Leadership Practiece Among Nurses in Tertiary Care Hospital Lahore

Introduction: The planned role of leadership can be used to examine on how to engage leadership models and use leadership behavior to progress organizational performance. The intangible assets such as leadership styles, culture, skill and competence, and motivation are key sources of strength in firms that can combine people and processes and organizational performance. Methodology: Leadership Practices Self assessment and Leadership Practices – Observer: The data collection tool was used for this study is self-assessment scale. It was designed in 1987 to be utilized by a leader to selfevaluate them in how frequently they engage in leadership practices. The thirty descriptive statements are given and a Likert scale was used. The five practices are identified as challenge the process, inspire a shared vision, enable others to act, model the way, and encourage the heart same repeatedly question asked from nurses to assess the perception (Posner & Kouzes, 1988). Results: The study revealed that the managers moderately performed the leadership practices. A significantly positive relationship was found between the manager and subordinate's assessment of challenging the process and inspiring a shared vision (p=.345). Discussion: the results of this study support the existence of a relationship between the self-assessment and the subordinate's assessment. This study also indicates that the managers in this study moderately exhibited the leadership practices as identified in Kouzes and Posner's (1987) research. DOI: 10.7176/JHMN/60-06 Publication date:March 31 2019 INTRODUCTION Background of study Abstract A need was also observed for nursing leaders to reflect and self-evaluate their leadership considering perceptions from the team on their adopted actions and practices, as the leadership practices are powerful indicators of the performance of the work of the nursing team (Eneh, et al., 2012) The planned role of leadership can be used to examine on how to engage leadership models and use leadership behavior to progress organizational performance. The intangible assets such as leadership styles, culture, skill and competence, and motivation are key sources of strength in firms that can combine people and processes and organizational performance (Khan, Bukhari, & Channar, 2016). Nurses face diverse challenges while providing the heath care facilities, so, self-confidence and strong believe on the self-capabilities help them to cope with these challenges. Thus, employee’s self-esteem plays a crucial role in the efficient health care services. Moreover, self-esteem is associated with the encouragement of head nurses and it ultimately influences the patient care (McGrath, Taenzer, Karon, & Blike, 2016). Leadership takes practice. Leadership is not a role that is practiced once and then mastered. Nurse leaders who encounter complicated issues should not rush to resolve them thus, the combination of established leadership styles is highly recommended for nurse leaders in clinical settings since various leadership styles and theories are relevant to nursing practice. Nurse Managers and clinical leaders should acknowledge the advantages and disadvantages of each theory (Xu, 2017). Collaborative practice with the nursing staff and effective management of individual is the patient care needs. Implementation of the APN role resulted in very positive perceptions of communication between the nursing staff and the APN/medical team; improved communication of the written plan of care; and learning opportunities for the nursing staff (Keenan, Mutterback, Velthuizen, Pantalone, & Gossack-Keenan, 2018). Challenge the Process does not mean challenge the values or standards, just because uncompromising integrity or flawless quality are too hard to live by. It does not mean attacking other people when we don't agree with their ideas or points of view. Nor does it mean seeking to dismantle what is working well, or attempting to eliminate something that is simply a personal inconvenience for you. Challenge the Process is about finding and implementing new and better ways of doing things in order to constantly improve to grow (Clinton, 2017). Leaders passionately believe that they can make a difference. They envision the future creating an ideal and unique image of what the organization can become. Through their magnetism and quite persuasion, leaders enlist others in their dream. They breathe life into their visions and get people to see exciting possibilities for the future (J. Kouzes & Posner, 2013). Journal of Health, Medicine and Nursing www.iiste.org ISSN 2422-8419 An International Peer-reviewed Journal DOI: 10.7176/JHMN

others to act, modeling the way, and encouraging the heart to become an extra ordinary leader Charge nurses: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people (Shaw, 2007). Operational Definition: Leadership: The art of leader working in health care sector to mobilize sub ordinates to achieve the goal. Leadership practices: The practice that a leader used to manage the sub ordinates working in Jinnah hospital. Charge nurses: A person working in health care sector and responsible for to take care the sick and injured person.

MATERIAL AND METHODS Study Design
A quantitative cross-sectional Analytical study design was used.

Study site
The study was conducted in Jinnah Hospital, Lahore.

Study Setting
The data was collected from charge nurses working in medicine ward, surgical ward, Peads Ward, Gynae ward, cardiac ward and from departmental head nurses except Operation Theater.

Study Population
Study papulation was 160 staff nursesand 140 head nurses.

Inclusion Criteria
The inclusion criteria for this study were:  Female head nurses  Female registered nurse  Willing to participate  More than one year experience  23-58 years of age Exclusion Criteria The exclusion criteria will be:  Nursing Student  Not willing to participate  Age below 23 years and above 58 years.

Sampling Technique
A convenient sampling technique was used for this study. Sample Size Sample size was calculated by using "Slovins formula". n=N/1+ (N) (E) 2 N=Population 304, n=Sample size =? E= 0.05% Margin of error Confidence interval 95% n =N/1+ (N) (E) 2 n=300/1+ (304) (0.05) 2 n=300/1+ (304) (0.0025) n= 300/1+0.76 n= 300/1.76 n=170 The sample size for this study was 170. Ethical Consideration/Institutional Review Board Written permission will be taken from the Ethical committee of LSN department in University of Lahore. Permission will be taken from the Deputy Nursing Superintendent of Social Security Hospital Lahore to conduct research study. Subjects have fully freedom to participate in this study. All the participants will be informed about the purpose of the study. The subject will be informed that there are no disadvantages or risk on the procedure of the study.

Data Collection Instrument
Three instruments were used to collect data for this research study  Demographic variables  Leadership Practices -Self assessment questionnaire  Leadership Practices -Observer questionnaire Data Analysis Method A statistical package for social sciences SPSS version 21 will use to analyze the data. Descriptive analyses will use to describe the sample. Frequency distributions will calculate for gender, age, educational level, experience. Mean values will be calculated for the various rankings given for leadership practices. Kolmogorov-Smirnov and Shapiro-Wilk test was used to check the normality of data. Pearson correlation test was used for relationships between Leadership Practices -Self assessment and Leadership Practices -Observer.

RESULTS
This study was conducted at Jinnah hospital to determine the leadership practices. The result of this study distributed into two sections, first section is statistics of demographic factors, independent and dependent tools named Leadership Practices -Self assessment and leadership practices -observer perception. Second section is relationship between demographic factors, Leadership Practices -Self Assessment and Leadership Practices -Observer Perception. Section 1: Demographic factors frequencies for leadership practices self-assessment Table 1 shows that only the female 85 (100%) were participate in this study with age group 23-31 years old were 27 (31.8%) and 32-40 years old were 45 (52.9%), 41-49 years old were 13 (15.3%). however near to 42 (49.4%) participants were general nursing diploma holder, and 40 (47.1%) were hold a degree of bachelor of sciences in nursing post Registered nursing and only 3 (3.5%) participants with degree of bachelor of sciences in nursing generic. Frequency percentage of experience of participants and the results were 1-9 years 41 (48.2%) in majority, 10-18 years 38 (44.7%), 19-27 years experienced participants were only 6 (7.1%).  Figure 1 shows that only the female 85 (100%) were participate in this study. Figure 2 this study revealed that the participants participate with age group 23-31 years old were 27 (31.8%) and 32-40 years old were 45 (52.9%), 41-49 years old were 13 (15.3%). Figure 3 shows Frequency percentage of experience of participants and the results were 1-9 years 41 (48.2%) in majority, 10-18 years 38 (44.7%), 19-27 years experienced participants were only 6 (7.1%).   Table 2 show that mean, median, mode, standard deviation and variance of gender, age, experience, and qualification of the participants and the mean (1.00, 1.84, 1.59, 1.54), median (1.00, 2.00, 2.00, and 2.00), mode (1, 2, 1, 1), standard deviation (.000, .670, .623, .568) and variance (.000, .449, .388, .323) respectively .323 Leadership practices -Self assessment frequency Table 3 shows the participants response on the items of Leadership practices -Self assessment and frequency of participants from rarely orVery Seldom = 1, Once in a While = 2 Sometimes = 3 Fairly Often = 4Very frequently or Almost Always = 5 and the result revealed that22 (25.9%) Once ina While, 14 (16.5 %) Sometimes, 24 (28.2%) Fairly Often, and majority25 (29.4%) were agree with Almost Always regarding the "I seek out challenging opportunities that test his or her skills and abilities". 7 (8.2%) agree with Rarely, 16(8.8%) agree with Once in a While,8 (9.4%) participants response as Sometimes and majority 27 (31.8%) were response as Fairly Often and 26(30.6%) in response of item two which was "I describe the kind of future he or she would like for us to create together". In the response of item three which was "I involve others in planning the actions that will be taking". 13 (15.3 %) agree with rarely, majority 30 (35.3%) Once ina While, 15 (17.6%) select Sometimes6 (7.1%) agreed with Fairly Often and 21 (24.7%) were select Almost Always.

Figure 3
Item four was "I am clear about his or her own philosophy of leadership' and participants respond as 16 (18.8%) rarely, majority 27 (31.8%) Once ina While, only 15 (17.4%) agree with Sometimes, 15 (17.4%) Fairly Often and 12 (14.1%) agree with Almost Always. In the reaction of question five which was "I take the time to celebrate accomplishments when project milestones are reached" 29 (34.1%) rarely, majority 39 (45.9%) Once in a While, 12 (14.1%) Sometimes, 4 (4.7%) agree with Fairly Often, 1(1.2%) agreed with Almost Always. In the reaction of item six which was "My I stay up-to-date on the most recent developments affecting our organization" only 3 (3.5%) agree with Once ina While, 19 (22.4%) Sometimes and 29 (34.8%) agreed with Fairly Often and majority 34 (40%) select Almost Always. Item seven was "I appeals to others to share his or her dream of the future as their own" and the participant respond as only 4 (4.7%) go with rarely, majority 23 (27.1%) agree with Once in a While, 14 (16.5%) Sometimes, 20 (23.5%) Fairly Often, 24 (28.2%) agree with Almost Always. Item eight was "I treat others with dignity and respect." and response was only 3 (3.5%), 5. (5.9%) participants respectively agreed with rarely and Once ina While, 33 (38.8%) Sometimes, majority 47 (47.1%) Fairly Often, 4 (4.7%) go with almost always. In the reaction of item nine which was "I make certain that the projects he or she leads are broken down into manageable step" only 3 (3.5%) agree with rarely, 23 (27.1%) Once in a While, 13 (15.3%) Sometimes, 18 (21.2%) Fairly often, 28 (32.9%) participants were agreed with almost always. In the reaction of item ten which was "I make sure that people are recognized for their contributions to the success of our projects" 22 (25.9%) Once in a While, 14 (16.5%) Sometimes, 24 (28.2%) Fairly often, 25 (29.4%) participants were agreed with almost always. 16 (18.8%) participants were agreed with rarely, 8 (9.4%) Once in a While, 27 (29.8 %) Sometimes, 26 (30.6%) Fairly Often, and majority1 (1.2%) were agree with Almost Always regarding the "I Challenges the way we do things at work".0agree with Rarely and Once in a While respectively, 16 (18.8%) participants response as Sometimes and majority 34 (40%) were response as Fairly Often and 35(41.2%) in response of item twelve which was "I clearly communicate a positive and hopeful outlook for the future of our organization". In the response of item thirteen which was "I give people a lot of discretion to make their own decisions". 16 (18.8%) agree with rarely, majority 27 (31.8%) Once in a While, 15 (17.6%) select Sometimes15 (17.6%) agreed with Fairly Often and 12 (14.1%) were select Almost Always. Item fourteen was "I spend time and energy making certain that people adhere to the values that have been agreed on and participants respond as 29 (34.1%) rarely, majority 39 (45.9%) Once ina While, only 12 (14.1%) agree with Sometimes, 4 (4.7%) Fairly Often and 1 (1.2%) agree with Almost Always. In the reaction of question fifteen which was "I praises people for a job well done" 0rarely, 4 (4.7%) Once ina While, 8 (9.4%) Sometimes, 33 (38.8%) agree with Fairly Often, majority 40 (47.1%) agreed with Almost Always. In the reaction of item sixteen which was "I look for innovative ways we can improve what we do in this organization" 0 rarely and Once in a While, 13 (15.3%) Sometimes and 35 (41.2%) agreed with Fairly Often and majority 37 (43.5%) select Almost Always. Item seventeen was "I show others how their long-term future interests can be realized by enlisting in a common vision" and the participant respond as only 2 (2.4%) go with rarely, majority 12 (14.1%) agree with Once in a While, 14 (16.5%) Sometimes, 22 (25.9%) Fairly Often, 35 (41.2%) agree with Almost Always. Item eighteen was "I develop cooperative relationships with the people he or she works with." and response was only 3 (3.5%) participants respectively agreed with rarely, majority 3 (3.5%) agree with Once in a While, 3 (3.5%) Sometimes, 29 (34.1%) Fairly Often, 47 (55.3%) agree with Almost Always. In the reaction of item nineteen which was "I let others know his or her beliefs on how to best run the organization he or she leads" only 3 (3.5%) agree with rarely, 5 (5.9%) Once ina While, 33 (38.8%) Sometimes, 40 (47.1%) Fairly often, 4 (4.7%) participants were agreed with almost always. In the reaction of item twenty which was "I give the members of the team lots of appreciation and support for their contributions" 0 agree with rarely, 18 (21.2%) Once in a While, 18 (21.2%) Sometimes, 23 (27.1%) Fairly often, 26 (30.6%) participants were agreed with almost always. 0% participants were agreed with rarely, 29 (34.1 %) Once in a While, 21(24.7%) Sometimes, 17 (20%) Fairly Often, and majority18 (21.2%) were agree with Almost Always regarding the "I ask "What can we learn?" when things do not go as expected".2 (2.4%)agree with Rarely, 12(14.1%) agree with Once in a While,14 (16.5%) participants response as Sometimes and 22 (25.9%) were response as Fairly Often and 35(41.2%) in response of item twenty two which was "I look ahead and forecasts what he or she expects the future to be like.". In the response of item twenty three which was "I create an atmosphere of mutual trust in the projects he or she leads". 0 agree with rarely and Once ina While, 3 (3.5%) select Sometimes31 (36.5%) agreed with Fairly Often and 51 (60%) were select Almost Always. Item twenty four was "I am consistent in practicing the values he or she espouses" and participants respond as 11 (12.9%) rarely, majority 17 (20%) Once ina While, only 10 (11.8%) agree with Sometimes, 25 (29.4%) Fairly Often and 25 (29.4%) agree with Almost Always. In the reaction of question twenty five which was "I find ways to celebrate accomplishments." 0rarely, 22 (25.9%) Once ina While, 14 (16.5%) Sometimes, 24 (26.2%) agree with Fairly Often, majority 25 (28.4%) agreed with Almost Always.
In the reaction of item twenty six which was "I experiments and takes risks with new approaches to his or her work even when there is a chance of failure." 7 (8.2%) rarely, 16 (18.8%) agree with Once in a While, 8 (9.4%) Sometimes and 27 (31.8%) agreed with Fairly Often and majority 26 (30.6%) select Almost Always. Item twenty seven was "I am contagiously excited and enthusiastic about future possibilities" and the participant respond as only 2 (2.4%) go with rarely, majority 8 (9.4%) agree with Once in a While, 13 (15.3%) Sometimes, 32 (37.6%) Fairly Often, 30 (35.3%) agree with Almost Always. Item twenty eight was "I get others to feel a sense of ownership for the projects they work on" and response was 0% participants agreed with rarely, 6 (7.1%) agree with Once in a While, 16 (18.8%) Sometimes, 25 (29.4%) Fairly Often, 38 (44.7%) agree with Almost Always. In the reaction of item twenty nine which was "I makes sure the work group sets clear goals, makes plans, and establishes milestones for the projects he or she leads" only 2 (2.4%) agree with rarely, 12 (14.1%) Once in a While, 14 (16.5%) Sometimes, 22 (25.9%) Fairly often, 35 (41.2%) participants were agreed with almost always. In the reaction of item thirty which was "I make it a point to tell the rest of the organization about the good work done by his or her group" 0 agree with rarely and Once in a While, 3 (3.5%) Sometimes, 31 (36.5%) Fairly often, 51 (60%) participants were agreed with almost always. 60.0% Note: Rarely or Very Seldom = 1, Once in a While = 2 Sometimes = 3 Fairly Often = 4Very Frequently or Almost Always = 5. Leadership practices-Self assessment statistics Table 4 shows the mean, median, mode, standard deviation, and variance of leadership practices-self assessment. High value of mean is 4.56 for item thirty that was "I create an atmosphere of mutual trust in the projects he or she leads" and lowest value of mean 1.93for item five that was "I spend time and energy making certain that people adhere to the values that have been agreed on". Note: STD= Standard Demographic factors frequencies for leadership practices observer assessment Table 5 shows that only the female 85 (100%) were participate in this study with age group 23-31 years old were 49 (57.6%) and 32-40 years old were 35 (41.2%), 41-49 years old were 1 (1.2%). however near to 72 (84.7%) participants were general nursing diploma holder, and 5 (5.9%) were hold a degree of bachelor of sciences in nursing post Registered nursing and only 8 (9.4%) participants with degree of bachelor of sciences in nursing generic. Frequency percentage of experience of participants and the results were 1-9 years 62 (72.9%) in majority, 10-18 years 23 (27.1%).  Table 6 shows that mean, median, mode, standard deviation, variance and the mean value mean (1.00, 1.44, 1.27, 1.54), median (1.00, 1.00, 1.00, 1.00), variance (.000, .273, .200, 394). And mode is 1 respectively for gender, age, experience, qualification.     Figure 8 shows that 72 (84.7%) participants were general nursing diploma holder, and 5 (5.9%) were hold a degree of bachelor of sciences in nursing post Registered nursing and only 8 (9.4%) participants with degree of bachelor of sciences in nursing generic. Table 7 shows the participants response on the items of Leadership practices -observer perception and frequency of participants from rarely or Very Seldom = 1, Once in a While = 2 Sometimes = 3 Fairly Often = 4Very frequently or Almost Always = 5 and the result revealed that 3 (3.5%) participant go with rarely, 16 (18.8%) Once in a While, 10 (11.8 %) Sometimes, 25 (29.4%) Fairly Often, and majority31 (36.5%) were agree with Almost Always regarding the "seek out challenging opportunities that test his or her skills and abilities". 11 (12.9%) agree with Rarely, 18(21.2%) agree with Once in a While,19 (22.4 %) participants response as Sometimes and majority 22 (25.9%) were response as Fairly Often and 15(17.6%) in response of item two which was "describe the kind of future he or she would like for us to create together". In the response of item three which was "involve others in planning the actions that will be taking". 10 (11.8 %) agree with rarely, majority 19 (22.4%) Once in a While, 10 (11.8%) select Sometimes19 (22.4%) agreed with Fairly Often and 27 (31.8%) were select Almost Always.

Figure 8 Leadership practices -Observer perception frequency
Item four was "is clear about his or her own philosophy of leadership' and participants respond as 12 (14.1%) rarely, majority 30 (35.3%) Once ina While, only 16 (18.8%) agree with Sometimes, 16 (18.8%) Fairly Often and 11 (12.9%) agree with Almost Always. In the reaction of question five which was "take the time to celebrate accomplishments when project milestones are reached" 14 (16.5%) rarely, majority 22 (25.9%) Once in a While, 8 (9.4%) Sometimes, 26 (30.6%) agree with Fairly Often, 15 (17.6%) agreed with Almost Always. In the reaction of item six which was "stay up-to-date on the most recent developments affecting our organization" only 3 (3.5%) rarely, 6 (7.1%) agree with Once in a While, 15 (17.6%) Sometimes and 30 (35.3%) agreed with Fairly Often and majority 31 (36.5%) select Almost Always. Item seven was "appeals to others to share his or her dream of the future as their own" and the participant respond as 0% go with rarely, majority 33 (38.8%) agree with Once in a While, 7 (8.2%) Sometimes, 21 (24.7%) Fairly Often, 24 (28.2%) agree with Almost Always. Item eight was "treat others with dignity and respect." and response was only 4 (4.7%) participants respectively agreed with rarely and only2 (2.4%) agreed with Once in a While, 33 (38.8%) Sometimes, majority 42 (49.4%) Fairly Often, 4 (4.7%) go with almost always. In the reaction of item nine which was "make certain that the projects he or she leads are broken down into manageable step" 7(8.2%)agree with rarely, 21 (24.7%) Once in a While, 15 (17.6%) Sometimes, 16 (18.8%) Fairly often, 26 (30.6%) participants were agreed with almost always. In the reaction of item ten which was "make sure that people are recognized for their contributions to the success of our projects" only 3 (3.5%) agree with rarely, 16 (18.8%) Once in a While, 10 (11.8%) Sometimes, 25 (29.4%) Fairly often, 31 (36.5%) participants were agreed with almost always. 11 (12.9%) participants were agreed with rarely, 18 (21.2%) Once in a While, 19 (22.4%) Sometimes, 22 (25.9%) Fairly Often, and majority15 (17.6%) were agree with Almost Always regarding the "Challenges the way we do things at work".0 %agree with Rarely, 21(24.7%) agree with Once in a While, 8 (9.4%) participants response as Sometimes and majority 29(34.1%) were response as Fairly Often and 27(31.8%) in response of item twelve which was "clearly communicate a positive and hopeful outlook for the future of our organization". In the response of item thirteen which was "give people a lot of discretion to make their own decisions". 12(14.1%) agree with rarely, majority 30 (35.3%) Once in a While, 15(17.6%) select Sometimes17 (20%) agreed with Fairly Often and 11 (12.9%) were select Almost Always. Item fourteen was "spend time and energy making certain that people adhere to the values that have been agreed on and participants respond as 14 (16.5%) rarely, majority 22 (25.9%) Once ina While, only 7 (8.2%) agree with Sometimes, 26 (30.6%) Fairly Often and 16 (18.8%) agree with Almost Always. In the reaction of question fifteen which was "praises people for a job well done" 0%rarely, 10 (11.8%) Once in a While, 9 (10.6%) Sometimes, 25 (29.4%) agree with Fairly Often, majority 41 (48.2%) agreed with Almost Always. In the reaction of item sixteen which was "look for innovative ways we can improve what we do in this organization" 0% rarely, only 4 (4.7%) agree with Once ina While, 3 (3.5%) Sometimes and 32 (37.6%) agreed with Fairly Often and majority 46 (54.8%) select Almost Always. Item seventeen was "show others how their long-term future interests can be realized by enlisting in a common vision" and the participant respond as only 12 (14.1%) go with rarely, majority 18 (21.2%) agree with Once in a While, 19 (22.4%) Sometimes, 21 (24.7%) Fairly Often, 15 (17.6%) agree with Almost Always. Item eighteen was "develop cooperative relationships with the people he or she works with." and response was 0%participants respectively agreed with rarely, majority 33 (38.8%) agree with Once ina While, 7 (8.2%) Sometimes, 21 (24.7%) Fairly Often, 24 (28.2%) agree with Almost Always.
In the reaction of item nineteen which was "let others know his or her beliefs on how to best run the organization he or she leads" only 4 (4.7%) agree with rarely, 2 (2.4%) Once in a While, 33 (38.8%) Sometimes, 41 (49.4%) Fairly often, 4 (4.7%) participants were agreed with almost always. In the reaction of item twenty which was "give the members of the team lots of appreciation and support for their contributions" 0 agree with rarely, 15 (17.6%) Once in a While, 15 (17.6%) Sometimes, 19 (22.4%) Fairly often, 36 (42.4%) participants were agreed with almost always. 3(3.5%) participants were agreed with rarely, 18 (21.2 %) Once in a While, 14 (16.5%) Sometimes, 19 (22.4%) Fairly Often, and majority31(36.5%) were agree with Almost Always regarding the "ask "What can we learn?" when things do not go as expected". 12 (14.1%) agree with Rarely, 18(21.2%) agree with Once ina While,19 (22.4%) participants response as Sometimes and majority 21 (24.7%) were response as Fairly Often and 15 (17.6%) in response of item twenty two which was "look ahead and forecasts what he or she expects the future to be like.". In the response of item twenty three which was "create an atmosphere of mutual trust in the projects he or she leads". 0%agreed with rarely, 10 (11.8%) Once ina While, 9 (10.6%) select Sometimes25 (29.4%) agreed with Fairly Often and 41 (48.2%) were select Almost Always. Item twenty four was "consistent in practicing the values he or she espouses" and participants respond as 5 (5.9%) rarely, majority 17 (20%) Once in a While, only 16 (18.8%) agree with Sometimes, 26 (30.6%) Fairly Often and 21 (24.7%) agree with Almost Always. In the reaction of question twenty five which was "find ways to celebrate accomplishments." 3 (3.5%) rarely, 16 (18.8%) Once in a While, 10 (11.8%) Sometimes, 25 (29.4%) agree with Fairly Often, majority 31 (36.5%) agreed with Almost Always.
In the reaction of item twenty six which was "experiments and takes risks with new approaches to his or her work even when there is a chance of failure." 11 (12.9%) rarely, 18 (21.2%) agree with Once in a While, 19 (22.4%) Sometimes and 22 (25.9%) agreed with Fairly Often and majority 15 (17.6%) select Almost Always. Item twenty seven was "contagiously excited and enthusiastic about future possibilities" and the participant respond as only 0%go with rarely, 20 (23.5%) agree with Once ina While, 12 (14.1%) Sometimes, 39 (34.1%) Fairly Often, 24 (28.2%) agree with Almost Always. Item twenty eight was "get others to feel a sense of ownership for the projects they work on" and response was only 7 (8.2%) participants respectively agreed with rarely, majority 26 (30.6%) agree with Once in a While, 4 (4.7%) Sometimes, 28 (32.9%) Fairly Often, 20 (23.5%) agree with Almost Always.
In the reaction of item twenty nine which was "makes sure the work group sets clear goals, makes plans, and establishes milestones for the projects he or she leads" only 12 (14.1%) agree with rarely, 18 (21.2%) Once ina While, 19 (22.4%) Sometimes, 21 (24.7%) Fairly often, 15 (17.6%) participants were agreed with almost always. In the reaction of item thirty which was "make it a point to tell the rest of the organization about the good work done by his or her group" 0% agree with rarely, 10 (11.8%) Once in a While, 9 (10.6%) Sometimes, 25 (29.4%) Fairly often, 41 (48.2%) participants were agreed with almost always.   Table 8 shows the mean, median, mode, standard deviation, and variance of leadership practices-self assessment. High value of mean is 4.41 for item sixteen that was "Looks for innovative ways we can improve what we do in this organization." and lowest value of mean 2.81for item four that was "Is clear about his or her own philosophy of leadership?. Note: STD= Standard Normality of data for leadership practices self-assessment Table 9 shows the significance of data normality and p ≤ .200 for Kolmogorov-Smirnov and p ≤ .444 for Shapiro-Wilk. Note:*. This is a lower bound of the true significance. Figure 9 and 10 shows that the normal distribution of data.

Figure 9
Journal of Health, Medicine and Nursing

Figure 10
Normality of data for leadership practices observer assessment Table 10 shows the significance of data normality and p ≤ .200 for Kolmogorov-Smirnov and p ≤ .444 for Shapiro-Wilk.  Figure 11 shows that the normal distribution of data.

Correlations between leadership practices self-assessment and perception of subordinates
Descriptive Statistics  Table 12 shows that the positive linear correlation between leadership practices self-assessment and perception of subordinates regarding leadership practices and the p=.345.  -tailed) .345 N 87 87

DISCUSSION
The focus of this study was to identify the self-assessment and the subordinate's assessment of leadership practices of the first line nurse manager and determine the relationship between them. The study findings show a significant positive relationship between the manager's self-assessment and the subordinate's assessment of leadership practices. Kouzes and Posner's (1987) model of leadership provided die conceptual framework for this study. They describe the five leadership practices and ten behavioral commitments that are linked to extraordinary leaders. The leadership practices are: challenging the process, inspiring a shared vision, enabling others to act, modeling the way, and encouraging the heart. The ten behavioral commitments directly relate to the leadership practices. The concept of Kouzes and Posner's leadership model emphasizes that it is the star manager who consistently uses all five leadership practices and ten behavioral commitments and becomes an extraordinary leader(J. M. Kouzes & Posner, 1987).
A study conducted in 2012 regarding leadership practices perceived by nurses and result revealed that the seven out of 10 nursing staff held positive perceptions about leadership ethics and their professional development. Over one-third of nursing staff were dissatisfied with the nursing process and with their feedback and rewards, while only four out of 10 evaluated their nursing director either in a positive or negative way. There were no significant differences regarding their perceptions when different background variables were taken into account (Eneh et al., 2012).
In related studies it was discovered that it was easy to talk about leadership, but difficult to practice (Lee, Smith, & Cioci, 1993). The authors contended that becoming an outstanding leader was difficult, but within each manager is the capacity to do so. Author identified that inadequate educational preparation of nurse managers has limited their ability to become excellent leaders (Cress, 1996). Meighan (1990) also notes that nurse managers are often unprepared to meet the challenge of outstanding leadership. The findings in this study support these notions (Meighan, 1990).
The demographic data in this study also revealed a variety in experience, and educational profile for the leadership. Years of experience ranged from 1-27 years and the gender was deferent from others studies because only female participate in this study, and the highest educational level obtained varied, BSN, no any manager holding an MSN in nursing.

LIMITATIONS OF THE STUDY
This study found many limitations;  Time duration was too short.  The study design is convient sample technique.  Likert scale questionnaire has been used in this study.  Data collection was faced lot of issues.  The respondents of the study have very careless attitude regarding filling questionnaire. Participants of study have no idea about the importance of the filling questionnaire sincerely.

CONCLUSION AND RECOMMENDATION
In summary, the results of this study support the existence of a relationship between the self-assessment and the subordinate's assessment. This study also indicates that the managers in this study moderately exhibited the leadership practices as identified in Kouzes and Posner's (1987) research.
Implications for Nursing Administration As this study suggests, the managers, as perceived by themselves and their subordinates, moderately exhibit extraordinary leadership practices. There is a need for nurse administrators to be cognizant of these practices and recognize that for extraordinary things to be accomplished in an organization the five leadership practices must be exhibited consistently. Attention must be given to the current nurse manager's growth as leaders.
Current educational preparation is varied amongst the nurse managers. Decisions about the future educational level and preparation expected of a first line nurse manager are crucial for nurse administrators to determine. The implications for future research as a result of these study findings are great. First, replication studies are needed to further validate and examine study findings. Ongoing measurement of the leadership practices for the first line nurse managers through self and subordinate assessment would provide valuable insight into the practices of the first line nurse manger and allow for ongoing opportunities of growth and strengthening of the leadership practices.
Future researchers conducting the leadership practices study should exercise caution in the number of subordinates per manager included in the study. They would do well to determine a number of subordinates that would be a representative percentage of die managers to better facilitate the accuracy of the subordinate's perception of the manager's leadership practices