The impact of informal leader nurses on patient satisfaction.

Background The relationship between informal leaders, i.e., highly competent individuals who have influence over peers without holding formal leadership positions, and organisational outcomes has not been adequately assessed in health care. Aims We evaluated the relationships between informal leaders and experience, job satisfaction and patient satisfaction, among hospital nurses. Methods Floor nurses in non-leadership positions participated in an online survey and rated colleagues' leadership behaviours. Nurses identified as informal leaders took an additional survey to determine their leadership styles via the Multifactor Leadership Questionnaire(TM). Six months of patient satisfaction data were linked to the nursing units. Results A total of 3,456 (91%) nurses received peer ratings and 628 (18%) were identified as informal leaders. Informal leaders had more experience (13.2 +/- 10.9 vs. 8.4 +/- 9.7 years, p < 0.001) and higher job satisfaction than their counterparts (4.8 +/- 1.2 vs. 4.5 +/- 1.1, p = 0.007). Neither the proportion of informal leaders on a unit nor leadership style was associated with patient satisfaction (p = 0.53, 0.46, respectively). Conclusion While significant relationships were not detected between patient satisfaction and styles/proportion of informal leaders, we found that informal leaders had more years of experience and higher job satisfaction. More work is needed to understand the informal leaders' roles in achieving organisational outcomes. Implications for Nursing Management: Nurse informal leaders are unique resources and health care organisations should utilise them for optimal outcomes.