Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Terry Jones

Second Advisor

Dr. Patricia Kinser

Third Advisor

Dr. Kathy Baker

Fourth Advisor

Dr. Leroy Thacker



Introduction: Ineffective leadership by frontline nurse managers (FLNMs) is associated with costly outcomes; thus, organizations seek effective strategies to facilitate consistent implementation of leadership behaviors. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed. Therefore, the purpose of this work was to examine how FLNMs perceive and experience the different aspects of social support and how social support relates to their leadership behaviors. In addition, this study looked at the impact of personal factors on the Transformational Leadership (TL) behaviors of FLNMs.

Methods. A parallel convergent mixed-methods approach was used to examine the relationship between personal factors, social support, and leadership practices of FLNMs, explore the experience of social support as lived by FLNMs, and develop a corroborated understanding of formal and informal social support within the leadership context. In this multisite study, a sample of FLNMs with at least 3 months experience as a nurse manager participated in survey data collection which employed the Leadership Practice Inventory, the Survey of Perceived Organizational Support, and the Multidimensional Scale of Perceived Social Support to measure Leadership behaviors, and formal and informal social support respectively. A subset of participants who showed willingness to be interviewed were invited to participate in the individual qualitative interview.

Results. In this study, FLNMs (n=97) usually used TL practices, LPI (M=53, SD=5.5), generally felt supported by their organizations SPOS (M=5.95, SD=1.4), and perceived receiving high support from outside the organization MSPSS (M=6.02, SD=1.1). There is a weak to moderate significant positive correlation between formal social support and TL practices (β= 0.28, p 0.000) and between informal social support and 2 LPI subscales encourage the heart (β=0.31, p 0.001) and Enables others to act (β=0.27, p 0.006). No significant relationship was found between personal characteristics and leadership practices. Qualitative data (n=10) revealed the following key themes for formal support: social connectedness, effective communication, opportunity to grow, and meaningful recognition. In addition, the following themes for informal support were identified: listening and understanding, getting advice and new perspectives, and sharing responsibilities at home. The findings from the qualitative arm confirmed and expanded the quantitative data and provided complementary insights of social support within the leadership context.

Conclusion: This work is the first to explore the phenomenon of formal and informal social support and its impact on TL behaviors of FLNMs. The findings highlight the critical significance of social support within the leadership context of FLNMs and offer potential strategies for promoting social support among this population.


This work could not have been completed without the support of many people. I would like to express my heartfelt gratitude to my husband Jawad, my daughter Jihane, and my two sons Georges and Rami, for their unwavering support throughout my academic journey. I am also deeply grateful to my dissertation committee chair, Dr. Jones and my committee members, Dr. Kinser, Dr. Baker, and Dr. Thacker for their guidance, mentorship, expertise, and their dedication to my project. I also want to thank my classmates, colleagues, and friends who were an incredible source of inspiration. Your kindness and support have made all the difference in my journey.

Finally, I would like to express my deepest gratitude to Life itself!


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