The dynamic nature of leader-member exchange relationships in health-care organizations.

PURPOSE: This study aims to make visible the dynamic nature of leader-member exchange (LMX) in the changing realm of health-care leadership.

DESIGN/METHODOLOGY/APPROACH: The qualitative study used an open questionnaire, which was distributed amongst nursing staff and managers at a Finnish public university hospital.

FINDINGS: The participants described partly LMX theory, but the leader-member relationship was also influenced by the organizational culture and the existing management practices. Nursing staff were found to have a more variable and dynamic role in the LMX relationship than has previously been reported. The research therefore provided novel information for the field of health-care research.

RESEARCH LIMITATIONS/IMPLICATIONS: The presented research was limited by the content of the data, as the collected single narratives were rather short; however, the fact that a large number of narratives were collected from diverse participants strengthened the ability to reliably answer the research questions.

PRACTICAL IMPLICATIONS: Although the participants described partly LMX theory, the leader-member relationship is also influenced by the organizational culture and existing management practices; the finding that nurses have more variable roles in LMX relationships in the health-care context was new insight in this field. Therefore, the presented findings can help decision-makers change the current, perhaps antiquated, leadership practices at health-care organizations.

ORIGINALITY/VALUE: This study provides new insight into the field of LMX research in terms of the important role of nursing staff, the organizational factors that influence the LMX relationship and the dynamic nature of LMX relationships.