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American Journal of  Physical Education 
and Health Science (AJPEHS)

The Influence of  Transformational Leadership on Nurses’ Performances in Indonesia
Kartika Ningsih Desy1*

Volume 2 Issue 1, Year 2024
ISSN: 2992-9679 (Online) 

DOI: https://doi.org/10.54536/ajpehs.v2i1.2502
https://journals.e-palli.com/home/index.php/ajpehs

Article Information ABSTRACT

Received: January 28, 2023

Accepted:  February 25, 2024

Published: February 29, 2024

Leadership has been known as one of  the most influential factors in enhancing job 
performance. Leaders play a crucial role in this endeavor by facilitating opportunities for 
skill enhancement through training initiatives and other skill-improving activities. This study 
implements a qualitative approach, with deep interviews as the data collection method. The 
study was performed in several hospitals in Indonesia that apply transformational leadership 
styles to their management atmospheres. The research findings underscore the pivotal role 
and the potential of  transformational leadership style as a driving factor for improved 
performance. Building upon these findings, it is recommended that leaders intensify 
efforts to enhance the leadership style and bolster further training programs to ensure a 
broader participation base. Additionally, transformational leadership can potentially provide 
specialized resources tailored to the nurses’ specific functional responsibilities. This may 
include the provision of  learning modules covering various areas surgical medical-surgical, 
communication, and documentation. By equipping these nurses with the requisite knowledge 
and skills, leaders empower them to fulfill their duties effectively, thereby fostering a culture 
of  service excellence within the institution.

Keywords
Transformational Leadership, 
Nurses’ Performance, Hospital

INTRODUCTION 
Adaptability is paramount for survival and growth in 
today’s dynamic and fiercely competitive organizational 
landscape, marked by ever-evolving complexities. It is 
imperative for organizations, spanning various sectors 
including the corporate realm, to exhibit heightened 
responsiveness to navigate these shifting tides effectively. 
Recognizing this imperative, scholars such as Alrowwad et 
al. (2020) underscore the indispensable role of  individual 
change in facilitating organizational transformation. 
However, effecting this alignment between organizational 
and individual change poses a formidable challenge. 
Leaders, as the vanguards of  organizational culture 
and ethos, wield significant influence in catalysing such 
transformative shifts (Labrague et al., 2020a). Thus, 
initiating and championing change initiatives necessitates 
proactive engagement from leadership, starting at the 
apex of  the organizational hierarchy. 
By serving as exemplars of  change, leaders set the tone 
and direction for organizational evolution (Finkelstein 
et al., 2009). Their commitment to personal growth 
and adaptation not only instils confidence within the 
workforce but also fosters a culture conducive to change 
and innovation. Consequently, by leading by example, 
leaders inspire individual change and cultivate a collective 
mindset geared towards embracing and leveraging 
change as a catalyst for organizational advancement. In 
contemporary organizational contexts characterized by 
rapid change and heightened competition, the imperative 
for effective leadership has never been more pronounced. 
Acknowledging the exigency of  navigating turbulent 
waters, scholars have emphasized the pivotal role of  
reformist leaders in driving organizational change (Gill, 
2002) These leaders, imbued with a visionary outlook 

and a propensity for innovation, serve as the driving 
force behind transformative initiatives, steering their 
organizations towards sustainable growth and adaptation 
in dynamic environments.
Central to the discourse on effective leadership is the 
concept of  employee engagement, which has garnered 
considerable attention in organizational research. 
Numerous studies have underscored the intricate 
relationship between transformational leadership and 
employee engagement, positing transformational leaders 
as catalysts for fostering a sense of  purpose, motivation, 
and commitment among their subordinates (Dwivedi et 
al., 2020; Labrague et al., 2020b). Furthermore, empirical 
evidence consistently links heightened levels of  employee 
engagement to enhanced organizational performance 
across various domains (Barreiro & Treglown, 2020; 
Setyaningrum & Pawar, 2021). These findings underscore 
the significance of  nurturing a workforce that is not only 
intellectually and emotionally invested but also actively 
aligned with organizational goals and values.
Despite the burgeoning body of  literature on the 
individual constructs of  transformational leadership, 
employee engagement, and performance, there remains 
a conspicuous gap in scholarship concerning their 
interrelationships. While extant research has established 
the direct impact of  transformational leadership on 
employee engagement and subsequently on performance 
outcomes, the mediating role of  employee engagement 
in the relationship between transformational leadership 
and performance has received scant attention. This 
gap in knowledge represents a critical lacuna in our 
understanding of  the underlying mechanisms through 
which transformational leadership exerts its influence on 
organizational effectiveness (Olofunke, 2023).

1 Universitas Indonesia Maju, Indonesia
* Corresponding author’s e-mail: deskartik123@gmail.com



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Addressing this gap holds significant implications for 
both theory and practice. By elucidating the mediating 
role of  employee engagement, scholars can offer nuanced 
insights into the intricate dynamics of  leadership and 
organizational performance. From a practical standpoint, 
such insights can inform the development of  targeted 
interventions and leadership strategies aimed at enhancing 
employee engagement and, by extension, organizational 
performance. Thus, future research endeavours should be 
focused to unravel the complexities of  this relationship, 
thereby advancing our understanding of  effective 
leadership in contemporary organizational settings (Islam 
et al., 2021).
The Regional General Hospital (RSUD) in Indonesia, 
operates as a vital governmental institution within the 
healthcare sector, catering to the diverse medical needs 
of  the local populace. As a subsidiary of  the Regional 
Government system, its mandate encompasses the 
enhancement of  public health and the provision of  
quality healthcare services to the community. Central to 
its operational framework is the delivery of  professional 
medical care, with nurses assuming a pivotal role as 
primary caregivers who engage extensively with patients, 
medical professionals, and administrative personnel. 
Given their frontline position, nurses play a fundamental 
role in ensuring the delivery of  compassionate and 
effective healthcare services (Baljoon et al., 2018; 
Botchwey & Ahenkan, 2021). Their daily interactions 
with patients, alongside their collaborations with 
doctors and management, underscore their multifaceted 
responsibilities spanning clinical care, communication, 
and administrative duties. As such, their professionalism 
and dedication serve as linchpins in upholding the 
hospital’s commitment to excellence in patient care.
Furthermore, RSUD prioritizes transparency and 
accountability in its operations, exemplified by its robust 
system for addressing patient grievances. Patients and 
their families are afforded the opportunity to voice their 
concerns and lodge complaints, either directly or through 
established channels, thereby facilitating continuous 
feedback and quality improvement initiatives. This patient-
centric approach underscores the hospital’s unwavering 
commitment to fostering a culture of  responsiveness and 
accountability, thereby ensuring that the healthcare needs 
and concerns of  the community are addressed promptly 
and effectively. In essence, RSUD stands as a beacon of  
healthcare excellence in Indonesia, embodying the values 
of  professionalism, compassion, and accountability in 
its pursuit of  enhancing the health and well-being of  
the local populace. Through its dedicated workforce and 
patient-centred practices, the hospital remains steadfast in 
its mission to provide accessible, high-quality healthcare 
services to all members of  the community (Friebel et al., 
2018).
Apart from its pivotal role in building healthy community, 
the environment in healthcare is increasingly fraught with 
problems such as payment reduction, higher workload, 
turnover, and professional conflicts (Mwachofi et al., 

2011). there are several complaints often delivered by 
patients attended Indonesian RSUD, through both direct 
and indirect channels. Direct complaints are typically 
addressed during working hours, either to relevant unit 
officers or directly to the public relations department. 
Conversely, indirect complaints may be lodged through 
various avenues such as mass media, call centres, or 
questionnaire sheets provided by the hospital. The 
complaint data highlights several recurring issues brought 
forth by patients or their families (Hidayah & Nurmiati, 
2021). These include concerns related to administration, 
behaviour and communication of  hospital staff, quality 
of  treatment, queueing times, facilities and infrastructure, 
as well as response times or processing speeds. Notably, a 
substantial portion of  these complaints pertains to aspects 
directly linked to nurse performance, underscoring the 
significance of  addressing these issues within the nursing 
department. Despite concerted efforts, the report from 
the nursing department indicates a performance gap in 
the inpatient unit. 
In response to these challenges, the hospital 
administrations adopt a proactive approach focused on 
identifying root causes, implementing corrective measures, 
and fostering a culture of  continuous improvement 
within the nursing department. This may entail initiatives 
such as comprehensive training programs to enhance 
communication and interpersonal skills among nursing 
staff, streamlining administrative processes to reduce wait 
times, and investing in infrastructure upgrades to improve 
overall patient experience. Furthermore, fostering open 
communication channels and soliciting feedback from 
patients and staff  can facilitate a deeper understanding of  
the underlying issues and inform targeted interventions. 
However, evidence shows that there is still a relatively low 
performance on inpatient treatment cases over the last six 
months, underscore critical areas for improvement within 
the nursing department. While nursing documentation 
activities are being carried out, the failure to meet 
established standards highlights systemic challenges that 
warrant attention. One plausible explanation for these 
shortcomings could indeed be attributed to the leadership 
style and work involvement of  nurses within the hospital. 
Leadership plays a pivotal role in shaping organizational 
culture, setting expectations, and fostering accountability 
among staff  members. In this context, the influence 
of  leadership styles, particularly transformational 
leadership, on nursing performance cannot be overstated. 
Transformational leaders have the potential to inspire 
and motivate their teams, instilling a sense of  purpose 
and commitment that drives excellence in patient care. 
Concurrently, the level of  work involvement among 
nurses is another crucial determinant of  performance. 
High levels of  work involvement signify a deep sense 
of  engagement and dedication to one’s role, resulting in 
enhanced productivity and quality of  care. However, if  
nurses perceive a lack of  support or recognition from 
leadership, it can adversely impact their morale and 
motivation, potentially leading to suboptimal performance 



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and incomplete documentation practices.
Addressing these challenges necessitates a multifaceted 
approach that encompasses leadership development, 
fostering a culture of  accountability, and providing 
adequate support and resources for nursing staff. 
Leadership training programs can equip leaders with 
the skills and tools necessary to inspire and empower 
their teams effectively. Additionally, initiatives aimed 
at promoting greater work involvement, such as 
recognition programs and opportunities for professional 
growth, can bolster morale and motivation among 
nurses, thereby enhancing their performance and 
commitment to documentation standards. Furthermore, 
establishing clear expectations and protocols for nursing 
documentation, coupled with regular monitoring and 
feedback mechanisms, can help ensure compliance with 
established standards.

LITERATURE REVIEW
Performance within a government agency serves as a 
critical yardstick for evaluating the effectiveness and 
efficiency of  its operations, aligning with the overarching 
vision and objectives of  the organization. As articulated 
by Spreitzer & Porath (2012) and Tătar (2011), 
performance is a key indicator of  an agency’s success 
in achieving its goals and objectives, providing valuable 
insights into the efficacy of  operational policies and 
their impact. In essence, performance encompasses both 
tangible outcomes and intangible manifestations of  work, 
spanning physical/material as well as non-physical/non-
material domains (Nandasinghe, 2020; Porter, 1998; Warr 
& Nielsen, 2018). At its core, employee performance, as 
defined by Riyanto et al. (2021) pertains to an individual’s 
capacity to fulfil their assigned responsibilities and tasks, 
typically gauged against predetermined success indicators. 
This evaluation process facilitates the categorization 
of  employees into varying performance levels, often 
delineated as high, medium, or low, or as exceeding, 
meeting, or falling short of  targets.
Such categorizations offer a comprehensive overview of  
an employee’s overall performance, enabling stakeholders 
to discern patterns, identify areas for improvement, 
and make informed decisions regarding resource 
allocation, policy refinement, and strategic planning. By 
systematically evaluating and interpreting performance 
data, government agencies can optimize their operations, 
enhance service delivery, and ultimately advance their 
mission of  serving the public interest. In sum, performance 
serves as a cornerstone of  organizational effectiveness, 
providing the requisite insights and benchmarks for 
continuous improvement and strategic decision-making 
within government agencies (Ersarı & Naktiyok, 2022). 
By prioritizing the cultivation of  high-performance 
cultures and fostering accountability at all levels, agencies 
can strive towards greater efficiency, transparency, and 
responsiveness in fulfilling their mandates and serving the 
needs of  their constituents.
Leadership, as elucidated by various experts in the field, 

represents a multifaceted phenomenon characterized by 
its dynamic and influential nature. At its core, leadership 
can be conceptualized as a process of  influence that 
unfolds within the intricate interplay between leaders 
and their subordinates (Kasapoğlu, 2018; Nandasinghe, 
2020). While the essence of  leadership lies in its relational 
dynamics, scholarly discourse often emphasizes the 
figure of  the leader as a focal point for analysis and 
understanding.
Rost, as cited by Thompson & Glasø (2018), articulates 
leadership as a relational nexus marked by mutual 
influence between leaders and followers who aspire for 
tangible change aligned with shared goals. This conception 
underscores the interactive and reciprocal nature of  
leadership dynamics, emphasizing that influence is not 
unilateral but rather manifests as a symbiotic relationship 
devoid of  coercion. Thus, leadership emerges as a 
dynamic process characterized by reciprocal influence, 
wherein both leaders and followers actively shape and 
drive organizational change (Banutu-Gomez & Banutu-
Gomez, 2016; Jansson, 2013). Crucially, leadership entails 
a collective endeavour towards effecting meaningful 
change, with leaders serving as catalysts for translating 
shared aspirations into actionable outcomes. Importantly, 
the impetus for change emanates from a shared vision 
embraced by both leaders and followers, underscoring the 
collaborative nature of  leadership pursuits (Lynch, 2015). 
This shared vision serves as a guiding beacon, motivating 
individuals to transcend personal interests and coalesce 
around common objectives.
As explored in the current study, transformational 
leadership epitomizes a leadership paradigm characterized 
by the ability to inspire and mobilize employees towards 
collective goals while transcending self-interests 
(Alrowwad et al., 2020; Dwivedi et al., 2020). Dwivedi et al. 
(2020) delineate four key dimensions of  transformational 
leadership: idealized influence, intellectual stimulation, 
inspirational motivation, and individualized consideration. 
These dimensions encapsulate the leader’s capacity to 
engender admiration, stimulate intellectual curiosity, foster 
motivational fervour, and demonstrate personalized care 
towards subordinates. In essence, leadership unfolds as a 
collaborative endeavour predicated on mutual influence 
and shared aspirations, with transformational leaders 
embodying the ethos of  inspiration, motivation, and 
collective empowerment. Through their adept navigation 
of  relational dynamics and commitment to shared goals, 
transformational leaders galvanize organizational change 
and propel their teams towards sustained success.

MATERIALS AND METHODS
The research methodology employed in this study aligns 
with a qualitative approach, as advocated by. In this study, 
the data collection method is operationalized with a non-
structured or open interview. To picture the sources’ 
demographic condition, we also provide data regarding 
age distribution, working period, and gender. By 
leveraging this methodological framework, the research 



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aims to elucidate the influence between phenomena 
under investigation, namely transformational leadership 
and nurse performance. Overall, through meticulous data 
collection and analysis, the study endeavours to contribute 
to the body of  knowledge on leadership and performance 
dynamics within healthcare organizations. The collected 
data will be analysed qualitatively to provide systematic 
and comprehensive results.

RESULTS AND DISCUSSION
The demographic characteristics of  the respondents 
reveal that the majority fall within the age range of  25 to 
35 years old, which aligns with the broader demographic 
trends observed among nurses at the hospital. This 
demographic profile holds significant implications 
for the study, as younger nurses are often perceived to 
possess greater physical strength and vitality, which may 
contribute to heightened productivity and effectiveness 
in delivering healthcare services to the community. The 
prevalence of  younger nurses underscores the importance 
of  considering age-related factors in examining the 
relationships between transformational leadership, work 
involvement, and employee performance within the 
hospital setting. By accounting for demographic variables 
such as age, researchers can gain deeper insights into 
how age influences nurses’ attitudes, behaviours, and 
performance outcomes, thereby informing targeted 
interventions and strategies aimed at enhancing 
organizational effectiveness and employee well-being.
The findings of  this study indicate a significant and 
simultaneous influence of  transformational leadership 
on nurses’ performance. This result underscores the 
pivotal role of  transformational leadership in shaping 
and enhancing nurse performance within the healthcare 
setting. Transformational leaders, characterized by 
their ability to inspire, motivate, and empower their 
subordinates, play a crucial role in fostering a culture 
of  excellence, innovation, and patient-centred care. 
Transformational leaders can effectively mobilize and 
empower nurses to deliver high-quality healthcare services 
while achieving organizational goals by cultivating a 
shared vision, providing intellectual stimulation, and 
demonstrating individualized consideration.
The substantial contribution of  transformational 
leadership to nurse performance highlights the importance 
of  investing in leadership development initiatives 
and fostering a supportive organizational climate that 
nurtures and sustains transformational leadership 
behaviours. By empowering leaders to embrace their role 
as change agents and champions of  excellence, healthcare 
organizations can enhance nurse engagement, satisfaction, 
and ultimately, patient outcomes. Overall, the research 
findings underscore the significance of  transformational 
leadership as a key determinant of  nurse performance, 
emphasizing the need for strategic interventions aimed 
at fostering and sustaining transformational leadership 
practices within healthcare leadership structures.
The outcomes of  this research serve to reinforce the 

conclusions drawn by (Alrowwad et al., 2020), highlighting 
the substantial impact of  transformational leadership 
and work engagement on employee performance when 
examined concurrently. Within organizational contexts, 
leadership plays a paramount role in steering subordinates 
towards task accomplishment while nurturing an 
environment conducive to professional growth and 
productivity (Erezina et al., 2023). Transformational 
leaders possess the unique ability to not only provide 
clear direction and guidance but also to inspire and instil 
a sense of  purpose among their followers.
By effectively transmitting their enthusiasm and expertise, 
transformational leaders empower their subordinates 
to perform at their best and strive towards meeting and 
surpassing established performance standards. This 
dissemination of  vision and motivation fosters a collective 
commitment to excellence, driving individuals to exert 
greater effort and dedication in their work. Moreover, the 
findings resonate with the research conducted by Grin et 
al. (2018), which underscores the transformative potential 
of  leadership in elevating both performance levels and 
employee engagement. Transformational leadership 
serves as a catalyst for organizational improvement, 
catalysing positive change and fostering a culture of  
continuous growth and development (Caldwell et al., 
2012; Montuori & Donnelly, 2018; Shields, 2010; Shields 
& Hesbol, 2020).
In essence, the synergy between transformational 
leadership and work engagement underscores their 
collective influence in shaping employee performance 
outcomes. Organizations can cultivate a dynamic and 
high-performing organizational culture by embracing 
transformational leadership principles and fostering an 
engaged workforce. Through targeted interventions and 
leadership development initiatives, organizations can 
harness the full potential of  their workforce, driving 
sustained success and achievement of  strategic objectives. 
The findings suggest that superior support, particularly in 
the form of  transformational leadership, plays a crucial 
role in enhancing nurse performance. Transformational 
leaders serve as role models who inspire and motivate 
nurses to perform at their best, fostering a culture of  
excellence and continuous improvement within the 
hospital environment. By embodying the characteristics 
of  transformational leadership, superiors can effectively 
guide and empower nurses, driving them towards 
achieving higher levels of  performance and professional 
fulfilment.
Furthermore, the results highlight the significance of  
work involvement in influencing nurse performance. 
Nurses who exhibit high levels of  work involvement 
demonstrate a strong commitment to their roles and 
responsibilities, actively contributing ideas for hospital 
improvement and readily complying with regulations 
and policies. Their deep sense of  engagement and 
identification with their work not only enhances their 
performance but also fosters a positive and supportive 
organizational climate. Conversely, nurses with lower 



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levels of  work involvement may exhibit less enthusiasm 
and commitment towards their work, leading to routine 
and uninspired performance. Such nurses may be less 
supportive of  hospital initiatives and may only engage in 
their work at a superficial level, lacking the passion and 
dedication necessary for optimal performance. In summary, 
the findings underscore the importance of  superior 
support, particularly through transformational leadership, 
in cultivating a work environment that promotes high 
levels of  work involvement and, consequently, enhanced 
nurse performance. By fostering a culture of  engagement, 
empowerment, and collaboration, organizations can unlock 
the full potential of  their nursing staff, driving excellence in 
patient care and organizational outcomes.
The results gleaned from this study underscore the 
pivotal role of  transformational leadership in shaping 
the performance of  nurses. It’s evident that leaders wield 
significant influence in fostering professional development 
through avenues like formal continuing education and 
certified informal training, which are customized to meet 
the diverse needs of  nurses within their specialized fields. 
These initiatives not only empower individual practitioners 
but also contribute to the collective enhancement of  
organizational capabilities.
However, the successful execution of  such programs 
necessitates robust support from hospital management. 
It’s imperative for management to ensure the availability 
of  diverse resources required to facilitate these initiatives 
effectively. This includes but is not limited to financial 
investments, access to learning materials, and dedicated 
personnel. Without this crucial backing, the transformative 
impact of  leadership initiatives may be stymied, impeding 
the attainment of  optimal organizational performance.
In essence, the synergy between transformational 
leadership and management support is indispensable 
for realizing the full potential of  nursing teams and, by 
extension, the broader healthcare organizations they serve. 
Only through collaborative efforts can we truly harness the 
power of  leadership to drive sustained improvements in 
nursing performance and patient care outcomes.

CONCLUSIONS
Transformational leadership exerts a profound influence 
on enhancing nurse performance, with the efficacy of  
its implementation directly correlating to the extent of  
performance improvement achieved. To amplify the 
positive outcomes stemming from transformational 
leadership practices, fostering synergy among all 
stakeholders is essential. This includes active participation 
from nurses themselves, who serve as implementers of  
leadership initiatives, as well as proactive engagement 
from management and directors in allocating requisite 
resources. One critical resource allocation strategy involves 
earmarking educational funds to support nurses pursuing 
higher levels of  education or engaging in certified informal 
education, such as specialized training programs tailored to 
enhance their skill sets. By investing in continuous learning 
opportunities, organizations can equip nurses with the 

knowledge and competencies needed to optimize their 
performance and adapt to evolving healthcare dynamics 
effectively. Moreover, fostering a culture of  professional 
engagement among nurses is paramount. Encouraging 
active involvement in professional organizations provides a 
platform for ongoing knowledge exchange, enabling nurses 
to stay abreast of  emerging trends and pertinent issues in 
healthcare and nursing. This proactive approach not only 
empowers nurses to address challenges proactively but 
also safeguards against potential obsolescence in an ever-
evolving healthcare landscape. In essence, by nurturing 
collaboration among all stakeholders and investing in 
continuous professional development, organizations 
can thereby transformational leadership’s full potential, 
fostering a culture of  excellence and innovation in nursing 
practice.

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