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Leader Member Exchange In Contemporary Nursing

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Discuss about the LeaderMember Exchange in Contemporary Nursing.



According to the report by the European Agency for Safety and Health at Work (EASHW), every organization should focus on its managerial significance and role in the improvement of the psychosocial working environment for its employees (Cogliser, 2015).  In their study, Gupta (2015) points out that leadership and the successful performance of an organization are dependent on the quality of leader-member exchange (LMX). Various researches also denotes that LMX is essential in determining the quality of the dynamic working relationship between the leaders of the organization and the employees based on the interrelated dimensions such as respect, trust, and mutual obligation (Torres, 2014). For instance, Hunt (2014) points out that when the leader provides the necessary resources in a beneficial and fair manner, the employees will have a positive view of the relationship. It will be reciprocated through increased effort and commitment to work hence resulting in high performance and good relationship.  The theory has it that the relationship between the leaders and the subordinates ranges from those based on those characterized by reciprocal influence, trust, and respect to those based on the formal employment contract (Kacmar et al., 2013).

The Scope of the Paper

The quality of LMX in the organization is associated with positive work attitudes, well-being, performance, job satisfaction, and organizational commitment. Hanse et al. (2014), also point out that adverse psychological factors of workforce increase the risks to ill-health such us burnout, sickness absence, stress-related disorders, and labor turnover among healthcare workers. The healthcare workers are often experiencing high workplace stress levels leading to a higher risk of mental health complications than other occupational groups Gupta (2015). This paper hence aims at examining the associated relationship between the LMX and nursing professionalism.The paper evaluates the LMX theory, related inter-communication, and the strategic recommendations that can be adopted by healthcare leaders in the nursing industry to improve the quality of LMX in the industry. The main information presented in this paper will be conducted through secondary research with sophisticated sources from databases such as EBSCO and Google Scholars available in the web.


Leader-Member Exchange Theory

Leader-Member Exchange LMX theory mainly describes how the management and leadership in groups maintain their relationship and position in a series of intra-communication strategies and exchange of agreements with the members as pointed out by Hanse et al. (2014). Having emerged in the 1970s, the theory mainly focuses on the development of relationships between leaders and members of their team. In their study, Kacmar et al. (2013) denote that leaders and managers of groups and organizations often develop special relationships with the inner circle of trusted advisors, assistants, and lieutenants to whom they give a high level of decision influence, access to resources, and responsibilities. The group is referred to as the in-group and often works harder, more committed to task goals and objectives, and share most of the administrative duties. In his review, Rubin (2011) points out that this particular group is expected to be loyal to the leadership and fully committed to the assigned responsibilities while sharing more of the administrative tasks. However, the out-group consists of members who are often given a low level of influence and choice. The resulting effect is a constrained environment for the leaders who are expected to nurture the relationship with the in-group. Leaders have the responsibility of balancing the power while maintaining their position so as to ensure the inner cycle do not strike demands on their own without his concern.

After joining any group or organization, Stratton (2011) points out that every individual or employee must find themselves in these kinds of relationships that often start in three stages. The stages include the role taking, role making, and routinization as denoted by Kunze (2016).

  • Role taking- At this stage, an individual joins a team while the leader is assessing their talents and abilities based on the duties within the organization, from which the leader will offer them the opportunities for the demonstration of their capabilities. At this stage also, Gupta (2015) points out that both parties are at the point of learning or discovering the behavior of the other party regarding respect, performance, duty, etc.
  • Role taking- it is the second phase where the member and the leader take part in an informal and unstructured negotiation. The responsibilities and roles are given to the member while the often-tacit promises of benefits and power in return for loyalty, trust, and dedication takes place. Gupta (2015) points out that building trust between the parties is very essential at this point and any form of betrayal mainly by the managers or leaders results in the member relegating him or herself to the out-group. The same study also denotes that the negotiation process at this stage includes relationship factors and pure working strategies with a promise that hard work and positivity in various ways to give the member a successful frontier. According to Kumbra (2010), it is perhaps the reason as to why same-gender relationships are often more successful than mixed-gender ones as it also affects the first stage respect development, an aspect that is experienced in both racial and cultural differences.
  • Routinization- It is the phase of establishment of a continuous social exchange between the leader and the member.

Successful members are often similar to the leader in many ways, perhaps an explanation of why most of the senior teams are often male, white, middle-aged, and middle-class according to Hunt (2014). In ensuring that the relationship is maintained, these inner cycle members are often patient, sensitive, empathetic, reasonable and good at evaluating the viewpoint of other members and specifically the leader. On the other hand, the out-group often suffers from sarcasm, aggression, and egocentric behavior as pointed out by Cogliser (2015).


Importance of leader-member exchange intra-communication

Leaders with high LMX in their style of operation have been found to experience multiple personal and organizational benefits. For instance, Gupta (2015) identifies increased followers self-efficiency and more voluntary initiatives from the employees in relation to the in-groups as compared to the out-groups. The leaders hence train their juniors within the in-group towards exercising their leadership skills to make the work more effective while taking higher risks in the attempt of accomplishing a mission according to Sparrowe and Liden (2014). The leaders are thus able to extend leadership capabilities to the juniors and build networks that can influence others towards high-quality performance that at the end can even get the leaders promoted. In the nursing environment, high LMX within the organization will promote the performance of the nurses who will, in turn, show higher job satisfaction and lower turnover intentions resulting in a positive employee citizenship behavior and better patient care.

According to Hunt (2014), the focus on the relationships between followers and leaders is as well beneficial for other specific supervisory responsibilities mainly those in the middle management. It is this kind of relationship that determines the influence towards job satisfaction and increased organizational benefits. As a result, Hanse et al. (2014) point out that every employee in the nursing industry with high-quality LMX relationships often experiences a great access to organizational resources from leaders. They are often in-group who are assured of more work-based benefits that the out-group with poor quality relationships. LMX hence gives the group a more rapid career progression experience as well as a higher perception of the organizational influence of the employee. In his review, Gupta (2015) asserts that more responsible and complex nursing roles are often assigned to nurses with higher levels of respect, obligation, and trust based on the supervisor- employee relationship. The resulting impact of high-quality relationship LMX hence means a positive work experience thus performance and effective nursing care outcomes.

The nature of communication within the workforce- Rubin (2011) points out that there is often an element of satisfaction when there is proper communication between the management and the staff on various aspects and responsibilities of the organization. The satisfaction in communication can boost the level of LMX in the nursing industry. For instance, personal or interpersonal communication between co-workers and leaders often provides the sense of organizational citizenship to the nurses that they are part of the organization whose contribution to its success is respected and valued. In their review, Hanse et al. (2014) point out that the higher the decisional power of a leader within the hierarchy of the organization, the higher the staff gets motivated and satisfied. As a result, the influence can be felt both in strategic (decision-making related aspects) and work-related in relation to task assignments and performance review (Cogliser, 2015). The same study adds that more transparency between the workforce and the leaders of an organization leads to confidence and motivation for the members in regard to their focus o career goals and exceeding patient expectations in the case of nursing care.


Leader-member exchange exploration and discussion in nursing

According to Gupta (2012), leader-member exchange mainly focuses on the interaction between the leadership of the organization. Gupta contends that every leadership outcome is dependent on the nature and existence of interaction expressed by the leaders as they often have discretion, limited time, and positional power. In the nursing environment, such leaders will often attempt to maximize their leadership outcomes by allocating duties to trusted nurses within the in-group. Morgeson (2015) denotes that unlike other theories that were either subordinate centric or leader-centric, LMX examines the dynamic relationship between the two approaches as the major contributors of effective leadership in a workplace. Unlike other leadership theories that that views subordinate as a team or a group, LMX often considers every individual in a team as a contributor to the success or failure of the organization.

In the nursing industry, the theory recognizes two major types of relationships based on the nature of the interaction between the leaders and the subordinate staff as pointed out by Jordan and Troth (2011). Within the nursing industry, the in-group nurses often go beyond their expected responsibilities and possess a constructive approach to tasks. According to Hanse et al. (2014), they are often viewed as the staff that proactive in seeking to ensure success in the leadership roles. They are hence forming the high-quality LMX in-group with positive outcomes in their patient care roles for better healthcare provision since they negotiate and initiate their role expansion beyond the job description. Their relationship with the leaders is often of mutual trust, and respects hence receive a reciprocal attention, concern, and information from the leaders (Zivnuska& Gully, 2013). The nurses within the in-group also receive positive performance evaluation, support to desired work, and higher promotion frequency.

On the other hand, the out-group within the nursing workforce often only try to work to fulfill their contract obligations but do not receive any additional benefits or attentions since their interaction with the leaders is task-oriented and formal Hanse et al. (2014). It is a group with low LMX degree since the reciprocity with the communication strategies from the leader is often little. In such cases, the nurses involved are often concerned with self-fulfillment rather than meeting the objectives of the healthcare organization (Cogliser, 2015). As a result, the interaction between the nurses and the leaders is often formal.

Practical strategy recommendations for improving the quality of LMX in nursing workplaces

In his study, Stratton (2011) denotes that the overall nature and quality of the LMX relationships in a workplace vary depending on many factors. These include the size of the group, the challenge of the job whether extremely high or extremely low, overall workload, and the availability of financial resources. The same study denotes that the principle works onwards and upwards as well since the leader is also becoming a member of the inner cycle of their managers which is then shared downwards with the members (Laschinger, 2011). It hence gives a clear explanation as to why individuals at the low levels of organizations and have unusual powers tend to get it from the unbroken chain of the hierarchical circle.

 From the analysis of the theory, Torres (2014) denotes that it is advisable that every nurse should work hard to be part of the inner circle of a team and learn to take on more than his share of administrative and other tasks. Such a case requires nursing professionals to be reasonable, supportive towards solving organizational health and patient care challenges and demonstrating unswerving loyalty. On the other hand, Rubin (2011) also points out that leaders need to pick their inner circle with responsiveness and care and to reward them for their hard work and loyalty. They should also be very careful to ensure that they maintain a positive commitment to their patient care delivery for the betterment of the health care industry and professionalism as pointed out by Gupta (2015).


Observations of information behaviors in leadership clearly show that the action and relationship of leaders are not the same towards the subordinate in a nursing workplace. The essentiality of this potential difference is clearly proven by the LMX theory showing that leadership consists of various dynamic relationships linking the followers and the leaders. In every healthcare organization, it is often easy to identify the out-group and in-group existence. In their study, Kacmar et al. (2013) denote that it polarizes the organizational performance and de-motivates its general success. However, it is an internal factor that always affects every health care organization. As a result, a good healthcare professional is required to continuously make efforts of expanding his in-group while adopting strategies that can lead to the reduction of the out-group. The following strategies can hence be adopted in ensuring the improvement of the quality of LMX within the nursing profession.

Identifying the out-group- The leader of the health care center should identify the out-group of nurses; analyze their past and present performance. Such a strategy will be helpful in identifying the relevant key characteristics that can be adopted in exploring their interests to increase their unity and positive relationship with the leadership hence leading to better health care to patients (Wing, Xu, & Snape, 2017).

Exploration of the staff motivation- the leader, should adopt strategies that can initiate planned dialogs with the nurses. In doing this, Stanton and Casimir (2014) denote that the leader will have a better understanding of the subordinate’s career goals, personal aspirations, and task-related preferences. The motive of such an exercise will help the leader to test the willingness of the nurses in taking their patient care responsibilities and their ability to test and develop their confidence in the leadership of the workplace (Scholarios, 2014). The leader can thus obtain more feedback from the nurses who are the subordinate, an aspect that will also reduce his self-interest oriented strategies and approaches of dealing with the staff.

Reducing de-motivation- In his study, Torres (2014) points out that it is essential to identify and understand what factors proves de-motivational just the same way it is to identify motivational factors for a workforce. According to the study, de-motivational factors among employees that can lead to low LMX include;

Perceived contractual breach- occurs when an employee joins an organization when expecting to receive some reciprocal promises and expectations for his services that he then finds not available in the written contract (Winkel, 2016). In such a case, the employee will feel the organization has not lived to their expectations resulting into low LMX.

Low willingness and ability- according to Hanse et al. (2014), a situational model of leadership recommends that low ability and willingness of a workforce towards the achievement of the goals and objectives of a company often force leaders to adopt a directive style. The resulting effect is commands and pressure on the employees to achieve deadlines hence resulting to low LMX.

Cognitive similarities- when both the nurses and the leaders have similar behavior when it comes to finding solutions to different challenges, the situation is described as cognitive similarity (Clays, 2014). The cognitive similarity is hence resulting into a low LMX between the leadership of the organization and the nurses hence leading to poor patient care service provision Stratton (2011).

Task characteristics- when tasks and responsibilities of the organization are unclear or unstructured, the LMX is often high as the work methods are new or not known to the workforce. Rubin (2011) denotes that challenging tasks often elevate the interest of the staff on going beyond their roles. The attention of the leaders is often high due to the risky nature of the task and the high demand of the subordinate in finding solutions to the challenging task (Kacmar et al., 2013). However, caution needs to taken especially for the nursing industry since unclear tasks make it hard for efficiency evaluation as well as the outcome of the nurses hence creating an opportunity for pseudo role expansion without a significant contribution to the patients of the organization.

The resulting effect is a constrained environment for the leaders who are expected to nurture the relationship with the in-group (Wayne, Shore, &Liden, 2011). Leaders have the responsibility of balancing the power while maintaining their position so as to ensure the inner cycle do not strike demands on their own without his concern (Gemmel, 2014). One way in which the LMX model implies for managers and leaders in an organization is that the type of relationship they have with the employees is very essential in influencing their interaction and performance (Wang et al., 2015). In his strategic analysis, Judge and Piccolo (2014) point out that relationships in the workplace naturally develops due to the personal interaction and the work-related relationships between the leaders and the workers. Since they naturally take place, some leaders are often not aware of the power which lies in them to develop the positive relationships. Janssen Van Yperen (2012) also denote that these relationships have essential influence over the attitude and behavior of the employees.

 In work cases, they can potentially create negative work environment characterized by unfairness and favoritism. Such managers are often advised to take responsibilities of building these relationships by putting forth the effort to consciously cultivate these relationships. The leaders should also be open to form good and healthy relationships to employees from all backgrounds despite their permanent characteristic such as race age, disability status, and sex among other factors (Ilies, Nahrgang&Morgeson, 2017). The leaders should hence understand that they have the sole responsibility of preventing these relationships from the possibility of leading to unfair work environment as such can affect not only the nurses but even their attitude towards helping patients. The resulting effect can thus be poor healthcare performance and bad name for the healthcare providers (Ilies, Nahrgang, &Morgeson, 2017).


The quality of the relationship between leaders and nursing practitioners in a workplace is reflected by respect, obligations, loyalty, support, and degree of mutual trust between them. However, it is very clear that most leaders offer their support to the inner cycle, an aspect they may even make him inflate their ratings even on poor performance. The out-group is often denied this kind of treatment as the leader have a belief that the in-group perform better and have a positive attitude towards the leader and the duties as well. The job satisfaction and effective performance are high in the in-group as they often receive more support towards mentorship, bonuses and salary increment, and promotions among other benefits that are not enjoyed by the out-group.

From the literature analyses, it is evident that LMX is very practical and positively contributes to better communication between the leaders and the subordinate. For instance, it is easy to recognize or identify the out-group and in-group within the organization hence giving a clear reason as to why there is normally unequal contribution on individual performance. LMX provides a strong base of communication due to the importance of the various aspects of exchange and communication between the leaders and the staff. However, as conflict ethics and law governs the health industry to be fair while prohibiting discrimination, identifying in-group and out-group is a form of segregation. Additionally, there are no diagnostic methods that have been proven to the intention of the segregation on whether to promote the citizenship of the organization or its use for other purposes like a demotion of the out-group. The leaders should hence understand that they have the sole responsibility of preventing these relationships from the possibility of leading to unfair work environment as such can affect not only the nurses but even their attitude towards helping patients.



Cambra, R. (2010). Apprehension about speaking in the organizational setting. Psychological Reports, 45, 58.

 Clays, E. (2014). The impact of organizational support and leader-member exchange on the work-related behaviour of nursing professionals: the moderating effect of professional and organizational identification. Journal Of Advanced Nursing, 70(2), 373-382. doi:10.1111/jan.12201

Cogliser, C. (2015). Leader-Member Exchange (LMX) Research: A Comprehensive Review of Theory, Measurement, and Data-Analytic Practices. Leadership Quarterly.  (1):63–113.

Gemmel, P. (2014). The importance of social exchange to nurses and nurse assistants: impact on retention factors. Journal Of Nursing Management, 22(5), 563-571. doi:10.1111/jonm.12039

Guneri, B. (2008). Leader–member exchange, organizational identification and the mediating role of job involvement for nurses. Journal Of Advanced Nursing, 64(4), 354-362. doi:10.1111/j.1365-2648.2008.04809.x

Gupta, A. (2015). Leader Member Exchange, Journal of practical management, 5(4):448–60.

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