and demographic characteristics of head nurses in specialized wards revealed that the task-oriented styles were more common among head nurses aged 30\u0026ndash;40 with 10\u0026ndash;20 years of experience, integrated styles among those aged 40\u0026ndash;50 with 20\u0026ndash;25 years of experience, and relationship-oriented styles among those aged 50\u0026ndash;60 with 25\u0026ndash;30 years of experience. In general wards, similar patterns emerged: task orientation was frequent among head nurses aged 30\u0026ndash;40 with 10\u0026ndash;20 years of experience, relationship orientation among those aged 40\u0026ndash;50 with 20\u0026ndash;25 years of experience, and integrated styles among those aged 50\u0026ndash;60 with 25\u0026ndash;30 years of experience. This trend suggests a shift from a task-oriented to a relationship-oriented approach as age and experience increase.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean (SD) score of Leadership styles of Head Nurses based on the hospital wards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLeadership styles\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWards\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e19.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between Head nurses\u0026rsquo; leadership style and satisfaction of nurses\u003c/h2\u003e \u003cp\u003eIn line with the primary objective of the present study, after identifying the leadership styles of each ward (three styles) and determining nurses\u0026rsquo; satisfaction levels, the ANOVA statistical test was employed for data analysis. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, our findings indicated significant differences in satisfaction scores across leadership styles in both specialized wards (F (2, 28)\u0026thinsp;=\u0026thinsp;20.05, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and general wards (F (2, 37)\u0026thinsp;=\u0026thinsp;18.28, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For a better understanding, the Post-hoc Tukey tests revealed that in specialized wards, satisfaction was highest with integrated leadership, followed by relationship-oriented leadership, and lowest with task-oriented leadership.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of nurses\u0026rsquo; satisfaction scores across leadership styles in specialized and general wards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWards\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eleadership style\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eTotal Satisfaction with Head Nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e20.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e18.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHowever, in specialized wards, a statistically significant association was observed only between the relationship-oriented and task-oriented leadership styles, as well as between the integrated and task-oriented styles (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The difference between the relationship-oriented and integrated styles was not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This result suggests that both relationship-oriented and integrated leadership styles yielded higher levels of nurse satisfaction compared to the task-oriented style. In general wards, satisfaction was highest with relationship-oriented styles, followed by integrated styles, and lowest with task-oriented styles. Similarly, in these wards, a statistically significant relationship was observed only between the relationship-oriented and task-oriented leadership styles, as well as between the integrated and task-oriented styles (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The difference between the relationship-oriented and integrated styles was not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This finding indicates that both the relationship-oriented and integrated leadership styles resulted in higher levels of nurse satisfaction compared to the task-oriented style (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost-hoc Tukey test comparing nurses\u0026rsquo; satisfaction across leadership styles in special and general wards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWards\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eleadership style\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-8.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-12.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-20.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-16.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-10.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMultiple linear regression\u003c/h2\u003e \u003cp\u003eAfter adjusting for individual and occupational variables, the regression models for specialized wards significantly predicted satisfaction (F (3, 27)\u0026thinsp;=\u0026thinsp;28.74, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with R\u0026sup2; = 0.77, indicating that 77% of the variance in satisfaction was explained by leadership style. Regression coefficients showed positive associations for relationship‑orientation (B\u0026thinsp;=\u0026thinsp;0.65) and integrated style (B\u0026thinsp;=\u0026thinsp;0.87), and a negative association for task‑orientation (B = \u0026minus;\u0026thinsp;0.39). A one‑unit increase in relationship‑orientation or integrated style corresponded to increases of 0.65 and 0.87 units in satisfaction, respectively. In contrast, a one‑unit increase in task‑orientation corresponded to a decrease of 0.39 units. In general wards, the model also significantly predicted satisfaction (F (3, 36)\u0026thinsp;=\u0026thinsp;32.28, p\u0026thinsp;\u0026lt;\u0026thinsp;0.005), with an R\u0026sup2; of 0.75. Relationship‑orientation (B\u0026thinsp;=\u0026thinsp;0.57) and integrated style (B\u0026thinsp;=\u0026thinsp;0.50) were positive predictors of satisfaction, while task‑orientation (B = \u0026minus;\u0026thinsp;0.25) was a negative predictor (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). In summary, the regression analyses indicated that both relationship-oriented and integrated leadership styles had the most potent positive effects on nurses\u0026rsquo; satisfaction. In contrast, the task-oriented style showed a negative association. This pattern was consistent across specialized and general wards, where leadership style significantly explained a large proportion of variance in satisfaction (77% and 75%, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression results predicting nurses\u0026rsquo; satisfaction across leadership styles in specialized and general wards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSpecialized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e28.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelationship-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e32.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTask-oriented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to examine the relationship between head nurses\u0026rsquo; leadership styles\u0026mdash;relationship-oriented, integrated, and task-oriented\u0026mdash;and the satisfaction of nursing staff with their head nurses in teaching medical hospitals affiliated with Zanjan University of Medical Sciences. The results showed that in both specialized and general wards, the majority of nurses and head nurses were women, married, held a bachelor\u0026rsquo;s degree, and reported a moderate income level.\u003c/p\u003e \u003cp\u003eAmong head nurses, those in specialized wards were older and had more years of work experience than those in general wards. In line with their greater age and seniority, head nurses in specialized wards worked fewer total and overtime hours per month compared to their counterparts in general wards. However, in both ward types, most head nurses had fixed shifts and all were in permanent employment. Nurses in specialized wards also tended to be older, worked fewer total and overtime hours, and were more likely to hold permanent positions or a master\u0026rsquo;s degree. These patterns suggest that human resource management in the studied hospitals placed individuals with higher age, longer experience, and advanced education in the specialized wards\u0026mdash;likely due to the greater complexity and sensitivity of the work, as well as the need for experienced staff to care for critically ill patients.\u003c/p\u003e \u003cp\u003eThe distribution of leadership styles varied between ward types. In specialized wards, integrated leadership was most common, followed by relationship-oriented and task-oriented styles. In general wards, relationship-oriented leadership dominated, followed by integrated and task-oriented styles. The relationship between the demographics of head nurses and their leadership style was significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In both ward types, younger head nurses with 10\u0026ndash;20 years of experience preferred a task-oriented style. Head nurses with 20\u0026ndash;25 years of experience opted for integrated leadership in specialized wards and relationship-oriented leadership in general wards. Those with 25\u0026ndash;30 years of experience used relationship-oriented leadership in specialized wards and integrated leadership in general wards. These findings suggest that younger head nurses tend to focus more on organizational goals and task management. In contrast, those with longer experience view relationship-oriented or integrated styles as more suitable. Previous research has linked the use of relationship-oriented and integrated leadership to greater skill in managing stress through interpersonal connections, which is consistent with its prevalence among more experienced head nurses [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnalysis of satisfaction scores revealed that, in both specialized and general wards, the mean satisfaction with head nurses was high, as indicated by the study instrument. However, it was slightly higher in specialized wards. In specialized wards, competence was rated highest, while in general wards, communication was rated highest; fairness scored lowest in both settings. In specialized wards, nurses valued their head nurses\u0026rsquo; ability, talent, and capacity for effective management, often viewing them as ideal leaders. In general wards, nurses most appreciated their head nurses\u0026rsquo; ability to maintain good communication. In both contexts, dissatisfaction often stemmed from unfair monthly schedules or unequal task distribution. It is essential to recognize that satisfaction with the head nurse is distinct from overall job satisfaction\u0026mdash;it represents just one dimension of job satisfaction, which also encompasses factors such as organizational climate, salary and benefits, nature of work, support, and relationships with colleagues. Inferential statistics revealed significant associations between job satisfaction and specific demographic variables (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Satisfaction was higher among nurses over 35 years old and those with more than 20 years of experience. This finding aligns with studies by Mamić [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], Matagi [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], Ghaleh [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], Medeni [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and Antoine [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], which reported greater satisfaction among older staff members compared to their younger colleagues. Low age in nursing can be accompanied by unrealistic workplace expectations, limited cooperation from peers or supervisors, work-related stress, lower income, and increased total and overtime hours due to lack of seniority\u0026mdash;all of which may directly or indirectly reduce satisfaction with head nurses and overall job satisfaction. Gender differences were also notable: female nurses reported higher satisfaction with their workplace and head nurse than their male counterparts, a finding supported by multiple studies [\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. This result may be explained by the compatibility of women\u0026rsquo;s dispositions with the caregiving nature of nursing, as well as working in environments where most staff and leadership are female\u0026mdash;factors that can positively shape attitudes toward the profession, colleagues, and managers.\u003c/p\u003e \u003cp\u003eIn general wards, nurses with fewer total and overtime hours reported greater satisfaction, consistent with studies by Hell\u0026iacute;n Gil [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], Elsayed [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], and Geier [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Extended time on duty and prolonged separation from family may lower satisfaction with the profession and with head nurses, especially given their role in allocating workload and overtime. Nurses with fixed shifts were more satisfied than those with rotating shifts, a finding supported by prior research [\u003cspan additionalcitationids=\"CR52 CR53\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Fixed shifts enable better life planning and create a stable work routine, leading to higher satisfaction compared to irregular schedules and rotating shifts\u0026mdash;especially those involving nights\u0026mdash;that are often associated with gastrointestinal problems, sleep disorders, psychological symptoms, and cardiovascular issues [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. These health impacts can themselves diminish job satisfaction and, by extension, satisfaction with the head nurse responsible for scheduling. Moreover, fixed shifts are often assigned to more experienced nurses, which can further explain the association with higher satisfaction. Inferential findings also revealed significant associations between satisfaction and leadership style in both specialized and general wards (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In specialized wards, satisfaction was highest with integrated leadership, followed by relationship orientation, and lowest with task orientation. In general wards, satisfaction was highest with a relationship-oriented approach, followed by an integrated style, with task-oriented approaches again being the lowest. In the specialized wards, nurses preferred leaders who balanced effective task management with strong interpersonal relationships. In contrast, leaders who focused solely on tasks\u0026mdash;often younger and less experienced\u0026mdash;were less well received. In general wards, leaders who prioritized human relationships or used an integrated approach were preferred, while task orientation was similarly unpopular. Overall, satisfaction with head nurses was higher under relationship-oriented and integrated leadership, and lower under task-oriented leadership. These findings are consistent with many previous studies reporting greater satisfaction with relationship-oriented and integrated styles compared to task-oriented approaches [\u003cspan additionalcitationids=\"CR59 CR60 CR61 CR62\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. However, they contrast with some studies that identified task-oriented approaches as a better predictor of satisfaction through enhanced organizational oversight and ethical decision-making [\u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrengths\u003c/h2\u003e \u003cp\u003eA significant strength of our study is the large and representative sample. We included almost all nurses working in the hospitals of Zanjan University of Medical Sciences. The large sample size strengthened our statistical results, making them more robust and facilitating easier generalization. Additionally, we collected all the data in person and face-to-face at the hospitals, which ensured that almost everyone participated and reduced the likelihood of mistakes from unanswered surveys. Furthermore, the tool we used to measure satisfaction with head nurses was special. We built it ourselves based on several trusted international surveys, which means it was accurate for the specific work culture of Iranian nurses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eBecause we employed a one-time, cross-sectional design, we could not determine whether the leadership style directly caused the satisfaction level. We only saw the relationship at a single moment. Since nurses completed self-report questionnaires, their answers may be influenced by factors such as a desire to appear favorable (social desirability bias). Additionally, the research was conducted only in hospitals in one province, so the findings may not be entirely applicable to other parts of Iran or globally. Finally, we did not account for other factors, such as the workload's intensity or the resources available on different wards, which might have subtly influenced the nurses\u0026rsquo; opinions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eNursing implications\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eLeadership style is a primary determinant of nurses\u0026rsquo; supervisory satisfaction, with task-oriented leadership consistently associated with lower satisfaction in both specialized and general wards.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIntegrated leadership is more effective in specialized wards, whereas general wards show higher satisfaction under relationship-oriented leadership.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealth-care administrators should prioritize leadership development initiatives that reinforce relational, supportive, and flexible competencies among head nurses.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStructural issues\u0026mdash;particularly workload equity, scheduling fairness, and availability of managerial support\u0026mdash;require targeted policy interventions alongside leadership reforms. Further research is needed to examine contextual\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHead nurses have an important role in nurses\u0026rsquo; job satisfaction by interacting daily with staff. Their leadership style directly influences team function, job performance, and the alignment between individual and organizational goals. The results of this study show that nurses are more satisfied when their head nurse's leadership style aligns with the specific needs and working conditions of their ward.\u003c/p\u003e \u003cp\u003eNurses in specialized wards preferred an integrated leadership style that balances task completion with attention to interpersonal relationships. In general wards, nurses favored a relationship-oriented style, where empathy, open communication, and emotional support are central. In contrast, a task-oriented leadership style was associated with lower satisfaction in both ward types. This pattern suggests that when supervision becomes too strict and focused mainly on procedures, nurses may feel less empowered, less fairly treated, and less connected to their work environment. These findings highlight that leadership style is a key factor in both nurses\u0026rsquo; well-being and the overall effectiveness of healthcare organizations. Hospital administrators should therefore avoid relying too heavily on task-focused leadership. Instead, they should encourage head nurses to adopt approaches that combine relational, supportive, and flexible behaviors. Practical strategies such as leadership training, mentoring programs, and regular performance feedback can help head nurses strengthen these human-centered leadership skills. Beyond leadership, the study also revealed other important sources of dissatisfaction \u0026mdash; minimal managerial support and unequal distribution of duties and shifts. These issues require immediate attention from hospital management. Overall, to improve satisfaction and retention, head nurses should promote fairness in work schedules, provide consistent support, and act as advocates for their teams. A fair and supportive leadership climate fosters stronger trust, a greater sense of belonging, and higher commitment \u0026mdash; all of which help maintain staff stability and ensure high-quality patient care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLSI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Leadership Style Inventory\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCVR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Content Validity Ratio\u003c/p\u003e\n\u003cp\u003eCVI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Content Validity Index\u003c/p\u003e\n\u003cp\u003eKMO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Kaiser\u0026ndash;Meyer\u0026ndash;Olkin\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the participants in the selected hospitals who helped to obtain the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMK:\u003c/strong\u003e Supervision of data collection, Data analyzing, writing the initial draft, collating feedback, editing, and reviewing the final version. \u0026nbsp;\u003cstrong\u003eA.A:\u003c/strong\u003e Conceptualization of study, data gathering, writing the initial draft, collating feedback, and reviewing the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Zanjan University of medical sciences, which we thank sincerely.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData availability\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials that support the findings of this study are available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Zanjan University of Medical Sciences \u003cstrong\u003e(IR.ZUMS.REC.1403.220)\u003c/strong\u003e, and the hospital administrators granted permission to proceed. All participants received a clear explanation of the study, provided written informed consent, and were assured that all information would be kept confidential.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor details\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Nursing, Abhar School of Nursing, Zanjan University of Medical Sciences, Zanjan, Iran.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBenmira S, Agboola M. Evolution of leadership theory. BMJ leader. 2021:leader-2020-000296.\u003c/li\u003e\n \u003cli\u003eSpecchia ML, Cozzolino MR, Carini E, Di Pilla A, Galletti C, Ricciardi W, Damiani G. Leadership styles and nurses\u0026rsquo; job satisfaction. Results of a systematic review. International journal of environmental research and public health. 2021;18(4):1552.\u003c/li\u003e\n \u003cli\u003eYu-Wen L, Chung-Fan N, Shu-Fen H, Shiow-Luan T, Heng-Hsin T. Effects of length of employment and head nurse leadership style on the clinical competency of staff nurses in Taiwan. Journal of Nursing Research. 2024;32(3):e331.\u003c/li\u003e\n \u003cli\u003eBwalya A. Leadership styles. Global Scientific Journal. 2023;11(8).\u003c/li\u003e\n \u003cli\u003eHundie ZA, Habtewold EM. The Effect of transformational, transactional, and laissez-faire leadership styles on employees\u0026rsquo; level of performance: the case of hospital in Oromia Region, Ethiopia. Journal of healthcare leadership. 2024:67-82.\u003c/li\u003e\n \u003cli\u003eFischer T, Sitkin SB. Leadership styles: A comprehensive assessment and way forward. Academy of Management Annals. 2023;17(1):331-72.\u003c/li\u003e\n \u003cli\u003eRamos OAM, de S\u0026aacute; JAFTM, Gomes JMPA, Galv\u0026atilde;o AMNP, Gomes MJAR. Influence of leadership style on nurses\u0026rsquo; structural empowerment: a cross-sectional study. Cogitare Enfermagem. 2025;30:e97126.\u003c/li\u003e\n \u003cli\u003eAli A, Siddiqui DA. How Relation-Oriented, Task-Oriented and Objective-Oriented Leadership Affect Employee Performance During the Pandemic: The Mediatory Role of Individual Job Autonomy, and Work Tension, as Well as Team Cohesiveness, Teamwork Tension, Complemented by Digital Maturity. Task-Oriented and Objective-Oriented Leadership Affect Employee Performance During the Pandemic: The Mediatory Role of Individual Job Autonomy, and Work Tension, as Well as Team Cohesiveness, Teamwork Tension, Complemented by Digital Maturity (April 28, 2023). 2023.\u003c/li\u003e\n \u003cli\u003eIslam S, Schmidt GB. The Importance of Balance to Leadership. Elements of Leadership: Lessons from Avatar The Last Airbender: Emerald Publishing Limited; 2024. p. 9-19.\u003c/li\u003e\n \u003cli\u003eAlghizzawi M, Megdadi Y, Al Shibly MS, Alkhlaifat BI, Alzeaideen K, Ali M. The impact of leadership style on improve performance: A comparative approach. Artificial intelligence and economic sustainability in the era of industrial revolution 50: Springer; 2024. p. 1341-54.\u003c/li\u003e\n \u003cli\u003eUdin U. Leadership styles and sustainable performance. Multidisciplinary Reviews. 2024;7(8):2024171-.\u003c/li\u003e\n \u003cli\u003eCosta J, P\u0026aacute;dua M, Moreira AC. Leadership styles and innovation management: What is the role of human capital? Administrative Sciences. 2023;13(2):47.\u003c/li\u003e\n \u003cli\u003eAini Q, Dzakiyullah NR. Leadership styles in healthcare settings for hospital management and employee engagement. Integrative Biomedical Research. 2024;8(5):1-7.\u003c/li\u003e\n \u003cli\u003eKamaryati NP, Suyasa IGPD, Susanti NLPD, Dewi NMRC, Susanti NPA, Wahyu IMY. Leadership in Nursing: Styles, Challenges, and Barriers. Babali Nursing Research. 2024;5(4):631-49.\u003c/li\u003e\n \u003cli\u003eQtait M. Systematic review of head nurse leadership style and nurse performance. International Journal of Africa Nursing Sciences. 2023;18:100564.\u003c/li\u003e\n \u003cli\u003eAl-Bashaireh AM, Aljawarneh Y, Khraisat OMA, Alblooshi K, Almesmari M, Alsaadi M, et al., editors. The Relationship Between Managers\u0026rsquo; Leadership Styles and Registered Nurses\u0026rsquo; Job Satisfaction and Work Engagement: A Cross‐Sectional Study in the United Arab Emirates. Nursing Forum; 2025: Wiley Online Library.\u003c/li\u003e\n \u003cli\u003eIsmael H, Sleem W, Abd el-Ghani A. Relationship Between Transformational Leadership Style and Job Satisfaction among Nurse. Mansoura Nursing Journal. 2024;11(1):357-68.\u003c/li\u003e\n \u003cli\u003eAbd El Muksoud NO, Metwally FG, Ata AA. Leadership behaviors and innovative work behaviors among nurses. Zagazig Nursing Journal. 2022;18(2):1-14.\u003c/li\u003e\n \u003cli\u003eLabrague LJ, Toquero LM. Leadership styles and nurses\u0026apos; innovative behaviors: a systematic review. JONA: The Journal of Nursing Administration. 2023;53(10):547-53.\u003c/li\u003e\n \u003cli\u003eHall VP, White KM, Morrison J. The influence of leadership style and nurse empowerment on burnout. Nursing Clinics. 2022;57(1):131-41.\u003c/li\u003e\n \u003cli\u003eOnan G, S\u0026uuml;r\u0026uuml;c\u0026uuml; L, Bekmezci M, Dalmış AB, Sunman G. Relationships Between Positive Leadership Styles, Psychological Resilience, and Burnout: An Empirical Study Among Turkish Teachers. Behavioral Sciences. 2025;15(6):713.\u003c/li\u003e\n \u003cli\u003eMozolov\u0026aacute; V, Tup\u0026aacute; M. Migration intentions of nurses and nursing students from Slovakia: A study on drivers. Problems and perspectives in management. 2024;22(1):534.\u003c/li\u003e\n \u003cli\u003eSuliman M, Almansi S, Mrayyan M, ALBashtawy M, Aljezawi M. Effect of nurse managers\u0026rsquo; leadership styles on predicted nurse turnover. Nursing management. 2024;31(5).\u003c/li\u003e\n \u003cli\u003ePishgooie AH, Atashzadeh‐Shoorideh F, Falc\u0026oacute;‐Pegueroles A, Lotfi Z. Correlation between nursing managers\u0026rsquo; leadership styles and nurses\u0026apos; job stress and anticipated turnover. Journal of nursing management. 2019;27(3):527-34.\u003c/li\u003e\n \u003cli\u003eAslan M, S\u0026ouml;nmez S, Deniz M. Leadership styles and work stress: the role of workplace climate and feelings of entrapment. Current Psychology. 2025:1-14.\u003c/li\u003e\n \u003cli\u003eOyewobi LO. Leadership styles and employees commitment: the mediating role of job satisfaction. Journal of Facilities Management. 2024;22(5):737-57.\u003c/li\u003e\n \u003cli\u003eBorde PS, Arora R, Kakoty S. Linkages of organizational commitment and leadership styles: a systematic review. European Journal of Training and Development. 2024;48(1/2):41-66.\u003c/li\u003e\n \u003cli\u003eAl-Rjoub S, Alsharawneh A, Alhawajreh MJ, Othman EH. Exploring the impact of transformational and transactional style of leadership on nursing care performance and patient outcomes. Journal of Healthcare Leadership. 2024:557-68.\u003c/li\u003e\n \u003cli\u003eRaziq MM, Wazir R, Memon MA, Rice JL, Moazzam M. Empowering leadership, employee organizational commitment and organizational citizenship behavior: the roles of leader authenticity and trust. International Journal of Productivity and Performance Management. 2025;74(1):81-106.\u003c/li\u003e\n \u003cli\u003eCalluso C, Devetag MG, editors. The impact of leadership preferences and personality traits on employees\u0026rsquo; motivation. Evidence-based HRM: a Global Forum for Empirical Scholarship; 2025: Emerald Publishing Limited.\u003c/li\u003e\n \u003cli\u003eSokolic D, Croitoru G, Florea NV, Robescu VO, Cosac A. The effect of leadership styles on employee motivation and organizational performance in public sector organizations. Valahian Journal of Economic Studies. 2024;15(1):53-72.\u003c/li\u003e\n \u003cli\u003eBaxi B, Atre D. Exploring Job Satisfaction: Understanding the Meaning, Importance, and Dimensions. J Manag Entrep. 2024;18:1-10.\u003c/li\u003e\n \u003cli\u003eMemon AH, Khahro SH, Memon NA, Memon ZA, Mustafa A. Relationship between job satisfaction and employee performance in the construction industry of Pakistan. Sustainability. 2023;15(11):8699.\u003c/li\u003e\n \u003cli\u003eWong FMF. Job satisfaction in nursing: A qualitative inquiry into novice and experienced nurses\u0026apos; perspectives. Nurse Education in Practice. 2024;78:104018.\u003c/li\u003e\n \u003cli\u003eKaraferis D, Aletras V, Niakas D. Determining dimensions of job satisfaction in healthcare using factor analysis. BMC psychology. 2022;10(1):240.\u003c/li\u003e\n \u003cli\u003eGhanbari R. Job satisfaction and its related factors in pre-hospital and hospital emergency nurses of Ahvaz Jundishapur university of medical sciences. Iranian Journal of Nursing Research. 2021;15(6):29-36.\u003c/li\u003e\n \u003cli\u003eReams LC. Fred Fiedler\u0026rsquo;s contingency model revisited: 30 years later. Filosofiya osvity Philosophy of Education. 2023;29(1):111-24.\u003c/li\u003e\n \u003cli\u003ePolit DF BC, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing \u0026amp; health. 2007 Aug;30(4):459-67.\u003c/li\u003e\n \u003cli\u003eMujtaba B VP, Salamzadeh Y, Topaloglu E. Employee Stress Сaused by Socioeconomic Challenges: Task and Relationship Management as a Buffer to Mitigate the Stress Outcomes. SocioEconomic Challenges. 2025;9(2):190-206.\u003c/li\u003e\n \u003cli\u003eMamić M JT, Galić S, Jelinčić I, Mik\u0026scaron;ić \u0026Scaron;, Lovrić B, et al. Influence of Personality Traits and Organizational Justice on Job Satisfaction among Nurses. Behavioral sciences. 2024;14(3):235.\u003c/li\u003e\n \u003cli\u003eMatagi L BP, Baluku MM. Age, job involvement and job satisfaction as predictors of job performance among local government employees in Uganda. Journal of Organizational Effectiveness: People and Performance. 2022;9(3):489-505.\u003c/li\u003e\n \u003cli\u003eGhaleh RJ MH, Hosseinnataj A, Al‐Mamun F, Mamun MA. Job satisfaction and the role of self‐esteem and self‐efficacy: A cross‐sectional study among Iranian nurses. Nursing Open. 2024;11(6):e2215.\u003c/li\u003e\n \u003cli\u003eMedeni V Mİ, Altunay G, Dikmen AU, İlhan MN. Job satisfaction, life satisfaction, and associated factors among hospital nurses: a cross-sectional study in T\u0026uuml;rkiye. Scientific reports. 2025;15(1):5738.\u003c/li\u003e\n \u003cli\u003eAntoine L DS, Ahearn S. The Influence of Age and Gender on Work-Life Balance and Job Satisfaction among Department Chairs at Academic Health Centers. Open Journal of Leadership. 2024;13(3):279-89.\u003c/li\u003e\n \u003cli\u003eInayat W JKMAsojsaieotpoewipso, Peshawar. Education Research International. 2021;2021(1):1751495.\u003c/li\u003e\n \u003cli\u003eNadeem RN IZ, Sarfaraz B. Gender Differences in Job Satisfaction Among Bankers in Karachi. Pakistan Journal of Gender Studies. 2025:185-202.\u003c/li\u003e\n \u003cli\u003eZakariya YF WYJsomtAeitqtcots-eatmttMERJ.\u003c/li\u003e\n \u003cli\u003eHell\u0026iacute;n Gil MF RHJ, Ib\u0026aacute;\u0026ntilde;ez-L\u0026oacute;pez FJ, Seva Llor AM, Rold\u0026aacute;n Valc\u0026aacute;rcel MD, Mikla M, et al. Relationship between job satisfaction and workload of nurses in adult inpatient units. International Journal of Environmental Research and Public Health. 2022;19(18):11701.\u003c/li\u003e\n \u003cli\u003eElsayed AEM AA, Alshehri E, Sairafi RA, Hashem HA, Alsalmi HA, et al. Staffing levels, work schedules, required overtime, and turnover in acute care hospitals impact health care workers\u0026apos; burnout, intention to leave, and job satisfaction: A crosssectional study. Revista iberoamericana de psicolog\u0026iacute;a del ejercicio y el deporte. 2025;20(1):8-12.\u003c/li\u003e\n \u003cli\u003eGeier N BgLD, R\u0026ouml;bken H, Mertens A. Overtime and well-being among mid-level academic staff. Journal of Applied Research in Higher Education. 2025 May 20.\u003c/li\u003e\n \u003cli\u003eKim J LE, Kwon H, Lee S, Choi H. Effects of work environments on satisfaction of nurses working for integrated care system in South Korea: a multisite cross-sectional investigation. BMC nursing. 2024;23(1):459.\u003c/li\u003e\n \u003cli\u003eMoreno-Mart\u0026iacute;nez M S-MITAFoWE, Work Overload, Work Satisfaction, and Emotional Exhaustion and Their Effect on Healthcare Workers: A Cross-Sectional Study. InHealthcare 2025 Jan 16 (Vol. 13, No. 2, p. 162). MDPI.\u003c/li\u003e\n \u003cli\u003ePoormoosa Y AM, Alizadeh A, Kalhor R. The effect of circadian on the productivity of nurses with the mediating role of quality of work life. BMC nursing. 2024;23(1):89.\u003c/li\u003e\n \u003cli\u003eBayati MM SA, Jamasbi MM, Tapak L. Servant leadership, work-life quality, and organizational citizenship behavior in nurses: a cross-sectional design. BMC nursing. 2025 May 19;24(1):561.\u003c/li\u003e\n \u003cli\u003eChang W-P PY-XIorsafnsosqonodaaslram-aC.\u003c/li\u003e\n \u003cli\u003eDas M PSSw, sleep and well-being: a qualitative study on the experience of rotating shift workers. Management and Labour Studies. 2025;50(2):148-65.\u003c/li\u003e\n \u003cli\u003e;12:1-8. HTEoSWoOsPaPW-BANEiSHTijoph.\u003c/li\u003e\n \u003cli\u003eBakotić D BIOjalboapoejsEfCS.\u003c/li\u003e\n \u003cli\u003eHo DA TL, Ho MH. The Impact of People-Oriented Leadership Behavior on Employee Satisfaction in Small and Medium Enterprises in Vietnam. Journal of Organizational Behavior Research. 2023;8(1-2023):275-85.\u003c/li\u003e\n \u003cli\u003eHussain S UZEtIoP-OLSoUTJS, Motivation and Performance. Al-Aijaz Research Journal of Islamic Studies \u0026amp; Humanities. 2024;8(3):89-105.\u003c/li\u003e\n \u003cli\u003eKhosroabadi T BB, Vakilifard H, Pourzamani Z. Evaluation of the organizational efficiency of audit firms based on leadership style. International Journal of Finance \u0026amp; Managerial Accounting. 2021;6(22):45-67.\u003c/li\u003e\n \u003cli\u003eHult M TMA, Kaakinen P, Karki S, Nurmeksela A, Palonen M, et al. Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews. Nursing open. 2023;10(9):5920-36.\u003c/li\u003e\n \u003cli\u003eNjoku HI GRLsaeeitfioMsJoCRiB, Economics and Finance. 2023;5(2):35-51.\u003c/li\u003e\n \u003cli\u003eFletcher KA TS, Bedwell-Torres WL, Braun MT. Perceived Task-and Relationship-Oriented Leader Behavior on Followers\u0026rsquo; Team-Oriented Attitudes. Psychological Studies. 2025:1-17.\u003c/li\u003e\n \u003cli\u003eAl-Husseini N KS, Sarlab R. The Effect of the Task-Oriented Leadership Style of Coaches on the Moral Decision-Making of the Players of the Iraqi National Athletics Team with the Mediating Role of Team Satisfaction. Pakistan Journal of Life \u0026amp; Social Sciences. 2025 Jan 1;23(1).\u003c/li\u003e\n \u003cli\u003eKhuong MN MTElbfpsspm, satisfaction and organizational commitment-evidence from Vietnam. Вопросы государственного и муниципального управления. 2022(5):45-64.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Head Nurses, Leadership, Nurses, Job Satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-8230767/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8230767/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLeadership style is an essential factor influencing the satisfaction of nursing staff with supervision and their overall professional performance. This study aimed to examine the Relationship between Head Nurses\u0026rsquo; Leadership Styles and Nursing Staff Satisfaction in a Comparative Study of Specialized and General Wards.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study surveyed all nurses and head nurses in six hospitals affiliated with Zanjan University of Medical Sciences (Iran), comprising 1,354 participants from specialized and general wards. Data were collected using a demographic questionnaire, the Fiedler and Chemers Leadership Style Inventory, and a Supervisor Satisfaction Questionnaire. Analyses were performed using SPSS version 26, employing correlation, ANOVA, and regression analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAt first, the study found that nurses in both specialized and general wards reported relatively high satisfaction with their head nurses. Also, the predominant leadership styles were integrated in specialized wards and relationship-oriented in general wards. However, in both wards, task-oriented leadership showed the lowest satisfaction scores. ANOVA and post-hoc tests confirmed that both integrated and relationship-oriented leadership styles resulted in significantly higher satisfaction compared to the task-oriented style. Regression analyses revealed that leadership styles accounted for 77% of the variance in specialized wards and 75% in general wards.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eUnderstanding leadership styles can help optimize management structures and enhance the quality of health service delivery. Hospital administrators should pay close attention to this issue. Our findings indicated that one key factor influencing nurses\u0026rsquo; satisfaction with their head nurses is the leadership style of those head nurses. Nurses were more satisfied with relationship-oriented and integrated leadership styles, whereas exclusive reliance on a task-oriented style was associated with lower satisfaction.\u003c/p\u003e","manuscriptTitle":"Task-Oriented Leadership as an Unfavorable Style: Examining the Relationship between Head Nurses’ Leadership Styles and Nursing Staff Satisfaction in a Comparative Study of Specialized and General Wards","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 16:18:51","doi":"10.21203/rs.3.rs-8230767/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-29T05:50:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T19:37:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T10:41:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T11:28:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217603760683570383047610130183557858021","date":"2025-12-19T20:01:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88984754466896553145961813651135694489","date":"2025-12-19T05:18:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212750105393246583957623714674259489228","date":"2025-12-18T19:15:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T17:57:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194997893972537720009306736930553660492","date":"2025-12-16T17:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310719000421478060964726451655958010465","date":"2025-12-16T16:08:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T15:31:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-01T08:26:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-29T05:59:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-29T05:57:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-11-28T13:06:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f1135ca-0978-4c1d-bdbe-d1aa589fb809","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T06:54:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 16:18:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8230767","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8230767","identity":"rs-8230767","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}